St. Elizabeth Takes 'Handoff' from Pair of EMS Teams

Seamless Care "Outside of the Box" For When the World Isn't Perfect

This article was contributed by Paul Filipowicz, RN, BSN, MHA.

The title of this case study is probably not a question that we in the medical field ask on a daily basis, or even want to know if it can occur.

What happens when the emergency people have, well, an emergency?

But, for a patient suffering from the worst kind of myocardial infarction called an ST-Elevated Myocardial Infarction (STEMI) that question needed to be answered and answered quickly by EMS personnel.

This exact scenario took place in Berlin Center, Ohio. The Berlin Volunteer Fire Department was dispatched to a patient complaining of chest pain. Berlin Township Volunteer Fire Department medics Anthony Pilolli, Joe Kale, and EMT student Shannon Graf made initial contact with a 56-year-old male patient sitting in his vehicle complaining of chest pain with radiation into his left arm.

EMS personnel conducted their ALS assessment and moved the patient to their cot for transport to St. Elizabeth Health Center (SEHC) located in Youngstown, Ohio. Prior to leaving for the hospital a 3-lead and then a 12-lead electrocardiogram (ECG) were obtained and the ECG demonstrated that the patient was in the midst of a STEMI, with elevation in leads II, III, and AVF. The patient was also demonstrating depression in leads V2, V3, and V4.

With IV established, medications given and constant monitoring of the patient, transport to SEHC began. While enroute to the hospital an additional ECG was obtained and was progressively worse than the initial ECG.

With Berlin Fire Department enroute to SEHC, which is a 25.4 mile trip taking roughly 27 minutes, their ambulance developed engine difficulties and began going slower and slower.

The Berlin Township medics had mere seconds to establish a new strategy and put it into action to ensure that the STEMI patient reached the cath lab at SEHC in Youngstown.

One idea was to go to the St. Elizabeth Emergency and Diagnostic Center, a free-standing emergency department located in Austintown, Ohio and have the mobile intensive care unit (MICU) from SEHC dispatched to meet the Berlin Fire Department. From the emergency department the patient's care would be transferred to the MICU and the patient transported to the cath lab in Youngstown.

As plans were being developed, Berlin medic Joe Kale spotted a Lane Ambulance crew passing by on the opposite side of the road.

Medic Kale made the split-second decision to flag down the Lane squad by waving at them to turn around and follow them. Lane medics Barb Robinson and Cory Hinderliter heeded the call from Berlin Fire and turned their ambulance around, making their way to a business driveway to the waiting Berlin ambulance.

Prior to pulling into the business driveway Lane medics radioed in and advised their dispatcher that Berlin medics were flagging them down. At this time Lane Supervisor, Tom Lambert EMT-P, heard the call and met both ambulances at the rendezvous point where the patient was transferred from the Berlin Township squad into the Lane ambulance.

With Berlin and Lane medics at the patient's side, the Lane ambulance proceeded to St. Elizabeth Health Center in Youngstown. While in transport to SEHC a LIFENET ECG was sent to the emergency department where staff informed ED attending, Dr. Chad Donley of the patient's impending arrival. A heart alert was called and all team members were in place upon the patient's arrival.

Dr. Wahoub Hout, Department Chair of Cardiology and the Interventionalist on call, immediately transported the patient to the cath lab. The patient was found to have an RCA that was a large, codominant vessel with 50% proximal narrowing and total mid-vessel occlusion.

Subsequently, the patient received successful balloon angioplasty with the deployment of a drug-eluding coronary stent to the mid RCA with very good results and restoration of TIMI-3 flow. After 2 days in the hospital the patient was discharged home.

Data collected for the case demonstrated that the patient had a door-to-balloon (D2B) time of 27 minutes and a first medical contact (FMC) time of 76 minutes.

The above situation is proof that seamless care of the STEMI patient can occur when all parties involved are concerned about one thing and only one thing; the care of the patient.

The times achieved would not have been possible without the seamless transition of care from the initial scene to the need for an additional ambulance, the transfer of the patient in the business driveway from one ambulance to another, transport to the emergency department at SEHC, and the ultimate transfer to the cath lab for intervention. This scenario is proof that in an ever-changing healthcare environment that our front-line medical personnel continue to put the patient first and demonstrate why EMS personnel are one our greatest assets in the care of the STEMI patient.