Dr. James Killeen is the master of wireless emergency response. AMDIS award
winner Killeen, 45, is an associate clinical professor of medicine in the emergency and hyperbaric medicine departments at the University of California at San Diego and the developer of WebCharts, an electronic health-record system for the university's emergency department.
Killeen also serves as the technical lead for the federally funded San Diego Beacon Community, the recipient of a $15.3 million federal grant to, among several core projects, demonstrate how mobile wireless technology can be used by first responders to improve patient care even before a potential heart attack patient reaches the emergency room.
“If a patient calls up and says, 'Hey, I'm having chest pains,' the first responder usually gets there before the paramedic,” Killeen says. “Some of them are firefighters, some of them are police. Some of them are San Diego port police.”
They carry mobile EKG devices in their cars, “so they'll do a 12-lead, and if they can see they're having a heart attack they can transmit to eight base stations in the county,” Killeen says.
Each base station is run by a hospital emergency department, “where an RN runs all the calls for anybody who calls 911. They help guide the paramedic. The EKG can be sent to these nurses and can be sent to the ED and the cardiologists.” The EKG transmission, which can be read on a smartphone or other mobile device, finds the cardiologist, either on the go or at home, as well as in the hospital or office, Killeen says.
The program launched in August with a goal to consistently meet the 60-minute standard of door-to-balloon time for cardiac interventions, Killeen says. With wireless EKGs, “we're pushing that door-to-balloon time out to the field.”
An additional cost and patient-safety benefit attributed to getting the EKG results to the ED—and the cardiologist—before the patient hits the ED is a reduction in the number of emergency activations of cardiac intervention teams based on false-positive results from the first responders' not-always-accurate mobile EKG devices, Killeen says.
“There is about a 30% false positive on these activations,” Killeen says. “We actually pushed that down to zero.”
Killeen figures 10 to 15 patients a month are being saved the risk and discomfort of undergoing unnecessary cardiac interventions, while hospitals are being spared the costs of improperly activating their cardiac teams.
A second mobile pre-hospitalization initiative, up and running for about 18 months, involves converting national EMS information system (NEMSIS) standard documents to a Health Level 7 messaging format to link up the EHR systems carried by paramedics on their laptops with hospital emergency departments and their EHRs.
“The paramedics meet the state requirements to make sure their records get imported into the hospitals' records in a timely fashion and they can push information to the trauma surgeon in real time,” Killeen says.