System for cardiac resuscitation

• US 20070299473A1
• Filed: 08/18/2007
• Published: 12/27/2007
• Est. Priority Date: 06/11/2003
• Status: Active Grant

• Current Assignee: Jeffrey Matos
• Original Assignee: Jeffrey Matos
• Inventors: Matos, Jeffrey
• Granted Patent: US 7,769,465 B2
• Time in Patent Office: Days
• US Class Current: 607/5
• CPC Class Codes: A61N 1/046 Specially adapted for shock therapy, e.g. defibrillation
• CPC Class Codes: A61N 1/0476 Array electrodes (including any electrode arrangement with more than one electrode for at least one of the polarities)
• CPC Class Codes: A61N 1/0492 Patch electrodes A61N1/0412, A61N1/0428 take precedence
• CPC Class Codes: A61N 1/3904 External heart defibrillators [EHD]
• CPC Class Codes: A61N 1/39044 in combination with cardiopulmonary resuscitation [CPR] therapy
• CPC Class Codes: A61N 1/3968 Constructional arrangements, e.g. casings A61N1/375 takes precedence
• CPC Class Codes: A61N 1/3993 User interfaces for automatic external defibrillators

Abstract

System and method for monitoring and controlling, defibrillation and pacing which allows a victim of a cardiac rhythm abnormality immediate access to a medical professional at a central station, who will remotely monitor, diagnose and treat the victim at one of a plurality of remote sites in accordance with the following steps: (1) providing a plurality of contact electrodes for a victim at a remote site for the receipt of ECG signals and for the application of electrical pulses to the victim; (2) transmitting the signals from the remote site to a central station and displaying them for review by the medical professional; (3) the medical professional selecting from a menu of defibrillation and pacing pulses, if the application thereof is appropriate; (4) transmitting the selection results to the remote site; and (5) receiving the selection results at the remote site and applying the selected pulses to the victim.

Claims

1-366. -366. (canceled)

367. A cardiac monitoring and cardiac pacing system which allows an untrained human enabler immediate access to a medical professional who can and will remotely monitor, diagnose and treat a victim of medical emergency at one of a plurality of remote sites, said system comprising, in combination:

(a) a central station comprising;

(1) a display device for displaying cardiac information from a victim for evaluation by said medical professional;

(2) at least one input device, responsive to said medical professional, for producing a plurality of control signals for controlling the application of electrical therapy pulses to said victim, said therapy pulses providing cardiac pacing; and

(3) a first transmitting/receiving (T/R) device, coupled to said display device and to said at least one input device, for electronic communication with emergency cardiac monitoring and cardiac pacing apparatus disposed at each of a plurality of remote sites; and

(b) emergency cardiac monitoring and cardiac pacing apparatus disposed at each of a plurality of remote sites, each said apparatus comprising a portable unit including;

(1) a second transmitting/receiving (T/R) device for electronic communication with said first T/R device of said central station;

(2) a cardiac pacing circuit, having a pacing control input coupled to said second T/R device, for producing cardiac pacing pulses at a pacing circuit output in response to a selected control signal received at said pacing control input from said central station, said cardiac pacing pulses having at least one variable parameter, selected from the group consisting of pacing pulse rate, pacing pulse amplitude, pacing pulse width, pacing pulse shape, pacing mode, choice of particular sensing electrodes and sensitivity, which may be modified by said control signal;

(3) an electrocardiogram (ECG) circuit, having an ECG circuit output, coupled to said second T/R device, and an ECG electrode input;

(4) a plurality of contact electrodes, adapted to be placed by a nearby enabler upon a chest wall of said victim, said plurality of contact electrodes being adapted to be arranged at separate locations on said chest wall for (1) the receipt of ECG signals from said victim, and (2) for application of said pacing pulses to said victim; and

(5) a connecting cable having a plurality of electric wires for connecting each of said contact electrodes to at least one of (i) said ECG electrode input and (ii) said cardiac pacing output;

whereby (1) said ECG signals may be transmitted from a plurality of said contact electrodes via said ECG circuit to said central station for evaluation by said medical professional;

(2) said control signals may be transmitted from said central station to said pacing control input; and

(3) in response thereto, said cardiac pacing pulses with at least one parameter selected by the medical professional may be applied from said cardiac pacing output to a plurality of said contact electrodes for resuscitation of said victim.

368. The system defined in claim 367, wherein said input device at said central station is further responsive to said medical professional for producing pacing electrode control signals and wherein said cardiac pacing circuit is responsive to said electrode control signals to select the contact electrodes to which, from among said plurality of contact electrodes, said pacing pulses are applied.

369. The system defined in claim 367, wherein said input device at said central station is further responsive to said medical professional for producing ECG electrode control signals and wherein said ECG circuit has an ECG control input for receipt of said ECG electrode control signals and is responsive to said ECG electrode control signals to select the contact electrodes from which, from among said plurality of contact electrodes, ECG signals are received and transmitted to said central station.

