01 Jul 2011
By Thava Rani
All it takes is a minute. But that extra minute – for paramedics to run an electrocardiogram (ECG) on a person suspected of having a heart attack – could mean life or death.
Running an ECG at the patient’s home, instead of at the hospital, allows the results to be transmitted to Accident and Emergency (A&E) quickly. This, in turn, enables A&E doctors to begin preparations for treatment, including activating the procedure for opening a blocked artery, while the patient is in the ambulance en route to the hospital.
“The sooner the artery is unblocked, the less the damage, and the better the patient’s chances of survival,” said Associate Professor Marcus Ong, Senior Consultant, Department of Emergency Medicine, Singapore General Hospital (SGH).
In a heart attack, a blockage or clot in an artery cuts off oxygen supply to the heart, damaging the muscles. A person whose heart muscles are badly damaged can eventually suffer heart failure. He also has a high risk of dying from complications, such as abnormal heart rhythms. Depending on the type of heart attack, doctors may perform an angioplasty where a atheter is inserted and a balloon is inflated in the coronary artery to open it up, restoring blood flow and oxygen to the heart. A stent can also be placed to keep the artery open. About half of the 3,000 heart attack patients who seek treatment at public hospitals every year require acute angioplasty.
In the past two years, an estimated 30 additional lives have been saved each year by Singapore Civil Defence Force (SCDF) paramedics, who perform this check on suspected heart attack patients at their homes. In addition, the heart uscle function of many others has been preserved.
“The aim is to reduce the door-to balloon time, for patients needing acute angioplasty, as much as possible,” said Assoc Prof Ong, referring to the time taken from the moment patients enter the doors of the hospital to the moment they get the angioplasty.
On-site ECG transmission by paramedics has done just that, cropping an average of 37 minutes off the door-to-balloon time for public hospitals, according to a study that was presented at SGH’s Annual Scientific Meeting in April this year. Assoc Prof Ong was the principal investigator of the nationwide study, which involved all restructured hospitals, National Heart Centre Singapore and SCDF.
Before this study, an ECG was done only after the patient arrived at the hospital. Activation of the angioplasty team and other preparations could take place only then.
Now, with some 250 paramedics trained and 46 SCDF ambulances upgraded, on-site ECG has become routine. All preparations at the hospital are made while the ambulance, carrying the patient, is en route. When the ambulance arrives, everything is ready and waiting for the patient.
A revision of workflow processes also contributed to bringing down the median door-to-balloon time from 88 minutes to 51 minutes. At SGH, for instance, a mass paging system was put in place to activate the angioplasty team, which is particularly crucial at night when doctors need to be recalled from home to the hospital.
To further improve a patient’s chance of survival, a greater understanding and awareness about dealing with a heart attack, such as recognising the signs and symptoms as well as the appropriate response, are needed, Assoc Prof Ong said. “So far, we’ve only been looking at door-to-balloon time, but what is more important is the symptom-to-balloon time (the time when the patient first starts having severe chest pain).
“We hope public education can make a difference here.”
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