Get your cardiologist wherever you want: telecardiology supporting a regional EMS network (8 years and half a million ECGs)

Abstract

Background: Tele-medicine support is presently applied in several fields of medicine. Clinical evidence showed as pre-hospital ECG may shorten time to reperfusion in subjects with acute myocardial infarction, thus significantly affecting clinical outcomes of these patients. Methods: A tele-medicine service presently supports the public free Emergency Medical Service (EMS) 118 throughout whole Apulia, a 4-million inhabitants region in South-Eastern Italy. 118 is the Italian public free service for general medical or surgical emergencies, whose aim is an immediate diagnosis of critical diseases in order to avoid emergency room delay-to-diagnosis. Patients are discharged from the ambulance and not transported at all in case of normal findings; direct admission to a critical care unit is arranged according to the level of care. Thanks to tele-cardiology support, 118 crews may record a complete 12-lead pre-hospital ECG with an apposite device, in any case of suspected heart disease. The ECG is sent by mobile phone support to a single regional tele-cardiology hub control room where a cardiologist promptly reads the ECG and provides a consultation. The ECG may then be sent back via the internet and also visualized by EMS personnel on smart-phones or cath-lab physicians. The 118 control room, according to ECG and EMS crew report, then arranges for hospitalization when needed. Data from 2004 until early 2013 were hereby reported. Results: 523,449 ECGs were recorded since 2004. Constantly growing trend of ECGs performed by 118 crews emphasizes the usefulness and liability of tele-cardiology support in every-day EMS practice (16,534 ECGs in 2005, 31,535 2006, 42,854 2007, 49,999 2008, 69,198 2009, 94,326 2010, 106,870 in 2011, 109,750 in 2012). Referring symptoms were dyspnea (9%), dizziness or faint (21%), chest pain (24%), palpitations (7%), or other non-specific symptoms. In 35,898 cases (7%) ECG showed a significant arrhythmia, in 26,819 (5%) signs suggestive for myocardial ischemia needing further examination (ECG monitoring, cardiac enzyme assay, coronary care or cath-lab admission). Conclusions: A single tele-cardiologyhub may easily support EMS in a 4-million-inhabitant region.