370. The system defined in claim 367, wherein said portable unit further comprises a logic device for automatic control of the portable unit, coupled to the second T/R device and to the control input of said cardiac pacing circuit, for automatically producing a second pacing control signal for controlling the application of said pacing pulses to said victim, in the absence of proper communication between said first T/R device and said second T/R device, in response to electrocardiogram (ECG) signals received from said victim.

371. The system defined in claim 367, further comprising a stationary unit, adapted for permanent installation at the remote site of each portable unit, said stationary unit comprising:

(1) means for releasably holding said portable unit;

(2) third transmitting/receiving (T/R) device for electronic communication with said first T/R device of said central station; and

(3) fourth transmitting/receiving (T/R) device, coupled to said third T/R device, for electronic communication with said second T/R device of said portable unit;

whereby said portable unit communicates with said central station through said stationary unit.

372. The system defined in claim 371, wherein said portable unit has a battery for powering the electrical devices therein, and said stationary unit has a battery charger;

and wherein said battery charger is connected to and charges said battery when said portable unit is coupled to said stationary unit.

373. The system defined in claim 367, wherein said central station further comprises a second input device, responsive to said medical professional and connected to said first T/R device, for transmitting instructional information to said remote station, and wherein said portable unit further comprises a receiving device, connected to said second T/R device, for receiving said instructional information for use by said enabler.

374. The system defined in claim 373, wherein said second input device includes a microphone and said receiving device includes a speaker, for providing spoken audio instructions to said enabler.

375. The system defined in claim 373, wherein said receiving device includes a display device, for providing video instructions to said enabler.

376. The system defined in claim 375, wherein said receiving device further includes means for storing CPR instruction video information, connected to said display device, for causing said display device to display said video information, whereby said medical professional can activate the display of said video information by means of said second input device.

377. (canceled)

378. A cardiac monitoring and external defibrillation system which allows an untrained human enabler immediate access to a medical professional who can and will remotely monitor, diagnose and treat a victim of medical emergency at one of a plurality of remote sites, said system comprising, in combination:

(a) a central station comprising;

(1) a first display device for displaying cardiac information from a victim for evaluation by said medical professional;

(2) a first input device, responsive to said medical professional, for producing control signals for controlling operation of emergency cardiac monitoring and external defibrillation apparatus at one of said remote sites and the application of a defibrillation pulse to said victim at said one site; and

(3) a first transmitting/receiving (T/R) device, coupled to said first display device and said first input device, for electronic communication with emergency cardiac monitoring and defibrillation apparatus disposed at each of a plurality of remote sites; and

(b) emergency cardiac monitoring and external defibrillation apparatus disposed at each of a plurality of remote sites, each said apparatus comprising a portable unit including;

(1) a second transmitting/receiving (T/R) device for electronic communication with said first T/R device of said central station;

(2) a master control unit, connected to said second T/R device, for controlling the operation of said cardiac monitoring and defibrillation apparatus, said control unit having a plurality of operating states selected from the group consisting of;

(i) enable remote control by medical professional;

(ii) enable automatic local control; and

(iii) enable local control by emergency medical personnel;

(3) a defibrillator circuit, having a control input coupled to said second T/R device and said master control unit, for generating a defibrillation pulse at a defibrillator circuit output in response to a defibrillation control signal received at said defibrillator circuit control input;

(4) a logic device for automatic local control of the portable unit, coupled to said second T/R device, to said master control unit and to the control input of said defibrillator circuit, for automatically producing a second defibrillation control signal for controlling the application of said defibrillation pulse to said victim in response to electrocardiogram (ECG) signals received from said victim;

(5) an electrocardiogram (ECG) circuit, having an ECG circuit output, coupled to said second T/R device and to said logic device, and having an ECG electrode input;

(6) a plurality of contact electrodes, adapted to be placed by a nearby enabler upon a chest wall of said victim, said plurality of contact electrodes being adapted to be arranged at separate locations on said chest wall for the receipt of ECG signals from said victim and for application of said defibrillation pulse to said victim;

(7) a connecting cable having a plurality of electric wires for connecting each of said contact electrodes to at least one of (i) said ECG electrode input and (ii) said defibrillator output;

(8) a second display device, coupled to said ECG circuit output for display of said ECG signals; and

(9) a second input device, coupled to said control input of said defibrillator circuit, for locally activating defibrillation;

wherein

(1) said ECG signals are transmitted from selected ones of said contact electrodes via said ECG circuit to said central station and displayed on said first display unit for evaluation by said medical professional, (2) said first defibrillation control signal may be transmitted from said central station to said control input of said defibrillator circuit and (3), in response thereto, said defibrillator circuit generates said defibrillation pulse for application to at least one of said contact electrodes for resuscitation of said victim; and

wherein said master control unit selects the operating state of said portable unit at the remote site under control of said medical professional at said central station; and

wherein, if enabled by said medical professional, (4) said ECG signals are transmitted from selected ones of said contact electrodes via said ECG circuit and displayed on said second display unit for evaluation by said emergency medical personnel, (5) said first defibrillation control signal may be transmitted from said second input device said control input of said defibrillator circuit, and (6), in response thereto, said defibrillator circuit generates said defibrillation pulse for application to at least one of said contact electrodes for resuscitation of said victim.

