EMS Division Chief: The Importance Of Time…

EMS Division Chief
Los Alamos Frie Department

Each year more than a 790,000 Americans have a heart attack, of these nearly 15% will die as a result.

A heart attack is known clinically as a myocardial infarction (MI) and is the permanent damage to heart muscle. The prefix “my” means muscle, “cardial” refers to the heart and “infarction” is the death of tissue due to a lack of blood supply.

A heart attack happens when the blood supply to the heart is reduced or cut off. Cells within the heart will become starved of oxygen and begin to die. The more time that passes without treatment to restore blood flow, the greater the damage to the heart.

  • Heart disease or coronary artery disease is the leading cause of death for both men and women.
  • Cardiovascular disease (CVD) accounts for about 800,000 deaths per year.
  • In a 2005 survey, most respondents—92%—recognized chest pain as a symptom of a heart attack. Only 27% were aware of all major symptoms and knew to call 9-1-1 when someone was having a heart attack. 
  • On a global level, CVD accounts for 31% of all deaths. The estimated cost of CVD will be $1,044 billion by 2030.
  • About 47% of sudden cardiac deaths occur outside a hospital. This suggests that many people with heart disease do not act on early warning signs.

Time and the chain of survival

Time is a critical component to surviving a cardiac event, with every moment that passes, our chances of survival diminish tremendously. The timer starts when we are younger when we can make lifestyle choices that provide for a healthy heart later in life. Moments count during a cardiac event, the amount of heart muscle damaged is directly proportionate to the amount of time it takes to restore blood flow the heart. During a cardiac arrest, every second that passes without high-quality CPR and the use of an AED reduces the likelihood of survival. Each of these individual aspects makes up a “chain of survival,” and are an integrated component to reducing the number of fatal cardiac events.

Risk factors

There has been extensive research in the field of heart attacks; through understanding these risk factors, it is possible to reduce the chance of developing coronary artery disease and having a heart attack. The American Heart Association recommends focusing on heart disease prevention early in life. To start, assess your risk factors and work to keep them low. The sooner you identify and manage your risk factors, the better your chances of leading a heart-healthy life.

There are three significant factors that should be considered:

Major risk factors These factors have been shown to significantly increase the risk of heart disease. The major risk factors are those that you may have been born with and can not be changed. The more risk factors that you have, the higher the chance of developing heart disease. The major risk factors include age, gender, and heredity.

Modifiable risk factors These are major risk factors that can be modified, treated or controlled through a combination of medication and lifestyle changes. These risk factors can be reduced and should be the concentration of your risk reduction efforts. The modifiable risk factors include smoking, cholesterol, blood pressure, inactivity, weight, and diabetes.

Contributing risk factors These factors are associated with an increased risk of heart disease, but their significance or prevalence has yet to become clear. Contributing risk factors: stress, alcohol and overall nutrition.

Preventing heart attacks

Too young to worry about a heart attack?

A heart attack can occur at any age. You’re never too young to start heart-healthy living. If you’re over 40, or if you have multiple risk factors, work closely with your doctor to address your risk of developing cardiovascular disease.

Heart attack prevention is critical. It should begin early in life. Start with an assessment of your risk factors. Then work with your healthcare team to develop a plan you can follow to maintain a low risk for heart attack.

For many people, their first heart attack is disabling or even fatal. Do everything you can to lower your risk.

Signs and symptoms

One of the most important moments of time that you may encounter in life is knowing when to call for help. Paramedics have been trained and equipped to begin care and treatment of heart attack patients, carrying very similar equipment and medications to the Emergency Room. Additionally, LAFD paramedics have the ability to send time-critical information to physicians, allowing them to prepare for receiving the heart patient. This process begins with you; knowing the signs and symptoms associated with a heart attack can save precious minutes and ultimately be the difference in survival.

Heart attacks have several major warning signs and symptoms:

  • Chest pain or discomfort. Most heart attacks involve discomfort in the center or left the side of the chest that lasts for more than a few minutes, or that goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain.
  • Discomfort in other areas of the upper body. Can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
  • Shortness of breath. Often comes along with chest discomfort. But it also can occur before chest discomfort.
  • Other symptoms. May include breaking out in a cold sweat, nausea, or light-headedness.

Cardiac arrest.

Cardiac arrests are when the heart is no longer pumping blood in an organized fashion. These patients will not survive without your interventions. Studies have shown that there are only two interventions that will help these patients. Patients in cardiac arrest require cardio-pulmonary resuscitation (CPR) and the use of an automatic external defibrillator (AED). Some studies have shown that when CPR is provided by witnesses, the likelihood that Emergency Medical Services can regain a pulse nearly doubles. An American Heart Association study from 2014 showed data that had survival rates from out of hospital cardiac arrest reaching 45% when citizens would start CPR before EMS arrival. Alternatively, the survival rate plummets when CPR is not performed.

LAFD has been working for several years to train our community members in CPR; we have trained high school students, nurses, doctors, lab employees and anyone that would like to learn. Survival from out of hospital cardiac arrest honestly depends on the time from arrest to when CPR is started.  

For nearly five years, LAFD has provided our community with high-quality CPR. This program was born in Seattle Washington, was adopted in Howard County Maryland and is now an integral component of your community’s CPR program. LAFD teaches the high-quality CPR model to first responders across the state of New Mexico during our annual Resuscitation Academy and upon request. It is the vision of the CPR program to teach every willing person the essentials of saving a cardiac arrest patient, with the hopes of improving survivability.

This year the LAFD CPR team has partnered with Dr. Rosen of the St. Vincents Emergency Department, The Los Alamos Heart Council, the Los Alamos Health Council, the Los Alamos Medical Center, the National Labs and many others to teach this critical curriculum to providers and responders across the state. The responders at LAFD are PROUD to provide the community of Los Alamos with the highest quality care. With the help of each of our citizens, Los Alamos could have one of the highest cardiac arrest survival rates in the nation.

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  1. CDC, NCHS. Underlying Cause of Death 1999-2013 on CDC WONDER Online Database released 2015. Data are from the Multiple Cause of Death Files, 1999-2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed Feb. 3, 2015.
  2. CDC. Disparities in Adult Awareness of Heart Attack Warning Signs and Symptoms—14 States, 2005. MMWR. 2008;57(7):175–179.
  3. CDC. State-Specific Mortality from Sudden Cardiac Death: United States, 1999. MMWR. 2002;51(6):123–126.