Area emergency departments continue to find newer, faster, and better ways of saving lives in cases of heart attack, stroke, and major medical emergencies. Maryland is a leader in this effort nationwide, but the District and Northern Virginia also have good emergency centers.

Maryland was the first state to establish designated trauma centers; it has also designated 31 stroke centers. The latest innovation is heart-attack centers, called STEMI centers. STEMI is an acronym for ST-elevated myocardial infarction. An elevated ST wave on an electrocardiogram is an indication of heart attack.

According to Lisa Myers, director of special programs for the Maryland Institute for Emergency Medical Systems Services (MIEMSS), the formal designation of STEMI centers in Maryland awaits consensus among state hospitals on standards for designation.

The STEMI-center concept, according to Dr. Robert Bass, MIEMSS executive director, is based on evidence that percutaneous coronary intervention (PCI), formerly called angioplasty, is safer and more effective for patients suffering an elevated-ST heart attack than clot-dissolving drugs such as TPA; a potential side effect of clot-dissolving drugs is stroke. To be designated a STEMI center, a hospital must be equipped with a catheterization lab and have cardiologists available 24 hours.

“We know every 15 minutes of time you save with heart-attack patients results in a measurable reduction in mortality,” Bass says. The goal for MIEMSS is to get a patient’s vessel blockage opened within 90 minutes of the 911 call. In some parts of the US, EMTs bypass a hospital’s emergency department and take heart-attack patients directly to a catheterization lab.

Emergency departments in DC and Northern Virginia are designating specialty emergency centers following standards established by the Joint Commission (TJC)—formerly the Joint Commission on Accreditation of Healthcare Organizations—for stroke centers and by the American Heart Association for heart-attack centers. Northern Virginia has established stroke centers and is in the process of establishing STEMI centers.

Trauma centers have been established for years based on the original prototype, R Adams Cowley Shock Trauma Center in Baltimore. Maryland hospitals abide by MIEMSS standards, similar to those being developed by the American College of Surgeons that hospitals in DC and Northern Virginia will follow.

Primary Heart-Attack Centers

These hospitals have the basic elements needed to treat heart-attack victims but have not yet been officially designated heart-attack centers:

DC: George Washington University Hospital, Howard University Hospital, Washington Hospital Center.

Maryland: Holy Cross Hospital, Prince George’s Hospital Center, Shady Grove Adventist Hospital, Southern Maryland Hospital Center, Suburban Hospital, Washington Adventist Hospital.

Northern Virginia: Inova Alexandria Hospital, Inova Fairfax Hospital, Virginia Hospital Center.

Primary Stroke Centers

To be designated a primary stroke center in Maryland, MIEMSS requires that hospitals have an on-site integrated emergency-response system as well as access to an acute-stroke unit and 24-hour neurosurgical and neuro-imaging services such as CT scans and MRIs. The standards for Virginia and District hospitals are from TJC and are similar to MIEMSS’s.

These hospitals have been officially designated stroke centers:

DC: Georgetown University Hospital, George Washington University Hospital, Washington Hospital Center.

Maryland: Holy Cross Hospital, Montgomery General Hospital, St. Mary’s Hospital, Shady Grove Adventist Hospital, Southern Maryland Hospital Center, Suburban Hospital.

Northern Virginia: Inova Alexandria Hospital, Inova Fairfax Hospital, Inova Loudoun Hospital (TJC accreditation pending), Inova Mount Vernon Hospital (TJC accreditation pending), Virginia Hospital Center (TJC accreditation pending).

Trauma Centers

Hospitals are designated as Level I or Level II trauma centers by the American College of Surgeons.

These Level I centers have 24-hour in-house coverage by general surgeons and prompt-availability specialists in orthopedic surgery, neurosurgery, anesthesiology, radiology, and critical care:

DC: Children’s National Medical Center, George Washington University Hospital, Howard University Hospital, Washington Hospital Center MedSTAR.

Maryland: R Adams Cowley Shock Trauma Center in Baltimore at the University of Maryland Medical Center is the prototype on which trauma centers were established.

Northern Virginia: Inova Fairfax Hospital.

Maryland also has two Level II centers in the Washington area—at Suburban Hospital and Prince George’s Hospital Center—that have surgeons and anesthesiologists on call 24 hours a day and provide emergency care to trauma patients who don’t need Level I trauma services.

This article first appeared in the April 2009 issue of The Washingtonian. For more articles from that issue, click here.