1. STEMI Case Review
Improving System of Care for the AMI
Population
June 20th, 2011

2. Review Process
• Introductions • Results
• Background • - times
• Communication • - patient outcome
• Diagnosis • Barriers and
• Care Provided Opportunities
• Hand-off of Patient • Conclusions
• Follow Up Needed

3. Participants
• Patient
• RN in Charge of Medic Tent at Scottish Games*
• Mobile Care Ambulance Service
• Chest Pain Center
• Call Center
• STAT RN
• Cardiac Catheterization Lab *
• Cardiologist*
* Presenters

4. 2011 Scottish Games at Furman University MEDIC
TENT

5. Freedom Weekend Aloft
MEDIC TENT (Mobile Care also covering)

6. First Aid/Medic Tent
Jeanne Sandahl, Nurse Manager

7. Scottish Games
Sword Fights

8. Scottish Games
Caber Toss

9. Method of Travel to Patient
(in Bagpiper Tent)

10. GHC Mobile Care Ambulance Service
• Mission: Transport GHS patients
• Mobile Care established in April of 1972 and is an affiliate of GHS UMC
• Primarily inter facility, discharges and Referral Center transports
• EMTs and Paramedics
• Second highest transport volume in Greenville County; approximately
10,000 annually
• Mutual Aid Agreement with GC EMS
• - Provides 911 ‘back-up’
• All ambulances ‘advanced life support’ staffed and equipped

11. MCAS Staff
• 30 Paramedics (8 CC EMT-P)
• 13 EMTs
• 2 RNs
• 2 in Nursing School
• 11 also work for GC EMS or other 911 agencies
• 9 also work for Fire Departments (3
Lieutenants and 1 Captain)

12. MCAS
Medical Control
• Martin E. Lutz, M.D.
• Medical Director, Emergency Services
• Vice President Medical Staff
• Also Medical Control for:
• Greenville County EMS
• GHS Med Trans (medical helicopter)

13. Mobile Care Crew
John Reid, CC EMT-P
• EMT since 1998
• Works also PT for GC EMS
• CC EMT-P in 2010
• John also provided Medic coverage at
2010 Scottish Games, to Prince Edward

14. Mobile Care Crew
Beth Smith, EMT-I
• EMT for 13 years
• Started EMT career in New York
• Fire Department – 6 years
• Life Link at Roper St. Francis Hospital
• Mobile Care
• EMT –I 2009

15. Patient
Chief Complaint, Symptoms and
History
• Patient: 60year old male
• History
• Family history of coronary artery disease
• Sedentary lifestyle
• Chief Complaint
• Chest Pain
• Symptoms
• Chest pain since approximately 7:30 am; most severe in substernal area and radiating to left arm
• Diaphoretic
• SOB
• Nauseated

16. Mobile Care Ambulance Service
Initial EKG 10:20:36 am

17. Chest Pain Center
Activates STEMI Alert
• STEMI activated via CPC; Dr. Crumpler
at 10:36
• Play Recording

18. Mobile Care Ambulance Service
Care Provided
• Oxygen initiated via nasal cannula
• Cardiac monitor for ECG
• Nitroglycerin, 0.4 MG
• Peripheral IV initiated
• Heparin
• Taken to GMH Chest Pain Center 4

19. Mobile Care Ambulance Service
Times
• 10:00 – Request received via radio
• 10:06 – At patient
• 10:22 – enroute to GMH
• 10:37 – arrived at GMH
• 37 minutes from initial notification to
arrival at GMH/Chest Pain Center

20. GMH Cardiology
Stat RN
• STEMI Role
• - Meet EMS crew at ambulance bay/CPC or approach landing pad and assist with
patient transfer (training required).
• - Receive brief report from flight/EMS crew regarding patient stability or changes
during transport
• - Introduce self/role to patient and family; verbalize next steps and provide support
• - Review and confirm pre-GHS meds given specific to AMI/cardiac cath
• - Review targeted health history with patient, and biometrics pertinent to cardic cath
procedure
• - Perform targeted assessment if time allows
• - Assist with tracking times and documentation
• - Support CPC/CC-ER, cath lab personnel, and cardiologist as required and within
scope of practice
• - assist with patient transfer in CCU
• Note: crossed trained for CCL for 2nd STEMI situations

21. Greenville Memorial Hospital
Cardiac Catheterization Lab

22. Cardiac Cath Lab Team
• Dr. Josh Doll - Interventional Cardiologist
• Beth Cook, RN – Circulator
• Mary Sturges, RN – Circulator
• Joelle Bridgesm RN - Scrub
• Leigh Godbee-Stephens, RN, BSN -
Monitor
• Gary Szeto, RN – Stat/STEMI RN

23. Cardiologist
Carolina Cardiology Consultants
• Hometown: Batesville, Indiana
• Area of Specialization:
• Interventional Cardiology, Structural Heart Disease Therapies, Cardiac Pacing
• College:
Indiana University, Bachelor of Science-Biology, Cum Laude, 1996
• Medical School:
Indiana University of Medicine, Doctor in Medicine, 2000
Residency:
Vanderbilt University Medical Center, 2000-2003
• Cardiology Fellowship:
• Medical University of South Carolina, Interventional Cardiology
Medical University of South Carolina, Cardiology

24. Cardiac Cath
Vital Signs at 11:04 am
• Sp02 98%, HR 66, BP 118/69/76
• 11:02:59 – GMH Door Time
• 11:03:00 – Greet/table
• 11:11:54 – Case Start
• 11:23:42 – Balloon

25. E2B
D2B
• 77 minutes – E2B (EMS to Balloon)
• 43 minutes – GMH D2B (Door to Balloon)

26. Pre Cath

27. Stent

28. Final

29. Procedure Performed
• INDICATION FOR PROCEDURE:
• Acute anterior ST-elevation myocardial
infarction with occlude proximal LAD
• 1. Left heart catheterization with coronary angiography and left
ventriculography
• 2. Percutaneous coronary stenting of the proximal left anterior
descending

30. Cath Report
Findings
• Intervention
• Lesion is a complete thrombotic occlusion of the proximal LAD
with TIMI-zero flow
• Conclusions
• Coronary disease with acute thrombotic proximal left anterior descending
occlusion
• Successful stenting of the proximal left anterior descending with a bare-metal
stent after aspiration thrombectomy
• Mild left ventricular systolic dysfunction

31. Questions and Thanks to All!