Improving EMS Patient Care with Communication Technologies

We sat down with Chief Barry Luke, Deputy Executive Director at the National Public Safety Telecommunications Council (NPSTC), to discuss how new communications technologies benefit EMS patient care.

Chief Luke has more than 44 years of experience in public safety communications as a firefighter, paramedic and police officer. He’s well known in the public safety community as a vocal advocate of Next Generation 9-1-1 (NG911) and respected leader on emergency communications. He also supported the development of the new resource, NG911 For Leaders in EMS.

Q: Communication technologies are developing at a rapid pace. How will two significant ones, NG911 and FirstNet, work together?

A: NG911 and FirstNet are complementary systems that will help prioritize and route data coming through public safety answering points (PSAPs). FirstNet provides a high-speed nationwide public safety broadband network, allowing first responders and public safety agencies to communicate with each other. NG911 is the critical IP-based communications system that will link emergency callers with public safety agencies. It’s the first piece of the puzzle that allows 9-1-1 access via voice, wearable technology like smart watches, or building sensors, all of which can send rich data to PSAPs. NG911 is the first half of the critical communication ecosystem that takes information from the public to the PSAP. The FirstNet network then delivers the information to first responders. They are two important systems whose full benefits are realized then they integrate and work together.

Q: What do you see as the key benefits of NG911 for EMS Providers?

A: Its main priority is to improve the safety and efficiency for both EMS and patients. By moving to an all-digital NG911 system, PSAPs will be better able to accommodate emerging technologies such as: those that improve the accuracy of the patient’s exact location, those that provide data on how fast their car was traveling before the crash, or patient medical telemetry from body worn devices. It saves vital seconds, minutes, and sometimes hours off of an EMS response to a serious emergency call, and that’s how we help serve our communities more efficiently. As for EMS personnel, NG911 will provide essential pre-arrival data for them to ensure they can do their job and save lives to the best of their ability.

Q: Are we seeing the benefits of some of these technologies already? Are 9-1-1 centers and EMS agencies using new technologies now?

A: Technology that we thought was going to be available in five to 10 years from now is already coming into the marketplace. New medical and patient care technologies are being brought to market every day–at this point, we can only predict how these new technologies will eventually impact EMS. But, with what has already been seen, there are exceedingly high expectations for what is to come.

MIT [Massachusetts Institute of Technology], for example, is developing a medical sensor bra that performs the equivalent of a 12-lead ECG and monitors the patient for signs of cardiac distress. It will communicate with a patient’s smartphone if something abnormal is detected. NG911 will allow for that alert to be communicated to the PSAP if the patient developed a life-threatening arrhythmia.

The Department of Homeland Security has facilitated development of a vital signs sensor that looks like a large bandage. It can be used in mass care situations to detect pulse, respiration, pulse oximetry, inferred blood pressure, shock index and single-lead ECG. There are so many other devices and technologies being developed for both patients and EMS, and each new innovation brings an even better one to life. Our job is to make sure they all work together for the benefit of the public and EMS community.

Q:  Can you explain more about how these technologies will help provide more accurate pre-arrival data for providers?

A: It’s going to vary from situation to situation, but in almost any emergency, these technologies will help EMS prepare for anything faster and more efficiently. If an EMS crew gets a call about a possible stroke victim, they can receive comprehensive information about the patient while en route. The dispatcher could be getting vital signs from the patient’s smart watch or heart monitor. Once on scene, paramedics could have a video consultation with a physician to confirm the best destination for the patient, such as a hospital or dedicated stroke center. Then, paramedics can alert the staff at the receiving hospital that a patient will soon be arriving, so they can prepare necessary resources. That notification could include patient telemetry and provide more meaningful data than a voice call to the hospital. Not only does this help reduce time and miscommunication when relaying patient information, but it also significantly improves the patient’s outcome and quality of life after treatment.

EMS scene safety is enhanced through the sharing of situational awareness data where law enforcement, fire and EMS can exchange information on unit locations, hot zones, and other tactical information. Liability is reduced when the EMS crew can use a body camera to document a patient’s refusal of care, or to document patient care and disposition of valuables.  

There’s a significant enhancement of EMS unit efficiency when the right resources and sent to the right call.

Q: Can you address the continuity of patient data and how these new technologies might help? We are collecting and sharing data now (at some level). How will that improve?

A: Today, patient information may be gathered by fire department first responders who arrive on scene first. Additional patient information is gathered when EMS personnel arrive. In other cases, the patient is handed off to an EMS transport crew or an aeromedical provider. When the patient finally reaches the emergency department, the only patient data that is typically available for the hospital staff is the data which the transport crew collected. NG911 and FirstNet will enable seamless sharing of patient data between all agencies who have patient contact. A video clip captured during the 9-1-1 call that shows the patient’s facial drooping might be very helpful to the ED physician in determining the time window for stroke treatment. True success with data sharing depends on more than technology. There’s a need for data standards and cost effect interfaces and exchange systems.

Q: How do we receive the new data and how do EMS agencies process data coming from different sources? Is the data reliable?

A: Data interoperability is the biggest challenge we will face. Vendors create their own data structures and there is no standard on what you should call the field that records the patient’s heart rate. So, when Application A is trying to send data to Application B, all sorts of things have to be worked out in advance. Anyone who has lived through the transition from one computer-assisted dispatch (CAD) system to another knows the challenges involving matching historical data to the new system format.

A determination must also be made about the level of trust for any data set. Data coming from an EMS agency AVL [automated vehicle location] system is probably trusted. Patient data coming from the hospitals EHR [electronic health record system] is trusted. What about data coming from the assisted living facility’s patient monitor? What about data coming from the consumer grade Apple Watch? Machine Learning and AI [artificial intelligence] can eventually help determine the degree of trust. For example, a faulty sensor may indicate that the patient is in v fib but other sensors show the patient is still walking down the street. EMS agencies will have to modify and adapt their response protocols to deal with all sorts of new sensor driven alerts, including a decision to either not respond in some instances or defer the initial response to law enforcement or another agency.

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