Heart Attack Response and Transport Protocol by Ambulances

The immediate response to a heart attack by an ambulance team is crucial in determining the patient's survival rate and the degree of recovery. Understanding the measures taken and the speed of transport can significantly impact the outcome.

Initial Response and Assessment

Upon arrival at the scene of a potential heart attack, the EMTs conduct a rapid and targeted assessment. This initial step involves obtaining a 12-lead EKG to identify any signs of an ST-elevation myocardial infarction (STEMI).

STEMI is often the cause of heart attacks, and if confirmed, the EMTs initiate an intravenous (IV) line, administer medications, and contact the nearest hospital equipped to handle such cases. They also provide the hospital with a report, potentially send a copy of the EKG, and administer aspirin and nitroglycerin (nitro) to alleviate symptoms. The patient is then promptly transported to the hospital where an emergency response team is already prepared with the necessary equipment.

Quick Transport to the Hospital

The duration of the transport depends on the distance from the patient's location to the hospital. However, the motto is to transport as quickly as possible, adhering to legal speed limits, to ensure rapid intervention. This rapid transport is crucial given that timely medical intervention significantly improves the patient's chances of survival and recovery.

Upon arrival at the emergency room (ER), a nurse takes a report from the EMTs, while others prepare to treat the patient. The ER team will likely place the patient on a bed, administer medications, and potentially perform more tests. In cases where the right side of the heart is involved, morphine may be given to reduce preload, and the patient's groin may be shaved for a potential catheterization procedure. The catheterization can be performed within minutes, and the nurse will follow the patient to the catheterization lab to ensure a smooth transition.

Emergency Cardiac Arrest Response

In the case of a cardiac arrest, immediate action is paramount. The primary steps include continuing cardiopulmonary resuscitation (CPR) and defibrillation to restore normal heart rhythm. The use of drugs and other interventions is also carried out until the patient's spontaneous circulation is restored (return of spontaneous circulation, ROSC).

Once ROSC occurs, the patient is anaesthetized and intubated, placed on a ventilator, and then transported to a receiving hospital. In some cases, the patient may be transported by road or air to an intensive care unit (ICU) located further away if necessary. The nearest receiving hospital may be 250 kilometers away, emphasizing the importance of rapid response.

Primary Treatment and Outcomes

The primary goal is to keep the brain viable, which explains the emphasis on CPR to maintain blood flow throughout the body. Defibrillation is used to stop the chaotic heart rhythm and allow the heart to naturally reboot. The type of shocks required can vary widely—some patients may receive as few as one shock, while others may require up to 13 before successfully restoring cardiac rhythm and output.

Without immediate CPR, only 6% of adult cardiac arrest survivors make it to hospital, and if CPR is started within the first five minutes along with defibrillation, this rate improves to 50%. The primary therapy includes clot-busting drugs and possibly stents. In more severe cases, open-heart surgery with coronary artery grafts may be necessary.

Despite aggressive treatment, only about 30% of patients who make it to the hospital survive to be discharged due to the extensive brain and organ damage that often occurs.

This article highlights the critical role of prompt and effective response by emergency medical teams and the importance of rapid transport to ensure the best possible outcomes for patients suffering from heart attacks or cardiac arrest.

Keywords: heart attack, ambulance response, emergency medical team