Columns, Equipment & Gear, Operations

EMS Response of the Future Can Harness New Technology to Save Lives

Issue 5 and Volume 42.

Ambulance 57’s crew comes on duty, gets assigned one of 25 units operated by their agency, walks over to the ambulance and completes their mandatory vehicle check in less than two minutes, shaving 45 minutes off their past practice of checking each cabinet and its contents at the start of each eight-hour shift.

How do they accomplish this? Their service takes advantage of currently available technology that allows the crew to use a handheld device that reads radio frequency identification (RFID) tags on cabinets, critical equipment and supplies, and then performs an automatic inventory check of the vehicle. The device tells them exactly what items are missing and they quickly retrieve them and get their unit underway.1

If you do the math, that’s 45 minutes saved per crew multiplied by 25 crews per shift multiplied by 3 shifts is 3,375 minutes saved per day. Multiply that by 365 days and that’s a savings of 20,531 hours of staff time per year! That frees up personnel to answer an additional call valued at a profit of $100 per call (after expenses). So, a 25-unit ambulance service can save at least $2 million a year by implementing a high-tech vehicle inventory system. That’s enough to recoup the technology investment in the first six months!


Zapata’s 44-lb. Flyboard dual-engine aviation device features a vertical lift of 12 feet per second (700 feet per minute), can reach speeds of over 100 mph, and stay airborne for more than 20 minutes. Photo courtesy Zapata

In their haste to answer their first call, the crew inadvertently leaves their stretcher and cardiac monitor outside the ambulance.

After they travel 50 feet out of the garage bay, they get alerts on their vehicle’s computer telling them what they’re leaving behind. They retrieve them in seconds and are back on their way.

When they arrive on scene they find a military veteran in emotional distress triggered by a graphic scene in a movie he was watching. He tells the crew he witnessed several soldiers die as a result of an IED attack in Afghanistan and now suffers from post-traumatic stress.

They know it’s dangerous to leave him alone and need to get him care ASAP, so they calm him down, touch a section of their tablet screen and bring up veteran assistance resources.

They contact a designated hotline, get the veteran an appointment and take him to a location where he can get immediate care.

A ‘Bad Shift’

In another service area, Medic 27 responds to a pediatric trauma code, their third major stress-generating call this shift. An algorithm in their ePCR software recognizes the high volume of stressful, gut-wrenching calls and notifies their supervisor.

The supervisor meets with the crew and they tell him that, in fact, it has been a “bad shift.” He sends them back to quarters to relax while he requests a replacement crew.

When the fresh crew arrives, he sends the crew home and follows up with them the next day to check on their welfare.

Reminded by his data system a week later, he contacts the crew members individually and learns one has been having nightmares and not sleeping, which is affecting his thought process on calls.

He has the employee contact the department’s designated stress counselor who sees him that day and confidentially works to reduce his anxiety.


Concept design for SONAS, a portable, battery-powered ultrasound device designed for the noninvasive, transcranial diagnosis of major strokes. Photo courtesy BURL Concepts

Data trending & Alerting

A tractor-trailer on fire on a highway overpass spews and blankets smoke across parts of the city on a windy day. Dispatchers begin to receive calls from areas west of the incident, the same direction that the wind is blowing.

Soon thereafter, they’re alerted by software on their computer dashboard that respiratory distress calls are escalating in that area, particularly from an elementary school complex and shopping center.

Extra resources are dispatched to the locations to evacuate children from the affected school and shopping center. Parents of the schoolchildren are automatically notified of the event and the location where their children are being relocated via a reverse 9-1-1 system.

Evacuation Pod

A gunman opens fire in the courtyard of a government center, critically injuring a police officer. Pinned down by gunfire, a tactical officer with the wounded officer calls in a Medical Evacuation Pod (MEP) designed to access inaccessible and remote locations such as ski mountains and hostile environments.2

One minute later a drone-like MEP, based on balance methodology, algorithms, and advance designs, flies in rapidly to a secure area.

A canopy opens and the injured officer is placed in the fortified ballistic, self-flying pod and rapidly evacuated to a safe area for definitive care.

Response Board

A paramedic who’s on duty at a boat race is alerted to a cardiac arrest in a parking lot a quarter of a mile outside his location.

He puts on a medical pack equipped with an automated external defibrillator (AED) and flies to the scene in less than a minute on a Rescue Response Board.3 The patient is converted from v fib and survives.


A medical drone rapidly transports an AED and medical care supplies to remote areas. CanStockPhoto/finearts

Body Sensors

At a fire scene, a firefighter collapses during an interior fire attack. A body sensor worn in the firefighter’s ear alerts incident command and he’s rapidly found and treated.

In another part of the same city, a community paramedic is alerted by a patient’s Star Trek tricorder-style body sensor that she’s tachypneic and has gained a pound in two days due to increasing fluid in her lungs.

He stops by the patient’s house and adjusts her medications. Her condition improves and she doesn’t need to be sent to a hospital, saving her and the hospital money by avoiding a return visit five day’s post-discharge.4,5

Microbubbles & Ultrasound

Medic 66 responds to a home and finds a 72-year-old male unconscious and exhibiting stroke symptoms.

