The future of emergency medicine: 6 technologies that make patients the point of care
Home injuries, natural disasters, car crashes: every second spent without treatment following one of these accidents or medical emergencies could seriously reduce the chance of a proper recovery or survival. When deprived of oxygen, in fact, irreversible brain damage begins after just four minutes, and 4-6 minutes later, death can occur. Digital healthcare technologies can help in this race against time. By turning the patient into the point of care, these technologies could be real game-changers for emergency units and first responders.
Artificial intelligence and advancing technologies are evolving the emergency services field, from medical drones to driverless cars. It is worth researching deeper into how the advancing technologies influence emergency patient care and what is ahead of us.
Following an interview with Dr. Gabor Csató, CEO of the National Ambulance Service in Hungary, their own unique system’s innovation was discussed. A system that has stood alone for 133 years, the OMSZ is the centralized national healthcare institution. It is the largest ambulance service in the country and pushes innovation into the future.
The innovations and trends that are pushing emergency medicine into the fast lane will also be covered throughout this article. But before we look forwards, we will look back to have clearer pictures of how this field has changed over the years.
Patients to the hospital or hospital to the patient?
Emergency medicine is still rather new; despite its traditional specialty in popular media, it is one of the most accelerated healthcare sectors in the world we live in. In the US, the development of modern-day emergency medical services dates back to the early 1960s. It was a response to the growing number of road traffic accidents as a result of the booming car market and the American highways. Sometime after, Australia, Canada, Hong Kong, the United Kingdom, and Singapore followed suit by creating their own emergency medical systems during the 70s and 80s.
The later emergency medical systems are used in nearly all European countries, meaning that medical doctors and paramedics can treat more patients at the scene of an accident, or in the ambulance on the way to the hospital. In the American model, a lower number of patients are treated at the scene, instead, they are taken as quickly as possible to the emergency room for treatment. Countries in the developing world are currently using practices from both models, however, the latest drive in digital technologies will push emergency medicine further into the direction of the “hospital to patient” route.
Below we take a closer look at the newest innovations in technologies that make it possible to treat trauma and medical emergencies quicker and more efficiently than before.
1. Artificial Intelligence for logistics and capacity allocation
Artificial intelligence is impacting the medical world from helping in diagnoses through drug discoveries to finding unusual links. These technologies are also starting to be used in the emergency department. OMSZ in Hungary is using AI for capacity and logistics allocation in its daily operations. With daily cases of over 3000 patients and cars that cover over 40 million km each year, their operations create huge amounts of data, by using smart algorithms, they can use this data for predictions.
Dr. Csató said in his interview: “AI does not know that there will be an accident tomorrow afternoon on a major two-lane road between two cities but can predict the statistical probability of that.”
“We are also dealing with planning daily capacity allocation within the country. Our vehicles can be easily deployed to neighboring areas, where we experience capacity peaks.”
The software company Hexagon also presented their AI solution for emergency services in 2020. Their HxGB OnCall Dispatch | Smart Advisor system uses real-time operational data to find patterns and recognize major events as they occur. With abnormalities noticed sooner, emergency services teams can coordinate and react quicker.
2. Apps streamlining emergency care
Up to 80% of medical errors, according to some reports, are caused by miscommunication between medical staff. Such errors in emergency care need to be minimized, and new software programs are being developed to help.
Pulsara is a developer based in Montana in the US. It created a HIPAA-compliant platform for EMS, emergency, and ambulance management. It has a connected mobile application that gives paramedics the power to alert an emergency department before the patient’s arrival, allowing them to prepare ahead. It sends this alert not only by working out the ETA by using GPS but also by letting the users share crucial details like images of the ECG from the field. It has been found by some studies that treatment time decreased by almost 30% when using Pulsara.
To save even more time, volunteers at the scene can perform CPR until the ambulance gets there. An app called Szív City was introduced in Hungary, which uses this potentially life-saving method. The app sends an alert to volunteers within 500 meters of the accident location, and with more than 30,000 volunteers registered on the app, the OMSZ more than doubled the number of successful CPRs in only one year.
Another app called Full Code Pro, was launched by the American Heart Association. The app is a real-time CPR event tracking tool. It lets its users document critical interventions. By using the app, first responders can start a countdown, log administered medication, and have access to a metronome to assess chest compression rhythm. The collected information can be used at a later time so the team can learn from it. It means that the patient can be the primary focus, rather than the documentation.
Emergency response happens up in the air, as well as on the ground. In-flight medical emergencies are a real thing, and digital medical solutions can help a great deal in these conditions. An app called airRx containing 23 of the most common medical emergency scenarios that guide physicians in-flight to help travelers who have medical issues. The recent app called MedAire Aviation is for cabin crew. The app connects them to physicians for guided patient assessment. Icelandair have recently integrated this technology into its flights.
3. Video game for practice
Gaming features are being merged into digital health and its influence is expanding into the emergency medical field.
Level Ex, a Chicago-based start-up, created mobile video games that train healthcare professionals. They created the Airway Ex app which gives paramedics and doctors realistic scenarios to better prepare them for the challenges of airway management.
The app scores the worker’s damage caused, bleeding, and speed and it monitors the virtual patient’s vital stats all while the “procedure” takes place. Furthermore, it can be used literally anywhere – at home, on the subway, or even in the Maldives while on holiday!
