When local physicians talk about the importance of paramedic response times, they use a couple of common phrases.

“We have a saying that ‘heart is muscle’ and even a few minutes can make a huge difference in the amount of heart muscle that is saved or lost,” said Dr. Michael Widmer, a cardiologist at St. Charles Heart and Lung Center in Bend. He said that within 20 minutes of a blood clot blocking a heart artery, heart muscle starts to die.

Dr. Bruce McLellan, also a cardiologist at The Heart and Lung Center in Bend, agreed.

“In the heart attack world, we think every minute counts because every minute means death of some heart muscle, and that ultimately affects mortality,” McLellan said. “It affects heart function once the hospitalization is complete.”

Dr. Matthew Eschelbach, medical director of the emergency department at St. Charles Redmond, has a different key phrase.

“We have in trauma what is called the ‘golden hour,’” Eschelbach said. “In that golden hour, we are supposed to get the majority of our evaluation and treatment done for severely injured trauma patients.” Eschelbach also advises several Central Oregon EMS agencies including Redmond, Sunriver, La Pine, Crescent and Chemult.

The issue of firefighter paramedic response times arose Wednesday when Dr. William Reed, an emergency physician who advises the Bend Fire Department on its medical care, told the Bend City Council that three patients died unnecessarily in the last year because it took too long for paramedics to reach them. Reed did not provide details of the medical conditions of these patients, but other doctors said Friday that some of the common medical emergencies where a quick response is critical are heart attacks, cardiac arrest and trauma.

The Bend Fire Department responds to 80 percent of all calls within nine minutes.

Steve O’Malley, acting battalion chief and a certified paramedic for the Bend Fire Department, said Friday that other medical issues that are “very much time-sensitive” include any type of airway issue, from an asthma attack to pulmonary edema, which is fluid in the lungs commonly caused by heart problems. Victims of heroin overdose will also stop breathing, and paramedics must arrive quickly in order to resuscitate them, O’Malley said.

Widmer said paramedics play an important role in providing the information necessary to start St. Charles’ Heart 1 system, which was established to more quickly prepare to treat heart attack patients.

“Where you have a completely blocked heart artery and an individual’s having a heart attack, our national guidelines are we try to get that open within 90 minutes,” Widmer said. Lost minutes add up, whether in paramedic response times or the time it takes to diagnose a heart problem, “and all of a sudden you’re missing your 90-minute contact to balloon time” goal, Widmer said, referring to the balloon used to clear a blockage of the artery.

Brain essentials

McLellan said cardiac arrest can deprive the brain of oxygen, causing brain damage.

“There’s virtually no blood flow going on once the person has suffered the cardiac arrest, so the issue is largely that of brain function, meaning most of the body’s organs can get along without some blood flow for a while,” McLellan said. “What often is the determining factor is brain function and it starts the deterioration at about that five-minute mark that the fire department’s talking about. With lack of oxygen, brain damage starts to occur.”

The goal is a “functional recovery,” McLellan said, and “that means someone who’s walking, talking, able to care for themselves.”

Both Widmer and McLellan said a major challenge is getting more people who suffer heart attacks to call for help immediately, rather than dismissing it as indigestion or another problem. “If it is a witnessed event, the two things that determine survivability is calling for help and getting that help there with a defibrillator and getting someone there who can perform CPR,” McLellan said.

In Central Oregon, many law enforcement agencies have automatic external defibrillators in some of their vehicles, McLellan said. “Then, when the paramedics arrive, they have full resuscitation equipment.”

Paramedics can administer medications intravenously to prevent recurrences of “lethal” heart rhythms, McLellan said. Paramedics can also provide medications for heart rates and blood pressures that are dangerously low.

“The defibrillator is the first step, but there are many layers to the incremental care of a cardiac arrest patient,” McLellan said.

Paramedics also carry an electrocardiogram, or EKG, so “they can identify whether cardiac arrest is potentially due to a heart attack.” If they identify signs of a heart attack, paramedics call the hospital to give that team a head start to prepare for the patient.

Other examples of care that paramedics or EMTs often administer immediately are intubation to open a patient’s airway, starting resuscitation and starting intravenous fluids. “They’re also able to stop massive bleeding, and perhaps their greatest job is determining where that patient goes and how soon he gets there, whether that’s by ambulance or helicopter,” Eschelbach said. “Sometimes they can tell in the first 30 seconds whether this person is going to necessitate a helicopter flight to a trauma center.”

Trauma victims often need fluids such as saline to be administered intravenously, to maintain blood pressure, Eschelbach said. “And of course pain management is important in trauma.”

“Our experience in the Gulf War and Afghanistan and Iraq (wars) led us to … tourniquets, a practice that had been abandoned for a number of years,” Eschelbach said. “Used correctly, it can be lifesaving to stop bleeding.”

Eschelbach said sometimes it is impossible to quickly get patients to a hospital. “Because Central Oregon is unique, meaning we have so much outdoor space, sometimes it’s just impossible to make that golden hour,” Eschelbach said. “A couple examples would be, I recently had a trauma victim from Steelhead Falls and it took two hours to get him out of the canyon. Or a rescue on Smith Rock might take even longer.”

Be prepared

How to recognize if someone is having a heart attack

According to the Centers for Disease Control and Prevention, the five major symptoms of a heart attack are:

• Pain or discomfort in the jaw, neck or back

• Feeling weak, light-headed or faint

• Chest pain or discomfort

• Pain or discomfort in arms or shoulders

• Shortness of breath

What to do in response

• Call 911 immediately.

• If you have been trained to perform CPR or use a defibrillator, follow your training.

• The chances of surviving a heart attack are greater when appropriate care can be delivered quickly.

How to be trained

Visit the American Red Cross website at www.redcross.org/take-a-class to learn about available First Aid, CPR and AED training in your area.

Source: CDC