Kudos from the Cath Lab: Volume 19

Aetna Paramedic receives Kudos from the Cath LabSOMERS — During June 2016, ASM Paramedic Billy Schnepp and his partner Bill Gorman responded to a medical call in Somers, CT. The patient had a witnessed cardiac arrest, was defibrillated by Somers Fire Department prior to ASM’s arrival. The patient had a return of spontaneous circulation (ROSC) from Somers FD efforts and was being loaded into their ambulance.

The patient became slowly able to follow commands and answer questions in the ambulance and responded to care consistent with protocol. The EKG was indicative of a STEMI and Billy wirelessly transmitted the 12-lead EKG to [Hospital], activating their cardiac catherization lab from the field. (#16-43800). Early intervention, teamwork and technology all in play to improve outcomes.

Somers Fire DepartmentExcellent job by Somers Fire Department in their aggressive, accurate and appropriate care. Great job by Billy and Bill on deploying wireless STEMI transmission. This is a strong example of teamwork among ASM and our partners. ASM is proud to work alongside Somers Fire Department. 

Kudos from the Cath Lab: Volume 18

Aetna Paramedic receives Kudos from the Cath LabSOMERS — During early May 2016, ASM Paramedic Billy Schnepp and his partner Brian Langan responded to a medical call in Somers, CT. The EKG was indicative of a STEMI and Billy wirelessly transmitted the 12-lead EKG to UConn Health in Farmington, activating their cardiac catherization lab from the field. (#16-33635).

Per UConn Health: 
A 12-lead ECG revealed a high lateral STEMI. Schnepp consulted with medical control for destination due to patient’s requested choice of PCI center, and received permission to transport to UCONN John Dempsey Hospital. Due to concern for potential patient deterioration, Schnepp received intercept help from Windsor EMS paramedic Wayne Cabral.

STEMI UConnSchnepp called in a STEMI Alert from 33 minutes out. When they arrived at the hospital, thanks to the early notification, the patient was taken directly to the cardiac cath lab on the EMS stretcher where Dr. Michael Azrin and team found a 100% acute thrombic occlusion of the patient’s mid left Anterior Descending Artery (LAD), which was successfully cleared and stented, restoring perfusion. The patient is doing well, thanks to the great job by the EMS/Hospital STEMI team!

19 Minute Door to Balloon. 71 Minute First Medical Contact to Balloon
ED Team: Paul Kaloudis, MD, Leslie Mulhall, RN
Cardiology/Cath Lab Team—Dr. Christopher Pickett, Dr. Michael Azrin, Dr. Nelson Chavarria, Elizabeth Drotar,
R.N., Patricia. Weigle, R.N. , Patty Fagan, R.N., Shelia LaFleur, R.N.

Kudos from the Cath Lab: Volume 17

Aetna Paramedic receives Kudos from the Cath LabROCKY HILL — During early February 2016, Aetna Paramedic Ryan Gonska and his partner Logan Royale responded to a medical call in Rocky Hill. The EKG was indicative of a STEMI and Ryan wirelessly transmitted the 12-lead EKG to Saint Francis Hospital, activating their cardiac catherization lab from the field. (#16-8644).

Rapid identification, treatment, and early notification (STEMI ALERT) is vital in the care of patients with cardiac emergencies such as ST Segment Elevation Myocardial Infarction.  We hope the attached information is useful in the design and monitoring of your treatment strategies.     — Saint Francis Hospital staff

SFH Cath Lab Patient Follow-Up Form

Treatment by EMS and Direct to SFH ED

EMS Agency: Aetna Ambulance

Indication: STEMI

First Medical Contact (FMC) (at pt side)                             16:13    elapse: 00:00

EMS 12 Lead Acquisition Time:                                           16:17          elapse: 00:04

EMS STEMI Alert Request Time (source: cmed):                16:37          elapse: 00:20

EMS 12 Lead Transmit Rec’d Time (source: Lifenet):        16:19          elapse: 00:02

Arrival Time (SFHED):                                                          16:51          elapse: 00:14

Cath Lab Arrival Time (SFH):                                              17:13          elapse: 00:22

Procedure Start Time:                                                        17:28          elapse: 00:15

Vessel Angiography Findings / Treatment: 3V Dz; Coronary Artery Bypass Graft Consult.

Comments: Patient went MD office due to prolonged chest pain and shortness of breath; APRN performed EKG and administered Aspirin; No first medical contact time, so EMS times utilized- EMS dispatched 16:05 on scene 16:10. Transport 16:31. EMS performed 12-lead; STEMI Center activation at 16:37. Cath lab notified prior to arrival of patient. Patient required emergent coronary artery bypass graft instead of stents.

