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North Dakota ambulances and hospitals streamline equipment for heart attacks
Helping hearts

North Dakota ambulances and hospitals streamline equipment for heart attacks


Bismarck hospitals and the region’s ambulances, along with their counterparts across the state, are streamlining the way they care for acute heart attack victims. It will lead to better care for patients, especially those in rural North Dakota, officials say.

The goal is to have all North Dakota ambulances equipped with EKGs — equipment that takes an electrical reading of the heart — by Jan. 1. The new equipment has the ability to transmit the reading to the six major hospitals in North Dakota, said Joan Enderle, director of communications with the American Heart Association.

As of last week, about 70 percent of ambulances across the state, including Metro ambulances that serve the Bismarck region, had the equipment, Enderle said.

The 12 lead EKGs read the heart from 12 different directions, said Neil Frame, an operations director with Metro Ambulances.

The EKG reads the way electricity travels through the heart and, if there is a blockage, electricity goes through it differently, he said.

Frame said Metro has been using 12 lead EKGs since 1996. For a few years, Metro could send the readings to the Bismarck hospitals, but,at some point, a technology gap made that impossible.

“We’ve still been doing 12 leads all along and medics interpret them and call (the information) in (to the hospitals),” he said.

Metro has the new equipment but it won’t be up and running until the Bismarck hospitals are able to receive its information.

Sanford Health and St. Alexius Medical Center of Bismarck are two of the six hospitals that have the technology and staff to open the artery when a patient has a STEMI heart attack, the most deadly kind of heart attack in which there is a complete blockage of one or more coronary arteries.

Two of the other hospitals are in Fargo, one in Grand Forks and one in Minot.

Both Bismarck hospitals have funds to implement equipment that will allow them to receive electrocardiograms, Enderle said, and they should have their systems up and running within the next few weeks.

The ability to transmit electrocardiograms directly to doctors’ phones or fax them to the hospitals will benefit patients, especially those who are being transported from rural areas of the state, said Noelle Riehl, STEMI coordinator at Sanford Health in Bismarck. If the patient already has had an EKG and doctors have been able to interpret it, patients will be able to go straight to the cath lab, skipping the ER, and the doctors will be prepared for the patient when he or she arrives, Riehl said.

When a patient has a heart attack, speed is critical, said Dr. Karthik Reddy, cardiologist and cath lab director at Sanford Health.

“I think it’s going to save a few more lives,” Reddy said. “Many times, in five or 10 minutes, patients have dangerous heart rhythms and can die ... If we can get to them earlier, long term results are much better.”

Muscle damage and the chances of future complications such as congestive heart failure or shortness of breath are reduced the earlier the artery is opened, he said.

North Dakota is considered Class 5, the highest mortality rate for patients who have heart attacks, Riehl said.

“North Dakotans, in general, do not seek emergency help upon having symptoms of chest pain, or they wait too long or use other methods at home first,” she said.

The American Heart Association received $7.1 million in funding to implement Mission: Lifeline, an initiative to improve the system of care for heart attack patients throughout the state.

Enderle said the association is implementing the equipment by region. Minot was the first region to have its equipment up and running and Bismarck will be next, she said.

Sanford sees about 150 patients in the Emergency and Trauma Center for chest pain, Riehl said. Of those, about 15-20 patients are diagnosed with a heart attack and, of those heart attacks, about a half dozen are categorized as STEMIs.

Representatives of Mission: Lifeline may be working soon on protocols to address STEMI heart attack emergencies across the state.

An advisory committee that includes interventional cardiologists, ER physicians and nursing leaders representing the six major hospitals, agreed on a statewide protocol Monday, said Mindy Cook, Mission: Lifeline director for North Dakota. The committee has been working on it since June.

The protocol includes identifying STEMI heart attacks, providing patients with medication and transferring patients to one of the six major hospitals if they are within 120 miles of the hospital. If patients are outside the timeline, the second best treatment option is medication, Cook said.

“What this really does is get a practitioner in a smaller center the tools they would need to treat the patient quickly and efficiently, and protocol they could use at their facilities so they’re all treating them the same,” Cook said.

Right now there is no standardized protocol in place in North Dakota, she said.

“Everyone operates based on their knowledge of the guidelines. It’s up to the individual crisis assistant,” Cook said.

The committee will present its recommendation to the Mission: Lifeline Task Force on Oct. 25. If the taskforce accepts the recommendation, Mission: Lifeline will begin training referring hospitals and start “full force” with the protocols in January, Cook said.

Dr. Bob Oatfield, an interventional cardiologist at St. Alexius, said the changes will be “a marked improvement for patient care in hospitals.”

Workers at smaller hospitals or rural ambulances would have to call a larger hospital to ask whether a patient should be taken to a larger hospital or treated at a smaller hospital, he said.

“(There’s) a lot of disparity with what happens to patients outside of Bismarck,” he said. “Some will hospitalize (patients) overnight and call us the next day. Patients will backtrack 40 miles to go to a small hospital rather than come 60 miles directly here (to Bismarck.)”

Lance Pollert, a paramedic with Metro Ambulance, said, besides having the capability to transmit the readings to the Bismarck hospitals, the new equipment can take a patient’s blood pressure and measure the amount of oxygen and carbon dioxide in a patient’s bloodstream.

Before the new equipment, Pollert said paramedics would call the hospitals and tell them what the EKG reading said.

“Now, (doctors) will be able to see for themselves the same thing we’ve been telling them. It’s taking the human error out of it, so to speak,” he said.

Reach Mara Van Ells at 701-250-8251 or


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