A matter of minutes to save a heart
March 12, 2009 · Updated 3:25 PM
As Joe Kinney lay beside the road, frantic for help during December’s snowstorm he did not know that a clock was ticking away the minutes that could mean the difference between not only his survival, but the quality of the rest of his life. There were a lot of things he did not know, some he would not find out until much later.
What he did know, was that the pain in his chest was so bad it could only be a heart attack, he was on a hard-to-find road, cell phone coverage was spotty and he was scared.
The ticking clock was a 90-minute one. That’s how long there is from the onset of a heart attack to arrival at a hospital cath lab, specializing in the treatment of heart attacks, before there is major damage to the heart. After 90-minutes, Kinney’s heart damage would be more dramatic. It could mean numerous drugs for the rest of his life, a heart transplant, or death.
On Orcas, in the most optimal conditions, with clear blue skies and an Airlift helicopter ready and available, it takes an average of 60-minutes to get a helicopter to the Port of Orcas and the patient transported to a cath lab.
For Kinney, the conditions were far from optimal. Orcas was in the midst of a snow storm, helicopters were not flying, he was on an unnamed back road, emergency response was having trouble finding him, he had left his cell phone in his vehicle after calling his wife, the Sheriff’s boat was already transporting another patient and he was having a massive heart attack.
“We call the type of heart attack he was having the widow maker,” said Division Chief and Paramedic Patrick Shepler.
Kinney, 46, a stonemason, “strong as an ox” in his own estimation and with no history of heart trouble had been putting gravel on a back road because of the snow, when the hammering pains in his chest started. He had called his wife, asked her to call 911 and then walked down the hill to the main road, as the sledgehammer pounding on his chest got worse. He wanted to be on the road so someone would find him.
Immediately upon getting the call, Orcas Island Fire and Rescue headed toward the Ferry Landing area. The road name had been confused, and they were unsure of where they were going except for a general direction. But critical time was passing, so it was better to be heading in the right direction than waiting for a precise location. That clock was ticking.
A former EMT was the first to find Kinney beside the road. He was able to call in a better location, wrap Kinney in blankets and he stayed with him until Shepler, and EMT Bob Nutt arrived. The EKG that Shepler ran, showed that Kinney was in the midst of a bad heart attack.
One of those things that Kinney did not know, was that Orcas Island paramedics are the only ones in northern Washington, and perhaps the state, according to Dr. Michael Sullivan, the San Juan County Medical Director, who have been carrying a clot busting drug called TNKase on their ambulance for the past ten months. The drug, which has a shelf life of a year and a half, had not yet been used on a patient.
TNKase is expensive at $2800 a dose and it’s very dangerous to use. It can cause internal bleeding and other medical problems. Optimally, it should be used within 60-minutes from the start of the heart attack.
“Do the benefits outweigh the risks?” Shepler said. “That’s what we have to determine before using it.”
Shepler knew that medical transport was outside the 90-minute window. He had come in to work because Paramedic Valerie Harris had left on the sheriff’s boat with another patient. He knew that the heart attack was massive, and he knew he could not get an EKG to their emergency medical advisor, Sullivan, because of the bad cell phone coverage in the area.
“It’s a huge risk procedure,” Sullivan said. “Most programs are set-up that the EKG is faxed to the medical advisor. I had enough trust in the team involved, to say ‘go ahead and administer the drug,’ without seeing the EKG. It was a huge leap of faith for a medical director, but the paramedics are so good at what they do, that I had trust in them to evaluate the situation.”
The year before, in August, the same conditions had been in play: bad helicopter weather and a heart attack. That patient survived, but according to Sullivan, there was major heart damage. It was because of that patient, that Sullivan recommended that the ambulance start carrying the TNKase. They had discussed it in the past, and Sullivan had worked for two years with the paramedics and EMTs in evaluating their advanced ability in using a 12-lead electrocardiogram.
“With every tick of the clock, heart muscle is dying,” Sullivan, said. “In order to address our unique medical environment, the OIFR established a thrombolytic program. One other drug that we used with Joe Kinney, that is unique to the San Juan County program, is Plavix. This drug, usually reserved only for cardiologist use is administered on Orcas to help prevent an additional clot from forming.”
Both TNKase and the Plavix, as well as 10 other medications, were given to Kinney within 30-minutes of the onset of his heart attack. He was transported to the hospital cath lab by the sheriff’s boat. Kinney had minimal heart damage.
His life has changed, but not in terms of a heart transplant or having to carry oxygen for the rest of his life. He has had to give up some of the foods he loves. He eats less red meat and his daily dose of two old-fashioned donuts are gone. He is losing weight and getting more cardiovascular exercise. He has a $60,000 dollar medical bill.
But, three days after his heart attack he was home, celebrating his third wedding anniversary with his wife Missy and their dog. One more thing Kinney didn’t know, on Orcas, during a snowstorm, when your wife has to be driven by the OIFR to meet you at the sheriff’s boat, Captain Rita Harvey will babysit your dog while you are in the hospital.
Shepler said, “It’s a bold cocky statement, and I would not make it unless it was true. We saved his life.”