Written by Rebecca Budde • Photography by Jim Hawker and Jeff Wagner
On a late June day, with temperatures soaring over 100 degrees, the village of Sainte Marie, Ill., held its 175th Anniversary Celebration. Shortly after the parade, Julie Alzate, a paramedic with Jasper County Ambulance Service, learned that a member of the band was “looking gray” and having chest pain. Alzate knew the protocol to treat the symptoms was to perform a 12-lead electrocardiogram (ECG) and transmit the results to the nearest hospital.
A year ago, Alzate lacked the training needed to use the 12-lead EKG. Recent efforts from SIU School of Medicine’s Rural Health Initiative (RHI) improved the quality of care for this region by providing more than $80,000 to Sarah Bush Lincoln Health Systems and area emergency medical services (EMS) for 12-lead EKG technology, transmission equipment and training. The initiative is funded through the Rural/Downstate Health Act, which has been providing financial assistance to downstate communities since 1994. In keeping with the mission of the School, the goal is to help these communities expand their health care programs and improve access to care to better meet local needs.
Sarah Bush Lincoln Health Systems (SBLHS) is nestled between the towns of Charleston and Mattoon. Its service area spans seven counties in east central Illinois. “Of the ten emergency medical service agencies that transport to Sarah Bush, none had the full technological capabilities to perform a 12-lead EKG, even though it’s accepted as the standard of care,” says Robert M. Wesley, SIU executive director of regional medical programs.
SBLHS’s emergency department handled more than 38,000 visits last fiscal year. An estimated 10,000 of these patients arrive via EMS. The distance for patient transport in this region can consume up to one-third of the precious time needed to treat patients presenting with symptoms of cardiac trouble, risking irreparable damage to the heart muscle. A fully equipped and professionally trained emergency team, which includes 12-lead EKGs and transmission equipment in the pre-hospital setting, allows for early identification and timely treatment.
Sheri Barnett, RN, is the lead EMS instructor at Sarah Bush. She saw the need to equip all EMS providers with the standard technology to save lives in this rural area where hospitals can be many miles from home and the agencies don’t have the means to finance the equipment and training. “If we can decrease the turn-around time by 30-35 minutes, that really makes a big difference in patient outcomes,” says Barnett. Providers also needed training to effectively use the equipment. She wrote a proposal and took it to Molly Daniels, SBLHS’s grant writer.
The needs of the EMS agencies varied. Some simply needed a wireless component to transfer the EKG readings directly to the ED; others needed a complete upgrade of the essential technology. Ten local EMS agencies servicing SBLHS participated in the grant. The cost of the 12-lead equipment and training for the staff just wasn’t a possibility on their own, according to Joseph Burton, D.O., and head of SBLHS’s emergency department. “These agencies need all the help they can get,” says Dr. Burton.
After learning about the proposal, Wesley was confident that SIU’s Rural Health Initiative could help. “SIU made this an easy process,” says Daniels.
If this one process speeds diagnosis, and we can decrease the turn-around time by 30-35 minutes, that really makes a big difference in patient outcomes,” says Barnett. It definitely made a difference for Alzate and her patient. “We knew as soon as we hooked him up to the 12-lead, that we had to go immediately to the hospital.” During the 15-minute drive, Alzate transmitted all of the results to the emergency department in Olney.
The hospital immediately called air transport to take the patient to Evansville, the nearest hospital capable of performing a heart catheter. “Julie Alzate’s work in the pre-hospital setting saved critical time; the Evansville hospital, which would have been an hour and a half drive, had him on the table in 30 minutes,” says Shirley Sherwood, emergency medical services coordinator at SBLHS. “The national goal from onset of symptoms to catheter table is 90 minutes so that heart muscle can be saved and permanent heart damage avoided.”
If Alzate had not been trained to use the 12-lead technology, they would have lost valuable time. According to Sherwood, without having the 12-lead EKG results, Alzate would have given Davis nitroglycerin. And, in this patient’s case, it most likely would have caused a severe drop in his blood pressure as well as lost time in the emergency department while waiting for the air transport team to arrive. “Now, with the 12-lead transmissions to the hospital, I can see what the paramedics are seeing and assess the situation quickly,” says Dr. Burton.
Similarly, paramedic student Brian Duvall of Clark County Ambulance Service in Casey was able to put his 12-lead training to use to save patient Bill Tipsword of Casey, Ill. Prior to the RHI grant, the Casey ambulance was equipped with the 12-lead technology, but they were unable to transmit the results to the hospital.
On February 8, 2012, 57-year-old Tipsword suffered a heart attack. The Casey team transmitted Tipsword’s results en route to SBLHS where the attending physicians alerted the nearest cardiac catheterization team. “Bill left on a helicopter from the hospital before we did,” says Duvall. Tipsword was able to get to a heart catheter lab for treatment and was released five days later.
Training was the key to expand the initiative beyond SBLHS’s seven counties. Thirteen agencies have received training as a result of the grants. “Other agencies are coming to us for training,” says Barnett. “Some have the equipment on the truck but just don’t know how to use it. When I see them become comfortable with what to look for, it’s amazing.” The efforts have been so successful that SBLHS is integrating the 12-lead instruction paramedical training into a formal process.
With fully stocked EMS ambulances and fully trained EMS staff, Sarah Bust Lincoln Health Systems is now looking to further improve cardiac patient care. According to Dr. Burton, the hospital is in the process of developing in-house interventional cardiology capabilities. He believes that the increased use of the 12-lead EKG has proved invaluable for patients in the area. Currently, the hospital mainly works with Prairie Cardiovascular’s Stat Heart Program in Springfield to provide timely cardiac care to patients in the area.
Dr. Burton is also excited about the further technological capabilities for assessing and treating cardiac cases. Some hospitals and pre-hospital providers are using apps on their iPads and SMART phones for the transmission of the 12-lead EKG results. “At some point, this will be the transition we would start making,” Dr. Burton says. “We’re on the cusp of being able to send a 12-lead right to my smart phone, and then I can just press ‘forward’ to the cardiologist.”
The project has a broad geographic sweep, covering a 10-county geographic area with one coordinated effort. “This grant is an example of meeting the intention of RHI – to provide money to improve access to health care in rural and underserved areas and to meet a locally defined need,” Wesley says.
“We’ve really raised the standard of care for the region,” says Dr. Burton. lll