Since 9/11, emergency medical services teams across the country have been looking at ways to improve field operations during catastrophic emergencies. “Getting equipment through a debris pile could take minutes, or sometimes hours, depending on where the victim is trapped,” said Mike Kurtz, the medical team coordinator for the Pennsylvania Urban Search and Rescue (PA USAR) Task Force. His group is one of 28 federally mandated specialized task forces in the United States mobilized in emergencies involving mass casualties or collapsed structures.
“Sometimes, my group gets into confined space they can barely fit through,” Kurtz explained. “So they need smaller devices to get into those areas and rapidly evaluate a patient’s need for treatment.” Some of the technology they have since implemented can prove beneficial to other medical organizations that depend on immediate access to data in the field. Let’s look at one solution that is already paying off for this team.
Med-Media to the rescue
When his team returned from the World Trade Center disaster, Kurtz decided to investigate technology that would help medical personnel perform triage more easily under adverse conditions. He turned to a source already familiar to him: Med-Media, a Harrisburg, PA-based software company specializing in public safety solutions. As a full-time employee of the Life Lion Air Medical Service out of Penn State University Hershey Medical Center in Hershey, PA, and a volunteer at the Dauphin-Middle Paxton Ambulance Service, Kurtz was a daily user of Med-Media’s medical reference software on his Palm personal data assistant.
“What we were looking for was to lighten our load,” said Kurtz. “The USAR medical team already carries about 60 pounds of equipment to do their jobs. Typically, they take three reference guides with them whenever they are called out,” explained Kurtz. He refers to a fire and rescue guide, an emergency medical services guide, and an emergency response guide that informs the medical team of the latest protocols, toxicology, hazardous materials, and other critical data. The three flipbooks together are about five inches thick—a lot of bulk to cope with in a confined space.
To add to the challenges, one of the first diagnostic tools used in a disaster situation is an EKG machine. Weighing about 20 pounds, the typical cardiac monitor is about the size of a home fax unit. If the emergency response team could find a more compact device, one better suited to the confined spaces they usually faced, Kurtz felt his USAR team would be able to assess victims the moment they found them, rather than losing precious minutes waiting to diagnose them after they’d been extricated from the rubble.
What Med-Media offered the PA USAR was a completely off-the-shelf solution of compact hardware and comprehensive reference materials that could aid the team in rapid diagnostics even in the tightest of spaces. The package included:
- Palm m515s in ruggedized titanium cases
- A comprehensive medical reference software library
- ActiveECG, a pocket-sized cardiac monitor
- R-EMStat, an electronic patient data collection system
“A Palm handheld is about a tenth the size of a standard EKG monitor,” explained Kurtz. “And the miniature cardiac monitoring device is about the same size as the Palm.” Compact and lightweight, the two units connected by a simple PC cable make it feasible to do the critical initial assessment on the spot, even in the most precarious environments.
Having a comprehensive reference library embedded on the Palm gives response team personnel instant access to the most up-to-date emergency services information during a disaster. The library is Med-Media’s electronic version of three popular pocket field guides published by Portland, OR-based InforMed: the EMS Field Guide, the Fire Rescue Guide, and the Emergency Responders Terrorism Guide. The paper-based versions of these guides have been in standard use by emergency service professionals for more than a decade. The three electronic versions sell for $29.95 each, with the software regularly updated by Med-Media through a standard Web connection.
“The nice thing about having all this information on the Palm,” said Kurtz, “is that you simply put it in the cradle to get updates. You don’t have to go out and buy a whole new manual. It makes it so much easier to keep abreast of the latest medical treatment protocols, toxicology [poison], and drug lists.”
The ActiveECG software runs as a Palm OS application, allowing the medical technicians to view patient heart activity on the Palm screen in real time. The software also allows paramedics and other medical professionals on the scene to store, print out, and even beam the ECG strips via e-mail to another location for viewing, interpretation, or archiving.
The R-EMStat software collects patient care information at the scene. The software allows personnel to capture patient demographics and medical status on the Palm via Graffiti, a keyboard, or by checking boxes with a stylus. The resulting report can be transmitted via wireless connection to state and local emergency management centers and 911 centers to expedite the care of the patient at the receiving emergency room facility.
The goal is to triage victims at a disaster site and send the diagnostic data in real time to a command cell that would then forward the report to the hospital that would be receiving the patient. That command cell could be one of the state or local emergency management centers or 911 centers reviewing victims’ specific medical needs and dispatching them to the facility best equipped to handle those cases. “With real-time information,” said Kurtz, “these command centers could streamline the flow of patients from a disaster site to the proper medical facility. This would avoid overloading any one hospital emergency room or trauma center.”
For the past two years, Med-Media has been field-testing this process with 17 hospitals in eight counties in South Central Pennsylvania. Called the Hospital Status Incoming Patient Notification program, the Web-based tool eliminates many of the hassles, errors, and inefficiencies associated with traditional communication protocols during an emergency. The software helps authorized emergency personnel make timely decisions on a patient’s destination by allowing them to check bed availability at participating facilities. Once the destination has been determined, ambulance personnel can transmit non-confidential patient data wirelessly to the destination hospital’s Web site.
Richard Pizzarro, president and CEO of Med-Media, explained that the software is designed to avert the communications bottleneck that often occurs at the command center. In an emergency, the dispatcher is fielding 911 calls, trying to answer radio transmission from inbound ambulances about the condition of the incoming patient, and then finding a spare moment to relay that critical data to the appropriate hospital. Precious minutes are often lost depending on how long it takes the dispatchers and emergency room personnel to answer the radio.
“We’re cutting the 911 dispatcher out of the loop,” said Pizzarro. “The ambulance can notify the hospital directly that it’s coming and the status of the patient being brought in.” The patient information being relayed by the ambulance personnel can be printed out on the hospital’s emergency room computer so that it’s ready for the ER doctors to review when the patient arrives. It can also be kept on the hospital’s computer as part of its intake log.
To ensure HIPAA compliance (a federal regulation governing patient record confidentiality), the patient medical data can be transmitted without the demographics information that would reveal a patient’s identity. For instance, the initial report sent to the destination hospital would only indicate that the incoming patient is a 25-year-old male exhibiting chest pains. Once at the hospital, ambulance personnel can do an infrared printing of the complete patient record before leaving the ER.
Eliminate duplicate entries
Ultimately, Med-Media would like to see hospitals take the data collected from the ambulance personnel and input it directly into their own systems. This would save the facility the need to recreate the patient record from scratch. “We’re working on some projects right now that would close the whole patient encounter to patient outcome loop,” said Pizzarro.
However, given the diversity of computer technology used by the hospital industry and the incompatibilities created by such diversity, that dream is currently out of reach. “We’d love to have a single digital record follow the patient all the way through,” said Pizzarro. “That’s not going to be the norm, or even close to the norm, in most parts of the country. But that’s where we’d love to be able to go.”
In the meantime, Med-Media knows that the triage tools it’s providing emergency medical services and homeland security teams with are offering paramedics and physicians the edge they need to give emergency victims a better chance for survival.