Barren-Metcalfe EMS gives first thrombolytic in pre-hospital study

By SHERRY TABOR
Director, Patient Services / Public Relations and Marketing, 
T.J. Samson Hospital

(Left to right) Bunch, Green, and the Wells.

GLASGOW — Heart disease is a number one killer in the United States today. The public is told to look for warning signs and symptoms of heart disease from newspapers to radio broadcasts. Billy Jo Wells of Glasgow is one of those people who knew the signs, but had not family history of heart disease so really didn't feel as if he were at risk. Little did he and his wife, Donnell, realize that they would need this knowledge to save his life!

Saturday, September 8, 1999 started out as any other for Wells, who is an avid fisherman and employed at Dana Corporation. Saturday evening, he began to experience the classic symptoms of a heart attack ... nausea, sweating, shortness of breath, and chest pain.

Within minutes of calling 911, an ambulance from the Barren-Metcalfe EMS arrived at his home where Wells was quickly assessed by Paramedic Brian Bunch and EMT Steely Green. He was then placed in the ambulance where emergency workers completed his assessment, started an IV, and then using advanced cellular technology transmitted a 12-lead ECG to the Emergency Department at T.J. Samson Hospital.

At the hospital, emergency department physician Gary Hogan reviewed the transmitted ECG and confirmed that Wells was having a heart attack. Hogan then gave Bunch an order to administer an injection of the "clot busting" drug Retavase™. With Bunch's injection of the drug in the ambulance, Wells became the first heart attack victim in Kentucky to receive a thrombolytic drug prior to their arrival at a hospital.

T.J. Samson Hospital has partnered with the Barren-Metcalfe EMS to be the only state approved site in Kentucky and one of only twenty in the United States and Canada to participate in the study of the pre-hospital administration of Retavase. Retavase is a thrombolytic commonly given to heart attack victims upon their arrival at the hospital. The purpose of this national study is to evaluate the significance on patient outcome by the administration of the drug prior to the patient's arrival at the emergency department. Studies show that the damage done to the heart muscle will be decreased by the earliest administration of a thrombolytic. This study may show further benefit by pre-hospital initiation.

"Mr. Wells met all the criteria for the study; the transmitted ECG indicated his heart muscle was being damaged, and he was a prime candidate for the drug," said Dr. Hogan. Wells reported an immediate relief in his chest pain and once he arrived in the emergency department he was re-evaluated and admitted to the cardiac care unit at T.J. Samson Hospital in Glasgow.

"Brian asked me all sorts of questions and then asked if I would be willing to participate in the study. Once I understood that I would get the same drug as soon as I got to the ER, I said 'Okay.' I felt the quicker I received the drug, the less damage I might have," said Wells.

Cardiologists Melissa Walton-Shirley, Dr. Jim Whiteside and Dr. Venkata Reddy, along with emergency department physicians Gary Hogan, Dr. David Moss and Dr. Wayne Kopp have been instrumental in the study. "Everyone talks about the 'golden hour' for trauma patients which refers to the first hour after trauma in which treatment received has a huge impact on the patient's final outcome. The same is true for heart patients who receive quick care," Dr. Walton-Shirley said.

Mr. Wells has been doing well and is at home recouperating from an angioplasty to repair arterial damage. "He was certainly a fortunate man, as he and his wife initiated the chain of events that ultimately may have saved his life -- calling 911 in any emergency is important and activates the EMS system in our community. The fact that he received the thrombolytic drug in the pre-hospital setting was an added benefit to him in this case," said Dr. Moss.

Mike Swift, director of the Barren-Metcalfe EMS, said, "I'm very happy for Mr. Wells and wish him the very best as he continues his recovery. I'm also very proud of Brian and Steely for their efforts, along with our other staff, for their continued work with the study. I think the state EMS Council and the Kentucky Board of Medical Licensure displayed tremendous foresight in permitting us to participate in the study as the results will impact patient care not only in the Commonwealth but also nationwide."

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