Calling 9-1-1 can be the difference between life and death, new study reconfirms

"We want people to trust their care to medical professionals and call for help at the first warning signs of a heart attack," said Lowell F. Satler, MD, the study's co-author and director of the Cardiac Catheterization Laboratory at MedStar Heart & Vascular Institute at MedStar Washington Hospital Center. "Our message is simple. Don't call a relative or friend or drive yourself or others to the hospital. Calling 9-1-1 first can be the difference between life and death."

Alarmingly, three-quarters of the patients in the study chose to either drive themselves or were driven by someone else or used public transportation, indicating a greater need for community awareness and outreach.

The study evaluated the "door-to-balloon" (DTB) time, or the time between when a patient arrives in the Emergency Department (ED) and when a balloon angioplasty procedure restores blood flow. The study showed that 83 percent of heart attack patients who used emergency medical services (EMS) reached the Cardiac Catheterization Laboratory in fewer than 90 minutes -- the gold standard -- compared to 54 percent of self-transported patients. The Median DTB time was 20 minutes shorter when patients arrived by EMS than when they were self-transported: 65 minutes versus 85.

"Every second wasted is heart tissue lost. The faster blood flow is restored to the heart, the greater chances of survival and recovery," added Dr. Satler. "It is important to seek trained help as quickly as possible by calling 9-1-1. In the long run, an efficient EMS provider corresponds with timely, lifesaving treatment."

The retrospective study was conducted between Jan. 2007 and Dec. 2012. Researchers analyzed 309 patients who suffered a complete blockage of a heart artery, known as ST-segment elevation myocardial infarction (STEMI), the most serious type of heart attack, and underwent angioplasty at the Hospital Center. Of those, 226 patients arrived by self-transport and 83 patients were transported by the District of Columbia Fire and Emergency Medical Services (DCFEMS,) which is the only EMS provider in the District. The majority of patients in both groups arrived at the ED during off hours.

The study concluded that EMS-transported patients spend less time being triaged in the ED compared to those who arrived by self-transport. That's because DCFEMS personnel can begin treatment immediately on-site and en route to the hospital, expediting timely communication of critical medical information directly with hospital ED personnel before a patient arrives.

MedStar Washington Hospital Center and two D.C. hospitals have integrated the CODE STEMI system with DCFEMS where any suspected STEMI patients in the District are transported to one of these primary cardiac centers. The system activates the pre-notification and transmission of electrocardiogram (EKG), mobilizing the hospital ED and catheterization teams to quickly move these patients for emergency angioplasty.

"This study is a huge validation of our hard work over the years at D.C. Fire and EMS. We have supported extensive 9-1-1 dispatch and paramedic education, as well as deploying cutting-edge technology to transmit EKGs to the three D.C. STEMI hospitals," said David Miramontes, MD, FACEP, medical director, DCFEMS. "Our cooperative partnership with these centers now has been proven to benefit those we serve by leveraging a system-based approach to cardiac care. It is vital people know that they have a better chance to survive a heart attack, if they call 9-1-1."

The study suggests the public needs more education on when to call 9-1-1 and how to seek treatment of a possible heart attack, especially a STEMI. Quick treatment can help limit damage to the brain or heart and increase the chance of a full recovery.