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A centre for trans-telephonic electrocardiographic monitoring (TTEM) was established at the Escorts Heart Institute in May 1996. We have reviewed our experience in the first 398 patients. There were 321 males (81%) and 77 females (19%); their age range was 1 month to 95 years. Sixty-five per cent of patients were from New Delhi, while the remainder were from other cities in India and abroad. As well as follow-up of patients after discharge, the system was used for the evaluation of chest pain, palpitation, chronic angina, arrhythmias, and pacemaker implants. Out of 664 symptomatic transmissions, 510 (77%) were for cardiac symptoms like chest pain (309), palpitation (90), uneasiness (61), dizziness (28) and breathlessness (22); the other 154 (23) were for non-cardiac symptoms like stitch pain and backache (51), typical chest pain (39), weakness and fever (45), and sweating (19). The majority of patients with chest pain (84%), palpitation (78%) and dizziness (75%) transmitted their electrocardiograms within one hour of the onset of the symptoms. Out of 664 symptomatic transmissions, 531 required either reassurance or drug-dose adjustment by telephone and 97 were called to the outpatient department on an elective basis. Immediate hospitalization was advised for 36 patients, for acute management of their symptoms. TTEM was useful in avoiding 628 unnecessary visits to the hospital, while 36 patients were immediately hospitalized for acute care.

Introduction: Emergency Department (ED) overcrowding has been shown to delay time sensitive tests and therapies. North American guidelines call for Door-to ECG (DTE) times to be <10min in patients presenting with chest pain as delays have been shown to lead to poorer patient outcomes. We hypothesize that increased ED crowding will increase the DTE times. Methods: This was a retrospective cohort study from July 2015-May 2016 at a single tertiary care Canadian ED (53000 visits per year). Data were extracted from the ED information system (EDIS) which contains an organized record of ED activity for each visit. Our selection criteria screened for patients presenting with complaints that included chest pain, chest heaviness, chest tightness and chest burning. The primary outcome of the study was the association between ED occupancy and DTE time, which was measured using a nonparametric Spearman correlation. Multivariable linear regression models controlling for age and sex were developed for both time in minutes, and the log transformed time in minutes. Results: There were 2479 ECGs done on patients presenting with chest pain that met inclusion criteria. The median DTE time was 55.1 minutes. There was a significant positive association between DTE time and ED occupancy (rho = .133, p < 0.001). DTE time increased by 0.64 minutes (or approximately 0.4%) for each additional patient in the ED, p < 0.001. Additionally, younger age and female sex were also associated with increased DTE time. Conclusion: Increased ED occupancy was correlated with longer DTE times at a single Canadian ED, even after controlling for age and sex. This study provides an example of the negative consequences of ED overcrowding. Introduction: EMS time factors such as total prehospital, activation, response, scene and transport intervals have been used as a measure of EMS system quality with the assumption that shorter EMS time factors save lives. The objective was to assess in adults and children accessing ground EMS (population), whether operational time factors (intervention and control) were associated with survival at hospital discharge (outcome). Methods: Medline, EMBASE, and CINAHL were searched up to January 2015 for articles reporting original data that associated EMS operational time factors and survival. Conference abstracts and non-English language articles were excluded. Two investigators independently assessed the candidate titles, abstracts, and full text with discrepant reviews resolved by consensus. Risk of bias was assessed using GRADE. Results: A total of 10,151 abstracts were screened for potential inclusion, 199 articles were reviewed in full-text, and 73 met inclusion criteria. Amongst included studies, 49 investigated response time, while 24 investigated other time factors. All articles were observational studies. Amongst the 14 (28.6%) studies where response time was the primary analysis, statistically significant associations between shorter response time and increased survival were found in 5 of 7 cardiac arrest, 1 of 5 ge...