CANTON - Time saves lives when treating heart attack or stroke, so Northside Hospital Cherokee, as well as emergency medical technicians at Cherokee Fire and Emergency Services, regularly train together to get the fastest times possible and rehearse best practices.
Friday, the hospital shared how those drills are done with the Tribune as well as the Cherokee Chamber of Commerce's current class of Leadership Cherokee.
Two drills were done for both a heart attack and stroke scenario, which saw the process from the patient arriving by ambulance to doctors and nurses finishing a procedure in the operating room.
"We can practice with our staff at any point, but to have the partnership and relationship with EMS so that we can connect with them and bring them through, it allows us to stay a well oiled machine," said Katie Pearson, the hospital's director of operations. "We have some of the best scores in getting our patients to the cath lab, for example, and that is because we have gone through various scenarios and constantly test ourselves, challenge ourselves, with new scenarios, new situations, based on what's going on in the community, in the world, so we are always prepared."
For the heart attack drill, an electrocardiograph test was taken in about two minutes, though in a typical situation EMTs are able to do it on the ambulance and send results to the hospital staff before they arrive.
Paramedics and emergency room nurses rushed the "patient," Sgt. Paramedic Waylon White of Cherokee Fire, to the cath lab, where Dr. Gordon Azar, with nurses from the cath lab, used a sheath on a simulator to project images of each of the patient's coronary arteries. In a real patient, the team would use the wire in the arteries to more closely examine them after getting some information from the ECG.
The hospital reports an average door-to-balloon time of 60 minutes, with a best of 20 minutes.
When one of the arteries was barely showing up on the screen, the team knew that one had a blockage. They used a balloon to open up the clogged artery, and install a stent to keep it open and allow blood flow.
When White sat up after the procedure, he reported that he had no more chest pain- a success for the medical team.
In the stroke simulation, the emergency team hurried to get the patient, Sgt. paramedic Scott Townsend, to a computerized tomography. The goal for these teams is to get the patient to CT in 20 minutes.
For patients receiving tPA, the year-to-date average door-to-CT time is 12.5 minutes, and the fastest door-to-needle medicine administration time is 18 minutes, according to the hospital.
There it was determined the patient was able to be treated with tissue plasminogen activator, or tPA, which dissolves blood clots that cause stokes. A pharmacist can prepare the drug in the CT room, prescribing a patient-specific dose based on their weight. The hospital reports that tPA is used in 30 percent of stroke patients. If the patient's brain is bleeding, they have had a recent surgery or they're on blood thinners, or if it may have been longer than four and a half hours since the symptoms started, tPA can't be used.
Northside Hospital Cherokee is a primary stroke center. For some patients, they can be referred to a partnering comprehensive stroke center, which can provide further interventions, while others will go on to receive occupational and physical therapy.
The stroke drill highlighted one of the hospital's telemedicine robots, "Maxine," with which neurologist Dr. Gavin Brown talked with the patient, testing his movement abilities in what is known as the NIH Stroke Scale. A few minutes later, the doctor joined the rest of the medical team. Through the robot, the emergency department has 24/7 access to a neurologist, who can log into the hospital's system and make decisions for the patient's care.
"Telemedicine has really changed the treatment of stroke," Brown said. "It's an exciting time."
Those at risk for a heart attack or a stroke can improve outcomes by recognizing the symptoms. Warning signs for a heart attack include chest discomfort, upper body pain or discomfort, shortness of breath, nausea and lightheadedness. The acronym BE FAST can help people remember common stroke symptoms: sudden loss of balance, trouble seeing out of one or both eyes, weakness on one side of the face, weakness in one arm or leg or sudden loss of speech. Those who experience any of these symptoms should call 911.
For the hospital staff, training often is the best way to be prepared and efficient when an emergency arrives at their door, said Rachel Cox, a coordinator for the emergency department.
"Our big thing is drilling, drilling and more drilling," she said. "Even if we shave off two to three, four minutes in the process, that's important. It's worth it for us to update the process if we make any sorts of improvement. I can't say enough that time is brain, because the faster you can give medication, the better your patient outcome will be."