Tanner Morgan

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Research Assessment #5
Date: October 26, 2018

Subject: Emergency Medicine

Analysis:

As a result of my research last week, regarding the history of emergency medicine, I

decided to focus on the future of emergency medicine this week. This week I read an article
entitled “The Future of Emergency Medicine: Innovations Making Patients The Point-of-Care”,
which discusses various technologies and inventions that have developed to help with patent in
the field of emergency medicine. These inventions range anywhere from apps to connect with
emergency responders to a medical drone that assists with patient care, even before EMTs arrive
to the scene. Upon reading the list, I was fascinated to see what can be expected from emergency
medicine, just over the next several years and comparing it to what we had just forty years ago
when paramedicine was nonexistent.

Whenever there is a medical emergency, the difference between life and death could
depend on the speed and efficiency of the emergency response team. For some patients like
cardiac arrest patients, brain death begins to occur in around four to six minutes, meaning first
responders have to be especially fast. Around the world, there are different methods used to get
the necessary care to patients, the two biggest are Anglo-American and Franco-German. They
basically mean “patient to hospital” and “hospital to patient”, respectively. In the Anglo-
American model, fewer patients are treated on the spot but are rushed to the hospital as fast as
possible for treatment. However, the Franco-German model is the opposite, doctors tend to go to
the scene of an emergency to treat the patient on site and paramedics are there to assist the
doctors. Even though there are these different strategies for patient care, providers from each of
these backgrounds can agree that there is much development that can and is being done to
improve the field of emergency medicine.

The first mentioned tools in the article are all apps for various purposes such as
communication between EMTs and hospitals, one to document and help with the administration
of CPR and even one that acts as a videogame to stimulate the performance of airway
procedures. The first app is called Pulsara and is used for communication between EMTs and
staff in the ER, they can share pictures of the patient, their vitals, their ETA and what resources
they need once they arrive. This is actually very helpful, all too often there are gaps in
communication, the hospital does not have the resources and the proper people do not show up,
Pulsara can fix all of that because it gets in direct contact with the hospital staff. There is also an
app called Full Code Pro, it allows you to keep accurate records of what happens in a situation of
cardiac arrest. It allows you to keep track of shocks, chest compressions and counts them for you
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if you use the metronome feature. You can than relay accurate information with others without
having to worry too much about documentation.

There are more helpful new tools that are not just apps on your phone, they include
handheld ultrasound devices, blood tests and ECGs. The most interesting piece of equipment I
found was the i-STAT testing equipment, which is a blood test that gives you the same
information as a standard lab test but in just two minutes and in the palm of your hand.
Emergency personnel can use this to find problems, increase the speed of decision making to
find a solution in as little as two minutes. Another tool that I came across was a device that
connected to an app on your phone, called Smart Heart Pro. Users can create a 12 lead ECG on
their phone or tablet, wirelessly and with just as much accuracy as there would be with a
standard bedside exam.

Lastly, the article mentioned two items that I found very intriguing, drones and driverless
ambulances. Google, the technology giant with a surprising medical background, has patented
drones that can fly supplies to the scene of a medical emergency with whatever supplies you
need. The University of Toronto has also been experimenting with drones that can deliver
automated external defibrillators (AEDs) to the scene of an emergency and even having it where
the dispatcher can see through the attached camera and walk you through the steps of cpr. They
are able to move very quickly to the scene, lowering response time to a quarter of what it is in an
ambulance, and are already starting to be used in the Netherlands.

Finally, there was the discussion of driverless ambulances and how they could help the
community. With the development of driverless cars we are expanding our horizons to become
even more useful and are already being considered by some countries. Driverless ambulances
would act more like emergency taxis, to take low risk patients to the hospital. For example, if a
woman is going into labor and needs to get to the hospital, she can call for one and be rushed to
the hospital. It would also have the capability of measuring vital signs passively, notifying
patients if there is something wrong. This technology is already being pursued by Mercedes-
Benz, there could be sensors everywhere the driver touches to detect if someone becomes unable
to drive.