Kudos from the Cath Lab: Volume 16

Aetna Paramedic receives Kudos from the Cath LabSTAFFORD SPRINGS — During January 2016, ASM Paramedic David White and his partner Ray Philbrick responded to a medical call in Stafford with Stafford Ambulance. The EKG was indicative of a STEMI and Dave wirelessly transmitted the 12-lead EKG to Saint Francis Hospital, activating their cardiac catherization lab from the field. (#16-0017.

“Here is the full feedback report. Great job!!” – John Quinlavin, Manager, Emergency Medical Service, Saint Francis Hospital and Medical Center.

SFH Cath Lab Patient Follow-Up Form Treatment by EMS and Direct to SFH ED

EMS Agency: Ambulance Service of Manchester & Stafford Ambulance

Indication: STEMI

First Medical Contact (FMC) (at pt side) Date/Time: 1/1/2016 01:00          elapse:  00:00

EMS 12 Lead Acquisition Time:                                           01:02          elapse: 00:02

EMS STEMI Alert Request Time (source: cmed):                01:19          elapse: 00:17

EMS 12 Lead Transmit Rec’d Time (source: Lifenet):          01:19          elapse: 00:17

Arrival Time (SFHED):                                                         01:41          elapse: 00:22

Cath Lab Arrival Time (SFH):                                              02:03          elapse: 00:22

Procedure Start Time:                                                          02:20          elapse: 00:17

First Device Time:                                                                02:46          elapse: 00:26

————————————————————————————————————–

SFHED Door to First Device:                                                65 min

FMC to First Device:                                                              106 min

Vessel Angiography Findings / Treatment: 100% SVG-RCA lesion open not stented.

Comments: Onset chest pain 00:00. Once patient on EMS stretcher Asystole, went to start CPR, patient responsive prior to any compressions.  This occurred again during transport.  STEMI team paged prior to arrival at 0122.

Kudos from the Cath Lab: Volume 15

EMS team receives Kudos from the Cath LabGLASTONBURY — During July 2015, ASM Paramedic Joshua Traber and his partner Supervisor Michael Sparks responded to a medical call in Glastonbury with Glastonbury Ambulance. The EKG was indicative of a STEMI and Josh wirelessly transmitted the 12-lead EKG to Saint Francis Hospital, activating their cardiac catherization lab from the field. (#15-53809).

SFH Cath Lab Patient Follow-Up Form Treatment by EMS and Direct to SFH ED

EMS Agency: Ambulance Service of Manchester & Glastonbury Vol Ambulance

Indication: STEMI

First Medical Contact (FMC) (at pt side)                           14:09          elapse:  00:00

EMS 12 Lead Acquisition Time:                                           14:17          elapse: 00:08

EMS STEMI Alert Request Time (source: cmed):                14:38        elapse: 00:21

EMS 12 Lead Transmit Rec’d Time (source: Lifenet):        14:37          elapse: 00:20

Arrival Time (SFHED):                                                            14:46          elapse: 00:09

Cath Lab Arrival Time (SFH):                                              15:37          elapse: 00:51

Procedure Start Time:                                                             15:46          elapse: 00:09

First Device Time:                                                                  16:07          elapse: 00:21

————————————————————————————————————–

SFHED Door to First Device:                                                81 min

FMC to First Device:                                                              118 min

Vessel Angiography Findings / Treatment:100% LAD and 80% RCA lesions; LAD open and stented. IABP required. NOTE: delay to PCI due to CTSCAN  to r/o aortic aneurysm-family history.

Kudos from the Cath Lab: Volume 14

Aetna Paramedic receives Kudos from the Cath LabSTAFFORD — During June 2015, ASM Paramedics Jonathan Lentini, and Greg Derosier responded to a medical call in Stafford with Stafford Ambulance. The EKG was indicative of a STEMI and Jon wirelessly transmitted the 12-lead EKG to Hartford Hospital, activating their cardiac catherization lab from the field. (#15-46694). The following are comments provided by Hartford Hospital’s Dr. Marcin Dada with some acronyms and patient information removed:

Today’s STEMI: Stafford to Hartford Hospital TOTAL Ischemia time 73 min !!!

Congratulations everyone!!!

This patient was brought from Stafford to HH by ASM and Stafford Ambulance (pre hospital ECG was sent and communicated to the ED attending: Drs. Dufel/Price and Cath Lab was activated).

