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November 8, 2016 — Elección General de California

Ciudad de Pleasant HillCandidato para Consejo Municipal

Photo de Jonathon S. Feit

Jonathon S. Feit

Chief Executive Officer
3,857 votos (13.05%)
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Mis 3 prioridades principales

  • Ensuring that every tax dollar is spent wisely, with accountability and transparency
  • Enacting local and regional policies to create jobs, raise spending power, and improve quality of life
  • Ensuring a just and safe community, including support for public safety personnel, policies that reduce or eliminate bullying, and public efforts to enshrine a culture of social equality



Profesión:Chief Executive Officer (Entrepreneur)
Co-Founder & Chief Executive, Beyond Lucid Technologies, Inc. (2009–current)
MBA Intern, Executive Office of the President of the United States, Office of Management & Budget (Performance & Personnel Management Division) (2009–2009)
Chief Editor & Publisher, Citizen Culture Magazine (2004–2007)


Carnegie Mellon University Master of Business Administration, Entrepreneurship and Accounting (2010)
Massachusetts Institute of Technology - Sloan School of Management Graduate Certificate (Executive Education), Entrepreneurship Development Program (2007)
Boston University Combined BA / MA, "Psychology, Religion and Conflict Negotiations" (2004)
Pepperdine University School of Law Graduate Certificates, Mediation and "Mediation & Religion" (2003)

Actividades comunitarias

Member at Large, National Press Club (2007–current)


Jonathon Feit is Co-Founder & Chief Executive of Beyond Lucid Technologies, a software company that connects ambulances and hospitals prior to the patient's arrival, and documents patients' prehospital care over time.  A widely published marketing expert focused on new media and the strategic use of information technology, Jonathon has presented to audiences that include the 2012 Morgenthaler Ventures DC to VC competition, Health 2.0, the mHealth Summit, the Skolkovo Foundation (Moscow), and Young Inventors International. In 2009 Jonathon was honored to serve as an MBA Intern in the White House Office of Management & Budget (Performance & Personnel Management division), where he helped spearhead the redesign and relaunch of – the “Face of Federal Hiring.”  


At Beyond Lucid Technologies, Jonathon has forged market-facing collaborations with Dell, AthenaHealth, Lockheed Martin, Telamon, and other major corporations. He has led Beyond Lucid Technologies through revenue growth spurts up to 8600%, acceptance into the CommonWell Health Alliance as its first EMS-facing member, and critical acclaim as winner of both the EMS World Innovation Award (2014) and JEMS Hot Product award (2015).  Jonathon has been featured in Inc. Magazine, San Francisco Chronicle, and the Harvard Business Review.


Prior to BLT, Jonathon co-founded and published Citizen Culture, the world's first all-digital print-form magazine [more...], and With This Ring, the first all-inclusive weddings magazine. From 2004-2008 he was the youngest member of the American Society of Magazine Editors, and in 2005 he became the youngest Faculty appointee in College of Communication at Boston University. He is a member of the National Press Club (USA), with an extensive consumer business and trade publications list that includes,,, Advertising Age, 944 Los Angeles, EMS World, and The Health Care Blog. He was a finalist for the 2010 WPP Fellowship.


Jonathon has Tourette’s Syndrome and is passionate about advocating on behalf of people with disabilities. Concurrent with his professional activities, and following a short term in the U.S. Army Reserve, he engaged in scholarly research on the etiology and treatment of psychiatric disorders including Post-Traumatic Stress. He has presented original papers before the World Congress of Psychosomatic Medicine (2009) and the American Academy of Religion (2004), and edited a textbook chapter on the pharmacological treatment of epilepsy. Jonathon holds an MBA from Carnegie Mellon University's Tepper School of Business, and a Combined BA/MA cum laude in “Psychology, Religion, and Conflict Negotiations” from Boston University. He earned graduate certificates in Mediation from the Straus Institute for Dispute Resolution at the Pepperdine School of Law, and in Entrepreneurship Development from the Sloan School of Management at the Massachusetts Institute of Technology.

Creencias poliza

Filosofía política

Please see also for an extended discussion of my political philosophy.


