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Cardiac care

New in-ambulance treatment of heart attack patients

NEWMARKET, Ont. – Residents north of Toronto are the first in Ontario to benefit from a new initiative that enables those suffering from a heart attack to receive life-saving treatment in an ambulance while en route to the cardiac centre.

The initiative – a joint program of Newmarket-based Southlake Regional Health Centre and York Region Emergency Medical Services (EMS) – will save lives and significantly reduce the extent of damage to the heart by starting initial treatment earlier, says Dr. Warren Cantor (pictured), medical director of the Interventional and Invasive Program at Southlake.

Using advanced technology, paramedics in York Region suspecting that a patient is experiencing a heart attack will wirelessly transmit an electrocardiogram – which they perform in the ambulance – to Southlake Regional Health Centre cardiologists. The physicians then view the electrocardiogram on a hospital computer screen or on their Personal Digital Assistant (PDA) to confirm the patient’s diagnosis and recommend the appropriate treatment, including authorizing paramedics to immediately administer intravenous clot-busting drugs.

In most regions of North America, clot-busting medications cannot be given in the ambulance because the physician is not able to view the electrocardiogram and confirm the diagnosis of heart attack. York Region is now one of the very few regions in North America that is able to administer clot-busting medications in the ambulance. Southlake Regional Health Centre and York Region will be participating in an international study – the STREAM trial – comparing clot-busting medications given in the ambulance with angioplasty in patients who are too far from a cardiac centre to undergo angioplasty within one hour.

Heart attacks occur when one or more of the arteries that supply blood to the heart become blocked, depriving the heart of the oxygen it requires to function effectively. The length of time the blood supply is cut off determines the amount of damage done to the heart.

Angioplasty – which uses catheter-mounted balloons and stents to open a blocked artery and restore blood flow to the heart – is accepted by the medical community as the best initial treatment for heart attacks.

Since this is often difficult to perform at an early stage, clot-busting medications can be given in the interim to help reduce heart damage.

“The technology enables us to give better treatment quicker by shifting the initial treatment from the emergency room to the ambulance,” Dr. Cantor said, estimating that the time savings translates to about an hour, which research has shown results in substantially improved survival. Anyone experiencing symptoms that may represent a heart attack should call 911 immediately in order to receive treatment quickly, he emphasized.

“A project of this magnitude requires strong cooperation between the partners involved,” said York Region Chairman and CEO Bill Fisch. “York Region is committed to working with Southlake Regional Health Centre on the STREAM Study project, with over 100 York Region EMS Advanced Care Paramedics trained and ready to participate.”

The initiative, which operates 24 hours a day, seven days a week, is similar to a program launched in December 2008 in Edmonton - the first of its kind in Canada. For more information about the Southlake Regional Health Centre-York Region EMS program, please visit

About Southlake Regional Health Centre
Based in Newmarket, Southlake Regional Health Centre is a full-service hospital with a focus on cancer care, cardiac care, pediatric and perinatal care, child and adolescent eating disorders, and child and adolescent mental health care. Serving more than one million residents of York Region and South Simcoe, Southlake is the fourth-largest cardiac centre in Ontario. Southlake works with hospitals and emergency medical services throughout York, Simcoe and Dufferin regions to ensure patients suspected of having a heart attack are taken by ambulance directly to Southlake’s cardiac centre for specialized care.

The new Southlake Regional Health Centre/York Region Emergency Medical Services (EMS) in-ambulance cardiac treatment initiative is part of the international STREAM trial. The STREAM – short for Strategic Reperfusion Early After Myocardial Infarction – trial is being coordinated in Canada by the Canadian VIGOUR Centre (CVC) at the University of Alberta. This trial will compare two treatment strategies for patients diagnosed with a heart attack in the ambulance who have had pain for three hours or less. The first treatment strategy is administration of intravenous clot-busting drugs in the ambulance, followed by angioplasty within 24 hours. The second strategy is direct angioplasty within three hours without clot-busting drugs. Sponsored by Boehringer Ingelheim, with additional support from Roche Canada, the STREAM trial is being led by Dr. Paul Armstrong, Director of CVC and Co-Chairman of the STREAM trial and Dr. Robert Welsh, Canadian National Coordinator and Steering Committee member of the STREAM trial. Globally, 65 patients have been enrolled in the trial to date, with the ultimate number of patients expected to reach 2,000 by December 2010. Patients will be recruited from Canada, France, United Kingdom, Russia, Spain, Poland, Austria, Belgium, Northern Ireland, Norway, Germany, Italy and Brazil. Through a combined initiative of the Canadian VIGOUR Centre – an academic research organization that specializes in managing clinical trials of cardiovascular therapies – and the Edmonton Emergency Medical Services, the city of Edmonton was the first site in Canada to launch the program, beginning in December, 2008. Newmarket-based Southlake Regional Health Centre and York Region EMS together are the second participants in the trial in Canada. Other Canadian cities that will be taking part in the study include Halifax, St. John’s and Winnipeg. “We are looking forward to having Southlake join this key investigation of life-saving therapy for heart attack patients and are confident, given Dr. Warren Cantor’s experience and leadership, that they will make an excellent contribution to the trial,” said Dr. Armstrong.