379. A cardiac monitoring and external defibrillation system which allows an untrained human enabler immediate access to a medical professional who can and will remotely monitor, diagnose and treat a victim of medical emergency at one of a plurality of remote sites, said system comprising, in combination:

(a) a central station comprising;

(1) a display device for displaying cardiac information from a victim for evaluation by said medical professional;

(2) a first input device, responsive to said medical professional, for producing a first defibrillation control signal for controlling the application of a defibrillation pulse to said victim;

(3) a second input device, responsive to a medical professional, for producing a defibrillation command signal, for initiating the automatic application of a defibrillation pulse to said victim; and

(4) a first transmitting/receiving (T/R) device, coupled to said display device and to said first and second input devices, for electronic communication with emergency cardiac monitoring and defibrillation apparatus disposed at each of a plurality of remote sites; and

(b) emergency cardiac monitoring and external defibrillation apparatus disposed at each of a plurality of remote sites, each said apparatus comprising a portable unit including;

(1) a second transmitting/receiving (T/R) device for electronic communication with said first T/R device of said central station;

(2) a logic device for automatic control of the portable unit, coupled to the second T/R device, for automatically producing a second defibrillation control signal for controlling the application of a defibrillation pulse to said victim, upon receipt of a defibrillation command signal from said central station, in response to electrocardiogram (ECG) signals received from said victim;

(3) a defibrillator circuit, having a control input coupled to said second T/R device and to said logic device, for generating a defibrillation pulse at a defibrillator circuit output in response to a either a first or a second defibrillation control signal received at said defibrillator circuit control input;

(4) an electrocardiogram (ECG) circuit, having an ECG circuit output, coupled to said second T/R device and to said logic device, and having an ECG electrode input;

(5) a plurality of contact electrodes, adapted to be placed by a nearby enabler upon a chest wall of said victim, said plurality of contact electrodes being adapted to be arranged at separate locations on said chest wall for the receipt of ECG signals from said victim and for application of said defibrillation pulse to said victim; and

(6) a connecting cable having a plurality of electric wires for connecting each of said contact electrodes to at least one of (i) said ECG electrode input and (ii) said defibrillator output;

wherein (1) said ECG signals are transmitted from selected ones of said contact electrodes via said ECG circuit to said central station for evaluation by said medical professional, (2) said logic device includes means for analyzing said ECG signals and produces a signal representing the result of the analysis, said analysis signal being transmitted to said central station via said second and first T/R devices, respectively, for display by said display device for the consideration by said medical professional, whereby said medical professional is able compare the analysis of said logic device with his/her own medical judgment;

(3) said first defibrillation control signal may be transmitted from said central station to said control input of said defibrillator circuit and, in response thereto, said defibrillator circuit generates said defibrillation pulse for application to at least one of said contact electrodes for resuscitation of said victim; and

(4) said defibrillation command signal may be sent from said central station to said logic device at said remote site and, in response thereto, said defibrillator circuit is responsive to said second defibrillation control signal generated by said logic device to generate said defibrillation pulse for application to said at least one contact electrode for resuscitation of said victim, thereby allowing said medical professional to take advantage of the analysis by said logic device.

380. A cardiac monitoring and external defibrillation and cardiac pacing system which allows an untrained human enabler immediate access to a medical professional who can and will remotely monitor, diagnose and treat a victim of medical emergency at one of a plurality of remote sites, said system comprising, in combination:

(a) a central station comprising;

(1) a display device for displaying cardiac information from a victim for evaluation by said medical professional;

(2) at least one first input device, responsive to said medical professional, for producing a defibrillation control signal for controlling the application of a defibrillation pulse to said victim;

(3) at least one second input device, responsive to said medical professional, for producing a cardiac pacing control signal for controlling the application of one or more cardiac pacing pulses to said victim; and

(4) a first transmitting/receiving (T/R) device, coupled to said display device and to said first and said second input devices, for electronic communication with emergency cardiac monitoring, defibrillation and cardiac pacing apparatus disposed at each of a plurality of remote sites; and

(b) emergency cardiac monitoring and external defibrillation and cardiac pacing apparatus disposed at each of a plurality of remote sites, each said apparatus comprising a portable unit including;

(1) a second transmitting/receiving (T/R) device for electronic communication with said first T/R device of said central station;

(2) a defibrillator circuit, having a defibrillation control input coupled to said second T/R device, for producing a defibrillation pulse at a defibrillator circuit output in response to a defibrillation control signal received at said defibrillation control input;

(3) a cardiac pacing circuit, having a pacing control input coupled to said second T/R device, for producing said one or more cardiac pacing pulses at a pacing circuit output in response to a cardiac pacing control signal received at said pacing control input;