My slogan, “SOCIAL CONSCIENCE + PROFIT MOTIVE,” is meant to spark a dialogue about the complex issues facing our shared world: for example, success should be celebrated, but it should also be earned in a way that is equitable.  I think Americans are smart, just as I think most people are good, and I remember that not long ago we had an ability to converse.  Both sides of the aisle talked to one another.  Complex subjects like law, economics, and politics are ill-suited to 140 characters, and vital details get glossed over when policy is crafted for bumper stickers.  I am running for City Council because change often comes from within, and change is always local.  I’m putting my money where my mouth is: if we can boost our own communities, all across the land, then we will raise the country.  

Most Americans will need a job someday, and most jobs will be supplied by enterprise; therefore, industry should be an engine of social progress, not seen as our enemy.  But doing well in business does not mean slamming the door of opportunity on fingers that are trying to crack it open, or stealing from our planet and our children’s dreams to feed near-term goals. Our local, state, national, and global societies will thrive when all boats rise.  And all boats can rise if we have strong stomachs, hard heads, and hearts made resilient by optimism.



Some issues that inspire my passion:

PUBLIC SAFETY, INCLUDING AN ELIMINATION OF BULLYING IN SCHOOLS (AND ELSEWHERE), WHILE ENSURING CONSISTENT ACCESS TO FOOD AND SHELTER.  Nothing about our city (and county and state and country) will work if people are afraid to focus on schoolwork, walk in the streets, take kids to the park, or enjoy a day in the sunshine.  Yet public safety means more than police: we need to care for our EMS and Fire personnel, undersung heroes on whom we rely daily, yet whose work we try to pare down to dollars and cents. (Did you know that ambulance operators are paid by the mile in the U.S. — yes, like taxis — and they are not even classed as healthcare providers under federal law? Do you recall that Contra Costa County’s Measure Q, whose goal was to keep 10 out of 28 fire stations from closing, failed because some people thought our firefighters had not earned their pensions?). 

PROCUREMENT REFORM AND FINANCIAL EDUCATION.  I may be a Democrat who believes we all have to pay our taxes, but I also run a local “bootstrapped” technology business.  Procurement reform seems like a boring subject, but it is also one of the biggest wastes of citizens’ money that most people don’t even realize is happening.  It should be a scandal.  If my cash is going to be wasted on purchasing practices that breed monopolies and feed bureaucracy, give it back to me — I have better uses for it, like creating jobs or paying for school.  We need to shine light on government buying habits at every level. And speaking of finances: Isn’t it past time that we have a national conversation, starting in our own backyards, about the importance of managing cash with as much seriousness as we talk about physical security and the terror of trans fat?  Debt is a time-bomb that many of our citizens are sitting on, with little sense of how to control it.

HEALTHCARE…and not just a chance to be seen by the right doctor, right away.   I mean the Triple Aim: that is, ensuring that smart, lifesaving, cost-effective care is available when and where we need it, because anyone can need it, anytime.  Did you know that Emergency Medical Services were the reason that Supreme Court Chief Justice John Robert’s voted in favor of the Affordable Care Act?  Yet Contra Costa County’s EMS Director patted her department on the back for wasting “only” up to $480,000 on false activation of hospital processes related to heart attacks.  Unnecessary, old-school processes that could be so much more efficient consume nearly half a million dollars each year in our own county, in just one department.  Imagine how many clinic visits and vaccinations a half-million dollars would pay for!

RESPECT & HONOR FOR OUR ELDERS AND OUR VETERANS…because if you have survived through life — a feat until itself — you deserve a prize, the chance to tell your life story to all who want to learn from what you’ve seen, and for someone to bring you a cup of tea.  As for our veterans: You offered us everything and we accepted.  Now we owe you everything.

A ROBUST AND ACCOUNTABLE MEDIA.  I have been a journalist for over 10 years, but I will never forget the first time I was ashamed to say it: I was working at the White House, helping to redesign the federal government’s hiring portal (, when I read a news article describing the sorts of projects that were going on in my division.  The story wasn’t even close to right.  The reporters had little accountability for facts; and the department had no commitment to transparency. Mutual distrust had become entrenched, and everyone forgot that democracy flourishes when the media engages in more than “GOTCHA!” sensationalism.  When government, business, and the Press together inform the citizenry, we’ll hear about more than sadness and fear.  We’ll hear about accomplishment…and how much work we have left to do.  But it takes more than 140 characters.  I hope to bring back the dialogue, inspiring both the Left and the Right to engage in detailed discussions on issues like finance, taxation, social equity, access to opportunity / employment / education, environmentalism and entrepreneurship.  Our world is beautifully complex…but our challenges can’t be solved with sound bites.

