When a person has a heart attack it means the flow of blood that brings oxygen to the heart suddenly becomes blocked.
Without a medical intervention to clear that blood clot from artery, time starts ticking and the cells of the affected part of the heart being starved of oxygen begin to die. For every 30 minutes that goes by, the chances of that person surviving drop 10 per cent.
Fortunately for heart attack patients in Prince George, there’s a new clot-busting intervention provided by advanced care paramedics as soon as they arrive in an ambulance and determine a heart attack has occurred.
First introduced in 2019 in Kamloops as a pilot project started by emergency physician Dr. Anders Ganstal, CHAMP (Collaborative Heart Attack Management Program) is saving lives all over the province using a drug that rapidly dissolves the clot to restore blood supply and oxygen to the heart, providing better medical outcomes and reducing the length of costly hospital stays.
In consultation with an emergency physician online for support, paramedics run an EKG tracing on the patient and send that by email to the physician. Once it is determined a heart attack has occurred the paramedic is given the authority to administer the clot-busting drug Tenectplase (TNK).
“The goal is to break up that clot as quickly as possible because the heart is having a breath-holding spell and the sooner we open up the artery to the heart the quicker the heart gets to breathe again and there’s less damage - sometimes death can occur if it’s forced to hold its breath too long,” said Ganstal, BCEHS regional medical director for the Interior.
A partnership between B.C. Emergency Health Services - Northern Division and Northern Health brought the CHAMP to Prince George in September 2022.
Just two other provinces – Nova Scotia and Alberta – equip their paramedics with the thrombolytics needed to break up blood clots to the heart. Kamloops cardiologist Suman Dhesi, who trained at the University of Alberta, convinced BCEHS to bring the Vital Heart program to B.C. paramedics.
“The Canadian Cardiovascular Society guidelines recommend that from first medical contact to treatment, you should be giving the clot-busting drug in 30 minutes or less,” said Ganstal, who works at Royal Inland Hospital in Kamloops. “For every 30-minute delay in treatment there is a 10 per cent increase in death. If you treat within the first hour you’ll save twice as many lives as in the second hour.
“We’ve met our target of treating patients in under 30 minutes and we’ve had some amazing cases treated and have now treated (112) patients B.C.-wide. With the success of the program in Prince George and Nanaimo we now have support to scale up to the rest of British Columbia that has access to advanced care paramedics.”
In the first year CHAMP was used in Prince George, 14 heart attack patients were given the drug by paramedics, including a 26-year-old man who suffered his attack in a gym lifting weights. Several of those patients walked out of the hospital without suffering any apparent longterm damage.
“If they call 9-1-1 and the paramedics arrive in your house and recognize right away they’re having a heart attack, if they get drug we can completely remove signs of heart damage in 30 per cent of persons if they’re treated within 60 minutes,” said Ganstal. “This program reduces death because the stats are very clear. We see that in the reduction of heart damage and the return of activity for our patients back to their usual lives.”
In cities where CHAMP is in place, the length of hospital stays for heart attack patients has dropped from an average 6.8 days to 3.6 days for an acute care bed which costs the health care system about $4,000 per day. That works out to $1.4 million in opportunity cost savings, Ganstal said.
“We evaluated on the patient perspective and they all said that every patient in British Columbia should have this treatment,” he said. “The paramedics don’t want to drive a sick patient to hospital because they know that person could have a cardiac arrest and this reduces that (risk) by giving treatment in the field and. They feel so empowered by it.”
Advanced care paramedics (ACP) are trained in the procedure but primary care paramedics (PCP) do not have the authority. If a PCP crew diagnoses a heart attack and they are far from the hospital an advanced crew will be dispatched to meet them halfway on the roadway to give the necessary medication.
More than 100 of the province’s nearly 300 ACPs are trained to give the clot-buster and there’s a plan in the works to add it to the scope of practice for the city’s critical care paramedics (CCP) so they can bring the drug with them on the BCEHS helicopter when they respond to calls in rural and remote areas.
Three B.C. cities – Kelowna, Vancouver and Victoria – have cardiac catheterization labs which treat heart attack patients by physically opening up the arteries with a catheter to remove the clot. Paramedics attending to heart attacks will bypass the hospitals and will bring the patient directly to the CATH lab to avoid delaying the treatment if the patient arrives within two hours of the heart attack. That option is not available in most parts of the province and the CHAMP program is addressing those gaps in coverage by giving thrombolytics in the field.
Ganstal stresses the importance of calling 9-1-1 right away at the onset of heart attack symptoms, chest pains, shortness of breath, pain running down your arm and in the jaw area, nausea, vomiting and profuse sweating. He said people should know how to perform cardio pulmonary resuscitation and how to use a defibrillator.
“Those are so important in the chain of survival,” said Ganstal.
The CHAMP program has been scaled up to every part of the Interior Health region which has an ACP ambulance station, including Cranbrook, Salmon Arm, Trail and Penticton. Fort St. John, which has ACP service, is expected to launch it on May 1st and other rural/remote communities in Northern Health could soon follow suit.
CHAMP will potentially help 450 British Columbians annually in the province, including 30-50 heart attack patients in the Prince George area.
Before the CHAMP was started in 2019, Northern Health evaluated in its largest six hospitals to determine how soon heart attack patients in the North receive thrombolytics in the emergency room upon arrival at the hospital. The median time was 34 minutes, meaning half of the heart attack patients received the drug within 34 minutes, while 85 per cent got the clot-buster within 79 minutes.
“CHAMP made it possible for heart attack patients to receive this life-saving treatment before even arriving at the hospital door,” said Dr. Yaser Ahmed, Northern Health’s regional lead, cardiac and stroke, and an adjunct professor with the Northern Medical Program.
“We’re very glad that here in Prince George we became the second city to implement this in B.C. BCEHS leadership and particularly, Dr. Devin Spooner, the medical director of the north division, has been instrumental in rolling CHAMP to Prince George in partnership with Northern Health. I want to thank everyone who has been part of this and especially all the paramedics staff.”
Based on the success of the program, Ahmed promises the CHAMP treatment will be coming to other northern communities in the near future.
“This aligns with our vison of building more services in the North and having better access to cardiac services closer to home,” he said.
