It was just before midnight when Gary Keimig woke up nauseous and soaking in sweat. A week earlier, he brushed off pain in his lower chest, but now he knew something was definitely wrong. The 66-year-old artist was having a heart attack.

By sunrise, Keimig was nearly 200 miles from his home in Dubois, Wyoming, having been airlifted to a large medical center in Casper, where doctors inserted two stents to open a blocked heart artery and stop his heart attack.

“It certainly didn’t seem like the symptoms of what you hear about a heart attack. Sometimes the warning signs can be surprising,” said Keimig, who survived his 2007 heart attack and now is healthy and spreading awareness about heart attack symptoms and the importance of calling 9-1-1.

Not all heart attack patients are so lucky, particularly the hundreds of thousands of Americans who each year experience the most deadly type known as ST-segment elevation myocardial infarction, or STEMI, in which blood flow is completely cut off to a portion of the heart.

In rural America, the vast landscape and sparse healthcare resources have made it difficult to deliver fast treatment to STEMI patients. But the American Heart Association’s Mission: Lifeline program is helping to improve care for STEMI patients in remote areas by reducing the time it takes to get someone to lifesaving care.

It’s a race against time when someone has a heart attack, says Tom Stys, M.D., a Sioux Falls-based interventional cardiologist and state chair of Mission: Lifeline South Dakota. “It’s especially a struggle in rural states, where a patient can present with an acute heart attack two hours or more from the nearest facility that offers treatment,” Stys said.

The treatment of choice for STEMI is angioplasty, in which tiny balloons and wire mesh tubes called stents are used to open the blocked arteries.

Nearly 60 million Americans — roughly one in five — live in rural areas, according to 2010 census data. Since 2010, the American Heart Association has launched Mission: Lifeline initiatives in Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming, anchored by $32.2 million in grants from The Leona M. and Harry B. Helmsley Charitable Trust.

Nationally, Mission: Lifeline includes 810 hospitals, clinics, EMS agencies and first responders that cover more than 80 percent of the U.S. population.  Recognized Mission: Lifeline systems can be found using your nationwide map.

The program streamlines STEMI diagnosis and treatment among emergency medical services providers and hospital staffs across each state by ensuring everyone has the right equipment, the right training and follows the same protocols for transporting and treating STEMI patients.

One step to speed diagnosis is new equipment. Ambulances have been outfitted with mobile 12-lead electrocardiograms, or EKGs, that can be done from a patient’s living room or the back of an ambulance. Paramedics then electronically transmit test results to hospitals, where doctors read them and get ready to treat or transport a heart attack patient upon arrival.

Before the program, doctors didn’t always know the details of a patient’s case when the ambulance rolled in, says Michael Eisenhauer, M.D., a cardiologist and state co-chair of Mission: Lifeline Wyoming. “There might be a patient who’s taken an hour or two to get here and all I know is they have chest pain.”

Now hospitals are fully prepared when a heart attack patient comes through the door. For a STEMI patient, that may include a clot-busting drug followed by airlifting the patient to the nearest hospital that can perform an artery-opening procedure. Or the ambulance may skip the nearest hospital altogether and take the patient directly to an angioplasty-capable hospital.

“I can have the equipment warmed up and the treatment team ready and waiting,” Eisenhauer says. “That translates into lives saved.”

Early data trends show heart attack patients in Wyoming now have a 96.5 percent chance of survival if they get treated. For STEMI patients, the survival odds are 93.7 percent.

Those odds might improve even further if there were fewer delays between symptom onset and restoring blood flow to the heart.

“If you think you’re having a heart attack, don’t hesitate to call 9-1-1,” Stys said. “Patients who drive themselves delay care and risk having worse outcomes.”