4. Portable point-of-care diagnostic devices
The availability of user-friendly, palm-sized, and portable diagnostic devices is making it much faster and easier to treat patients at the scene. Whether it’s ECG, lab testing, or ultrasound, giant machines are in the past. Today, doctors can carry a whole department’s worth of tools in their briefcase.
Ultrasound diagnosis was privy only to radiologists some time ago. Still, in today’s medical world, emergency medical specialists can use bedside point-of-care ultrasound devices (PcCUS) to answer vital questions. Claruis and Philips Lumify are types of handheld ultrasound devices that let doctors and first responders easily see a critically ill patient, no matter the location.
We all know, however, that size doesn’t matter. Only a few years ago, the innovation of a smartphone making a one-lead ECG was huge. Now, even though it gives the rhythm, it wasn’t going to replace the usual 12-lead ECG. In a lot of cases, when doctors didn’t see 12 leads, a possible heart attack could easily be mistaken. A new app called Smart Health Pro lets users make a 12-lead ECG with a tablet or smartphone wirelessly. The app is as accurate as a normal bedside examination, except it is available anywhere in the world.
In addition, waiting for a laboratory’s blood test results will also be a thing of the past. A device such as the i-STAT from Abbott, which is a lightweight point-of-care testing (PoCT) device, will make this possible. The device will test a patient’s blood sample on the spot and wirelessly send the outcome of the results to colleagues. A considerable amount of time is gained in emergencies.
5. Medical drones for delivering care from the air
Drones have huge capabilities in transporting vaccines, drugs, and medical aid faster than lots of other options. A medical drone company in Rwanda called Zipline delivers medical supplies to medical centers using drones as part of the local medical system. The drone delivery service allows Zipline serviced healthcare facilities to receive valuable emergency blood supplies within minutes, rather than hours. During the COVID-19 pandemic, the Zipline service was expanded to the US so that medical supplies and PPE could be delivered contactlessly.
In emergency care settings, another use for drones is to deliver automatic external defibrillators (AEDs) straight to patients that have just suffered a heart attack. Already explored in the Netherlands and Canada, AED-carrying drones went on to be tested in Stockholm with excellent results: the drones arrived to the patient within a quarter of the time the ambulance took.
Furthermore, drones are not only transportation machines, they can also give instructions to passers by on giving CPR, using the AED machine and they can also dispatch a team to provide feedback via its very own video connection. Swedish developer Everdrone declared its partnership with Karolinska Institutet in 2019. It will go on to investigate emergency deliveries of equipment and medicine to critical patients, wherever they are located.
These AED drones, however, have slightly limited use and haven’t been widely used. However, that is hopefully not going to be the case for much longer.
6. Easing transportation and the era of driverless ambulances
A substantial barrier to entry for healthcare worldwide is proper transportation. More than 3.6 million people all across the globe miss their doctor’s appointments because of a lack of transportation. However, with services like Lyft and Uber, issues within transportation could become something in the past.
Uber has launched Uber Health, the service revolves around non-emergency medical transportation (NEMT), and is a HIPAA-compliant service. Also expanding into NEMT rides is Lyft. Other services to curb missed appointments are Kaizen Health, Veyo, and Circulation; all ride-hailing start-up companies helping patients to reach the hospital and helping to reduce patient no-shows by 68%.
While on the transportation topic, driverless cars are being developed that will have the potential to allow cars to become point of care. This new technology can take some of the burdens away from emergency transport services and allow better patient care. Some governments are already considering driverless ambulances, which would work as “medical taxis.” They would collect low-risk patients and take them to the closest clinic or hospital for treatment. Introducing these ambulances would see a reduction in the need for paramedics to respond to every call.
However, it could be slightly less comfortable for patients to hop into a driverless vehicle to go to the clinic to begin with. Imagine your wife going into labor in a driverless ambulance – an idea we may have to get used to!
A possible emergency scene from the future
The use of digital technologies can help patients get care faster and more efficiently, however, they can also give support to emergency care units in handling scenarios more confidently and safer. With these tools being adopted on a wider scale, critical care patients can gain quicker assistance in a nature that wasn’t possible before. With these new advanced technologies, emergency services have the potential to become more patient-focused and efficient in the close future. The US Department of Homeland Security published an image-based scenario of these high-tech first responders of the future, to help us visualise it.
With clothing made of light, smart materials that would protect the wearer from punctures and gunshots, they may easily switch on their clothing’s high-visibility mode if they work at night or in dark locations. Wearables and sensors could potentially monitor their own fitness and health while detailing their location. First responders, using driverless ambulances, would have time to receive patient data and prepare for the situation on route to the scene. This would enable them to take the correct equipment to the patient in need. With a digital tattoo, sensor, or wearable, it would be far easier to track patient data and monitor vital signs. Also, with the help of exoskeletons, patients could be lifted without the need for much effort.
The emergency services of the future look more data-based, efficient, streamlined, and quicker than ever before, while considering the limitations of caregivers and ensuring the needs of the patient. Hopefully, within a few years, there will be a lower wait time for the receipt of proper care. In the meantime, knowing how to provide CPR in an emergency situation will always come in handy, so be sure to study the method so you can help others.