Joy McCage was determined to give his cat, Alex, a proper burial after it was run over by a car. Rather than just burying his pet in the dirt, Joy wanted to bury Alex in the little house he’d made for her. That meant he’d have to dig a wider,
deeper hole, and Joy’s wife Marilyn didn’t like the idea — especially since he’d just had surgery to remove his cancerous prostate 13 days earlier.
She knew there was no reasoning with him. As Joy, 70, dug the hole in an orchard near their house, he began feeling ill. He walked to the house and told Marilyn his jaw and chest hurt.
“It felt like I had a car literally sitting on my chest,” Joy said.
Marilyn, a registered nurse, told him to sit on a bed while she called 911. Joy said he wanted to take a shower, but Marilyn knew he might be having a heart attack, and told him to skip that.
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EKG equipment in the Beatrice Fire & Rescue
ambulance helped Nick Koch, EMT (left), and paramedics
Bryan Jelinek and Jeff Hays steer Joy McCage (seated)
to the fastest possible care for his heart attack —
BryanLGH Heart Institute.
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He already had two stents and a pacemaker — but lucky for him, Beatrice Fire & Rescue is uniquely equipped to deal with people who are having heart attacks, and it’s participating in a program designed to save more heart attack victims. The ambulance has a 12-lead machine that can perform an electrocardiogram, or EKG, to determine if patients are having a heart attack.
The ambulance crew did an EKG on Joy and transmitted the results to BryanLGH Heart Institute (BHI) cardiologist Joseph Kummer, MD — who read the EKG waves on his cell phone in Lincoln, Neb., as the ambulance sped away from Joy’s home west of Beatrice, Neb. Dr. Kummer could see that Joy was having an acute heart attack and told the crew to bring Joy directly to BryanLGH East rather than the Beatrice hospital, which was not equipped to handle Joy’s condition.
“When we backed into the hospital, staff members were waiting for my arrival,” Joy remembers.
As part of the heart attack program, the emergency room is bypassed and patients are taken straight to the heart catheterization lab. Even so, they almost lost Joy.
“In the cath lab, he actually coded (his heart stopped),” Dr. Kummer said. “He pretty much died halfway through the procedure.”
Joy was resuscitated, and angioplasty opened the blocked artery and allowed blood to flow to his heart again.
If the Beatrice rescue crew hadn’t had that EKG and wasn’t involved in the program designed to recognize heart attacks in the ambulance, Joy probably wouldn’t be alive today. Normally, the ambulance would have taken Joy to the Beatrice Community Hospital, which is not equipped to do a catheterization (heart test) or angioplasty to open blood vessels. He likely would have been given clot-busting medicine — which only works about half the time, according to Dr. Kummer — and then transported to Lincoln.
He would have lost precious time — as much as 45 minutes to an hour, Dr. Kummer estimated.
Timothy Gardner, MD, an interventional cardiologist at BHI, said Joy did not have even five minutes to spare.
“The time that we saved was really what ended up saving his life,” Dr. Gardner said. “The staff was there waiting with open arms to help him.”
This is exactly the type of scenario Donald Rice, MD, envisioned when, as Gage County’s medical director, he set up the protocol for heart attack victims. He oversees other county medical directors statewide as EMS physical medical director for Nebraska, and he has worked to develop statewide protocol and get EKGs on ambulances so heart attacks can be detected in ambulances, rather than emergency rooms.
That way, ambulance crews can make informed decisions about where to take the patient: Should they drive to the nearest ER and get medicine or drive farther to a hospital that can handle a heart attack?
Most medical literature says it’s best to go straight to a cardiac cath lab in less than 90 minutes. The ability to do a more informative 12-lead electrocardiogram in the field is “paramount to this process,” Dr. Rice said, but only about 10 percent of rescue services statewide are currently equipped to do so.
“We’d like to see that number go up,” he added.
Beatrice Fire & Rescue has been doing 12-lead EKGs and following Rice’s protocol since February 2010, said Beatrice Fire Chief Brian Daake. One man who benefitted from the new protocol had a heart attack on a Tuesday night and was back gardening by Friday.
“He popped in (to the station) and said, ‘If it wasn’t for you and this program, I’d probably be dead right now,’ ” Daake recalled.
Beatrice has Nebraska’s only “fully functioning” EKG system outside of Lincoln’s fire department, Dr. Rice said.
“We wanted to do this as a proof of concept — to show that it can be done,” Dr. Rice said. “I needed one hospital that was cooperative in giving me good feedback on what we needed to change and do to make it work better. Once we finish that, we’d like to involve other hospitals that demonstrate a willingness to participate with us on this project.”
Dr. Kummer said they are trying to get all rural communities within 100 miles of Lincoln on board with the program.
Why do it? “Because it saves lives,” Dr. Rice said.
He points out there are people he’ll never meet whose lives will be saved by this program — people like Joy McCage.
Marilyn has no doubt Joy was saved because he went straight to Lincoln.
“He’d never have made it if he’d have gone to Beatrice first,” she said on a sunny morning in her dining room, as she sat next to Joy sharing sliced strawberries and bananas. “He had not a minute to spare.”
Joy doesn’t doubt it either.
“I would’ve been dead by then,” he said.
To learn more about the BryanLGH Heart Institute, click here.
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