Never self-transport
friend or family to the hospital if you suspect Heart Attack or Stroke. Never.
Paramedics know
which Hospitals specialize in treating specific medical conditions and
symptoms.
In Ontario,
and most other places, Paramedics are highly trained and well equipped to
assess the presence and severity of heart attack and stroke. Based on the patient
presentation during their initial assessment the Paramedics will decide which
hospital is the appropriate facility to treat the specific symptoms they are
observing. At the start of every shift
and updated throughout each shift as changes occur, Paramedics are informed
which hospitals in the region are receiving patients with specific
symptoms. A wide range of factors from
off load delays, too broken equipment, to Doctors being away on vacation can
effect which hospitals are receiving which patients. It would be impractical,
perhaps impossible to keep the public updated on this information. The message
to the public has to be when symptoms are observed Call 911 and let the Paramedics decide which hospital is best for
your situation.
For two of
the most common and most devastating medical emergencies, Stroke and Heart
Attack, the most significant factor in determining patient outcome is time,
specifically the time from the onset of symptoms to the time when blood flow to
the affected part of the body is restored. When human tissue is denied blood
due to a blockage in an artery it is denied oxygen and without oxygen tissue
begins dying. In the case of heart muscle after 90 minutes some tissue will be
dead and there will be permanent damage to the heart and loss of some heart
function. In the case of Stroke, brain cells may last 150 minutes in a low
oxygen environment but beyond that damage is typically permanent and full
restoration of all function is unlikely.
In Ontario
15 of 165 hospitals have fully equipped and staffed Cardiac Catheterization
Labs that operate around the clock every day.
At these facilities Cardiac Intervention Teams perform the procedure
that is most effective for restoring blood flow to affected heart muscle,
emergency angioplasty or PPCI – Primary Percutaneous Coronary Intervention. Nearly 12 million of Ontario’s 13 million
residents live close enough to one of these hospitals to make the 90 minute
window if 911 is called as soon as definitive symptoms
are recognized. If you self-transport a family member to the wrong hospital by
the time you get inside and the staff identifies the problem and calls for an
ambulance to transport the patient to the appropriate facility it is almost
assured that the 90 minute window will be closed.
For Stroke
the target is a moving one and the local hospital that is receiving Stroke
patients may change throughout the day as the availability of a CT Scan machine
and trained technicians is considered. Clot busting TPA Therapy – tissue
plasminogen activator – can only be started after a CT Scan to confirm if the
stroke is in fact being caused by a blocked (not ruptured) artery. Again, getting to the right hospital, with the
right equipment in the right timeframe is the only way to achieve the best
possible outcome for Stroke.
What does
the best possible outcome for Heart Attack or Stroke look like? What does it
mean for patients, families and taxpayers when the best possible outcome is achieved?
Stay tuned for the next blog in this three part series.
