Time is Muscle. Peel Paramedics and Trillium Cardiology Teams Work Together to Save Lives Under 'code Stemi'
Regional Direct PPCI Program for STEMI patients in the Mississauga Halton LHIN is a model of health care partnership and integration
Mississauga/West Toronto (January 22, 2010) - A grateful patient who benefited from the new partnership between Trillium Health Centre and Peel Regional Paramedic Services (PRPS) returned today to thank the paramedics, cardiologists and nurses who added years – and quality – to his life after he suffered a heart attack on October 14, 2009.
Peel Paramedic Jolene Fonseca is reunited with STEMI heart attack patient Ed Skrlj just three months after his heart attack.
“I urge everyone to improve their heart health. Eat better and work out more - and if you’re in an at-risk group, get a cardiac stress test,” says Ed Skrlj, cardiac patient at Trillium Health Centre in Mississauga. “Middle aged men, especially, need to drop their macho attitudes that everything is fine. Don’t ignore severe indigestion or arm or chest pain. Learn the symptoms of heart attacks and strokes, get first aid training and learn how to use an automated external defibrillator. And if you think you might be having a heart attack, call 911 right away. The people who saved my life can save yours too.”
The new Code STEMI protocol, designed to improve cardiac care services for patients in Mississauga was launched by Trillium and Peel Regional Paramedic Services on August 10, 2009, with the support of the Mississauga-Halton Local Health Integration Network (LHIN), the Sunnybrook-Osler Centre for Pre-Hospital Care (SOCPC) and The Credit Valley Hospital (CVH).
How 'Code STEMI' works
Research has shown that patients with ST-Elevation Myocardial Infarction (STEMI), a specific type of heart attack involving a blocked coronary artery, receive greater benefit from treatment with primary percutaneous coronary intervention (PPCI) than from traditional thrombolytic (blood clot busting drugs) therapy. In short, patients have better outcomes when cardiologists use a balloon catheter and a stent to open the blocked coronary artery instead of drugs that dissolve the clot blocking the artery.
When an advanced care paramedic (ACP) identifies a patient whose electrocardiogram (ECG) indicates they are experiencing a STEMI, the paramedic consults one of Trillium’s interventional cardiologists by telephone - 24 hours a day, 7 days a week - to initiate the Code STEMI process. Upon acceptance of the patient by the interventional cardiologist, the patient is transported directly to the cardiac cathetherization lab at Trillium for PPCI, without stopping in the emergency department at Trillium, Halton Healthcare Services or The Credit Valley Hospital.
The objective is for the patient to receive treatment at Trillium within 90 minutes from the initial diagnosis by the paramedics, including transport and intervention time.
“The expansion of this important cardiac service to the people of Mississauga is a credit to health care and emergency service providers in our community,” says Charles Sousa, MPP Mississauga South. “This partnership between the Ontario government, the Mississauga-Halton LHIN, Peel Regional Paramedic Services, the Sunnybrook-Osler Centre for Prehospital Care, Credit Valley Hospital and Trillium Health Centre means STEMI patients will get what they need - the right treatment in the right time in the right place - to achieve better outcomes and recover more quickly.”
“The collaboration between healthcare partners to deliver the STEMI bypass program is an excellent example of how we’re always working to improve patient care in Peel,” says Peter Dundas, director, Peel Regional Paramedic Services.
Time is Muscle
Heart muscle dies when it does not receive blood and oxygen. It never repairs itself. Literally, every minute matters. The aim of this new program is that patients will have PPCI within 90 minutes of EMS arriving at the patient’s side. This quick access to best practice care is known to support the best outcomes.
”Time to definitive care is crucial to the outcome of patients sustaining myocardial infarction,” says Dr. Sheldon Cheskes, medical director, Sunnybrook Osler Centre for Prehospital Care - Peel Region. “The treatment provided by Peel paramedics and Trillium cardiologists is ‘state of the art’ maximizing the benefit to patients we serve.”
The Code STEMI program in the Mississauga Halton LHIN is delivering impressive results.
In the second quarter of fiscal 2009-10 (July-August-September), 34 patients were transported under Code STEMI. Peel paramedics did 24 of those calls.
The average time from a paramedic arriving at the patient’s side to a cardiologist restoring the flow of blood through the artery was 68.5 minutes - well below the program's 90 minute 'first contact to device' goal.
"The results of this team effort are outstanding. At 68.5 minutes, we are greatly exceeding the goal of treating the patient in Trillium’s cath lab within 90 minutes of the first arrival of EMS personnel," says Dr. Randy Watson, a Trillium cardiologist and co-lead of the STEMI program. "The evidence shows this time frame is crucial because time is muscle. Bringing patients directly into the cath lab makes all the difference to a speedy, successful recovery for most patients. The Trillium cardiology team has enjoyed working with the paramedics on a program that will deliver positive results for many patients for years to come."
From January 1 to September 30, 2009, a total of 58 patients across the Mississauga Halton LHIN have bypassed their local emergency department under Code STEMI. This diversion of critically ill patients past their local emergency department and directly into the catheterization lab at Trillium helps reduce pressure and wait times in our busy EDs by reducing the number of high acuity patients.
“This program underscores the importance of collaboration and partnerships among regional community health-care providers in offering the highest quality care," said Janet Davidson, O.C., president and CEO of Trillium Health Centre. "We would like to thank the Mississauga-Halton LHIN, the Ministry of Health and Long-Term Care and Peel Region for their support of this successful partnership, along with our partner hospitals and EMS providers. I’d also like to offer a special thank you to our donors who helped to fund the cath labs."
The Code STEMI protocol is now in effect across the Mississauga-Halton Local Health Integration Network (LHIN) catchment area. Halton Region EMS launched the program in December 2008 for patients in Halton Hills, Milton and Oakville with the support of Halton Healthcare Services. Toronto EMS began bringing south Etobicoke patients to Trillium under Code STEMI in May 2009. In August 2009, Peel Regional Paramedic Services joined the program, with the support of the the Sunnybrook-Osler Centre for Prehospital Care and The Credit Valley Hospital, for patients from Mississauga.
About the Region of Peel
The Regional Municipality of Peel was incorporated in 1974 on the principle that certain community and infrastructure services are most cost-effectively administered over a larger geographic area. The Region of Peel serves more than one million residents in the Cities of Brampton and Mississauga and the Town of Caledon. Responding to more than 80,000 emergency medical calls every year, Peel Paramedics work to save lives, decrease suffering and improve and promote community safety.
For more information about the Region of Peel and Peel Regional Paramedic Services, please call 905-791-7800, or visit our websites at www.peelregion.ca or www.peelems.ca.
About Trillium Health Centre
Trillium Health Centre is one of Canada’s largest academically-affiliated tertiary care hospitals with highly-specialized regional programs in advanced cardiac, vascular, stroke, neurosciences, orthopaedic, and sexual assault/domestic violence services. Housing a model ambulatory care centre and the largest free standing day surgery centre in North America, Trillium serves over one million residents in Peel and West Toronto and from other communities across Ontario. Last year Trillium’s doctors, staff and volunteers cared for more than 700,000 patients at the Mississauga (100 Queensway W.) and West Toronto (150 Sherway Dr.) locations. With the continued support of the Trillium Health Centre Foundation, the hospital’s fundraising arm, the two-site facility is attracting international attention for its innovative approach to providing safe, high quality health care services and has received numerous national awards for quality and innovation.
For more information on Trillium Health Centre, visit: www.trilliumhealthcentre.org.