Cardiac arrested

www.chicagotribune.com/news/opinion/chi-1022edit2oct22,0,716256.story

October 22, 2009

If you're struck by a heart attack in Los Angeles, Boston or many Chicago suburbs, you're fortunate in at least one way: The ambulance that speeds you to the hospital is outfitted with the latest in high-tech equipment to help save your life. It's a device called a 12-lead EKG and it is designed to let paramedics and hospitals know quickly if you're having a so-called STEMI, or "widowmaker," heart attack. That's the kind in which a major artery to the heart is largely or completely blocked. It's the kind that most consistently kills.

But heart attack victims in Chicago aren't so lucky. Not one of the Chicago Fire Department's 75 ambulances carries these advanced EKGs, Tribune reporter Judith Graham has reported.

"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.

Why isn't Chicago keeping pace with Waukegan, Winnetka, Franklin Park, Bolingbrook, Bensenville, Aurora, Arlington Heights, La Grange -- and many more suburbs that outfitted ambulances with these machines?

The Fire Department explanation:

1. Money. The cost of buying the equipment and training Chicago paramedics is estimated at $4 million.

2. Protocol. Fire Department ambulances operate under strict rules: They rush heart attack patients to the nearest hospital. But the new equipment would complicate that decision. Some hospitals aren't ready to treat STEMI (short for ST segment elevation myocardial infarction) heart attacks. They don't have special teams ready to perform emergency balloon angioplasty around the clock. Only about half of Chicago's hospitals can do that, and many are on the North Side. Sounds like a hospital turf war brewing.

Chicago fire officials say there's no reason to buy expensive EKGs before everyone agrees on rules that will establish equal care for every neighborhood across the city.

Health care professionals have a different view, a different sense of urgency. For the last year or so, the American Heart Association has led a drive called Mission: Lifeline to bring 12-lead EKGs to Chicago.

But right now it should be called Mission: Life Support because progress is frustratingly slow. What the effort needs, says Anne Gavic-Ott, the director of Mission: Lifeline, is a leader who will say, "This is a priority. Get it done."

We know money is very tight (see the editorial at left). If Chicago can't start now with a buying program, private givers ought to step up. As for the rules, many cities and towns in Illinois have figured that out. They've done so because hospitals and ambulance operators got together and worked out the rules.

Couldn't Chicago take its cue from them? How about rolling out a pilot program? Northwestern Memorial Hospital offered to launch such a program a couple of years ago but talks with the Fire Department "never went anywhere," says Dr. Charles Davidson, medical director of the cardiac catheterization laboratory at Northwestern Memorial.

Why not plug into the hospitals that are ready right now to receive radio transmissions of the vital EKG information from an ambulance? Or a fax.

Even if EMS workers hand-carried the information from the EKGs into the emergency room, they'd still save a minimum of 10 to 15 critical minutes.

A heart attack victim in an ambulance doesn't want to hear about endless talks.

Let's focus on what's best for patients and get this done.

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