The Cook County Department of Public health is planning to conduct H1N1 mass vaccination of those deemed at high risk for developing serious complications if they become infected with the H1N1 virus, and we urgently need health professionals to assist with these vaccination efforts beginning in late October.
Please contact the Cook Co. Health Department directly. The information follows below:
Healthcare Providers Needed to Help VaccinateAgainst Novel H1N1 Flu This Fall and Winter 2009
CALLING ALL:• advanced practice nurses • physicians• emergency medical technicians (EMTs) • physician assistants• licensed practical nurses • registered nurses• pharmacists
REGISTER TODAY:
ONLINE www.cookcountypublichealth.org/volunteer
EMAIL volunteer@ccdph.net
PHONE 708-492-2820
Monday, September 28, 2009
Monday, September 14, 2009
Rep. Biggert Co-Sponsors FIT Kids Legislation!
As you know, the FIT Kids Act (S. 634/H.R. 1585) is legislation that amends the No Child Left Behind (NCLB) Act to support quality physical education for all public school children and ensure they learn about important health and nutritional information. Recently, U.S. Representative Judy Biggert co-sponsored this legislation showing that physical education and nutrition is vital for kids in Illinois and nationwide. Rep. Biggert's co-sponsorship is vital as she helped originally craft NCLB and serves on the Education and Labor Committee, which will help move forward the FIT Kids legislation.
Follow the link below or call to thank Representative Biggert for being a leader on this important legislation:
OR
Call Rep. Biggert at 630-655-2052 to Thank Her for Co-sponsoring the Fit Kids Act.
The message is simple: Thank You for Supporting the Fit Kids Act.
*Note: If you call Representative Biggert's' office, please let us know by e-mailing Melissa Horn, Grassroots Advocacy Director at Melissa.Horn@heart.org
Want to let your legislators know you support FIT Kids?!
Visit http://www.fitkidsact.org/ TODAY!
Visit http://www.fitkidsact.org/ TODAY!
Thursday, September 10, 2009
Statement by American Heart Association CEO Nancy Brown on President Obama’s Address to Joint Session of Congress on Health Care Reform
Washington, September 10, 2009 -- The President has reminded us that health care reform is not about politics, it’s about real people who wake up each day hoping that a medical emergency won’t throw them into bankruptcy. We all agree that the current health care system is not working well for the insured, it’s not working well for the underinsured and it’s certainly not working for the uninsured. That’s why we’re pleased the President has brought the debate back to where it started – focusing on the needs of Americans who cannot access affordable, quality health care. We cannot forget the children with congenital heart defects who surpass their lifetime insurance coverage limits before they’re toddlers, we cannot forget the families who lose their homes because of high out-of-pocket medical expenses to treat a chronic illness, and we cannot forget those who go without needed, even lifesaving care because they can’t access or afford insurance. Their stories must be the reason why Congress must continue in their efforts to find common ground and pass meaningful health reform this year. We urge Congress to not lose sight of the goal we all share - to build upon what works in our health care system and fix those parts that are broken and simply unsustainable.
Wednesday, September 9, 2009
For Chicago Public Schools, gym class finishes last
State requires physical education, district advises it, but schools aren't doing it
By Monica Eng
Tribune reporter
September 8, 2009
On paper, Chicago Public Schools' gym program sounds great.
The district boasts one of the country's strictest wellness policies, recommending 155 minutes to 225 minutes of physical education per week for elementary school students. And it's located in Illinois, one of only two states to require daily gym for students.
The problem is the district doesn't follow those rules. Several elementary schools surveyed by the Tribune reported offering gym class once a week, and a district spokeswoman said that was typical.
A lack of physical education may not seem urgent compared with other challenges Chicago schools face, from gang violence to a 50 percent dropout rate. But obesity experts say structured daily exercise is crucial for the city's schoolchildren, many of whom are at unusually high risk for weight-related health problems.
Federal data show Illinois suffers from the fourth highest level of childhood obesity in the nation, and other research has found children in Chicago are heavier than their counterparts in the rest of the state.
To put Chicago's physical education program in some context, the Tribune called four diverse districts in the area and found that Evanston-Skokie, Naperville, River Forest and Joliet all offered gym more often than Chicago.
