Time Sensitive Emergencies – STEMI

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By Stu Willis, MD
Emergency Department Medical Director
STEMI Center Medical Director
Boundary Community Hospital

Thump-Thump, Thump …

Pain in the chest, down the left arm, shortness of breath, nausea, pale and clammy –  these are sure signs of a heart attack, right? Not always.  If you are female, have diabetes, or are elderly you may not have the “classic” signs when you have a heart attack.

Boundary Community Hospital has always held an essential role in meeting the healthcare needs of Bonners Ferry and Boundary County.  With the development of the Idaho Time Sensitive Emergency System, the hospital is working towards meeting the stringent criteria for official designation as a TSE Level II STEMI (Heart Attack) Center. This designation will ensure an organized, coordinated system of care along the complete journey of the heart attack patient – from the EMS ambulance paramedics, to the Emergency Department staff, and then transport by air (or by ground if the weather doesn’t allow flying) to the heart specialists at a large cardiac center capable of giving definitive treatment. The goal of the TSE System is to prevent deaths and improve patient outcomes by providing the rapid movement of patients to appropriate centers for their required treatment – it’s all about getting the RIGHT patient to the RIGHT place at the RIGHT time.

There are two types of heart attacks:  ST elevation attack (STEMI) – blockage of a large, major vessel; and Non-ST elevation attack (Non-STEMI) – blockage of a small, minor vessel. It takes an electrocardiogram (ECG) to tell the difference. While small, minor heart attacks are still important and require prompt attention, the blockage in a large, major heart attack requires extremely urgent, “time-sensitive” treatment to avoid long-term consequences and complications. So, time is of great importance – TIME IS MUSCLE !

Heart disease is the leading cause of death in the U.S and Idaho. About 635,000 new heart attacks occur each year in the U.S. – one every 44 seconds; and there are another 300,000 repeat heart attacks annually. And very worrisome is that around one in five are fairly “silent” in that they don’t have significant pain and few of the more classic signs. Some heart attacks are sudden and intense – these are not hard to mistake. But most heart attacks start slowly and with only mild or moderate discomfort.

CHEST DISCOMFORT – Most heart attacks involve some form of discomfort in the middle of the chest that lasts more than a few minutes, or that comes and goes, and then stays. It can feel like uncomfortable pressure, squeezing, fullness, tightness, or actual pain.

OTHER AREAS OF DISCOMFORT – Signs can also include discomfort of pain in one or both shoulders or arms, or the upper back, neck, jaw, or stomach region.

SHORTNESS OF BREATH – The shortness of breath of a heart attack may occur with or without pain or discomfort in the chest or another region.

OTHER SIGNS – Often other signs occur during a heart attack, and can include breaking out in a sweat, nausea or lightheadedness, and appearing pale.

Similar to men, most common heart attack sign in women, diabetics, and the elderly is pain or discomfort in the chest. However, this group is also more likely to exhibit other symptoms, particularly shortness of breath, vomiting, and back or jaw pain.

WHAT SHOULD I DO IF I SUSPECT A HEART ATTACK? Even if you’re not sure it is a heart attack, immediately call 9-1-1 and chew four baby aspirin or one adult aspirin unless you have a true allergy to aspirin. The EMS paramedics can begin other early essential treatment with an ECG and medications while you are on the way to the hospital.

WHY DON’T PEOPLE ACT FAST ENOUGH? Many people having a heart attack wait more than two hours before getting help. Some people feel it would be embarrassing to have a “false alarm.” Others are so afraid of having a heart attack that they tell themselves they aren’t having one. These feelings are easy to understand, but they are also very dangerous.

HOW CAN I HELP AVOID A HEART ATTACK?

  • Don’t smoke, and avoid second-hand smoke
  • Treat high blood pressure if you have it
  • Eat foods low in saturated, trans fat, and sodium (salt)
  • Be physically active – exercise regularly
  • Reach and maintain a healthy weight
  • Take medicines as prescribed
  • Get regular medical check-ups
  • Control your blood sugar if you have diabetes

The Emergency Department staff of Boundary Community Hospital has coordinated with Boundary Ambulance, Life Flight Network, and the cardiology staff of Kootenai Health in developing a state-of-the-art process to quickly start the initial standardized treatment of heart attack victims and deliver them directly to the heart catherization lab to open the blockage…the faster, the better.

