E.M.S. in the
21st Century
Jim Holliman, M.D., F.A.C.E.P.
Professor of Military and Emergency Medicine
Uniformed Services University of the Health Sciences
Clinical Professor of Emergency Medicine
George Washington University
Bethesda, Maryland, U.S.A.
Medical Director, Paramedic Service
Reading, Pennsylvania, U.S.A.
E.M.S. (Emergency Medical Services) in the
21st Century : Lecture Outline
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Ideas on the future of E.M.S. (or "prehospital care") :
Vehicle-based computer communication systems
Electronic patient monitoring units
Telemedicine
Patient care
Business and Education
Robots
Simulator training
Field lab testing and radiographs
Provision of primary health care services
Public education, illness and injury prevention
Home environmental assessments
Why is the Future for E.M.S. Bright ?
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Lots of energetic and enthusiastic personnel
Support by the public
Recognition of importance by the government
Caseload should not decrease
Increasing population
Increasing percentage of elderly patients
Potential to further utilize existing technology
Multiple roles and responsibilities
"Core" component of national health care system
Advanced Vehicle-Based Computer
Communication & Monitoring Systems
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Perhaps the most important and greatest potential
advance for E.M.S.
All motor vehicles can be equipped with small
electronic monitoring & communication devices
Should be made standard required equipment
Continually monitor vehicle position via GPS (Global
Positioning System, satellite based)
Activate in event of vehicle collision
Then automatically send report to central
communications facility
Information Relayable from Vehicle
Monitoring Sensors
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Type and severity of vehicle damage
Vehicle GPS location
Condition of humans in the vehicle
Mental status and major injuries
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Environmental hazards or conditions
Use of Relayed Information from
Vehicle-Based Sensors
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The receiving communications center can then send
the closest EMS unit to the scene
Can inform EMS units of victim numbers and
conditions
Other types of units can be mobilized if needed
Fire, police, heavy rescue, HAZMAT
Prearrival instructions can be sent to the vehicle
occupants
Advantages of GPS Devices on
EMS Vehicles
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Allows central control facility to monitor exact
positions of all vehicles at all times
Dashboard computerized maps allow crews to
determine fastest ingress and egress routes to
scenes, and avoid getting lost
Supervisors can also monitor speed of vehicles
Allows more effective Systems Status Management
Electronic Medical Monitoring
Units for Patients
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Small sized units can be carried by patients with
recurrent or chronic illnesses
Monitor patient's geographic position using GPS
Activate if patient has sudden illness or incapacitation,
and then send location & condition message to
communications center
Center can then send EMS unit directly to patient
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Could also be used for emergency remote treatment :
External defibrillation if dysrhythmia sensed
Medication injection for other sensed conditions
Computerized Communications
Between EMS Vehicles and E.D.'s
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Hand held or voice activated computers can send detailed info
from scene to E.D. (via cell phone transmission)
Hand held P.D.A.'s also useful as references for protocols &
medical reference info
E.D. can then print the info to be part of the patient's medical
record
This saves the need for the EMS crew to do any other
documentation
Continuous 2 way info from E.D to EMS units allows updating
on E.D. bed availability & hospital condition or capacity
One type of hand-held computer for recording EMS patient
information
Ambulance vehicle – mounted computer system
Advantages of Computerized 2-Way
Communications Between EMS & E.D.'s
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Allows better management of multicasualty
situations
Helps avoid overload of any one receiving
facility
Patient medical information can be transmitted
much more quickly & completely than can be
done verbally
Enables more rapid turnaround of EMS units
after delivering patients
NATO nurses transporting patient on military “mini-ICU”
stretcher
U.S. military stretcher with built-in ICU equipment
Telemedicine in the Future of EMS
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Miniaturized television (TV) cameras can be carried on
helmet, hat, or uniform of EMS personnel
Sending live video images of the scene to the
communications center helps determine need for
additional responding resources
Helps manage multicasualty situations & terrorist
incidents
Also allows monitoring for scene dangers not noticed
by the EMS crew
Other Telemedicine Uses in EMS
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Allows hospital-based doctors to assist field EMS
personnel to make diagnoses & treatments
Allows hospital physicians to direct EMS personnel to
do medical or surgical procedures
Can be used for followup visits or "checkups" for
patients with chronic illnesses
