Abstract 163: Use of a Free, Non-proprietary Iphone App (STEMISend) to Substantially Improve Pre-hospital ECG Transmission Capability

Introduction: Pre-hospital diagnosis of ST-segment Elevation Myocardial Infarction (STEMI) promotes pre-arrival decision making and minimizes reperfusion delays. However, many commercial ECG transmission systems are expensive and based on proprietary technology. Recent advances in phone and app technology suggest another approach. As an alternative, a smartphone app (STEMISend) was developed and partnered with an inexpensive cell signal booster. This combination was then tested in multiple head-to-head comparisons with commercial systems. Results showed the app + booster approach to be non-inferior or superior to commercial systems -particularly in signal-limited environments. Hypothesis: Based on preliminary testing, the STEMISend smartphone app was suggested as a cost-effective alternative to commercial systems. Extensive field testing looking at percent success, cycle reliability and comparative performance in low-signal environments was conducted. Procedure: The STEMISend/booster combo was field-tested on 2 national cell networks and compared to an existing commercial system. Success was defined as a successful transmission within 120 seconds. Data was collected at 125 individual waypoints at all signal strengths. Testing was in geographically diverse areas of central Virginia. App performance was evaluated on a success/failure basis and on the time required to transmit the image. Commercial system performance was similarly evaluated and the two approaches were compared. Results: Figure 1 shows STEMISend performance compared to an existing commercial system. In signal-rich environments (3-5 bars), both showed nearly equal performance. However, in signal-limited environments (2 bars or less), the app/booster combo displayed slightly higher success. In terms of transmission duration, the cell signal booster decreased transmission cycle time in both signal -rich and signal-limited environments, though the effect is more pronounced in signal-limited environments. Conclusion: The STEMISend iPhone app is a potential alternative to commercial ECG transmission systems--particularly when coupled with inexpensive cell signal boosters. STEMISend is easy to use, reliable and non-proprietary. Additional testing in EMS environments is in progress.