It is safe to say that in the future EMS will become much more streamlined, with the
ability to monitor several patients and communicate effectively with the hospital, deaths are
much more preventable. I personally think it is incredible how far we have come in just a few
years. When EMS was starting out, there was a small chance of survival if one got into a car
crash. Now we can communicate much easier and are well educated, but in the future, pre
planning and patient care will will become much easier. I find it fascinating to imagine much
more effective means for transportation, patient monitoring and almost immediate medical
response, all of this just in the near future.
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Works Cited:
“The Future of Emergency Medicine: Innovations Making Patients The Point-of-Care.” The
Medical Futurist, 8 Aug. 2018, medicalfuturist.com/future-emergency-medicine-innovations-
making-patients-point-care.

Article:

The Future of Emergency Medicine: Innovations

Making Patients The Point-of-Care

The Medical Futurist | 12 minute read

28 November 2017

Every minute spent without treatment could reduce the chance of survival in case of
medical emergency and trauma patients. Digital health innovations making patients the
point-of-care could become a great help for first responders and emergency units in the
battle against time. Here, we collected what trends and technologies will have an impact on
the future of emergency medicine.

Six minutes before brain damage

Car crashes, home injuries, fires, natural disasters. The difference between life and death
often depends on the speed and efficiency of emergency care services. The work of doctors,
paramedics, and nurses being in the first line of the battle against early and meaningless
death or paralyzation is extremely difficult and inspirational at the same time. Sometimes
there are only seconds left to save a patient’s life. In case of high-risk patients, each minute
waiting for treatment significantly reduces their chance of surviving. This includes cardiac
arrest patients, where brain damage typically starts within four to six minutes.
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No wonder that millions of people (including The Medical Futurist team) jittered through
more than 300 episodes of Chicago County General Hospital’s ER starting from the 1990s,
and that the gig ensured a standing place for George Clooney among the biggest stars. The
suggestive power of doctors and nurses saving lives also gave a rise to medical
documentaries, such as the BBC’s An Hour To Save Your Life, the American docudrama
entitled Untold Stories of the ER with re-enactments of real-life medical stories or the more
recent incarnation of ER, entitled Chicago Med.

Patients to the hospital or hospital to the patient?

In spite of the impression through the television screens that the emergency department is
one of the most important medical specialties, the field is relatively new and it is mostly the
product of the accelerated, globalized world we live in. Some experts say that modern
emergency medicine services were first developed in the United States in the 1960s; as a
response to the increased number of traffic accidents due to the boom of cars on the newly
built American highways. Later one, the United Kingdom, Australia, Canada, Hong Kong,
and Singapore followed shortly thereafter, developing their respective emergency medical
systems in the 1970s and 1980s.

While the aim of emergency care is the same in every country – providing timely care to
victims of sudden and life-threatening injuries or emergencies in order to prevent needless
mortality or long-term morbidity –; two different approaches emerged. The Anglo-
American model represents the “patient to the hospital” practice, while the Franco-
German model means the “hospital to the patient” way of thinking.

The latter is used in most European countries, and it means that medical doctors supported
by paramedics treat more patients on the scene of an accident or in their homes before
bringing them to the hospital, thus emergency care happens on the scene or en route to the
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hospital. In the case of the Anglo-American model, fewer patients are treated on the spot,
and they rather transport the injured to the emergency room as fast as possible for
treatment. Currently, countries in the developed world use some practices from both
models, but the latest digital technologies will rather push emergency medicine in the
direction of the “hospital to the patient” approach. Let me show you how!

We collected the latest innovations making it possible to treat medical and trauma
emergencies faster and more efficiently than ever before. Dávid Márkus, first aid expert
and medical student at Semmelweis Medical School, helped us a lot with finding the
relevant directions. He is also the developer of a chatbot on Messenger that teaches people
how to do proper CPR in Hungary.

