Paramedics bypass ER to get faster heart attack care

A program that saves precious minutes by allowing paramedics to bypass the emergency department and go directly to the heart investigation unit has been so successful that work is underway to expand it to stroke.

“As time progresses, you lose cardiac muscle, so time is death basically,” said David Thompson, superintendent of education and program development with the Hamilton Paramedic Service. “With the implementation of this program, we’re able to take patients from where they are having the heart attack ... right to the operating room where the interventionalist is waiting for us.”

Years in the making, new Ontario-wide heart attack protocols were implemented on Feb. 1, 2017, to get faster care to approximately 7,000 Ontarians a year having a major heart attack called a STEMI that can cause death if not treated in minutes. Hamilton paramedics diagnosed 187 people with a STEMI in 2017 and took them directly to Hamilton General Hospital’s cardiac catheratization suite where doctors insert a catheter into a heart vessel for diagnosis or treatment.

So far this year, 78 ambulance patients have gone directly to the heart investigation unit.

The faster protocols can lead to a 6.5 per cent decrease in death, estimates the paramedic service in its 2017 annual report.

“We’re definitely making a difference,” said Thompson. “We’re bypassing the emergency department and going right to where that patient needs to be.”

In the past, patients would call 911, be transported to a local hospital, get an electrocardiogram (ECG), be diagnosed with a STEMI and sent to a heart investigation unit.

Now, paramedics do the ECG in the field and interpret it. If it is a STEMI, they call a hotline and talk to one of the 10 specialized interventionalist cardiologists who can direct them to bypass emergency departments and come directly to the catheratization suite from as far as 60 minutes away.

“You are moving the diagnosis right into the field and also the activation of the appropriate team, so you save a lot of time,” said Dr. Madhu Natarajan, a director with the Hamilton-Niagara Integrated Heart Investigation Unit. “From the patient’s point of view, it’s basically survival.”

Natarajan says it is crucial patients get treatment within two hours of the first symptoms.

“We know that 10 or 12 years ago in Ontario the chance of dying from heart attack was over 10 per cent,” he said. “Over time with co-ordinated care, those numbers have dropped to the single digits. You get the patients to the right care without delays.”

Both Natarajan and the paramedic service expect it won’t be long before a similar process is in place for stroke, which also requires fast care.

“I think it is going to be pretty quick progress,” said Thompson. “If we identify these patients in the field and get them right to the stroke team and right to a CT scanner, it speeds up care.”