by: Cullen Hebert, MD
[Dr. Hebert is a critical care physician & pulmonologist in Baton Rouge, LA. We are excited to have him present his experience as a pioneer in emergency telemedicine]
The American Heart Association (AHA) recommends that a patient having an acute myocardial infarction have cardiac catheterization within 90 minutes of arrival at a hospital.
This time interval is known as the “door-to-balloon” time or DBT. The faster the patient gets to the catheterization laboratory and heart/life (or both) saving procedure is completed, the better the outcome.
With that in mind, what about the time it takes the patient to arrive at the hospital?
“Call-to-balloon-time” (CBT) includes door-to-balloon plus the time elapsed between the patient calling emergency medical services (EMS) and arriving at the hospital. This includes time elapsed while EMS is deployed, arrives at the patient’s location, assesses & initiates treatment and then transports the patient to the emergency department.
In Baton Rouge, LA, we were not satisfied to get our DBT down to the recommended 90 minutes. We wanted the entire CBT under 90 minutes.
In order to do this, we had to design a comprehensive system encompassing both pre-hospital and in-hospital care. Wireless technologies that allowed the emergency medical technician (EMT) to communicate heart rhythm with the emergency department physician were a critical piece of the puzzle.
Read below to see how we did it.
This is how it works. After picking up the patient and initiating treatment, the EMTs communicate with the ED physician. The heart rhythm is sent wirelessly to the ED physician who reviews the ECG. Upon noting changes consistent with an acute myocardial infarction, the ED physician alerts the hospital team that the patient en-route is having an acute myocardial infarction.
The cardiologist and the cath team are notified and early preparations are being made to get that patient into the cath lab as quickly as possible. The patient arrives at the most appropriate hospital and is quickly brought to the cath lab where the cath team and the cardiologist perform coronary artery angioplasty, which opens the blocked artery. The heart attack is minimized or prevented. Heart and life saved.
In Baton Rouge, we have been working for several years to improve our process. We have a unique process where all the major hospitals in the parish (what is called a county in the other 49 states in the nation) cooperate in a process via pre-hospital evaluations called BR-Med Connect. Our team based approach was highlighted in this news item.
The technology is General Devices’ 10e-Bridge telemedicine units utilized in two of the fifteen ambulance trucks and General Device Care Point system in each of the hospitals. The other thirteen trucks have Panasonic toughbooks with wireless capability. We found the General Device system to be the most open architecture EMS system on the market.
This allows many other proprietary systems to work within this system. Our region’s wireless coverage is diverse. A small area of about 8 sq miles has a broadband WiFi mesh while the remainder of our 464 sq miles has a combination of 3G and in some areas 4G cellular coverage.
How well did we do? Our most recent times averaged DBT 23 min and CBT 40 min.
One might think, why do this?
We did this to improve our ST segment elevation myocardial infarction (STEMI) outcomes for those who live in our East Baton Rouge Parish. Our passion is not to be at the recommended national standard for DBT as recommended by the AHA. We want our CBT to be less than 60 minutes. Even now, we are starting the work on stroke evaluation in the fields.
Technology is really a small part of the overall process. In the second part of this article, I will discuss the team approach that was required to achieve this great result.
Watch the Video
[Do you have a story to share of using mobile or telehealth in your practice? We would love to share it with iMedicalApps readers. Drop us a line.]