1) Apps simplifying communication, administration and in-flight

emergency care

Pulsara is a Montana-based U.S. start-up whose app simplifies communication in

emergency care. It allows paramedics to alert an emergency department before arrival
with the patient. It does so not only by calculating the estimated time of arrival based on
GPS, but users are able to attach pictures of the ECG, the injury, the medicine list of the
patient, send the personal data and the parameters of the patient, etc. Alerting the stroke
team/cardiologists or anyone else who might be involved in the treatment of the patient this
way allows the ED workers to prepare much better and faster for the arrival of the
critically ill patient.

On their website, the team said they got the idea when a group of physicians, fed up with
the pitfalls of their current acute care protocols, posed the question at a dinner table “How
can we improve patient care in our facilities?” I hope in the future, they’ll have more
fruitful dinners like this one.

Full Code Pro is a free and easy-to-use app developed by the American Heart Association.
It makes it easy to document critical interventions, a „code” during critical events such as
CPR or cardiac arrest resuscitation. It not only allows the worker to record events (e.g.
shock) with only one tap, measures times, counts down according to the protocol but also
helps the team by having a metronome built in to optimize chest compression rhythm. Full
Code Pro makes it easy to administer cardiac arrests, and also gives an opportunity to
debrief the case so that the team can learn from the collected data as well. Thus, you can
fully focus on the patient without sacrificing proper documentation. A win-win situation!
Dr. Ray Bertino, Clinical Professor of Radiology and Surgery at the University of Illinois
College of Medicine, worked with a team of aviation experts to develop airRx, the world’s
only smartphone app that’s designed to help physicians deal with some of the most
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common in-flight medical emergencies. The app contains the 23 most common medical
emergency situations that could be encountered during a flight, various flight and cabin
crew roles, as well as the medico-legal implications for volunteering to assist. It could give a
piece of mind for doctors traveling on board of an airplane as well as passengers fearing
that something might happen to them while going from San Francisco to Beijing.

2) Video game for practice & 911 chatbot for real situations

Airway EX is a professional video game developed by Level Ex, a Chicago-based start-up

applying video game technology to healthcare. The app allows practicing anesthesiologists,
CRNAs, and medical professionals to simulate the performance of airway procedures. It
provides realistic endotracheal intubation scenarios so that the doctors and paramedics can
better prepare for difficult airway management. The app scores the worker’s speed, the
caused damage, bleeding and also monitors the virtual patient’s vital signs while the
procedure takes place. Moreover, it can be used anywhere – on the subway, at home or on
the Bahamas during holidays (but we don’t recommend that).

The 911bot, a messenger-based chatbot was developed during a Disrupt Hackathon in New
York with the aim to help users in emergency situations. It lets anyone report emergencies
to the authorities through a quick image-based interface, which might be a lot faster than
making a phone call. And as your report is sent through the system, it offers options to
send extra information and pictures or video footage. As most people are frozen when a
lethal or serious accident happens, the app gives advice on how to handle the situation well
and how not to cause even more harm to the injured or bystanders.

3) Portable ultrasound, ECG & other point-of-care devices

The appearance of pocket-sized, user-friendly and portable diagnostic devices make it

easier and faster to treat a patient on the spot. No matter whether it iss ultrasound, ECG or
laboratory testing, behemoth machines are things of the past.

While some years ago ultrasound diagnosis was the privilege of radiologists, nowadays
emergency medical specialists have an opportunity to use bedside point-of-care ultrasound
devices (PoCUS) to answer some yes-or-no questions (e.g. intraabdominal bleeding).
Ultrasound machines such as SonoSite’s or Clarius’ hand-held products allow any doctor
to use them easily while working on a code or a critically ill patient.
Yet, we all know it’s not only about the size. Not so long ago, it was a huge innovation that
a smartphone was able to make a one-lead ECG. However, even if it showed the rhythm, it
wasn’t able to replace standard 12-lead ECG. In many cases, if the doctor does not see all
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the 12 leads, a possible heart attack might be easily mistaken. Now, Smart Heart Pro allows
users to make a 12-lead ECG with a smartphone or tablet wirelessly, which is as accurate
as a similar standard bedside exam.