The state can grant waivers to districts who argue they cannot provide daily gym, but officials said Chicago Public Schools has never applied for or received such a waiver for its elementary schools.
In e-mailed comments, district spokeswoman Monique Bond said the district faces a nearly "half-billion-dollar deficit this year and cannot afford to add additional programs that contain large new cost drivers without finding substantial new cost savings elsewhere."
Bond also said "scheduling PE five days a week would cut into instructional time, a priority that we must also carefully balance."
Supporters of physical education say that, far from impeding academic instruction, exercise makes students more receptive to learning. Many point to the work of Harvard Medical School clinical psychology professor John J. Ratey, who found physical exercise has direct neurological and intellectual benefits.
"A fast-paced workout boosts the production of a protein called brain-derived neurotrophic factor. I call it Miracle-Gro for the brain," Ratey wrote in his book "Spark: The Revolutionary New Science of Exercise and the Brain." "The end result is a brain that's better able to perform."
Responding to the district's economic objections, the Illinois Heart Association's Beth Mahar said that supporting physical education for Chicago students now would pay high dividends later.
"The money it takes to provide a child with daily PE now doesn't even come close to the money it will cost the nation or that child in terms of the chronic diseases they are looking at in the future," said Mahar, a former gym teacher on the heart association's advocacy committee. "If they don't establish healthy habits early on, the ballgame is over. And we are never going to catch up with that child."
Linda Wallace taught gym at Prescott Elementary School in Lincoln Park for more than six years but was laid off last spring when the position was reduced to half time.
She said she finds this sad personally and professionally, "but mostly I feel bad for the kids because they're the ones who really suffer."
The gym teacher said that last year she calculated the body mass index of students and found "a high percentage of kids who were overweight and even one 7th grader who qualified as morbidly obese."
"It's terrible," she said. "And the exercise they got at school was pretty much it, because they didn't do it at home. I know this because I was there for more than six years."
Julie Carter, a gym teacher at Carson Elementary School in Chicago, saw firsthand how districts can differ when she moved to the Chicago district after teaching in Wheaton and Berwyn, where she said students had gym much more often. "Also in the suburbs my students could play safely outside when they got home, a lot of their parents could afford to sign them up for after-school sports programs and they got recess every day," said Carter, president-elect of the Illinois Association for Health, Physical Education, Recreation and Dance's Chicago chapter.
Activists have been lobbying for more Chicago schools to offer recess; those who don't cite time, staffing and safety.
Holden Elementary School gym teacher Kathleen Cantone recalls that when she was a child in Chicago schools decades ago, "we walked to and from school every day and we walked home and back for lunch every day. Things are very different now."
Some suburban districts that offer more physical education than Chicago can do so in part because they have more resources, facilities and equipment.
But Joliet District 86, which also serves many low-income children, has found a way to incorporate exercise into the classroom, which doesn't require gyms or new teachers. The district requires teachers to conduct fitness exercises in class three days a week in addition to students' twice weekly gym classes.
"Our teachers know that in order for children to function well in a classroom they need physical activity periodically to perk them up and get them going again," said Carol Sossong, assistant superintendent for curriculum and instruction.
Advocates of physical education stress that today's "new gym" (actually about 20 years old) is much different from the humiliating dodge-ball games of yesteryear. Activities are offered in "a cooperative environment where students of all abilities experience success so they can enjoy being active through adulthood," Carter said.
According to the Illinois State Board of Education, about 30 percent of Illinois districts have received waivers that allow them to opt out of daily gym. But others, including Chicago and northwest suburban District U-46, have not applied for the waiver for their elementary schools despite failing to meet the mandate, according to the state board. Both did obtain waivers for high school students who meet certain requirements.
David Thomas, an exercise science professor at Illinois State University, looked at the issue in 2001 and found that a third of the districts followed the gym mandate, a third had obtained a waiver and "one-third operated as if they had the waiver when they didn't."
Critics say the waiver program, even when followed, makes it too easy for districts to neglect student fitness. Last year, the program was tightened to limit schools' use of the waivers to a maximum of six years -- and each waiver must now be applied for in two-year increments, with up to two extensions.
Still, there are few consequences for violating the rules. The state board said it has never sanctioned a district for non-compliance with the physical education law. And although the creation of wellness policies is federally mandated, actual implementation is not.
