Combined service efforts, newly-stocked medication saves Soldier's life

Published June 16, 2010
By Capt. Joe Campbell
386th Air Expeditionary Wing Public Affairs

SOUTHWEST ASIA -- Recent decisions by joint military medical officials here to outfit paramedics with specialized equipment and to stock medicine rarely-needed by typical military patients in the Air Forces Central Command area of responsibility, saved a serviceman's life after he suffered a heart attack June 9, 2010.

Doctors at the 386th Expeditionary Medical Group, at an air base at this undisclosed-location, recently began stocking a specialized medicine known generically as "Tenecteplase". Without this medication, the outcome in this case may have been different.

"We just received the drug two weeks ago in the [emergency medical support] clinic here; Tenecteplase is a thrombolytic drug also known as a clot-busting agent. It was a drug we urgently needed for this situation," said Air Force Capt. (Dr.) Matt Hoyt, deployed from Hill Air Force Base, Utah.

The patient, a 36-year old U.S. Army forward-deployed Soldier whose garrison unit is based at Fort Bragg, N.C., was transiting the Army's Life Support Area which is adjacent to the air base here. He was on his way home on leave to see his wife and newborn daughter. The sergeant said he was sitting in a pre-departure briefing when the irritating feeling in his chest that he'd been experiencing for about an hour persisted.

"I didn't think too much about it when it started; I thought the pain was just heartburn, it wasn't a sharp pain at all," said Army Staff Sgt. Michael Weintz Jr., a field artilleryman deployed with Bravo Company, 3rd Battalion, 321st Field Artillery unit. "About 20 minutes into the briefing my buddy asked me if I was okay and then he decided to go get help."

Paramedics at the LSA responded and hooked him up to a heart monitor. First responders then began giving him medications based on his irregular heartbeat as indicated on the equipment, said Sergeant Weintz, a Scottsbluff, Neb. native.

"The paramedics orally administered nitroglycerin spray, which is a vasodilator to let blood pass through the artery; and baby aspirin which helps to prevent further clotting," said Dr. Hoyt, a Brigham City, Utah native. "Sergeant Weintz was then transported by ambulance to the [386th EMDG] clinic here."

Once he arrived at the clinic, he was met by Capt. Nicole Gramlick, a registered nurse deployed from the 88th Medical Group at Wright-Patterson AFB, Ohio and Dr. Hoyt. Captain Gramlick said the electrocardiogram machine indicated a very serious situation.

"The EKG indicated a classic 'tombstone reading' which is the shape associated with cardiac stress," said Captain Gramlick. "I made sure Sergeant Weintz understood the doctor's plan for his treatment and I began administering the medications prescribed."

After the patient was stabilized, he was transported by ambulance to the host nation civilian hospital.

"I rode in the ambulance with him as an escort to keep him safe and comfortable on the ride and then stayed with him at the hospital," said Captain Gramlick, a native of St. Louis, Mo.

At the hospital and after specialized tests, doctors there confirmed just how serious an attack Sergeant Weintz had experienced.

"After finding out the test results and learning the extent of the lesions within his heart, one or two hours later and he may not have made it," said Dr. Hoyt, deployed from the 75th Medical Group at Hill AFB, Utah. "The location of the lesion in cases like this is referred to as the 'widow maker', so we were very fortunate to have the medications we needed to provide the treatment and prevent that from happening."

Doctors at the civilian hospital told Sergeant Weintz that one of his arteries was 70 percent closed and it required stents to open it up.

"I also found out the medicine they gave me at the base clinic is something they've only had for two weeks and if this would have happened a few weeks earlier, the outcome could have been different for me," said Sergeant Weintz. "It ain't just a hop, skip and a jump to a hospital here so when the medics say they need something, they really need it!"

Sergeant Weintz was aeromedically evacuated June 13 from the contingency aeromedical staging facility here to Landstuhl Regional Medical Center in Germany.

"Once he gets to Landstuhl, doctors will insert two stents to restore blood flow to his heart," said Dr. Hoyt. "Then it is up to the cardiologist there as to how long he'll need to recover in Germany before heading home."

Air Force Lt. Col. (Dr.) Jennifer Brooks, a family practice physician deployed from McGuire AFB, N. J., said the previous rotation of medical professionals at the 386th EMDG suggested keeping several doses of a thrombolytic drug on hand and the current rotation approved the idea.

"Prior to stocking the medication here, the closest local source was about an hour and a half drive or 50 minutes by helicopter," said Dr. Brooks, a native of California whose family now lives in East Sandwich, Mass.

The medication, which only has about an 18-month shelf life costs about two thousand dollars per 50 milligram dose, she added. The clinic standard is now to stock a primary and a back-up dose.

"A typical case may call for a 30 to 50 milligram dose of Tenecteplase, along with a protocol of other complementary drugs prescribed to help preserve heart muscle," said Dr. Brooks.

Air Force Col. (Dr.) Michael Schaffrinna, 386th EMDG commander, said the decision to add the drug to the pharmacy here turned out to be a great investment as did the inter-service and host nation coordination efforts.

"This life was saved by decisions made by Air Force, Army and Navy medics months prior to the event. We pushed to give paramedics advanced cardiac life support medications," said Dr. Schaffrinna, deployed from the 88th Medical Group at Wright-Patterson AFB, Ohio. "We developed more direct referral routes with our host nation partners for our heart patients and we pushed to get clot-busting drugs into our formulary."

Dr. Schaffrinna said the cost to be prepared for cardiac situations like this case was $50 thousand for two heart defibrillators, $818 for three paramedic Advanced Cardiac Life Support medication kits and $1,822 for a single, clot-busting combination kit. But, the investment is worth the cost.

"A soldier's life is priceless," he said.

386th EMDG team saves life thanks to swift action, new drug