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September is Aortic Disease Awareness Month. Drs. Milind Desai, Vidyasagar Kalahasti, and Eric Roselli, from the Aorta Center at Cleveland Clinic, speak with Tom Beers, Manager of Emergency Medical Services, about how Cleveland Clinic is working with First Responders to improve how we care for patients with a life-threatening aortic dissection.

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Caring for You Before the Hospital: How Doctors and EMS Work Together

Podcast Transcript


Welcome to Love Your Heart, brought to you by Cleveland Clinic Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy and information about diseases and treatment options. Enjoy.

Milind Desai, MD, MBA:

I'm Milind Desai and I'm the medical director of the Aortic Center. And let me introduce Tom Beers, the manager of Emergency Medical Services, and he's going to talk about emergency services and what they bring to the table. As you very well reckon, most of us strive so that there's no emergency, but often emergencies may be par for the course and that's where his perspective becomes very important.

Tom Beers:

Hi, my name's Tom Beers. I work as a firefighter paramedic in the city of Cleveland Heights. And here at the Cleveland Clinic, I liaise between the hospital and these amazing physicians you and the nursing staff here at the Clinic and bring those resources to frontline responders. I've worked at Cleveland Clinic for almost 20 years, a world-renowned heart hospital, the best in the world as far as education. It was always STEMI, specific types of heart attacks, strokes or trauma centers working with them. But this didn't get enough of the spotlight that it deserved. So, I was looking through all my paramedic textbooks and the amount of information that was in there about aortic dissection, you could fit on the top of this page. There was almost nothing there.

When I did research on it online and in medical literature that pertains to pre-hospital medicine EMS, the last paper that was out there was maybe 2012. And it was wonderful that it was out there, but there wasn't really much to train paramedics on. And what people don't realize is EMS is only about 50 years old. It's a very nascent form of medicine really coming into its own, still. And every community is different, whether it's urban community, suburban, rural, and the resources they have. And so, what we've actually done recently is try to write a new script for the types of levels of training that paramedics should have in aortic dissection. So, for everyone who doesn't know, paramedics operate underneath the medical license in the state of Ohio, underneath the physician's license to be able to get medications and all the things they do. And those physicians also go out and they train all of the paramedics on the different diseases, different traumatic injuries. So, we wrote a paper bringing together the scientific literature from a paramedic's perspective, not from a physician or a surgeon's perspective, but what does the street medic out there in the field have to know about aortic dissection? So, we're really excited to bring that to the field and really train paramedics about some of the tools they can utilize in the field.

Everything we do is based upon quick assessments and really having the paramedics to look at the types of diseases or maladies that someone may have prior to calling 911. Be able to identify and differentiate between specific types of heart attacks, STEMIs, but those are the types of patients that come in by ambulance and go right up to the cath lab. And so, we've done a lot of work with that. And so, we want to bring the same type of spotlight to aortic dissection. From a paramedic's perspective, we probably get 30 minutes with our patients. Rarely do patients come back to the fire station and drop off cookies. Hint. But to be serious, I would encourage you guys to go visit your firehouse and especially if someone in your family or you yourself has dealt with aortic dissection or aortic diseases, to ask them what they know about it. And speak to those clinicians in the field and let them know that you live in the community, you have this disease, and you guys can have a knowledge sharing moment between patients and provider and the pre-hospital care.

Milind Desai, MD, MBA:

And if I can add a couple of words, it is crucial for the firefighters, the EMS, to recognize that not every chest pain is a heart attack. Treatment for a heart attack is to give powerful blood thinners, which are completely opposite to what would be needed in an aortic dissection, which is essentially a tear. When you get something torn, you don't give blood thinner. So, it is important that the system takes this into consideration as somebody is in the middle of an emergency. So, a heart attack is one way. Often when your aorta is torn and depending upon where the progression is, it could impact your neck vessels and your first presentation may be a stroke. What is the treatment of acute stroke? Give blood thinner.

Vidyasagar Kalahasti, MD:

I just want to echo the sentiments that Tom had brought up about the amount of time that they have that they spend with patients. One of the first encounters that I have with patients is not in the front end, but more in the back end. Meaning that they have gone for an emergency surgery and I'm meeting them for the first time after they have recovered from the surgery. And 99 percent of the patients that I talked to have no idea what had happened to them, nor did they have the understanding of what exactly aortic dissection is. So, I find that an incredible opportunity to educate. And the same thing that Tom has mentioned with that education if you go back to your communities and talk to your EMTs and firehouses, you are doing a service to any other patients who may face similar type of situations.

Eric Roselli, MD:

If I could just chime in about the sort of emergency side of things. I've got the email from the head of our ED department, and they jumped all over this. And they do this, lessons learned education internally, and they share these cases and go over dissections, and they make sure they review an aorta dissection case every few months internally for their sort of internal lessons learned program. Even though it's not something that they see as commonly as a lot of other things because it's a really important problem that's life-threatening. And it's cool because they're also speaking at their national emergency medicine meetings about it. And we just have to make sure we focus on it and we're all working on not only educating the community of patients and lay people about this but each other. And so, I just wanted to share that with you, that our emergency medicine physician team is also working on making sure that it's high on the list of diagnoses.

Tom Beers:

It is. And all of the emergency physicians across the Cleveland Clinic enterprise go out and give educational pieces to the firefighter. We have 87 cities that we're medical direction for across enterprise. It's thousands of first responders of firefighters and paramedics, and even sometimes police officers to recognize this disease pattern.


Thank you for listening. We hope you enjoyed the podcast. We welcome your comments and feedback. Please contact us at heart@ccf.org. Like what you heard, subscribe wherever you get your podcasts, or listen at clevelandclinic.org/loveyourheartpodcast.

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