"There is no carrot and stick here," said Jamie Chriqui, senior research scientist at the University of Illinois at Chicago's Institute for Health Research and Policy.
Chriqui was the lead author on a study of wellness policy implementation that found even those districts that follow the letter of the law "aren't necessarily following the spirit of the law because these policies lack teeth."
Funded by the Robert Woods Johnson Foundation, the study was released in July to coincide with this fall's reauthorization of the federal Child Nutrition Act, which mandated the wellness policies in 2004. Chriqui is urging Congress to strengthen the law with national physical education standards, more specific language and a system for monitoring progress.
Bond said the Chicago district is "quite concerned about meeting ... compliance" with state physical education laws and is creating a task force to look at these issues.
As a veteran of Chicago schools, Cantone said she would like to see daily gym but acknowledges the issue is complex. "There are serious scheduling issues that would have to be considered, and we'd need to hire more gym teachers," she said. "It's a lot more complicated than people think. ... But if CPS really decided this was a priority, it would happen."
meng@tribune.com
Chicago Tribune
By Monica Eng
Tribune reporter
September 8, 2009
On paper, Chicago Public Schools' gym program sounds great.
The district boasts one of the country's strictest wellness policies, recommending 155 minutes to 225 minutes of physical education per week for elementary school students. And it's located in Illinois, one of only two states to require daily gym for students.
The problem is the district doesn't follow those rules. Several elementary schools surveyed by the Tribune reported offering gym class once a week, and a district spokeswoman said that was typical.
A lack of physical education may not seem urgent compared with other challenges Chicago schools face, from gang violence to a 50 percent dropout rate. But obesity experts say structured daily exercise is crucial for the city's schoolchildren, many of whom are at unusually high risk for weight-related health problems.
Federal data show Illinois suffers from the fourth highest level of childhood obesity in the nation, and other research has found children in Chicago are heavier than their counterparts in the rest of the state.
To put Chicago's physical education program in some context, the Tribune called four diverse districts in the area and found that Evanston-Skokie, Naperville, River Forest and Joliet all offered gym more often than Chicago.
The state can grant waivers to districts who argue they cannot provide daily gym, but officials said Chicago Public Schools has never applied for or received such a waiver for its elementary schools.
In e-mailed comments, district spokeswoman Monique Bond said the district faces a nearly "half-billion-dollar deficit this year and cannot afford to add additional programs that contain large new cost drivers without finding substantial new cost savings elsewhere."
Bond also said "scheduling PE five days a week would cut into instructional time, a priority that we must also carefully balance."
Supporters of physical education say that, far from impeding academic instruction, exercise makes students more receptive to learning. Many point to the work of Harvard Medical School clinical psychology professor John J. Ratey, who found physical exercise has direct neurological and intellectual benefits.
"A fast-paced workout boosts the production of a protein called brain-derived neurotrophic factor. I call it Miracle-Gro for the brain," Ratey wrote in his book "Spark: The Revolutionary New Science of Exercise and the Brain." "The end result is a brain that's better able to perform."
Responding to the district's economic objections, the Illinois Heart Association's Beth Mahar said that supporting physical education for Chicago students now would pay high dividends later.
"The money it takes to provide a child with daily PE now doesn't even come close to the money it will cost the nation or that child in terms of the chronic diseases they are looking at in the future," said Mahar, a former gym teacher on the heart association's advocacy committee. "If they don't establish healthy habits early on, the ballgame is over. And we are never going to catch up with that child."
Linda Wallace taught gym at Prescott Elementary School in Lincoln Park for more than six years but was laid off last spring when the position was reduced to half time.
She said she finds this sad personally and professionally, "but mostly I feel bad for the kids because they're the ones who really suffer."
The gym teacher said that last year she calculated the body mass index of students and found "a high percentage of kids who were overweight and even one 7th grader who qualified as morbidly obese."
"It's terrible," she said. "And the exercise they got at school was pretty much it, because they didn't do it at home. I know this because I was there for more than six years."
