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Community Builder: Dr. Brian Gross dreamed of saving lives Dr. Brian Gross helped build Rogue Regional Medical Center into a leading cardiology hospital. [Mail Tribune / Jamie Lucsh] Sunday Apr 30, 2017 at 12:01 AM By Steve Boyarsky for the Mail Tribune Editor’s note: Community Builder is a periodic Q & A series providing perspectives from local people who have been involved in significant change in Southern Oregon. Today's conversation is with Dr. Brian Gross. Q: How did you end up practicing medicine and living in the Rogue Valley? Brian: At the end of my fellowship at University of Washington, I had job offers in Missoula and Wenatchee. A colleague recommended I check out Medford, where a friend of his, Dr. John Forsyth, was in practice. I had never heard of Medford. Dr. Forsyth met me at the airport that night in 1982, and we went straight to the hospital, where I met Dr. Earl Showerman working the ER shift and Dr. Alan Bates visiting an elderly patient scared about an upcoming surgery. Before I had laid eyes on Medford, I met these three incredibly impressive doctors and decided this was where I wanted to practice. Q: Please describe the State of Jefferson STEMI program that you and others were able to orchestrate for the region. Brian: This program is a highly coordinated effort to treat acute heart attacks. Physicians, emergency medical service responders, nurses and hospital emergency rooms from throughout Southern Oregon and Northern California, along with our heart catheterization lab at Asante Rogue Regional Medical Center, are involved. STEMI (ST elevation myocardial infarction) is a large heart attack when sudden, complete blockage of a major heart artery occurs, resulting in potentially devastating loss of heart muscle function and high rates of death. Our local cardiologists and cardiac surgeons have met weekly since the 1970s to share ideas about challenging and educational cases. Occasionally a case would generate a sigh, “if only.” “If only” we had gotten that patient to the cath lab quicker to stent open the occluded artery, we might have been able to preserve more heart muscle function … or even saved a life. The policy for STEMI patients around the country, as well as in Southern Oregon and Northern California, was to always divert to the closest hospital. But by the time they were ultimately transferred to us at Rogue Regional, two or more hours might have had passed. The idea of change took root during one of those Wednesday sessions in 2003. We decided to develop a process where every STEMI patient in our I-5 corridor State of Jefferson would go directly to the cath lab, which was contrary to national recommendations of going to the closest hospital first. Other more remote hospitals on the coast or in Eastern Oregon would continue to administer a blood clot dissolving medicine prior to being flown to us as soon as possible. It was incredibly exciting, yet stressful. The process entailed taking a painful, dangerously ill STEMI patient, often with low blood pressures, unstable heart rhythms and shortness of breath … and rushing them anywhere from two to 60 miles to the RRMC cath lab to open their occluded heart artery with a stent. When a stent was placed, you would often witness life and hope flow back into their face. Prior to 2003, we were often rated as a top 100 hospital in the nation for STEMI care, with an in-hospital mortality rate of 8.6 percent, while the rest of the country averaged 11.8 percent. Between July 2003 and December 2004, we treated 233 consecutive STEMI patients, and our in-hospital mortality rate plummeted to an astounding 2.1 percent. A medical mortality reduction of that degree was unheard of. Several years later, I was at a major cardiology meeting and shared these results with the president of American College of Cardiology, who exclaimed, “You need to publish this data!” Our publication in 2007 created a minor stir. Other communities began to copy it. But it really didn’t gain traction and capture national attention until 2009 when we co-published a second article replicating the results with several large, medium and small communities like Los Angeles, Charlotte and Medford. That article proclaimed if STEMI care was coordinated, and afforded highest priority, it could be implemented everywhere. On the basis of that 2009 article, a major shift occurred in the way STEMI was treated around the country. Providence Medford Medical Center and Sky Lakes Medical Center have subsequently developed similar smaller STEMI programs. Q: So, you had to get an agreement among a lot of EMS providers and hospitals? Brian: EMS agencies were excited to be involved in the new protocol. Paramedics were empowered to wake the cardiologist in the middle of the night: “We have a STEMI and will be there in 17 minutes.” Hospital administrators were on board since improved survival was the outcome. We also had the critical assistance of Dr. Paul Rostykus (Jackson County EMS medical director) and multiple emergency room physicians from the participating hospitals. Q: What have you learned about working with people in a regional effort? Brian: People choose medicine because they are passionate about helping patients. Give them the opportunity to make a difference in an emergency, and they respond accordingly. Get everyone on the same team, and the amazing efficiency of STEMI care can happen. Q: Is there a next step? Is there a group of patients who need different types of response? Brian: There are two kinds of heart attacks. “Plumbing heart attacks” involve occluded arteries, and opening them emergently with stents relieves chest pain and saves heart muscle and lives. That is our State of Jefferson STEMI program. From the time a STEMI system is activated to an open artery can range from 30 minutes up to 2 hours depending on transfer distances. There are about such 500,000 