Minutes matter when it comes to a heart attack.
The longer it takes to open a blocked artery to the heart, the more likely the muscle will suffer permanent damage. Wasted time may leave a heart attack sufferer with dead tissue.
As Stella Williams, coordinator for San Joaquin Community Hospital's Chest Pain Center, put it, "dead meat don't beat."
Knowing every minute counts, several local hospitals and Kern County Emergency Medical Services have worked for more than a year to create a new countywide system to help people with the most serious kind of heart attacks get the right care as quickly as possible.
That means getting them to a hospital with a catheterization lab where doctors can open up the arteries and restore blood flow to the heart.
Nearly 300,000 people have a ST-Elevation Myocardial Infarction (STEMI) in the United States every year, the American Heart Association reported in June. Exactly what percentage of all heart attacks that makes up varies by the source of the data, according to a 2011 Association report.
Heart disease is a major killer in Kern County. It was the second leading cause of death here from 2008 to 2010 and the top cause for 13 years before that, according to the Kern County Public Health Services Department.
The goal is for all players -- hospitals, EMS, ambulance companies and even patients -- to follow county policy, quickly, when someone has a STEMI.
That means identifying the heart attack fast in the field and getting that person to one of three hospitals in the county with the right facilities to open up an artery or perform surgery if necessary.
"The whole idea is trying to eliminate the dead time," said Dr. Brij Bhambi, an interventional cardiologist and chief-of-staff of Central Cardiology.
STEMI systems of care aren't new. The American Heart Association lists 652 on its website.
And while the concept sounds simple, it's been difficult to get off the ground in Kern County, clinicians and administrators say, especially when it came to bringing competing hospitals together and getting them to share data.
"There've been some trying times along the way, issues of probably personalities and politics, but through it all we got it done," said Randy Rolfe, president of the Bakersfield Heart Hospital.
In June, the Kern County Board of Supervisors approved a policy detailing how the system will work. Since then, Bakersfield Memorial, San Joaquin Community and Bakersfield Heart hospitals have all applied to be STEMI-receiving centers.
A few more details must be hammered out before the system is fully in place, including agreements between the county and the hospitals formally designating them as STEMI-receiving centers.
Lynne Ashbeck, regional vice president for the Hospital Council of Northern and Central California, said Bakersfield already has good cardiac care, but once the system is in place it will elevate everyone's performance.
"So whether you are in Frazier Park, Delano or downtown Bakersfield, the system is ready to respond regardless of where you are in the county," Ashbeck said.
Kern County Emergency Medical Services, which coordinates emergency medical care, was approached with the STEMI system concept four or five years ago, but the idea didn't quite take off.
"There was some interest, but we didn't know how big the issue was," said Director Ross Elliott. "We weren't all that hot on moving it forward because we didn't know what the benefits would be."
The system required a big up-front expense for ambulance companies: 12-lead electrocardiograms (EKGs) to allow paramedics to recognize a STEMI heart attack in the field. Elliott said he wasn't keen on requiring ambulance companies to spend $1 million or more on equipment without data justifying the expense.
The idea was resurrected when Hall Ambulance bought the equipment on its own, rolling out the devices in late 2010.
The movement gained strength with guidance from the American Heart Association and a grant.
"It helped when we got American Heart Association involved as a neutral party saying, 'Hey, the rest of the country's already doing this. That ship's sailed a long time ago every place else. Bakersfield, get with the program,'" Williams said.
The clinical side of the project began to fall into place after a conference in Atlanta that brought together STEMI systems that were up and running and systems that were just starting.
"That was the pivotal point," said Michele Shain, director of transformational care for Memorial.
But negotiating what kind of data from the hospitals would be collected and shared proved to be another sticking point, which is common.
"You got the clinical people who are all about patient care and having people's lives improved and then you've got the financial component of the hospital that needs to remain in business," Elliott said.
Hospitals have agreed to submit the data to a national database to measure weak points in the system and where minutes might be shaved off. Those numbers will show how long the system is taking to meet crucial time frames between when people have symptoms and when they're treated in the hospital.
Elliott said it was too early to say what Kern County's numbers are like yet, pointing out the hospitals aren't designated as STEMI-receiving centers yet.
Elliott three hospitals already have the personnel and cath labs to treat heart attacks, but "what we don't have in place is the coordinated system where we're constantly looking at data and setting benchmarks and looking at ways to improve."
"That sharing of information, that coordination is really what I think the beauty of the STEMI system is," Elliott said.
READY TO GO
If the system works as planned, paramedics will identify a STEMI with the 12-lead EKGs before a patient even sets foot in a hospital.
The paramedics will then transmit that information to a STEMI-receiving center -- a hospital equipped with a catheterization lab and approved by the county to take those patients.
The receiving centers must take a STEMI patient from another hospital that doesn't have the designation if a "STEMI Alert" is called. With the alert that the patient is on the way, the hospital can start assembling its staff and have a cardiac team ready to meet the patient at the door, Williams said.
"Time is basically the key factor and that's what this whole system of care is about," Rolfe said.
Several hurdles must still be cleared before the system is up and running, including contracts between the county and the three potential STEMI-receiving centers and transfer agreements among the various hospitals in the county. Elliott said EMS will have to give paramedics direction on whether they should bypass a rural hospital in the case of a STEMI.
"We can't leave it gray. We've got to provide paramedics a black-and-white way to make the decisions," he said.
Public awareness is another bar to clear. The doctors and administrators that put the system together said it won't work if people don't dial 911 when they think they are having a heart attack.
They still have to iron out how they will get that message out before the system rolls out, something Elliott expects to happen in the first quarter of the New Year.
"The clock doesn't begin when the patient shows up in that ER, the clock begins when the patient starts having the symptoms," Bhambi said.