Julie Carter, a gym teacher at Carson Elementary School in Chicago, saw firsthand how districts can differ when she moved to the Chicago district after teaching in Wheaton and Berwyn, where she said students had gym much more often. "Also in the suburbs my students could play safely outside when they got home, a lot of their parents could afford to sign them up for after-school sports programs and they got recess every day," said Carter, president-elect of the Illinois Association for Health, Physical Education, Recreation and Dance's Chicago chapter.
Activists have been lobbying for more Chicago schools to offer recess; those who don't cite time, staffing and safety.
Holden Elementary School gym teacher Kathleen Cantone recalls that when she was a child in Chicago schools decades ago, "we walked to and from school every day and we walked home and back for lunch every day. Things are very different now."
Some suburban districts that offer more physical education than Chicago can do so in part because they have more resources, facilities and equipment.
But Joliet District 86, which also serves many low-income children, has found a way to incorporate exercise into the classroom, which doesn't require gyms or new teachers. The district requires teachers to conduct fitness exercises in class three days a week in addition to students' twice weekly gym classes.
"Our teachers know that in order for children to function well in a classroom they need physical activity periodically to perk them up and get them going again," said Carol Sossong, assistant superintendent for curriculum and instruction.
Advocates of physical education stress that today's "new gym" (actually about 20 years old) is much different from the humiliating dodge-ball games of yesteryear. Activities are offered in "a cooperative environment where students of all abilities experience success so they can enjoy being active through adulthood," Carter said.
According to the Illinois State Board of Education, about 30 percent of Illinois districts have received waivers that allow them to opt out of daily gym. But others, including Chicago and northwest suburban District U-46, have not applied for the waiver for their elementary schools despite failing to meet the mandate, according to the state board. Both did obtain waivers for high school students who meet certain requirements.
David Thomas, an exercise science professor at Illinois State University, looked at the issue in 2001 and found that a third of the districts followed the gym mandate, a third had obtained a waiver and "one-third operated as if they had the waiver when they didn't."
Critics say the waiver program, even when followed, makes it too easy for districts to neglect student fitness. Last year, the program was tightened to limit schools' use of the waivers to a maximum of six years -- and each waiver must now be applied for in two-year increments, with up to two extensions.
Still, there are few consequences for violating the rules. The state board said it has never sanctioned a district for non-compliance with the physical education law. And although the creation of wellness policies is federally mandated, actual implementation is not.
"There is no carrot and stick here," said Jamie Chriqui, senior research scientist at the University of Illinois at Chicago's Institute for Health Research and Policy.
Chriqui was the lead author on a study of wellness policy implementation that found even those districts that follow the letter of the law "aren't necessarily following the spirit of the law because these policies lack teeth."
Funded by the Robert Woods Johnson Foundation, the study was released in July to coincide with this fall's reauthorization of the federal Child Nutrition Act, which mandated the wellness policies in 2004. Chriqui is urging Congress to strengthen the law with national physical education standards, more specific language and a system for monitoring progress.
Bond said the Chicago district is "quite concerned about meeting ... compliance" with state physical education laws and is creating a task force to look at these issues.
As a veteran of Chicago schools, Cantone said she would like to see daily gym but acknowledges the issue is complex. "There are serious scheduling issues that would have to be considered, and we'd need to hire more gym teachers," she said. "It's a lot more complicated than people think. ... But if CPS really decided this was a priority, it would happen."
meng@tribune.com
Chicago Tribune
Tuesday, September 8, 2009
You're Invited! Join a Heart Walk in Your Area!
Heart Walk season is upon us and people throughout Illinois are advocating for heart healthy lifestyles by getting physical fit and educating their friends and family about our nation's top killers: heart disease and stroke!Not involved in a heart walk yet? No problem! It's easy to get involved! Follow the links below for more information:
Upcoming Heart Walk Event:
Got 2 Have Heart – Heart Walk Fundraiser
Time: 10pm
Entry:$10 Donation
Place: The Playground 3209 N Halsted St.Chicago, IL
Time: 10pm
Entry:$10 Donation
Place: The Playground 3209 N Halsted St.Chicago, IL
The evening will include great entertainment...the line up includes:
Musicians that will be tugging on your heart strings (Guitars)
Multimedia Musical Group
On Tap Chicago, Tap Dancing
2 Improv Groups, Rick, Oops Sorry and BP
Wednesday, September 2, 2009
Dangerous delays: Chicago ambulances lack equipment to detect the deadliest heart attacks early
3 hours, 6 minutes 50 minutes
Dangerous delays
Chicago ambulances lack equipment to detect the deadliest heart attacks early
By Judith Graham
Tribune reporter
September 2, 2009
3 hours, 6 minutes was how long after 911 was called before Roy Frazier, 81, of Chicago had a balloon angioplasty performed. His ambulance lacked a 12-lead EKG machine. (Tribune photo by Brian Cassella / August 7, 2009)
If you're struck by crushing chest pain in Los Angeles or Boston and call 911, an ambulance will bring equipment that can tell if you're having a "widowmaker" heart attack -- the most consistently deadly kind.
