Speed could save you in a heart attack

It’s the chest-grabbing moment nearly all of us fear, the pressure and pain of heart attacks that comedian Redd Foxx used to call “The Big One.”

In Snohomish, Island and Skagit counties, a new system is now speeding patients with the most common type of heart attacks directly to a hospital that performs angioplasty, a lifesaving procedure to clear clogged arteries.

The goal is to cut every minute possible between the time symptoms commence and treatment begins.

In the past, patients were often taken to the closest hospital for initial treatment, then transferred to a hospital for angioplasty procedures.

For Ric Prael of Freeland on Whidbey Island, it meant that just 110 minutes after 911 was alerted to his chest pain, nausea and shortness of breath in the early morning hours of Nov. 10, a cardiac team at Providence Regional Medical Center Everett had opened a life-threatening blockage from his right coronary artery.

“The longer that vessel is blocked, the more heart muscle is destroyed,” said Dr. Larry Schecter, chief medical officer at Providence.

If a condition like Prael’s isn’t quickly treated, heart muscle begins to die. Nationally, 1.1 million people have heart attacks each year and almost half of them die, according to the National Heart Lung and Blood Institute.

Yet when follow-up tests were conducted on Prael three months later, they found no damage “because they took care of it so quickly,” he said.

Prael had to override the instincts of his brother that morning, who wanted to drive him to the closest hospital, Whidbey General Hospital in Coupeville. “I said, ‘No, I want an ambulance,’ ” Prael said. The local hospital said that Prael should be taken directly to the Everett hospital.

“That was fortunate,” Prael said. “That saved me an hour.”

It took a lot of behind-the-scenes work to make that happen: paramedics correctly reading the squiggly peaking and falling line of his EKG that signaled his heart problem, a physician at the Coupeville hospital alerting the cardiac team at Everett’s hospital to begin prepping for a patient, and a plea to the Clinton-Mukilteo ferry to delay its 6:30 a.m. departure an extra three minutes — just enough time to allow the speeding southbound ambulance carrying Prael to board.

He arrived at the Everett hospital at 7:03 a.m. “They wheeled me out of the ambulance and onto a table,” Prael said. “The next thing I knew I was on the way to surgery.”

Prael, 66, was discharged the following afternoon.

All this meant that Prael, who has had a dental practice on Whidbey Island for 35 years, was back at work in his office on First Street in Langley just eight days after his heart attack.

Higher heart attack rates

The heart attack response system has been activated in three counties where people are hospitalized for heart attacks at rates exceeding the state average.

In Snohomish County, there were 3,119 hospitalizations for heart attacks from 2005 to 2007, according to the state Department of Health.

In Island County, 432 patients were hospitalized for heart attacks during this same two-year period; Skagit County had 678.

In Washington, blacks, American Indians, Alaska Natives and Hispanics have higher death rates from heart attacks than whites and Asian/Pacific Islanders, according to state health data.

Even with this heart attack treatment system in place, one big barrier to getting medical care is that people with heart attack symptoms often don’t call 911 to get help.

Nationally, the time between the onset of symptoms and a patient’s arrival at a hospital ranges from 90 minutes to six hours, according to a study in Circulation, a medical journal published by The American Heart Association.

Each additional 30 minutes of delay increases by 7.5 percent the chances of a patient dying within the next 12 months.

What causes delays

Delay in getting treatment can be caused by a number of factors.

One recent study of patients who arrived at emergency rooms with chest pain showed that 60 percent were driven to the hospital by nonemergency medical services, said Rachel Saunders, an educator for heart disease and stroke prevention at the state Department of Health. And 16 percent of these patients drove themselves.

“We’re hoping to change that,” Saunders said. “It could have a huge impact on whether they live or die or have lasting disability. Every moment counts.”



People driving with chest pain or other heart attack symptoms are a danger not only to themselves, but others.

Since 2007, the Washington State Patrol has documented five accidents involving people having heart attacks. In each case, the driver died. Two of the accidents involved collisions with other cars.

Chest pain and other heart attack symptoms “are exactly what 911 is there for,” Saunders said.

Some patients think the fastest way to get hospital care is to have someone drive them.

Yet the chances of patients returning to good health after heart attacks increase when emergency medical services are called, said Kim Kelley, a coordinator for cardiac and stroke issues at the state Department of Health.

“They can call ahead … instead of you getting to the hospital and figuring out if it’s a heart attack … and it’s delay after delay,” Kelley said as patients make their way from the emergency room to the lab where tests are conducted to check for coronary blockages.

Other patients fear the potential embarrassment of calling an ambulance only to learn that the chest pain they thought was signaling the onset of a heart attack instead was heartburn.

“A lot of times, they wait to see if it will go away,” said Michelle Sand, chief nursing officer at Cascade Valley Hospital in Arlington.

Some patients delay due to anxiety that they are having a heart attack. “Humans are great at denial,” said Brenda Rogers, an associate administrator at Monroe’s Valley General Hospital.

Women have an added obstacle in seeking timely heart attack care. Their symptoms can be very different from the chest pain and nausea often experienced by men.

In fact, both of Saunders’ grandmothers were mistakenly thought to have intestinal problems or flu. Instead, their abdominal pains, cold sweats and light-headedness were signaling the onset of heart attacks. In the end, both women died.

System could expand

The state wants to have the same trauma-like system for treating heart attack patients expanded throughout Washington to save lives and give patients a better chance of full recovery — perhaps within the next year.

Thirty-one of the state’s 95 hospitals conduct angioplasty, in which a surgical balloon is used to gently open a clogged artery. In some cases a fine wire mesh, called a stent, is inserted as a brace to keep the artery open.

In the north Puget Sound region, these procedures are conducted at Providence Regional Medical Center Everett, Skagit Valley Hospital in Mount Vernon and St. Joseph Hospital in Bellingham, Kelley said.

Stevens Hospital in Edmonds hopes to get state approval to begin routinely offering the procedure later this year.

Fire departments, paramedics, and hospitals in Snohomish, Island and Skagit counties were the first in Western Washington to put together a system to help speed patients to the nearest hospital where the artery-clearing procedure is conducted, providing a test of how well the system works.

Hospitals in Wenatchee, the Tri-Cities, Yakima and Olympia are interested in launching their own programs.

“The difference is that this is more coordinated, starting in the beginning and including all the components in the chain of survival for the patient — the paramedic, dispatch, the emergency room and cardiologists,” said Cherish Hart, director of state health alliances for the Washington chapter of the American Heart Association.

The new system cuts delays in getting care “to the bare minimum,” said Dr. Paul Zaveruha, medical program director for emergency medical services on Whidbey and Camano islands.

“We eliminate a huge step, where an hour in the emergency room doesn’t happen anymore,” he said. “Other parts of the state are still trying to catch up.”

Sharon Salyer: 425-339-3486, salyer@heraldnet.com.





Why you should call 911

Snohomish County is one of 11 counties in the state where death rates from heart disease are higher than the state average.

Anyone with heart attack symptoms is urged to call 911 for help. One recent study of patients who arrived at emergency rooms with chest pain showed that 60 percent were driven to the hospital by nonemergency medical services, slowing treatment of their symptoms.

The state Department of Health has launched a campaign this year in the north Puget Sound region urging people to call 911 if they have heart-attack symptoms.