St. Louis Fire Department ambulances have been outfitted with new defibrillator units that allow paramedics to transmit a patient’s 12-lead electrocardiogram (ECG) waveform image to doctors while in-route to a hospital. The upgraded communication allows personnel to analyze the data and determine in advance what kind of care a victim needs upon arrival.
A 12-lead ECG provides doctors with an image of the heart’s electrical activity from 12 different angles. Doctors use that data to see if there is damage to various walls of the heart and how severe it is.
Previously doctors had to wait to read the ECG until the ambulance arrived at the emergency room before any medical decisions could be made. But by sending the image ahead of time, steps such as preparing a catheterization procedure — utilizing a balloon and stent to open up a person’s blocked arteries — can be made much sooner.
Nelda Martin, a clinical nurse specialist at the Washington University and Barnes-Jewish Heart and Vascular Center in St. Louis, said it’s routine for most emergency medical services (EMS) personnel to perform an ECG out in the field and report back their interpretation.
But doctors at the hospital would often do another ECG once the patient arrived so they could do their own analysis of the data, causing precious minutes to tick away.
“Depending on where [the ambulance] is, it may take an additional 15 to 20 minutes after obtaining that 12-lead to get to the hospital,” Martin said. “It doesn’t sound like a lot of time, but it is.”
According to recommendations set by the American Heart Association and American College of Cardiology, the goal for “door to balloon” time — the period from which a patient gets to the hospital to getting treatment for a heart attack — is no more than 90 minutes.
The technology is already helping St. Louis hospitals get well under that number.
According to a press release from Barnes-Jewish Hospital, Averil Taylor, a resident of St. Louis, experienced heart attack symptoms on March 9. The ambulance that picked Taylor up was equipped with the new defibrillator units and by communicating his ECG to the hospital ahead of time, Taylor’s door-to-balloon time clocked in at 37 minutes.
Long-Time Coming
Martin said the technology to transmit ECGs to hospitals via Wi-Fi networks has been around for a few years. But it took awhile for the St. Louis Fire Department to get the project rolling, chiefly due to funding issues.
But thanks to grants from the St. Louis Fire Department Lifesaving Foundation, Barnes-Jewish Hospital, Barnes-Jewish Hospital Foundation, AT&T Foundation, Emergency Nurses Association, Saint Louis University Hospital and U.S. Bank, the equipment made its debut in February.
Ambulances transmit the ECGs to a server located at Barnes-Jewish Hospital. The waveform images then are rerouted to the hospital closest to the ambulance so that doctors can evaluate them.
Martin felt that the collaboration between EMS departments, hospitals and the fire department was a critical factor in making the project successful.
“[EMS personnel] aren’t just sending ECGs to our hospital, but every hospital in the area,” she said. “That type of cooperation was essential to make this become reality and make care better for patients.”
