A Coordinated Effort to Improve Mississippi’s Heart Attack Care, Communications and Outcomes
Nobody is ever really ready for a heart attack. As one recent television commercial reminds us, we don’t get a warning note or text message alerting us in advance. It is that element of surprise that catches us off guard and can prevent our taking immediate and appropriate action. Our lack of preparedness can have devastating results.
Two of the most important things for us to know about heart attacks, are: 1) how to recognize the symptoms and 2) what to do when they occur.
HEART ATTACK SYMPTOMS: Chest discomfort Pain in arm, back or jaw Sweating or nausea Shortness of breath Dizziness or weakness WHAT TO DO IF YOU ARE EXPERIENCING SYMPTOMS Call 911.
Well-Being spoke to Dee Howard, executive director of the Mississippi Healthcare Alliance (MHCA), a collaboration of Mississippi hospitals, emergency medical service (EMS) professionals and other healthcare providers around the state, about one of the organizations’ groundbreaking statewide systems to improve care, communications and outcomes for heart attack patients – the STEMI Heart Attack System of Care.
The idea of developing a coordinated system emergency care for heart attack patients all began when representative members of MHCA came together to find ways to collectively improve Mississippi’s statistics relating to heart disease. What evolved would be a state-wide project to identify Percutaneous Coronary Intervention (PCI) hospitals, increase communications with EMS providers, establish evidence-based treatment protocols, provide professional and community education, collect data for the purpose of quality improvement, and to participate in research opportunities.
Dee Howard explains why the EMS element is so important to the system and to improved patient outcomes.
“Think about it,” notes Howard, “in the past, when someone called 911 with the symptoms of a heart attack, the standard practice was to take that patient to the nearest hospital. On the surface that sounds reasonable, but if the hospital is not staffed or equipped to provide critical emergency cardiac care, valuable time can be lost. With the STEMI system, EMS personnel are educated about which hospitals can perform emergency cardiac catheterization or heart surgery on the STEMI patient 24 hours a day, seven days a week. ‘Time is Muscle’ when you think of treatment of a heart attack. Early recognition and treatment with restoration of blood flow to the heart that is being deprived of blood and oxygen is key to optimal outcomes.”
The critical time element is the reason calling 911 if someone is experiencing heart attack symptoms is far preferable to taking them to the hospital in a private vehicle or the patient driving themselves to the ER.
According to MHCA President Dr. Harper Stone, people who have symptoms of a heart attack tend to wait two hours to seek medical attention if they drive themselves to the hospital.
An ST-segment elevation myocardial infarction (STEMI) is the most serious form of heart attack in which one or more coronary arteries is completely blocked and a large part of the heart muscle is unable to receive blood and oxygen. “ST segment elevation” refers to a pattern that shows up on an electrocardiogram (EKG).
“If they dial 911 they tend to call an hour earlier, which saves critical time and heart muscle,” adds Stone. “Seeking medical attention an hour earlier may mean the difference between life and death. That’s why we say ‘Dial Don’t Drive.’ Early activation of EMS by paramedics is a critical link in the heart attack chain of survival. We are very fortunate that EMS agencies across our state are very engaged in participation in our STEMI and stroke systems of care. Furthermore, by standardizing care with heart attack protocols for non PCI hospitals, patients are able to receive a higher quality of care even in smaller hospital emergency departments in more rural areas of the state prior to transport to a PCI center.”
“Early access to emergency care is crucial to optimal outcomes,” Howard continues. “Dialing 911 gets the patient into the emergency system of care begun by paramedics on scene. They can then perform an electrocardiogram, obtain history and assess vital signs and other important information needed to determine if the patient should be taken to a PCI center (hospital with round-the-clock emergency cardiac catheterization and cardiovascular surgery capabilities and staffing). EMS personnel pre-notify the hospital, keep the patient on the cardiac monitor, give oxygen if needed, and other medications such as nitroglycerine, morphine, and aspirin if indicated. While all of this is happening, they are rapidly transporting the STEMI patient to a hospital that can immediately begin emergency intervention.”
PCI Center hospitals are grouped by regions of the state.
The northern region PCI hospitals are Baptist Memorial Hospital (BMH)-DeSoto, BMH-Golden Triangle, BMH North MS, Delta Regional Medical Center, Magnolia Regional Medical Center, Methodist-Olive Branch, and North MS Medical Center.
The central regional PCI hospitals are Anderson Regional Medical Center, MS Baptist Medical Center, Merit Health Central, Merit Health River Region, Rush Foundation Hospital, St. Dominic Hospital and University of MS Medical Center.
South region PCI hospitals are Forrest General Hospital, Memorial Hospital at Gulfport, Merit Health Wesley, Singing River Health System-Ocean Springs; Singing River Health System-Pascagoula, Southwest Regional Medical Center.
It’s important not to overlook two elements of Mississippi’s STEMI Heart Attack System that continue day in and day out and which go beyond the process of getting the patient to the right facility for the right care. The first is the quality improvement process. The STEMI system is under constant review by a committee whose job it is to review the data that is collected regarding STEMI patients and their treatment and look for ways to improve every step in the process for better patient outcomes and lower mortality rates from heart attacks. The STEMI System of Care plan was adopted by the MS Department of Health in 2011. That means there have already been five years of data collection and quality improvement efforts underway.
The other element of the program is community education – getting out the message to Mississippians so they know the symptoms of a heart attack and what to do if it strikes. With advertising campaigns like “Dial Don’t Drive” that are reaching the public through radio and TV commercials, including those played during college games at Ole Miss, Mississippi State, Jackson State and the University of Southern Miss, MHCA is hoping to give the public the tools to help reduce the number of fatal heart attacks in the state.
Improving heart attack statistics in Mississippi is an effort where there is room for us all to participate. We can make a difference by recognizing heart attack symptoms and the appropriate action to take, and sharing that knowledge with our friends, family, neighbors and co-workers. Along with the tremendous efforts of MHCA and its partners, we can all fight back against debilitating and fatal heart attacks.
For more about the STEMI Heart Attack System and other MHCA programs of care and projects, visit www.mshealthcarealliance.org