Highlight:   We utilized the quick registration where the EMS team was met at the triage and the patient was brought straight to the Cath Lab.

In a nut shell:

STEMI Stafford to HH 2 STEMI Stafford to HH1) HH D2B Time = 30 min

2) Total Ischemia Time =  73 min  (goal <90 min [1st Medical Contact in the field to Open Artery Time in the Cath Lab]

3) 100% mid-RCA –> 2 DES (TIMI III Flow)

In particular, we would like to recognize the following teams:

1) HH Cath Team – Dr Hirst; D. Jordan, T Schrimer

2) HH ER Team – Drs Dufel, Price and Tilden, and the rest of the clinical team (I am sure we missed many as this was a quick triage)

3) EMS team : G. Derosier and J. Lentini and the Stafford crew.

Strong Work.

Regards,

Marcin Dada, MD

Co-Director, CPC

Manager, Structural Heart Program

Manager, Cardiovascular Data Management Center

Manager, Preventive Cardiology and Cardiac Rehab

Kudos from the Cath Lab: Volume 13

Aetna Paramedic receives Kudos from the Cath LabHARTFORD — During April 2015, ASM Paramedic David White and his AEMT partner, Al Pardi, responded to a medical call in Stafford with Stafford Ambulance. The EKG was indicative of a STEMI and Dave wirelessly transmitted the 12-lead EKG to Hartford Hospital, activating their cardiac catherization lab from the field. (#15-29463). The following are comments provided by Hartford Hospital’s Dr. Marcin Dada with some acronyms and patient information removed:

Congratulations everyone on a great care of this antero-lateral STEMI pt last Sunday.

STEMI Ambulance Service of Manchester Pre-hospital EKG TransmissionThis patient was brought to HH by ASM (prehospital ECG was sent and communicated to the ED attending: Dr. Herbst)

While in the ER, patient arrested with return of spontaneous circulation… and was brought to the Cardiac Catheterization Lab.

In a nut shell:

1) HH D2B Time = 77 min (off hrs, Sun 3 AM)

1) STEMI Total Ischemia Time = 115 min

In particular, we would like to recognize the teams involved:

1) HH Team – Dr Hirst, Engles and the Cath Lab team – W. Arcisz, D. Jordan, F. Natale.

STEMI Ambulance Service of Manchester Pre-hospital EKG Transmission B2) HH ER Team – Dr Herbst, and Snyder, and the ED team: M. Moquin, D, Phillips, S. Ferri.

3) and last but not least : ASM and Stafford Ambulance

Strong Work.

Regards,

Marcin Dada, MD

Co-Director, CPC

Hartford Hospital

Kudos from the Cath Lab: Volume 12

Aetna Paramedic receives Kudos from the Cath LabHARTFORD — During April 2015, ASM Paramedic Supervisor Matt Tuttle and his EMT partner, Supervisor Mike Sparks, responded to a medical call in South Windsor. The EKG was indicative of a STEMI and Matt wirelessly transmitted the 12-lead EKG to Saint Francis Hospital, activating their cardiac catherization lab from the field. (#15-24713).

Matt Tuttle

ASM’s Matt Tuttle.

“Nice job, Matt. Thanks for calling early.”

         – John Quinlavin, EMS Manager, Saint Francis Hospital and Medical Center.

Additionally the patient returned a Satisfaction Survey with every one of the 21 boxes checked Strongly Agree or Excellent. In a follow-up phone call he said that Matt should be commended, that he was “absolutely fantastic”, caring and took the time to explain everything as it was happening. Further, he said, “I have nothing but good things to say about your service.”

Vessel Angiography Findings/Treatment:  100% thrombotic occlusion of Distal RCA; hypotensive, required Dopamine, ejection fraction 55%.

Comments: onset 20 min PTA dispatched 0822; EKG transmitted on scene to ED & med control contacted prior to departure; left scene @ 0840 (South Windsor location)- in ED pt remained on EMS stretcher then to cath lab.

