Guidelines in the U.S. support that any patient who presents with a possible heart attack (ST elevation myocardial infarction-STEMI) is planned to have a cardiac catheterization promptly, and ideally within 90 minutes of being diagnosed with an EKG. One of my friends who is an interventional cardiologist like me, recently found himself in a interesting situation. My friend was on call and received an urgent page from the emergency department, notifying him of a patient possibly with an acute presentation of a heart attack. He promptly responded and was rushing over to the hospital where he works, which is about 10 to 15 minutes away from where he lives. En route while rushing, he was going over the speed limit when when suddenly he saw the flashing blue lights of an approaching patrol car. He pulled over and had to wait until a trooper got out of a car and approached him. He showed the patrol man his identification and tried to explain the need for expediency for at least 5 to 10 minutes before he was able to convince the policeman of the nature of the medical emergency, and was allowed to proceed. Fortunately, the patient was promptly treated as soon as my friend arrived, and had a successful outcome without any detriment as a result of the delay. However, this incident brought some issues to my attention.
Most hospitals require interventional cardiologists to live within 15-20 minutes of driving distance – however, in crowded, urban areas, the estimates may well be off especially during crowded business hours and traffic congestion. Remaining in-house during call may circumvent the issue on occasion, but does take a toll on the personal and family life of the interventionist. In the situation of a evolving heart attack, where speed is of the essence – should/could there be some form of an alerting system to enable easy and quick passage for the care providers attending to that emergency? These thoughts crystallized more and while driving today, I pulled to the side to allow a fire truck with blaring sirens and flashing lights to pass me – potentially to respond to call where multiple other trucks were headed. It made me wonder if for a medical emergency where attendance of a physician and a team with a specific skill set maybe life-saving, if having any systems-based assistance was worthwhile if it could be provided without excess cost?
Additionally, it is also imperative for the personal safety of the care providers when their minds may be preoccupied with continuous interruptions in the form of phone calls and pagers going off to coordinate care. I was recently discussing this when it was brought to my notice that a situation like this is not without precedent, and the state of California actually provides tags which allows expedient passage for caregivers rushing to provide emergency medical assistance.
In this era of glo-signs and neon markers with even ride share services like Uber or Lyft displaying logos prominently – would it not be worthwhile for emergency medical care providers to display their mission so as to allow speedy and safe transport? Maybe the thought leaders and national societies can deliberate on this and consider future research to identify and validate the need for same.
Saurav Chatterjee is a Staff Interventionist at Saint Francis Hospital of the University of Connecticut, and an Assistant Professor of Medicine and Research at the Frank H Netter School of Medicine, Quinnipiac University- living in Hartford, Connecticut. He volunteers for the PAD council and the Council on Clinical Cardiology. @SauravChMD