Documentos sobre determinadas posturas

Measure Q’s Fail in Contra Costa: What Happens When Too Many Folks Forget the Vital Nature of EMS & Fire Services (2013)


When Measure Q failed in Contra Costa County, back in 2013, we should have known better: if people want to have a conversation about complex topics like pensions, let's have that conversation.  But at a time when California is experiencing both a severe drought and an influx of new participants in the healthcare system (including Emergency Medical Services), cutting 40% of Contra Costa Fire's fire stations is a short-sighted mistake.

This is not about politics, but rather, about what should have been common sense.

There are “easier ways to make a buck” than to work in EMS, Fire, Police, the military and other public safety roles. But there are few more gratifying professions, not only for those on the ground but for we who build tools and technologies to help medics perform their sacred duties safely and effectively. A vocation is exhilarating when one can to wake up to know that today harbors the potential to make tomorrow possible for someone in crisis.

Yet it seems that as long as there are Emergency Medical Service and Fire professionals saving lives and property and the American dream, there will also be a shortsighted (but electorally loud) counterpoint: the minority who forget that public safety is a uniquely vital service offered thanklessly and often despite profound personal risks. Empowering public safety should be a shared responsibility, but the failure of Measure Q in California’s Contra Costa County in 2012 proves that when politics take precedence, everyone loses. Whole communities could be at risk while obstinacy and contention flourish.

There’s really no other way to put it: As technologies for EMS and Fire become more sophisticated, feature-rich, and (hopefully) more useful, the need for experienced medics who can deploy them during critical moments and leverage their myriad capabilities is ever more critical, not less so. In November 2012, Contra Costa’s residents failed to pass a tax measure that would have kept 10 out of 28 (35.7%) of the county’s fire stations—including their associated EMS teams—from closing within months. Exit interviews showed that a primary point of contention against Measure Q was discontent over firefighters’ pensions.

It pains me to say this—both as an American and as a business owner in the county—but poor judgment was precisely what made the Founding Fathers of these fine United States fear the public’s fickle persuasions and susceptibility to hogwash. Here is what should have been, but ultimately was not, seen as indisputable fact: You don’t vote to close fire stations in a fire-prone district so that you can save a buck; that’s how you find yourself and your home on fire. You vote to keep the stations open—then negotiate any financial concerns separately.

Most who know me (and are still willing to speak with me!) will tell you that I’m content to buck political ideology with a passionately extended finger,especially when it comes to public safety: there are topics that should surmount the cacophony of political grandstanding and yelling-to-hear-one’s-yell. We are, by various measures I care about, the greatest nation on Earth by far; yet we also make some really stupid decisions sometimes. I’ve never had qualms about swimming against the current, because sometimes the current leads over a waterfall to smash on jagged rocks. Let me say this, then, as one who once offered up his life to defend democracy: to vote down Measure Q was dangerous, petty, and foolish. Those who did so were either: (a) blinded by shortsightedness; or (b) ignorant of the challenges of governing; or (c) too weak to swallow a rough-edged pill. In any case, a vocal minority of voters was led astray by comparatively unimportant influences that should have been pushed back under the bed in the
interest of saving lives.

Welcome to your near-term future: California’s families work, play, and raise families in one of America’s most fire-prone states. Contra Costa County’s families live and work and play and raise families in one of California’s most fire-prone counties. At points, rich and poor live just blocks apart; rural lands funnel into urban clogs; the state’s industry ranges from agriculture to finance to film; and there are points where skyscrapers stand sentinel not far from mysterious, massive pipelines. When a Chevron refinery exploded in Richmond, California, in August 2012, inky plumes drifted over my Concord office and my and my colleagues’ homes.

How can a county with streets that local firefighters call “tinderboxes” (I lived on one) lack the gumption to pass a $75 per parcel tax to keep ~40% of its fire stations from closing within two years? California requires a 2/3 vote to pass new taxes. How is it possible that 33% of the county was insufficiently concerned for its own safety—not to mention those of its mothers and fathers and sons and daughters and dogs and cats and colleagues and neighbors and homes—to keep hills from burning and people from dying…for the cost of a few mid-priced dinners out?

