2. Review Process
• Introductions • Results
• Background • - times
• Communication • - patient outcome
• Diagnosis • Barriers and
• Care Provided Opportunities
• Hand-off of Patient • Conclusions
• Follow Up Needed
3. Participants
• Patient
• RN in Charge of Medic Tent at Scottish Games*
• Mobile Care Ambulance Service
• Chest Pain Center
• Call Center
• STAT RN
• Cardiac Catheterization Lab *
• Cardiologist*
* Presenters
10. GHC Mobile Care Ambulance Service
• Mission: Transport GHS patients
• Mobile Care established in April of 1972 and is an affiliate of GHS UMC
• Primarily inter facility, discharges and Referral Center transports
• EMTs and Paramedics
• Second highest transport volume in Greenville County; approximately
10,000 annually
• Mutual Aid Agreement with GC EMS
• - Provides 911 ‘back-up’
• All ambulances ‘advanced life support’ staffed and equipped
11. MCAS Staff
• 30 Paramedics (8 CC EMT-P)
• 13 EMTs
• 2 RNs
• 2 in Nursing School
• 11 also work for GC EMS or other 911 agencies
• 9 also work for Fire Departments (3
Lieutenants and 1 Captain)
12. MCAS
Medical Control
• Martin E. Lutz, M.D.
• Medical Director, Emergency Services
• Vice President Medical Staff
• Also Medical Control for:
• Greenville County EMS
• GHS Med Trans (medical helicopter)
13. Mobile Care Crew
John Reid, CC EMT-P
• EMT since 1998
• Works also PT for GC EMS
• CC EMT-P in 2010
• John also provided Medic coverage at
2010 Scottish Games, to Prince Edward
14. Mobile Care Crew
Beth Smith, EMT-I
• EMT for 13 years
• Started EMT career in New York
• Fire Department – 6 years
• Life Link at Roper St. Francis Hospital
• Mobile Care
• EMT –I 2009
15. Patient
Chief Complaint, Symptoms and
History
• Patient: 60year old male
• History
• Family history of coronary artery disease
• Sedentary lifestyle
• Chief Complaint
• Chest Pain
• Symptoms
• Chest pain since approximately 7:30 am; most severe in substernal area and radiating to left arm
• Diaphoretic
• SOB
• Nauseated
18. Mobile Care Ambulance Service
Care Provided
• Oxygen initiated via nasal cannula
• Cardiac monitor for ECG
• Nitroglycerin, 0.4 MG
• Peripheral IV initiated
• Heparin
• Taken to GMH Chest Pain Center 4
19. Mobile Care Ambulance Service
Times
• 10:00 – Request received via radio
• 10:06 – At patient
• 10:22 – enroute to GMH
• 10:37 – arrived at GMH
• 37 minutes from initial notification to
arrival at GMH/Chest Pain Center
20. GMH Cardiology
Stat RN
• STEMI Role
• - Meet EMS crew at ambulance bay/CPC or approach landing pad and assist with
patient transfer (training required).
• - Receive brief report from flight/EMS crew regarding patient stability or changes
during transport
• - Introduce self/role to patient and family; verbalize next steps and provide support
• - Review and confirm pre-GHS meds given specific to AMI/cardiac cath
• - Review targeted health history with patient, and biometrics pertinent to cardic cath
procedure
• - Perform targeted assessment if time allows
• - Assist with tracking times and documentation
• - Support CPC/CC-ER, cath lab personnel, and cardiologist as required and within
scope of practice
• - assist with patient transfer in CCU
• Note: crossed trained for CCL for 2nd STEMI situations
23. Cardiologist
Carolina Cardiology Consultants
• Hometown: Batesville, Indiana
• Area of Specialization:
• Interventional Cardiology, Structural Heart Disease Therapies, Cardiac Pacing
• College:
Indiana University, Bachelor of Science-Biology, Cum Laude, 1996
• Medical School:
Indiana University of Medicine, Doctor in Medicine, 2000
Residency:
Vanderbilt University Medical Center, 2000-2003
• Cardiology Fellowship:
• Medical University of South Carolina, Interventional Cardiology
Medical University of South Carolina, Cardiology
24. Cardiac Cath
Vital Signs at 11:04 am
• Sp02 98%, HR 66, BP 118/69/76
• 11:02:59 – GMH Door Time
• 11:03:00 – Greet/table
• 11:11:54 – Case Start
• 11:23:42 – Balloon
25. E2B
D2B
• 77 minutes – E2B (EMS to Balloon)
• 43 minutes – GMH D2B (Door to Balloon)
29. Procedure Performed
• INDICATION FOR PROCEDURE:
• Acute anterior ST-elevation myocardial
infarction with occlude proximal LAD
• 1. Left heart catheterization with coronary angiography and left
ventriculography
• 2. Percutaneous coronary stenting of the proximal left anterior
descending
30. Cath Report
Findings
• Intervention
• Lesion is a complete thrombotic occlusion of the proximal LAD
with TIMI-zero flow
• Conclusions
• Coronary disease with acute thrombotic proximal left anterior descending
occlusion
• Successful stenting of the proximal left anterior descending with a bare-metal
stent after aspiration thrombectomy
• Mild left ventricular systolic dysfunction