Hospitals discuss heart attack response times

In 2009, Ken Moulden had a heart attack while he was at work in Berryville.

Frederick County Fire & Rescue personnel were at the scene within minutes, and when Moulden got to the Winchester Medical Center, staff members were ready to begin treatment.

He was in the cardiac catheterization lab within 13 minutes, and a cardiologist put in a stent.

His experience was not uncommon for heart patients in the Shenandoah Valley and Central Virginia. The average “door-to-balloon time” — or time from a patient arriving in an emergency room to the opening of the blocked artery — here is 44 minutes, or half of the national goal of an hour and a half.

That’s an encouraging statistic, but there’s still room for improvement, Dr. David Burt said Friday.

“Today it’s all about going from good to great,” said Burt, who works in the University of Virginia Medical Center’s ER.

He led a meeting of the Northwest Region of the Virginia Heart Attack Coalition at Rockingham Memorial Hospital, and the topic of the day was how to better emergency response times to heart attacks.

The meeting focused on the importance of patients calling 911 when they believe they are having a heart attack, the work of emergency medical service crews and heart catheterization procedures.

“The disease itself is pretty simple: The coronary artery is plugged, and you’ve got to get it open,” Burt said. “But it’s everything in between that’s so important.”

VHAC is a volunteer coalition that also includes EMS professionals, cardiologists, paramedics and nurses from various hospitals across the state.

The group’s members specialize in STEMI care. A STEMI is a severe type of heart attack brought on by an extended period of total blockage in blood flow to the heart. Because of its severity, EMS and ER professionals have a small of window to save patients who are experiencing a STEMI. About 250,000 people a year die from these types of heart attacks.

STEMI treatments can take place only at a Percutaneous Coronary Intervention center, or a hospital that has the resources to perform a heart catheterization. Staff from RMH, UVa Medical Center, Augusta Health, Martha Jefferson Hospital and Winchester Medical Center attended the gathering. All of these facilities have PCI centers.

Augusta Health, for example, treated 78 patients who experienced STEMIs in the past year, and it features one catheterization lab with a second expected to open between 2012 and 2013.

The coronary intervention program at RMH’s Heart & Vascular Center has been named No. 1 in the state four out of the past five years.

“Maintaining that reputation requires a good team effort,” said Dave Grembi, the center’s director. “Our emergency department works very collaboratively and very closely with the heart and vascular center, and they are all constantly looking for ways to improve the process.”

When the current RMH facility opened in June 2010, a big upgrade was the location of the Heart & Vascular Center. It is now located less than 60 seconds away from the ER, down a private hallway.

John Dugan serves as director of Mission: Lifeline VA, the Virginia branch of a national American Heart Association community-based program whose goal is to enhance heart attack response times. He noted that even though the Northwest Region is crowded with state-of-the-art hospitals, the most important part of VHAC’s initiative is working together to achieve a common goal.

“My boss is from South Carolina, and she used the NASCAR term ‘coopetition’ for this region,” Dugan said. “It’s all about patient care, not market share. Rockingham is competing against Augusta and Winchester, but we’re all coming together in one room to make the whole process better.”

The cardiac catheterization teams are on call 24/7 at these hospitals, and their EMS squads are equipped with the best technology, including EKGs, initial diagnostic tools used to check heart rhythm and to help determine if a patient is having a heart attack.

Dugan called the communication between EMS responders and ER professionals essential to saving a patient’s life.

The diligence of the Frederick County Fire & Rescue and the Winchester Medical Center’s cardiology staff is one of the major reasons Moulden is still alive today. Two days after his stent was put in, Moulden underwent quadruple bypass surgery.

Today he is in as good of shape as ever and speaks on behalf of VHAC.

“A lot of people call it a miracle,” Moulden said, referring to his surviving the heart attack. “But I just see it as well-trained people doing their job efficiently.”