The effectiveness of using ECG teletransmission during emergency medical team interventions

Background To determine the importance of ECG teletransmission on the time required for decisions on diagnosis and treatment and the transport of myocardial infarction. Methods This study is retrospective in character and concerns the regional activities of the Bielsko Emergency Medical Services and the possibility of sending medical data electronically from a patient’s location to the clinic of interventional cardiology (CIC). Group A (n=237) included patients in whom the Medical Response Team confirmed an ST-ACS and carried out an ECG with data teletransmission to the CIC. Group B (n=101) included patients in whom the Medical Response Team confirmed an ST-ACS and carried out an ECG without teletransmission. For both groups, the Medical Response Team recorded the time of arrival at the patient’s location and the time when the patient was handed over to the CIC. A group of 638 patients were identified in whom the chest pain was of cardiac origin. Of these patients, 338 were identified as patients with diagnosed ST-ACS. A significant dependence was demonstrated of the time t mins of teletransmission (p=0.00308). A significant dependence was demonstrated of the effect of distance s kms. A significant dependence was demonstrated of the time t from the place of residence, taking into account the distance s (p=0.00929). Using ECG teletransmission in pre-hospital procedures shortens the time for diagnosis and transport of patients with ST-ACS, and thus improves the results of treatment. Abstract Background: To determine the importance of ECG teletransmission on the time required for decisions on diagnosis and treatment and the transport of patients with myocardial infarction. This study is retrospective in character and concerns the regional activities of the Bielsko Emergency Medical Services and the possibility of sending medical data electronically from a patient’s location to the clinic of interventional cardiology (CIC). Group A (n=237) included patients in whom the Medical Response Team confirmed an ST-ACS and carried out an ECG with data teletransmission to the CIC. Group B (n=101) included patients in whom the Medical Response Team confirmed an ST-ACS and carried out an ECG without teletransmission. For both groups, the Medical Response Team recorded the time of arrival at the patient’s location and the time when the patient was handed over to the CIC. Results : A group of 638 patients were identified in whom the chest pain was of cardiac origin. Of these patients, 338 were identified as patients with diagnosed ST-ACS. A significant dependence was demonstrated of the time t [mins] of teletransmission (p=0.00308). A significant dependence was demonstrated of the effect of distance s [kms] (p=0.00000). A significant dependence was demonstrated of the time t from the place of residence, taking into account the distance s (p=0.00929). Conclusion : Using ECG teletransmission in pre-hospital procedures shortens the time for diagnosis and transport of patients with ST-ACS, and thus improves the results of treatment.


Abstract Background
To determine the importance of ECG teletransmission on the time required for decisions on diagnosis and treatment and the transport of patients with myocardial infarction.

Methods
This study is retrospective in character and concerns the regional activities of the Bielsko

Results
A group of 638 patients were identified in whom the chest pain was of cardiac origin. Of these patients, 338 were identified as patients with diagnosed ST-ACS. A significant dependence was demonstrated of the time t mins of teletransmission (p=0.00308). A significant dependence was demonstrated of the effect of distance s kms. A significant dependence was demonstrated of the time t from the place of residence, taking into account the distance s (p=0.00929).

Conclusion
Using ECG teletransmission in pre-hospital procedures shortens the time for diagnosis and transport of patients with ST-ACS, and thus improves the results of treatment.

Abstract
Background: 3 To determine the importance of ECG teletransmission on the time required for decisions on diagnosis and treatment and the transport of patients with myocardial infarction.

