Telemetric Rhythm…Heartbeats by Phone

Some things happen on the way to other things. Then you look back and what had been a mere milestone along the way was actually where you should have been going. When I joined the American Heart Association as National Training Manager, people from Texas Instruments where I had been a program manager said it was career suicide. Of course any business person secretly thinks the non-profit world is career suicide. But I was full of the good intentions that hamstring the young, and thought that Texas Instruments did not have a real world platform for the innovative training technologies I had imagined. Or perhaps I rationalized…because here was finally a real position in a real national organization whereas at Texas Instruments you were like a small business having to sell your programs and account for their success. Little did I know: (1) that the Texas Instruments Profit-Loss centers were the best life education I could possibly have and (2) that only if you became instrumental in bringing in money could you call more of the shots.

I’d made several friends in the electrical engineer crowd at Texas Instruments in the early 70s, and even won some national awards for training videos (which at the time were a strange bird) on supervisory skills and ethics in the technical sales area. The obstacle to my career there was that I was not an Electrical Engineer. However, at the American Heart Association, the action was all doctors. A staff member at the AHA had a definite subordinate role to all of medicine, and the initial training challenges which were handed to me were in fundraising, and management of community programs. Most of these had little to do with the basic research which was the main goal of the Heart Association in those times, and thus, though fairly successful, I was definitely a staff member who was shunted out of the mainstream mission.

These were the terribly exciting days of heart medicine, when the heart-lung machine could reproduce 29 body functions and make ready for the first heart transplants. These were the days when angioplasty was developed, a bizarre notion that you could insert a balloon where there was plaque like concrete, and enlarge the balloon and the concrete plaque would harden into a channel for the blood that was stronger than the artery wall itself. What a fantastic concept, laughed at until it became a rock solid reality and bedridden patients were up and out running marathons and swimming channels like new superhumans. And these were also exciting days for Cardiopulmonary Resuscitation… or CPR.

CPR was perhaps the craziest of all. Its progression to modern medicine started about the time of Genesis …really. The CPR combination of heart massage and breathing had been developed by Dr. Peter Safar in the early 60s, though the Paris Academy of Sciences recommended mouth-to-mouth resuscitation as early as 1740, (and there are numerous Old Testament references to breathing life into those thought to be dead). Dr. George Crile in the US developed a method of closed chest massage in 1903. There are accounts that Dr. Safar also studied the ancient Egyptian Temple of Medicine, where there are several examples in the wall art of patients being revived with hands on their chest. Even in the sixties there were still many medical skeptics who laughed at breathing carbon dioxide into victims, but then they discovered that even discharged air had 80% oxygen in it. In Seattle emergency Physicians had developed a community program in 1981 for citizens to learn CPR, and they taught that CPR within the first five minutes could prevent the brain death that often comes with saving a heart attack victim, since the oxygen circulated to the brain is the most critical area. Because of the emphasis on citizen training, it was often said that Seattle was “the safest place in the world to have a heart attack.”

I would in time contribute in a fairly large way to CPR, but at first I had to address some major staff training challenges such as fundraising. Other things arose however. I saw that Prestel, the British Post Office had developed a way to send text over the telephone lines to small personal computers which were starting to gain attention, especially the Apple computer which some guys in California had built in a garage. I thought that could be a way to distribute medical information that was much faster than the quarterly journals. Early on our information systems guy who programmed the IBM mainframe for AHA assured me that these small computers in widely distributed system would never go anywhere. Nonetheless, I got one of the Apples and tried to learn to program in BASIC. I made a box appear on the screen, and a few other tricks, but most of the useful programming at that time was done at the intricate machine language level that you either had to be an electrical engineer to master, or have the marathon concentration of a 12th century monk carving intricate cabinet doors for the church.

Along the way I got to talk with a lot of doctors, and studied a little book on Medical Terminology which gave me scads of useful terms and was a bit easier because of my two years of Latin in high school. With those words, at times I could pass for a doctor. Certainly I could parse meanings as they flew at me. One example of the synergetic connections one can make when straddling two worlds was the telemetry project. Because of my interest in CPR, I talked to a lot of paramedics who used it. Pacemakers were one of the prescriptions for heart attacks, but the paramedics said they wished they had something the person could wear at home that would give warning of upcoming problems and could also transmit information to the rescuers while they were on the way.

