Conn. Hospitals Work for Faster Heart Attack Response

July 05--When someone has a heart attack, the clock starts ticking. Every minute added to the response means more damage to the heart.

"Minutes are muscle," said Matt Cassavechia, director of emergency medical services at Western Connecticut Health Network.

For the past several years, the network -- which has allied Danbury and New Milford hospitals -- has studied how to speed its response, from the time a person makes a 911 call, ending with a blocked artery opened by angioplasty at Danbury Hospital and kept open with the insertion of a stent.

"It started in 2005, when we began to do angioplasty," said Dr. Hal Wasserman, an interventional cardiologist at Danbury Hospital. "Now we have a monthly meeting to discuss every heart attack patient we have."

The multi-disciplinary approach -- involving emergency medical personnel, cardiologists, emergency room physicians, nurses and lab personnel -- has slowly whittled down the time it takes to get a patient to Danbury Hospital.

The American Heart Association has set a goal for a hospital to give patients treatment within 90 minutes of the 911 call. Since 2011, the network has bettered that 90-minute mark for all the patients brought to Danbury Hospital for a myocardial infarction -- a heart attack caused by a blocked artery. In 2012, the average was 56.8 minutes.

"Our fastest was 31 minutes," Wasserman said.

The team has broken the entire process of heart attack treatment into 36 steps. It starts with the 911 call. It ends with the interventional cardiology team finishing its work with cardiac catheterization -- inserting a catheter into the blocked artery, using a balloon at the end of the catheter to open the blocked portion, then inserting a metal stent to keep the artery open.

By studying each step in each case, the multi-disciplinary team has been able to see where it can save time at the home of the patient, on the ambulance trip in, at the emergency department and at the catheterization lab.

"Each link has to be as important as the other," Cassavechia said. "It goes across the culture."

Wasserman said there's been big improvements in time due to one crucial improvement. Thanks to a $25,000 grant given to the hospital by the Hawley and Steiner families in 2009, 17 ambulances within a 25-mile radius of Danbury were equipped with electrocardiograph equipment.

The emergency crews are trained to perform a full EKG on the patient when they respond to a heart attack call, then transmit that information to the hospital. There is a dedicated EKG machine in the emergency department as well.

Wasserman said that means that as soon at the physician in the ER sees that EKG and diagnoses the problem as a heart attack, the hospital can quickly assemble the team it needs for proper care.

While the emergency crews are providing additional treatment on the trip in -- oxygen, nitrogylcerin, aspirin -- Wasserman said, the hospital staff is readying to receive the patient.

"Let's say it's 3 a.m.," he said. "If a patient is coming in from Ridgefield, that means we have maybe 20 minutes to get started at the hospital."

There are complications. In areas where there's poor cell phone service, ambulance crews can't always transmit EKG results to the hospital.

"We know the dead zones," Cassevechia said.

The New Milford area has other complications.

The seven towns in New Milford Hospital's area -- Bridgewater, Kent, New Milford, Roxbury, Sherman, Washington and Warren -- are served by volunteer ambulances departments.

The paramedic who works with them can perform the EKG to see whether a patient is having a heart attack, but that's not always an optimal situation.

"We have one paramedic working with the seven towns," said Greg Bollard, who heads the Bridgewater emergency medical team with the Bridgewater Volunteer Fire Department. "That's one paramedic for 250 square miles."

"It's not like an urban setting," Bollard said. "It can take us 15 minutes sometime just to get to a patient."

But they have also found ways to speed patients to the care they need.

Since the affiliation of Danbury and New Milford hospitals, the emergency crews now know if they're treating a patient with a heart attack, they head directly to Danbury Hospital, where there is a cardiac catheterization lab.

Dr. Thomas Koobatian, the director of emergency medicine at New Milford Hospital, said the volunteer crews have been made part of the collaboration on response time.

"The EMTs are 100 percent behind this," Koobatian said.

And because the towns are soWorking with the state Department of Emergency Medical Services, the network is starting a pilot program to allow trained volunteers in the rural towns to perform a full EKG on patients they think are having heart attacks and send those tests to the emergency department at New Milford Hospital.

"If it's not a heart attack, we can say 'Bring that patient here,' " Koobatian said. "If it is a heart attack, we can say, 'Go straight to Danbury Hospital and the cath lab.' Then with the push of a button, we can send that EKG on to Danbury Hospital."

bmiller@newstimes.com; 203-731-3345

Copyright 2013 - The News-Times, Danbury, Conn.