Alta Bates Community Connection

Feature Story

Above, left to right: Al Bengtson, administrative director of cardiovascular services; David Anderson, M.D., chief of cardiology; Gavin Aubert (holding the
12-lead EKG machine), Albany Fire Department paramedic; Earl Holloway, M.D., medical director of the Interventional Lab; Jim Pointer, M.D., Alameda County EMS medical director; and John Gentile, M.D., vice president of medical affairs.

Timely Stroke Care

Just as with a heart attack, every minute counts for stroke victims. The specialized emergency care stroke patients need is available without delay at the Alta Bates Summit Regional Stroke Center. “We’ve built a relationship with emergency medical services to streamline their assessment of stroke patients in the field,” says Alison Scherrer-Bannerman, stroke center coordinator.

A pilot project with the Berkeley Fire Department (soon to be expanded elsewhere) includes rapid assessment for a possible stroke. Paramedics rush the patient to the Alta Bates campus, and radio ahead to its Emergency Department, whose staff, in turn, alerts the stroke care team—a neurologist, a trained stroke nurse, and a CT technician (for CT scan). Emergency personnel are available immediately when the patient arrives. “Patients are going to have the best outcomes treated within 90 minutes of their first symptoms,” explains Alison. If a patient arrives in less than two and a half hours from stroke onset, he or she may be eligible for tPA, a drug that dissolves the blood clot. Even patients who don’t meet the strict criteria for tPA can still be medically managed according to national guidelines on Alta Bates’ designated stroke unit.

“We’ve done an enormous amount of education with our staff about the best practices for stroke care,” says Alison. “We’ve also worked with Alta Bates Summit’s Ethnic Health Institute to educate community members—to teach them to identify stroke warning signs and know that complications can be prevented if they seek help quickly.”

Diagnosis in a Heartbeat

Alta Bates Summit has purchased cardiac monitors for ambulances and fire trucks that will save lives and transform emergency heart care in Alameda County

Midway through his second game of hoops at Live Oak Park in Berkeley, Jacques Bronson got short of breath. “When I sat down on the bench, a wave of nausea came over me, and I had pain over my whole chest,” says the 47-year-old Albany resident, who went home and tried to sleep it off, but ended up calling 9-1-1.
The Albany Fire Department responded in minutes, and once the paramedics understood his symptoms, they began their chest-pain protocol, which included giving oxygen, aspirin, and nitroglycerin. But inside the ambulance, they also hooked Jacques up to a sophisticated new tool in their arsenal: a 12-lead electrocardiogram (EKG) machine to assess his heart rhythms in detail. An EKG with 12 leads (the wires that are patched to your skin) is the only tool that can accurately diagnose the most serious type of heart attack, called an ST-elevation myocardial infarction (STEMI), which requires immediate unblocking of clogged coronary arteries to save the patient’s life. An estimated one-quarter of all heart attacks are STEMIs.

The 12-Lead EKG: An Invaluable Tool
The 12-lead machine is so valuable for emergency heart care that Alta Bates Summit decided to purchase 12 machines—a $200,000 investment—for the fire trucks and ambulances in the cities of Albany, Berkeley, Alameda, and Piedmont, which could not have otherwise afforded them. Alta Bates Summit also assisted these cities in a program to train personnel to use the 12-lead machines. Emeryville has been using the machines since 2003, and American Medical Response (AMR), which serves Oakland, now has 12-leads as well.

“This purchase is incredibly important for our community because heart attack patients will now have faster access to emergency treatment,” says Jim Pointer, M.D., medical director for Alameda County Emergency Services and an architect of the 12-lead program. “In the past, our paramedics would not have known if a patient had a STEMI, and might have transported the patient to a hospital that didn’t offer the most effective treatments. But now, they can make the diagnosis and bring patients directly to Alta Bates Summit—the only hospital in northern Alameda County to offer full-time angioplasty (with cardiovascular surgery backup), the most desirable technique for treating these heart attacks.”

Hidden Heart Attacks Revealed
Jacques was the first Albany patient to receive a paramedic-administered 12-lead EKG, on August 28, 2005. Paramedic Gavin Aubert examined the readout of his electrical heart rhythms, which showed ST elevation: Jacques was in the throes of a dangerous heart attack. Gavin now knew the situation was critical, and instead of more conservative treatment, Jacques would need immediate care and close monitoring en route to Alta Bates Summit. In Summit’s cardiac catheterization lab, his blocked coronary artery was re-opened using angioplasty and stenting. During a situation in which every second counted, Jacques pulled through.
12-Leads Make a Major Difference

Had it not been for the 12-lead EKG machine, Jacques’ outcome could have been very different. “In the past, if paramedics suspected a heart attack, they would take patients to whatever hospital was closest,” says Al Bengtson, administrative director for Cardiovascular Services at Alta Bates Summit. “The emergency staff at that hospital would diagnose a STEMI, and determine that the patient needed to be transferred to Summit. This diagnosis and transfer could sometimes take hours. But with the 12-lead EKG, paramedics are able to diagnose STEMIs immediately, and are mandated to bring patients directly to Summit, which is where they need to be. The sooner patients get into the cath lab for angioplasty, the better their outcomes will be.”

“The 12-lead machines will save so much time for heart attack patients, because paramedics can give a report over the radio to the Summit staff, who can then contact their on-call cardiologist and cath lab team,” says Dr. Pointer, “so the proper people will be ready to handle the patient when he or she arrives.”

On average, heart attack patients receive angioplasty treatment at Alta Bates Summit in times that meet or exceed national guidelines (90 minutes). But with the introduction of the 12-lead machines, Al expects to reduce that time to 60 minutes, a relatively lightning-fast speed that most hospitals are unable to achieve. “We have four cath labs and a fifth being built, and 24/7 coverage with cardiologists, nurses, and technical staff,” he says, “so we will always have the resources to handle these patients.”

A Consensus Among Professionals
The initiative to equip paramedics with 12-lead machines has enjoyed broad support among Alameda County hospitals and emergency medical services. A committee of community physicians and administrators, spearheaded by Dr. Pointer, engineered the approval of the machines and the change in county protocols. At Alta Bates Summit, support and advocacy from Earl Holloway, M.D., David Anderson, M.D., and Robert Greene, M.D., made the purchase possible. In the past year, approximately 300 first responder paramedics on ambulances and fire trucks have been trained to use the 12-lead EKGs.

“I get excited phone calls at night from the paramedics I’ve trained to use the 12-lead,” says Gail Porto, R.N., M.S., quality improvement coordinator and emergency medical services educator for Albany, Emeryville, and Piedmont fire departments. “They tell me about a patient who just felt a little dizzy, but when they slapped on the 12-lead, it showed a huge [heart attack in progress.] So we’re able to pick up heart attacks we would have missed before, and that’s exciting.”