12 Lead EKG Goes Operational


9/20/2011

This past year, EMMCO West's Medical Advisory and Communication Committees identified an inability of ALS personnel to transmit 12 lead EKGs to regional hospitals. In order for medical command physicians to identify a treatment plan for a suspected heart attack patient, a 12 lead EKG is needed.  Given the rural topography of the region, cellular communication systems are not able to reliably transmit the 12 lead EKGs via cellphone.12 lead EKGs are being performed by prehospital personnel, but due this technology gap there was no effective means to transmit the 12 lead EKGs to medical command.

I want to update you on a regional project that has just gone operational in the last several weeks to enable the transmission of 12 lead EKGs to regional hospitals. Instead of cellular phones to transmit, 400 MHZ radios will be used to transmit the 12 lead EKGs to regional hospitals. Regional ALS and BLS personnel are to be aware of the use of this technology, as to not interrupt a 12 lead transmission.

Let me explain the system!

12 Lead EKG Transmission via Rosetta System

Rosetta lt

General Devices Corporation has providedregional ALS services and hospitals participating in the 12 lead project* with a device called the Rosetta. The Rosetta LT device is used by ALS personnel, while the Rosetta RX device is used by hospitals.The Rosetta LT unit is compatible with PhysioControl, ZOLL, and Phillips 12 lead monitors. The 12 lead EKG downloads from the monitor to the Rosetta LT. The Rosetta LT unit easily fits into the carrying case of most 12 lead EKG monitors. Once the EKG is downloaded, the EKG is stored by the Rosetta LT until it is transmitted to the hospital.

A transmission cable from the Rosetta LT connects it to either a 400 MHZ portable radio or mobile radio. Transmission of the Rosetta LT has been integrated aspart of a medial command transmission process. Using the existing 400 MHZ radio frequency for transmission to the hospital, ALS personnel will depress the Rosetta's transmit button to send the 12 lead EKG.  The Rosetta LT transmission is a dual audio transmission. The first transmission is for the EKG, which takes about 45 seconds to transmit. The second transmission, that immediately follows, are patient information records and takes between 15 - 30 seconds. The transmission sound is similar to that of a FAX machine noise.

To assure a clear transmission of the 12 Lead EKG,the transmission should be free of interruptions from other 400 MHZ radio traffic. All regional ALS or BLS services are to be aware that when switching a 400 MHZ radio to a medical command or hospital radio frequency that if they hear a "fax machine sounding noise" to refrain from transmitting to the hospital until the initial transmission is completed.

aed mapOn the hospital end, there is a receiving station called the Rosetta RX. The "fax machine sound" is received by the Rosetta RX at the hospital. A laser printer is used to print out a 8 1/2 x 11 page size 12 Lead EKG tracing. The Medical Command Physician then reviews the 12 Lead EKG and can provide additional medical direction to ALS personnel.

PA DOH Statewide ALS & BLS Protocol 5001 notes that 12 lead EKGs should be obtained by ALS personnel and transmitted to receiving/medical command facilities as soon as possible. The importance of the 12 lead EKG, along with a prehospital assessment of the patient's condition, helps a medical command physician in determining the care and transport of a heart attack patient. A symptomatic patient that is exhibiting ST segment elevation on the 12 lead EKG may be a candidate for aggressive cardiac care treatment. A medical command physician may direct ALS personnel to transfer the patient directly to a recognized cardiac care center, either by ground or by air. (See www.emmco.org, breaking news for a listing of recognized PCI centers).

Regional Medical Director, Dr. Brian Risavi, D.O., and the regional medical advisory committee, are reviewing the use of 12 lead EKGs by both the Rosetta system and other cellular/Internet based systems. The ultimate goal is for patients exhibiting symptoms of a STEMI (ST segment elevation myocardial infarction) to obtain rapid field and hospital treatments to reduction the severity of the heart attack.

* Phase I of the Rosetta 12 lead EKG project involves three regional hospitals and four ALS services. Sharon Regional Health System, Meadville Medical Center, and UPMC Northwest are participating in the Rosetta 12 Lead EKG project. Sharon Regional Health System is one of the three recognized PCI cardiac care centers in the region. The four ALS ambulance services are McGonigle Ambulance, Conneaut Lake Area Ambulance, Meadville Area Ambulance, and Community Ambulance Service.

Currently Meadville Medical Center and UPMC Northwest Hospital have operational Rosetta systems. Conneaut Lake Area Ambulance, Meadville Area Ambulance, and Community Ambulance Services are capable of transmitting the Rosetta signals. Within the next several weeks, Sharon Regional Health Center and McGonigle Ambulance too will be operational.

Based on funding for FY 09-10, additional hospitals and ALS services will be contacted and asked to participate in Phase II of the Rosetta 12 Lead EKG project. Questions about the project should be directed to EMMCO West.


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