27 Oct 2021 Dialing 911 is key

By John Patton

When it comes to providing heart and stroke emergency care, there is no substitute for dialing 911. 

Because time is so crucial, the American Heart Association (AHA) recognizes emergency and heart care teams based on the time it takes them to care for heart attack and stroke patients. The national gold standard — The American Heart Association Get with the Guidelines Gold Plus Quality Achievement Award — is recognized as the highest achievement in treating both of these life-threatening conditions. In Conway, a new video application is helping paramedics and the Conway Regional Emergency Department and Cardiac Team achieve the gold standard by sharing crucial information such as EKGs, patient vital signs, and other medical information while en route to the hospital. 

More than one third of all deaths in the United States are traced to heart disease, stroke, or other cardiovascular diseases, according to the Centers for Disease Control and Prevention (CDC). That is more than 859,000 people per year. Both strokes and heart attacks are caused by arterial blockage of blood flow to the brain or heart. 

In late August, the Conway Regional heart team earned the AHA’s top achievement for hospitals in the Mission Lifeline program. The award honors hospitals that provide artery-opening treatment to heart patients in fewer than 60 minutes, which is considered AHA’s gold standard for heart care. “It’s based on door-to-balloon time, from the first medical contact at the hospital to the time they place a device in the artery to restore blood flow to the heart,” said Paula Weatherley, director of Cardiovascular Services for the hospital. 

Weatherley credits the video phone app called Pulsara, EMS paramedics, and the work of the Conway Regional ER and heart team, as well as the staff of the Cardiac Catheterization Laboratory, for achieving the outstanding response. The Conway Regional heart team includes interventional cardiologists Don Steely, MD, Rimsha Hasan, MD, and Yalcin Hacioglu, MD.

“All emergency response agencies have an app on their phones that enables them to activate the cardiac cath lab,” Weatherley explained. “We get to have a conversation with the paramedics when they are in the ambulance or the helicopter. We can see if the patient has an IV, look at the EKG, ask about COVID-19 testing, and get additional information, so we can get the cath lab properly prepared. All this is taking place while the on-call heart team and interventional cardiologist are on their way to the hospital.” 

She added: “By the time the heart team gets here, we have examined the EKG and know where the STEMI (heart attack) is happening and we can prepare for the appropriate procedure.”

Interventional cardiologists perform heart catheterizations using stents and other devices to open the clogged arteries that cause heart attacks. There are 16 technologists on staff in the Conway Regional Cardiac Cath Lab. 

Gold Standard Stroke Care 

Down the hallway, the Emergency Department staff is also focused on responding to stroke calls. 

The Conway Regional stroke team achieved the AHA’s Mission Lifeline’s top award for hospitals, the 2021 Gold Plus Quality Achievement Award, in late August. The award honors hospitals that administer the clot-dissolving tPA drug to stroke patients in fewer than 90 minutes. 

The hospital’s stroke coordinator, Brandi Alred, RN, said stroke response is also a team effort driven by technology and coordinated by the ER nurses. 

After responding to a 911 call, EMS paramedics activate the Pulsara application on a cell phone to link them with the ER staff via a video connection. “They take the video and send it to us and there is a lot of communication back and forth with the medic,” Alred said. “The information goes straight to a device at the charge nurse’s desk and sounds an alarm so we know an emergency is taking place.” 

The staff watch the video and communicate back and forth with paramedics, sharing information about the patient, and an IV is usually started. 

The stroke team begins to assemble and the nurse-directed stroke-prep process begins. A vascular neurologist at UAMS who specializes in stroke care assists the stroke team as part of the UAMS Institute for Digital Health and Information Stroke program (formerly ARSAVES). This is done via a telemedicine video call as the emergency progresses and the patient arrives. Radiology and clinical laboratory testing is often ordered to confirm a stroke diagnosis. If the patient is diagnosed with an ischemic (non-bleeding) stroke, a physician in the ER is available to immediately administer a clot-busting drug. 

Know the Symptoms, Make the Call 

Whether it’s a stroke or a heart attack, the key is knowing the symptoms and calling 911 immediately. For instance, stroke warning signs can include:  

• Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body. 

• Sudden confusion, trouble speaking, or difficulty understanding speech. 

• Sudden trouble seeing in one or both eyes. 

• Sudden trouble walking, dizziness, loss of balance, or lack of coordination. 

• Sudden severe headache with no known cause.

Heart attack warning signs include: 

• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes – or it may go away and then return. It can feel like uncomfortable pressure, squeezing, fullness, or pain. 

• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach. 

• Shortness of breath. This can occur with or without chest discomfort. 

• Other signs include breaking out in a cold sweat, nausea, or lightheadedness.

It is important to remember that there is a difference between warning signs in men and women. For men, the most common heart attack symptom is chest pain (angina) or discomfort. However, women are more likely to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain. 

The use of video technology has increased the importance of calling 911, said Weatherley and Alred.  

“If you can call 911, ischemic stroke patients are treated an average of 12 minutes faster with the clot-dissolving medicine, which is why the acronym BE FAST (Balance, Eyes, Face, Arm, Speech, Time) is so important for the public to remember,” said Alred. “Twelve minutes can make a difference when it comes to life and quality of life.”

Weatherley added: “If you are at home, you definitely need to call 911. If you call 911, our team will be en route simultaneously and have the room prepared before your arrival.”