Question: Can community hospitals provide adequate emergency treatment or do all heart patients need to be transferred to major medical centers?
Answer: Well, the answer to that question is a little bit complicated because it depends on what's really wrong with the patient. If we're talking about someone who's having a heart attack, there are two types of heart attack. The EKG, or electrocardiogram, will tell us which type the patient is suffering.
If a certain portion of the electrocardiogram is elevated, that usually means there's a total blockage of one of the coronary arteries. In such cases, the best treatment is a trip to the cardiac catheterization lab, if that cardiac catheterization lab has a team that's capable of doing angioplasty.
Angioplasty, or the balloon procedure, is a procedure in which, if a clot is found blocking the vessel, that clot can be opened up with the catheter. In some cases a stent can be put in to keep that vessel open afterwards.
So, hospitals that can provide cardiac catheterization -- particularly cardiac catheterization with angioplasty -- would be the best place for a person to go if they're having a suspected heart attack. The problem is: only about one in four or one in five US hospitals currently can perform angioplasty. And not all of those hospitals are equipped with a team in hospital around the clock who can do it in a very timely fashion.
So the answer to the question is really dependent upon what resources are available, what choices are available in your community. Usually calling 911, getting the paramedics, the emergency medical technicians, to your side very quickly is your best way of getting to the most appropriate facility, because most EMS, or emergency medical services systems really have a pretty good idea of who's got what treatment available.
In addition to that, when a patient is brought in with a suspected heart attack by an ambulance, they generally go straight to the back. We may take a quick look at them in front, just to make sure we've got a proper disposition for them -- that is, we're sending them to the right portion of the emergency department -- but in most cases they're going to be seen very promptly.
What we really don't like to happen is have someone walk in and come in the door, particularly in many of our very busy, overcrowded emergency departments, where the triage nurses are doing the very best they can, but if ten patients come in all at once, they've got ten patients all at once, and they're going to have to try to go through them and sort them out as quickly as possible.
So, the most important message, I think, that we can give anyone potentially having a heart attack, or attack symptoms, is to call your emergency number. In most communities, that's going to be 911. That's your best way of getting prompt care and getting brought to the most appropriate facility.