STEMIs in the U.S. every year, and we deal with about 160 cases per year here in our State of Jefferson region. Another type of heart attack is an “electrical heart attack.” There are approximately 350,000 a year of those in the U.S. This cardiac event requires an even faster response than STEMI. In this situation, the heart electrically short circuits, and patients collapse unconscious immediately … and for every minute that passes there is a 10 percent reduction in survival. After 10 minutes of no heart beats, survival rates are extremely low. To restore a normal heart beat, you need to rapidly institute CPR and shock the heart. That is where we are headed on the local level now. Only about 7 percent of patients around the country will survive an electrical heart attack because of the inherent delays in shocking a heart back to a normal heart rhythm. EMS units are fast, but not fast enough in the majority of cases. Guess where the highest survival rate for the electrical heart attack is? Casinos — 70 percent survive a cardiac arrest. Why? Because security personnel are right there and are skilled in rapidly implementing CPR and AEDs (Automatic Electronic Defibrillators) to shock the heart … even before EMS arrives. Q: How do you replicate that on a community scale? Brian: The emergency medical service providers here in Jackson County were the motivators for a new program we just rolled out in February with the help of Asante, Providence, Mercy Flights, the West Foundation and the Darby Heart Fund. If you witness a person suddenly collapse and become unresponsive with abnormal breathing … dial 911! That call will alert the nearest EMS units, but also utilizes social media to send an instant alert to a smartphone app called PulsePoint designed for people who know CPR and are willing to help. If that volunteer is within 400 yards of the victim, their phone will alert them: “CPR Needed!” A Google map pops up and identifies their location, the victim location, and any nearby AEDs. We just had a contest to locate AEDs and found over 1,200 AEDs in Jackson County, which will be mapped into that app. Because there is that 10 percent mortality for every minute that passes without the return of a normal heart beat, we need volunteer bystanders with CPR and AED capabilities to mirror the rapid casino response while awaiting the arrival of EMS. Over the past 2 months, we have already enlisted large numbers of citizen CPR volunteers. My dear friend, Dr. (Senator) Alan Bates, passed away last year in a remote part of Oregon from such a cardiac event. Had he been in downtown Medford today, when his event occurred, there would have been a high likelihood he could have been saved. So he has been my inspiration to enthusiastically support EMS providers with the roll out of this program, enlisting the assistance of local citizens to help save a life. It is the right thing to do for our community. Q: Where did this idea of saving lives originate with you? Brian: When I was a Boy Scout, I loved reading the section in Boy’s Life, Scouts in Action. I would dream of being that scout who raced into a burning house to save a life, or pull a drowning person to shore. That was a major part of my motivation for going into medicine. Cardiology, in particular, has afforded me numerous opportunities over the years to do just that. When you contribute to saving a life, an incredible feeling of pride swells over you. Q: You’ve announced that you’re going to retire in a month or so. How do you redirect all your energy, enthusiasm and knowledge? Brian: I am having a great deal of trepidation in that regard, I really am. The good news is, if I fail at this retirement gig, my partners say they want me back. I could adapt very well to that kind of failure by being back with my patients and my wonderful partners. I am 68 and mindful of the sage advice many previously retired physicians, friends and some elderly patients have shared with me. “Your present good health won’t follow you forever.” Now may be the time to chase a few dreams and opportunities that eluded me for 10 years of medical training and 35 years of cardiology practice. Q: You seem pleased with your career choice. Brian: During medical training I loved every rotation, but I really loved cardiology. At the last moment I decided to specialize in cardiology. It was that quick, and that emphatic. I have never regretted it despite the long, 80- to 100-hour work weeks. Roy Vinyard, CEO of Asante, called me last week about yet another award RRMC had received. Hospitals are monitored these days for all manner of metrics, and Asante has recently won a large number of awards, but this was related to our State of Jefferson STEMI program. Medicare is constantly surveying hospitals with higher readmission rates, because that costs Medicare money. Last week, RRMC was voted the number one hospital in the entire nation with the lowest heart attack 30-day readmission rate. That is a wonderful reflection of our team of physicians, nurses, EMS, administrators, therapists and all the hospital personnel who keep the hospital running efficiently and compassionately. What an incredible accolade for the medical teams and service to our community that our heart care is as good, or better, than anywhere in the country. Q: What has made Southern Oregon a good place for you to call home? Brian: Southern Oregon is simply a magical place to live. Nancy, our four kids and I enjoy the outdoors. We particularly enjoy the Rogue River, rafting, fishing, skiing and running. And it is all right here within minutes of our front door. The schools prepared our children to be well-rounded, inquisitive and independent. We’ve got great friends and opportunities, and this is where we’ll spend the rest of our lives. — Steve Boyarsky is a retired educator and longtime resident of the Rogue Valley. He continues to be involved in educational and youth programs.