When a patient comes through the double doors at Mid-Columbia Medical Center’s Emergency Department complaining of chest pain – even just discomfort, a squeezing, pressure-filled sensation – the staff doesn’t mess around. There’s no paperwork to fill out first. There’s no hesitation at all, but no rushing either. Just efficient, precise speed.
A respiratory therapist or nurse attaches electrodes to the patient that lead to an electrocardiograph device, which records the rhythm of the heartbeat. On average, MCMC’s emergency room staff receives the results in three minutes, telling them if the patient is having a heart attack. Then a doctor decides the best course of treatment.
Most often this will mean using the medical muscle of Oregon Health & Science University. An arrangement developed in 2009 between MCMC and OHSU now allows residents of the Mid-Columbia to benefit from the vast heart expertise and resources of Oregon’s only academic medical center.
The first component of the agreement provides MCMC with a state-of-the-art partner for the quick transfer and treatment of patients suffering a heart attack. MCMC and OHSU have developed what’s called a STEMI protocol (STEMI is short for segment elevation myocardial infarction, the most common cause of a heart attack). This protocol is a tightly controlled and choreographed plan to treat a heart attack as fast as possible.
An attack, at its simplest, is caused by a blood clot in the heart. The clot chokes the muscle, starving it of oxygen, causing the heart to fail. The faster that block is broken, the less the heart will suffer, and the more completely the patient will recover.
“Time is heart muscle,” says Patrick Grimsley, M.D., MCMC’s Emergency Department (ED) director, “so we want to keep what is called door-to-treatment times down.” The target is 90 minutes.
In MCMC’s ED, the moment the doctor diagnoses a heart attack the staff calls OHSU and gives a short instruction: “STEMI.” That’s it. It’s military fast.
LifeFlight, the helicopter transportation company now based in Dallesport, is called. In the 10 minutes it takes the helicopter to fire-up and reach MCMC, the patient receives a chest X-ray and lab tests are started.
“We expect specific elements of our protocol to happen from zero to five minutes, five to 10 minutes, 10 to 15 minutes,” says Joaquin Cigarroa, M.D., director of OHSU’s cardiac catheterization lab.
Within 20 minutes of arriving at MCMC, the patient is in the air, heading down the Gorge to OHSU. Waiting for the helicopter in Portland is a rapid-response team, which rushes the patient to the catheterization lab for treatment.
As critical as this part of the MCMC-OHSU arrangement is, it’s what happens after the attack that is most important for future patients. The hospitals’ close relationship allows their staffs to improve the treatment of heart attacks and make the protocol run smoother and faster.
Before 2009, many of MCMC’s patients with heart problems, from high cholesterol to congestive heart failure, have needed to travel to Portland to receive not only their treatment, but also their follow-up care. That has been far from ideal patient care, says Bill Hamilton, M.D., MCMC’s executive director of medical affairs. The relationship with OHSU now allows more of the care to happen in the patient’s hometown.
“We wanted to provide those services without making patients drive into Portland,” he says. “To do that, we had to partner with a large institution.”
Though located in the heart of Portland, OHSU believes it has a mission to smaller communities. It’s a mission Dr. Cigarroa is personally committed to.
“I grew up in a small community, where we didn’t have an active cardiologist or subspecialists,” he says. “So I know what it was like having that missing in a community. Just the distance is an obstacle to good care.”
To fix this problem, MCMC and OHSU have recruited two cardiologists to The Dalles, Drs. David Guarraia and, most recently, Dr. Kevin Wei.
Whether during an emergency or in treatments to ward off an emergency, MCMC’s arrangement with OHSU gives The Dalles area patients the combined clinical speed and know-how of two institutions truly committed to their health.