By Melanie Tucker
How long is 45 minutes? If you’re stuck standing in line at the bank or waiting for your meal at a restaurant, 45 minutes can seem like forever, each moment drawing out like an eternity. But, in the grand scheme of life, 45 minutes is almost nothing at all, barely enough time to watch an episode of your favorite television show — provided you skip commercials. Under the right circumstances, 45 minutes can fly by in a blink.
For Blount Memorial Hospital’s STEMI (ST segment elevation myocardial infarction) team, 45 minutes is more than just an amount of time passing by slowly or quickly; it’s a target.
On average, 45 minutes is the amount of time it takes the team to help a heart attack patient, measured from the time he or she enters the hospital to the moment when the team unblocks the vessel causing the heart attack. This is referred to as “door-to-balloon” time. Blount Memorial’s 45-minute time also is half of the American Heart Association’s goal of 90 minutes for hospitals nationwide.
Better than average
“We’re performing in the 90th percentile or greater in many of our metrics in terms of heart attack care, not just regionally — but nationally,” said Blount Memorial cardiologist Dr. Jane Souther. “The national goal for door-to-balloon time continues to be 90 minutes, although most hospitals have gotten that time down to around 60 minutes. One of the things the American Heart Association has recognized now is that, nationally, everyone is doing better with their times.
“Because of that, they’ve started looking at the time from first medical contact to open vessel, which is measured from the time the paramedics first get to the patient’s home to the time we get the vessel open. The American Heart Association is looking at a goal of 120 minutes for that. At Blount Memorial, our time for that was 67 minutes in 2014, with the national average at about 81 minutes,” she explained.
Every minute counts
Whatever you make of those numbers, it’s hard to deny that if you’re having a heart attack, every single one of those minutes counts and each minute gained is a small victory. “The longer the heart muscle goes without blood supply, the more likely you are to have permanent damage to the heart. Therefore, the quicker you can get a vessel open, the chance of saving any heart tissue that might be in jeopardy increases,” Souther said.
“One of our big advantages is that we live in a smaller community,” she added. “Many times, smaller hospitals get bad reputations simply because they’re small. I think being in a smaller community helps us because we can mobilize our staff faster.
“We’ve also put in place a process that allows paramedics to call a heart attack from the field if they recognize symptoms.
“They can call the emergency room from the field and activate the STEMI team before they ever get to the hospital. That allows us to be there and be ready much faster. In many cases, we don’t even stop a patient in the emergency room. We take him or her from the back of the ambulance straight to the cath lab. It really cuts down on those times,” she explained.
Use an ambulance
Blount Memorial’s STEMI coordinator Mike Headrick knows the value of time in heart attacks all too well. When his father had a heart attack in 2013, he made the classic mistake of having a family member drive him to the hospital instead of calling 911. “My dad was outside mowing one afternoon and started having sudden chest discomfort,” Headrick said. “He came into the house and told my mom to take him to the hospital because he thought he was having a heart attack.
“He thought she could get him to the hospital quicker than an ambulance, so that’s what they did. They live very close, about five minutes away, so they got here very quickly. His door-to-balloon time was 42 minutes, which was very good. He did very well. He didn’t have any damage or any pain. He got here quickly, and had a very good outcome. That was almost two years ago and he’s still doing well today,” he explained. “I kind of fussed at him a little bit for not calling 911, because the advance life support begins with those first responders,” he added.
“Our goal for the future is to make our times even better,” Souther said. “Part of that requires educating people that they need to activate the medical system faster if they believe they or their loved one is experiencing a heart attack. We need to get people more accustomed to recognizing symptoms and contacting 911 as quickly as they can.
“It doesn’t matter how quickly we can get a vessel open if the patient has been sitting at home for six hours denying symptoms. It’s also important for people to realize that the ambulance is not just a ride to the hospital.
What you don’t see
There are a lot of things that are going on in the back of an ambulance — such as defibrillation for arrhythmias, starting blood thinners and transmitting an EKG — that can save a life before a person gets to the emergency department,” she said.
“Unfortunately, nationally, statistics show that about half of patients come by car, which is something we need to work toward changing,” Headrick added. “It’s a really important message. Don’t drive yourself here, don’t have a family member drive you here, call 911,” he explained. “It’s not just getting here quickly, it’s also getting here the right way,” he added.