medical emergencyNorth Carolina is speeding up emergency care during heart attacks thanks to the nation's most ambitious statewide project to redo how serious heart attacks are handled.

Only two years ago North Carolina was one of the worst places to have a heart attack. Now the state is one of the fastest in terms of heart attack care due to the statewide project involving 65 hospitals. Paramedics, doctors and hospitals put aside powerful individual interests like money and control, and focused on giving faster care. 55 smaller hospitals agreed to transport immediately the serious cases to 10 more advanced hospitals.

Heart attacks happen when arteries are blocked, crimping a critical blood supply. The first choice of treatment is angioplasty, in which a tiny balloon is pushed into the vessel and inflated to flatten the clog. However, many small hospitals lack specialized suites called catheterization labs needed for angioplasties. Instead, they sometimes give clot-dissolving drugs, which do not always work.

The one-year results of this project have been published in the Journal of the American Medical Association. More patients got care at top-tier heart hospitals, and more quickly than similar patients did before the project began. Helicopter transfers rose, and more paramedics diagnosed heart attacks from EKGs done in ambulances. Every single measure of time improved. Examples: the average time it took a small hospital to evaluate and refer patients to a larger one dropped from two hours to 71 minutes; average transfer times plunged more than half an hour. Surgical teams are ready to go in 30 minutes. Bigger hospitals cannot refuse admission even if the beds are full.