It is worth noting that in Contra Costa County—as in most of the country—the majority of fire service activations are not for fires at all: some 70-80% of 9-1-1 calls to fire departments are medical in nature. Until their services are desperately needed, EMS professionals are oft-forgotten heroes among us who yet aid our beck and call when Grandma has fallen and Grandpa’s chest hurts and Mom is walking funny and Dad hurt his back and Baby stopped breathing and we need help NOW! But rather than pass a $75 per parcel tax, we’ve condemned 10 out of 28 county fire stations to close. Where I come from (the similarly fire-prone city of Los Angeles) we have words for such behavior, starting with “shameful,” and going downhill from there.

Counterarguments will be made by citizen-critics with ancillary agendas. For example: “Firefighters and paramedics don’t work enough hours to justify the pay they receive.” (I DARE you to try working a 96-hour shift and then putting out a structural fire...) Or this old saw: “Public safety pensions are too high.”(How would you feel if each day you risked lung scarring
that could leave you unable to chase after your children ever again?)
 The same arguments haunt Fire, EMS and Police; the military has politics to thank for a general reprieve from debates on pay.

Here’s the thing: I’m a centrist—fiscally conservative and socially liberal—and I think we should engage in debates about the nature and amount of public spending. In an era of historic municipal bankruptcies, these are legitimate conversations to have at length, and communities
that have them will ultimately emerge stronger for their more nuanced understanding of what it takes to make a business, city, county, and country. But these conversations should happen later.

As a dear friend likes to say, “Common sense isn’t so common.” Chuck Carpenter, chair of the Contra Costa County Democratic Party, once told me: “There needs to be a distinction between public employees and public safety.” Why? Because we can debate pension reform for every category of public employees, from teachers and legislators to janitors and mailpersons to public safety professionals. (Disclosure: I’m married to a public employee.) But when public safety is cut, everything goes downhill. We need people extinguishing fires, hunting rapists, and resuscitating a child who drowned in the pool.Something is different—indeed, special—about
public safety. EMS, Fire, and Police agencies are not only selfless, but they allow the rest of us to be, because we can rely on them day-in, day-out. 
As I wrote for an article published by the Contra Costa Times in November 2013 (, most Americans who watched the Supreme Court’s healthcare debate from the sidelines and relied (too heavily) on cable news for insight, missed the fact that the true universality of EMS in the U.S. was a central tenet of the court’s thought process.

How will Contra Costa County’s residents feel when they call 9-1-1, but there are no longer enough fire and EMS personnel on staff nearby to respond quickly enough to save the day—all because of $75?

What will you say, Fellow Citizen, when you’re lying on a stretcher in the back of an ambulance after you voted against funding to buy new defibrillators for your local EMS agency? You know who I’d hate to be? A legislator who votes against public safety, and then has a stroke.


The opinions expressed are solely those of the author, and do not represent any official position or opinion of Beyond Lucid Technologies, Inc., its employees, directors, investors, partners, or clients.

E.M.S. and the V.A. We have Technologies that can Track the Most Vulnerable Patients. (2014)


Patient tracking technologies to go from the bedside to the ambulance to the hospital…and back…are available today. Why isn’t the VA using them?

Our nation’s heroes speak countless languages, ascribe to a rainbow of faiths, and wear badges bearing crosses, hydrants, serpents and swords. From veterans to warfighters, medics to firefighters to police officers, they stand vanguard over us — and how I wanted to stand among them! I dreamed of West Point as a boy, but without knowing where life would lead post-college, I instead vowed to respond if ever America needed me.

Not many people know this, but on September 11, 2001, I enlisted in the U.S. Army Reserve. My country was crying, so I stood to fight, and more importantly, to help: I was training to be a Field Medic, but due to a disability I returned home earlier than expected. Things have worked out since then, but it’s not the future I planned.

With reverence in my mind (there really is no better word for it), over the past few weeks I’ve watched in horror and disgust as tales of veteran neglect have poured in from around the country. I feel these personally, not only because — were it not for a disability that’s no fault of my own, I could have been (or saved) a wounded warrior.

