Bypassing emergency for faster cardiac care

No one has to explain the value of faster emergency cardiac care to Durham resident Kaleem Salam. Getting treated quickly for his heart attack this spring has meant everything to the 49-year-old. Just one day after a special cardiac care program at Rouge Valley Health System expanded to include the Durham region, he became its first patient. In late April, Salam, of Oshawa, arrived at Lakeridge Health Oshawa’s emergency department with chest pains and a tingling sensation in his arms. He was quickly assessed by a highly-trained triage team. Following an immediate electrocardiogram confirming a heart attack, and after blood clot-busting medication was given to him, he was taken by Durham Region Emergency Medical Services (EMS) to Rouge Valley Centenary’s coronary care unit. Salam received an angioplasty by cardiologist Dr. Ram Vijayaraghavan, and the experienced cardiac care team, in the catheterization lab. Just hours after the procedure, he was returned to Lakeridge Health, where he could recover closer to his family. Activation of this new program, called Code STEMI, for patients like Salam located outside the recommended 90-minute travel time, means they will receive clot-busting medicine, then be sent quickly to the catheterization lab to reduce the impact of the heart attack. Such patients are admitted directly to the lab, bypassing the emergency department. “My doctors said that timing made the difference. They are all heroes. It’s because of them that I’m here today,” says Salam, who is recovering well. How it works In the event of specific types of heart attacks, Lakeridge Health’s emergency department team will call RVHS to activate the Code STEMI response. The patient is then transported immediately via ambulance to the RVHS cardiac catheterization lab, located at Rouge Valley Centenary in east Toronto, for an angioplasty. Following the angioplasty, the patient is returned to Lakeridge Health’s critical care department for ongoing care and recuperation. The program was piloted in east Toronto last winter, as led by Rouge Valley’s cardiac care team in partnership with Toronto EMS and The Scarborough Hospital. Code STEMI fits in with Rouge Valley’s designation as a cardiac care regional centre of excellence in the 401 corridor, as designated by the Central East Local Health Integration Network (CE LHIN) in 2009. Ajax-Pickering MPP Joe Dickson sums up what the new program means for patients: “This is precisely the kind of system thinking that LHINs were designed to create and encourage. The Code STEMI initiative gets patients the care they need faster and most effectively by bringing them in directly from the ambulance to Rouge Valley’s cardiac catheterization lab, bypassing the emergency department. I congratulate Rouge Valley, Lakeridge, Durham EMS and the Central East LHIN for this terrific innovation for patients and the community.” Partnership “Having the ability to expedite angioplasty ensures patients across Durham region and east Toronto receive the right care, at the right time, in the right place. The sooner treatment can be administered by one of our cardiologists and our specialized team, the better a patient’s chance of surviving a heart attack,” says Natalie Bubela, vice president, regional programs, program integration, and chief nursing executive of Rouge Valley Health System. “Durham Region EMS is honoured to be a member of this cooperative partnership with Lakeridge Health, Rouge Valley and the Central East Pre-Hospital Care Program to introduce Code STEMI to our communities,” says Richard Armstrong, director, Durham Region EMS. “Now, all 911 calls for patients experiencing chest pain, who meet the conditions for STEMI bypass, will result in these patients being immediately transported by Durham Region EMS directly to the Rouge Valley Centenary coronary care unit, then immediately to the cardiac catheterization lab, for timely PCI (percutaneous coronary intervention).” “During a heart attack, we can’t skip a beat in getting patients to the right team, treatments and technology. This new program ensures that we are all working together, in perfect sync to save lives,” says Kevin Empey, president and chief executive officer of Lakeridge Health. Deborah Hammons, chief executive officer the CE LHIN, is pleased with the successful expansion of the Code STEMI program into Durham Region. “This collaboration between healthcare partners to deliver the Code STEMI program is an excellent example of how, by working together, we can make a difference,” says Hammons. Please visit for more information.