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Time Sensitive Emergencies – STEMI

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.


  • 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.

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