Eight emergency medicine innovations that could save your life.
by Cassie Richardson
If you're feeling stressed out by your job, listen up! Having a highly demanding job, combined with a heavy workload and the belief that you have little control over how or at what pace the work must be done, can put your heart at risk.
A 2012 study of 200,000 men and women working in seven European countries concluded that employees who suffer from psychological stress on the job are more likely to develop a heart attack or die from heart disease than their peers who perceive their jobs as less stressful.
While other factors including smoking, poor nutrition and lack of exercise contribute to heart disease much more than your 9-to-5, job strain increases the risk for heart attack by 23 percent, the British study reports. Although this study doesn't prove that hard work will kill you, it reminds us that lifestyle contributes to heart disease. And with heart disease ranking as the leading cause of death among Hoosiers, this study also points to the importance of knowing what to do if ever faced with a heart episode.
If you think you've been having symptoms of a heart attack for five minutes, call 911, says Connie Adams, a cardiovascular clinical nurse specialist at Methodist Hospital in Gary. When a heart attack strikes, minutes count. The longer a heart attack goes untreated, the more damage it causes to heart muscle tissue. Therefore, receiving prompt treatment to open blocked arteries in the heart is crucial for a happy ending.
“The average person in our country waits a couple of hours before coming to the ER and many people drive themselves, which is very dangerous. But by calling 911 we can activate emergency medical services and start your heart attack care in your living room,” Adams says.
Methodist Hospital now equips ambulances in its network with portable EKG machines that alert the staff and send real-time readings of patients' heart activity to an emergency room computer screen. This helps the ER team make all the necessary arrangements before the patient arrives, shaving valuable minutes from the time between patient arrival and treatment.
Methodist Hospital is not alone in adding lifesaving technology to its scope of emergency care. Hospitals across Northwest Indiana are investing in leading-edge medical innovations that promise to bring better, faster crisis care to patients who live, work and travel through the region. Take a look at these lifesaving medical technologies that have recently become available in an emergency department near you:
ER ULTRASOUND
Although ultrasound has been around for years, its use in South Bend's Memorial Hospital emergency department stands as the top lifesaving technology to arrive in recent years.
“Ultrasound, certainly in the last five years in our department, has had a huge impact because we're able to do bedside ultrasound on patients right in the resuscitation room,” says Keith Sherry, M.D., medical director of Memorial Hospital Emergency Services. “We use it for a variety of things. But the number one thing that we use it for is in trauma patients” to quickly determine whether a patient has bleeding or abnormal fluid inside the abdomen.
Recently, physicians used this technology to save a patient who arrived in the ER with severe injuries from a car accident, then had a cardiac arrest shortly afterward. “Most patients who have a blunt trauma and have a cardiac arrest, even if it happens after they get to the emergency department, most of the time die because it's not [immediately] clear what's going on with them,” Dr. Sherry says.
An ER physician administered a Focused Abdominal Sonography for Trauma (FAST) test, and discovered a rupture in the patient's heart. The physician paged a thoracic surgeon, who drained the leaking fluid around the heart, which bought enough time to move the patient to an operating room for surgery.
Thanks to the FAST test, the patient survived and made a full recovery. Without it, “the chances of discovering [a heart rupture] among all of the things that could have caused this patient's death would have been very, very low. It's not something you could discover any other way except with sonography,” Dr. Sherry explains.
STROKE CARE ROBOT
Local emergency departments are leveraging two-way communication technology to offer the care of neurologists to stroke patients, 24 hours a day, seven days a week.
Stroke patients may receive emergency treatment in the form of a potent, clot-busting medication, which should be administered as soon as possible after the onset of symptoms. Because this medicine can have strong side effects, an ER physician may want to consult with a neurologist if the patient's situation is a little unclear.
At Porter Regional Hospital in Valparaiso, “We have an actual robot in our ER that's connected to Loyola University in Chicago,” says Michael Woods, M.D., medical director of the Porter Regional Hospital emergency department. Porter does not staff a full-time neurologist, but with the help of its new robot, patients can benefit from a neurologist's expertise around the clock.
“It's truly an amazing thing where we can bring a highly skilled person out of Chicago right into our emergency room, right into the room of the patient. [The neurologist] can examine the patient through that,” Dr. Woods says.
Porter Regional's robot consists of a monitor with a video camera, which allows a consulting neurologist to speak with the patient in his or her room and examine any neurological deficits. “It's like a Skype-type setup.” Also, the robot is on wheels and includes a GPS monitor, so the neurologist can drive it around the emergency room from his or her remote location.
“It speeds up time, the accuracy of the examination, and the accuracy of information that's being provided to the neurologist, who's making a very critical decision for our patient,” says Dr. Woods.
The emergency department at Indiana University Health LaPorte Hospital uses similar technology to consult with neurologists on call from other campuses within the IU Health system, when that hospital's neurologists are not physically in the building. Likewise, Memorial Hospital's emergency department uses two-way communication technology to connect stroke patients to area specialists when staff neurologists are not in the hospital.
THERAPEUTIC HYPOTHERMIA
Cardiac arrest patients are not only at risk for heart damage. When the heart stops, the flow of oxygen to the brain decreases, which also puts these patients at risk for seizures, brain swelling, permanent brain damage or death.
“You can fix the heart easily with the cath lab. The cardiologist goes in, puts a catheter, puts a stent, fixes the heart. But then after the heart is fixed, you have the brain issue to worry about,” says Wassim Shwaiki, M.D., an intensivist/pulmonologist and associate director of the St. Catherine Hospital intensive care unit.
The good news is “hypothermia improves the outcome in the brain injury,” Dr. Shwaiki adds. By lowering body temperatures to about 93 degrees, physicians can slow down the body's need for oxygen and minimize significant brain damage caused by cardiac arrest.
