"If you're going to have a heart attack, it couldn't happen in a better place than Gothenburg," remarked a TV commentator in a report on Gothenburg's effective and humane care for heart attack patients. Thanks to ambulances specially equipped for mobile data communications, heart specialists at the hospital can begin the process of diagnosis and treatment while the patient is in the ambulance.

Mobile data in ambulances saves lives

More lives can be saved and damage to the heart's muscles is reduced. Emergency medical services function more rapidly yet more smoothly for the patient, the family and medical personnel. Ambulances now have paramedics with special training modeled after the U.S. Mobimed, the system for mobile data communication, is Swedish and was introduced in full scale in spring 1993.

Getting to the right place - as quickly as possible In Sweden, some 30.000 Swedes suffer a heart attack each year. This is the most frequent reason for which people need for emergency medical services. As emergency wards are closed to cut costs in the health care sector, emergency medical service become increasingly important. Each minute can mean the difference between life and death, so it is essential to get the patient to the right hospital and the light ward as quickly as possible. The faster the patient receives treatment the better the chances that he or she will survive. Complications can be limited, and under optimal conditions, it may even be possible to stop the heart attack.

“Medical authorities in Gothenburg have made major efforts to provide information on heart and circulatory illness. For an entire year in 1987 and 1988, a campaign was conducted under the name "Hjärta-Smärta-90 000," which encouraged the city's residents to phone the 90 000 emergency number if they experienced chest pains lasting longer than 15 minutes. Specially equipped ambulances were able to reach 90 percent of the city's population within 10 minutes. Data communication is used to supplement traditional voice communication via radio so that all patient data can be transferred to the hospital with no loss of privacy or risk of errors and without interruptions of communications. If the data transfer is unsuccessful, the system ensures that it is retransmitted.

EKGs using a PC and Mobitex

Gothenburg has two OLA ambulances which are specially equipped for accidents and heart attacks. These vehicles are larger than normal and equipment includes an EKG unit as well as a PC and a radio modem. The cost of the Mobimed system is approximately SEK 200.000 per ambulance, an investment that is expected to be regained in less than one year.

Electrodes are put in place as soon as the patient has been taken into the ambulance. Pressing a SEND button on the PC starts the transmission of a complete 12-channel EKG to the hospital's coronary intensive care unit. The Mobimed also alerts personnel at the hospital via their Minicall pagers. The cardiologist is able to examine the patient's EKG on a monitor, as well as a print-out.

Heart attack or false alarm?

By examining the EKG records, the cardiologist can determine if there is a heart attack in progress, where the blockage is located and what type of treatment is needed. Additional information can also be requested from the ambulance personnel.

The doctor can give instructions to the ambulance personnel via the PC. A full EKG is shown every five minutes or upon request The cardiologist can select the channel that best shows where the blockage is located for continuous monitoring. This channel is then updated every 60 seconds. Both the doctor at the hospital and the ambulance personnel can exchange messages through the system, and there are also a number of predefined standard messages.

Menus for patient records

The PC display in the ambulance presents menus for registering information for the patient record: name, civil registration number, pulse, general health, blood oxygen level, etc. All data entered in the ambulance is transferred to the hospital and can be stored and printed out to monitor the entire course of events.

If the doctor prescribes medication during the ambulance transport, it would even be possible to scan the bar code from the medicine's packaging into the Mobimed system. All data concerning medication can then be made part of the patient record generated in the ambulance and used for subsequent treatment.

When the heart attack victim arrives at the hospital, he or she is transferred directly to the coronary intensive care unit. The staff have been able to prepare the treatment most suitable for the patient. Frequently this is a thrombolytic treatment using a substance intended to dissolve the dot causing the blockage.

In one study it was shown that it took an average of 48 minutes from the time that a patient arrived at the emergency room of a hospital until he or she is received at the proper ward. With the new Mobimed system, heart patients can be taken to the correct ward immediately, and treatment can be started about 40 minutes earlier.

Remote control of the heart

With this kind of "remote control" of heart patients, the effect of treatment can be nearly doubled and more lives can be saved. At the same time, damage to the hearts muscles can be limited, the need for post-treatment care is reduced and false alarms are avoided. During the first six months using the system, the Gothenburg Eastern Hospital found that only two patients had been admitted to the coronary intensive care unit unnecessarily.

With mobile data communications, specialist medical care can be extended to ambulances, thus improving care and life quality for heart patients. In Sweden, post-treatment care for heart attack victims currently requires 600.000 hospital days each year at a total cost of about SEK one billion. This is naturally a national economic concern. It would also be possible to extend specialist services and improve health care if the hospital to sold expert support services via mobile data links to general practitioners and local clinics.

First in Europe

The Gothenburg Eastern Hospital is the first in Europe to introduce mobile medical technology for heart patients as a normal procedure. The system has attracted considerable attention worldwide. The Mobimed application used in Gothenburg is a PC-based system for the digital transmission of patient records, status reports, messages and 12-channel EKG via the nationwide Mobitex network Mobimed was developed by Bengt-Arne Sjöqvist, Kaj Lindercrantz, Michael Gudmunds and Anders Enger of the Medical and Technical Foundation at the Chalmers Institute of Technology. For several year's, Mobimed has been part of an the EU project European Prototype for Integrated Care (EPIC) in which eight European countries participate. Today, Svenska Telemedicin system AB is responsible for marketing and continued development of the system.

Portable solution for care in the home

Mobile data communication for medical data has been tested in Uppsala, Lund and Gothenburg. The first trials started in Uppsala in 1989. Virtually all Swedish county councils now plan to introduce some form of mobile data communication. Mobimed is based on the nationwide Mobitex network and is very reliable.

There are many areas of application for mobile medical technology. In addition to heart patients, specialist care in cases of severe burns and trauma, for example, could be extended to the ambulance. With portable equipment, Mobimed could be used for care in the home, allowing the general practitioner to communicate directly with specialists in the hospital. Newly born children known to be in the risk zone for sudden infant death could be monitored in the home and the parents notified via the PC or telephone if they need to bring the child to the hospital.

In cooperation with Hogia Communication, Mobimed will be supplemented with GPS (Global Positioning System) for vehicle location via satellite. It will then be possible to dispatch ambulances rationally and effectively over a large area. Call response and transport times can be further reduced. Every minute is a matter of life or death.

The history of a heart attack in two versions

With Mobimed:
A man playing golf suddenly feels a chest pain. It is 3.30 p.m. Twenty minutes later he phones for an ambulance. Despite the pains, he does not appear ill. The ambulance arrives at 4 p.m. After twenty minutes, the first EKG is received at the hospital, and ten minutes later the golfer arrives at the intensive care unit. By 5 p.m. he has been given a pacemaker, and has received thrombolytic medication, a heart stimulant, and intravenous drip.

Without Mobimed:
The man would have arrived at the hospital's emergency room at 4.30 p.m. and be on his way to the intensive care unit by 5.18 p.m. Under the best of circumstances, he would receive the pacemaker, thrombolytic medication and a heart stimulant by 6 p.m., and hour later than with Mobimed. Perhaps he would have needed to be treated in a respirator and suffer heart failure three of four times a year following release from the hospital.