Elevation

We've had a long night already, and we're not even half done. We finally got dinner, and we're eating on the move when the tones go off again. Male, 40s, chest pain, I read on the computer before I haul the ambulance around in a sweeping u-turn. We're maybe half a mile from the address, too.

My partner snorts, through a bite of tuna fish. She's tired and in no mood for the standard crap. "Unless it's a STEMI, I'm not interested," she chuckles.

* * *

The man lays on the bed, sweating and nervous. He was working out when his chest started hurting. He's never had heart problems before, but he did get checked out for chest pain recently. Everything was normal. He's got a history of anxiety, though. He's breathing fast. His fingers are tingling, and oh god the pain.

Hmmm, we say. Slow your breathing down. We'll take good care of you. My partner collects history while I get vitals. I slap the ten round stickers on arms and legs and chest, ask him to lie still, and thumb the 12 LEAD button. Glance down at the printout, expecting to see nothing remarkable.




* * *

Things move quickly then. I run to the ambulance and grab the phone, to send the EKG. My partner starts the workup - oxygen is already on, aspirin, nitro, and oral zofran follow. The firemen grab the stretcher. I've got the 12 sent and the hospital alerted before he's even on the stretcher. We load and roll. The strobes make flickering freeze frames of the snow that is falling lightly.

We get to the hospital, one of our favorites, and the doc (best in the city, in the opinion of most medics) all but meets us at the door. Nurses and techs and x-ray are all waiting. I ask if they've called the cath lab. "Of course," the doc replies. "They've been headed in for twenty minutes now."

When the patient thanks the doc, he points out the door to us - me making the gurney, my partner charting. "Thank them. They got you here fast."

By the time I come back in after cleaning up the rig, the patient is gone to the lab.

* * *

The standard of care for interventional cardiology, the benchmark everyone strives to make, is 90 minutes door to balloon. That is, 90 minutes between the time the patient rolls or walks into the ER until the time the interventional cardiologist inflates a tiny balloon to re-open an occluded artery.

Tonight, everything came together and the system worked perfectly. From the time our patient called 911 until the time the balloon went up in his occluded LAD, barely 78 minutes elapsed.