(4) a logic device, coupled to the second T/R device and to the control input of said defibrillator circuit and to the pacing control input of said cardiac pacing circuit, for automatically producing at least one of a second defibrillation control signal for controlling the application of said defibrillation pulse to said victim, and a second cardiac pacing control signal for controlling the application of said cardiac pacing pulses to said victim, in the absence of proper communication between said first T/R device and said second T/R device, in response to electrocardiogram (ECG) signals received from said victim;

(5) an electrocardiogram (ECG) circuit, having an ECG circuit output, coupled to said second T/R device and to said logic device, and an ECG electrode input;

(6) a plurality of contact electrodes, adapted to be placed by a nearby enabler upon a chest wall of said victim, said plurality of contact electrodes being adapted to be arranged at separate locations on said chest wall for (1) the receipt of ECG signals from said victim;

(2) for application of said defibrillation pulse to said victim and (3) for application of said one or more pacing pulses to said victim; and

(7) a connecting cable having a plurality of electric wires for connecting each of said contact electrodes to at least one of (i) said ECG electrode input;

(ii) said defibrillator output and (iii) said cardiac pacing output;

whereby (1) said ECG signals may be transmitted from selected ones of said contact electrodes via said ECG circuit to said central station for evaluation by said medical professional;

(2) said defibrillation control signal and said cardiac pacing control signal may be transmitted from said central station to said defibrillation control input and said pacing control input, respectively; and

(3) in response thereto, said defibrillation pulse may be transmitted from said defibrillator output or said cardiac pacing pulses may be transmitted from said cardiac pacing output to selected ones of said contact electrodes for resuscitation of said victim.

381. Multiple-pin electrical connector apparatus capable of sensing when and which two specific connector elements are connected together, said connector apparatus comprising, in combination:

(a) a first connector element having a plurality of first pins each adapted to be electrically connected to a first electric circuit element;

(b) a plurality of second connector elements, each having a plurality of second pins each adapted to be connected to a respective one of said first pins of said first connector element and adapted to be electrically connected to a second electric circuit element, each second connector element having a different pair of said second pins electrically connected together to create a low electrical resistance path between them; and

(c) logic means, coupled to at least three first pins of said first connector element, for determining which pair of first pins of said first connector element have a low resistance path between them when said two connector elements are coupled together, thereby to determine which one of said plurality of second connector elements is connected to said first connector element.

382. The apparatus defined in claim 381, further comprising a first circuit element connected to some of said first pins of said first connector element and a second circuit element connected to some of said second pins of said second connector element, and wherein said first circuit element comprises a defibrillator circuit and said second circuit element comprises a plurality of contact electrodes for application to a chest wall of a victim of medical emergency.

383. The electrical connector defined in claim 381, further comprising a cardiac monitoring and external defibrillation system which allows an untrained human enabler immediate access to a medical professional who can and will remotely monitor, diagnose and treat a victim of medical emergency at one of a plurality of remote sites, said system comprising, in combination:

(a) a central station comprising;

(1) a display device for displaying cardiac information from a victim for evaluation by said medical professional;

(2) a first input device, responsive to said medical professional, for producing a first defibrillation control signal for controlling the application of a defibrillation pulse to said victim; and

(3) a first transmitting/receiving (T/R) device, coupled to said display device and said first input device, for electronic communication with emergency cardiac monitoring and defibrillation apparatus disposed at each of a plurality of remote sites; and

(b) emergency cardiac monitoring and external defibrillation apparatus disposed at each of a plurality of remote sites, each said apparatus comprising a portable unit including;

(1) a second transmitting/receiving (T/R) device for electronic communication with said first T/R device of said central station;

(2) a defibrillator circuit, having a control input coupled to said second T/R device, for generating a defibrillation pulse at a defibrillator circuit output in response to a defibrillation control signal received at said defibrillator circuit control input;

(3) an electrocardiogram (ECG) circuit, having an ECG circuit output, coupled to said second T/R device, and having an ECG electrode input;

(4) a plurality of contact electrodes, adapted to be placed by a nearby enabler upon a chest wall of said victim, said plurality of contact electrodes being adapted to be arranged at separate locations on said chest wall for the receipt of ECG signals from said victim and for application of said defibrillation pulse to said victim; and

(5) a connecting cable having a plurality of electric wires for connecting each of said contact electrodes, via said electrical connector, to at least one of (i) said ECG electrode input and (ii) said defibrillator output;

whereby (1) said ECG signals may be transmitted from said contact electrodes via said connecting cable and said electrical connector to said ECG circuit and from thence to said central station, (2) said first defibrillation control signal may be transmitted from said central station to said control input of said defibrillator circuit and (3), in response thereto, said defibrillator circuit may generate said defibrillation pulse for application to at least one of said contact electrodes, for resuscitation of said victim, via said electrical connector and said connecting cable.

