St. Croix EMS: A pacesetter in heart attack response
If you have heart disease, you're fortunate to live in the Hudson area.
Nine years ago, St. Croix Emergency Medical Services became an Advanced Life Support service, allowing its personnel to diagnose heart attacks in the field and administer front-line medications and procedures to keep patients alive.
The ability to diagnose eliminates a trip to the local hospital and allows the ambulance to take patients directly to an operating room at Regions or United hospitals in St. Paul.
There, a catheter is inserted into the patient's artery and used to remove the blockage in the heart. In some cases, stents are placed in the heart to keep vessels open.
Every year since 2004, St. Croix EMS has done something to improve its response to heart attacks and cardiac arrests, according Kim Eby, chief of the ambulance service.
This year is no different. St. Croix EMS has been able to buy a machine that performs CPR chest compressions, thanks to a $15,000 grant from the Hudson Hospital Foundation.
The Lucas 2 Chest Compression System went into service at the beginning of March, after all 60 members of the EMS crew were trained how to use it.
The device is wrapped around a cardiac arrest victim's chest and a battery-powered arm delivers uninterrupted compressions at a consistent rate and depth to get the heart started again.
Eby and four on-duty staff members met with a reporter to talk about the new device, fittingly, on Valentine's Day last month.
The crew explained that manually delivering chest compressions is difficult work. People become fatigued. Sometimes they don't push hard enough to compress the heart and send blood from it. They may do CPR too deep, or not deep enough, too fast, or not fast enough.
"In the old days, we just pumped on the chest as hard and as fast as we could," said Joe Elkin, one of the service's part-time paramedics. "Now they are really stressing the fact that you completely take your hands off the chest, because the heart needs time to refill with blood before it pumps back out to the body."
Elkin has close to 20 years of paramedic experience. He came to St. Croix EMS three years ago from Life Link III in the Twin Cities.
The Lucas 2 will automatically give appropriate compressions, and the battery-powered device won't get tired.
It is recommended that first responders do CPR for just two minutes at a time, rotating with one or more other people, in order to maintain their strength and attend to other tasks, explained Jennifer Hintze-Olson.
Between the time of the interview and this story being published, Hintze-Olson resigned her position as one of three full-time paramedics with St. Croix EMS. She is leaving to work as a patient advocate for the National Marrow Donor Program in Minneapolis.
A lot to do
The EMS crew explained that the Lucas 2 also will free up personnel to do other vital tasks that are necessary if someone has gone into cardiac arrest -- when the heart stops beating and circulating blood to the body.
An automatic external defibrillator, or AED, is often used to deliver an electric shock that can stop an irregular rhythm in the heart and return it to normal rhythm.
An electrocardiogram, or EKG, machine is used to check the heart's electrical activity and determine if a heart attack has occurred.
The term heart attack refers to a blockage that stops blood flow to a part of the heart, leading to damage of the heart muscle. But not everyone who has a heart attack goes into cardiac arrest, in which the heart stops pumping blood altogether.
After determining that a patient is having a heart attack or is in cardiac arrest, St. Croix EMS personnel are able to begin IV therapy. The IV delivers medications to open blood vessels and relieve pain directly into a vein.
"I'll never claim to be a doctor, but that is as close as we'll ever get," Elkin said of the ambulance service's treatment of heart attack victims. "We carry the same medications they have in the ER (emergency room). We do the same EKGs they do in the ER. (We give) not only the same cardiac medication, but the same pain medication."
"So everything that they would initially do in an ER, we now do in the back of an ambulance," he said. "In the old days, we used to just throw you in the back of the ambulance and drive fast to the hospital."
Family members and friends of the victim sometimes wonder why the crew spends 10 or 15 minutes at the scene of the heart attack.
"That's because, if we can get the EKG now, and treat you now, and drive you to the cities, it saves that much more time," Eby explained.
EMT-Intermediate Mark Van de Sande said the goal is to get the patient from "down time" to "balloon time" within 90 minutes, which greatly increases the odds of surviving a heart attack or cardiac arrest.
The reference is to the time between the patient experiencing pain or going unconscious and the blockage in the heart being opened by angioplasty.