SFH Cath Lab Patient Follow-Up Form

EMS Agency: ASM 

Indication: STEMI

First Medical Contact (FMC) (at pt side) Time:  08:28           elapse:  00:00

EMS 12 Lead Acquisition Time:                          08:32           elapse: 00:04

EMS STEMI Alert Request Time (source: cmed):      prior to dept.       elapse: 00:01

EMS 12 Lead Transmit Rec’d Time:                  08:36           elapse: 00:04

Arrival Time (SFHED):                                        09:01           elapse: 00:25

Cath Lab Arrival Time (SFH):                             09:17           elapse: 00:16

Procedure Start Time:                                         09:26           elapse: 00:09

First Device Time:                                                09:33           elapse: 00:07

————————————————————————————————————–

SFHED Door to First Device:                                                 32 min     

FMC to First Device:                                                              65 min

Kudos from the Cath Lab: Volume 11

Aetna Paramedic receives Kudos from the Cath LabHARTFORD — During March 2015, ASM Paramedic Adam Fine and his partner David Tedeschi responded to a medical call in Coventry with Coventry Volunteer Fire Association (CVFA) ambulance. The EKG was indicative of a STEMI and Adam wirelessly transmitted the 12-lead EKG to Saint Francis Hospital, activating their cardiac catherization lab from the field. (#15-17116)

Adam Fine

ASM’s Adam Fine

“First Medical Contact to device under 90 minutes!!!”

         – John Quinlavin, EMS Manager, Saint Francis Hospital and Medical Center.

SFH Cath Lab Patient Follow-Up Form

  • 100% left posterior descending artery ballooned.
  • Re-clotted, managed medically.

EMS Agency:                   ASM (Coventry)

Indication:                        STEMI

First Medical Contact (FMC) (at pt side) Date/Time:           16:31          

EMS 12 Lead Acquisition Time:                                             16:34          elapse: 00:03

EMS 12 Lead Transmit Rec’d Time (source: Lifenet):       16:42           elapse: 00:08

Arrival Time (SFHED):                                                          17:06            elapse: 00:24

Cath Lab Arrival Time (SFH):                                               17:21           elapse: 00:15

Procedure Start Time:                                                           17:42           elapse: 00:21

First Device Time:                                                                  17:57          elapse: 00:15

————————————————————————————————————-

SFHED Door to First Device:                                                 51 min

FMC to First Device:                                                               86  min

 

Kudos from the Cath Lab: Volume 10

Aetna Paramedic receives Kudos from the Cath LabHARTFORD — During March 2015, ASM Paramedic Ted Oliver and his partner David Rice responded to a medical call in Somers with Somers Fire Department ambulance. The EKG was indicative of a STEMI and Ted wirelessly transmitted the 12-lead EKG to Saint Francis Hospital, activating their cardiac catherization lab from the field. (#15-21457)

“Another great job by our ASM partners and this time with Somers Fire. The bar has been raised now with measuring the time from first medical contact to device in the Cath Lab and this requires a strong team effort to meet the new benchmark. Rapid identification and notification are critical elements to success.”

         – John Quinlavin, EMS Manager, Saint Francis Hospital and Medical Center.

SFH Cath Lab Patient Follow-Up Form

  • 100% occlusion of the posterior left anterior descending artery.
  • 90% occlusion of the ramus artery (a division of the left main coronary artery)
  • 100% occlusion of the first through third obtuse marginal arteries
  • 80% RCA ejection fraction < 20%. IABP placed. No PCI – CABG performed.

Treatment by EMS and Direct to SFH ED

EMS Agency: ASM  (run # 21457) (Somers FD Ambulance transported)

Indication: STEMI

 First Medical Contact (FMC) (at pt side)            15:05          elapse:  00:00

 EMS 12 Lead Acquisition Time:                         15:10          elapse: 00:05

EMS 12 Lead Transmit Rec’d Time:                    15:22          elapse: 00:12

Arrival Time (SFHED):                                         15:56          elapse: 00:34

 Cath Lab Arrival Time (SFH):                             16:14          elapse: 00:18

 Procedure Start Time:                                         16:17          elapse: 00:03

SFHED Door to First Device:          to start proc.                 21 min

FMC to First Device:                        to start proc                  72 min

Kudos from the Cath Lab: Volume 9

Aetna Paramedic receives Kudos from the Cath LabHARTFORD — During August 2014, ASM Paramedic Rachel Buechele and her partner Stephanie Boutot responded to a medical call in one of the towns ASM serves. The first EKG was indicative of a STEMI and Rachel wirelessly transmitted the 12-lead EKG to Saint Francis Hospital, activating their cardiac catherization lab from the field. (#14-73447)

“An incredible job by EMS with efficient recognition, treatment and early notification. St Francis Hospital and Medical Center is excited about the partnership we have with the ASM and Aetna staff. We are grateful for the teamwork displayed toward improving care for our STEMI patients, as well as others.”            – John Quinlavin, EMS Manager, Saint Francis Hospital and Medical Center.