The information allows paramedics to alert hospitals immediately so doctors can prepare to administer potentially lifesaving treatments soon after you arrive.
That's how it works in many U.S. cities and many Chicago-area suburbs, from Aurora to Cicero to Waukegan. But not in Chicago.
None of the Chicago Fire Department's 75 ambulances carries equipment that can identify "widowmaker" heart attacks, or STEMIs, which occur when a major artery supplying blood to the heart is largely or completely blocked.
As a result, medical experts say, treatment is often delayed, increasing the chances that the patient will suffer permanent heart damage or die.
"The ugly truth is that Chicago is behind the times" on its emergency response, said Dr. John Kao, director of cardiology at the Jesse Brown Veterans Affairs Medical Center in Chicago. "We are doing a disservice to our patients."
The cost of buying the diagnostic equipment, called 12-lead EKGs, and training Chicago paramedics to use it is estimated at $4 million, less than 1 percent of the Fire Department's annual budget.
Chicago fire officials say they plan to buy the equipment when it can be incorporated into a broader plan for improving emergency medical services for patients with STEMI heart attacks.
"We are 100 percent behind this," said Marc Levison, assistant deputy fire commissioner for EMS operations.In the meantime, officials say, ambulances respond rapidly to emergency calls and patients aren't compromised.
"Our patient care has not suffered at this time," Levison said.Medical experts disagree, noting that because Chicago paramedics can't determine which people are having the potentially deadly heart attacks, hospitals can't mobilize the appropriate treatment in advance.
"There's no question that patients are sometimes compromised," said Dr. Richard Feldman, a medical director for part of Chicago's EMS system who is based at Advocate Illinois Masonic Medical Center.
For every 30-minute delay in treatment, the risk of dying from a STEMI heart attack rises substantially, said Dr. Peter Kerwin, who directs the cardiac catheterization laboratory at Advocate Good Samaritan Hospital in Downers Grove.
Nationally, about 400,000 people a year suffer STEMI heart attacks (the term stands for ST segment elevation myocardial infarction), and half die before reaching the hospital. Of those who get hospital treatment, another 10 percent to 15 percent die. A little more than 2,300 STEMI patients were treated in Cook County hospitals in 2007.
The American Heart Association has made improving care for STEMI heart attacks a national priority, and many suburbs and private ambulance services in the Chicago area have outfitted their ambulances with 12-lead EKGs over the last five years. When the Journal of Emergency Medical Services surveyed 34 major U.S. cities this year, Chicago was the only one that didn't have the equipment for emergency medical responders.
"The question you have to ask is, how big a priority is this for them?" said Dr. Charles Davidson, medical director of the cardiac catheterization laboratory at Northwestern Memorial Hospital. "It should be a priority, because lives are at stake."
Leslee Stein-Spencer, the Fire Department's manager of medical administration and regulatory compliance, said the department requested $4 million for 12-lead EKGs in 2008 but withdrew the request because of other operational needs. Another request for funding is now outstanding.
She also said officials have been meeting for more than six months with hospitals to discuss a plan for improving care for heart attacks. Davidson is one of the participants.
The 12-lead EKGs provide a detailed representation of the heart's electrical activity and identify key abnormalities. Paramedics place six leads, or electrodes, on a patient's arms and legs; the other six go on the chest.
Oak Park bought new software for its current monitors in two ambulances, upgrading them to 12-lead status this year. "It's changed our way of thinking and responding," said Bob Rehse, an EMS coordinator with the suburb's Fire Department.