384. A flexible, semi-rigid pad having a substantially flat surface adapted to be placed upon the chest wall of a victim of medical emergency for establishing an electrical connection with a plurality of points on said chest wall, said pad comprising, in combination:

(a) a pad substrate of flexible, semi-rigid material, said substrate having a substantially flat surface which is substantially conformable to the chest wall of said victim;

(b) at least three contact electrodes disposed in spaced relation on said surface, said contact electrodes being electrically insulated from each other and adapted to make contact with the chest wall of said victim;

(c) a detection device, connected to said contact electrodes, for determining the resistance between respective pairs of said electrodes when said pad is attached to said chest wall of said victim, thereby to determine whether the resistance between said chest wall and said respective pairs of electrodes are sufficiently low for the transmission of electric current to effect at least one of monitoring and treatment of said victim; and

(d) a defibrillator circuit connected to said contact electrodes,

whereby said detection device determines which pair of electrodes, if any, are usable as contact electrodes for said defibrillator circuit.

385. The system defined in claim 384, wherein said detection device includes means for applying a voltage between one electrode and at least one other electrode and measuring the current flow.

386. The system defined in claim 385, wherein said voltage applying means applies a voltage between said one electrode and all other electrodes.

387. The system defined in claim 386, wherein said voltage applying means applies a voltage between each electrode, in turn, and all of the other respective electrodes.

388. A cardiac monitoring and external defibrillation system which allows an untrained human enabler immediate access to a medical professional who can and will remotely monitor, diagnose and treat a victim of medical emergency at one of a plurality of remote sites, said system comprising, in combination:

(a) a central station comprising;

(1) a display device for displaying cardiac information from a victim for evaluation by said medical professional;

(2) at least one first input device, responsive to said medical professional, for producing a defibrillation control signal for controlling the application of a defibrillation pulse to said victim;

(3) at least one second input device, responsive to said medical professional, for transmitting instructional information to said enabler;

; and

(4) a first transmitting/receiving (T/R) device, coupled to said display device and to said first and said second input devices, for electronic communication with emergency cardiac monitoring and defibrillation apparatus disposed at each of a plurality of remote sites; and

(b) emergency cardiac monitoring and external defibrillation apparatus disposed at each of a plurality of remote sites, each said apparatus comprising a portable unit including;

(1) a second transmitting/receiving (T/R) device for electronic communication with said first T/R device of said central station;

(2) a defibrillator circuit, having a defibrillation control input coupled to said second T/R device, for producing a defibrillation pulse at a defibrillator circuit output in response to a defibrillation control signal received at said defibrillation control input;

(3) an instruction receiving device, coupled to said second T/R device, for receiving said instructional information for use by said enabler;

(4) an electrocardiogram (ECG) circuit, having an ECG circuit output, coupled to said second T/R device, and having an ECG electrode input;

(5) a plurality of contact electrodes, adapted to be placed by a nearby enabler upon a chest wall of said victim, said plurality of contact electrodes being adapted to be arranged at separate locations on said chest wall for (1) the receipt of ECG signals from said victim;

(2) for application of said defibrillation pulse to said victim; and

(6) a connecting cable having a plurality of electric wires for connecting each of said contact electrodes to at least one of (i) said ECG electrode input; and

(ii) said defibrillator;

whereby (1) said ECG signals may be transmitted from selected ones of said contact electrodes via said ECG circuit to said central station for evaluation by said medical professional;

(2) said defibrillation control signal may be transmitted from said central station to said defibrillation control input and said pacing control input, respectively; and

(3) in response thereto, said defibrillation pulse may be transmitted from said defibrillator output to selected ones of said contact electrodes for resuscitation of said victim.

389. The system defined in claim 388, wherein said second input device includes a microphone and said instruction receiving device includes a speaker, for providing spoken audio instructions to said enabler.

390. The system defined in claim 388, wherein said instruction receiving device includes an instructional display device, for providing video instructions to said enabler.

391. The system defined in claim 390, wherein said instruction receiving device further includes means for storing instructional video information, connected to said instructional display device, for causing said instructional display device to display said video information, whereby said medical professional can activate the display of said video information by means of said second input device.

392. The system defined in claim 391, wherein said instructional video information includes at least one of:

(i) instructional information concerning the performance of cardiopulmonary resuscitation;

(ii) instructional information concerning the use of said portable unit; and

(iii) instructional information concerning the placement of said contact electrodes by said enabler.

393. The system defined in claim 390, wherein said central station further includes means for storing instructional video information, coupled to said second input device and said first T/R device, for causing said instructional display device to display said video information, whereby said medical professional can activate the display of said video information by means of said second input device.

394. The system defined in claim 393, wherein said instructional video information includes at least one of:

(i) instructional information concerning the performance of of cardiopulmonary resuscitation;

(ii) instructional information concerning the use of said portable unit; and

(iii) instructional information concerning the placement of said contact electrodes by said enabler.

395. The system defined in claim 390, wherein said central station further includes means for generating instructional video information in substantially real-time, coupled to said second input device, said display device and said first T/R device, for causing said instructional display device to display said video information, said instructional information consisting of at least one of

(i) video file information with at least one real-time video annotations by said MP;

and

(ii) real-time diagrammatic information by said MP.