It so happened that in those Texas Instrument days I had a friend who was working on data compression for sound, which would be essential fitting recordings into small packages for listening and most especially for voice recognition. Electrical engineers held out voice recognition as the Holy Grail, and over and over when they thought they had something which could take dictation, it really couldn’t. But they kept trying, from those year right up to now. If you have used Siri or Cortana you have seen voice recognition at work, and probably have managed to confuse those systems even after they had been worked on and refined over 50 years. The engineers at TI even hired opera singers to record the largest range of data that could be assembled.

The American Heart Association National Center was only a few miles from Texas Instruments, and I still had lunch with the TI guys at times. On one occasion I asked if the voice recognition devices and software they were working on — which always fell so short of complete human voice recognition – could possibly be used to recognize heart rhythms. They said of course, that would be trivial. But why would anyone want to do that?

Why would anyone want to recognize heart rhythms and send the information over a phone line? Why indeed? How about communicating your precise heart rhythms to emergency services when your heart is failing? I went back to work that afternoon, and fortunately there was a conference on Emergency Medicine at the National Center that day. I asked one emergency doctor what they could do with a device which could read heart rhythms and send them over a phone line. Well that doctor wanted to talk immediately with the TI researchers, and sure enough, two years later they had developed the world’s first telemetry system which would be worn by the patient when recovering from a heart attack. It would call the emergency center if the rhythms diverged, and would transmit that information over a phone line for assessment by the emergency teams. I had little further involvement in that project, but it was the sort of thing that gave me several open doors when I later needed them. When various gatekeepers said “Who is this guy?” they were told that I had helped put telemetry together, and also increased fundraising income by 30%. One of those doors got us to the CPR simulator.

I saw that I must Immediately raise the possibility of a training simulator with the Emergency Care Group in charge of standards for CPR. They would meet in a week and I had to get the CPR simulator on the agenda. Many agendas were set by consensus months ahead. But if CPR was not on this meeting agenda it would have to wait, even to be considered, for another year. I had this feeling that millions of heart attack victims could not wait that long to be saved. And who knows what could be another set of priorities when a year goes by?

The Gallup Poll had just found for us that 75% of Americans who had heard of CPR wanted to learn it, to be citizen lifesavers. As a market this was incredible, and one that the ordinary teaching of a class of 10 or 12 could not make a meaningful impact on in 40 years. The case for the simulation trainer was made in serveral ways: (1) The logistics of meeting rooms and scheduling would be obviated if this were not just a simulator, but an entire learning system that kept scores, etc. so that a single administrator could martial 100s through in a week. (2) the consistency of instruction would be immutable, since the varieties of instructors would not be a factor, and (3) the costs of training would not include salaries, rent, or much upkeep since the systems would be electronic, computer based, and thus not subject to ordinary wear and tear.

I absolutely had to get a spot on the meeting, and had to lay all this out – without actually begging — to the doctor, Steve Scheidt of New York Hospital Medical Center, who was the group’s chairman that year. He was difficult to get hold of as he ran resident programs and the emergency room and a hundred busy things an administrator must do. Close call. I didn’t get him until the very last afternoon, before he left from New York to Dallas for the meeting. But he listened intently to my case, and asked me if I really thought it could be done. I said yes, and he said OK he’d squeeze me into 15 minutes on the program. This is the way things seem to happen…as if by magic…when indeed they have been pushed and prodded and developed to a point and redeveloped to touch another direction.

At that meeting, they gave me the go-ahead to develop a prototype simulator, using of all things, interactive videotape.

The only problem, which I did not mention, was that interactive videotape had not yet been invented. I called a group in Oklahoma City who had mentioned they had a card for doing interactive audiotape. That was close enough for a start. People would have to see what I was talking about, even before it was completely operable, so the interactive videotape would take them a good part of the way to the interactive videodisc, which I had only heard about but which immediately dominated my future plans. I felt a little guilty, hanging out this way, and mentioned it to a friend. He said this was not actually lying, that I was merely imitating a future reality. It takes such friends to get you through.

Copyright 2017 David Hon – All rights reserved

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