Martha’s Vineyard Hospital and EMS teams connect to save lives

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Martha's Vineyard Hospital and first responders have a new system that relays critical medical information to waiting emergency room doctors. —Photo by Ralph Stewart

In case of a heart attack, improved recovery rates — even survival — are dependent upon how quickly a patient receives treatment. This is critically important on Martha’s Vineyard, where patients must be transported to a mainland facility for advanced treatment.

Martha’s Vineyard Hospital and the Island’s emergency medical first responders now have a new tool in their medical arsenal that is designed to provide critical medical information to waiting doctors even before a patient arrives in the emergency room (ER). LIFENET System software from Physio-Control, Inc., connects EMS teams anywhere on the Island as soon as paramedics have reached a patient with heart attack symptoms.

Data from the ambulance’s cardiac monitor/defibrillator is automatically fed to the ER over an innovative web-based network. The emergency room team can now see the patient information on the hospital computer screen in real time. This direct connection has several benefits, according to Dr. Jeffrey Zack, chief of emergency services at Martha’s Vineyard Hospital.

“We are able to more quickly interpret subtleties in the electrocardiogram and give much better guidance to the EMS team in the field before they even transport the patient to us,” he told The Times.

Before the launch of LIFENET, first responders spoke with emergency room doctors by phone in order to provide a preliminary picture of a patient’s condition. This was dependent on a dedicated medical mobile-phone network. Paramedics read the results of an EKG over the phone to a doctor who was waiting for diagnostic information. Not only was this voice communication sometimes compromised by weak wireless connections in one of the Island’s many dead zones, it could also be difficult because of the emotional and sometimes chaotic scene at the location of the call. As a result, it could be challenging for the doctor to know with certainty which were the most appropriate immediate treatments to recommend for the person in distress.

Door to balloon

When a severe heart attack occurs, treatment options may include placement of a stent or a balloon angioplasty. Martha’s Vineyard patients must be transported, most often by MedFlight helicopter — or in the case of really bad weather, by the Coast Guard — to an advanced cardiac operating room in Boston or another mainland location. It is up to the ER doctor to plan these next steps, and decide how to route the patient. It can often take up to 30 or even 45 minutes for an ambulance crew to reach the hospital from the far reaches of the Island, so providing a clear and detailed picture of the patient’s situation during the early stages of a heart attack is absolutely critical to a successful response.

“Saving 30 minutes is not inconsequential,” Dr. Zack emphasized. “No one in this situation has an infinite amount of time. Our goal is to diagnose and stabilize the patient, mobilize appropriate resources in the hospital, and consider the issue of transportation as quickly and efficiently as possible.”

D2B (Door to Balloon) is a term used in medical circles to measure speed of treatment for heart attack victims. This means simply the time it takes after EMS reaches the door of the patient until that patient receives a stent or begins an angioplasty procedure. Reports in the Journal of the American College of Cardiology report that hospitals stays are shorter and patient outcomes are “significantly improved” when the D2B is held to 90 minutes or less. This means that especially in an island community, anything the doctor can do to organize resources and tasks in parallel will help slash otherwise wasted minutes.

Knowing whether and when to call for a helicopter is a key part of the decision-making process, as launching that resource is certainly not without cost or risk to the flight crew as well as the patient. In the case of a severe heart attack, where Boston-based care is the necessary next step, already having the data at the hospital early in the cycle and before the ambulance arrives can mean the helicopter is already in the air and approaching the Island. Furthermore, that same data can be quickly forwarded to the team that will begin surgery, it is hoped within the hour.

New protocols

The ability to demonstrate improved patient outcomes is also an increasingly important component of reimbursement for doctors and hospitals in the brave new world of health care financing. More and more often, insurance companies, especially Medicare and Medicaid, are moving to a model of increasing fee payouts only when doctors and hospitals meet defined targets and goals for improved health care. The 90-minute D2B standard has become an important quality measurement for something as fundamental as licensing and accreditation.

According to Dr. Zack, the LIFENET program was tested and rolled out earlier this fall, but has been in the planning stages for many months. Alex Schaeffer, deputy Edgartown fire chief, and his EMS team led the efforts to identify a source of funds, submit a successful grant proposal, and coordinate efforts with other towns’ EMS departments and the hospital.

Mr. Schaeffer told The Times the Edgartown Fire Department spearheaded the successful $476,000 FEMA grant proposal.  “We reviewed technical requirements each month with other Island towns during our ongoing coordination meetings at the hospital,”  Mr. Schaeffer said.  “Physio-Control assisted with implementation and walked us through the detailed use of the system. Once everything was a go, our final rollout occurred prior to Thanksgiving.”

Physio-Control, Inc., is headquartered in Redmond, Wash., and is an international supplier of cardiac monitoring and defibrillation equipment. The company’s experience with EMS personnel and field requirements led to its interest in adding software solutions like LIFENET to its product portfolio.

In serious heart attack cases on the Island, the best-case scenario has these main characteristics: The appropriate emergency room personnel are ready and waiting; the doctor is certain that a helicopter is needed, and it is already in flight; the Boston hospital team is on alert and ready to operate; and all this has taken place while the ambulance is still on its way to the emergency room. With the LIFENET system in place, Martha’s Vineyard Hospital and its EMS partners in the field expect to make great progress in successfully challenging the 90-minute D2B window for victims of a heart attack.