396. The system defined in claim 395, wherein said emergency cardiac monitoring and external defibrillation apparatus further comprises a video camera, coupled to said second T/R device for the transmission of video images of said victim to said medical professional, and wherein said instructional video information consists of at least one of:

(i) video images of said victim with at least one real-time video annotation by said MP; and

(ii) instructional information for said enabler, based on analysis of said victim video image by said MP.

397. A cardiac monitoring and internal defibrillation and pacing system which allows a patient with an implanted cardiac pacing-defibrillator device immediate access to a medical professional who can and will remotely monitor, diagnose and treat a medical emergency, said system comprising, in combination:

(a) a central station comprising;

(1) a display device for displaying cardiac information from a patient for evaluation by said medical professional;

(2) a first input device, responsive to said medical professional, for producing a first defibrillation control signal for controlling the application of a defibrillation pulse to said patient; and

(3) a second input device, responsive to said medical professional, for producing a first pacing control signal for controlling the application of a pacing pulse to said patient;

(4) a first transmitting/receiving (T/R) device, coupled to said display device and said first and said second input devices, for electronic communication with emergency cardiac monitoring and defibrillation apparatus disposed at each of a plurality of remote sites; and

(b) emergency cardiac monitoring and internal pacing-defibrillation apparatus disposed at each of a plurality of remote sites, each said apparatus comprising a unit implanted in a patient and including;

(1) a second transmitting/receiving (T/R) device for electronic communication with said first T/R device of said central station;

(2) a defibrillator circuit, having a control input coupled to said second T/R device, for generating a defibrillation pulse at a defibrillator circuit output in response to a defibrillation control signal received at said defibrillator circuit control input;

(3) a pacing circuit, having a control input coupled to said second T/R device, for generating at least one pacing pulse at a pacing circuit output in response to a pacing control signal received at said pacing circuit control input;

(4) a logic device for automatic control of the implanted unit, coupled to the second T/R device and to the control inputs of said defibrillator circuit and said pacing circuit, for

(i) automatically producing a second defibrillation control signal for controlling the application of said defibrillation pulse to said patient in the absence of proper and timely communication between said first T/R device and said second T/R device, in response to electrogram (EGM) signals received from said patient;

(ii) automatically producing a second pacing control signal for controlling the application of said at least one pacing pulse to said patient in the absence of proper and timely communication between said first T/R device and said second T/R device, in response to electrogram (EGM) signals received from said patient;

(5) an electrogram (EGM) circuit, having an EGM circuit output, coupled to said second T/R device and to said logic device, and having one or more EGM electrode inputs;

(6) a plurality of electrodes, adapted to be coupled at separate locations to internal tissue of said patient, for the receipt of EGM signals from said patient and for application of said defibrillation pulse to said patient; and

(7) a means for connecting each of said electrodes to at least one of (i) said EGM electrode inputs and (ii) said defibrillator output;

whereby (1) said EGM signals may be transmitted from selected ones of said electrodes via said EGM circuit to said central station for evaluation by said medical professional, (2) said first defibrillation control signal may be transmitted from said central station to said control input of said defibrillator circuit and in response thereto, said defibrillator circuit may generate said defibrillation pulse for application to at least one of said electrodes for resuscitation of said patient; and

wherein, in the absence of proper and timely communication between said first T/R device and said second T/R device, said defibrillator circuit is responsive to said second defibrillation control signal received from said logic device to generate said defibrillation pulse for application to said at least one electrode for resuscitation of said patient, and (3) said first pacing control signal may be transmitted from said central station to said control input of said pacing circuit and in response thereto, said pacing circuit may generate said at least one pacing pulse for application to at least one of said electrodes for resuscitation of said patient; and

wherein, in the absence of proper and timely communication between said first T/R device and said second T/R device, said pacing circuit is responsive to said second pacing control signal received from said logic device to generate said at least one pacing pulse for application to said at least one electrode for resuscitation of said patient.

398. The system defined in claim 397, further comprising a control unit, adapted for use at the remote site of each implanted unit, said control unit comprising:

(1) third transmitting/receiving (T/R) device for electronic communication with said first T/R device of said central station; and

(2) fourth transmitting/receiving (T/R) device, coupled to said third T/R device, for electronic communication with said second T/R device of said implanted unit;

whereby said implanted unit may communicate with said central station through said control unit.

399. The system defined in claim 398, wherein said first T/R device and said second T/R device include means for direct duplex communication between them, without transmission through said third T/R device and said fourth T/R device, said communication means being selected from the group consisting of:

(i) a wireless transmission link;

(ii) a transmission link with wired and wireless segments; and

(iii) a transmission link with the Internet and wireless segments.

