Paramedics and doctors in Roseville, Calif., are using electrocardiogram-transmitting technology to cut an average of 20 minutes off of the time it takes from when a patient enters a hospital until doctors provide life-saving intervention.
The state-of-the art technology allows paramedics to wirelessly transmit 12-lead electrocardiogram (ECG) results, or information from 12 angles of the heart’s electrical system, to one of two specially designated hospitals where emergency room doctors and cardiologists can assess a patient’s heart condition before arrival.
“This greases the wheels,” said Vicki Wolf, nurse educator for the Roseville Fire Department. “It gets things moving much, much faster.”
Receiving the information early means doctors can coordinate with paramedics and direct patient care right away, including having EMS crews administer intravenous lines and clot-clearing drugs, ensuring an interventional cardiologist is on-site and preparing the cardiac catheterization lab — where the mechanical intervention happens.
“Many pieces of specialized equipment, medications preparation and appropriately trained staff must be activated as quickly as possible anticipating the arrival of the patient,” Wolf said.
This coordinated rush to get patients to an intervention is all because of the deadly heart attack known as STEMI — or ST segment elevation myocardial infarction — caused by a blockage of blood to the heart. In STEMI cases, the sooner doctors can open the blockage with an angioplasty procedure, the more heart muscle is saved.
“This type of system is one of the few things that is clearly demonstrated that improves patient outcomes and patient lives,” said Joseph Morris, emergency medicine physician and EMS liaison at Kaiser Roseville, a local STEMI-receiving hospital.
The time to deliver care in Roseville and surrounding areas falls well under the American Heart Association’s guideline that “door to balloon time” — or the time from the patient’s arrival in the ER to intervention — be 90 minutes or less.
For ambulance patients receiving care in Roseville and nearby areas, the average interval from when patients hit the hospital door to intervention is 53 minutes, versus 73 minutes for patients who walk into an emergency room.
“That’s because of the early notification and the transmission of the ECG information,” said John Poland, quality improvement and education coordinator for the Sierra-Sacramento Valley EMS Agency, which oversees paramedic protocols for Roseville and the nine-county surrounding region.
In 2012, the fire department purchased its high-tech wireless cardiac monitors, which have improved transmission and sensitivity over the original ones acquired in 2006. Wireless also did away with cumbersome Internet cables, Wolf said.
The 12 machines cost $324,000, of which $248,000 was paid with a federal grant. Physio Control provides the pre-hospital monitors and wireless modems, and also the cloud platform and receiving software on the hospital side.
The new battery-operated machines also deliver electrical energy with a defibrillator, take automated blood pressure readings and measure carbon monoxide levels.
While 12-lead ECGs are standard equipment, the ability to transmit their information is not. “That’s what makes Kaiser so phenomenal is that we have this type of system established,” Morris said, “and we’ve been doing it for a number of years now.”
On Roseville’s fire trucks, at least one and as many as three paramedics answer calls for help; the department has saved five heart patients in a recent six-week time frame. During the pre-hospital response, the ECG machine itself is connected to stickers on the patient’s chest and confirms whether the patient’s chest pain is a STEMI, though the paramedics are also trained to decipher the ECG’s printout.
When the paramedics digitally transmit the ECG to the hospital, they can also communicate with a physician by phone or radio, who now has the ECG information on a desktop or mobile device. Having the extra set of eyes to review the information prevents any false activations because in about 5 to 10 percent of cases, the machines incorrectly declare the patient is having a heart attack, Poland said.
Finally, the life-saving part happens in the catheterization lab where an interventional cardiologist uses a balloon to inflate the clogged artery and then inserts a cardiac stent — a spring-looking device — to get the blood flowing again.
Originally the Roseville Fire Department made the move to invest in the ECG communication system, buying the monitors and the receiving end of the system for Sutter Roseville Medical Center.
Then, in 2009, the Sierra Sacramento Valley EMS Agency required EMS providers and receiving hospitals in the nine-county region to equip themselves and work together using the 12-lead transmitting ECG machines. Not all agencies in the state have made this move; Poland estimates that about 25 percent have mandated the technology.
“We all agreed and made a commitment together that, as an EMS system, we would move forward and establish a high standard of care for patients,” Wolf said. “Through education, implementation of technology and standardized protocols, that goal has been achieved.”
On the hospital side, health care providers use the LIFENET System, a secure cloud-based platform and data management system that delivers needed information to reduce time-to-treatment for STEMI patients, and coordination for post-event review.
The system’s consult feature makes it mobile-compatible, allowing remote consults from physicians, according to the site. In Roseville, emergency physicians interpret the 12-lead ECGs to confirm a STEMI and activate a response team in the catheterization lab, which also receives an ECG. ER doctors contact the interventional cardiologist on call who reads the 12-lead transmissions on a mobile device, often remotely, Wolf said.
“Very often the interventional cardiologist will then arrive at the cardiac department the same time the patient does already with a diagnosis,” she said.
Last year, Roseville’s two hospitals served 309 STEMI patients directed there from all over Placer County.
Before the fire department could transmit the ECGs to Kaiser, Morris said there was a lot of guessing based on verbal descriptions regarding what the ECGs said.
“There’s more room for error that way,” he said. “This way, we’re seeing directly what they’re seeing.”
In addition to the ECGs, Wolf said, public education, enhanced dispatch systems, paramedic continuing education and medical technology at STEMI-receiving centers have also contributed to the area’s success in treating heart conditions.
The next frontier? Increasing patient awareness of symptoms to reduce the time from symptom onset to treatment. “Our biggest challenge that we still have is the public education piece,” Poland said.
As for technology, Wolf said the cardiac monitors remain cutting edge, but that doesn’t mean improvements aren’t being made in other areas to save lives.
“We’re always looking at ways to improve our service,” she said.