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Introduction

One morning in 2013, Ted Carroll (not his real name), a man in his mid-sixties, was awakened from a sound sleep by a sharp, burning pain in his chest that radiated down his left arm. Ted suspected that he was having a heart attack, so he went to the nearest emergency room. At 6:02 a.m., he arrived at the Twinsburg Family Health and Surgery Center in Twinsburg, Ohio, a suburban clinic and outpatient surgery center operated by Cleveland Clinic.

The treatment team moved fast. When someone is having a heart attack, every minute counts. The longer the wait before intervention, the more lasting damage the heart muscle sustains. By 6:06, a nurse had seen and triaged Ted. At 6:10, an emergency room physician gave him an EKG, which confirmed that he was having a heart attack. By 6:18, he had received a chest x-ray. The situation was serious: Ted had a blockage in his left anterior descending artery, which provides the main blood supply to the heart. If doctors couldn't get blood flowing through the artery soon, Ted would die. He needed cardiac catheterization—the placement of a stent into his artery via a catheter inserted in his groin.

Catheterization and the subsequent monitoring and treatment of a heart patient are complex, performed by only 20 percent of the hospitals in the United States; Cleveland Clinic's main campus hospital is one of them. Unfortunately, few hospitals that offer catheterization are able to get a heart attack patient checked in and evaluated, activate a team at the catheterization lab, and perform the cardiac procedure, all within an hour. Studies show that approximately a third of all patients don't get the procedure within 90 minutes. Fortunately for Ted, he didn't have to wait that long because, instead of traveling the 25 miles from Twinsburg to Cleveland Clinic's main campus in an ambulance, he could fly there.

Ted had the advantage of being a patient in one of Cleveland Clinic's large regional network of care facilities. At 6:20, a mere 18 minutes after Ted had arrived at Twinsburg, a helicopter containing a fully equipped mobile intensive care unit staffed with intensive care specialists arrived. Working side by side with the Twinsburg Emergency Department staff, the critical care transport team transferred Ted to a cot, started an IV, and gave him aspirin and other vital medications. At 6:30, they took Ted outside and loaded him into the helicopter. By 6:35, the critical care transport team was in the air and flying toward Cleveland at speeds of up to 170 miles an hour. Ten minutes later, Ted and the team arrived at the main campus. He was rushed to a catheterization lab and was handed over to the waiting catheterization team at 6:55. The team members performed the procedure, placing the stent and restoring blood flow to his heart. The catheterization was completed at 7:05—only one hour and three ...

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