Some ambulance services will no longer be able to transmit their 12-lead ECG tracings after Monday, Feb. 18, when the Federal Communications Commission allows cellular carriers to stop supporting analog wireless services. This "analog sunset" affects agencies using analog cell phones. It also affects those that subscribe to digital wireless services provided by carriers that will change their digital transmissions from the old analog "circuit-switched data" method to the newer "packet-switched data" mode.
The issue is that many cardiac monitor/defibrillators -- including the ubiquitous LifePak 12 -- contain analog modems, which use circuit-switched data.
"The sunset of analog services from cellular providers means you can no longer use a cell phone as an analog modem or fax machine to go directly from a defibrillator to a computer or fax machine," said Brendan Shea, product manager for Philips Healthcare's ALS Data Management Solutions. "You can still fax via a landline to a landline fax machine, but you can't use the cellular service to perform fax operations." He said the sunset won't affect the Philips MRX, which"delivers 12-lead ECG over the Internet in an all digital fashion to the 12-lead transfer station [at a hospital] from where it can be faxed, or e-mailed or forwarded to an ECG cardiology data base."
To allow the wireless transmission of 12-lead ECGs from most other cardiac/monitor defibrillators in the field, ambulance services and receiving hospitals must purchase special hardware (e.g., "gateway" devices or converters) and/or software.
"ZOLL offers multiple options for transmission," Jan Innes, Zoll Medical Corporation's STEMI program manager, said. "We provide a cost-effective Bluetooth Pod to Bluetooth phone to fax machine [which] works on AT&T/Cingular/T-Mobile and Verizon. We provide a solution using Bluetooth-to-PDA phone via server gateway to e-mail or fax. We also offer a radio solution from General Devices, [which] is a good solution in rural areas."
General Devices makes the Rosetta device, which takes transmissions from Philips, Physio-Control and ZOLL products and turns them into radio signals "so they don_t need cellular to transmit," said the company_s Vice President Curt Bashford.
Welch Allyn offers a "SmartLink" wireless upgrade for its newer PIC 50 monitor/defibrillator that "primarily uses digital transmission," according to William Smirles, group product director. "For older units, before 2001Ï2002, you would need a connector on the front to send a 12-lead via cellular. We offer fax as an option, but that_s been dwindling to practically nothing; for those who want to continue using fax, there_s a digital fax converter."
But Physio-Control, which makes the LifePak 12, offers a different solution: For 12-lead transmission from an ambulance, the company requires the purchase of a gateway device for each ambulance. Both the ambulance service and receiving hospital will need to subscribe to Physio-Control's Web-based Lifenet STEMI Management Solutions program. Subscribers will pay a subscription fee for each ambulance and 12-lead data will go from the ambulance through a Physio-Control server for translation into digital mode and then on to the receiving hospital.
"We're trying to foster a community approach and get customers together," said Cees Verkerk, Physio-Control's product marketing manager for Lifenet STEMI Management Solutions. "But this does not happen overnight; it generally takes between 60 and 90 days." Therefore, he said, "If their analog suddenly goes away there will be a gap."
AT&T Mobile and Verizon Wireless announced they would discontinue their analog support on Feb. 18, as will many smaller carriers.
However, Innes said, "Circuit-switched data for faxing is still being offered by AT&T/Cingular forEMS users and [has] been extended for this use." She adds that this option is "not offered to commercial, non-public safety customers."
Verkerk advises customers to talk with their cellular carriers and to their local Physio-Control representative. "There's a lot of confusion out there, and we don't know when a particular customer will not be able to transmit," he said.
"The end of analog technology is being driven by the cellular industry and not by medical technology companies," said Anne Devine, public relations manager for Physio-Control Global Marketing and Communications. "Physio-Control has been working closely with customers to plan for this transition."