At St. Catherine Hospital, physicians reduce brain injuries in cardiac arrest patients with a hypothermia catheter. This piece of equipment is part of an intravascular temperature system that cools the bloodstream with tiny intravenous balloons filled with cold water. When inserted into a major artery, typically in the groin, after the heart blockage is addressed, the catheter lowers body temperature quickly and precisely.
“Since we've had this protocol and using this specific catheter, our outcomes have improved. We have fewer mortalities and brain injuries in patients who get hypothermia protocol after cardiac arrest,” Dr. Shwaiki says.
PHYSICIAN TEXT MESSAGING
Franciscan Healthcare-Munster expects its new emergency department–slated for a 2015 opening–to receive a number of emergency referrals from ambulatory care physicians in its network. More than likely, these patients will need to be admitted to the hospital.
So, to get these patients into a hospital bed and treated as quickly as possible, the Franciscan Healthcare system will soon install software that will allow referring physicians to start the admitting process before their patient reaches the ER.
This software, called the Direct Admit System for Hospital (DASH) program, will allow referring physicians to prepare a form that lists much of the information emergency room doctors will need to treat the patient upon arrival. This form “would summarize in an electronic format what's going on with the patient; obviously, all the patient demographics, what medications they may be on, and [then] actually text message it to the patient,” says Barb Greene, president of Franciscan Healthcare-Munster.
Patients will use this text message as a boarding pass that will facilitate that patient's fast and efficient check-in.
PSYCHIATRIC TELEMEDICINE
Telemedicine is a virtual communication system that helps ER physicians at Indiana University Health LaPorte Hospital leverage the expertise of psychiatrists located at other IU Health locations.
Like many community emergency departments, IU's LaPorte campus receives patients seeking psychiatric help. Some of these patients are homicidal, suicidal or acutely psychotic and pose an immediate threat to themselves or others. “The challenge is we have to get a psychiatrist face-to-face with the patient as soon as possible so we can safely disposition them,” says James Leonard, M.D., director of emergency services at IU Health LaPorte.
LaPorte's 13-bed emergency department does not staff a full-time psychiatrist (also like many community hospitals), so telemedicine makes it possible to connect patients with a psychiatrist who can determine whether it's best to transfer a patient to an inpatient facility, or send the patient home safely with urgent follow-up instructions.
To leverage this technology, an ER staff member places a monitor in the patient's room and explains that he or she will have a virtual interview with a psychiatrist. The psychiatrist will then conduct the interview while sitting in his or her office at another location. Both doctor and patient can see each other during this detailed discussion about what brought the patient to the emergency department.
Before telemedicine, ER doctors had to provide a synopsis and describe patient's symptoms to the evaluating psychiatrist by phone. “Now, with this new technology, you get direct patient to physician interaction with the patient and psychiatrist, which optimizes proper medical decision-making as to where the patient goes–home or to a psychiatric facility,” Dr. Leonard says.
Telemedicine is reserved for patients with emergent psychiatric symptoms that could be life-threatening.
PORTABLE X-RAY EQUIPMENT
The emergency department at Porter Regional Hospital in Valparaiso has a new portable x-ray machine. This technology has become a game-changer in trauma situations because it provides fast and accurate pictures doctors may need to save lives.
In addition to giving physicians flexibility to capture medical images in the room with a patient, the equipment can display that image on a computer screen, immediately. “What that does in trauma situations when we're trying to rule out if someone needs a chest tube or have something very serious going on when we need to intervene right away, we can get that image immediately,” Dr. Woods explains.
In earlier years, without this equipment, Dr. Woods remembers feeling anxious during the process of waiting for the patient to take x-rays in the radiology suite, then waiting again for the film to be developed, presented and taken to a viewer where it could be read.
“It would be very nerve-wracking,” he says. The newer technology “saves a lot of time for fast decision-making and better patient care. Definitely technology leads to better patient care in my mind.”
Similarly, Memorial Hospital uses portable x-ray equipment with trauma patients.
THROMBOELASTOGRAPHY (TEG)
Memorial Hospital, in partnership with the University of Norte Dame, is studying the values of using thromboelastography–a super-sophisticated blood clotting test–in ER trauma patients.
“This is cutting edge. Even at big trauma centers, they do not do a lot of this. Memorial has really been a pioneer in the use of thromboelastography,” Dr. Sherry says.
Thromboelastography uses an electrical device to analyze a tiny bit of blood to produce a complex, graphical representation of the blood's entire clotting mechanism. This information is proving to be extremely important in managing trauma patients' bleeding, as well as helping those who are very sick and/or taking anti-coagulant medications.
“It's an enormous investment, but [this test] has allowed us to tailor the treatment of clotting disorder in trauma patients and other patients really incredibly. There is definitely a return on investment,” he explains, adding that besides saving patient lives, TEG helps physicians use blood products in better targeted and more cost efficient ways.
PORTABLE EKG
Methodist Hospital's portable EKG technology (mentioned above) is part of a comprehensive radio system, called Care Points. In addition to alerting and sending information to hospital emergency rooms, the system alerts the cardiologist on-call, via text message. Soon, emergency crews are expected to receive video equipment that will help ER staff visually assess patients' conditions while en route to the hospital.
So far, the impact of this new technology has been remarkable, says Cindy Mele, R.N., interim director of emergency services. Methodist continuously exceeds national expectations that heart attack patients receive treatment to open blocked heart arteries within 90 minutes of their arrival at the ER.
“We are breaking some phenomenal records,” Mele says. “We are having patients who are coming in from the field and getting to the cath lab and having their arteries opened within 18 minutes, which is way, way, way above the standard. And that's saving lives.”