One crewmember opens a small AED-size case and applies an ultrasound headset no larger than stereo headphones to the patient’s temples, while a second crew member establishes an IV and injects microbubbles.6

Ultrasound waves bounce off the microbubbles and show a clot on the right side that’s “excited” and pulverized by another ultrasound pulse. The patient regains consciousness and is transported to a stroke center for follow-up care.

Dispatch

An EMS system dispatcher starts work at 6 a.m. at a special console and, during her eight-hour shift, carries out the following tasks that save her agency 3 million dollars annually.

>> Schedules 30 routine hospital-to-home and hospital-to-nursing facility transfers to be handled by just six EMTs, each in a Ford Transit Uni-Ambulance. Once the patient is placed on board via a self-loading stretcher, the solo EMT presses a touchscreen and the self-driving ambulance moves on to its destination facility.7,8 An EMS Rover Car is automatically dispatched to assist the solo EMT on arrival if secondary assistance is necessary at a home or facility with stairs.

>> Dispatches four Uni-Ambulances, two Self-Driving Special Resource Vehicles (SRVs) and a Mobile Rehab and Decontamination Unit (MRDU) to designated geographic locations where they’re staffed by available personnel.

>> For Priority 1/Charlie/Delta calls, dispatches EMT-certified Uber and Lyft drivers equipped with AEDs and medical equipment as First Responder Care Cars (FRCCs) if their location is in closer proximity than other available first responder or ambulance resources. The drivers are paid a response and care fee.

>> Receives a cellphone call from hikers in a wilderness area who are requesting assistance because one of them stepped on a bee hive, was stung multiple times and is in apparent anaphylactic shock. The dispatcher locks on the cellphone coordinates and launches a strategically-located multipurpose emergency drones equipped with an AED, wound control pouch and EpiPen that can arrive at the remote geographic location in < 10 minutes. A special two-way cellular pod allows open communication between the dispatcher, drone, calling party and responding emergency units. The same drones are dispatched as needed to remote areas where cardiac arrests are reported.

>> An aquatic video-capable drone unit is launched from a lifeguard tower after the lifeguard aims a locator “gun” at a distressed swimmer 200 yards away in the water. The drone is equipped with a bright LED flood and forward-looking infrared (FLIR) camera and personal flotation device (PFD) that can be automatically released from overhead by the dispatcher who takes control of drone flight as it begins to circle the struggling swimmer. The drone arrives overhead in one minute and releases the PFD, eight minutes before the lifeguard team arrives. The drone automatically returns to its charging nest where it’s re-armed with another PFD when the lifeguards return.

>> A supply drone unit delivers restock items to remote ambulance stations throughout the day and is available to send supplies and special equipment to scenes as necessary.

>> A Drone Command Unit (DCU) is launched from the roof of a command unit at a major emergency scene from a clamshell nest. It circles the scene for an initial or periodic scene assessment and returns to the nest for recharging as necessary. It’s equipped with a camera, LED and FLIR units, a hazardous material “sniffer” system, a geo-altimeter and radar sensors that can track the location of emergency personnel wearing special tags on their belts—by location as well as height in a structure.9 The DCU can also be launched to hover overhead for an indefinite time continuously powered while tethered to provide a well-lit, bird’s eye view of the incident to the command post, communications center and remote officials.

Conclusion

Thinking outside the box, using data to its maximum capabilities and investing in current and future technology can help you save time reaching patients, accomplish important EMS system tasks, present you with a high return on your investment in technology, save you money on personnel and in operational areas and, most importantly, save additional lives.

References

1. RFID Systems for Ambulance Services. (n.d.) GAO. Retrieved April 12, 2017, from www.gaorfid.com/ambulance-services-rfid-systems.

2. Medical evacuation. (n.d.) Zapata. Retrieved April 12, 2017, from www.zapata.com/medical-rescue.

3. Hydro-flyers. (n.d.) Zapata. Retrieved April 12, 2017, from http://www.zapata.com/hydro-flyers.

4. Appelboom G, Camacho E, Abraham ME, et al. Smart wearable body sensors for patient self-assessment and monitoring. Arch Public Health. 2014;72(1):28.

5. Firefighters have higher heart attack risk ‘because of heat.’ (April 3, 2017.) BBC News. Retrieved April 12, 2017, from www.bbc.com/news/health-39478080.

6. Lapchak PA, Kikuchi K, Butte P, et al. Development of transcranial sonothrombolysis as an alternative stroke therapy: Incremental scientific advances toward overcoming substantial barriers. Expert Rev Med Devices. 2013;10(2):201–213.

7. Flatow I, Rice S. (March 17, 2017.) Would you be on board with a self-driving ambulance? Science Friday. Retrieved April 12, 2017, from www.sciencefriday.com/segments/would-you-be-on-board-with-a-self-driving-ambulance.

8. Newby J. (Nov. 2, 2015.) The future of autonomous emergency response. Frog Design. Retrieved April 12, 2017.

9. Cowan C. (Mar. 31, 2017.) Drones at the border: Agents ask Silicon Valley for help securing nation. FOX News. Retrieved April 12, 2017, from www.foxnews.com/us/2017/03/31/drones-at-border-agents-ask-silicon-valley-for-help-securing-nation.html.