400. An audio system comprising:

(a) a first input device, arranged at each of at least one first locations, having a first microphone and audio input signal processing means, electrically connected to said first microphone, for producing a first audio signal representing received sound;

(b) a sound producing device, arranged at each of said at least one first locations, having a loudspeaker and audio output signal processing means, electrically connected to said loudspeaker, for causing said loudspeaker to produce a sound in response to a test signal;

(c) a sound transducer, arranged at a second location remote from said first location, for producing a sound in response to, and represented by, an audio signal;

(d) a control device, arranged at said second location, for producing said test signal in response to a manual control input by a human operator; and

(e) a first transmitting device, located at each first location, coupled to said audio input signal processing means;

(f) a first receiving device, located at each first location, coupled to said audio output signal processing means;

(g) a second transmitting device, at said second location and coupled to said control device, for electronic communication with each of said at least one first receiving devices; and

(h) a second receiving device, at said second location and coupled to said sound transducer, for electronic communication with each of said first transmitting devices;

wherein a human operator may remotely test said audio system by providing a manual input to said control device;

thereby (1) transmitting said test signal from said control device at said second location to said sound producing device at said first location;

(2) transmitting said first audio signal from said microphone at said first location to said sound transducer at said second location; and

(3) listening to said sound transducer at said second location;

whereby, following said test signal, the presence and quality of the sound at said second location provides information to the human operator about the quality of said audio system.

401. The audio system defined in claim 400, further comprising a second input device coupled to said second transmitter, allowing said human operator to select one particular first receiving device, whereby said operator may test the apparatus at one particular first location, in an audio system comprising a plurality of first locations.

402. The audio system defined in claim 401, further comprising a second microphone coupled to said second transmitting device arranged at said second location for producing a second audio signal representing received sound, said second audio signal being transmitted to said loudspeaker at said first location by said second transmitting device and said first receiving device;

whereby said human operator may remotely test the audio system at a first location by listening to said sound transducer at said second location while speaking into said second microphone.

403. The audio system defined in claim 402, further comprising means for delaying the production of sound by said sound transducer to avoid producing the sound spoken into said second microphone at substantially the same time that said sound is generated by said human operator.

404. The audio system defined in claim 401, further comprising an audio quality control input device, coupled to said second transmitter, for inputting at least one audio quality control signal, and wherein said audio input signal processing means is further coupled to said first receiving device

whereby said operator may

(1) adjust the quality of the sound produced by said loudspeaker by inputting a first audio quality control signal which affects signal processing by said audio output signal processing means;

and

(2) adjust the quality of the sound produced by said sound transducer by inputting a second audio quality control signal which affects signal processing by said audio input signal processing means;

thereby allowing said operator at said second location to control sound quality at at least one of said first and said second locations by remotely adjusting at least one of said signal processing means at said first location.

405. The audio system defined in claim 404, wherein said audio quality control signal controls at least one of:

(i) amplifier gain;

(ii) emphasis/de-emphasis of different segments of the audio spectrum;

(iii) noise management;

(iv) frequency response;

(v) the audio signal sampling rate; and

(vi) the number of bits per audio sample.

406. The audio system defined in claim 401, further comprising a cardiac monitoring and external defibrillation system which allows an untrained human enabler immediate access to a medical professional who can and will remotely monitor, diagnose and treat a victim of medical emergency at one of a plurality of remote sites, said system further comprising:

(a) at said second location;

(1) a display device for displaying cardiac information from a victim for evaluation by said medical professional, coupled to said second receiving device;

(2) a defibrillator control input device, coupled to said second transmitting device, responsive to said medical professional, for producing a defibrillation control signal for controlling the application of a defibrillation pulse to said victim; and

(b) at each said first location, emergency cardiac monitoring and external defibrillation apparatus including;

(1) a defibrillator circuit, having a control input coupled to said respective first receiving device, for generating a defibrillation pulse at a respective defibrillator circuit output in response to a defibrillation control signal received at said defibrillator circuit control input;

(3) an electrocardiogram (ECG) circuit, having an ECG circuit output, coupled to said respective first transmitting device, and having an ECG electrode input;

(4) a plurality of contact electrodes, adapted to be placed by a nearby enabler upon a chest wall of said victim, said plurality of contact electrodes being adapted to be arranged at separate locations on said chest wall for the receipt of ECG signals from said victim and for application of said defibrillation pulse to said victim; and

(5) a connecting cable having a plurality of electric wires for connecting each of said contact electrodes to at least one of (i) said ECG electrode input and (ii) said defibrillator output;

whereby (1) said ECG signals may be transmitted from said contact electrodes via said connecting cable to said ECG circuit and from thence to said second location, (2) said defibrillation control signal may be transmitted from said second location station to said respective control input of said respective defibrillator circuit and (3), in response thereto, said respective defibrillator circuit generates said defibrillation pulse for application to at least one of said respective contact electrodes, for resuscitation of said victim, via said respective connecting cable,

2wherein said audio system allows said medical professional to (1) determine the operability of the audio apparatus at a particular first location, and (2) communicate with said enabler when said particular audio apparatus is operating properly.

407. The audio system defined in claim 402, wherein said second location further comprises third input device, responsive to said human operator and coupled to said second transmitting device for producing a transmission control signal and wherein said first receiving device is further coupled to said first transmitting device responsive to said transmission control signal, to retransmit said second audio signal back to said first location, thereby to determine whether each component of the system is operable.

