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

Summary Background 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. Methods 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. Results 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. Conclusions 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.