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Level One Cardiac Care and Partnership

  • Need: Fast diagnosis and stabilization in order to survive a cardiac emergency in the rural areas around Davenport, Washington.
  • Intervention: Lincoln Hospital is prepared to quickly assess needs, deliver medications, and air transport heart attack patients to Sacred Heart Medical Center in Spokane, Washington.
  • Results: Increased survival rates and other quality of life outcomes for heart attack patients from the rural areas of Lincoln County, Washington.

Lincoln Hospital logo In a cardiac emergency, time is of the essence. People in rural areas are already at a disadvantage for surviving a cardiac emergency. In 2007 a Level One Cardiac Care protocol was established partnering Lincoln Hospital, Northwest MedStar Critical Care Transport, and Sacred Heart Medical Center (now Providence) in order to provide these cardiac patients with better outcomes.

When a potential cardiac patient comes into Lincoln Hospital, a critical access hospital in Lincoln County, Washington, staff immediately assess and diagnose patients in order to determine if they are experiencing a cardiac emergency. If so, appropriate medications are delivered and helicopter transportation is arranged. Northwest MedStar Critical Care Transport then flies the patients to Sacred Heart Medical Center in Spokane, Washington.

During the patient’s transfer, a call is made to Sacred Heart Medical Center to assemble its Cardiac Cath Lab team so patients receive quick treatment when they arrive. The goal is for the team and equipment to be in place for immediate treatment as soon as the patient lands.

Cardiologist Dr. Stephen Thew states, “Level One is working. It’s saving lives and giving rural people improved outcomes and quality of life. I just wish we’d thought of it sooner!”

Each organization charges the patient for services performed in their facility.

Services offered
  • Quick diagnosis, intervention and stabilization by Board Certified Physicians and mid-level providers (bi-phasic cardiac defibrillator and cardiac chest pump available at all times, aspirin therapy and diagnostic EKG within 10 minutes of arrival)
  • Helicopter transport by Northwest MedStar Critical Care Transport
  • Immediate treatment by Sacred Heart’s Cardiac Catheter Lab Team

2013 Results:

  • 100% of patients received fibrinolytic therapy (special drugs to break up blood clots in a major artery) when appropriate within 30 minutes of arriving in the Emergency Department (ED) at Lincoln Hospital.
  • 100% of patients either received aspirin at Lincoln Hospital or a contraindication was documented why they did not.
  • 99% of patients had an EKG (electrocardiogram) within 10 minutes of arriving in the ED at Lincoln Hospital. The remaining one percent was a patient who did not initially present or admit to chest pain, but later the symptom was identified during patient care/workup.
  • 60% of patients (3 out of 5) were transferred from the ED at Lincoln Hospital under 60 minutes. Transfer delays included insertion of a central line/confirmation (70 minutes) before transfer and MedStar being unable to fly (94 minutes). Both were valid reasons for transfer delays.

Delays in care have been a challenge, but group discussions have helped problem-solve this issue. New and creative solutions have been put into place to prevent future delays.


Collaboration with all involved partners is the key to success with this kind of program. Agreement on protocol driving treatment is essential, but also the willingness of partners to look critically at patient care protocols and come up with new approaches.

Contact Information
Jennifer Larmer, Chief Clinical Officer
Lincoln Hospital Dist. #3 & North Basin Medical Clinics
Level One Cardiac Care and Partnership
509.725.2979 x1455
Cardiovascular disease
Critical Access Hospitals
Emergency department and urgent care services
Networking and collaboration
States served
Date added
October 19, 2007
Date updated or reviewed
March 28, 2016

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.