408. A communication system with fault correction means comprising, in combination:

(a) a central station operated by a first person, comprising;

(1) a first transmitting and receiving (T/R) device;

(2) a first microphone, coupled to said first T/R device;

(3) a first listening apparatus including at least one of;

(i) a first loudspeaker, coupled to said first T/R device; and

(ii) a first earphone, coupled to said first T/R device; and

(4) an input device, coupled to said first T/R device; and

(b) at least one peripheral station, operated by a second person comprising;

(1) a second transmitting and receiving (T/R) device;

(2) a second microphone, coupled to said second T/R device;

(3) a second listening apparatus including at least one of;

(i) a second speaker, coupled to said second T/R device; and

(ii) a second earphone, coupled to said first T/R device; and

(4) a display device for viewing text messages;

(5) a text-generating device, coupled to said display device and to said second T/R device, for receiving at least one signal from said input device and, in response thereto, generating text messages for display on said display device;

whereby, if said second person can not adequately hear said first person using said first microphone and said at least one second listening apparatus, (1) said second person may communicate said problem to said first person from said second microphone to said at least one first listening apparatus, and (2) said first person may utilize said first input device to send text messages to said display device, thereby allowing said first person and said second person to maintain two-way communication.

409. The system defined in claim 408, wherein said text generating device has a memory which stores a plurality of text messages, and wherein said first person may communicate with said second person by selecting at least one text message using said input device.

410. The system defined in claim 408, wherein said first person may communicate with said second person by selecting a series of individual text characters, using said input device.

411. The system defined in claim 409, wherein said central station further comprises:

(4) a display device for viewing text messages;

(5) a digital memory device, coupled to said display device, said input device and to said first T/R device, for storing text messages;

whereby said first person may view and select a text message for transmission to said second person.

412. The system defined in claim 408, comprising a plurality of peripheral stations and wherein said first person may utilize said input device to generate a peripheral station selecting signal, thereby causing said first T/R device to select one particular peripheral station with which to communicate.

413. A communication system with fault correction means comprising, in combination:

(a) a central station operated by a first person, comprising;

(1) a first transmitting and receiving (T/R) device;

(2) a first microphone, coupled to said first T/R device;

(3) a first listening apparatus including at least one of;

(i) a first loudspeaker, coupled to said first T/R device; and

(ii) a first earphone, coupled to said first T/R device;

(4) an input device, coupled to said first T/R device; and

(5) a display device, coupled to said first T/R device; and

(b) at least one peripheral station, operated by a second person comprising;

(1) a second transmitting and receiving (T/R) device;

(2) a second microphone, coupled to said second T/R device;

(3) a second listening apparatus including at least one of;

(i) a second speaker, coupled to said second T/R device; and

(ii) a second earphone, coupled to said first T/R device; and

(4) a speech recognition device, coupled to said second microphone and to said second T/R device, for producing an output representing the text of the speech of said second person, for transmission to said display device;

wherein, if said first person can not adequately hear said second person using said second microphone and said at least one first listening apparatus, said first person may utilize said first input device to activate said speech recognition device, causing said speech recognition device to convert said second person speech into text messages for transmission to said first person;

thereby allowing said first person and said second person to maintain two-way communication.

414. The system defined in claim 413, wherein said speech recognition device further comprises a logic device for the translation of one language to another;

thereby allowing said first person to understand said second person, if said first and said second person speak different languages.

415. The system defined in claim 413, comprising a plurality of peripheral stations and wherein said first person may utilize said input device to generate a peripheral station selecting signal, thereby causing said first T/R device to select one particular peripheral station with which to communicate.

416. A communication system with fault correction means comprising, in combination:

(a) a central station operated by a first person, comprising;

(1) a first transmitting and receiving (T/R) device;

(2) a first microphone, coupled to said first T/R device;

(3) a first listening apparatus including at least one of;

(i) a first loudspeaker, coupled to said first T/R device; and

(ii) a first earphone, coupled to said first T/R device;

(4) an input device, coupled to said first T/R device; and

(5) a display device, coupled to said first T/R device; and

(b) at least one peripheral station, operated by a second person comprising;

(1) a second transmitting and receiving (T/R) device;

(2) a second microphone, coupled to said second T/R device;

(3) a second listening apparatus including at least one of;

(i) a second speaker, coupled to said second T/R device; and

(ii) a second earphone, coupled to said first T/R device; and

(4) a keyboard for inputting alphanumeric characters, coupled to said second T/R device;

wherein, if said first person can not adequately hear said second person using said second microphone and said at least one first listening apparatus, said first person may instruct said second person to use said keyboard to input text messages,

thereby allowing said first person and said second person to maintain two-way communication.

417. The system defined in claim 416, comprising a plurality of peripheral stations and wherein said first person may utilize said input device to generate a peripheral station selecting signal, thereby causing said first T/R device to select one particular peripheral station with which to communicate.