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June 24, 2012

Program designed to assist rural heart attack victims

By James Chilton
The Wyoming Tribune-Eagle A new three-year program funded by the Leona M. and Harry B. Helmsley Charitable Trust and administered by the American Heart Association aims to improve the speed with which rural heart attack victims are able to receive prompt and effective care throughout Wyoming. By James Chilton

CHEYENNE, Wyo. — A new $7.1 million statewide project is designed to get proper care to rural heart attack victims faster.

Speaking in the State Capitol rotunda Friday morning, Gov. Matt Mead gave thanks to both the Leona M. and Harry B. Helmsley Charitable Trust and the American Heart Association. The two organizations are respectively responsible for funding and implementing the bulk of the program, dubbed "Mission: Lifeline Wyoming."

"Thanks to this $7.1 million fund, the American Heart Association will be able to get right to work putting into place the elements needed to address a heart attack and appropriate response in a rural area," Mead said.

"This includes helping ambulance services obtain the equipment they need to better diagnose the most deadly heart attacks, training for EMS and hospital personnel, and tracking data for quality improvement."

Speaking for the Helmsley Charitable Trust, trustee Walter Panzirer discussed the efficacy of similar programs the trust has funded in South Dakota and North Dakota over the past two years, and the promise they bring to Wyoming residents.

He noted that the key component of the new program will be the incorporation of 12 lead electrocardiograms. They are equipped with Bluetooth technology that makes them capable of taking a detailed snapshot of a patient's vital signs, then wirelessly transmitting them to hospitals dozens of miles away.

The EKGs will be installed in ambulances across the state. They will allow hospital medical staff to remotely observe, diagnose and prepare to treat a heart attack victim long before they make it to the hospital's emergency department.

The improved information exchange between emergency medical service agencies and doctors will also make it easier for the ambulance drivers to determine which hospital to take a patient to, or whether they should request a helicopter for more immediate transport.

Noting that 1,200 Wyomingites die each year from complications related to heart disease and cardiac arrest, Panzirer said saving even 10 percent of those patients in a state as sparsely populated as Wyoming could be the equivalent of saving an entire town.

"That's everything from teachers, to bankers, to a mother and father," he said. "You can put a face to the people you're saving."

American Heart Association President Dr. Gordon F. Tomaselli said that by being able to prepare for heart attack patients in advance, hospitals will be able to substantially cut down the time between when the patient arrives at the hospital and when their heart blockage has been successfully treated via balloon catheter.

"'Mission: Lifeline Wyoming' will reduce death and disability rates of all emergency cardiac events by focusing on the two most lethal types: STEMI and sudden cardiac arrest," Tomaselli said.

STEMI is an abbreviation for "ST segment elevation myocardial infarction," which occurs when the coronary artery is blocked by a blood clot, causing the heart muscle to begin to die from lack of oxygen.

By comparison, Tomaselli said, sudden cardiac arrest occurs when the heart suddenly stops beating altogether, cutting the supply of oxygen to all parts of the body immediately.

Both conditions, he added, can cause death within just minutes, making every second count between when a 911 call is placed and when the patient arrives at the hospital.

"During STEMI, we say that 'time is muscle,'" Tomaselli said. "The more time that passes without treatment, the more the heart muscle is permanently lost, and the risk of death and disability rises dramatically."

He added that time is even more critical in the event of sudden cardiac arrest, since the entire body is at risk of permanent damage, rather than just the heart muscle, at least initially.

"In the case of sudden cardiac arrest, a victim's chance of survival decreases by 7 to 10 percent for every minute they go untreated," he said.

Doctors Adrian Fluture of Wyoming Medical Center in Casper and Gerrie Gardner of Cheyenne Regional Medical Center both agreed that heart disease continues to be the state's leading cause of death, and that the new EKG program would give their hospitals the resources they need to ensure patients receive the most effective care possible, as quickly as possible.

Fluture specifically pointed to the "door-to-balloon" interval, the time between when a patient arrives in the emergency department to when they receive the proper treatment, as a crucial area of the program's focus.

While his hospital has managed to reduce its average door-to-balloon interval from 85 minutes to fewer than 45 over the past year and a half, Fluture said it still has a long way to go before he will be satisfied.

"Our national guidelines say that this interval should be less than 90 minutes," he said. "Thirty-eight minutes is much less than 90 minutes, but it needs to shorter than that."

Midge LaPorte Epstein of the Heart Association said the new EKG machines will be installed throughout the next year, with training, data tracking and program adjustments occurring simultaneously, and over the following two years.

While the bulk of the $7.1 million program will be funded through a $5.9 million grant from the Helmsley Charitable Trust, other funding sources include First Interstate Bank and the Wyoming Community Foundation's Working for Wyoming Fund.

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