Duty-bound to serve those who serve the rest of us, who risk life and limb and mind to protect the rest of us, my career arced toward research and development for Post-Traumatic Stress Disorder (PTSD), traumatic brain injury, and field trauma triage, which is how I got into the Fire & EMS technology business. Few rival our warfighters, firefighters, medics, and police officers in terms of bravery, skill, and commitment. For the same reason, our veterans — at every age — deserve honor and prizes, not to be discarded like old cars.

The other reason I take the recent VA fiasco personally is because a few years ago I told a top technical executive there that we have the technical ability to:

• track patients over time and across encounters, in a longitudinal fashion;

• ensure that physicians, caregivers and families are apprised of patients’ conditions to-the-minute, from anywhere; and

• let responders know a patient’s identity instantly upon arrival on-scene…or even beforehand. Today, even in San Francisco—the heart of the technology world—no such system for tracking veterans in the E.M.S. is in use.

This unnamed V.A. executive said to me? “We’re working on other things.”Clearly. So I couldn’t help but wonder, might adopting such technology years ago have forestalled the Veterans Administration’s current healthcare crisis?

Today, a similar approach to patient tracking as I suggested years ago has been corralled under the heading “Community Paramedicine.” A simple concept with quite complex economics (given how emergency responders are compensated in the U.S., like glorified taxis paid by the mile), at the heart ofCommunity Paramedicine — a.k.a., Mobile Integrated Healthcare (or CP/MIH)– is knowing who the patient is; why he or she needs to be cared for; when the last time was that he or she was cared for (and why); and who needs to be notified. It’s all very journalistic, and then a matter of deciding whether and where to treat the patient: in the home, in the hospital, or elsewhere.

What the Fire & EMS industry calls CP/MIH, the hospital community calls “Accountable Care,” but the two systems are veritable mirror images of one another, as if a political-mental moat floated between the two primary stakeholder groups: doctors and nurses on one side, medics and firefighters on the other; in-between areinstitutions and municipalities looking to stave off readmissions, improve access to care, lower the cost of care, and improve care quality. Both sides hesitate to acknowledge that they speak related dialects, and CP/MIH and Accountable Care boil down to common principles. To be sustainable, each model must start with technology to identify the patient from the bedside; provide enough context to understand his or her clinical needs; and communicate his or her condition in real-time to medical directors who will ultimately decide whether, where, and how to intervene.

That’s it; there are few kinks in the the elegant care model (though proving efficacy post-facto demands extensive data mining and financial modeling). What’s ironic (or sardonic) is most of the American populace thinks end-to-end communication between EMS and hospitals already happens. After all, why shouldn’t they? The lack of pre-hospital data movement between ambulance and hospital may be the most obvious deficiency of the emergency response workflow. Today, information flow into the emergency department still happens mostly as it did decades ago—by radio and on paper.

While we pay for EMS transports with outdated models that make little sense (and that yield $3 billion in annual uncompensated care), our veterans—who are relatively easy to track in the healthcare ecosystem because their data records are closed—become chits and political currency. When it comes to implementing technologies to improve their lot in life, the DoD and VA are among the slowest to reform, and the most wasteful. Consider the following excerpt from a 2014 study by the Government Accountability Office:

The Departments of Veterans Affairs (VA) and Defense (DOD) abandoned their plans to develop an integrated electronic health record (iEHR) system and are instead pursuing separate efforts to modernize or replace their existing systems in an attempt to create an interoperable electronic health record. Specifically, in February 2013, the secretaries cited challenges in the cost and schedule for developing the single, integrated system and announced that each department would focus instead on either building or acquiring similar core sets of electronic health record capabilities, then ensuring interoperability between them.However, VA and DOD have not substantiated their claims that the current approach will be less expensive and more timely than the single-system approach.”

This mind-numbing quote from the federal auditor brings to mind a poignant clip from “Contact,” the Jodie Foster movie: “The first rule of government contracting: why build one when you can have two at twice the price?

The VA and DoD together have one of the — if not the — county’s largest unified repositories of electronic health records. When they can do patient lookups and field-to-facility communications in seconds, why aren’t they? They currently have access to lifesaving, efficiency-facilitating, patient tracking technologies that can go into the hands of emergency response teams, doctors, and nurses alike. These technologies exist now. Why not appropriate Best Practices for CP/MIH into the VA?

