Texas County Memorial Hospital received a designation last month from the Department of Health and Senior Services as a “Level Four STEMI” hospital.

TCMH earned the designation – “ST-Elevation Myocardial Infarction (STEMI) Protocols – as a result of its ability to respond to patients experiencing a STEMI, more commonly known as a heart attack. In level four centers like TCMH, patients are stabilized and quickly transferred to a level one or level two center for interventional care.

The state of Missouri’s benchmark for STEMI response from the time a patient walks in, to the moment they are transferred to a higher level of cardiac care is 30 minutes.

Many rural hospitals do not have quick access to an air ambulance or a higher level of cardiac care, making this benchmark extremely difficult to meet.

For TCMH, the closest air ambulance is 24-26 minutes away. In situations of bad weather, patients are transferred by ground ambulance as quickly as possible to a facility that can offer a higher level of cardiac care.

“In our community many patients live far enough away from an emergency room that they feel like they could drive to a hospital in a shorter amount of time than it would take an ambulance to reach them,” said Wes Murray, TCMH chief executive officer.

At TCMH, a large majority of our STEMI patients arrive to our doors in private vehicles due to the rural area.

Murray said patients depend on the hospital to deliver top notch care and every minute counts.

“It is our job to perform at our very best and having the STEMI protocols in place allow the hospital staff to make knowledgeable, stream-lined decisions consistently, with every patient encounter,” Murray said.

Doretta Todd-Willis, TCMH chief nursing officer, said the protocols hospital staff go through with each STEMI patient are working and are saving lives.

“TCMH sees a lot of patients with cardiac issues,” she said. “The level of acuity is high, and cardiac related issues is by far our number one reason for patient transfers to other facilities.”

A LOOK AT THE PROTOCOLS

Given the short amount of time, TCMH staff must work fast.

Within 5 minutes of walking in the door and complaining of chest pain, the registration clerk calls a “chest alert” to hospital staff, the patient is checked into a room, an EKG is run and a heart attack is either confirmed or ruled out.

“The state wants the time from door to EKG to be 10 minutes,” said Lauren Toman, STEMI medical coordinator said. “Our goal is to have the door to EKG time under 5 minutes.”

After confirmation of a heart attack, hospital staff have 25 minutes to get a helicopter on the ground to transfer the STEMI patient.

“The heart is a big muscle, and during a heart attack blood stops flowing to the heart which causes the muscle to die,” Toman said. “Every minute that we have with a heart attack victim is an opportunity to save more of that patient’s heart.”

ABOUT THE DESIGNATION

Toman said hospitals don’t have to receive the designation, but TCMH was already prompt and wanted to provide access to this system of care for patients.

“Going through the designation process to be certified in this level of care just made sense,” Toman said.

The process to become a STEMI designated hospital is not a short one. TCMH began in 2014 and was just recently issued the designation.

The state reviewed TCMH in December 2016, and the hospital received the official designation in May 2018.

Randall Qualls, D.O., STEMI medical director, and Toman explained that the hospital staff perform mock codes and they provide education for the staff, so they are fully prepared when a STEMI patient comes through the doors.

In addition to mock codes and education, Toman attends regional meetings to discuss processes and strategies to help improve those times even more. She also provides community education.

IMPROVING PATIENT CARE

Since implementing this protocol, the hospital has seen improvements.

“We are offering care as quickly and efficiently as possible to minimize the damage to a patient’s heart,” Qualls said. “We are able to see our numbers improving, confirming to us that we are providing better care.”

Brittany Walter, emergency room registered nurse, said the protocols save time and help reduce errors.

“STEMI protocols are efficient,” she said. “We know what to do next so we can save as much of the heart and life as possible.”

Hospital staff also explained the positive impact that the protocols have had on their lives and their jobs.

“We are able to see an improvement in our patients before they ever leave our facility,” said Jerry Sue Crump, emergency department director. “It gives us the feeling that we are doing our jobs well and it makes us proud.”

Crump said when a STEMI patient comes through the hospital doors, you can see the fear on their face. Many see they are going to die.

“The most impactful part for me is seeing the look of ‘impending doom’ on their face when they come through the doors, and then having the privilege of watching it lift from their face—knowing I had a part in that,” Walter said. “I’m thankful to the patients that I get to be a part of making their worst experience ever, the best it can be.”

SAVING LIVES

“Protocols and standardization allow us to take the guess work out of treating a patient,” Toman said. “Everybody has the same goal—to save lives.”

Toman said the STEMI protocols offer benchmark goals that make it fast and efficient to getting the patient the care they need.

“We do several things to shave down those times too,” Toman said.

She said “hot loading” a patient is one of those things. A “hot load” is when the air ambulance lands on the helicopter pad and staff immediately load the patient and leave without stopping the engine or the rotors.

Toman said sometimes women experience heart attacks differently than men. While chest pain is a common sign of a heart attack in men, women might experience fatigue or shortness of breath. It is important to speak with your primary care provider if you notice any changes in your health.

According to the American Heart Association, chest discomfort, discomfort in one or both arms, back, neck, jaw or stomach, shortness of breath, sweat, nausea, or lightheadness can all be signs of a heart attack. If you are experiencing any of these symptoms go to the nearest emergency room immediately or call 911.