by Tom Stone, Guest Writer
(& Chair Emeritus of the PLVC Wellness Committee)
Last month I was attending a committee meeting at
the Beach Club. One of the attendees was about ten
minutes late arriving and was uncharacteristically very
quiet during the meeting. About fifteen minutes after
she arrived, she got up from the table and walked out of
the room with no mention to anyone about where she
was going. Three minutes later, Kim, the Beach Club’s
Assistant Manager interrupted our meeting announcing
that the lady who left our meeting appeared to be ill and
that she showed possible stroke symptoms so 911 was
called and they were on the way.
Very soon, a paramedic ambulance and fire engine arrived
and began treating her. They thought she had a serious
medical condition that needed rapid response and called
in the medical evacuation helicopter. Our struggle began
when we were asked “Does she have a contact nearby?
Her cell phone did not reveal emergency contact information.
We were also asked by the firefighters, “Does she
have a Living Will or a Durable Power of Attorney?” and,
“Where are they located?”
We knew her address and someone in the group knew a
couple of people who were personal friends. It took several
phone calls to find a neighbor who knew family member
names and other emergency information. By the time the
information was accessed, the patient was in a helicopter,
on the way to the hospital. She is home now and all is well
but here are few lessons learned from this incident:
• If you carry a cell phone, add an “In case of emergency
(ICE)” contact. Put “ICE” in the phone, then the name
or names of your emergency contacts and their phone
numbers. Responders are trained to look under “ICE”
for this information.
• Check the Bay or Beach Club’s Membership
Information papers. Are yours up to date?
• Give a local neighbor a key to your house or hide a
key and let appropriate folks know where to find it for
access in an emergency.
• Place a copy of your Power of Attorney, if you have
one, and your medical wishes in an envelope next to
your FILE OF LIFE packet taped to your refrigerator.
Giving a copy of these documents to your emergency
contact is also a good idea.
• Look into subscribing to the Airlift Northwest’s
subscriber plan, if you are not already a member.
Information can be found at www.airliftnw.org. Go to the
page and look on the far right side for AirCare Program.
Or, go by and pick up a pamphlet at the fire station.
Washington Dept of Health: Cardiac Triage & Protocols:Signs and symptoms:
Chest discomfort (pressure, crushing pain, tightness, heaviness, cramping, burning, aching sensation), usually in the center of the chest lasting more than a few minutes, or that goes away and comes back. Epigastric (stomach) discomfort, such as unexplained indigestion, belching, or pain. Shortness of breath with or without chest discomfort. Radiating pain or discomfort in 1 or both arms, neck, jaws, shoulders, or back. Other symptoms may include sweating, nausea, vomiting. Women, diabetics, and geriatric patients might not have chest discomfort or pain. Instead they might have nausea/vomiting, back or jaw pain, fatigue/weakness, or generalized complaints.
Call 911 [If possible, call by "landline"; if you need to call by cell-phone, make sure to identify the county you are in as well as your exact location; you can never be sure which cell tower will pick up your call]
Aspirin for heart attack: Chew! Don't swallow. [Harvard Medical School]
"...people who think they may be having an attack need an extra 325 mg of aspirin, and they need it as quickly as possible. For the best results, chew a single full-sized 325-mg tablet, but don’t use an enteric-coated tablet, which will act slowly even if chewed....]
The patient should not be driven by spouse or friend.... call 911! Treatment can start already in the ambulance -- in communication with the hospital -- all of which saves time!
The hospital CathLab can be alerted and prepared for patient's arrival -- possibly bypassing the emergency room.
In case of cardiac arrest (and after calling 911 and trying to secure an AED) CPR should be applied. For adults and teens, push hard (hand-over-hand) and fast (about 100 beats per second) at the center of the chest. Call for help to be able to take turns with applying CPR. Continue CPR until paramedic not just arrives, but is ready to take over...
Cardiac Arrest... [PLFR]
Hands-only CPR (American Heart Association) | or here!
CT Cardiac Exam: Medicare now covers cardiac CTA for the evalution of patients with acute chest pain present in an emergency room (or equivalent) when necessary to rapidly differentiate among reasonably probable aortic, pulmonary, and/or coronary etiologies....
What causes a Heart Attack [NIH: National Heart, Lung and Blood Institut]
A heart attack happens if the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked. Most heart attacks occur as a result of coronary heart disease (CHD).
Hope Heart Institute
Lester R. Sauvage, MD founded the Reconstructive Cardiovascular Research Laboratory as a branch of Providence Seattle Medical Center (renamed The Bob Hope International Heart Research Institute in 1980, and later the Hope Heart Institute in 1988). The world's first successful experimental Coronary Artery Bypass Graft (CABG) operation using the patient's own vein as a bypass graft was accomplished in 1963.
The purpose of the Stroke Triage and Destination Procedure is to help you identify stroke patients in the field so you can take them to the most appropriate hospital. Like trauma, stroke treatment is time-critical – the sooner a patient is treated, the better their chances of survival. Fast treatment can mean less disability, too. For strokes caused by a blood clot in the brain (ischemic), clot-busting medication must be adminis-tered within 4.5 hours from the time they first have symptoms. For bleeding strokes (hemorrhagic), time is also critical. As an emergency responder, you play a crucial role in getting patients to treatment in time.
