Emergency-Care Plan Altered by Edward Mostel

Beginning in June, if you have a heart attack in Palm Beach County, paramedics will no longer necessarily take you to the closest hospital. You'll go to the nearest hospital that does angioplasty; that's either JFK Medical Center in Atlantis, Palm Beach Gardens Medical Center or Delray Medical Center.

The change, being made by the Palm Beach County and Boca Raton fire-rescue departments and the American Medical Response ambulance service in Belle Glade, comes after studies show heart attack victims are more likely to survive if they get quick access to angioplasty instead of drugs.

Part of the county, including West Palm Beach, Palm Beach, Lake Worth and Delray Beach made the switch in 2002.

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Coverage areas changing service in June include Jupiter, Wellington, Royal Palm Beach, Belle Glade, Juno Beach, Lantana, Boca Raton and all unincorporated areas.

"This is great news for the people of Palm Beach County," said Dr. Edward Mostel, a Palm Beach Gardens cardiologist who lobbied Palm Beach County Fire-Rescue to make the change. "This is going to save lives."

The change is being fueled by a major study last year that found angioplasty superior to clot-busting drugs in unclogging blocked coronary arteries that cause acute myocardial infarction, the medical name for a heart attack.

The study, published by the New England Journal of Medicine, found fewer complications and reduced chances of another attack when patients were transferred to an angioplasty-capable hospital within two hours.

The Treasure Coast has only one hospital that does angioplasties: Lawnwood Regional Medical Center and Heart Institute in Fort Pierce. Ambulances there still take heart attack patients to the nearest hospital.

Angioplasty, a procedure in which a small balloon is inflated inside the blocked artery, lets blood reenter the heart.

Typically, the patient also gets a stent, or tiny tube, to keep the artery open.

Clot-busting drugs, or thrombolytic therapy, also unclog arteries, but they can't be used on as many patients as angioplasty, and studies show they don't work as well.

Palm Beach County Fire-Rescue, which provides emergency response to half the county's population, including Jupiter, Royal Palm Beach and Wellington, delayed changing its policy because it did not think the three county hospitals with heart units were prepared to perform emergency angioplasty 24 hours a day.

Now that issue has been resolved, and policies and logistics have been worked out, said Al Sierra, chief of Palm Beach County Fire- Rescue.

When the change takes effect June 1, ambulance personnel will perform EKGs on suspected heart-attack patients, and if the results meet certain diagnostic parameters, the patient will be taken to the nearest hospital that offers angioplasty.

Florida law lets hospitals perform angioplasty only if they have approval to perform open-heart surgery.

There is an effort to change the law that would make angioplasty available at Boca Raton Community Hospital, Bethesda Memorial Hospital in Boynton Beach and Good Samaritan Medical Center in West Palm Beach.

About 1.2 million Americans suffered heart attacks in 2001, and 42 percent of those died, according to the American Heart Association.