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Seconds matter
Rich Serino should know a thing or two about heart attacks.
He has worked at Boston Emergency Medical Services (EMS) for the last 34 years and has been chief since 1999.
In the last year alone, Boston EMS responded to 6,894 calls involving cardiac distress across the city. Nearly 35 percent of those calls were made from Roxbury, Dorchester and Mattapan.
By way of comparison, Boston EMS responded to about 439 calls involving gunshots — and many of them didn’t require sending emergency personnel. In all, Boston EMS responded to 97,344 ambulance calls last year.
Heart attacks are a priority.
“The first thing that people have to recognize is that they must call 911,” Serino said. “Time is of the essence. There are so many more things that doctors can do in a hospital, so someone is much better off the sooner we can get to them.”
On average, it takes Boston EMS a little more than six minutes to arrive at a caller’s door. The department has 20 ambulances and other vehicles to transport emergency cases and uses 11 different emergency rooms throughout the city.
But it starts with the telephone call to 911. A call-taker at police headquarters in Roxbury routes the call to police, fire or medical. For medical, a trained Emergency Medical Technician (EMT) determines the level of urgency by asking basic questions at first — address, telephone number — and then more medical questions, starting with a description of the symptoms.
If the situation requires immediate attention and response, the EMT then dispatches an emergency vehicle to the location and, if needed, is able to deliver medical instructions — cardiopulmonary resuscitation (CPR), for example — over the telephone while the ambulance is en route.
Let’s say a caller is experiencing chest pains and shortness of breath. The call is immediately categorized as a high priority and given preference over lower priority calls such as fractures, minor injuries or wound infections.
The questions might seem time-consuming but are important to make sure you receive the appropriate help for your particular situation. Do you have chest pains? When did they start? What were you doing when they started? Was the pain intense right away or did it gradually get worse? Do you have other symptoms – nausea, sweating, light-headedness? How bad is the discomfort?
The emergency crew is equipped with advanced life support, 12-lead electrocardiograms (EKGs), oxygen tanks and all sorts of medicines — everything from adult aspirin to nitroglycerin and morphine. In other words, it’s an emergency room on wheels.
Once on site, emergency medical personnel can take vital signs, assess your medical condition and, with a defibrillator, get a stopped heart pumping again. Using an EKG, they can record the electrical activity of the heart, as well as abnormal blood flow and irregular heartbeats. The EKG will tell them if a heart attack has occurred and the extent of damage. They can administer nitroglycerin to relax blood vessels and morphine to ease the pain.
Communication is critical. En route to the hospital room, an EMT calls in to the emergency room. They determine where a patient should be taken. Depending on the situation, it could be to the emergency room or directly to a lab that is equipped with cardiac catheterization equipment to immediately diagnose and treat the attack.
But Serino is quick to point out that none of the city’s emergency services can start without that initial telephone call to 911.
He explained that in some cases, a person having a heart attack either doesn’t recognize the symptoms or is in denial. “The biggest lag time we have in getting [our personnel] to a call is getting a patient to recognize that they are having a cardiac event,” Serino said. “Sometimes a person is in serious denial, believing that they couldn’t be having a heart attack because they believe they are healthy.”
All too often, that simply is not true, and in heart attack cases, seconds matter. “We can get to you pretty quickly,” Serino said. “And what we are really doing is bringing an emergency room to your house.
But the biggest lag time that we have is getting people to initiate the telephone call.” |
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