Most of what we do in our lives today has an electronic or mechanical advantage attached to it. Our smartphones and computers make us more effective than ever—so much so that today, nearly anyone can be trained to save a life. Citizen responders are becoming an invaluable early response benefit to patients (read “Citizen Rescuers: Trained & equipped volunteers alerted by smartphone to quickly respond to emergencies in Jersey City, N.J.,” by Robert Luckritz, JD, NREMT-P, in the January issue) and the White House’s Stop the Bleed initiative seeks to train bystanders to stop life-threatening bleeding. (Read more about this initiative in next month’s issue.)
EMS TECH REVOLUTION
We’re also witnessing technological advances in EMS equipment, our vehicles and our processes almost weekly. It’s hard to find a manual-lift stretcher anymore, an indication that system administrators and manufacturers have gotten the message that crews’ backs are highly susceptible to injury, particularly as the volume of overweight patients climbs nationwide.
Our data systems are being upgraded and enhanced to be more relational than ever, communicating with our medical monitors and computer-aided dispatch systems.
There will continue to be significant changes in ambulance and response vehicle design and safety aspects due to the expiration of the KKK specifications and the introduction of the new ambulance standards. Regardless of what the new standards present to us, there are a few things that make so much common sense that we need to explore them.
The use of smaller, adjustable seats in the patient compartment is proving to be a heavily adopted trend that will enhance crew safety and patient accessibility.
And, as companies increasingly adopt European-style ambulance interior designs, we’re seeing more efficient interiors, with devices, switches, controls, computers and access to essential equipment without having to leave our seats or be unbuckled.
Although some ambulance manufacturers are installing cameras on a 360-degree basis around the vehicle to give drivers the opportunity to see blind spots, I feel this will distract the driver, who has to take their eyes off the road to monitor four small screens in a mirror or on a console. We should take a cue from the auto industry and install back-up and blind spot obstacle detection sensors and alerts to help avoid front and rear-end collision and turning accidents.
One area where I envision major emphasis and innovation is in the area of resuscitation.
The 2015 AHA Guidelines Update, while not yet comfortable with the research on prehospital comparisons of manual vs. mechanical CPR, make a strong statement that addresses the everyday EMS environment and dilemmas we face in maintaining consistent and adequate compression depth on our patients.
Part 6: Alternative Techniques and Ancillary Devices for CPR states: “The use of mechanical [piston and compression band] devices may be considered in specific settings where the delivery of high-quality manual compressions may be challenging or dangerous for the provider (e.g., limited rescuers available, prolonged CPR, during hypothermic cardiac arrest, in a moving ambulance, in the angiography suite, during preparation for extracorporeal CPR [ECPR]), provided that rescuers strictly limit interruptions in CPR during deployment and removal of the devices.”
The 2015 Guidelines Update also note that active compression-decompression (ACD) CPR is now recognized as being effective when coupled with an impedance threshold device (ITD) to enhance venous return during chest decompression and improve blood flow to vital organs. I’ve seen the positive effects of the combined ITD, ACD-CPR and mechanical compression devices in animal labs and encourage all EMS agencies to put these innovations on their radar screens.
I also believe we’ll see more and more systems moving to the use of mechanical ventilators in all paramedic ambulances. The benefit of these compact, easy-to-use ventilators has been proven in medical helicopters and in systems like the Mesa (Ariz.) Fire and Medical Dept. and EMSA in Tulsa and Oklahoma City, Okla., as well as many other forward-thinking systems.
When we take critical patients into an ED or specialty center, the staff quickly replaces the bag-valve mask with a finite-controlled ventilator that consistently and appropriately delivers the right tidal volume and rate to the patient. It’s a natural fit for EMS, especially since we have 25 things to do and limited staff to do them.
We need our highly trained and clinically astute personnel to use their brains and not force them to get tied up using their hands to resuscitate patients. That’s so ‘70s!
Consistency, continuous monitoring, algorithmic patient assessment and alerting, as well as the complete control of our patients’ vital parameters of ventilation and circulation are the keys to successful resuscitation.
Be forward-thinking and take advantage of the electronic and mechanical innovations available to us to implement processes that will enhance safety and clinical effectiveness in the fast-paced, challenging and highly-mobile environment we work in.