Concord Hospital, LRGHealthcare Collaborate to Save Lives

For the most serious heart attack patients in Central New Hampshire and the Lakes Region, a longer ride to the hospital now means a shorter route to life-saving treatment. In a program started by Concord Hospital, Franklin Regional Hospital, Lakes Region General Hospital, and Lakes Region Emergency Medical Services (EMS), patients most at risk for cardiac arrest or permanent heart damage are rushed directly to Concord Hospital, the closest hospital offering the specialized treatment that opens severely blocked arteries.

The goal of the Regional Early Activation Care Team (REACT) program is to save time, heart muscle and lives, by taking patients to Concord Hospital’s cardiac catheterization suite, where a team on call 24 hours a day can remove a blockage by inflating a balloon or inserting a stent in the artery to restore blood flow. “Hours can get lost, in a world where you are measuring things in minutes,” Concord Hospital cardiologist Dr. Mark Klinker said of the previous process, in which patients were taken to Franklin Regional or Lakes Region General Hospital for assessment and preliminary treatment, then transferred to Concord Hospital, if necessary.

“It’s much quicker, with the appropriate Emergency Medical Services (EMS) care, to go directly from there to here and knock off what can be unnecessary delays,” Klinker said while tracing a straight line with his finger on a map between the Lakes Region and Concord.

Emergency Medical Services personnel in 18 Lakes Region communities have new communications equipment enabling them to transmit a heart attack patient’s electrocardiogram (EKG) monitoring results from the field to the Emergency Departments at Franklin Regional or Lakes Region General Hospitals. With that information, doctors determine whether an artery blockage is serious enough to require immediate treatment at Concord Hospital.

The program aids patients suffering STEMI heart attacks. STEMI is short for ST Segment Elevation Myocardial Infarction, the worst type of heart attack, where blocked blood flow destroys heart muscle and can lead to cardiac arrest – when the heart stops beating or beats ineffectively. “The whole point is to identify patients having STEMI heart attacks in the field before they head to the nearest community hospital, where they used to go,” said LRGHealthcare Emergency Medicine specialist Dr. David Strang.

En route to Concord Hospital, the ambulance is a virtual emergency room. Paramedics in contact with Emergency Department doctors can stabilize a patient by administering life-saving techniques and medications that previously would have been delivered at the Emergency Departments in Franklin or Laconia. The goal is to open the artery – the sooner, the better – because the longer it takes, the more heart muscle is damaged or destroyed. “Timing absolutely can mean the difference between life and death, but it also can mean the difference between making a full recovery and having life-long medical issues,” said Shawn Riley, Deputy Chief of LRGHealthcare/Laconia Fire Department EMS Program.

Administrators at LRGHealthcare and the Laconia Fire Department began researching better options for their STEMI heart attack patients when they realized it was taking too long to get them to Concord Hospital’s catheterization suite. They streamlined diagnosis and initial treatment, then initiated the regional approach – with the crucial diagnosis now made in the field – in use in other areas around the country.

Catheterization suites are like mini-operating rooms. They are too expensive for smaller community hospitals, where they would be used less often, making the regional approach more practical Strang said.

Regional STEMI programs also are in place in southern New Hampshire and the Seacoast, but the Concord Hospital-LRGHealthcare program is the most far-reaching in the state. “Everyone in the Lakes Region EMS community is fully aware of STEMI care and is on board and excited,” Riley said. The hospitals and EMS personnel have been phasing in the new protocol since December. As of September, 14 patients had been taken directly to Concord Hospital, including one whose heart stopped on the way. That patient was revived, then the blocked artery was opened in the catheterization suite, much sooner than if the patient had been taken to another hospital first. “If there had been a delay, there is a strong likelihood the patient would have died,” said Strang.

The life-saving change in procedure means some Lakes Region patients will not be taken to their familiar, community hospital. “Our goal is to ensure that patients have access to the care they need, as quickly as possible,” said Strang. “For a patient having this specific type of heart attack, that means getting him or her to a hospital that provides emergency cardiac catheterization services. As with many other programs, LRGHealthcare works with our partners throughout the statewide healthcare network to provide our patients with the best standard of care.” The national goal is to open a patient’s blocked artery within 90 minutes of reaching the hospital. REACT’s goal is to provide the quickest way to that appropriate treatment.

In one case from Center Harbor, one of the farthest reaches in the new protocol, a patient’s artery was re-opened at Concord Hospital just 97 minutes after the ambulance began a nearly 50-mile ride to the Hospital. Klinker said the example highlights the importance of all members of the team, from the first responders to Emergency Department and cardiology doctors to the catheterization suite staff.

After treatment and catheterization at Concord Hospital, patients from the Lakes Region can receive follow-up care close to home from local cardiologists in the Lakes Region and through LRGHealthcare’s Cardiac Rehabilitation program. “It’s not a one-way trip to Concord,” Klinker said. “It’s a round-trip, creating other levels for collaboration.”

The life-saving collaboration has turned medical services competitors into partners, with Lakes Region and Franklin General Hospitals willingly sending patients to Concord, all for a common goal. “It simply is the right thing to do for our community and our patients,” said Kathy Waldron, Vice President of Clinical Services and Chief Nurse Executive at LRGHealthcare.

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