St. Croix EMS is often able to deliver the patient to the cath lab at Regions or United - and occasionally to St. Joseph or the Veterans Administration hospital - within the "golden hour."
A catheterization laboratory is an examination room with diagnostic imaging equipment to support inserting a catheter in an artery, and using it to perform a variety of procedures to correct the problem in the heart.
Elkin said that in one of the first heart attack runs he was on with St. Croix EMS, the patient's blood vessel was opened 36 minutes after the call for the ambulance came in.
The paramedic said he was in a waiting area typing the report on the ambulance run when he heard the doctor say, "You're not having any more chest pain are you?"
The patient thought a moment, Elkin recalled, and said, "No. I'm fine."
Only local anesthesia is used for most cath lab procedures. The patient is aware of what is happening.
The doctors and other observers watch the wire go into the beating heart on a live-picture X-ray machine.
"It's like watching live TV," Chief Eby said.
"Most of the time, the patient is wide awake," Elkin said. "They're having chest pain, but it isn't a cardiac-arrest situation."
The reception at the hospital is unique. A medical team meets the ambulance at the back door and takes the patient to the operating room.
"It's not like walking into the clinic waiting room and getting called back," Elkin said. "You're (rushed) from the back of the ambulance into the OR. You're ready to go ... it is a flurry of activity. You've got people yelling questions."
From the beginning of 2012 to the middle of February this year, St. Croix EMS responded to 22 cases of someone in full-blown cardiac arrest.
Eight of those people regained a pulse, for a success rate of 36.4 percent.
The national average survival rate for someone in cardiac arrest is 2 percent, Eby reported, although the percentage climbs into the 20- or 30-percent range if a defibrillator or CPR is used before the ambulance arrives.
In 2012, St. Croix EMS went on 1,700 runs. About half of them involved someone with chest pain or a cardiac problem.
Elkin credits St. Croix EMS's paramedic response system as part of the reason for the good survival rate.
"Really, it's because we're out the door right away and have somebody at your house within a few minutes," he said.
The typical response time for a paramedic is four minutes or less in the city of Hudson. It takes a little longer to reach a patient in the town of Hudson or Troy.
Hudson's police officers and many of its firefighters are trained medical first responders, too, and respond to calls when CPR is needed.
"When I first started in EMS, you wouldn't see a police officer anywhere near a medical call. Now they pretty much show up at all of them," Elkins said.
In addition, the police department's squad cars and the fire department's engines are equipped with defibrillators.
St. Croix EMS has a primary and a backup paramedic on duty at all times. The paramedics are in one of the service's quick-response vehicles (a Ford Explorer and a Dodge Durango) and drive directly to the location of an emergency when the call comes in.
The ambulance follows, staffed by at least two people -- either EMTs or paramedics or a combination of the two.
Primary and backup ambulance crews are also on duty 24 hours a day, seven days a week. If a third emergency occurs, St. Croix EMS has a third ambulance that can be sent after giving an all-call for volunteers.
Of the 60 medical personnel on the staff, most are part-time. The service has just five full-time employees - Chief Eby, Office Manager Joanne Kenney, paramedics Ben Wasmund and Brandon Lyksett, and the departing Hintze-Olson. The service's part-time and casual paramedics will fill in for Hintze-Olson until her replacement is selected.
The staff is comprised of 41 EMTs and 19 paramedics. Chief Eby, a paramedic, can also respond to calls.
Dr. Aaron Burnett, a HealthPartners emergency room physician who works at Hudson, Lakeview and Regions hospitals, is the service's medical director.
Eby and the St. Croix EMS staff have high regard for him.
"He is very proactive on training in new medications and procedures," Eby said of Burnett. "He wants us up on stuff."
Eby said the St. Croix EMS staff also is a cut above average.
Some work in health care and moonlight as members of the Hudson ambulance crew because they live here. They include a couple of nurses whose regular jobs are at the Regions Hospital Trauma Center.
"We've got a great staff. Our clinicians are very well trained," Eby said. "If you ever have to call 911, I don't think you should worry about who you are going to get at your front door, because everybody is very good at what they do."