k patients. In mountainous Santa Cruz County, ambulance runs are often lengthy. "Every minute that heart cells are deprived of blood flow, they are dying," says Barbara Drew, the study's principal investigator and a professor of physio- logical nursing in UCSF's School of Nursing. "Once heart cells are dead, they don't regenerate. So the initial treatment goal is to get the blockage in the obstructed artery open as quickly as possible before any more heart cells die." The new "tele-electrocardiography" system consists of a cardiac monitor that takes readings every 30 seconds and can detect ischemia, the diminished flow of blood through an artery that signals heart damage. The unit is hooked to a mobile phone that transmits vital information directly to the emergency TELEMEDICINE department of the receiving hospital. Drew based the device on her years of experience in cardiac intensive care unit. "Usually when patients arrive at a hospital, they are evaluated by a triage nurse," says Drew. "If their condition warrants it, they are attached to a cardiac monitor for further evaluation. But all that takes time. What we wanted to do was to move the clinical decision- making to a point before the patient even gets to the hospital." The standard heart-monitoring procedure used by medics who respond to calls from people experiencing heart attack symptoms involves attaching a cardiac monitor with a single recording lead to the patient's chest. The monitor provides only a basic electrocardiogram (ECG) that measures the patient's heart rate and rhythm. The unit can't detect ischemia. Some ambulances in the United States are equipped with 12-lead cardiac monitors. Although these can detect ischemia, they require the attachment of 10 separate electrodes to the patient's chest and they make only a single 10-second recording, which may miss rapidly changing abnormalities common in heart attacks. The "tele-electrocardiography" system Drew is using in her study consists of several components, including a 12-lead cardiac monitor t