The Power of the Glove:
Rural EKG Transmission
A Pilot Study among E.M.S. Providers to Expedite Rural Heart Attack Care
One Year Later…..
Angela Powell, RN, MSN
About Us…
“… to advance
rural health through
education, innovation,
and collaboration."
Wabash Valley Rural Telehealth Network
Access to Care...Reducing Disparities
The Need
High Risk Counties
Cardiac Death Rates per 100,000
Indiana Life Expectancy: CDC Final Data 2003-2009
Identified Gap
Project Area
Vermillion County
Parke County
Union Clinton
Critical Access
Hospital
Union Hospital PCI
Parke County Ambulance
Vermillion County Ambulance
Benefits of Field EKG Program
Door-to -Balloon (D2B) time <75 minutes
(Reported as percentages of patients)
Copyright © American Heart Association
Krumholz H M et al. Circulation 2011;124:1038-1045
EKG Transmission...
Why isn’t everyone doing it?
Project Goal
Implementation
Protecting Participants
Identified Risk
Delay in treatment due to technology failures
• Per medical direction EMS providers are instructed “do
not interrupt life-saving interventions and /or ever delay
transport in order to obtain or transmit an EKG”
• Extensive training and support of EMS staff including real
time feedback and technology support.
Patient anxiety related to new process
• Patient education regarding the integration of the
Emergency Department physician
IRB
Training
 Multiple Sessions
 Hands-on approach
 Physioglove Technology
 Identification of STEMI
 Chest Pain and EKG
Transmission Protocols
 Interactive skills
assessment
 Pocket guides sent
with participants
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.
Equipment Overview
Physioglove
by Commwell
Toughbook
PC
Wireless
Booster
Antenna
EKG Transmission
Challenges
Overcoming
Technological Challenges
One Year of Data
Parke County EMS
Vermillion County EMS
Total BLS EKG Transmissions
6
Total BLS EKG Transmissions
52
Total Number of Subjects that met criteria
for EKG
6
Total Number of Subjects that met criteria for
EKG
52
Total BLS EKG Diagnostic Quality
6
Total BLS EKGs Diagnostic Quality
50
Total BLS Non-Diagnostic Quality
0
Total BLS Non-Diagnostic Quality
3
Total Number of Failed Transmissions –
Technician
0
Total Number of Failed Transmissions –
Technician
1
Total Number of Failed Transmissions –
Technology
1
Total Number of Failed Transmissions –
Technology
5
Total Number of STEMIs
0
Total Number of STEMIs
0
Average Scene to EKG Time (minutes)
Average Acquisition to Transmission Time
11.2
6.2
Average Scene to EKG Time
8.2
Average Acquisition to Transmission Time
3.2
Opportunities
Next Steps….
• Continuous Quality Improvement
• Data Collection
• Process Improvement
• Outcomes Reporting
 IRB
 HRSA (OAT)
 Indiana EMS Commission
• Share Findings
BLS EKG Implementation- Tips
• Engage all STEMI team members in project
development and implementation
• Provide ongoing provider education for all
appropriate aspects of cardiac care
• Manage expectations related to transmission
limitations – clearly outline plan for
transmission failure within protocols
• Check server and all transmission equipment
daily
• Implement Continuous Quality Improvement
Process
Special Thanks and Recognition
• Health Resources and Services Administration
(HRSA)- Office for the Advancement of Telehealth
(OAT)
• Indiana Department of Homeland Security- E.M.S.
Commission
• American Heart Association: Mission Lifeline
• Indiana University School of Medicine
• All Project Stakeholders
Visit Us At
www.ruraltelenet.org
Angela Powell
Office: 812-237-8698
Cell: 812-230-3362
apowell@uhhg.org
Stephanie Laws
Office: 812-238-7479
Cell: 812-243-9767
slaws@uhhg.org
Thank You