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Field STEMI BLS Transmission

Field STEMI BLS Transmission. A Pilot Project Brought to you by Richard G. Lugar Center for Rural Health Joe Biggs, PH.D Stephanie Laws , RN, BSN Angela Powell, RN, BSN . Richard G. Lugar Center for Rural Health.

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Field STEMI BLS Transmission

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  1. Field STEMI BLS Transmission A Pilot Project Brought to you by Richard G. Lugar Center for Rural Health Joe Biggs, PH.D Stephanie Laws , RN, BSN Angela Powell, RN, BSN

  2. Richard G. Lugar Center for Rural Health

  3. “Advancing rural health through education, innovation, and collaboration”

  4. Lugar Center Project Involvement Rural Graduate Medical Education Network Telemedicine (LVI and Store-and-Forward) Pipeline / Recruitment Simulation Center (RHIC) Legislative & Regulatory Processes Rural Health Innovation Collaborative Interprofessional Education (IPE) IU School of Medicine Expansion (RMEP) School Based Mobile Telehealth (VPCHC) FQHC Planning Grant (Cork Medical Center) Upper Midwest Telehealth Resource Center

  5. Where Are They Now?

  6. Where Are They Now? 4 1 1 1 1 1 1 1 1 1 2 2 4 1 4 2 3 1 1 3 1 1 50 4 4 2 1 4 2 2 2 1 1 1 1 1 1 1

  7. Lugar Center Grants (Selected) 7

  8. Wabash Valley Rural Telehealth Network

  9. Telemedicine Grant Project The Telemedicine Network Grant Project promotes the development of telemedicine solutions to rural critical access facilities in order to provide access to specialized medical services and support evidence-based clinical outcomes at the community hospital level.

  10. TNGP Grant - Overview • August of 2010 Union Hospital’s Richard G. Lugar Center for Rural Health was awarded the Telehealth Network Grant. • Union Hospital is one of only eight recipients nationally of this competitive grant, awarded by Health Resources and Services Administration (HRSA). • The three year award will bring upwards of $600,000 in federal funds to the Wabash Valley. • The grant allows Union Hospital and its partners to improve access to quality health care services in surrounding communities using telemedicine technologies

  11. Wabash Valley Rural Telehealth Network Partners • Greene County General Hospital, Linton, IN • Sullivan County Community Hospital, Sullivan, IN • St. Vincent Clay Hospital, Brazil, IN • Putnam County Hospital, Greencastle, IN • Paris Community Hospital, Paris, IL • Crawford Memorial Hospital, Robinson, IL • Union Hospital Clinton, Clinton, IN • Union Hospital, Terre Haute, IN • Hamilton Center, Inc., Sullivan, IN • Hamilton Center, Inc., Linton, IN • Hamilton Center, Inc., Bloomfield, IN • Clay City Center for Family Medicine, Clay City, IN • Cork Medical Center, Marshall, IL • Vermillion Parke Community Health Center, Clinton, IN • Vermillion Parke Community Health Center, Cayuga, IN • Federal Bureau of Prisons, Terre Haute, IN • Vigo County Corrections Center, Terre Haute, IN • Parke County Emergency Medical Services, Rockville, IN • Vermillion County Emergency Medical Services, Newport, IN

  12. Current Network Providers • Providence Medical Group Cardiology, Terre Haute, IN • UAP Cardiology, Terre Haute, IN • UAP Pulmonology, Terre Haute, IN • Internal Medicine Nephrology, Terre Haute, IN • Hamilton Center, Inc., Terre Haute, IN • Vincennes Cardiovascular Consultants, Vincennes, IN • Shriners Hospital for Children, Cincinnati, OH • Shriners Hospital for Children, St. Louis, MO • Union Hospital Center for Diabetes Education, Terre Haute, IN • Union Hospital Respiratory Care Department, Terre Haute, IN • Union Hospital Behavioral Health, Terre Haute, IN • Dr. Charles Lewis, IU School of Dermatology, Indianapolis, IN

  13. Current Telemedicine Programs • Cardiology (hospital and clinic based) • Pulmonology • Hematology/Oncology • Behavioral Health (Acute and Crisis Intervention) • Child Psychiatry • Routine Psychotherapy • Dermatology • Nephrology • Chronic Disease Management (diabetes and respiratory) • Pediatric Specialties with Shriner’s Hospital for Children (Cincinnati and St. Louis) • Rural EMS Pre-Hospital STEMI Care

  14. Pilot BLS EKG Transmission Project • Primary Market Area- Parke and Vermillion Counties • Chest Pain Center Accredited • 2nd Largest Employer • Designated HPSA and MUA • Largely Agricultural

  15. Cardiac Death Rates – Parke County

  16. Good News ! We Can Make a Difference

  17. Project Statement • The broad goal of the project is to develop and implement a Field ST Elevation Myocardial Infarction (STEMI) 12 Lead transmission process that will meet or exceed a target of “field EKG to balloon time” of 90 minutes or less. Protocols include pre-hospital BLS and ALS 12 lead EKG transmission to the local emergency department to initiate the one call “Code STEMI” process. Early initiation will facilitate timely patient transport to the receiving percutaneous coronary intervention (PCI) facility.

