Paramedics EKG Transmits to Cardiologists
Handheld Computer; Heart Attack Patient Goes from Scene Straight
to Cath Lab
New Digitized Heart Imaging Information System Sets New Emergency
Heart Catheterization Benchmark at 33 Minutes from National Average
Concord, NC, October 2, 2003 - A new digitized Cardiac and Imaging
Information System at NorthEast Medical Center that links Cabarrus
County paramedics to cardiologists and emergency medicine teams
at Northeast Medical Center has led to a national patient "door-to-dilation"
"Door-to-dilation" response time includes the time
between the patients arrival at a cardiac catheterization
lab and the successful completion of an angioplasty procedure
to alleviate the effects of a blocked coronary artery. The national
average is 104 minutes.
The process involves preparing the catheterization (cath) lab
to receive the patient, assembling the procedure team, prepping
the patient, locating the blockage and inserting a balloon device
to reduce pain and symptomsall hopefully before damage from
lack of blood flow impacts the heart muscle.
Following his exercising at a local gym, a 41-year old resident
had chest pains. Upon arrival home, his daughter called the paramedics,
who started their evaluation.
||Since June, area paramedics have carried special electrocardiogram
(EKG) units capable of transferring digital information direct
to a cardiologists handheld computer. While paramedics
have used EKGs for years, transmissions were sent directly
to the hospital emergency department (ED), where emergency
physicians evaluated the EKG. If a heart attack was detected,
aggressive treatment began upon patient arrival, generally
before a cardiologist arrived. Now if the EKG shows a heart
attack, paramedics transmit to the ED where personnel forward
it directly to a staff cardiologist. The cardiologist receives
a 12 lead EKG transmission, enabling the doctor to view all
12 leads of the EKG simultaneously or enlarge a specific lead
This early notification allows for assembly of the heart team
prior to patient arrival, allowing direct transport to the cath
lab. If paramedics have questions or problems, the emergency physician
is always available by radio. The patients EKG transmission
went straight to Paul Campbell, MD, cardiologist on call at the
hospital. Dr. Campbell viewed the EKG reading transmitted from
the patients home, and quickly determined he immediately
needed a cardiac cath due to blockage of a coronary artery. Without
quickly restoring proper blood flow to the heart muscle, the patient
could experience heart damage or even death.
Dr. Campbells (in picture on the right) order to
the paramedic teamthough rehearsed over several monthswas
the first to actually say, Direct to Cath Lab.
Those words simultaneously activated teams to get staff
to the lab and prepare for the patients arrival. When
the ambulance pulled into the ED 19 minutes later, the lab
was ready for the patient, who bypassed the ED and went
straight to the cath lab, where Dr. Campbell and the team
The door-to-dilation clock started the moment the patient
came through the Cath Lab door, and 33 minutes later Dr.
Campbell successfully established good blood flow to the
affected coronary artery. Under normal circumstance,
it takes 30 minutes just to get the team assembled when
the lab is closed or during off hours, but yesterday proved
that new technology and training can really pay off,
said an elated Dr. Campbell.
||That new technology and training came in the
form of support from The Duke Endowment and William T. Morris
Foundation. Together, over $175,000 was funded to provide
the local program with field-transmission EKG devices, receiving
equipment for the Emergency Department and cardiologists and
English and Spanish language materials to increase awareness
of early warning signs and symptoms of heart attacks. As part
of the project, NorthEast Medical Center and Cabarrus County
EMS (Emergency Medical Services) is conducting ongoing clinical
research in collaboration with Duke University. A team of
doctors will review analysis and reporting of data collected
during the year-long study. Bringing the project to fruition
last month was the result of more than two years of research,
grant application work and training.
Prior to implementing the system, NorthEasts median door-to-dilation
time was 93 minutes, less than the national average of 104 minutes.
But after implementing and connecting the new technology and procedures
from the field to cath lab, that former time has been reduced
by two-thirds. Everything came together to make this happen
with outstanding results for our first patient using the new system
and protocols, explains Dr. Campbell. We hope this
event can serve as an excellent example what can happen when technology,
people and careful planning work together to save lives.