2009-02-20 / Community

SJEH Designated 9-1-1 Hyperthermia Center

Eric Nazziola, MD, Chairman of the Department of Emergency Medicine at St. John's, and Ione Folkes, RN, examine a patient in the Emergency Department at St. John's where quality indicators for heart care exceed national averages and waiting times and lengths of stay have been reduced. Eric Nazziola, MD, Chairman of the Department of Emergency Medicine at St. John's, and Ione Folkes, RN, examine a patient in the Emergency Department at St. John's where quality indicators for heart care exceed national averages and waiting times and lengths of stay have been reduced. St. John's Episcopal Hospital recently was designated by the Fire Department of the City of New York as a 9-1-1 Hypothermia Center. This means that St. John's Episcopal Hospital now offers the new cooling therapy and therapeutic hypothermia, which will be used to treat patients in cardiac arrest. According to recent data, St. John's quality of care for heart attack and heart failure exceeds national averages for hospitals in the United States.

Therapeutic hypothermia is a treatment in which mild hypothermia is induced through cooling of patients who are suffering from specific types of cardiac arrests. This therapy is indicated to be started within four hours for patients who have been successfully resuscitated after a cardiac arrest but are neurologically compromised. Recent medical literature and findings indicate that therapeutic hypothermia increases both survival rates and rates of favorable neurological outcomes.

Dr. Sergio Sokol performs a transesophageal electrocardiogram, which is among the diagnostic tools, including therapeutic hypothermia, available for treating heart patients at St. John's Episcopal Hospital. Dr. Sergio Sokol performs a transesophageal electrocardiogram, which is among the diagnostic tools, including therapeutic hypothermia, available for treating heart patients at St. John's Episcopal Hospital. Recently the hospital forged a partnership with Mount Sinai School of Medicine, a renowned leader in medical and emergency care. The partnership provides a high level quality of medical leadership through recruitment of board-certified emergency physicians who would also qualify for faculty appointment in the Mount Sinai School of Medicine Department of Medicine. Mount Sinai is also assisting in development of protocols for patient care, further strengthening quality of care.

Once at St. John's Emergency Department, doctors act quickly to confirm a diagnosis of heart attack through a battery of blood tests, as well as tests such as electrocardiograms (also known as ECG or EKG), ambulatory electrocardiography, chest x-rays, and echocardiography.

A more advanced form of echocardiography, called digital echocardiography, is available at St. John's. Digital echocardiography provides valuable information about the heart's health, including abnormal rhythms or arrhythmias. Echocardiography uses a hand-held device, which is placed on the chest, which sends out high-frequency sound waves to produce images of the heart's size, structure and motion. Because the tests are stored digitally, they can be recalled easily and can be compared side by side on the computer screen with a previous test in order to find changes in the heart's condition.

Transesophageal echocardiograms (TEEs) are also performed at St. John's. During this test, a tube is passed down the throat and through the esophagus and emits ultrasound waves that produce images of the heart.

In the Emergency Department, medical therapies to restore blood flow and stabilize coronary arteries include tPA (tissue plasminogen activators), which is a clot-busting drug; anti-platelet therapies such as aspirin; anti-coagulant medications such as heparin; statin drugs which lower cholesterol and decrease inflammation; and beta blockers which block certain body chemicals from increasing the heart rate.

In addition to utilizing these treatments for increasing blood flow and stabilizing the heart, the Emergency Department offers therapeutic hypothermia, which will slow down damage to the brain after a patient has been resuscitated but remains comatose, which should help to improve survival and functionality outcomes.

Most significantly, the quality of care at St. John's for heart attack victims has measurably improved, increasing patients' survival outcomes.

According to the Centers for Medicare and Medicaid Services (CMS) recently released data, St. John's exceeds national averages for all hospitals in the US for heart attack and heart failure care.

Sheldon Jacobson, MD, Chairman of Emergency Medicine at the Mount Sinai School of Medicine, said, "St. John's now has the ability to resuscitate a victim in cardiac arrest that meets or exceeds the national standards set by the American Heart Association."

Once stabilized, heart attack patients are transferred to the Hospital's Coronary Care Unit, which is under the direction of the Chief of Cardiology, Dr. Sergio Sokol, and the Assistant Chief, Melvin Young, MD. It is noteworthy that both of these physicians are on the "Top Doctors: New York Metro Area" book compiled by Castle Connolly. In the Coronary Care Unit, patients may receive thrombolytic medications, sophisticated anti-platelet medicines and adjuncts to aspirin therapy that help to stabilize angina. If additional assessment is required, St. John's also offers nuclear imaging or thallium stress testing, and echocardiograms.

The Hospital's team of cardiologists, includes Ghanshyam Bhambhani, MD; Israel Brafman, MD; Narendra Hadpawat, MD; Raul Mendoza, MD; Lalendra Sinha, MD; David Tarkoff, MD; and Michael Teigman, MD, are among these Sanjay Kirtane, MD, who is also listed in the Castle Connolly book, "Top Doctors: New York Metro Area."

Under the leadership of Mount Sinai and Dr. Eric Nazziola, St. John's Emergency Department is making significant strides in reducing waiting times and decreasing length of stay. Recently the Emergency Department opened a Fast Track program to treat less urgent patients, and early reports indicate high patient satisfaction with the high quality of care, courtesy and speed of being seen and treated. "Because time is so essential in cardiac arrest, local hospitals such as St. John's do an excellent job at diagnosing, stabilizing and treating patients," said Dr. Sokol. With the addition of therapeutic hypothermia, the steadily increasing quality of care as evidenced by rising CMS core measures, a partnership with a recognized leader in emergency medicine, and the recruitment of board-certified emergency physicians, diagnosis and treatment of heart attack on the Rockaway peninsula is improving the quality of health for its residents.

St. John's Episcopal Hospital is a full-service hospital for cardiac care. For more information about the tests mentioned in the article or to find a cardiologist near you please call the St. John's Episcopal Physician Referral Line at 1-877-SJEH-DOC (1-877-753- 4362).

To receive a complimentary copy of St. John's Physician Directory please call 718-869-7750.

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