When minutes counted, help has been many miles away for people who suffered heart attacks in Niagara County.
That will change on April 5, when the county's first cardiac catheterization lab is scheduled to open in the Heart Center of Niagara Falls Memorial Medical Center.
The cardiac cath lab is a collaborative effort among Memorial, Erie County Medical Center, Kaleida Health and Catholic Health, with each entity chipping in money to build, equip and staff the lab and each sharing the profits.
"This is unique, in my experience," said Dr. Neil Dashkoff, a cardiologist and medical director of the new cath lab at Memorial. "I've been around for a long time, and it's a different kind of model. It absolutely is collaborative."
The new cath lab, currently being built into a former scanning and office area one floor up from the emergency department, will do its most important emergency work on patients experiencing a serious type of heart attack known as a STEMI, which stands for ST-Elevation Myocardial Infarction. In this heart attack, a major artery to the heart is blocked and a large part of the heart muscle is dying from lack of circulation. Time is of the essence.
In the cath lab, the patient lies on a table in a room that holds a large, C-shaped monitor. A catheter is inserted into a small incision in an artery and threaded through the arteries to the heart, where it is used to both see the cardiac problem and treat it.
A dye injected through the catheter enables the cardiologist to see constant images of the heart and its arteries and diagnose the problem immediately. The cardiologist can then insert a tiny balloon through the catheter and inflate it to break up the plaque blocking an artery. A stent, or wire mesh tube, can then be inserted in the artery to keep it from re-closing.
The group of patients experiencing life-threatening heart attacks "is in the minority, but it's a very important minority," said Dashkoff. Other patients, who have chronic stable angina or issues from congenital heart problems that were treated in infancy, may be advised by a cardiologist to schedule a diagnostic visit to the cath lab -- "today, tomorrow, next week," said Dashkoff.
"But the guy who comes in with the heart attack, their time is important. You are either going to have a facility in your neighborhood, and if you don't, you're going to jump on an ambulance or MercyFlight and make an appearance in another city. That is hard," he said. "Niagara Falls has had this need for years and years."
Dashkoff is the former director of the cardiac catheterization laboratory at Erie County Medical Center. He will work with Chief Cardiologist Sachin Wadhawan and with James G. Conley. The other participating interventional cardiologists are Salvatore Calandra, Joseph Gelormini, Nadeem Haq, Vijay Iyer, Henry Meltser, Kishor Phadke and Ali Masud.
Dashkoff said doctors from the partner entities will work in the cath lab, which will accept patients on an emergency basis around the clock. "That's important because there are only so many hours in the day, so many days in the week, and no one or two people could cover that," said Dashkoff.
In the years leading up to the approval of this new facility, the state Department of Health, which must approve cardiac catheterization lab projects, rejected separate requests from Memorial, Catholic Health and Kaleida to open cath labs in Niagara County, and urged them to work together instead. A new request filed by the four entities that emphasized the importance of the cath lab services gained approval.
Now that the opening date of the $2.2 million lab is nearing, Steve Lewis, director of Facilities Management, and Melissa Rackmil, a registered nurse and director of invasive and non-invasive cardiology at the Heart Center of Niagara, are keeping a close eye on progress. In the work site, where workers sweep as they go, walls are up but some are unfinished, and the ceiling is open while wiring and ventilation work continues. The 5,700-square-foot multi-room facility holds the actual cath lab, where the C-arm camera will be installed, as well as room for pre- and post-procedure beds, a nurse's station, and various support offices.
Rackmil is counting the days until April 5, which Lewis said looks probable as the opening day. When the hospital receives the first patient that will be sent upstairs for a cath lab procedure, rather than by ambulance or helicopter to one of several cath labs in Buffalo, "That will be a really nice thing," said Rackmil. "That will be a proud moment for the organization, for sure."
The cath lab is referred to as "freestanding," because it is not connected to an onsite cardiac surgical program. "There are a number of them throughout the state," said Dashkoff. "They have proliferated through the last few years, because it's an important thing for the community. It's been studied in a blind randomized fashion, looking at outcomes for heart attack victims from a freestanding lab and a full-service facility, and the outcomes are not different."
Although the camera and equipment will be brand new, the registered nurses and radiology technologists will have plenty of experience, said Rackmil. They have been training at cath labs in Gates Vascular Institute and South Buffalo Mercy Hospital since October.
That training opportunity, also part of the joint venture among the four partners, "is exciting for them," said Rackmil.
Also being trained are the pre-hospital care providers of Niagara County, the first responders who transport patients suffering from cardiac problems to the appropriate facility.
"We have already reached out to pre-hospital care people in Niagara County," said Dashkoff. "We have met with ambulance services, we have met with MercyFlight and they are all eager to participate. There is a helipad at Niagara Falls Memorial Medical Center, and it remains to be seen how far the catchment area is. I suspect some areas in Eastern Niagara County will find it more convenient to go that way that to go down into the city of Buffalo."
In 2015, records showed that about 1,900 Niagara County residents had angiography and other cardiac catheterization procedures in Erie County. An estimated 925 patients were expected to use the Niagara Falls Memorial Medical Center cath lab in its first year of operation, and that number was expected to climb to 1,100 patients in its second and third year as a result of outreach and education.
The new cath lab, working in conjunction with the Heart Center, will provide more convenient care for people who live in and near Niagara Falls, said Patrick J. Bradley, director of public relations and communications. "We've identified significant health disparities for people of color and people with transportation issues," he said. "Only one out of two households in Niagara Falls has a private vehicle."
When the joint operation was announced, Memorial President and CEO Joseph A. Ruffolo said that the facility "will also eliminate glaring local disparities in the heart care available to African-Americans, Native Americans, residents of low-income households, people challenged by mental health issues and those who are developmentally or intellectually disabled.”
"The community is the winner, absolutely," said Dashkoff.