Grant aims to improve heart-attack care in rural Minnesota

Ambulance
An ambulance at Hennepin County Medical Center in Minneapolis.
MPR Photo/Tim Post

In an effort to save the lives of people who suffer heart attacks, a grant being announced this morning will equip Minnesota ambulances with sophisticated electrocardiogram machines (EKGs).

The American Heart Association is announcing a $6.5 million grant aimed at improving heart-attack care in rural Minnesota. Although the grant will fund several initiatives, the largest part will go to equipment — in particular, 12-lead EKGs. The goal is to help patients having the most serious kind of heart attack, known as a STEMI.

"STEMIs are very dangerous," said Justin Bell, government relations director for the American Heart Association's Midwest affiliate. "A STEMI heart attack is a sudden and complete blockage of a coronary artery, so people do refer to it as the widowmaker." He said that "about one-quarter of heart attacks are STEMIs, and very few of STEMI patients get adequate treatment."

Bell said the STEMI fatality rate is higher in rural areas. "It has to do with the time. STEMI heart attacks are what are called a time-critical condition," he said. "That means the biggest factor determining outcomes is how quickly you can get medical intervention for the critical event, which is a challenge in rural Minnesota."

The grant, he said, would help patients get treatment sooner by transmitting information about their condition while en route to the hospital.

"The biggest part is going to be heart equipment costs for infrastructure for ambulance services and hospitals in rural Minnesota," Bell said. He said the grant would pay to equip a number of ambulances with EKGs so that information about a patient's condition can be gathered and transmitted to hospitals, "so the hospitals can be prepared to treat those patients immediately when they arrive, and save those precious minutes. ... They can prepare their cath lab for the procedure while the patients is en route, so that we're not losing time when the patient arrives at the hospital.

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"When you have a STEMI, every second that goes by that you're not removing the blockage, you're killing heart-tissue muscle. You'll hear people say a lot that with STEMI heart attacks, time is muscle, and the more muscle you lose, the more difficult it is to come back from that."

The grant will also cover training for rural-area EMTs, Bell said, but the greater need is for equipment. "The equipment is very expensive, and most small, rural ambulance services just don't have the funding to buy those up front and develop their own training protocol."

The EKGs will serve a different function from the portable defibrillators that are already widely available, Bell explained.

"There's a difference between a heart attack and a cardiac arrest," he said. "Heart attacks are a plumbing issue, like a STEMI where you have a blockage in a coronary artery. Defibrillators out in the field are used more often for a cardiac arrest, where someone has an electrical problem and their heart stops pulsing the way that it should, and the defibrillator can actually shock that back into a normal rhythm.

"It's often confusing and most people can't tell the difference between a heart attack, which is a plumbing issue, and a cardiac arrest, which is an electrical issue."

Friends or bystanders who can't tell the difference should go ahead and use a defibrillator, because it won't do any harm; it won't deliver a shock unless a patient has a shockable rhythm, he said.