Cardiac Care Hits the Road
Tuesday February 22, 2000
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Finding a 99% left main occlusion and diffuse, multivessel cardiovascular disease, cardiologists inserted an intraaortic balloon to protect Kelly's heart and arranged for quick transfer to Sarasota Memorial Hospital, a regional referral center. The hospital's Cardiac Transport Service was dispatched. Less than an hour later, Kelly was delivered safely to the hospital's preop unit, where a team stood ready to prepare her for heart surgery. The operation was a success, and Kelly was discharged after four days.
This well-oiled, on-demand transport service didn't come about overnight - it took nearly a year to coordinate the players, including county officials.
Birth of a Notion
It all started when Sarasota Memorial cardiologists in 1998 asked hospital administrators for more support in outreach efforts in neighboring counties - many outlying hospitals had EDs, but often lacked a cardiac cath lab and offered only limited critical care support. Patients were moved from one area hospital to another in search of more sophisticated care.
Out of the need to streamline treatment, the idea for the cardiac transport team was born. The hospital signed an interlocal agreement with Sarasota County Emergency Medical Services to provide emergency medical technician (EMT) and paramedic staff, vehicle maintenance, and other support. To prepare for the new partnership, nurses and the paramedics underwent cross-training, and RNs rode along on 911 calls. EMTs and paramedics underwent extensive training to become more familiar with IV infusion pumps, hemodynamic monitoring lines, intraaortic balloon pumps (IABPs), and ventilators used in critical care transfers. For now, the team drives a county ambulance, but will soon have its own vehicle, thanks to a grant from Sarasota Memorial's Century Foundation.
Cardiac transport began October 4 as a Monday-through-Friday operation, but high demand has since pushed it to a year-round service. The team answered nearly 150 calls in its first four months and has already transported patients from eight area hospitals to Sarasota Memorial. The hospital performs some 1,600 open heart surgeries a year and offers left heart mapping, transmyocardial revascularization, and other cardiac procedures not available at all area heart centers.
Wide-Ranging Services
The Cardiac Transport Service carries adult patients requiring critical care measures. The crew includes an EMT who drives the vehicle, an EMT-paramedic, and a critical care RN to provide continuous care during the trip. A registered respiratory therapist who's also a specialist in critical care accompanies the team on transports requiring ventilator support or an IABP. Many of the team's patients are referrals for further cardiac intervention, such as cardiac cath, stenting, electrophysiology studies, open heart surgery, or percutaneous transluminal coronary angioplasty.
Besides the focus on cardiac care, the team is equipped to transport any critically ill adult patient, including ones with diagnoses like a recent heart attack, respiratory failure, acute renal failure, or cardiogenic shock. The unit can care for patients with multiple vasoactive IV medications, hemodynamic monitoring lines, temporary pacemakers, and mechanical ventilator support. It's equipped with radio and cellular phone communication and has 12-lead ECG telephone transmission capabilities.
Tribute to the Team
Under the lead of cardiac intensive care director Joan Zettinger, RN, and Peggy Mortensen, RN, executive director of cardiovascular and radiology services, transport team members are already gathering honors. Along with their big sister, the Maternal-Neonatal Transport Team, they recently won kudos for team spirit at Sarasota Memorial's annual Awards of Excellence. According to the judges, team members showed "outstanding clinical expertise as well as professionalism" and shared with each other "their knowledge, experience and skill to expand the hospital's transport service."
The service is proving to be a great asset in the transfer of critically ill patients from outlying areas to tertiary care, says Zettinger. "We take pride in the quality of care we can provide."
Amen to that, says Mortensen. "We've been really pleased with the response to this service and are seeing the benefits - especially support from the cardiologists and developing relationships with community hospitals and physicians."
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