The ECG gets to the hospital forty minutes before the ambulance does

The nearest hospital that can open a blocked coronary artery is an hour and twenty minutes from the ambulance garage, in good weather, if nobody is towing a boat on Highway 61. For a heart attack, that is a long time. The question the crew asked was not how to make the drive shorter. It was how to use it.

The service runs two ambulances and about thirty volunteers: a retired teacher, a fishing guide, two nurses, a carpenter, a couple who run a resort, and a rotating handful of people who moved up from the Twin Cities and wanted to be useful. They answer about four hundred calls a year. A dozen or so are heart attacks.

Sending the picture ahead

For a heart attack caused by a fully blocked artery, the treatment is to open it, and every minute counts. Hospitals measure themselves on the time from the patient arriving at the door to the artery being opened. The fastest way to shorten that is for the hospital to know what is coming before it arrives.

The ambulances have always carried 12-lead heart monitors. What they did not have was a reliable way to get the tracing to the cardiologist. The highway runs along the lake through long stretches with weak or no cellular coverage. A transmission that fails halfway is worse than useless, because the crew thinks it has gone.

Since last summer, each rig has a Nexa Edge Vehicle hub bolted under the bench seat and wired into the monitor's data port. When the paramedic acquires a 12-lead, the hub sends it. If there is no coverage, it holds it and keeps trying, and the screen on the monitor says so in plain words. When it goes through, the receiving hospital's cardiology team gets it on a phone with the time it was taken, not the time it arrived.

One call in March

A 58-year-old man called 911 from a cabin north of the highway with crushing chest pain. The crew reached him in fourteen minutes. The first 12-lead showed a large heart attack. The hub sent it from the cabin's driveway, where there was one bar of signal. The cardiologist on call at the receiving hospital saw it nine minutes later and activated the catheterization lab.

When the ambulance pulled in an hour and eight minutes after that, the team was waiting at the door. The man went straight to the lab, past the emergency department, and his artery was open twenty-two minutes after he arrived. He went home five days later.

What volunteers need from equipment

Kristin is blunt about what the crew will tolerate. "Anything that needs a login, I won't use at three in the morning in a snowbank. Anything that needs charging, someone will forget. Anything that has a menu, someone will pick the wrong thing."

The hub has no login, runs from the vehicle's power, and has no menu. It shows one of three states on the monitor: sending, sent, or waiting for signal. Training took a single evening, most of which was spent on the receiving hospital's side of the process rather than the crew's.

Next

Two neighboring services have asked to join. The receiving hospital is now working on the reverse direction: sending a short note back to the ambulance so the crew knows which door to use and who will be there.

Nexaform Labs is a fictional company. The people, places and figures in this story are invented for demonstration.