Methods:
This study is retrospective in character and concerns the regional activities of the Bielsko Emergency Medical Services and the possibility of sending medical data electronically from a patient's location to the clinic of interventional cardiology (CIC). Group A (n=237)

Conclusion :
Using ECG teletransmission in pre-hospital procedures shortens the time for diagnosis and transport of patients with ST-ACS, and thus improves the results of treatment.
Keywords: emergency medicine, acute coronary syndrome, teletransmission, Background Data transmission in the field of medicine is used widely for sending diagnostic data and conducting teleconsultations, as well as video analysis of a patient's condition.
Teletransmission involves cooperation between a medical specialist and a person benefitting from the service -that is a patient -without the need for personal contact. In the Polish healthcare system, this type of teletransmission began at the beginning of the 21st century, and is currently a permanent feature of the diagnostic process for acute coronary syndrome (ACS). [1] Using this method, data is transmitted directly from a patient's location to a specialist clinic, where a printed or electronic ECG graph readout is analysed by a cardiologist. Thanks to teletransmission, ST-ACS can be diagnosed and prehospital treatment can be begun by the Medical Response Team (MRT) during transport of the patient to the cardiology surgery clinic in order to carry out percutaneous coronary intervention (PCI).

Methods
This study is retrospective in character and concerns the regional activities of the Bielsko

Results
In the three-year study period, the number of responses to patients with chest pain totalled 1200. After applying inclusion and exclusion criteria, a group of 638 patients were identified in whom the chest pain was of cardiac origin. Of these patients, 338 were identified as patients with diagnosed ST-ACS.

The demographic data of the patients in the study group is presented in Table 1 (in the Supplementary Files).
To achieve the study aims, results were selected that documented the effect of teletransmission on the time t for diagnostics and for transport of patients with myocardial infarction to the CIC. Evaluation was made of the dependency of time t as regards the use or non-use of teletransmission and the place of residence within the municipality or district.
Covariance analysis was used to take into account the distance s [kms] from the patient's location to the CIC or to a hospital with a cardiology ward, the use or non-use of teletransmission, and the place of residence within the municipality or district.
A significant dependency was demonstrated between t [mins] and teletransmission (p=0.00308). A significant effect was demonstrated of distance s [kms] (p=0.00000). A significant dependency was demonstrated between time t and place of residence, taking into account distance s (p=0.00929).

Discussion
According to many authors, teletransmission of ECG in cases of suspected ACS assists medical response teams in making the correct diagnosis, and speeds up the decision regarding the start of treatment [1][2][3][4][5][6]. Triverdi et al. [7], conducted a study in the USA into the emergency medical response system, in which teletransmission of ECG is not obligatory for patients with suspected acute myocardial infarction (AMI). The results obtained confirmed the high effectiveness in diagnosing ST-ACS by members of emergency medical response teams. Grieko et al. [8], in research on the emergency medical response system in Italy, demonstrated the influence of ECG teletransmission on shortening the time between the first chest pains and the start of treatment. Tekerlsen et al. [9], in their study on the Danish emergency medical system, where ambulance teams use ECG teletransmission, demonstrated a shortening of delays in the start of ST-ACS myocardial infarction treatment due to fast diagnosis and transport of patients directly to cardiology surgery wards. Dudek et al. [10], presented current standard procedures in Poland for cases of Acute Coronary Syndrome, which places particular emphasis on the model of the early intervention strategy based on a network of cardiology surgery clinics that maintain 24-hour hemodynamic shifts. Kleinrok et al. [11], demonstrated that teletransmission of ECG data and teleconsultations reduce system delays. ECG teletransmission is particularly useful in sparsely-populated rural areas with access to only one hospital in the region able to conduct primary percutaneous coronary intervention (PCI). Zimoch et al. [12], emphasised the influence of delays in diagnosis and treatment on rates of illness and morbidity among patients with ST-ACS. In cases where ECG data teletransmission was conducted, the time from the moment the MRT was called to the moment reperfusion therapy was started was significantly shorter, and the percentage of indirect transport to a hospital with PCI was lower. De Luca et al. [13], proved that every 30 minutes of delay in starting reperfusion therapy is linked to an 8% rise in morbidity. Our research has shown that if teletransmission is used, the time t for diagnosis and transport of the patient to the CIC is significantly shorter than if teletransmission was not conducted. A significant dependency has also been shown

Supplementary Files
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