  18. Door to Balloon Delays

  19. Door to Balloon - Best Practice • The Centers for Medicare Services set the established best practice standard for a patient to arrive in the Cardiac Catheterization Suite within 90 minutes. • Current best practice often will achieve a door to balloon times of less than 60 minutes. • Dr. Michael Lemay of Ottawa Heart Institute published support for paramedic field transmission by demonstrating that “patients with blocked arteries that were fast-tracked to angioplasty” demonstrated a 50% reduction in mortality (French and Koenig, 2009).

  20. Parke County Ambulance

  21. Vermillion County Ambulance

  22. Project Stakeholders Local BLS Emergency Medical Services Local Critical Access Hospital Nearest PCI Facility Citizens of Rural Communities EMS Medical Directors Cardiology Groups Cardiac Catheterization Team EMS Commission Mission Lifeline – Indiana STEMI Project Office for Advancement of Telehealth (OAT) Health Resources and Services Administration (HRSA)

  23. Challenges and Barriers • Indiana Scope of BLS Providers • Technological Challenges • End User Skill Level • Coordination of Education and Training • Variations of Bandwidth across counties • Different cellular providers with best coverage across the same County • Cost of sustainability • Creating buy in within the Rural Communities • Ongoing support and Education of EMS

  24. Program Development • Working within our 1 year waiver as granted by Indiana EMS Commission • Coordination among Emergency Medical Services (EMS), dispatch, CAH facilities, admitting departments, ED physicians at the CAH and the receiving facility, emergency room nursing staff at the CAH and the receiving facility, cardiac catheterization team and cardiologist • Development of evidence-based Field STEMI 12 Lead EKG Transmission policies, protocols and procedures • Training and staff development related to both equipment and process

  25. EKG’s Have Changed Over the years…..

  26. Getting StartedProtocol Development Collaborative effort • Emergency Department CAH • Emergency Department PCI • EMS Medical Director • Chest Pain Accreditation Team • Hospital Administration • EMS Commission for BLS Waiver

  27. Training • Multiple Sessions • Hands on approach • Super-User Training • Pocket guides sent with participants • Case Studies • Interactive skills assessment • Protocols • ER Staff

  28. Process !!

  29. Protocol Chest Pain/Suspected Acute Coronary Syndrome Protocol NOTE: This protocol applies to any patient complaining of chest discomfort , jaw pain, left arm pain, nausea, shortness of breath, dizziness or sweating.

  30. Chest Pain/ Suspected Acute Coronary Syndrome • Perform General Initial Medical Care, consider ALS care. • Administer four (4) 81 mg chewable aspirin for patient to chew and swallow if able to maintain airway and gag reflex is intact. • Acquire EKG via Physioglovewithin five minutes • Transmit to nearest receiving facility • Assist patient, family, or caregiver with the administration of the patient’s own sublingual or spray nitroglycerin

  31. Equipment Overview The Physioglove ES is a PC-based 12 Lead diagnostic resting EKG system designed as an alternative to standard EKG devices. The system is comprised of three basic units: A Physioglove An electronics unit Toughbook PC

  32. Physioglove

  33. Connecting the Physioglove To connect the PhysioGlove to the Preamplifier Unit Plug the ECG cable plug from the PhysioGlove carefully but firmly into the ECG cable plug socket at the end of the Preamplifier Unit. Tighten both of the plug screws.

  34. Connect to Laptop Computer To connect the PhysioGlove to the computer Take the USB cable (included in your product package) and connect it to the Electronic Unit and a PC USB port

  35. Step 1 Place the LA lead as high as possible in the armpit

  36. Step 2 Place the PhysioGlove over the patient's chest with the glove's centerline on the center of the sternum and electrodes V1 and V2 at the fourth intercostal space.

  37. Step 3 Position the LL electrode in the area of the pelvis close to the left leg, making sure the electrode makes skin contact.

  38. Step 4 • On the ECG tab, click the Run button

  39. Plan A – EKG Transmission • Toughbook Laptop Technology Built in wireless aircard • Obtain tracing via Physioglove • Transmit PDF file to FAX in the ER

  40. Plan A - Transmission Process

  41. Challenges with Plan A Initial field testing with wireless aircard • Impedance from the ambulance disrupted device signal • Challenges related to sporadic cellular coverage interrupted the transmission • Dropped or lost transmissions due to transmit time • Dropped or lost transmissions due to fax conversion software Transmission time- 3-12 minutes

  42. Plan B…. • Eliminate Impedance of the Ambulance via Wireless Booster Antenna • Utilize server solution so that the EKG would not be crossing a intermediary Fax • Transmit the EKG out of county as raw data and convert back to PDF at the server • Send PDF from Server to Hospital Printer IP New Transmission Time 22 Seconds

  43. Parke County EKG’s – Rocky Fork Lake or…. From the big rock

  44. Plan C…. Initial Cellular Service with Wireless aircard fails in one of the pilot ambulances located in Northern Vermillion County For this truck only a MIFI mobile hotspot is utilized through another provioder

  45. Sending EKG’s from …..Junky Joe’s Antiques

  46. And the Illinois State Line…

  47. Data Collection 90 minute D2B goal

  48. Data Collection Process & Procedure

  49. Next Steps …. • Maintain data collection and analysis • Facilitate development of long term sustainability plan with partners • Report outcomes to grantors, Indiana EMS Commission and IRB • Evaluate feasibility of replication • Collaborate with IRHA • Share findings with Mission Lifeline • Celebrate the efforts of our partners

  50. Visit Us At Ruraltelenet.org

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