"It's more obvious what's going on and it's more clear to us what we need to do," he said.
For Ken Roush, 75, of Glen Ellyn, rapid response by a suburban fire department helped lead to a full recovery from a massive heart attack that could have proved fatal last October.
Roush, who owns a marketing company, was on the way to a client meeting early in the morning when he started feeling "sweaty and clammy." Turning around, he went home and asked his wife to take him to a hospital. Instead, she called 911.
When paramedics identified a STEMI at Roush's home, the cardiac catheterization lab at Advocate Good Samaritan Hospital was activated. Doctors and nurses met him at the hospital door, and 14 minutes later Roush's completely blocked left anterior descending artery was opened via an angioplasty procedure.
"I was lucky to live in this district," Roush said.
By contrast, in Chicago the electrocardiograms are done at the hospital, which slows things down by 15 to 20 minutes and in some cases much more, said Dr. John Lopez, director of interventional cardiology research at Loyola University Medical Center.
Although paramedics call in all suspected heart attacks, according to Stein-Spencer, medical experts say the information is of limited value.
"The cardiac cath lab isn't going to be activated off a phone call like that," Northwestern's Davidson said. If it were, he said, there would be too many cases where medical teams mobilized unnecessarily.
During the day, such teams may be able to assemble relatively quickly. But at night, doctors and nurses on call may be at home, adding to delays.
Complicating the situation, only about half of Chicago's hospitals can perform the preferred treatment for STEMI heart attacks -- balloon angioplasty -- expeditiously around the clock, Feldman said. Yet the Fire Department takes heart attack patients to the closest hospital, regardless of its medical expertise.
Balloon angioplasty involves snaking a catheter through the groin to the site of a blood clot and inserting a thin wire with a tiny balloon. Inflating the balloon destroys the clot, and blood flow resumes.
Most hospitals can administer clot-busting drugs to patients with STEMI heart attacks, but 25 to 40 percent of the time, these don't work, said Dr. Atman Shah, interventional cardiologist at the University of Chicago Medical Center.
Roy Frazier, 81, experienced gaps in care that can occur in Chicago when he had a heart attack in February. Frazier knew what to do after he began to feel a burning sensation in his chest -- he'd had a first heart attack 10 years ago -- and quickly called 911.
He recalls asking dispatchers to take him to the University of Chicago, his regular hospital. Instead, the ambulance rushed him to St. Bernard Hospital, which was closest to his home but wasn't able to perform balloon angioplasty.
Since the ambulance didn't have a 12-lead EKG, Frazier had to get that test at St. Bernard. After more than an hour and a half there, he was transferred to the University of Chicago, where doctors opened his right coronary artery, which was 99 percent blocked.
It's likely Frazier's heart was permanently damaged because he didn't get the medical intervention sooner, said Dr. Neeraj Jolly, senior interventional cardiologist at the U. of C. Medical Center.
"We see this all the time: patients who get taken to the ER of a hospital that does not have the capacity to do emergency angioplasty and then are transferred here and their outcomes are worse," Jolly said.
"It's a bad policy they've got right now, taking you to the closest hospital instead of the right hospital for you," Frazier said.
Other cities have made different arrangements. For instance, for several years Los Angeles ambulances have taken patients to designated "STEMI ready" medical centers, bypassing closer hospitals.
The Chicago Fire Department and local hospitals are discussing a similar setup, but there's little agreement so far on what it might look like.
The Fire Department wants to ensure that "citizens get equal care throughout the city," said Levison, the EMS official. That's difficult because North Side hospitals tend to be better funded and have more robust cardiology programs.
Also, no hospital wants to be identified as not being able to deliver the best care. And medical providers that might be bypassed don't want to lose business.
Meanwhile, experts agree it's better to call 911 and let paramedics come to your aid than to ignore symptoms of a potential heart attack or drive to a hospital on your own -- in Chicago and the suburbs.
Roush was among the patients who thought: "I don't want to inconvenience the paramedics. What if they get here and nothing is wrong?" Now, he's glad his wife called 911.
