Last modified: Friday, February 29, 2008 12:40 AM EST Dr. Brian Kelley, associate chief of emergency services at Sturdy Memorial Hospital. (Staff photo by Mark Stockwell) Sturdy teams up with Rhode Island Hospital to help heart attack victims BY GLORIA LaBOUNTY SUN CHRONICLE STAFF ATTLEBORO - When heart attack patients are rushed to Sturdy Memorial Hospital in Attleboro, the emergency room staff has a strict timeframe in mind. The protocol is to treat the person initially, then transport to Rhode Island Hospital in Providence, where doctors aim to quickly open the blocked artery with a balloon catheter - and to do it all within 90 minutes. It's called "door to balloon time," the period that starts with the patient's arrival at the hospital door to the moment when the catheter successfully opens the artery. Medical professionals aim at a 90-minute window to reduce the severity of heart attacks, and that goal is now being met and even exceeded through a cooperative effort between the two hospitals. Dr. Brian Kelly, associate chief for emergency and ambulatory services at Sturdy, said the average time for treating heart attack patients in 2006 was 120 minutes, but in the last three months the hospital has been averaging 87 minutes, a rarity for community hospitals. When treatment is completed within that window, the survival rate is extremely high, Kelly said. Dr. David Williams, director of the cardiovascular laboratory and interventional cardiology at Rhode Island Hospital, said if blood flow is restored early in heart attack patients, the heart muscles can be salvaged, so the attack is not as big as it otherwise would be. The most important time period, he said, is the first couple of hours. "We are really on the clock," he said. Working cooperatively, the two hospitals have established a system of getting patients quickly through the process. When a heart attack patient arrives at Sturdy, a team including a doctor and several nurses is ready to perform an electrocardiogram and to administer blood-thinning drugs while a secretary contacts Rhode Island Hospital and arranges for an ambulance or rescue vehicle. The patient is then transported to Providence, a trip that takes about 15 minutes. Another team is ready at Rhode Island Hospital to get the patient into the catheterization laboratory, which is now located in the emergency room. There the doctor determines which artery is blocked, then inserts the catheter and opens the balloon to restore the blood flow. Williams said at one time, the procedure was completed within 90 minutes for only 39 percent of cases, but last year 92 percent came within the timeframe. That's good news for patients either going directly to Rhode Island Hospital or going first to Sturdy. Kelly said patients from this area are taken straight to Providence if the driving time is quicker. Otherwise they go to Sturdy, and paramedics can even take the EKG on board the ambulance, so the data is ready when they arrive at the hospital, which can save a few minutes. Kelly said emergency procedures at Sturdy have been refined so no time is wasted once the patient arrives. "It's almost like a drill," he said. The same approach has been taken at Rhode Island Hospital, where a protocol was developed for emergency room staff, who have been trained to do only the essentials to reduce the treatment time. If the emergency occurs during off-hours, a medical team is always on call and is contacted immediately when the hospital is notified that a patient is being sent there. Williams said the goal is to get the team there within 30 minutes, and that means it will be there by the time a patient arrives from Sturdy. The Providence hospital has also reduced treatment time by installing a catheter lab in the emergency room, rather than taking patients to another part of the hospital for the procedure, a change that cut up to 15 minutes, Williams said. As a community hospital, Sturdy does not have a catheter lab for emergency care because of the cost and the amount of staff that would be required to be on call around the clock. Last year, only 27 heart attack patients were treated first at Sturdy and then at Rhode Island Hospital. But Kelly said one advantage of bringing heart attack patients to Sturdy first is that the team at Rhode Island Hospital can be mobilized immediately, and drugs can be administered before transport. Williams said Kelly has been very instrumental in making the procedure successful between the two hospitals. The partnership, he said, has even become a model for other hospitals, and was the subject of a presentation earlier this month at a conference in Florida of the Voluntary Hospital Association. Williams, who is involved in efforts at a national level to improve care for heart attack patients, said the relationship with Sturdy is one that his hospital does not even have with other hospitals in Rhode Island. He attributes it to the ability of the two institutions to "relate, interact and communicate." Kelly said the key for patients is that they come to the hospital immediately after warning signs like chest pains, shortness of breath or unusual indigestion. And he said they should call 9-1-1 and not be driven by car because paramedics can administer emergency care if the patient should go into cardiac arrest. "People should realize there is great treatment" available, Kelly said. "If they get to the hospital, the survival rate is incredibly high."