This project which seeks to determine whether individuals who access the """"""""911"""""""" emergency medical system (EMS) with acute myocardial infarction (MI) or unstable angina will receive more timely hospital treatment and better outcomes if hospital clinicians are provided with 1) earlier, and 2) more complete ECG information. Earlier EKG information will be achieved in 2 ways: (1) by synthesizing a 12-lead ECG from a rapidly applied 5 electrode configuration, rather than using the cumbersome 10- electrode configuration required for a standard 12 lead ECG, and (2) by transmitting ECGs by cell phone tele-electrocardiography) from the field to the emergency department (ED) rather than waiting to obtain an ECG after hospital arrival. More complete ECG information will be achieved in 3 ways 1) by monitoring continuously rather than recording a one-time ECG, 2) by monitoring all 12 EKG leads, rather than a single lead, and (3) by monitoring with special ischemia detection software, rather than arrhythmia software alone. The software will continuously analyze ST segments in all 12 ECG leads for changes of acute ischemia and will automatically print out ECGs in the ED when ST events occur. This tele-electrocardiography intervention will be implemented as a county wide program in Northern California through Santa Cruz County's EMS. A total of 2,468 subjects will be recruited for this prospective, randomized controlled clinical trial. Subjects will be randomized to one of two groups: 1) the experimental group will have the pre-hospital tele-electrocardiography intervention and 2) the control group will have routine EMS cardiac care. Hypotheses to be tested are that patients randomized to the ST SMART intervention experimental group will, in comparison to patients in the routine EMS control group have: (1) no longer paramedic scene times, despite the acquisition of more ECG information, (2) reduced time to treatment for acute coronary syndromes, and (3) fewer adverse outcomes in the hospital and at one year following hospital discharge.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR007881-04
Application #
7082820
Study Section
Nursing Research Study Section (NURS)
Program Officer
Huss, Karen
Project Start
2003-09-15
Project End
2008-06-30
Budget Start
2006-07-01
Budget End
2007-06-30
Support Year
4
Fiscal Year
2006
Total Cost
$430,025
Indirect Cost
Name
University of California San Francisco
Department
Other Health Professions
Type
Schools of Nursing
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Zègre-Hemsey, Jessica K; Sommargren, Claire E; Asafu-Adjei, Josephine K et al. (2015) Normal prehospital electrocardiography is linked to long-term survival in patients presenting to the emergency department with symptoms of acute coronary syndrome. J Electrocardiol 48:520-6
Zègre Hemsey, Jessica K; Dracup, Kathleen; Fleischmann, Kirsten E et al. (2013) Prehospital electrocardiographic manifestations of acute myocardial ischemia independently predict adverse hospital outcomes. J Emerg Med 44:955-61
Zegre Hemsey, Jessica K; Dracup, Kathleen; Fleischmann, Kirsten et al. (2012) Prehospital 12-lead ST-segment monitoring improves the early diagnosis of acute coronary syndrome. J Electrocardiol 45:266-71
Zègre-Hemsey, Jessica; Sommargren, Claire E; Drew, Barbara J (2011) Initial ECG acquisition within 10 minutes of arrival at the emergency department in persons with chest pain: time and gender differences. J Emerg Nurs 37:109-12
Drew, Barbara J; Sommargren, Claire E; Schindler, Daniel M et al. (2011) A simple strategy improves prehospital electrocardiogram utilization and hospital treatment for patients with acute coronary syndrome (from the ST SMART Study). Am J Cardiol 107:347-52
Drew, Barbara J; Sommargren, Claire E; Schindler, Daniel M et al. (2006) Novel electrocardiogram configurations and transmission procedures in the prehospital setting: effect on ischemia and arrhythmia determination. J Electrocardiol 39:S157-60
Drew, Barbara J; Dempsey, Elise D; Joo, Tae H et al. (2004) Pre-hospital synthesized 12-lead ECG ischemia monitoring with trans-telephonic transmission in acute coronary syndromes: pilot study results of the ST SMART trial. J Electrocardiol 37 Suppl:214-21