Dave Smith, a reporter and weekend editor for the Fairmont Sentinel, knew that an insider's view of Mayo One, Mayo Clinic's emergency medical helicopter, would make a great story. Somehow, the timing for a ride-along was never right.

On Sunday, Oct. 22, 2006, he got the ride. But not as an observer; he was a patient having a heart attack.

The story he lived to tell is an example of what's right in the health care system. From Fairmont Medical Center's emergency department to the Mayo One emergency medical helicopter to the coronary care unit at Saint Marys Hospital at Mayo Clinic in Rochester, Minn., his timely care made for a happy ending — with no permanent damage to his heart. But a happy ending was not a foregone conclusion.

Mayo One can be in flight within minutes of a dispatch call, 24 hours a day, every day. Like
Dave Smith, about one-half of transports are cardiac patients.

At 2 p.m. that Sunday, Smith's chest began to hurt. Despite the pain, he went to the newspaper office to lay out pages, a typical Sunday chore. At 42 years old, with normal cholesterol and blood pressure and no history of heart problems, Smith was not alarmed. "Even to myself, I didn't want to admit or say heart attack," he says.

But the chest pain worsened. His head, neck and shoulders began to hurt, too. "I'm in a newsroom with computers," he says. "So I hit the Internet quick." The advice he found at the American Heart Association's Web site was 'call 911.' That got his attention. He called his wife Tanya to take him to the emergency department at Fairmont Medical Center — Mayo Health System, just minutes away from the newspaper office.

Immediately, Smith was given aspirin and nitroglycerin to relieve his symptoms, says Blake Anderson, M.D., emergency physician who cared for Smith. An electrocardiogram and a blood enzyme test confirmed what symptoms suggested; Smith was having a heart attack and needed access to advanced care quickly. "With that information, we pull the trigger, contact Mayo Clinic and call for air transport," says Dr. Anderson.

At 4:44 p.m., the calls were made. Mayo One, based that day in Mankato, Minn., was dispatched. Within 30 minutes, Smith was in the air, heading toward Saint Marys Hospital. "We didn't even shut the helicopter down when we landed in Fairmont," says
Todd Emanuel, Mayo One flight nurse. The helicopter lands just yards from the Fairmont emergency department.

Emanuel and his partner, paramedic Jessica Fite, continued the care started in Fairmont. En route, Smith's chest pain had diminished, but it wasn't gone. Emanuel called Jae Oh, M.D., the cardiologist on duty at the Saint Marys Coronary Care Unit, to get approval for additional medications to ease symptoms. Smith felt good enough to joke with his caregivers that he was finally going to get his Mayo One story.

When Smith arrived at Saint Marys at 6 p.m., his pain was gone. An electrocardiogram indicated that the immediate danger was over, says Dr. Oh.

The next morning, Mayo cardiologists performed coronary angiography, which found a 90 percent blockage in a major coronary artery. During the procedure, Smith was awake and comfortable as doctors inserted a long, thin tube with a balloon tip into an incision in his leg through the artery to the blockage near the heart. At the blockage site, the balloon tip was inflated to open the artery. A metal stent was placed to keep the artery open.

As part of his cardiac rehabilitation, Dave Smith is walking as much as he can. The sidewalks of Fairmont are slushy with melting snow in March, but that won't stop him.

From the emergency physician and nurses in Fairmont, to the Mayo One dispatcher and flight crew, to cardiologists and critical care nurses, at least 30 people provided hands-on care during the 24 hours after Smith's chest pain began. Smith, an avid sports fan, says that the coordination and care was an all-star performance. "The ones that are the best, practice and play together the most," he says. "That's the feeling I got from them."

That prompt and coordinated care, which began with Smith's choice to seek care quickly, is why his heart was unscathed. An electrocardiogram — done before Smith headed home — was normal and showed no signs of heart damage.

"If a patient seeks treatment in an hour or two of chest pain, we often can minimize heart damage or even stop the heart attack," says Dr. Oh. "If a patient waits six or seven hours to seek treatment, there's going to be major heart damage. Consequences could include shortness of breath, fatigue, heart failure and potentially fatal arrhythmias."

Two days later, Smith went home. Donna McMurtry, R.N., a Fairmont cardiac rehabilitation nurse, and Fairmont physician Durga Komaragiri, M.D., an internal medicine specialist, have worked closely with Smith since the heart attack.

"Donna gave me the wonderful and beautiful news that I should never shovel snow again," says Smith, whose sons, ages 9 and 13, now handle the chore. McMurtry also encouraged more exercise, healthier eating and losing weight. By mid-January 2007, Smith had attended 15 cardiac rehabilitation sessions in Fairmont, where supervised exercise was combined with learning about heart-healthy living. He'd lost about 12 pounds.

The changes aren't easy, wrote Smith in a column in the Fairmont Sentinel. "Learning to live a much healthier life is going to be a serious challenge for a hot-dog chomping, coffee-guzzling,
hash-brown loving, fried-chicken feasting fool like me," he wrote.

But he's doing it. He's become an evangelist on seeking prompt care for heart attack symptoms. "I can't stress it enough," he says. "If you think you might be having a heart attack, it's not that big of a deal to go in and find out that you're not."

Thinking back to when his chest pain began, Smith says, "I could have stayed on my feet and worked longer." He credits divine intervention — he's also a pastor of the Fair Lakes Apostolic Fellowship in Fairmont — as well as the Internet for his decision to seek care quickly. "Once I saw these were heart attack symptoms, the idea of gutting it out was gone," he says. "I don't want to be a tough guy. I'm going to be the alive guy."