Every minute matters. That is the stance area hospitals and paramedics have taken when it comes to quickly diagnosing and treating patients suffering from heart attacks or strokes.

This is the third year of a regional collaborative led by the University of Kansas Medical Center that seeks to improve rural health care for those patients and reduce death rates and health-care costs.

“There is a chain of survival, and everybody’s got their part to play in that,” said Lillian Slater, assistant director of Ellis County EMS. “We always say strengthening one link will not make the chain any stronger. You have to get all the different parts working.”

The collaborative consists of 14 northwest Kansas hospitals, including Hays Medical Center, which has worked closely with KU Med in collecting data and administering the program, said Carol Groen, manager for clinical certifications and special projects at HaysMed.

The Kansas Heart and Stroke Collaborative, launched with a three-year, $12.5 million grant, seeks to reduce cardiac-related deaths in rural communities by 20 percent. Another goal is to cut health-care costs by $13.8 million, according to the program’s website.

So far, the results have been promising, Groen said, noting critical patients are accessing life-saving care more quickly.

First on scene

Improving communication between all of the agencies involved in a patient’s care has been a key initiative. HaysMed, as well as other regional hospitals, has worked closely with its local EMS provider to establish an “alert” system that expedites care for stroke and heart-attack patients.

If a heart attack is suspected, Ellis County paramedics have the technology and training to administer and interpret EKG, or stress tests, in the ambulance en route to HaysMed. If that test indicates cardiac distress, paramedics send the results to the hospital and call to inform emergency staff that patient is coming.

HaysMed, in turn, is able to prepare necessary staff and equipment before the patient even arrives for treatment. That saves precious time, as the goal is to get critical patients into the cath lab for surgery within 90 minutes of first contact with paramedics. HaysMed, in reality, averages only 61 minutes, Groen said.

“For the heart patient, when we get that pre-notification, it gets us to be able to call in our cath lab team, even if it’s 2 a.m. or 5 a.m. It seems like a lot of these things happen after hours,” Groen said. “We have time to call our crew in before the ambulance is here, before the patient is here, which gives them a 10-minute head start.”

Stroke patients can be more difficult to identify, as symptoms can be more subtle and vary from person to person. If a stroke is suspected, paramedics quickly conduct a FAST test on a patient, which checks for drooping facial features and slurred speech, as well as the patient’s ability to hold arms out evenly.

It’s also important to determine the exact time the stroke might have began, as clot-busting medications must be given within approximately four hours, Groen said. Most stroke patients do not qualify for surgical intervention.

“Again, both stroke and (heart attacks) are time sensitive,” she said. “If the heart muscle gets damaged, it’s very difficult for it to regenerate and function again, but the brain doesn’t.”

While EMS have a large role to play in the “chain of survival,” it actually begins with the patient. The initiative also strives to improve public education of heart attack and stroke symptoms, so patients know to call for help when they are in need. HaysMed and EMS have worked together to distribute educational materials at community events.

“I think the rapport between EMS and the hospital is good. I think that is very important in the continuity of patient care,” Slater said. “It used to be, when I first started 30 years ago, there wasn’t a lot of communication between the two. We did our job; they did their job and that was it. And now it’s like everything is a collaborative.”

Dispatch is another important piece of the puzzle, and emergency operators can notify EMS immediately if the patient suspects a heart attack or stroke, Slater said.

Residents are strongly encouraged to call an ambulance if they suspect they are having symptoms of a stroke or heart attack. This allows them to access care faster, which can minimize the amount of damage.

It also ensures help is present during the commute in case the patient experiences distress. Symptoms sometimes can turn out to have benign causes, but when it comes to coronary syndromes, it’s better to be safe than sorry, Slater said.

“We all have to be on board that (heart attack and stroke) is a possibility. It’s going to happen,” she said. “We’d rather have (someone call and experience benign symptoms) than have someone slip though and not get the treatment they need.”


Going the distance

Time becomes even more of a challenge in remote areas of northwest Kansas, as distance from a tertiary care facility increases.

Protocols have been implemented at many regional hospitals as part of the collaborative, seeking to ensure all coronary patients receive the same standard of care and are transported to Hays as quickly as possible.

“There’s a lot of miles out here in rural Kansas,” Groen said. “And there’s a lot of difficulty sometimes getting transportation.”

Participating hospitals have been trained to conduct a stress test as soon as possible, even before the patient is taken off of the ambulance cot. If the test shows a potentially life-threatening heart blockage, rural hospitals also have been equipped to give clot-busting drugs before transporting the patient.

In stroke cases, a CT scan is taken as quickly as possible to determine if a patient qualifies for medical treatment.

That has proven effective, and in many cases, patients’ symptoms are resolved before they arrive in Hays, Groen said.

“They would go to the lab, and a lot of times the clot is dissolved and they do wonderful,” Groen said. “In preceding years, there was a lot of hesitancy in giving this drug. They just wanted to get them to a cath lab. But all that time without anything was just causing too much damage to the heart.”

Rooks County Health Center in Plainville is among the rural hospitals involved in the initiative. The protocols have allowed every patient to be treated the same, regardless of geography, said Pam Harman, chief nursing officer at RCHC.

“It’s saving lives,” she said. “We may not be a big hospital, but our patients deserve the same care. We do everything we can on our end to make sure we’re holding up our part of the bargain.”

The protocols were implemented with input from area physicians and have helped expedite care for rural patients by establishing clear guidelines.

“We have guidelines on what medications to give right away, so we don’t have to wait for doctors to say this is a heart attack, so get an EKG and aspirin,” Harman said. “We already have standing orders so we can do those things. It speeds up our time.”

Regional hospitals also communicate with HaysMed to notify a patient is coming so staff can prepare for prompt response.

The initiative has proven so successful that a second program is in the works to improve sepsis outcomes. RCHC is playing a significant role in that endeavor, she said.

It becomes even more important for patients to recognize their symptoms and call an ambulance immediately when they are located a great distance from a cath lab and face a long commute. Paramedics also are trained to do everything they can to help save time by preparing a patient for examination and surgery when they arrive in Hays, Slater said, noting Ellis County EMS has seen “excellent time frames” when transporting patients.

“Our goal is to get them there, and how can we do that and how can we shave minutes off,” she said. “It can be something as simple as, if we’re coming from Ellis and so we have that extra time, getting their clothes off (for surgery.) … If it takes two minutes, that’s two minutes you don’t need to lose.”