If the V.A. does not plan to learn and improve its ability to interact with its charges, then how dare the agency’s executive team—no matter who is governing—ignore ideas from outside the agency by flippantly saying “Don’t worry, we’ve got this”?

Many firefighters, cops, and medics have been soldiers, sailors, airmen, corpsmen, and guardsmen, so they can appreciate the urgency of our chance to “connect the dots” and close a disturbing gap in America’s healthcare machine. Unions can be complicated, and politics often derail core messages, but there is power in numbers, especially when those numbers are strapping, vital, public-facing, and uniformed. Elected representatives who seek to harness the veteran’s patriotic symbolism should be obliged to learn how Community Paramedicine and Accountable Care can save those who served—and then be held accountable for putting such programs in place (or else, give back the votes you “earned” and go back from whence they came).

The Fire & EMS industry knows how to keep tabs on patients; and we geekswho serve Fire & EMS have the technical capabilities to pull it off. The Fire and EMS industry is buzzing about CP/MIH from coast to coast, and there aresome half-dozen CP/MIH models to choose from. I run a technology firm that makes innovations to support these novel, mission-critical care models — shouldn’t we all be shouting from the rooftops, “Over here! We can help!” Why aren’t we? Are we not loud enough? Does the VA — or its new CIOwant to listen?

Veterans and Emergency Responders are among our electorate’s most under-attended but often glad-handed cohorts. We owe them an ethical debt to stop at nothing in tearing down the red tape to put in place cutting-edge tools that we have today, though we’re using them for less-important things.

Contra Costa County wastes up to $480,000 per year on false cath lab activations. Where else could we put that money?


Response to “The Hospital Is No Place for a Heart Attack” by Ron Winslow. Wall Street Journal, 2 February 2015.

To the Editors of the Wall Street Journal, and Mr. Winslow:

Regardless of one’s opinion of the Affordable Care Act, particularly its thornier elements (such as individual and corporate mandates, plans that don’t qualify, etc.), the elimination of wasteful spending on care that never happened has been like a welcome appendectomy to most of the country — in other words, it felt painful but the results have been worthwhile. The ACA’s readmission prohibitions keep people from unnecessarily visiting emergency departments, which ultimately will prove to be a positive, whether scored according to reduced hospital overcrowding or greater availability of ambulances and paratransit vehicles, along with a bevy of other applicable quality metrics.

As Mr. Winslow points out, one byproduct of the imperative to keep people from unnecessarily returning to the emergency department is a motivation to leverage technology to identify patients who need to be transported and who don’t — then to prep for the arrival of either one. (In the hospital-doctor-nursing world, this model is called “Accountable Care.” In the emergency medical services world, it is called “Community Paramedicine” or “Mobile Integrated Healthcare.” In the words of one physician, “the ACO model, with its emphases on innovation, collaboration and quality, could be the most viable framework for bringing CP into the Acute Care Continuum.”)

Eventually, when technology says “Treat this person!” resources will be ready to do so upon arrival at the hospital. Patients will be matched with providers will be match with facilities will be matched with records will be matched with facilities, all ready and waiting. Or, there will be an alternative means to interject the right level of care, keeping what could be a routine wellness check from morphing into a cost- and time-sink in the hospital.

But slashing the waste that plagues emergency medical services — specifically, the burden of $3 billion in annual “uncompensated care” (per Troy Hagen, immediate past president of the National EMS Management Association) thatmost Americans don’t even know they are paying for, and that sat at the heart of the Supreme Court’s decision to view healthcare mandates as a tax — goes beyond convincing patients that calling 9–1–1 is not the most effective conduit to care. We must also ask whether our EMS providers have the tools to maximize their responsiveness.[1]

For example: Mr. Winslow points out that “thanks to major initiatives launched a decade ago, most hospitals have sharply reduced the time to treatment for patients who suffer a heart attack outside the hospital. When an electrocardiogram, or ECG, reveals a major heart blockage, it activates a set plan designed to get the blockage causing the heart attack cleared as quickly as possible.”

