"What we showed in our study was by tweaking our
system, in this case by changing our mode of transportation from air
to ground, we actually took median treatment time from about 121
minutes beforehand to 90 minutes afterward," Dr. Timothy Mixon told
Reuters Health in a phone call.
"That's about a 30 minute decrease in total treatment time by going
by ground," he said. "Although that seems slower, it really was
Mixon is an interventional cardiologist with Scott and White
Healthcare in Temple, Texas. He and coauthor Dr. Luis Colato wrote
the paper that was published in the Journal of Emergency Medicine.
The change to ground transport resulted in more than 90 percent of
patients being treated within national guideline time of less than
120 minutes, the authors say, versus less than half getting
treatment within that two-hour window before.
An ST segment elevation myocardial infarction – or STEMI – is
usually caused by a total blockage of blood flow to a large portion
of the heart, so patients having this kind of heart attack need to
get the blockage cleared as soon as possible.
That procedure, known as angioplasty, isn't done at all hospitals.
"Across the country about 60 percent of patients with this type of
heart attack present to hospitals that have the capability of doing angioplasty
on a 24/7 basis, but only 25 percent of the hospitals have that capability" Mixon said.
When patients show up at a hospital that doesn't offer emergency
angioplasty, they need to be transferred to one that does.
The study looked at 43 patients who were initially diagnosed with
STEMI at Darnall Army Community Hospital in Fort Hood, but who
needed to be transferred for angioplasty at Scott and White Memorial
Hospital in Temple, about 30 miles away.
The authors compared treatment outcomes and transfer times for 19
STEMI patients who were flown between the two hospitals between 2007
and 2010 with 23 patients who were transported by ground ambulance
between 2010 and 2012. One more person was transported by air during
the second period.
None of the patients died during the study. But on average, those
who were flown between the hospitals had 123 minutes from the time
of first medical contact until angioplasty was performed. The
patients who were transported by ground ambulance averaged 90
minutes between first medical contact to angioplasty.
This study looked at only one pair of hospitals in Texas, but the
need to transfer a patient with a STEMI to a different facility
occurs nationwide, Mixon and his coauthor point out.
"Every hospital system is a little different. And 10 miles apart
might be prohibitive if you're in downtown Manhattan — while 10
miles apart in a more rural area is not a problem at all," Mixon
[to top of second column]
"Whether you go by ground or whether you go by air,
a lot of people would naturally assume that air transport would be
quicker, but basically our findings were that while yes, helicopters
can fly faster than a truck can drive, it takes a lot longer to get
a patient prepared and the helicopter prepared, and that time
essentially offsets the speed of transport and ends up being
slower," Mixon said.
Dr. Harlan Krumholz cautioned that a small, single-center study like
this may not be relevant to other places.
Krumholz is director of the Yale-New Haven Hospital Center for
Outcomes Research and Evaluation. He was not involved in the study.
"The best thing people can do who think they are having a heart
attack is call 911 — too many people still die before getting
emergency care and it is best for people not to spend time worrying
about which hospital," he told Reuters Health in an email.
"Ideally the EMS professionals can make an assessment and determine
if people need to go straight to a hospital with advanced facilities — and whether, if it is not the closest one, whether it is worth the
extra time," he said.
Mixon agreed that people who may be having a heart attack need
emergency help. He added that they should not try to transport
themselves to a hospital.
"We don't want people driving in cars with heart attacks because
some of them die — some of them have ventricular fibrillation and
don't survive," he said.
"On the other hand if that happens when you're in the back of an
ambulance they are equipped to manage that situation, so it's safe
for EMS to take you an extra 10 or 15 minutes, but not necessarily safe for
people to go by a private vehicle an extra 10 or 15 minutes," Mixon said.
The Journal of Emergency Medicine, online April 18, 2014.
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