My fire department recently upgraded to the “new” LIFENET system by Physio-Control because the “old” LIFENET system used so-called “sunset” Circuit Data Switch technology as opposed to Internet Protocol. In other words, it was only a matter of time before it stopped working.
Setting aside the issue as to whether or not ECG transmission is a “million dollar solutions to a 5 cent problem” I thought it would be interesting to find out exactly how long it takes to transmit an ECG to the emergency department.
Because this can be configured so many ways, it’s important to understand exactly how our system is designed. We use a Lifepak 12 which connects with a In Motion Gateway via Bluetooth. This is not the modem that attaches to the side of the Lifepak 12.
So what did we find out?
1.) It takes exactly 30 seconds for a Lifepak 12 to acquire, analyze, and print a 12-lead ECG.
2.) There are 4 steps to transmitting a 12-lead ECG, not including prepping the patient, applying the electrodes, or interpreting the 12-lead ECG.
A. Pushing the 12-LEAD button.
B. Pushing the TRANSMIT button
C. Selecting DATA
D. Selecting the In Motion Gateway
Actually, this is generous, because using the LP12′s “selector” is a two-part process. You turn the knob to your selection and then you have to press it.
In the testing we found that pushing it (and eliciting a sound) does not always mean the LP12 “recognizes” the selection. You have to watch the screen and watch for the brief “flash” of the selection for reassurance that the LP12 understood your intent.
If you get impatient and press it again, the transmission cancels, which wastes valuable time.
3.) The total elapsed time from pushing the PRINT button to “Transmission Complete” is approximately 2.5 minutes (a full minute of which is the transmission “stuck” at 99% which is the LIFENET verifying that the transmission was successful).
One of the “negatives” of our system design is that the patient has to be in the back of the ambulance to transmit an ECG with the In Motion Gateway.
So if our patient is on the 5th floor of a multi-family residential complex and we call the “STEMI Alert” it will be another 5 minutes (at least) before the patient is in the back of the ambulance, and then another 2 minutes (give or take 30 seconds) before the transmission can be completed.
We have not measured the time interval between “transmission complete” and an email actually showing up at the hospital.
You can watch one of the test videos here.
Can you be doing other things with the monitor while it is transmitting? And is this using their modem that attaches or bluetooth over to a cell phone?
It is Bluetooth to an In Motion Gateway. This is not the modem that attaches to the side of the monitor. We are using the In Motion Gateway because it was already installed in our ambulance for our CAD system. I have updated the post to say that more explicitly.
Thanks. We’ve got InMotion as well (and LP12′s for that matter). However the receiving hospitals are Philips or Zoll.
The lack of interoperability is a big problem although my understanding is that the LIFENET can now be modified to accept ECGs from other vendors (and of course CAREpoint work station has had this capability all along).
We have been working with different forms of 12-lead transmission over commercial wireless networks using Physio, Phillips, Zoll, and a few lesser-knowns for around 18 years now (we started out faxing using analog bag phones after hurricane Andrew damaged a significant amount of landline telco infrastructure in 1992). We have done thousands of test transmissions in multiple clinical and transport scenarios. We have learned that epochal improvements in transmission efficiency coincide with the evolution of the commercial wireless technology. Analog-to-digital; Circuit-switched-to-packet, etc. We are always interested in any anticipated changes that we may take advantage of or suffer from. We have also learned that there is frequently a parallel, profit-driven agenda being pursued by manufacturers and/or service providers when certain ‘absolutes’ are declared. Did Physio say when the circuit-switched technology was scheduled to be turned off?
We use the same system and configuration, and 2.5 minutes is about right. Add to that an extra 30 seconds because our hospitals like to have a name, age and sex attached to the EKG, so we have to input that…
It’s been my observation that most of our ED nursing staff and physicians are no more adept at interpreting a 12 lead than I am, usually even less so, and I’m certainly no Tom Bouthillet.
In our area, my personal opinion is that transmission (from the truck) is wasted effort, and does little to short door-to-balloon intervals.
Jon – Thanks for the comment. I asked but they were unable to estimate a date beyond which the Circuit Data Switch technology would cease to function. They basically said, “It could be tomorrow. It could be four years from now.”
AD – Do you guys have the authority to bypass non-PCI hospitals at your discretion? I’m also curious to know what happens at 0300 Sunday morning on a holiday weekend. Will they call in the cath lab from home based on the paramedic’s interpretation?
I have sent transmissions to the hospital (sent to the ER fax machine…) for the time you upload all this info to be sen to the ER, we are usuall at the er before the er gets it. I’ve sat next to the er fax, and pressed send data, several times it takes more that 10 minutes before the ER ever gets the info
we have the new phillips ekg transmission on the mrx monitors and it is under 2 minutes to acquire and transmit the ekg! The hosital can recieve ethier a fax or email which ever you prefer and you dont have a monthly fee as in the lifenet system!
Tom,
In our area the cath lab is often activated solely upon paramedic interpretation (depending on the service). Nights/Weekends means they’re coming in from home.
The county in which I am employed is very fortunate in that we carry TNKase on our units. In the event that we run a STEMI which meets all criteria for thrombolyitic therapy and the attending ED physician confirms via our transmitted 12-lead that it is in fact a STEMI, we can administer TNKase in the field and transport the pt directly to the closest PCI center which is about an hour away. We use the same LP-12/In Motion system and see about the same 2.5 minute time requirement. As soon as it shows “transmission complete” we call the attending physician and they are usually pulling it up within seconds of answering the phone. Tom; in the event that a STEMI pt is not a candidate for thrombolytic therapy, the cath lab at the nearest PCI center is usually good about activating upon our judgement but sometimes do request a 12-lead be transmitted to them for confirmation.
Yes, we can bypass non-PCI hospitals at our discretion.
Problem is, every system has a few indiscreet medics.
The operative word in our protocols, is closest appropriate facility, and hopefully one that the patient requests. We have 3 PCI capable hospitals in our area, and 3 non-PCI hospitals. The non-PCI hospitals are the type you shouldn’t even bring sick people, much less STEMI patients, so most of us try to bypass them, or convince the patients who want to go there that such a decision may quite possibly kill them.
Unfortunately, we have a few lazy medics who are only interested in getting the patient out of their rig, or the panicky types who wet their pants at a little hypotension or bradycardia, and wind up bringing the patient to an inappropriate destination anyway.