Comments: Cath showed 100% Mid RCA Lesion which was opened and stented.

 

STEMI 2

 

Kudos from the Cath Lab: Volume 8

Aetna Paramedic receives Kudos from the Cath LabHARTFORD — During August 2014, Aetna Paramedic Matthew Carter and his partner Kathryn Stewart, wirelessly transmitted a 12-lead EKG to Saint Francis Hospital, activating their cardiac catherization lab from the field.

“Another great job by your staff!! ”            – John Quinlavin, EMS Manager, Saint Francis Hospital and Medical Center.

Cath showed 100% LAD Lesion which was opened and stented.

STEMI Transmission 

ED Arrival 18:34 Sat
EKG Complete 18:37
Cath Lab Paged 18:17
Cath start 19:09
First PCI Time 19:17
Door to Balloon Time             43 Min
Mode of Arrival EMS Other EMS STEMI Alert Cath Lab Activated
EMS Agency Aetna Lifenet @ 18:13 Yes

Kudos from the Cath Lab: Volume 7

Aetna Paramedic receives Kudos from the Cath LabHARTFORD — During August 2014, ASM Paramedic Preceptor Dave White and his preceptee Paramedic Sean Norton, aboard Andover Fire Department ambulance, wirelessly transmitted a 12-lead EKG to Saint Francis Hospital, activating their cardiac catherization lab from the field.

“What a great job with notification and communication by your medic! He called early (19:08) to have a conversation with MD regarding an unclear EKG and provided additional information on subsequent patches. I was very impressed with his professionalism and clinical skill. Early notification and a very well presented paramedic report to the MD allowed for early activation of our cath team by 13-18 minutes.”            – John Quinlavin, EMS Manager, Saint Francis Hospital and Medical Center.

EMS Agency:    ASM

Indication:         STEMI

Time
ED Arrival 19:29
Cath Lab Paged 19:16
Cath start 20:17
First PCI Time 20:28
XXX – Total
Door to Balloon Time 0:59

Kudos from the Cath Lab: Volume 6

Aetna Paramedic receives Kudos from the Cath LabFARMINGTON — On October 21, 2013 a Paramedic Unit from Aetna Ambulance (David Noyes and Kelly Shapiro) responded to a sixty-two year old patient with a significant cardiac history, who had been having chest pain for an hour. They did a 12-lead ECG, which revealed a massive inferior infarction. They called in a STEMI Alert to the John Dempsey Hospital ED. Based on their radio patch, Dr. Sasha Gorenbeyn immediately activated the cath lab (16 minutes before patient arrival).

The patient received a heparin bolus in the ED, and then went right up to the cath lab on the EMS stretcher. The patient was found to have a 100% occluded SVG (saphenous vein graft) to the PDA (posterior descending branch). He underwent a successful thrombectomy and stenting restoring perfusion.

He is doing very well thanks to the great job by the combined EMS/Hospital STEMI Team. Kudos also to the staffs of the ICU and cardiac step down for their outstanding re-covery care. 41 Minute Door-to-Balloon time! The patient was discharged home yesterday doing very well. “Thanks again, and extend our compliments to your crew for a job well done.”

*Individually identifiable protected health information has been removed in accordance with Aetna’s HIPAA-related Privacy Policies. 

Kudos from the Cath Lab: Volume 5 – Update

An update was received to the story found here in the form of an email directly from the patient:

“You and you partners responded to a 911 call at my house. I was having a massive heart attack. I only remember being carried down the stairs. Thanks to you and your partners, I’m here at home about to have my 33 year [anniversary] with my wife to celebrate.  I just want to thank you from the bottom of my heart.”

The original story:

According to Aetna Ambulance Service Supervisor Paramedic Joyce Valentukonis:

  1. Assigned to Aetna 201, Alpha/Monitor 6,
  2. The 12-lead was transmitted with success and then a radio patch notifying of a STEMI alert was given.
  3. Just prior to arriving the patient went into cardiac arrest.
  4. The patient was resuscitated upon arrival of parking lot (eyes open and talking). In the hallway, patient went into cardiac arrest again.
  5. As of today: patient is extubated and talking.

Aetna Paramedic receives Kudos from the Cath LabPercutaneous coronary intervention (PCI): EMS-to-balloon time: 61 minutes.

The patient’s spouse returned a Patient Satisfaction Survey with perfect scores and a note that says, “Thank you for saving my husband’s life.”