Lifesaving Coordinated Care

edoebel | October 15th, 2019

 

It was easy for Dawn Bach to explain away the pain in her left shoulder as she prepared to gather with her coworkers at Buena Vista Regional Medical Center (BVRMC) for a leadership summit on the morning of January 30, 2019.

She had tweaked the shoulder over the holidays, and that was likely causing the discomfort.

Or maybe it was the bone chilling cold air–lows dropped to -22 degrees in Storm Lake that morning—that was making her joints a little creaky.

Whatever it was, Dawn was sure it was no big deal.

And even as she got lightheaded and her vision went a tad bit wonky, she suspected it was little more than a dip in her blood sugar and no more than a queue to grab a quick bite to eat.

The prospect of having a heart attack was nothing that Dawn even considered. But, just as the leadership team assembled to begin the quarterly meeting, Dawn collapsed.

Within seconds, she was surrounded by experienced care providers from BVRMC including Ambulance Manager David Schmidt and Director of ER/Ambulance Sarah Naberhaus. They checked for a pulse and when they found none, started CPR and called 911.

Police arrived on the scene quickly with an automated external defibrillator (AED) and the hastily assembled care team, which included representatives of departments from across BVRMC, delivered a life-saving shock to restart Dawn’s heart.

“I was in the right place at the right time,” says Dawn, who has served as the Chief Clinical Officer at BVRMC for nearly two decades. “We thought about canceling the meeting because it was one of the coldest mornings in years. It is a good thing we didn’t because it probably would have been a much different outcome without so many skilled providers around me.”

As soon as paramedics arrived, they analyzed the rhythm of Dawn’s heart and transmitted the results to Dr. Garrett Feddersen, Medical Director of the BVRMC Emergency Department. Dr. Feddersen confirmed it was a ST-Elevation Myocardial Infarction (STEMI), a type of heart attack involving a blockage in one of the main arteries of the heart.

When it comes to treating a STEMI, time is of the essence. The standard of care for this type of incident calls for getting the patient to a cardiac catherization lab as soon as possible for the placement of a stent to restore the flow of blood through the blocked artery. To facilitate this process, BVRMC has worked cooperatively with UnityPoint Health – St. Luke’s in Sioux City to develop procedures aimed at streamlining the delivery of life-saving care.

Ironically, Dawn was aware of the work that was being done on the American Heart Association Mission: Lifeline STEMI protocol involving BVRMC and St. Luke’s. She just never suspected she would find herself in the midst of it being put into action.

“Time is muscle,” Dawn says. “We know that the quicker we can get patients to the cath lab the more likely they are to survive a heart attack, and the less lasting damage they will have.

“After they shocked me,” she continues, “I still wasn’t sure it was a heart attack. But I do remember being in the ambulance. In talking with the paramedics, I asked them to see the monitor. It was clear that it was a STEMI.”

The STEMI protocol calls for paramedics in the field to stabilize patients and provide the local emergency room physician data to confirm the STEMI diagnosis. From there, the local physician will implement the protocol, which calls for paramedics to transport the patient to a primary care facility that can perform angioplasty, like St. Luke’s, without first stopping in the emergency department of the local hospital. Throughout the process, the local emergency department physician is in touch with the emergency department staff and cardiology team at St. Luke’s.

In Dawn’s case, paramedics transferred her to Holstein, where they were met by an air ambulance. Dawn was flown to St. Luke’s where Dr. Edward Zajac, interventional cardiologist, and team were ready and immediately moved Dawn into the cath lab.

In the cath lab, her blocked artery was accessed through her wrist, the plaque blockage was busted and blood flow was restored. It took 101 minutes from the time she collapsed to the time blood flow was restored.

“The level of coordination was impressive,” Dawn says. “From the first responders at the meeting who immediately began CPR to the paramedics who stabilized me, right through the transfer and the cath lab procedure, everyone was on the same page.”

Dawn credits the implementation of the STEMI protocol with saving her life.

“It is one thing to talk about it, but it is a whole other thing to be dropped in the middle of it with your life on the line,” she says. “I knew that we had been working on this protocol and I knew that we had some great outcomes. Being a part of it is humbling though. This type of planning, preparation and commitment to communication makes the difference between life and death for people who find themselves in a situation like mine.”

Dawn has completed eight weeks of cardiac rehabilitation at BVRMC and is now working out regularly on her own. She says that her father had a heart attack at a young age, but other than that, she didn’t have many warning signs that would have tipped her off to what turned out to be a 99% blockage in her left anterior descending artery (LAD).

She and her husband, Randy, recently welcomed their third grandson and had the opportunity to celebrate Mother’s Day with their three children. Gathering with family took on special meaning in the context of her near-death experience.

“I am so fortunate to be here. It makes me emotional,” Dawn says, choking back tears. “I am filled with gratitude thinking about everyone who helped get me through.

“It really takes a village,” she continues. “One thing after another was done to make this happen. I feel blessed to be at BVRMC and in Northwest Iowa where there is a spirit of coordination among providers that makes an outcome like mine possible. I feel blessed and I thank God for putting me in the right place, at the right time, surrounded by so many people who could help me. I don’t know what else to say.”

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