Can obviate need for "face to face" meeting with
doctor
Telemedicine with Robot Units
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Video camera equipped robot units :
Can search dangerous environments for victims :
Building fires
Buildings at risk for collapse
Possible chemical, biological, or radiation contamination
Boat or submarine robots can search water areas for
victims
Can have chemical detectors
Can perform remotely directed medical or resuscitation
procedures
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Telemedicine for Video
Conferencing
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Limits travel time & expense for business
meetings or educational conferences
Video based training & education materials are
easy to transmit & update
Allow personnel to conduct training or receive
education in "down time" between calls
Having personnel log on to on-line training
programs allows supervisors to monitor
completion of training & conduct tests
Use of Simulator Training in EMS
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Computerized mannequin patient simulators can be
used for more realistic clinical training
Allows demonstration of student's ability to recognize
problems & take action
Allows more accurate testing of students
Requiring completion of extensive simulator training
prior to licensing is protective for the public
Vehicle driving simulators can improve driving skills for
low cost
Ambulance vehicle driving simulator
Field Laboratory Testing by EMS
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Hand held miniaturized devices can rapidly measure a
wide variety of blood & body fluid components (using
only small amounts of blood)
Permits broader & more accurate prehospital
diagnoses
May obviate need to transport patient to E.D.
Results may determine type of receiving facility (such
as cardiac enzymes or toxin levels)
Radiographic Equipment for EMS
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If more portable & less costly radiographic equipment
is developed, this may be utilizable by EMS units
Transmission of images back to hospital emergency
physician or radiologist could be done
Interpretations may obviate need to transport patient to
hospital, or permit early thrombolysis
Can be used for verification of endotracheal tube
placement
Ultrasound may help with intravenous line placement
Expanded Roles for EMS Personnel :
Primary Health Care Services
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Proposals in U.S.A. for EMS personnel to undertake
more primary care services
Due to faults in the U.S. health care system, with
deficiencies in access to primary health care & health
maintenance services
Also proposed to more fully utilize the "down time" of
EMS personnel between runs
May be less expensive for EMS units to see multiple
patients at home versus transporting these patients for
exams by doctors
Proposed Primary Health Care
Services for EMS to Undertake
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Regular checkups on patients with chronic illnesses
Administer immunizations
Administer long term parenteral meds
Chronic wound care
Blood draws for medication level monitoring
Education reinforcement about managing chronic
illnesses and need for preventive measures
Some aspects of hospice-like care
Important Roles for EMS in Public
Education
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Illness prevention and healthy lifestyles
Injury prevention
Promote seatbelt & helmet use
Violence prevention
Safe driving
Greater EMS personnel involvement with local,
state, & national governments can promote
public health improvements via legislation &
regulation
Proposed Home "Environmental
Assessments" by EMS Personnel
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Important to evaluate the home environment, especially
for the elderly, for potential problems that could affect
health
Check heating & cooling units
Alter furniture, rugs, etc. to limit risk of falls
Identify need for safety equipment such as stair rails
Identify patients with inadequate nutrition or finances
who may be candidates for other social service
agency interventions
Aspects of Future EMS About
Which We Need to be Careful
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Realization of the limitations of the prehospital
environment
Avoidance of new & aggressive treatments until they
are proven MORE effective prehospital than if waited to
be done in the E.D.
Avoidance of expansion of the types of medications
carried by EMS units until proven that new or additional
medications offer clear benefit
Important to maintain cooperation & coordination of
care between EMS and hospitals
Research Important to Conduct in
EMS
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Patient outcomes from EMS interventions
International comparisons of outcomes in
different EMS systems
Comparisons of outcomes between patients
transported by ground versus aeromedical units
Effectiveness of different personnel training
techniques
Effectiveness of public education programs
EMS in the 21st Century
Lecture Summary
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The future for EMS in the 21st Century is very bright
Expanded use of present technology will allow
improved & more efficient EMS care
Vehicle monitoring systems
Telemedicine and robots
Simulator training
Field lab & radiographic studies
EMS can provide more primary & followup care
EMS has much research potential