Cath Lab Transport?

[Jon]

Vent brought up this in another thread:

Thrombolytics are also something that has recycled itself in the field as did cath labs. The 1980s brought us "Cath-in-a-Can" with many portable cath labs being set up but were often several miles from an OR that could do open chest quickly. The 80s also brought thrombolytics to Paramedics in the field. However, this was introduced to EMS providers in urban areas that had Cath Labs at nearby hospitals.

Around here, there are several hosptials that have cath labs, but don't do cardiac surgery. Instead, they pay for an ALS rig to be on standby outside during the day. If the patient needs surgery, the cath lab team brings the patient to the ambulance, then they go to another hospital equipped for open-heart surgery.

Does anyone else do this?

 

[MSDeltaFlt]

Vent brought up this in another thread:



Around here, there are several hosptials that have cath labs, but don't do cardiac surgery. Instead, they pay for an ALS rig to be on standby outside during the day. If the patient needs surgery, the cath lab team brings the patient to the ambulance, then they go to another hospital equipped for open-heart surgery.

Does anyone else do this?

What do you mean "they pay for an ALS rig to be on standby outside during the day."? You can't do an interventional cardiac cath unless you have a cardiothoracic surgeon on standby, because, if sugar turns to sh*t, you have seconds - not minutes - to get that patient to surgery.

Besides, it makes no sense to do a diagnostic cath and keep a truck on standy. Normally, if you think the patient might need intervention, go ahead and ship him anyway. I don't get it. It don't make a lick of sense.

 

[JJR512]

In the greater Baltimore metro area, many hospitals have a diagnostic cardiac cath lab, or cath labs that can do some but not all interventions. But they don't even have an ALS unit on standby outside; instead, the hospital has a contract with a commercial ambulance company. If the hospital finds the patient needs something they can't do there, they call the ambo company who comes and transports the patient to the full interventional cath lab equipped hospital (usually University of Maryland, Sinai, Union Memorial, or St. Joseph).

I have done many of these transports myself. Usually the response to the scene is Priority 3, as is the transport to the full cath lab hospital. Usually the patient presents with a fairly normal EKG and the patient is brought to the cath prep area, where it might still be a few hours until they actually get into the lab.

This type of transport is, around here, seen as the "routine" or "bread-and-butter" for the ALS units. The bigger companies (TransCare, LifeStar) will do several of these a day.

 

[firecoins]

In the greater Baltimore metro area, many hospitals have a diagnostic cardiac cath lab, or cath labs that can do some but not all interventions. But they don't even have an ALS unit on standby outside; instead, the hospital has a contract with a commercial ambulance company. If the hospital finds the patient needs something they can't do there, they call the ambo company who comes and transports the patient to the full interventional cath lab equipped hospital (usually University of Maryland, Sinai, Union Memorial, or St. Joseph).

I have done many of these transports myself. Usually the response to the scene is Priority 3, as is the transport to the full cath lab hospital. Usually the patient presents with a fairly normal EKG and the patient is brought to the cath prep area, where it might still be a few hours until they actually get into the lab.

This type of transport is, around here, seen as the "routine" or "bread-and-butter" for the ALS units. The bigger companies (TransCare, LifeStar) will do several of these a day.

pretty much the same in the lower NY Hudson Valley

 

[Flight-LP]

Dangerous as hell. No hospital nor physician should allow a cath to be performed diagnostically unless that hospital has full interventional capabilities. This issue has happened before in the north Houston area when a prominant hospital system had a patient die while awaiting transport to definitive intervention. It was a sad day that should have never occured...........

 

[fma08]

Both hospitals here have full cath labs and do cardiac surgeries.

 

[daedalus]

Vent brought up this in another thread:



Around here, there are several hosptials that have cath labs, but don't do cardiac surgery. Instead, they pay for an ALS rig to be on standby outside during the day. If the patient needs surgery, the cath lab team brings the patient to the ambulance, then they go to another hospital equipped for open-heart surgery.

Does anyone else do this?

Most hospitals in my area that have a cath lab also do open hearts for those who need CABG. There are one or two sh*it hole hospitals in bad parts of the county (There are LOTS of hospitals in my LA County) that have cath labs and do not do open hearts. I have CCTed these patients to another hospital. Any drip with a name on it requires a CCT/RN out here in LA.

