As an old salt in EMS, I watch what’s happening in EMS technology and product development and am absolutely amazed. Manufacturers in the smartphone technology era are now adapting, miniaturizing and enhancing products in ways we never thought possible.
My first computer—a Tandy bought from Radio Shack for $3,500—had what I thought was a massive 10 MB hard drive. I thought that was all the space I’d need. After all, the Apollo spacecraft that landed on the moon only had 10 MB of computer capability. Today, however, we laugh at the cost of a desktop computer being more than $1,000 and storage capability is measured in terabytes.
I believe the future of patient assessment and care will be in advanced sensors and algorithmic analysis of data collected by multiple devices at the same time, processed and reported in a summary manner for quick diagnosis. There are already small, wireless telemetry devices being attached to the wrists of patients in many hospitals that not only replace the old-fashioned “call for assistance” pods wired to the wall, but monitor and analyze each patient’s condition and normal vital signs, and alert a caregiver in the control center in the ICU when the patient needs immediate attention.
What does this have to do with prehospital care? Plenty! Rural services will be able to place a similar device on a patient being transported a long distance to a hospital and have that hospital or a regional command center immediately alerted of a condition change. It’ll be like having a physician intensivist riding with them in their ambulance.
Take this one step further and have these devices supplied by a discharging facility to a patient of concern and then enroll that patient into a community paramedicine program where a roving community paramedic can remotely monitor the patient’s tachycardia, bradycardia, dyspnea, fluid build-up, fever or other anomaly. With video conferencing capability, the community paramedic will not only be able to see and talk to the patient but also remotely monitor them without having to stop by on a daily, or perhaps weekly, basis. We’ll be able to greatly expand our reach into the discharged or high-risk population.
Don’t believe me? Read this month’s exclusive JEMS article on the innovative ETHAN (Emergency Telehealth and Navigation) program working tremendously well in Houston, where a Houston Fire Department fire and ambulance crews, equipped with two-way audio/video tablets, triage and consult with a physician in a centralized control center, and connect low-acuity 9-1-1 callers with community primary care resources. It’s basically a system-wide community paramedicine program connected with technology available on all fire and EMS response units.
If you look back at the epic work of Gene Nagel, MD, when he developed telemetry in a box in the early ‘70s to allow Miami Fire Department paramedics to send just a few vital sign parameters, you begin to realize how far we’ve come in the size and capability of technology and how far we can go in the future.
With the explosive development of cellular technology and microprocessors, I believe you’ll continually see smaller devices that offer more advanced capability—for example, second-by second monitoring of tissue oxygenation by small sensors on the patient. They may be integrated into your ECG pads or attached to the patient’s forehead as they already are in Tokyo.
At this year’s Pinnacle Conference, Melissa Costello, MD, FACEP, a medical director for Baptist LifeFlight in Alabama, showed me a new Thinklab One digital stethoscope (www.thinklabs.com) that wasn’t much larger, depth-wise, than the head on current stethoscopes. But, it was more powerful and functional, capable of amplifying sound over 100 times. It uses in-ear headphones and lets you listen to respiratory and cardiac sounds set at a numerical volume level best suited for your ears or noise environment.
The sound was exceptional—very distinct and clear. And, I was amazed with the 10 volume levels I could increase via the digital control panel to significantly amplify the sound if I was in a high-noise environment such as in a helicopter.
The Thinklab One digital stethoscope can amplify sound over 100 times. Photos A.J. Heightman
We all know it’s difficult to clearly hear lung sounds, heart tones and a blood pressure in a moving ambulance, let alone a high-noise environment. This inexpensive digital stethoscope solves that problem and means better assessment and, consequentially, better patient care. Better yet, its Thinklink app opens a world of possibilities for telemedicine, education, research and electronic medical records by allowing users to record and transmit results to a hospital while treating a patient in advance of arrival at the ED.
Think of the expanded applications for this device if it was used by community paramedics. And, as a gadget guru, I could see rescuers lowering it into deep holes or collapse sites to listen for patient sounds far below the surface. The only extra cost would be for earphone extensions that are readily available.
A.J. Heightman demonstrates the FLIR ONE thermal infrared camera by placing his hands in ice water. The device can be attached to any smartphone.
MARRYING LOW-TECH & HIGH-TECH PROCESSES
It’s amazing how manufacturers are merging simple but effective devices with complex technology. At the Fire Department Instructor’s conference this year, First Line Technology introduced its Arm Immersion Cooling Equipment (AICE), a small, easy-to-deploy, frame-supported water enclosure that holds ice water for rescuers to submerge their arms to lower their core body temperature. It’s not high tech, but very effective.
We often fail to realize that our skin, particularly the palms of our hands, offers a large surface area to help lower overall core temperature. As someone closely involved with emergency personnel rehab, I was interested in trying this cooling method. What the sales representative showed me to prove the effectiveness of the AICE system was mind boggling.
He used the FLIR (forward-looking infrared) ONE camera attachment that turned his cell phone into a powerful thermal infrared camera enabling you to measure temperature variances and capture, store and share thermal images and videos. The images shown here exhibit the effectiveness of the rehab cooling process, with my hands turning from red (hot) to blue (cold) in seconds!
The cost of FLIR and thermal imaging devices has historically cost $2,000–$5,000. Although some of the devices designed for public safety use offer more sophisticated technology and features, these tiny FLIR ONE units are available for $200-$600.
When I saw the instant results of my cooling on the FLIR ONE, I immediately envisioned use of these smartphone add-on models for more than just detecting fire sources in the walls of a structure and rehab purposes. They would be helpful for an EMS crew walking along the shoulder of a highway or looking down an embankment at a nighttime scene to determine if any patients had been ejected from a rollover collision.
Let’s take it one step further. The assessment of patient body temperature is going to become more critical as we move toward better detection of septic shock and infectious diseases that have body temperature elevation as a key indicator.
But products and technology aren’t just developing in the patient assessment and vital sign arena—they’re also developing in hemorrhage control, splinting, and patient packaging and movement.
Manufacturers that don’t recognize technology is driving down the size and price of products are going to find themselves behind in the EMS market. EMS and fire response agencies are no longer going to accept the status quo in equipment and technology. Not only are we in need of more technologically advanced products, but also expanded memory, algorithmic technology, devices that talk to each other and share data, and expanded battery life, reduced maintenance requirements and better service.
With budgets shrinking and the need and desire for additional device capabilities, it’s critical that medical technology keep pace with other technology in our lives. Manufacturers and their research and development think tanks that are walking along in EMS are going to be passed rapidly by those running to keep up with modern technology and today’s emergency response needs.
Learn more from A.J. Heightman at the EMS Today Conference & Expo, Feb. 25–27, in Baltimore, Md. EMSToday.com