Assess Applicability for Triage
Report from patient or bystander of one or more sudden:
Numbness or weakness of the face, arm or leg, especially on one side of the body Confusion, trouble speaking or understanding;
Trouble seeing in one or both eyes;
Trouble walking, dizziness, loss of balance or coordination;
Severe headache with no known cause.
Perform F.A.S.T. Assessment:
Face: unilateral facial droop?
Arms: unilateral drift or weakness?
Speech: abnormal or slurred?
Time last normal (determine time patient last known normal)
Yes to any one sign (Face, Arms, Speech) = YES
"Cognitive Coach Describes a Journey with a Special Client" by R. Rose Simon, MA, Certified Journal Instructor
PL Voice, June 2013 , scroll to pp.4-5
"In America at the moment, there isn’t a name for the work
I do. I am neither a speech pathologist nor a caregiver.
I just call myself a cognitive coach or “brain buddy.”
In Australia, Canada and the UK, the people who work
with stroke survivors, doing similar work to what I am
doing, are called communication partners, mentors and
“befrienders.” This describes a new type of support
worker that offers a lifeline to people with aphasia, which
encompasses problems with speaking and understanding
following a stroke. [.....] "
"Stroke treatment is time-critical – the sooner a patient is treated, the better their chances of survival. Fast treatment can mean less
disability, too. For strokes caused by a blood clot in the brain (ischemic), clot-busting medication must be adminis-tered within
4.5 hours from the time they first have symptoms. For bleeding strokes (hemorrhagic), time is also critical. As an emergency
responder, you play a crucial role in getting patients to treatment in time.
State & Local Cardiac and Stroke (Emergency) Protocols & Partnerships:
Emergency Cardiac & Stroke System [Washington State (DOH) 2011]
"A new state law creates an emergency cardiac and stroke system similar to the state’s trauma system. It’s intended to save lives and reduce disability for heart attack,
cardiac arrest, and stroke patients. Emergency medical services (EMS) will take patients directly to hospitals that meet care requirements and choose to participate in
Jefferson Healthcare Is Ahead of the Curve in
Emergency Cardiac and Stroke Care [Jefferson HC Newsletter, Autumn 2010, p.8]
"Jefferson Healthcare was the first hospital on the Olympic Peninsula
to partner with Swedish Medical Center for stroke care. Now, under
the new Emergency Cardiac and Stroke Care law (SSHB 2396),
Jefferson Healthcare will qualify as a level III stroke facility and a
level IV cardiac care facility. The law will allow Jefferson Healthcare
to voluntarily self-identify its cardiac and stroke capabilities and
designations, as of January 2011."
Press Release: Harrison Medical Center:
"Harrison's stroke program recognized for outstanding care"- 1/4/2012
[Program dedicated to positive outcomes for stroke patients; incl. Partnershipwith UW & Harborview]
Harrison Medical Center/University of Washington-Harborview Medical Center’s Partnership
[Harrison Press Release
"Harrison's stroke program recognized for outstanding care", January 4, 2012] "Harrison partners with Harborview
Medical Center’s Telestroke Program to allow 24/7 consultation with a vascular neurologist and access to University
of Washington stroke experts. Along with real-time consultation, the organizations share education and research as
well as evidence-based clinical protocols and practice guidelines to ensure constant innovation in care..... Harrison’s
coordinated approach to stroke care earned the Medical Center the American Stroke Association's Get With The
Guidelines-Stroke Bronze Performance Achievement Award. The award recognizes Harrison’s commitment
and success in implementing a higher standard of stroke care by ensuring that stroke patients receive treatment
according to nationally accepted standards and recommendations."
The Heart of the Matter; Health Matters; Harrison Medical Center,
George McCabe knows a little something about being in the right place at the right time. In February 2012, George and his wife Gina were in the waiting room of cardiologist Robin Houck, MD, for an appointment....
Cardiac Rehabilitation at
Jefferson Healthcare [Voice, June 2012 (pdf); scroll to p.9]
by Michael Graham, Guest Writer
"On July 13, 2011, I found myself traveling to Harrison
Medical Center for a triple coronary artery bypass
grafting. The surgery was an unqualified success and I
was able to return home after five days in the hospital.
However, part of my discharge requirements was to enroll
in a Cardiac Rehab program six weeks after my discharge.
The thoracic surgeon spoke highly of Harrison’s cardiac
rehab program and strongly recommended I attend.
Fortunately, I was aware that Jefferson Healthcare had a
similar program that is also highly rated and opted to travel
to Port Townsend instead of crossing the bridge to Bremerton...."
Washington State Emergency Cardiac and Stroke (ECS) System
A 2010 state law created an Emergency Cardiac and Stroke (ECS) System similar to the state's Trauma System. It's intended to save lives and reduce disability for heart attack, cardiac arrest, and stroke patients. Emergency medical services (EMS) take patients directly to hospitals that meet care requirements and choose to participate in the system.
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