To introduce the community to the Idaho Time Sensitive Emergency Initiative, Dr. Willis is speaking with community and church groups about “What You Need to Know About Heart Attack, Stroke and Trauma.”  If you would like to have Dr. Willis speak with your group, call 267-6912 to get on the calendar.

Time Sensitive Emergency – Trauma

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WaaahYah! WaaahYah! WaaaYah!…

By Dr. Stu Willis, Emergency Department Director

The sudden sound of a vehicle crash…the sight of a bloody leg from a chain saw encounter…the thump, thump, thump of granny pivoting down the stairs…these all produce instant fear, anxiety, and worry for an episode of serious injury.

As the first Pacific Northwest hospital to be awarded the Critical Access Hospital designation by the federal government, Boundary Community Hospital has always had an essential role in meeting the healthcare needs of Bonners Ferry and the surrounding county.  With the advent of the Idaho Time Sensitive Emergency System, the hospital is working towards official TSE Designations by meeting the stringent criteria as a Level IV Trauma, Level III Stroke, and Level II STEMI (Heart Attack) Center.

The 2014 Idaho Legislature approved and funded a plan to develop a statewide Time Sensitive Emergency System of care that includes three of the top five causes of death in Idaho: trauma, stroke, and heart attack.  Studies show that organized systems of care improve patient outcomes, reduce the frequency of preventable death, and improve the quality of life of the patient.  The goals of the TSE system are to decrease mortality and improve patient recovery by providing the rapid movement of patients to an appropriate center for definitive treatment.

Worldwide there are eleven deaths every minute due to trauma – that’s 5.8 million fatalities a year, and over one million are the result of motor vehicle crashes. Wearing seatbelts, not driving after drinking, and not driving while distracted (texting, etcetera) are major preventive efforts that have already shown to have a dramatic positive impact.

Trauma is the fourth leading cause of death in Idaho, and the third leading cause in Boundary County. It is estimated that by 2020, one out of every ten persons will die from an injury.

But short of death, other major disabilities result from trauma. For example, various degrees of brain injury, whether a concussion or a massive bleeding injury, occur in the U.S. some 1.7 million times per year. These injuries result in nearly 300,000 hospitalizations, over 52,000 deaths, and about 90,000 cases of severe disability each year. Protective headgear, such as helmets, help some, but preventing the injury in the first place is even more important.

Each year 10 million children visit U.S. emergency departments due to an injury – that’s one visit for every six children…and 10,000 are fatal. “Childproofing” the home and other areas children visit, and simple careful supervision are paramount to ensuring child safety.

For the lay person encountering an injury case, remember the A-B-Cs – Airway, Breathing and Circulation. Ensure the airway is open, but don’t move the neck around as there could be a major neck fracture. Assist with breathing, if necessary, and control ongoing bleeding with direct pressure.

According to Emergency Department Director, Stu Willis, MD, “As a rural community hospital, we have an obligation to provide services that improve survivability. However, we need the community to be aware of the signs and symptoms of time-sensitive emergencies so they can get help as fast as possible, whether it’s the paramedics with advanced life support training, the hospital emergency department staff, or Life Flight transporting a patient to a higher level of care facility such as a major trauma center. In addition, prevention education is a key and vital component of this, especially in regards to injuries and major trauma.”

“At Boundary Community Hospital, our goal is to provide the community with timely healthcare services that are second to none, whether it’s emergency services or long-term care, inpatient or outpatient,” says Hospital CEO Craig Johnson.

To introduce the community to the Idaho Time Sensitive Emergency Initiative, Dr. Willis is speaking with community and church groups about “What You Need to Know About Trauma, Stroke, and Heart Attack.”  If you would like to have Dr. Willis speak with your group, call 267-6912 to get on the calendar.

The TSE System could potentially save 244 lives annually in Idaho according to the Idaho Department of Health & Welfare.

