There's an app for everything these days, and EMS is no exception.
They range from guerilla -- "EMS Meds" is a study guide created by paramedic Gary Huntress for paramedic Gary Huntress, available to the public for $2.99 -- to bona fide: For $19.99, you can get Informed Publishing's full EMS Field Guides (ALS and BLS).
As for everything in between, there are protocol reference apps for certain agencies (namely "L.A. County Medic" [$3.99] and "Orange County Medic" [also $3.99]); several documentation apps, including one specifically for recording cardiac arrest events and times ("Full Code," $0.99, and "Full Code Pro," $2.99); a medical terminology English-Spanish translator ("Audio-Medical Spanish," $6.99); and shift calendar ("Emergency Calendar," $2.99).
While far from standard, apps like these are becoming a fixture with some providers.
Jason Martin, lieutenant with the Memphis Fire Department, says apps like Epocrates have been useful to his paramedics in ascertaining information on drugs they haven't encountered before, say, if a patient has taken or overdosed on it.
"I think it's generational," said JEMS Editorial Board Member Bryan Bledsoe, DO, FACEP. "The younger medics can't live without it, and the older ones don't understand it. I personally use Epocrates on my iPhone and really like it. However, providers should make sure they use reputable and properly vetted programs for patient care situations."
But in the Wild West that is the app store, it can be difficult to discern an app's credibility.For example, "L.A. County Medic," which puts Los Angeles' drugs and protocols at a user's fingertips, is one of the highest-rated EMS apps, according to the app store's starred system. But it was developed by an entity called "iPhone medic," whose Web site is no longer functioning.
"I've seen dosage charts from supposedly reliable sources that were just plain wrong math," said JEMS Editorial Board Member Kathleen Schrank, MD, FACEP, FACP, EMS medical director for City of Miami Fire Rescue.
And that's not the only concern. "One area that must be strictly regulated (or prohibited, as in our system): No making video images, pictures or recordings [on the devices] of patients or patient care]," says James J Augustine, MD, an emergency physician from Washington, D.C., and the medical adviser for Washington Township Fire Department in the Dayton, Ohio area.
But even those who are cautious recognize apps' potential to positively impact EMS. "For things that are rare but complicated emergencies -- such as how to handle a problem with medical devices, like an LVAD, or serious adverse reactions to prescription medications -- this could be a great tool for EMS," said Schrank.
So how can providers benefit from this technology's potential and still maintain the integrity of patient care? It's helpful think of EMS apps in three categories -- those to be used for training purposes (protocol guides, educational aids), those pertaining to the EMS lifestyle (shift generators, CE managers, radio scanners), and those intended for use in the field (call logs, ICE applications, maps and GPS programs) -- and recognize when and where each is appropriate.
Praise for apps as a useful tool in the educational setting seems to be universal. "A number of EMS educators have told me it's a great training tool," said Nick Schmitt, a firefighter/paramedic with Village of Hoffman Estates (Ill.) and software developer created "Full Code" and "Full Code Pro."
The jury is still out, however, as to their place in the field. "I think most of the time, [the providers aren't] actually just standing there when they're with a patient messing with their phone," said Martin. "I think it's more during the transport or afterward. I would hope it's only with a stable patient."
It's clear that EMS apps' popularity with providers will continue to grow, so the responsibility for using them appropriately around patients must be shared by providers -- who must know when it's appropriate to use them -- and agencies, which must set forth guidelines on their use, as apps will surely continue gaining popularity in EMS.
Oded Wurman, who developed "Paramedic Protocol Provider," warns providers to research apps' authors. "An app that doesn't have a functioning Web page or support information should send up red flags," he says. "Research 'hire an iPhone developer' sites to see if the developer paid someone to develop the app, which means that he or she probably doesn't know how to maintain it." Wurman wrote and maintains his own app, publishes his contact information and has aWeb site.
Schmitt, who says he thinks it's "fairly realistic" to use apps in the field, says providers need to rigorously test apps before using them in the field and choose simple apps over those that claim to do it all.
"You need a standard of care to address what to do when the data doesn't match the protocol (e.g., dosage, treatment option)," said JEMS Editorial Board Member David M. Williams, MS, senior consultant at Fitch & Associates. "It's also helpful to teach medics what to say [scripting] so they clearly share with the patient what they are doing so that there isn't a perception they are checking personal stuff and that it's care-related."
Lauren Coartneyis the associate editor of JEMS andjems.com.
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