Heart attacks The longer a patient waits, the greater the chances of death
When a person suffers a heart attack it is vital that their arteries be unblocked as soon as possible to prevent further damage. Unfortunately, a number of people suffer serious complications or die as a result of heart attacks. These complications can be prevented if the blocked artery is opened soon after the onset of chest pain or discomfort. A group of ER24 paramedics are currently researching ways of getting patients the medical attention needed before it is too late. Senior Flight Paramedic, Willem Stassen, who initiated the idea to conduct the research; said, “I thought of the idea because I was frustrated by the waiting times of patients needing to undergo reperfusion (restoration of blood flow to an area that is blocked). When one or more of the coronary arteries become blocked, there is a lack of blood flow and oxygen going to the heart that causes those parts of the heart to die. The longer these parts of the heart muscle are without oxygen, the more of the muscle ends up dying.” “The best way to reperfuse these vessels is to go to a cardiac catheterisation theatre and have a stent placed in the vessel itself. The American Heart Association suggests that a patient must have their vessel/s reperfused as soon as possible and preferably in under 90 minutes. In South Africa the delay is much greater. This is concerning as the longer a patient waits, the greater the chances of death,” he said. Stassen, who is currently busy with a dual PhD degree at Stellenbosch University in Cape Town and Karolinska Institutet in Sweden, said reasons for a delay in reperfusion times include patients not taking chest pain or discomfort seriously and patients being taken to hospitals that do not have the theatre facili-
ties required. Patients end up at inappropriate facilities for example when they are transported privately by friends or family. This is due to them not knowing which facilities have cardiac catheterisation theatres. “It is not a treatment problem as we are getting that right, for the most part. It is a network and referral problem. Patients are not going or being taken to the correct facilities in time,” said Stassen. Stassen’s research, and that of two
group will have a 12 lead ECG done and sent to a hospital with a cardiac theatre immediately. The second group will have an ECG but it will not be sent. A comparison will be made to determine which patients underwent reperfusion sooner,” said Stassen. • The viability of conducting blood tests in a pre-hospital setting to diagnose a heart attack. • A focus group discussion related to the concerns that healthcare providers may have locally with
Symptoms of heart attack include:
• Chest pain or discomfort. This pain or discomfort may or may not move or be felt in the left arm, the jaw and upper back. Often this is accompanied by nausea. • Severe sweating. The patient may have a “grey” appearance or may be pale. • Dizziness, fatigue. • Rapid or irregular pulse during rest. Individuals who are overweight, those who have high blood pressure, high cholesterol or diabetes are at a greater risk of having a heart attack. People who have a family history of heart attacks should also be examined so precautions can be taken should they also show signs of cardiovascular disease. In case of any medical emergency, contact ER24 on 084 124. For more information on heart disease visit www. heartfoundation.co.za Masters students, consists of six studies. The research entails the following: • Mapping all of the available cardiac hospitals and pre-hospital ECGs in the country in order to determine where additional resources are required to serve South Africans. • Conducting a first in Africa, pre-hospital randomised controlled trial (RCT). “This is a special kind of research design that, if done correctly, yields the most reliable results. The RCT aims to randomise patients presenting with a heart attack in Gauteng and the Western Cape into two groups. The one
the coronary care networks. The group’s intention is to determine if further solutions need to be sought. • Janine Taback, paramedic at ER24’s Johannesburg North Branch, came up with an idea to ensure that patients receive Aspirin much earlier when experiencing the symptoms of heart attack. Early Aspirin has been shown to reduce the chances of death. As part of her Master’s degree in Emergency Medicine, under the supervision of Stassen, she aims to determine whether it would be possible to prescribe Aspirin over the phone to these patients. “Many households have Aspirin in their medicine
cabinet. “By completing a checklist with the patient over the phone, emergency call centre agents could effectively determine whether it is safe for the patient to take Aspirin and ask him or her to take a certain dose at that point,” said Taback. Effectively, Aspirin will be taken by the patient much sooner. • The final Masters study assesses whether non-paramedic ambulance crews could perform a 12 lead ECG to screen patients in areas that do not have a paramedic who can perform and diagnose the ECG. “Non-paramedic ambulance crews can be trained on how to place a 12 lead ECG and send the results to a central server where a doctor or another qualified person can interpret it. “In this manner, patients suffering from a heart attack may be identified earlier,” said Stassen. Stassen stressed the importance of being transported to hospital by ambulance when experiencing the symptoms of heart attack. “It is better to be transported by ambulance instead of by family or friends. “If a patient’s condition were to worsen en route to hospital, for example if they were to suffer cardiac arrest, paramedics would be able to treat this during transport,” he said. If you have symptoms of a heart attack you should seek medical attention immediately.