"If everyone knew not to deny what is happening, not to put it off, to call for help," he said, "that would be a very good thing."
www.chicagotribune.com/health/chi-ambulances-heart-attacks-02-sep02,0,7168938.story
jegraham@tribune.com
Chicago Tribune
Dangerous delays
Chicago ambulances lack equipment to detect the deadliest heart attacks early
By Judith Graham
Tribune reporter
September 2, 2009
3 hours, 6 minutes was how long after 911 was called before Roy Frazier, 81, of Chicago had a balloon angioplasty performed. His ambulance lacked a 12-lead EKG machine. (Tribune photo by Brian Cassella / August 7, 2009)
If you're struck by crushing chest pain in Los Angeles or Boston and call 911, an ambulance will bring equipment that can tell if you're having a "widowmaker" heart attack -- the most consistently deadly kind.
The information allows paramedics to alert hospitals immediately so doctors can prepare to administer potentially lifesaving treatments soon after you arrive.
That's how it works in many U.S. cities and many Chicago-area suburbs, from Aurora to Cicero to Waukegan. But not in Chicago.
None of the Chicago Fire Department's 75 ambulances carries equipment that can identify "widowmaker" heart attacks, or STEMIs, which occur when a major artery supplying blood to the heart is largely or completely blocked.
As a result, medical experts say, treatment is often delayed, increasing the chances that the patient will suffer permanent heart damage or die.
"The ugly truth is that Chicago is behind the times" on its emergency response, said Dr. John Kao, director of cardiology at the Jesse Brown Veterans Affairs Medical Center in Chicago. "We are doing a disservice to our patients."
The cost of buying the diagnostic equipment, called 12-lead EKGs, and training Chicago paramedics to use it is estimated at $4 million, less than 1 percent of the Fire Department's annual budget.
Chicago fire officials say they plan to buy the equipment when it can be incorporated into a broader plan for improving emergency medical services for patients with STEMI heart attacks.
"We are 100 percent behind this," said Marc Levison, assistant deputy fire commissioner for EMS operations.In the meantime, officials say, ambulances respond rapidly to emergency calls and patients aren't compromised.
"Our patient care has not suffered at this time," Levison said.Medical experts disagree, noting that because Chicago paramedics can't determine which people are having the potentially deadly heart attacks, hospitals can't mobilize the appropriate treatment in advance.
"There's no question that patients are sometimes compromised," said Dr. Richard Feldman, a medical director for part of Chicago's EMS system who is based at Advocate Illinois Masonic Medical Center.
For every 30-minute delay in treatment, the risk of dying from a STEMI heart attack rises substantially, said Dr. Peter Kerwin, who directs the cardiac catheterization laboratory at Advocate Good Samaritan Hospital in Downers Grove.
Nationally, about 400,000 people a year suffer STEMI heart attacks (the term stands for ST segment elevation myocardial infarction), and half die before reaching the hospital. Of those who get hospital treatment, another 10 percent to 15 percent die. A little more than 2,300 STEMI patients were treated in Cook County hospitals in 2007.
The American Heart Association has made improving care for STEMI heart attacks a national priority, and many suburbs and private ambulance services in the Chicago area have outfitted their ambulances with 12-lead EKGs over the last five years. When the Journal of Emergency Medical Services surveyed 34 major U.S. cities this year, Chicago was the only one that didn't have the equipment for emergency medical responders.
"The question you have to ask is, how big a priority is this for them?" said Dr. Charles Davidson, medical director of the cardiac catheterization laboratory at Northwestern Memorial Hospital. "It should be a priority, because lives are at stake."
Leslee Stein-Spencer, the Fire Department's manager of medical administration and regulatory compliance, said the department requested $4 million for 12-lead EKGs in 2008 but withdrew the request because of other operational needs. Another request for funding is now outstanding.
She also said officials have been meeting for more than six months with hospitals to discuss a plan for improving care for heart attacks. Davidson is one of the participants.
The 12-lead EKGs provide a detailed representation of the heart's electrical activity and identify key abnormalities. Paramedics place six leads, or electrodes, on a patient's arms and legs; the other six go on the chest.
Oak Park bought new software for its current monitors in two ambulances, upgrading them to 12-lead status this year. "It's changed our way of thinking and responding," said Bob Rehse, an EMS coordinator with the suburb's Fire Department.
"It's more obvious what's going on and it's more clear to us what we need to do," he said.