Yet as a society and an industry, our emergency medical infrastructure has a distance to go before it can be called robust, not just reactionary. Mr. Winslow highlights “the heart attacks at issue…called STEMIs, for S-T segment elevated myocardial infarction, after the pattern on an electrocardiogram that is the telltale sign of a total blockage.” STEMI intervention takes place in a specialized facility called a catheterization lab. But a 2010 study published in the American Heart Journal found that hospitals in California’s Los Angeles and Orange counties suffered 20% and 23%, respectively, false activation of their catheterization labs.[2]

Contra Costa County, where my company is based, fared worse by similar measures: Contra Costa County EMS director Patricia Frost has written that 26–41% of STEMI activations in the county were false, at a cost of $5000 per incident to the local healthcare system, including taxpayers who support the public hospitals. (The range reflects the county’s six STEMI centers.) Ms. Frost determined that eliminating false activations — a paragon of waste caused by an overreaction to missing data that serves no clinical good but errs on the side of caution — could save $480,000 per year. In just one county. By doing nothing more than avoiding expensive mistakes.

It’s not necessarily a lack of technology that drives wasteful costs, but rather a reliance on — in some cases — faulty tools; or, in others cases, a need for targeted training on how to read and react to data emerging from such devices. According to Ms. Frost, a false-positive is “a paramedic tell[ing] the STEMI Center that a STEMI has been detected on the 12-lead ECG, but upon arrival at the hospital it is determined that the patient’s 12-lead does not show a STEMI. Most of these patients do not need the urgent availability of the catheterization lab.”[3] The Journal of the American Medical Association says “the frequency of false-positive cardiac catheterization laboratory activation for suspected STEMI is relatively common in community practice, depending on the definition of false-positive.”[4] It would be easy, but incorrect, to blame ECG errors on prehospital personnel, because the American Heart Journal study found that “recent surveillance of ‘unnecessary’ cath Lab activations…by ED physicians demonstrated a 5% rate from a single-center experience (n = 249 activations) in Virginia and a 6% rate across 14 hospitals (n = 2,213 activations) in a North Carolina STEMI system.”

Was one of these the same hospital network that Mr. Winslow surveyed?

Emergency clinicians across the gamut — from ambulances to nursing homes to hospitals — face a reality that rarely gets discussed: without the patient’s clinical history and current context, many conditions simply look alike. UCSF researcher Prasanthi Ramanujam challenged the reliability of decision-making by medics in the field, who successfully identified stroke less than half the time.[5] Yet Mr. Winslow reported that “at the University of North Carolina, a study of 275 STEMI patients treated between 2007 and 2011 found 40% of the 48 patients whose attacks occurred in the hospital died before being discharged, compared with a 4% death rate for those brought to the ER.” Assuming that the Affordable Care Act persists through the current Congress, and that the healthcare establishment keeps marching toward the IHI Triple Aim (“better health, better care, lower costs”), our society should mandate a fusion of technology, access to longitudinal care records, and the liberation of data to offer “perfect information” about patients…pre-arrival at the ED. The insurance value alone justifies the investment to eliminate wasteful line-items and resource shortfalls.

[1] Hagen T. The Value of EMS. EMS World. 1 Sept 2012.

[2] Rokos, IC, French WJ, Mattu A, Nichol G, Farkouh ME, Reiffel J, Stone GW. “Appropriate Cardiac Cath Lab activation: Optimizing electrocardiogram interpretation and clinical decision-making for acute ST-elevation myocardial infarction.” American Heart Journal. December 2010. 160(6):995–1003.

[3] Contra Costa County EMS Agency. “Contra Costa 60 Day STEMI System Review: A Great Launch with Challenges Ahead.” Accessed 15 Jan 2015. < >. See also: Contra Costa EMS Agency. “Contra Costa County Emergency Medical Services Data Infrastructure Project.” p.11. Published 28 Dec 2013. Accessed online 2 Feb 2015. < >

[4] Larson, DM, Menssen KM, Sharkey SW, Duval S, Schwartz RS, Harris J, Meland JT, Unger BTHenry TD. “ ‘False-positive’ cardiac catheterization laboratory activation among patients with suspected ST-segment elevation myocardial infarction.” J American Medical Assn. 2007 Dec 19. 298(23):2754–60.

[5] Ramanujam P, Guluma KZ, Castillo EM, Chacon M, Jensen MB, Patel E, Linnick W, and Dunford JV. “Accuracy of Stroke Recognition by Emergency Medical Dispatchers and Paramedics — San Diego Experience.” Prehospital Emergency Care. (2008) 12(3):307–313.

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