1. 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

2. About Us… “… to advance rural health through education, innovation, and collaboration."

3. Wabash Valley Rural Telehealth Network

4. Access to Care...Reducing Disparities

5. The Need

6. High Risk Counties Cardiac Death Rates per 100,000 Indiana Life Expectancy: CDC Final Data 2003-2009

7. Identified Gap

8. Project Area Vermillion County Parke County Union Clinton Critical Access Hospital Union Hospital PCI

9. Parke County Ambulance

10. Vermillion County Ambulance

11. Benefits of Field EKG Program

12. Door-to -Balloon (D2B) time <75 minutes (Reported as percentages of patients) Krumholz H M et al. Circulation 2011;124:1038-1045 Copyright © American Heart Association

13. EKG Transmission... Why isn’t everyone doing it?

14. Project Goal

15. Implementation

16. 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

17. 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

18. 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.

19. Equipment Overview Physioglove by Commwell Toughbook PC Wireless Booster Antenna

20. EKG Transmission

21. Challenges

22. Overcoming Technological Challenges

23. One Year of Data

24. Opportunities

25. Next Steps…. Continuous Quality Improvement Data Collection Process Improvement Outcomes Reporting IRB HRSA (OAT) Indiana EMS Commission Share Findings

26. 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

27. 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

28. Visit Us At www.ruraltelenet.org

29. 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

30. Thank You