Recording paper, think twice

There are many after market suppliers of recording paper that claim to save you “big dollars” on your consumables purchases. These may be short -term savings but in the long run can cost you a lot of money.

We often receive calls from customers who are experiencing a problem associated with the printing function on their ECG machine. They tell us, “The machine will not print an ECG” or “Every time I press the print button the machine feeds extra sheets of paper after the ECG has been printed”

Both of these problems are consistently related to the use of cheap recording paper that is badly manufactured. Usually the paper registration mark is in the wrong place or commonly is too small. The black registration mark is very important because it is used to correctly position each sheet of paper so that the next ECG printed is in the correct position. The registration mark is recognized by a sensor that is positioned close to the print head. If it is too small or in the wrong position is will either be missed completely or will incorrectly position the recording paper.

We make dozens of service calls each month to fix print problems that are related to the use of cheap recording paper. As this is not covered under the machine’s warranty the customer always ends up with a service charge that far exceeds any savings they have made. So think twice when someone offers you a cheap price. In the long run it can actually cost you a lot of money.

Pre-hospital ECGs critical for heart attack patients

Lifesaving procedures to open blocked heart arteries could begin much sooner for heart attack patients if electrocardiograms (ECGs) were recorded before they arrive at the hospital and used to put treatment teams into action, according to a scientific statement in Circulation: Journal of the American Heart Association.

Each year, about 920,000 people in the U.S. have a new or recurrent heart attack, also called myocardial infarction (MI). ST-segment elevation myocardial infarction (STEMI) is a common and especially severe type of heart attack. While there are no exact statistics for STEMI, the number has been estimated between 200,000 and 400,000.

Rapid treatment to reopen the blocked artery is vital because more heart muscle dies the longer it’s deprived of blood flow.

Current criteria for evaluating quality of care includes elapsed “door-to-balloon” or “door-to-drug” time — the time span from the moment a patient enters a hospital emergency room until blocked arteries are re-opened either by angioplasty or a clot-busting drug.

However, “the clock starts ticking from the moment a person develops symptoms of a heart attack,” said Henry H. Ting, M.D., lead author of the statement and a cardiologist at the Mayo Clinic in Rochester, Minn. “The pertinent measure of system performance is from the time of first medical contact with paramedics or other emergency medical personnel to reperfusion therapy (reestablishing blood flow to the heart muscle).”

Ting and colleagues evaluated progress since STEMI guidelines were first issued by the American Heart Association and the American College of Cardiology in 2004. They were updated last year. The guidelines recommend that all emergency medical services acquire and use pre-hospital electrocardiograms to evaluate patients with suspected acute coronary syndromes.

“If pre-hospital ECGs were more widely used and integrated with systems of care, the time from first medical contact to balloon reperfusion could be reduced to less than 60 minutes,” Ting said. The recommended goal is 90 minutes or less.

Delays from the time a person has heart attack symptoms to when they receive artery-opening treatment can be divided into four time intervals: (1) symptom onset-to-EMS arrival; (2) EMS arrival-to-hospital arrival; (3) hospital arrival-to-ECG; and (4) ECG-to-reperfusion. Pre-hospital ECG programs, if effectively implemented and coordinated with comprehensive systems of care, have the potential to decrease the latter three time intervals – and eliminate the third one.

The statement presents examples of using pre-hospital ECGs, including systems of care with door-to-balloon times approaching 30 minutes or less. In these systems, pre-hospital ECGs are used to activate the cardiac catheterization laboratory while the patient is en route to the hospital, and the patient is transported directly to the cath lab (bypassing the emergency room evaluation).

Despite the recent recommendations, fewer than 10 percent of EMS systems have adopted the use of pre-hospital ECGs, and the rate has not substantially changed since the mid-1990s.

“Furthermore, even when a pre-hospital ECG is acquired, the information is often not translated into effective action to decrease delays in treatment,” Ting said. “It is a lost opportunity to improve the quality of care for STEMI patients if the information from a prehospital ECG is not used to change downstream processes of care.”

The reluctance of patients with acute coronary syndromes to call 9-1-1 is a major obstacle to realizing the full public health benefits of pre-hospital ECGs and organizing systems of care. Studies show that more than half of STEMI patients take themselves to the hospital rather than use EMS. In addition, recent studies have shown that the longest delay for STEMI patients – two hours on average – is from the time of symptom onset to hospital arrival, said Ting.

Other barriers include:

• ensuring EMS and emergency rooms have the capacity to meet demand for services;
• developing standards for education and quality assurance for EMS providers;
• improving collaboration among EMS, emergency medicine physicians and cardiologists;
• co-ordinating hospital networks to provide the ideal patient care;
• overcoming insurance reimbursement issues for prehospital care;
• studying unintended consequences from implementing pre-hospital ECG programs.

Widespread implementation of pre-hospital ECGs is being addressed by the American Heart Association’s Mission: Lifeline, a national initiative launched in 2007 to improve regional systems of care for patients with STEMI. Mission: Lifeline’s initial phase includes emergency medical services system assessment and improvement.

Co-authors are Harlan M. Krumholz, M.D.; Elizabeth H. Bradley, Ph.D.; David C. Cone, M.D.; Jeptha P. Curtis, M.D.; Barbara J. Drew, R.N., Ph.D.; John M. Field, M.D.; William J. French, M.D.; W. Brian Gibler, M.D.; David C. Goff, M.D., Ph.D.; Alice K. Jacobs, M.D.; Brahmajee K. Nallamothu, M.D.; Robert E. O’Connor, M.D.; and Jeremiah D. Schuur, M.D. Author disclosures are available on the manuscript.

SCHILLER acquires Medilog

On 1st May, Medilog became part of the SCHILLER group. Medilog will be SCHILLER’s high-end Holter system. Medilog’s additional products are an ideal complement to SCHILLER’s present product range. The SCHILLER group very much looks forward to the coming co-operation.

SCHILLER is a leading international manufacturer and supplier of electrocardiographs, Holter ECG and blood pressure recorders, spirometers, medical IT-solutions, patient monitors and external defibrillators. More than 700 employees work for the SCHILLER group in 28 subsidiaries around the world. The company was founded by Alfred E. Schiller in 1974. The CEO is convinced that the addition of Medilog’s high-end Holter will enhance SCHILLER’s product range. Alfred E. Schiller’s comment on the acquisition: “We, at SCHILLER look forward to the coming co-operation. We are proud to have gained a brand as good as Medilog.”

What does the acquisition mean?

The SCHILLER group, with its leading position on the world market, will make every effort to further boost Medilog’s success. It is already certain, that the Medilog brand name will remain. Medilog will become SCHILLER’s high-end Holter system. Other details of the integration process are not yet fixed.

Medilog

Medilog is the trademark of Huntleigh Healthcare cardiology products, the former Medical Division of Oxford Instruments. Oxford Instruments is a leading international manufacturer of scientific research systems. The Huntleigh group was founded in 1975.

SCHILLER AG

SCHILLER is a leading international manufacturer and supplier of electrocardiographs, long-term ECG and blood pressure recorders, spirometers, medical IT-solutions, patient monitors and external defibrillators. The company was founded by Alfred E. Schiller in 1974. More than 700 employees work for the SCHILLER group in 28 subsidiaries around the world. SCHILLER has subsidiaries providing exclusive service centres in 15 countries and representatives in more than 100 countries worldwide. All shares are owned by the company CEO Alfred E. Schiller. SCHILLER is, and has been fully self-financed for more than 34 years.