By now, the value of EMS sending 12-lead EKGs ahead to hospitals is well established. It can speed the diagnosis and confirmation of patients’ ST-elevation myocardial infarctions (STEMIs), and help save valuable minutes toward activating cath labs.
The new BR Med-Connect system in East Baton Rouge Parish, Louisiana, allows that, and is showing early promise for cutting door-to-balloon times. Its potential next step—adding video telemedicine capabilities to parish ambulances—could go even farther toward merging the knowledge of ED docs with the skills of providers in the field.
With telemedicine, says Assistant Administrator Chad Guillot, “It’s not just about those few minutes you see a physician when you drop off a patient. The entire time you’re on a call, you can work more closely as a team, because you’re able to share all this information together. That’s what we want to see.”
The video element of BR Med-Connect will rely on a planned upgrade to a 4G wireless network in Baton Rouge; the area’s current 3G network leaves video transmission too choppy and vulnerable to dead spots. But the service has the equipment ready to go in a pair of ambulances, pending that improvement and its own rollout process.
Meanwhile, the current network is fine for data such as 12-leads, and all the service’s trucks can send those. The BR Med-Connect system, supplied by New Jersey-based General Devices, allows bidirectional voice and data among all system partners, including hospitals—“We saw it as a link between everybody,” says Guillot, “not just an EMS unit and a particular hospital.” It consists of the company’s Rosetta-DS laptop/tablet data solution in ambulances; CAREpoint Workstations to receive and integrate information in area EDs; e-Bridge mobile telemedicine components to allow hospital-to-hospital connections; and an e-Net Messenger system for exchanging voice, text and data among all players.
In sending the 12-leads, Rosetta-DS works over digital radios, cellular air cards and cell phones, and can switch among carriers as needed. It sends to any standard PC or PDA, and when using CAREpoint Workstations and e-Net Messenger, can tell senders when their reports get to their destinations. East Baton Rouge medics use it on laptops to send data from their ZOLL monitors, which is received, displayed, archived and reviewed on CAREpoints in the area’s five hospital emergency departments (Our Lady of the Lake, Ochsner, Lane, and Baton Rouge General’s Bluebonnet and Mid City campuses). The local office of emergency preparedness also has one for disaster use. ED staff use the CAREpoints to manage all EMS activities. The 12-leads, after physician review, are forwarded by e-Net Messenger to cath labs and elsewhere. On their cath lab arrival, an audio/visual alert notifies personnel; ED staff are in turn notified when the report is opened, or if it isn’t.
The BR Med-Connect system began operating in February, and there’s not yet been time to amass enough data for conclusions about its success. But there’s some early anecdotal evidence that the interval to definitive care for STEMI patients is being squeezed down.
“We’ve been watching the trends very closely,” says Cullen Hebert, MD, medical director for East Baton Rouge Parish EMS and a physician at Our Lady of the Lake. “In some cases we’re getting down into the 50- to 60-minute range for door-to-balloon times.”
“I’ve spoken to nurses in the cath labs at some of the hospitals,” says Guillot, “and they’ve told me that on several occasions now, because they’ve been alerted earlier with 12-leads from the field, they’ve been able to make their way down to the ER to receive the patient, in some cases even before we get there.”