Wake County used as model for EMS-hospital coordination
By Madison Iszler
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One second Michael Weddington was doing yard work outside his Raleigh home this summer. The next he was suffering from a stabbing pain that coursed through his chest.
Nancy Weddington, his wife of more than 50 years, took one look at him and said, “I’m calling 911.”
Everything happened fast. Firefighters and Wake County EMS paramedics arrived within minutes, hooking Weddington up to a cardiac monitor. Paramedics radioed the emergency department at Rex Hospital to say their patient was having a heart attack, and they transmitted results from the electrocardiogram, or EKG, directly to the hospital.
Within 30 minutes, Weddington arrived at a catheterization lab at Rex, where doctors cleared his blocked artery.
The next week in June, Weddington, 75, was back at work as a lawyer for Raleigh-based firm Smith Anderson.
Wake is one of the best-performing counties in the country in terms of the time it takes to treat heart attack patients, said Dr. James Jollis, a cardiologist with North Carolina Heart & Vascular and an author of a study published in August in the American Heart Association’s “Circulation” journal.
The study, which worked to coordinate efforts between 484 hospitals and 1,253 emergency medical services in 16 U.S. regions, used protocols of Wake County EMS and local hospitals as a model of success in treating patients whose heart attacks were caused by a blocked artery.
Known as STEMIs, such heart attacks can cause muscular damage if not treated properly and quickly.
Weddington, who had a STEMI, was treated well within the time frame recommended by the American Heart Association. Doctors did a procedure called percutaneous coronary intervention, or PCI, which involves inserting a tube through blood vessels to reach and clear the blockage.
The group recommends patients undergo a PCI within 90 minutes of paramedics’ arrival, or 120 minutes if the closest hospital can’t perform the procedure. But fewer than half of Americans who have STEMIs undergo the procedure within that time frame, according to the study.
Lack of adequate funding and training for EMS providers can lead to poor response times, Jollis said. Medical providers in rural areas can also struggle to meet the recommended timelines, and poor working relationships between EMS and hospitals are also a factor.
“Where you live shouldn’t determine how long you live. … What used to take hours now takes minutes, and that can make all the difference,” said Jollis, who credits former Wake County EMS medical director Brent Myers with implementing successful measures for treating heart attack patients.
Myers, who left his post in 2015, organized monthly training sessions in which doctors would talk to paramedics about the latest technology and best practices. He also got rid of a geographical approach to ambulance services and put in place a zone-based approach. That way, the closest ambulance was dispatched to an emergency instead of only covering certain parts of the county.
Myers said Wake County uses data to put in place methods that work and create less competition between emergency care providers.
“These measures enabled us to be efficient while still serving people’s needs,” Myers said. “It led to a robust interaction between hospitals and EMS.”
Dean McMorrine has worked as a paramedic for 27 years and joined Wake County EMS less than a year ago. He helped transport Weddington to Rex in June. It was the closest hospital to his home, or else he would have been taken to WakeMed or Duke.
McMorrine compared the health care system to a chair with the four legs: EMS providers, fire departments, hospitals and follow-up care.
“All four of those need to work together to form a strong system,” he said. “You can’t have one without the others, or it’s a broken system, a chair without a leg.”
Dr. James Zidar unblocked Weddington’s artery.
“Every second counts,” Zidar said.
Jollis and other researchers hope their efforts through the study will bridge the gap between medical services to get patients the care they need. Their goal is to implement a successful program in every U.S. city. In some cases, EMS agencies could adopt Wake County’s practices, including streamlined communication.
Dozens of hospitals across the country applied for the second round of the study, which began in 2015 and runs through 2017.
Weddington, a Detroit native who has lived in Raleigh for more than 50 years, had been healthy before his heart attack – no high cholesterol levels or high blood pressure. His only brush with the emergency department came when he was 6 and underwent an appendectomy.
Now Weddington is thankful to have more time with his two children and two grandchildren, all of whom live in Raleigh.
“We were all amazed at how quickly and efficiently it had gotten resolved,” Weddington said. “I’m extremely grateful.”
Madison Iszler: 919-836-4952; @madisoniszler
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