Time is the enemy when it comes to prehospital care. Pick a critical injury or illness, and you will usually hear a prognosis dependent on time. Once in a while, however, we manage a minor victory over Father Time, especially when we can steal back precious minutes and put them to better use. We've seen this not only with trauma care, but also in advances in stroke treatment and interventional cardiac care. The mantra we cite now is, "Time is muscle." The faster we can get time-sensitive patients recognized and into functioning systems of care, the better their overall outcomes. With the implementation of a program to recognize and treat suspected STEMI patients from the field to the table, the University of Medicine & Dentistry of New Jersey (UMDNJ) has managed to do just that.

     UMDNJ is the parent organization of The University Hospital (UH), New Jersey's premier Level I trauma center, located in Newark. UH-EMS is a hospital-based tiered service providing ALS and BLS coverage for Newark, Newark Liberty International Airport, Port Newark and Port Elizabeth, as well as primary ALS coverage for Orange and East Orange.

     In 2005, members of the UMDNJ cardiology department reviewed the department's procedures for STEMI patients, because their average door-to-balloon time was exceeding acceptable standards. They wanted a way to give cardiologists earlier notification of STEMI patients, and to consider the possibility of bringing recognized patients from the ambulance directly to the cath lab, bypassing the emergency department. "The name of the game is to open up the artery as soon as possible," says Vivek Dhruva, DO, who was the chief academic fellow of cardiology at the time the STAT-MI (for ST-segment Analysis using wireless Technology in acute Myocardial Infarction) project was proposed.

     Marc Klapholz, MD, FACC, FCSAI, director of cardiology, was the architect behind the program. After sketching out a process, he consulted every department to be involved: EMS, ED, information services and technology (IST), administration, cardiology, cath lab managers, regulatory affairs and the hospital's medical director. Medtronic/Physio-Control and Verizon Wireless were also consulted. Potential roadblocks were identified, such as an ongoing problem with bad or missing wires to connect cell phones to monitors to transmit EKGs.