Transcript Parke County EMS Field EKG 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
“Advancing rural health through education,
innovation, and collaboration”
Lugar Center Project Involvement
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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
Where Are They Now?
Where Are They Now?
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Lugar Center Grants (Selected)
Federal Grants
Grant
Agency
Telehealth Network HRSA,
Grant Program
OAT
Simulation
HRSA
Amount Period
$612,575
09/1008/13
$99,000
09/1008/11
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Wabash Valley Rural
Telehealth Network
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.
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
Wabash Valley Rural Telehealth
Network Partners
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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
Current Network Providers
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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
Current Telemedicine Programs
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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
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
Cardiac Death Rates – Parke County
Good News ! We Can Make a Difference
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.
Door to Balloon Delays
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).
Parke County Ambulance
Vermillion County Ambulance
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)
Challenges and Barriers
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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
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
EKG’s HavE CHanGEd OvEr tHE yEars…..
Getting Started
Protocol Development
Collaborative effort
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Emergency Department CAH
Emergency Department PCI
EMS Medical Director
Chest Pain Accreditation Team
Hospital Administration
EMS Commission for BLS Waiver
Training
 Multiple Sessions
 Hands on approach
 Super-User Training
 Pocket guides sent
with participants
 Case Studies
 Interactive skills
assessment
 Protocols
 ER Staff
Process !!
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.
Chest Pain/ Suspected Acute
Coronary Syndrome
1. Perform General Initial Medical Care, consider ALS care.
2. Administer four (4) 81 mg chewable aspirin for patient to
chew and swallow if able to maintain airway and gag reflex is
intact.
3. Acquire EKG via Physioglove within five minutes
4. Transmit to nearest receiving facility
5. Assist patient, family, or caregiver with the administration of
the patient’s own sublingual or spray nitroglycerin
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
Physioglove
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.
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
Step 1
Place the LA lead as high as possible in the
armpit
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.
Step 3
Position the LL electrode in the area of the
pelvis close to the left leg, making sure the
electrode makes skin contact.
Step 4
• On the ECG tab, click the Run
button
Plan A – EKG Transmission
• Toughbook Laptop Technology
Built in wireless aircard
• Obtain tracing via Physioglove
• Transmit PDF file to FAX in the ER
Plan A - Transmission Process
EKG Obtained
and converted to
PDF - Sent to
Email Server
0-4 Minutes
EKG sent by
Email to Fax
solution
2-4 minutes
Fax Server
forwards EKG to
Receiving
Hospital Fax
2-3 minutes
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
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
ParKE COunty EKG’s – Rocky Fork Lake
Or…. FrOm tHE BiG rOCK
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
sEndinG EKG’s FrOm …..
JunKy JOE’s antiquEs
and tHE illinOis statE linE…
Data Collection
90 minute D2B goal
Age
Sex
Day
Date
EMS
Dispatch
Time
EMS
Scene
Time
EKG
Acquire
Time
EKG
Transmit
Time
Code
STEMI
CAH Door
to
Transport
Protocol
Followed
Review by
Medical
Director
Data Collection
Process & Procedure
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
Visit Us At
Ruraltelenet.org
Thank You