Luckily, the long-hours waiting for laboratory blood test results will also be over soon with
hand-held, lightweight point-of-care testing (PoCT) devices, such as the i-STAT testing
equipment. Abbott’s fast and accurate blood analyzer allows doctors to evaluate the
patient’s blood sample on the spot and wirelessly transmit the results or the data to
colleagues. Invaluable time gain during emergency situations!

4) Medical drones

Drones have great potential in making the transport of drugs, vaccines or medical aids
faster. Thus, they could greatly support the work of emergency services. Google, the tech
giant with a significant medical portfolio, patented a device that can call for a drone in
emergency situations to fly in with life-saving medical equipment on board. You would
push a button, and a drone would appear on the spot. How amazing would that sound?

And what about drones delivering automatic external defibrillators (AEDs) directly to
people who have just suffered a heart attack? Researchers from the University of Toronto
are already experimenting with the idea based on their inspiration from ambulance drones
in the Netherlands. AED-carrying drones have also been tested in Stockholm with
promising results: it arrived at the patient within a quarter of the time that the ambulance
took to arrive. And drones are not simple transporting machines: they can provide
instructions to the bystanders on providing CPR, using the AED and they also allow the
dispatch team to give feedback via its own video connection. It is estimated that within 1-2
years this lifesaving innovation can take place in the daily routine in Sweden, and hopefully
other countries as well.

5) Driverless ambulances
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As the development of driverless cars continues, the potential for turning cars into points-
of-care and the use of their unmanned driving capacity will become more and more
obvious. There are already some governments considering driverless ambulances as
technology taking some of the strain off the emergency services. These ambulances would
work as “medical taxis”. They would pick up low-risk patients and transport them to the
nearest hospital or clinic for treatment. With the introduction of these ambulances, the
need for paramedics to respond to every call – regardless of severity – would be greatly
reduced. Although it might be less comfortable for people to get into a driverless car to the
hospital at first. Could you imagine sending your wife in labor to the emergency unit in a
driverless ambulance? We’ll probably have to get used to the idea!

Concerning “moving ambulances”, in the future the car will be a place to measure vital
signs passively and store the recorded data in clouds. Then it will either notify the patient if
there is something wrong or keep a finger on the pulse in the long-term. Mercedes-Benz
salesman Rob Tinkham described how one of their cars can already tell if the driver has
become too tired to drive. He added that the seat belt, the steering wheel or practically
anything the driver might touch, can be used as a biometric sensor to gain information
about the driver. It could help detect a drop in blood sugar or an imminent heart attack.
Perhaps, our driverless car will notify the emergency services and the robot receptionist of
the hospital in the future if there is an urgent matter to handle.

A possible emergency scene from the future

Digital technologies not only help patients receive care more quickly and in a more efficient
manner, but they can also support emergency care units to handle situations more safely
and more confidently. The U.S. Department of Homeland Security published an imagined
scenario about how technological innovations would help the work of emergency service
providers 15 years from now.

Their clothing made of smart, light materials would protect them from gunshots or
punctures. They might easily turn on the high-visibility mode of their clothing if they go to
dark places or work at night. Sensors and wearables would monitor their own health and
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fitness while providing their location. Using self-driving ambulances, first responders
would have the time to prepare for situations and receive patient data already on the way
to the scene. This could help bring exactly the right equipment to the patient in need. It
would be easier to access patient data and monitor vital signs through various sensors,
wearables – or digital tattoos. Moreover, with the help of exoskeletons, first responders
could lift patients with less effort.

The future of emergency services looks more streamlined, data-based, efficient and faster
than ever before, while both taking the needs of the patient and the limitations of
caregivers into consideration. So, hopefully, within a couple of years, no one will have to
wait for an unnecessarily long time until getting proper care. Yet, knowing what to do in an
emergency situation or how to do CPR will come in handy anytime, so check out this video
and keep stayin’ alive!