I asked my typical initial question, “Do you know where this is?”
It was met with my partner’s typical response, “Sort of—the general direction—but give me details when we get close.”
The two of us navigated together, with me barking out turn-by-turn instructions for my partner.
It was nighttime and we were pleased to have recently acquired new spotlights that plugged into the cigarette lighter. Those old school vehicle-mounted swivel spotlights usually broke after a short time. You had to be sure and remember to turn off the switch, or run the risk of starting a fire in your ambulance.
At the patient’s side, the tools were simple but practical: A manual blood pressure cuff, oxygen and a two-lead cardiac monitor where you had to be sure to grab both side of the handles, otherwise the defibrillator side of the machine would embarrassingly fall to the floor when you picked it up.
This was in the mid-’80s and I was working 24-hour shifts at a hospital-based ambulance operation in the upper Midwest. By today’s standards, the technology we used in dispatch, our vehicles, and in the field a generation ago was rudimentary. In general, EMS crews weren’t trained in the use of technology to guide patient care from a quality standpoint.
However, we still did our best to deliver great service, and the one thing technology will never replace is a compassionate crew. In fact, technology can sometimes be a barrier to a great patient experience. But there’s no denying we’ve come a long way in a relatively short period of time.
Here we will discuss the type of education, orientation and attitude that helps us best leverage that technology for the benefit of the patients we serve.
Explosion of New Technologies
Consider this: In 1803, when Thomas Jefferson sent Lewis and Clark to explore the uncharted West, nothing moved faster than a horse could take it. Not a person, not a product, not an idea. Enter the steam engine, the automobile, jet aircraft, and eventually the Internet.
In his book The World is Flat Thomas Friedman describes the pace of technology changes as happening at a rate never experienced before. The growth of technology from a historical standpoint has seen more advances in the past 30–40 years than in all of recorded history. When you stop to think about that, it’s pretty mind-boggling.
It wasn’t very long ago when only nations and large corporations had the opportunity to be relevant on a global scale. Now any teenager with a computer and an Internet connection literally has worldwide reach.
In order to be successful in this new environment, the required skill set of students, workers and leaders is quite different than in the past.
First developed in the 1930s, the FM radio “handie-talkie” or “walkie-talkie” was widely used in the war. Original models weighed approximately 35 lbs. and had a range of 10–20 miles.
For years public safety dispatchers have lived in an analog world, contributing greatly to the care of the sick and injured through the telephone, offering a calm voice in the midst of chaos, helping callers stop the bleeding, deliver a baby or perform CPR.
Now we have next generation 9-1-1. What happens in the brave new digital world when a dispatcher receives a text message with a photo of the caller’s dying grandmother? Or streaming video of the shooter standing over the murder victim?
As the old technological platform sunsets, we’re on the threshold of having to manage a never before encountered set of EMS issues not in the field, but in the communication center.
Operations & Patient Care
So much new technology—GlideScope, Auto-Pulse and LUCAS, Google Glass, telemedicine, SimMan, impedance threshold devices, ultrasound—what’s a prehospital clinician to do?
The clinical interventions we provide in the field should be analyzed to support our clinical practices. Gone are the days when we should tolerate doing things we do, just because we’ve always done them that way. Today’s practitioners should be taught and expected to challenge protocols and practices that can’t support by evidence-based analysis.
The need to collect and analyze data on vehicle operations has been recognized for years. Until recently, that need has been frustrated by limitations on the amount of information readily available and the ability to communicate the information in a timely manner.
Three recent advances in technology have relieved these frustrations:
- Vehicle manufacturers are constantly increasing the amount of information monitored and stored in the vehicle’s electronic control module and improving the access to that information via on-board diagnostic ports.
- The U.S. government has increased the scope and reliability of GPS and has made it readily available to commercial users.
- Cellular communication has expanded its capabilities and reduced its cost to the point it is an efficient method of communicating large amounts of information quickly.
These three technological advances are being combined to accumulate and communicate vehicle operating data and location information. This combination of technology is often referred to as “telematics” or “infomatics.” The numerous vendors providing telematics distinguish themselves by their ability to present the information in a form and format that’s useful to the vehicle operator and management.
Accepting the fact that the technology exists and works, and that the return on investment is often expressed in months vs. years, the pertinent question is “what can it do for the EMS agency?” The answer to that question is varied but can be summarized under a few broad categories:
- Vehicle Operations
- Vehicle location can be displayed on a current basis, a historical basis (breadcrumb trail) or tied to a preset map position (geofence).
- Vehicle speed can be compared to posted speed limits or a finite speed and then be reported for emergent and non-emergent operations.
- Engine idle time can be tracked and monitored.
- Vehicle operations immediately prior to a crash can be captured and retained. Both law enforcement and insurance investigators are very appreciative of the information you can provide.
- Fuel economy and be tracked and monitored.
