Pulsara App Improves EMS Communications with ED

Aug. 17—Every minute that blood flow is restricted during a stroke, 2 million brain cells die.

When every second counts, garbled radio transmissions and miscommunication between emergency responders and medical providers at the hospital can have a big impact. But for PeaceHealth Southwest Medical Center and local emergency medical services agencies, those obstacles are now a thing of the past—thanks to a smartphone app.

In late May, PeaceHealth Southwest, American Medical Response, North Country EMS and Camas-Washougal Fire Department began using the Pulsara app to streamline communication from the field to the emergency department. The app allows emergency responders to quickly and securely provide hospital staff with information about patients while they are en route to the emergency department—something especially important for stroke and heart attack patients, said Dr. Jason Hanley, PeaceHealth Southwest emergency department medical director.

"I truly see this, as an ER physician, as our future," he said.

The app allows emergency responders to transmit information for stroke, STEMI (an acute heart attack) and general emergency patients. The responder can input the patient's name, symptoms, when symptoms began, vital signs and any treatment being administered. They can also take a photo of the patient's drivers license—which allows the hospital to begin preregistering the patient—and other relevant things, such as EKG printouts from the ambulance.

Before the late-May implementation of Pulsara, emergency responders were using two-way radios to communicate with emergency department staff. The problem was relaying the information verbally took time, and radios aren't always clear, causing some miscommunication between providers, said Brooke Marling, paramedic field training officer with AMR.

In addition, there was only one radio channel. So if multiple ambulances were trying to call in information, they would have to wait until the channel was clear, she said. And, since it wasn't a secure transmission, they couldn't provide the patient's name or other identifying information.

Now, with Pulsara, the information is transmitted immediately to the emergency department charge nurse on duty, allowing him or her to begin preparations for the patient right away, said nurse Amy Ciecko. The app also alerts the relevant care team, including specialists, that a patient is on the way, she said.

"It integrates what was previously two separate systems," said Cliff Free, a Camas-Washougal Fire Department division chief, referring to pre-hospital and hospital care. "We are now considered part of the continuum of care."

Hospital staff continue to use the app until the patient leaves the emergency department, following stroke and STEMI patients until procedures begin in the cath lab, Ciecko said. That helps hospital staff keep track of how long a time-sensitive patient has been under medical care and how much time staff has to get treatment started in order to meet hospital goals, she said.

Hospital intervention times for stroke patients have gotten better since the Pulsara app was implemented, said Louise Jenkins, PeaceHealth Southwest's stroke program manager.

The hospital's door-to-needle time—the amount of time from a patient entering the ED until receiving clot-busting drugs—is down to 44 minutes. Before, it was at 53 minutes; the standard-of-care goal is 60 minutes, Jenkins said. The door-to-puncture time —when a clot-removing procedure begins in the cath lab—is down from 110 minutes to 92 minutes, Jenkins said.

"All of this is to create a better outcome for the patient," she said.