 

[JJR512]

Most hospitals in my area that have a cath lab also do open hearts for those who need CABG. There are one or two sh*it hole hospitals in bad parts of the county (There are LOTS of hospitals in my LA County) that have cath labs and do not do open hearts. I have CCTed these patients to another hospital. Any drip with a name on it requires a CCT/RN out here in LA.

A cath lab patient can be transported ALS in MD (Paramedic only) with some drugs, including Heparin, if it's less than a certain amount; other drugs, including Heparin over that amount, require SCT transport with a CCT/RN.

 

[Ridryder911]

Dangerous as hell. No hospital nor physician should allow a cath to be performed diagnostically unless that hospital has full interventional capabilities. This issue has happened before in the north Houston area when a prominant hospital system had a patient die while awaiting transport to definitive intervention. It was a sad day that should have never occured...........

Agreeable, but a routine process. My mother died because of exactly this problem and worse that the facility did have an interventional capabilities but since it was assumed there was no coronary occlusions the interventional suite (and thoracic surgeon) was occupied. The problem arises when the cardiologist relied upon the thallium scan and then found out while performing the angiogram that she had 97% occlusion on the main LAD and RAD. Yeah, oops! Unfortunately, they could not immediately perform CABG, etc.. and had to await the room to be opened..I settled not to pursue litigation (cardiologist is the most prominent one in my state) if the hospital made a firm policy that such would never re-occur.

I call the non-interventional then re-cathing ... "double dipping". In my local area we have a million dollar cath lab that only performs angiograms and that's it. Yes, I transport at the least 3-5 patients a week that requires to be re-cathed. Usually, it is similar to what I described occurred to my mother.. I routinely transport with the sheath in place.. or ones that needs stent and of course to be re-cathed.

It will never change, nor does the physicians want it to. I figured that they re-cath enough that the are making at the least an extra > million $$ by doing this each. Both have privilages at separate hospitals that do full interventional services.. of course if one can await three days,the charges can increase..

 

[mikeylikesit]

we have one cath lab in the area that is 30+ miles away...doesn't really do you any good.

 

[upstateemt]

As a Cath Lab Nurse for 14 years (I currently run a Cardiac Rehab program) I can attest to how quickly things can "go bad". Our cath lab is adjacent to the OR and there is always a Cardio Thoracic surgeon available when a cath is being done.

I am now running a Cardiac Rehab program in a city about 50 miles from my primary hospital (but still a hospital employee) . There is a local hospital here that has a diagnostic cath lab and I don't believe they make it clear to patients the dangers of having a cardiac cath without interventional capabilities or an open heart program. When things go bad (and they do) or require intervention the patient is transferred via local paid service to a hospital 120miles away which this hospital has an "agreement" with. Patients are not even given the option of going to my hospital, which is a "Top 100 in the Nation Solucient Hospital" because of political and competative issues.

The patient being transferred is not told that the ambulance ride will cost them significant money out of pocket because they are going to a facility that is further away or that is something goes wrong during the procedure there is no one to crack their chest.

I see these patients in Cardiac Rehab frequently, at the time of their event they are so stressed and emotional that they don't even know the right questions to ask. They trust their Cardiologist and never question what they are told to do.

Last year, I did a lot of clinical time in that hospital's ER (as part of my Intermediate and CC certification). I actually heard a Cardiologist tell a patient that he would not recommend the patient go to my hospital and would not be responsible for the "outcome" if he did.

It's just plain crazy!!

 

[JJR512]

My apologies to everone, but I'm going to have to retract my earlier post on the grounds that I apparently suffered a massive brain fart that day. Pretty much the entire contents of my previous post were completely inaccurate.

The type of patient transport I was actually describing was for a patient had had suffered or was suffering an MI but was in a stable, non-life-threatened state. They were being transported from whatever hospital they were at to one with a better cardiac program, including a full interventional cath lab, such as those hospitals I mentioned. This is completely off the point of what this thread was about.

In retrospect, I have never heard of a patient being transported from one cath lab to another, although that doesn't mean it doesn't happen around here.

Again, I apologize for the mixup.

 

[rmellish]

The private service I work for used to fairly regularly transport patients from a scheduled exploratory cath to a seperate facility (20-30mins) for an interventional cath...

We provided an ALS standby for this facility, for precisely this reason.