- Vehicle Maintenance
- Engine “codes” can be communicated to your maintenance vendor on a live basis and analyzed before the unit has to be taken out of service.
- Vehicle mileage and engine hours are available at any time.
- Critical engine data (e.g., RPMs, temperature, voltage) are recorded and available.
- Manufacturers’ recalls are available to you as soon as they are released.
- Service due needs can be tracked and communicated from within the system.
- Driver Behavior
- Your desired vehicle operating characteristics for speed, acceleration, deceleration, cornering, engine idle and seatbelt use can be programmed into the system.
- Vehicle operation outside your set parameters can be tied to an individual driver and communicated to leadership.
- In-cab audible tones can alert a driver that they’re approaching unsafe operating parameters and a second set of tones can be activated when parameters are exceeded.
- Driver score sheets can be generated that assign a numeric score to the driver’s performance. Those score sheets can become part of a driver coaching or award program.
All the data collected is only beneficial if it’s delivered effortlessly to the end user. Most of the systems available commercially will deliver information electronically on a scheduled, exception or ad hoc basis. Telematics systems can enable leadership to create a safer, more efficient operation via the use of data currently available without the users spending time in data collection or manipulation. The productivity and efficiency of both the vehicle and human asset can be advanced by the proper use of a telematics system.
EMT and paramedic vehicle operators, mechanics and managers alike need the skills to monitor, collect and analyze this information so it can be used to improve service, keep employees safe and better manage budgets.
According to the University of Minnesota’s Carlson School of Management, in today’s hyper-connected world, U.S. consumers generate 2.5 billion gigabytes of data each day. These data are derived from web analytics, real-time sensors, social media behavior and more. Hidden in this massive pool of data are invaluable business insights that demand sophisticated analytical minds to parse out.
Academic institutions around the globe are offering degree programs in an entire new area of study often referred to as data or business analytics. Central to these programs is the goal of translating this mountain of data into meaningful information that can be acted upon. EMS practitioners are among the beneficiaries of this movement. Data and its collection, interpretation and use are more important than ever.
EMS organizations have a responsibility to be clear to their staff why data collection is relevant. For example, if an ePCR is loaded with required data elements that are never used, it’s easy for EMT and paramedics to become cynical about proper collection of such information. We should strive to build connections between what an organization is asking its people to collect and the impact of that information on the service we provide.
We’ve all likely heard, “what gets measures gets managed.” But being able to ascertain the relevant vs. distracting—the need-to-know vs. nice-to-know—is crucial.
We rely on academic institutions to produce smart providers who have great technical skills, the ability to think critically and possess strong interpersonal skills. That’s no easy task. EMS curricula are dictated by the national standard curriculum authored by the National Highway Traffic Safety Administration (NHTSA). The most recent version was published in January of 2009.
EMS leaders might be wise to consider educators, providers and agencies as partners in making a concerted effort to include data analytics in the next revision. An aspirational statement articulated in the 2000 “Education Agenda for the Future: A Systems Approach” states:
“EMS education in the year 2010 develops competence in the areas necessary for EMS providers to serve the health care needs of the population. Educational outcomes for EMS providers are congruent with the expectations of the health and public safety services that provide them. EMS education emphasizes the integration of EMS within the overall health care system. In addition to acute emergency care, all EMS educational programs teach illness and injury prevention, risk modification, the treatment of chronic conditions, as well as community and public health.”
One might argue that the use of technology, collection of data and transformation of that data into actionable information, should be included in any updated EMS education standards to help facilitate the realization of this goal. The “standards” are available for review at www.ems.gov/EducationStandards.htm.
Distractions & Other Deadly Sins
Just because we can do something doesn’t mean we should. A discussion about data and the use of technology would be incomplete without a few words of caution.
Like many of you, when I was in paramedic school I often heard the reminder, “treat the patient, not the machine.” Good advice. Savvy EMS providers already know this, but the cues people look for when forming impressions about others are simple. Never let technology get in the way of a human interaction. Good advice.
Driving is the single most dangerous thing most EMS providers do. It’s not helpful to pack the cab of the ambulance with more and more technology that glows, beeps and takes attention away from the road. No one in EMS likes the term “ambulance driver.” But it’s a simple fact that we do indeed drive ambulances. Just like airline pilots, let our vehicle infomatics to do their work in data collection that can be reviewed after the run is complete, and wholly concentrate on driving whenever we’re behind the wheel.
The techies among us may enjoy exploring new gadgets, crunching numbers or using the latest toys. But what does all of this fancy technology do for us and our patients?
The magic of medicine happens when a provider puts his or her hands on a patient, looks into their eyes and listens intently. With all the possible data available to EMS practitioners today, what really matters is translating that information into protocols and practices that street level providers, dispatchers, mechanics and all the rest can easily understand, and see true, meaningful value in.