We’ve all heard the phrase, “speed kills,” but in response to a heart attack, the opposite holds true; getting a patient to the ER as quickly as possible and having the ER ready to treat upon arrival is the key to preserving life and avoiding disability.
A heart attack occurs when one or more of the heart’s arteries become blocked. Blood supply stops or slows; the heart muscle doesn’t get enough oxygen; heart tissue can die. According to the New York Times, the death rate from coronary disease has dropped 38% in a decade. Better blood pressure and cholesterol drugs and reduced smoking have contributed, but also highly significant are streamlined treatment protocols for when a patient arrives at the ER.
Reducing “door to balloon time” —the time it takes from the arrival at the hospital door to the pushing of a balloon into an artery to insert a stent and restore blood flow—is crucial. As a result, hospital cardiac teams, on call and ready to go in response to a single phone call, are becoming the gold standard of care. EKG’s (electrocardiograms) transmitted electronically by paramedics from an approaching ambulance, combined with that waiting cardiac team have reduced treatment time to about an hour or less for at least half of the patients who arrive in cardiac arrest.
The national average “door to balloon time” is 90 minutes. According to Dr. Michael Yen, a cardiologist at Vassar Brothers Medical Center, Vassar’s average in 2015 was 59 minutes. Since it’s going to take this long upon arrival at the hospital, getting there quickly is important.
So what happens when a Gardiner resident who suspects she or a loved one is having a heart attack calls 911? The call goes into the Kingston 911 Call Center. According to Deb Bailin, Captain of the Gardiner Rescue Squad, “What you tell the dispatcher is vitally important. Give as much information as possible.”
The dispatcher will decide if only Gardiner Rescue need respond or if Mobile Life (a paid service) should also be dispatched. Calls, however, can evolve. If only Gardiner has been dispatched and, upon arrival, the chief officer or EMT determines that a paramedic is also needed, Gardiner will call for one. Mobile Life will always have a paramedic on board but Gardiner does not. “We don’t have the licensing or the medications for a paramedic,” adds Deb Bailin.
The Gardiner Rescue Truck carries volunteers certified in cardiopulmonary resuscitation (CPR), while the ambulance cannot leave without an EMT (Emergency Medical Technician) aboard. In the case of a suspected cardiac arrest, Gardiner EMTs can take an EKG and verbally transmit results to the ER by radio or phone.
The steady decline of landline phones often makes it difficult to pinpoint a caller’s location. Landlines automatically provide the location; not so with cell phones. According to Fire Chief Dave Bailin,” A cell phone caller must be able to give the physical address. For those who employ babysitters or other caregivers who may not know the address, it’s essential to write it down. If the caller is incapable of providing the information, the 911 Center uses “ping” technology to obtain the GPS coordinates of the cell phone caller.” But, the Chief adds, “this wastes precious time.”
Houses that lack numbers visible from the road are a particular concern of Assistant Fire Chief Brain Stiscia. Time is wasted trying to find a house in the dark. “You can’t imagine how often this happens,” laments Brian. (For $10 the Gardiner Fire Department will make you a reflective house number sign that can be installed on a mailbox or post. The money is well spent and is also a fundraiser for the department.)
Gardiner Rescue Squad members are volunteers and are, for the most part, at their own jobs during the day, so Mobile Life covers Gardiner from 6AM to 6PM daily. Mobile Life’s closest location is Highland. In the summer though, when our area is full of visitors, a crew will try to edge closer to Gardiner to accommodate the increased number of calls. They may be seen parked in a parking lot in or close to Modena. Response times determine how quickly a patient arrives at the ER door. “Day, time, weather conditions, where a call is located; these all affect response time,” adds Chief Bailin.
AED’s or defibrillators (the machine that shocks a heart in cardiac arrest) are carried in Gardiner’s ambulance as well as in the Chiefs’ vehicles. Nevertheless, Deb emphasizes the importance of immediate response. “Your best chance of saving someone’s life is for a bystander to start CPR immediately. Compressions keep the heart muscle functioning.” (The Gardiner Rescue Squad gives courses in CPR to the public on request, and plans to offer a CPR course this spring when new protocols are released.)
To help our first responders help us, be prepared to provide as much detailed information as possible when calling 911; know your location if calling from a cell phone; teach your children how to use a cell or landline and give accurate information; be sure your house number is visible from the road; and take a CPR course this spring. By so doing we increase the odds of a good outcome in an emergency and empower ourselves to act in our own best interests or those of a loved one when the stakes are exceedingly high.
You can call Rescue Squad Captain Deb Bailin at 845 372-4921 for information about this spring’s CPR course or to order a house sign.
Editor’s Note: Also see “Medical Emergency” Ray Smith, Gardiner Gazette, summer 2012.