All for one, one for all: Remote telemedicine hub pre-hospital triage for public Emergency Medical Service 1-1-8 in a regional network for primary PCI in Apulia, Italy

• Published in: European Research in Telemedicine / La Recherche Européenne en Télémédecine 2014-03, Vol.3 (1), p.9-15
• Main Authors: Brunetti, N.D., De gennaro, L., Dellegrottaglie, G., Di Giuseppe, G., Antonelli, G., Di Biase, M.
• Format: Article
• Language: English
• Subjects: Emergency medical service; Health care service; Service de santé publique; Service médical d’urgence; Telecardiology; Télé-cardiologie
• ISSN: 2212-764X; 2212-764X
• DOI: 10.1016/j.eurtel.2013.11.001

Pre-hospital triage supported by electrocardiogram assessment and telemedicine was used to shorten time to reperfusion in subjects with acute myocardial infarction (AMI). Timely treatment of AMI presupposes huge geographical areas covered by one primary angioplasty network, one emergency medical service (EMS), and that pre-hospital electrocardiograms are interpreted by a physician, preferably a cardiologist. We report preliminary data on a telemedicine network which provides remote interpretation of pre-hospital triage EMS electrocardiograms for Apulia, Southern Italy (4 million inhabitants): the region is served by one public health care service, one public EMS, one hospital network and one telemedicine service provider. From October 2004 to September 2013, 598,140 electrocardiograms were read by the telemedicine hub. Fifty percent of subjects triaged via the pre-hospital telemedicine electrocardiogram network were male, 50% were aged over 70 years, 36% were triaged during night shift. Fifteen percent of electrocardiograms in subjects with chest pain were abnormal, therefore requiring direct access to the cath-lab or hospitalization. Frontline diagnosis was ST-elevation in 6178 subjects, while 40,106 electrocardiograms showed arrhythmias other than premature contraction or sinus rhythm. Typical chest pain was found in less than 50% of subjects diagnosed with ST-elevation AMI. The region of Apulia (4 million inhabitants, Southern Italy) is served by a unique combination of one telemedicine hub that reads pre-hospital electrocardiograms and provides cardiology consultations, one EMS, one hospital network for primary angioplasty in ST-elevation AMI. More than half a million electrocardiograms have been interpreted since 2004. L’orientation et le triage pré-hospitaliers par le biais d’une évaluation électrocardiogramme et la télémédecine ont été utilisée pour raccourcir le délai de reperfusion chez des sujets atteint d’un infarctus du myocarde aigu (IMA). Un traitement de l’IMA en temps opportun suppose de vastes zones couvertes par un seul réseau pour l’angioplastie primaire, un seul service d’aide médicale urgente (Samu), et que les électrocardiogrammes pré-hospitaliers soient interprétés par un médecin, de préférence un cardiologue. Nous présentons des données préliminaires sur un réseau de télémédecine qui fournit l’interprétation à distance des électrocardiogrammes pré-hospitaliers pour le Samu de l’Apulia, une région dans le sud de l’Italie (4 millions