12-Lead EKGs in Rural Wisconsin

Ministry Saint Joseph’s Hospital EMS Coordinator Update

Steven Mickel, MD, MSJH ED Physician & MSJH EMS Medical Director
Sandy Johnson, RN, NREMT-P, MSJH EMS Coordinator

Heart disease remains the number one killer in Wisconsin, in 2008, the estimated total direct costs for treatment (healthcare, provider visits, hospital and nursing home services, medications and home care) and associated indirect costs (such as lost productivity due to morbidity and mortality) was $8.9 billion in Wisconsin.

On a national level, it is estimated that each year 1.5 million Americans experience acute myocardial infarction (AMI) and approximately one half million die. Half of these deaths occur outside of the hospital within the first hour of symptoms. In addition, AMI often has a negative impact on quality of life. These consequences can be reduced by the rapid identification and treatment of AMI.

Rapid identification and treatment of AMI has been shown to preserve cardiac function, limit infarct size and reduce morbidity and mortality. Sometimes, patients experiencing AMI symptoms will delay seeking medical care for a variety of cultural and/or personal reasons. These delays in conjunction with various delays observed in the prehospital and hospital settings often hinder prompt treatment of patients.

The current goal is to provide reperfusion therapy, if indicated, within 90 minutes of first medical contact by Emergency Medical Services (EMS). Communities, EMS and hospital emergency departments are taking up the challenge to develop and implement strategies for reducing the time to treatment of patients with AMI.

A 12-lead EKG performed and transmitted from the field is useful in the early detection and prompt treatment of patients with AMI. The procedure takes five minutes or less to perform and when transmitted from the scene or enroute, has been shown to shorten time to in-hospital treatment by roughly 30 to 60 minutes.

To this end, Dr. Steven Mickel, Ministry Saint Joseph’s Hospital ED Physician & EMS Medical Director and Sandy Johnson, RN, NREMT-P, MSJH EMS Coordinator wrote for and received a grant for the funding of three PhysioControl ReadyLink units from the Foundation of Ministry Saint Joseph’s Hospital. The ReadyLink is a handheld, portable 12-lead EKG device that only requires a threestep process to capture and transmit a 12-lead EKG. It is our ultimate goal to insure that each one of our BLS Ambulance Services have the ability to acquire and transmit 12-lead EKGs.

To serve those farthest away from Ministry Saint Joseph’s Hospital and as such, most at risk for delay of cardiac healthcare, we awarded these first three ReadyLinks to Owen- Withee, Athens and Abbotsford Ambulance Services. All three ambulance services received training on the ReadyLink from the Company Representative and from Dr. Steve Mickel, Christine Mickel, Certified Cardiographic Technician and Sandy Johnson, RN, NREMT-P. EMS personnel are taught the appropriate way to apply the ReadyLink equipment, acquire the 12-lead EKG, then transmit the EKG to the hospital. After the 12-lead EKG is received in the Emergency Department in the hospital, the ED Physician on-duty reviews it and decides whether or not the Rescue-1 Cardiac Cath Team will then get involved in the patient’s care.

Used in this way, the ReadyLink 12-lead EKG helps to expand the reach of regional chest pain networks, like the Rescue-1 Programs at Ministry Saint Joseph’s and Ministry Saint Clare’s Hospital. The ReadyLink was designed specifically for the needs of BLS Services responding to chest pain calls, providing them with real-time decision support and cutting time to treatment by directing them to the appropriate care facility, making more successful patient outcomes possible.

We are very excited to have brought the ReadyLink Program to Central Wisconsin and look forward to expanding it into the rest of our EMS Ambulance Services in the very near future.

Sources: medtronic.com, boundtreeuniversity. com, American Journal of Emergency Medicine (2011) 29, 437-440, circ.ahajournals.org

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