Washington Studies Emergency Heart, Stroke Care

Oct 29 2008 - 7:23am
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Many people in Washington die or are disabled from heart attacks and strokes because they don't get life-saving treatment.

Fewer than three percent of people suffering the most common kind of stroke get the best treatment for that type of stroke. And less than half of all people who have a heart attack are treated with the most effective heart attack intervention.

"We've got to get people to recognize symptoms of heart attack and stroke and convince them to take it seriously. Often they have symptoms and don't call 9-1-1," said Secretary of Health Mary Selecky. "Each minute is critical for stroke and heart attack treatment."

A report just released by the state Department of Health, "Emergency Cardiac and Stroke Care in Washington," explains why many people don't get life-saving treatments. The report also discusses system changes needed because emergency response varies widely statewide.

The report was commissioned by the Governor's Emergency Medical Services and Trauma Steering Committee. The committee learned that rural areas have fewer resources and specialists (cardiologists and neurologists) than urban areas to respond to and treat heart attack and stroke. These areas also have fewer paramedics, who are qualified to do electrocardiograms in the field. These help diagnose heart attack before getting to the hospital, so a response team can be ready.

Heart attack and stroke patients in Washington are often transferred to other hospitals because the closest hospital is not able to treat. There are no uniform guidelines for 9-1-1 dispatch and emergency medical service to get patients to a hospital that can provide the treatment they need.

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"We must get the right patient to the right place in time," said Dr. Kathleen Jobe, medical director for University of Washington Medical Center's Emergency Department and chair of the state's Emergency Cardiac and Stroke Technical Advisory Committee. "This system should run like a well-oiled machine from dispatch to treatment."

The report suggests a systems approach, in which every part of the system knows its role. The committee accepted the recommendations, and is working with stakeholders to develop new methods and introduce them around the state. The Department of Health, working with the American Heart Association, has conducted several public awareness campaigns about heart attack and stroke, and plans a "call 9-1-1" campaign next spring.

Recommendations include:

· Early recognition and treatment. Educate the public about heart attack and stroke symptoms, and the importance of calling 9-1-1.

· Uniform standards. Make the American Heart Association's guidelines for heart attack and stroke care the state standard — assess patients in the ambulance, alert hospitals of incoming stroke or heart attack cases, have teams ready at the hospital, and take patients directly to hospitals that can give the care needed.

· Quality improvement. Use a statewide system to track performance and quality of care.

· Hospital verification. Assure that hospitals meet state standards for cardiac and stroke facilities.

· Use telehealth where available. Telehealth enables clinicians to diagnose and treat patients in remote areas using teleconferencing, videoconferencing, and digital imaging.

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