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‘I should be dead,” says Hampton Hall resident Ronald Clarke, and when you hear his story you know he’s not exaggerating for effect.
After suffering a heart attack on the Sun City tennis courts a year ago, Clarke flatlined three times while en route to — and inside — the cardiac catheterization laboratory at Hilton Head Hospital. Three times he was revived by different skilled professionals who worked together seamlessly to save his life.
“I should be dead,” he says, and the reason he’s able to say such a thing is exactly why Tom Neal, director of Cardiovascular, Cardiopulmonary, and Imaging Services at the hospital, is particularly proud of their efforts when it comes to streamlining and coordinating care for heart attack patients.
For the past two years Neal has been spearheading an effort to more efficiently treat the most critical cardiac patients — like Clarke. Part of that has involved figuring out ways to decrease the “door-toballoon time” (D2B), a critical quality measure that marks the time it takes a patient who enters the hospital’s ER to get the critical care needed, typically a balloon angioplasty or coronary intervention.
“Once the blood quits flowing through it, the heart muscle starts to die,” Neal says. “If you can get that (blocked artery) opened up within the first four hours, you start to see really, really good improvement.” The problem, he says, is many people ignore the symptoms of a heart attack or delay seeking medical attention, not realizing critical minutes are ticking away.
That’s why it’s essential to have the fastest D2B possible, Neal says. Industry protocol is 90 minutes or less. At Hilton Head Hospital, the goal for “EMS-to-balloon time” (E2B) is 90 minutes or less. "We've kind of licked that," Neal says of the hospital's efforts in the last quarter of 2010. "One hundred percent of the time we’re getting that door-to-balloon time in under 90 minutes.”
Clarke’s D2B was 49 life-saving minutes.
The retired physical education teacher says fate was on his side that day last January. He happened to be playing against a retired surgeon, who leapt into action when Clarke went into cardiac arrest on the sidelines. A retired nurse was playing a different game in a nearby field and she rushed to help as well. And the tennis courts were near the fitness center, which had a defibrillator on-site.
“Everything just broke my way,” says Clarke, a fit 67-year-old who has lived in the Lowcountry fulltime with his wife, Susan, for four years. He remembers the pain — “It was like someone was standing on top of me” — when he came to on the court, and he remembers the Beaufort County EMS technicians working on him while speeding to the hospital.
“I remember the one guy stayed right over me,” Clarke says. “He was yelling at me, ‘Hang in there! Don’t you die on me! We’re almost there!’”
One of the biggest E2B timesaving methods, Neal says, has been better communication with Beaufort County EMS. “Most patients call EMS before going to the hospital, but we were not coordinated, so we talked about how to work together to improve care,” he says. Under a new set of guidelines, if the EMS team does an EKG in the field, they transmit it to the hospital so that it’s in the hands of the ER doctor and the cardiologist before the patient even arrives.
When Clarke made it to the ER he went into cardiac arrest again, and the ER team of doctors and nurses revived him.
By the time he made it to the catheterization lab, interventional cardiologist Dr. Ravina Balchandani had on her hands a very critical patient.
“He arrested in the cath lab before we could even put him on the table,” says Balchandani. “It was a very tricky situation. He had a high-grade blockage in a critical place in the artery.”
But she was able to open up the artery, put a stent in it and stabilize him. After three days in the ICU, Clarke was released. He returned two weeks later for a follow-up procedure to put a stent in another artery, and went through several weeks of recommended rehabilitation services at the hospital’s cardiac rehab program.
Today when he thinks of all the people who touched his life in those 49 minutes, Clarke is overwhelmed with gratitude.
“These people never quit on me. Right from the get-go, the EMTs were great coming in, the doctors, the nurses, they just did their job so well,” Clarke says. “I owe my life to them.”
