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Heavy Is Dumb in the Field

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There’s a principle we both may have forgotten after our first EMS shift, Life-Saver, and it goes like this: Heavy is dumb.

I admit there’s nothing fancy about that rule. Nor is it as self-explanatory as “Never Do Anything You Know Is Stupid,” or “Come to a Complete Stop at Every Opposing Signal.” But you can bet on it, just the same. In the field, heavy really is dumb. So you choose lightweight equipment. You use your wheels to bear weight, instead of your body. (You get the big wheels as close as you can, then you get the little wheels as close as you can, then you consider helping sick people to walk if they can. Then you carry what you must, when you must, with help.)

So why do our monitors need to be boat anchors?

They don’t. They’re big and heavy because we let the manufacturers think we need stuff we don’t need. And we don’t imagine stuff. For instance, the screen resolution of our most popular monitor is 640 x 480. That’s Flintstone technology—about a tenth the resolution of an iPad 3, which weighs a few ounces and has a much larger screen. An iPad also has a much smaller battery, which lasts for hours instead of minutes on a single charge—and can be charged during use. Not to mention, the iPad can be used simultaneously to write a chart, access any number of medical references, check the status of your area’s EDs, map your routing, monitor the weather and play music. (We really should be playing more music for sick people. We’ve known for years, it’s good for them.)

What if you had a quick-release clamp on the head end of your cot that could hold an iPad, perhaps mounted on a ball joint, so you could see it every time you look at a patient’s face? A pair of inexpensive, single-use ear buds would enable them to listen to their choice of music while you keep an eye on their cardiac rhythm, vitals, sats and capnometry. A cable (or a Bluetooth interface) could connect them to a 10-ounce module that’s only a few inches square that might integrate with their sensors and electrodes.
In fact, if you were to attach the patient’s end of the electrodes to a piece of mesh, or stretchable, removable plastic film (like Saran Wrap), you could apply them all in seconds without tangling. If you had the right app and, say, 24 electrodes instead of 12, you could simultaneously gather enough data to see a three-dimensional image of an organ instead of making inferences about its size, orientation and functions based on what you see on a primitive oscilloscope.

You could use the same tool to photograph trauma mechanisms or document video of patient behaviors, including refusals.
The reason a conventional monitor-defibrillator is so bulky, weighs so much and does so little is that it’s a conventional monitor-defibrillator (with a strip-chart recorder built in). Why? We probably use a monitor 100 times as often as a defibrillator. If the resolution of the monitor were high enough (especially with zooming capabilities), it would be better for diagnosis than anything we’ve ever seen.
Manufacturers also think a defibrillator has to be capable of welding people 30 or more times, rather than five. And it has to generate a therapeutic charge in five seconds. So it needs big, honkin’, heavy batteries. Why?

In fact, a defibrillator could deliver a few shocks on a set of penlight batteries. Those could be supplemented by the vehicle’s electrical system. The defibrillator could be linked to an iPad for (rare) synchronized cardioversion. If it weren’t built around a video display, it could weigh a pound or two and look like an AED. You could easily connect an iPad’s video output to a big, 24-bit color flat-panel display, mounted on the wall of your ambulance and visible from any angle. The iPad’s audio system could alert you with spoken alarms when you’re busy and something bad happens. And you wouldn’t have to learn which buttons increase amplitude or select leads, because you wouldn’t need any buttons. Chances are, you’re already comfortable with an Apple-style interface, and you could control that using your smart phone as a remote.

What if you didn’t need a $1,200 clamp to prevent a $25,000 monitor you can’t even reach from becoming a lethal projectile in the event of a collision? You might actually be able to wear your ambulance’s safety restraints!

C’mon, you can make this happen. Next time you’re at a conference, talk to the product reps and tell them what you need. Or better yet, email the manufacturers directly. Do that now.

You can use your iPad.

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