BY ADELLE LARMOUR

Time is muscle when a heart attack occurs.
This is the motto grilled into paramedics who work in Sault Ste. Marie’s Fire and Emergency Medical Services (EMS) division.

Every minute it takes to get blood supply moving to the heart, muscle is dying. The quicker paramedics and emergency room staff act, the less damage there will be when a person suffers a myocardial infarction, said Jim Scott, manager of the Sault Area Hospital’s base hospital program.

It is this urgency to act that prompted the Sault’s EMS to purchase eight 12-lead electrocardiogram (ECG) acquisition and computerized interpretation units, diagnostic technology that identifies the type of injury, where the blockage is occurring and to what degree. Once diagnosed, an ST Elevation Myocardial Infarction (STEMI) Alert is initiated.

“The key to fixing that is to administer a clot-busting drug as quickly as possible to bust the clot up and allow circulation to get to the injured part of the heart muscle,” Scott said. “The quicker that can be done, the better chance there is of saving the heart muscle and minimizing the overall effects of the heart attack.”

Although paramedics cannot administer a clot-busting drug, they can start an IV in the field and alert the emergency room (ER) physician about the situation. Once alerted, hospital staff can immediately react to the injury.

“By alerting the ER physician, ECG tech and nurse, the drug can be ready at the door,” Scott said.

Reducing the “door to needle time” to 30 minutes or less has been recognized as a priority by the Ministry of Health and Long-Term Care. The “door to needle time” is the time it takes the heart-attack victim to reach the ER doors and have their MI identified and treated with the clot-busting drug.

Scott said since they’ve introduced the 12-lead ECG into their pre-hospital care last December, they’ve reduced their “door to needle time” down to 17 minutes from the 35 to 40 minutes it previously used to take.

“We’ve surpassed the target the government has placed by doing some of these procedures in the field.”

The Ministry’s mandate to reduce the “door to needle time” was encouraged in 2005, when the American Heart Association introduced the Advanced Cardiovascular Life Support standards into its new guidelines.

Since the introduction of this technology, Scott said they’ve had seven clearly identified STEMI alerts. To date, Sault Ste. Marie is the only city in northeastern Ontario using the 12-lead ECG, which cost the city approximately $300,000. The device is a software and small hardware component added on to an already existing cardiac monitor and defibrillator, ranging in price from $15,000 to $20,000 per unit.

Training was administered in two stages: 200 hours of self study over a three-month period, followed by four hours of classroom work with the equipment.

Scott said some naysayers voiced concerns about the extra time paramedics are now spending on the scene doing the 12-lead ECGs.

“We’ve added no more than three minutes of on-scene time. We’re showing that we’re saving close to 20 minutes.”

Scott would like to see the program expanded into the more rural communities in the area and estimates they can save up to an hour from “door to needle time.”

To date, paramedics have responded well to the new equipment.

“They are using good clinical judgments, making good clinical patient-care decisions, and making a difference in outcomes.”
Scott anticipates that other districts will invest in this equipment, particularly since the five northeastern Ontario base hospital programs will be amalgamated by year’s end, with Sudbury being the lead hospital.