For Ken Roush, 75, of Glen Ellyn, rapid response by a suburban fire department helped lead to a full recovery from a massive heart attack that could have proved fatal last October.
Roush, who owns a marketing company, was on the way to a client meeting early in the morning when he started feeling "sweaty and clammy." Turning around, he went home and asked his wife to take him to a hospital. Instead, she called 911.
When paramedics identified a STEMI at Roush's home, the cardiac catheterization lab at Advocate Good Samaritan Hospital was activated. Doctors and nurses met him at the hospital door, and 14 minutes later Roush's completely blocked left anterior descending artery was opened via an angioplasty procedure.
"I was lucky to live in this district," Roush said.
By contrast, in Chicago the electrocardiograms are done at the hospital, which slows things down by 15 to 20 minutes and in some cases much more, said Dr. John Lopez, director of interventional cardiology research at Loyola University Medical Center.
Although paramedics call in all suspected heart attacks, according to Stein-Spencer, medical experts say the information is of limited value.
"The cardiac cath lab isn't going to be activated off a phone call like that," Northwestern's Davidson said. If it were, he said, there would be too many cases where medical teams mobilized unnecessarily.
During the day, such teams may be able to assemble relatively quickly. But at night, doctors and nurses on call may be at home, adding to delays.
Complicating the situation, only about half of Chicago's hospitals can perform the preferred treatment for STEMI heart attacks -- balloon angioplasty -- expeditiously around the clock, Feldman said. Yet the Fire Department takes heart attack patients to the closest hospital, regardless of its medical expertise.
Balloon angioplasty involves snaking a catheter through the groin to the site of a blood clot and inserting a thin wire with a tiny balloon. Inflating the balloon destroys the clot, and blood flow resumes.
Most hospitals can administer clot-busting drugs to patients with STEMI heart attacks, but 25 to 40 percent of the time, these don't work, said Dr. Atman Shah, interventional cardiologist at the University of Chicago Medical Center.
Roy Frazier, 81, experienced gaps in care that can occur in Chicago when he had a heart attack in February. Frazier knew what to do after he began to feel a burning sensation in his chest -- he'd had a first heart attack 10 years ago -- and quickly called 911.
He recalls asking dispatchers to take him to the University of Chicago, his regular hospital. Instead, the ambulance rushed him to St. Bernard Hospital, which was closest to his home but wasn't able to perform balloon angioplasty.
Since the ambulance didn't have a 12-lead EKG, Frazier had to get that test at St. Bernard. After more than an hour and a half there, he was transferred to the University of Chicago, where doctors opened his right coronary artery, which was 99 percent blocked.
It's likely Frazier's heart was permanently damaged because he didn't get the medical intervention sooner, said Dr. Neeraj Jolly, senior interventional cardiologist at the U. of C. Medical Center.
"We see this all the time: patients who get taken to the ER of a hospital that does not have the capacity to do emergency angioplasty and then are transferred here and their outcomes are worse," Jolly said.
"It's a bad policy they've got right now, taking you to the closest hospital instead of the right hospital for you," Frazier said.
Other cities have made different arrangements. For instance, for several years Los Angeles ambulances have taken patients to designated "STEMI ready" medical centers, bypassing closer hospitals.
The Chicago Fire Department and local hospitals are discussing a similar setup, but there's little agreement so far on what it might look like.
The Fire Department wants to ensure that "citizens get equal care throughout the city," said Levison, the EMS official. That's difficult because North Side hospitals tend to be better funded and have more robust cardiology programs.
Also, no hospital wants to be identified as not being able to deliver the best care. And medical providers that might be bypassed don't want to lose business.
Meanwhile, experts agree it's better to call 911 and let paramedics come to your aid than to ignore symptoms of a potential heart attack or drive to a hospital on your own -- in Chicago and the suburbs.
Roush was among the patients who thought: "I don't want to inconvenience the paramedics. What if they get here and nothing is wrong?" Now, he's glad his wife called 911.
"If everyone knew not to deny what is happening, not to put it off, to call for help," he said, "that would be a very good thing."
www.chicagotribune.com/health/chi-ambulances-heart-attacks-02-sep02,0,7168938.story
jegraham@tribune.com
Chicago Tribune
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