Time Sensitive Emergencies in Boundary County

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Time Sensitive Emergencies in Boundary County

Recent news events have highlighted the statewide Time Sensitive Emergency (TSE) initiative in Boundary County.  A tree falling on someone working in their yard has the Boundary Ambulance Service paramedics working with Boundary Community Hospital Emergency Department physicians to call in Life Flight Network to transport the patient directly by air to the nearest Trauma Center.  Then a heart attack on a rainy day is rapidly treated in the Emergency Department and transported swiftly by ambulance directly to the Cardiac Catheterization Lab at Kootenai Health. These are but two prime examples of coordinated care when TIME is critical.

The 2014 Idaho Legislature approved and funded a plan to develop a statewide Time Sensitive Emergency system of care that includes three of the top five causes of death in Idaho: trauma, stroke, and heart attack. To introduce our community to TSE, Dr. Stu Willis, Emergency Department Director at Boundary Community Hospital and representatives from Boundary Ambulance will be speaking to the community about “What You Need to Know About Heart Attack, Stroke and Trauma” on Tuesday, November 29th at 5:30 pm at the University of Idaho Extension Office.

Boundary Community Hospital Emergency Department staff work closely with the Boundary Ambulance EMTs and paramedics and Life Flight Network personnel to design system-wide processes and procedures for expedited care based on the state and regional guidelines. This initiative has put strategies in place so the RIGHT PATIENT gets the RIGHT CARE at the RIGHT TIME, helping to ensure an optimal outcome, especially when TIME is a life-threatening factor.

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TSE Childhood Injury Prevention Month

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September – National Childhood Injury Prevention Month

 

By – Stu Willis, MD & Gina Gallette, RN

Boundary Community Hospital Emergency Department

 

Your three-year-old child falls from the ladder as he mimics his dad changing a light bulb a few minutes ago…he’s unconscious and has a softball-size swelling on his forehead!  Your six-year-old daughter slips and slices into her tummy while “playing mommy” cutting a zucchini…there’s a lot of blood and she’s barely breathing! What panic just the thought of these cause parents. What fret for friends and relatives. And then, “Where did I put the cell so I can call 9-1-1?”

According to the Centers for Disease Control and Prevention, 10 million children visit U.S. emergency departments each year due to an injury – that’s one visit for every six children…and tragically, over 10,000 are fatal. Injury is the leading cause of death and disability for U.S. children.

In the past 11 months, the Emergency Department of Boundary Community Hospital treated 287 persons under the age of 18 for injuries. Over 130 were fractures, dislocations, and sprains. Over 60 were injuries to the head and neck, more than 50 were deep cuts, along with a scattering of burns, bites, stings, and a few potential poison ingestions.  The majority of these injuries were related to motor vehicle accidents, organized sports, or playground-type activities.

In 2012 the Center for Disease Control (CDC) launched the National Action Plan (NAP) for Child Injury Prevention. The goals of this NAP are first to raise awareness of childhood injuries; second, highlight preventive solutions; and finally, implement those solutions to decrease childhood injuries through community education and training.

Looking back over the last few decades, various child safety initiatives have made a difference…“child-proofing the home,” use of child safety seats and bike helmets, concussion guidelines for sports injuries, installing smoke alarms and pool fencing, to name a few.  While childhood injuries have decreased, the NAP goal is for continuous improvement.

The staff of Boundary Community Hospital is dedicated to providing more than just treatment of injuries – we play an active and key role in community education in injury prevention.

 A Few “Be Safe” Reminders:

  • Motor vehicles: Inside of vehicles, use appropriately sized and fitted restraints and safety seats; watch for distracted drivers; and set an example – no texting or using the cell phone while driving. Outside of vehicles, teach and model safe pedestrian habits.
  • Water safety: Use life jackets…they float, you don’t. Also, install and maintain safety fencing around pools
  • Poisoning: Keep all medications and cleaning products secured and out of the reach of children. Also, post the Poison Control Center phone number, 1-800-222-1222
  • Fire safety: Prevent burns with safe cooking practices and review basic fire safety with your children. Also, use smoke alarms and carbon monoxide detectors, and review safe exits from your home in the event of a fire
  • Falls and sports: Always wear the proper helmet for the activity. Also, be aware of safety factors and potential hazards in your child’s play area

And parents, keep in mind your children are much more likely to follow safety measures if you model them. As the old saying goes, “More is caught than taught” – your example is powerful.

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