That morning, “Joan” felt fine. She baked a pound cake, ironed a shirt and picked four tomatoes from her garden.
But by late afternoon, she was feeling short of breath. An odd tightness gripped the center of her chest. She felt queasy.
Worried that she was having a heart attack, she called 9-1-1—and waited for help to arrive.
Beating the Odds
Each year in North Carolina, emergency medical technicians and paramedics provide emergency care to more than 1.1 million people. Of those patients, 7,500 will have suffered a cardiac arrest. Another 100,000 will have a condition that could develop into cardiac arrest or require aggressive treatment and monitoring.
Survival rates vary widely from county to county, from as low as five percent to as high as 40 percent. But thanks to a new effort, the odds are about to get better.
Emergency medical service systems across the state are receiving critical equipment and specialized training to improve the way they respond to people in cardiac crises. A $2.1 million grant from The Duke Endowment to the N.C. Department of Health and Human Services is supporting the “Lead the Wave” project.
“This is a win-win for everybody,” says Regina Crawford, chief of the North Carolina Office of Emergency Services. “It’s going to have a tremendous impact.”
Critical Equipment, Critical Care
If a person is having an acute myocardial infarction—a heart attack—medical experts say that clot-busting drugs and other artery-opening treatments work best when they’re given within the first hour.
Two pieces of equipment—12-lead electrocardiogram machines and waveform capnography—have proven vital in helping emergency medical professionals respond to patients quickly.
The 12-lead tells whether a patient is having a heart attack by monitoring the heart rhythm and identifying abnormalities.
Waveform capnography checks resuscitation efforts by measuring carbon dioxide in a patient’s breath.
Both devices are recommended as a standard in care for cardiac cases, and the North Carolina College of Emergency Physicians has strongly recommended that they be present on every in-service EMS vehicle in the state.
But each machine can cost thousands of dollars. In North Carolina, 76 percent of EMS vehicles have waveform capnography and 67 percent have 12-lead monitors.
Through “Lead the Wave,” the goal is to have the devices available at every emergency call that involves a cardiac crisis. The Endowment grant will help provide the necessary equipment for under-resourced counties.
Officials estimate that each year, 200 more lives may be saved as a result.
The Golden Minutes
So in the case of “Joan,” she would dial 9-1-1, and then listen as the emergency dispatcher asked questions and gave instructions.
If she lived in rural eastern North Carolina, an EMT or EMT-intermediate might be dispatched to her home. The EMT would assess her condition, give oxygen and apply the 12-lead monitor at the scene.
En-route in the ambulance, the 12-lead results would be remotely transmitted to the receiving hospital. If the hospital confirmed a heart attack, Joan would be able to bypass the emergency department and go straight into treatment as soon as she arrived.
“Those early minutes are golden,” says Tom Mitchell, the state’s interim EMS assistant chief. “You can’t waste them.”
About the EMS Care Grant
The $2.1 million grant is one of several from The Duke Endowment to improve the quality and capacity of EMS care in North Carolina and South Carolina.
Early efforts focused on developing a centralized database to collect and analyze information about EMS services and performance in every county. The data is organized through performance improvement initiatives that will allow EMS providers to evaluate how they’re doing and discover ways to improve.
By analyzing the database, experts found the disparity in cardiac arrest survival rates, which led to the “Lead the Wave” project.
The EMS Toolkits Project was funded by the Endowment and is administered by the EMS Performance Improvement Center, located within the Department of Emergency Medicine at UNC Chapel Hill. The center serves as an umbrella for major EMS initiatives.
The Performance Improvement Center is also helping to implement “Lead the Wave.”
Lin B. Hollowell III
Director of Health Care