Car crashes, home injuries, fires, natural disasters: every minute – if not every second – spent without treatment in such cases of medical emergencies and high-risk patients could reduce the chance of survival or proper recovery. In fact, when deprived of oxygen, permanent brain damage begins after only 4 minutes, while death can occur as soon as 4-6 minutes later. In this race against time, digital health technologies that turn patients into the point-of-care could prove to be game-changers for first responders and emergency units.
From driverless cars through medical drones to artificial intelligence (A.I.), advanced technologies are enhancing the field of emergency medicine. It’s helpful to have a better look at how those technologies are influencing emergency care and what lies ahead.
We talked with Dr. Gabor Csató, CEO of the National Ambulance Service in Hungary (abbreviated as OMSZ in Hungarian), about innovation in the field, given that their own system’s operation is unique. The OMSZ is a centralised, standalone national healthcare institution that has been active for 133 years. It is also the biggest ambulance service in the country and has had a strong inclination towards innovation. “Innovation is embedded in the DNA of the organisation,” the CEO of OMSZ told us.
We have also collected in this article those trends and innovations that are putting the future of emergency medicine on the fast lane. Before seeing how this lane looks like, let’s take a quick glance in the rearview mirror to better appreciate the evolution of the field.
Patients to the hospital or hospital to the patient?
Despite being depicted as a revered, traditional speciality in popular media, emergency medicine is relatively new, being mostly the product of the accelerated, globalized world, we live in. Estimates date the development of modern emergency medical services in the United States to the early 1960s. This happened in response to the increased number of traffic accidents resulting from the boom of cars on the newly built American highways. Later on, the United Kingdom, Australia, Canada, Hong Kong, and Singapore followed shortly thereafter, developing their respective emergency medical systems in the 1970s and 1980s.
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 hospital. In the case of the Anglo-American model, fewer patients are treated on the spot and are instead transported 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.
“An immense level of innovation is experienced in smart healthcare solutions nowadays,” Dr. Csató told The Medical Futurist. So, let’s take a closer look at the latest innovations making it possible to treat medical and trauma emergencies faster and more efficiently than ever before!
1. Artificial intelligence for logistics and capacity allocation
As A.I. impacts healthcare from drug discovery through helping in diagnoses to finding unusual associations, the technology is also finding a new home in the emergency department. Indeed, the OMSZ is using A.I. for logistics and capacity allocation in its day-to-day operation. Given how their operations generate an immense amount of data from the 3000 daily cases and how their cars cover over 40 million kilometres per year, smart algorithms are the logical solution to mine this data for predictions.
“A.I. 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,” Dr. Csató explained, regarding the implementation of A.I. in their practice. “We are also dealing with planning daily capacity allocation within the country. Our vehicles can be easily deployed to neighbouring areas, where we experience capacity peaks.”
In 2020, the software company Hexagon also introduced their A.I. solution for emergency services. Their HxGN OnCall Dispatch | Smart Advisor system mines and analyses operational data in real-time to detect patterns and identify major events as they happen. As anomalies are identified sooner, the insights allow emergency teams to react and coordinate faster
2. Apps streamlining emergency care
According to some analyses, up to 80% of clinical errors are due to miscommunication between medical staff. In emergency care, such errors should be minimised as much as possible and new software programmes can help.
Based in Montana in the U.S., Pulsara is the developer of a HIPAA-compliant platform for EMS, ambulance and emergency management. Its connected mobile app allows paramedics to alert an emergency department before arrival with the patient and prepare beforehand. It does so not only by calculating the estimated time of arrival based on GPS but also by allowing users to share important details like the ECG or images from the field. Some studies even report an average decreased treatment time of nearly 30% when using Pulsara.
To further save precious time, volunteers on the spot can also perform CPR until an ambulance arrives. Dr. Csató told us about the “Szív City” app they introduced in Hungary that taps into this potentially life-saving approach. The app alerts volunteer users of any street resuscitation event within 500 meters of their location. With over 30.000 volunteers using Szív City, the OMSZ doubled the number of successful street CPRs in just one year.
Coming from the American Heart Association is the free iOS app, Full Code Pro. It is a real-time CPR event tracking tool, allowing users to document critical interventions. With a single tap, first responders can log administered medication, start a countdown and even have access to a metronome to optimize chest compression rhythm. The documentation collected can later be reviewed 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!
Emergency care not only happens on the ground but also up in the air. In-flight medical emergencies are very real and digital health technologies are well-suited for those situations. The free airRx app contains the 23 most common medical emergency situations that guide physicians in-flight to assist travellers experiencing medical concerns. For the cabin crew, the recent MedAire Aviation App connects crew members to physicians for guided patient assessment. It has recently been integrated into Icelandair commercial flights.
3. Video game for practice
In a recent article, we explored how gaming features are merging in digital health; and gaming’s influence is expanding into emergency medicine.
The Chicago-based start-up Level Ex develops mobile video games to train medical professionals. Their Airway Ex app for example offers realistic scenarios for doctors and paramedics to better prepare for challenging airway management.
The app scores the worker’s speed, damage caused, 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).
4. Portable point-of-care diagnostic devices
The appearance of pocket-sized, user-friendly and portable diagnostic devices makes it easier and faster to treat a patient on the spot. No matter whether it is ultrasound, ECG or laboratory testing, behemoth machines are things of the past. Nowadays, physicians can literally carry a department’s worth of diagnostic tools in their briefcase.
While some years ago ultrasound diagnosis was the privilege of radiologists, emergency medical specialists now have the opportunity to use bedside point-of-care ultrasound devices (PoCUS) to answer some yes-or-no questions such as intra-abdominal bleeding. Handheld ultrasound devices such as the Clarius and Philips Lumify allow doctors and first responders to easily assess a critically ill patient, no matter where they are.
Yet, we all know it’s not only about the size. Not so long ago, it was a huge innovation for a smartphone 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 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. This is as accurate as a similar standard bedside exam, only available practically anywhere.
Additionally, the long-hours waiting for laboratory blood test results will also be over soon. Handheld, lightweight point-of-care testing (PoCT) devices, such as the i-STAT testing equipment from Abbott, will make this possible. 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!
5. Medical drones for delivering care from the air
Drones have great potential in transporting drugs, vaccines or medical aid at a faster rate. In Rwanda, the medical drone company Zipline delivers medical supplies to hospitals via drones as part of the local healthcare system. This method enables healthcare facilities that Zipline serves to receive emergency blood packs within minutes, instead of hours. For the COVID-19 pandemic, Zipline expanded their service in the U.S. to deliver medical supplies and PPE, entirely contactless.
Another potential for drones in the emergency care setting is to deliver automatic external defibrillators (AEDs) directly to people who have just suffered a heart attack. This concept was already explored by researchers in the Netherlands and Canada. AED-carrying drones were also tested in Stockholm with promising results; they arrived at the patient within a quarter of the time that the ambulance took to arrive.
Moreover, such 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. In 2019, the Swedish drone developer Everdrone announced its partnership with Karolinska Institutet to investigate emergency deliveries of medicine and equipment to critical care patients, wherever they are.
However, such AED drones have rather limited use and haven’t been widely adopted. But we hope that won’t be the case for too long.
6. Easing transportation and the era of driverless ambulances
Lack of proper transportation is a significant barrier to access to healthcare worldwide. Every year, as many as 3.6 million people miss their doctor’s appointment due to poor transportation services. But with ride-hailing services such as Uber and Lyft, transportation issues in healthcare can become a thing of the past.
Indeed, Uber launched Uber Health, its HIPAA-compliant service for non-emergency medical transportation (NEMT). Lyft also expanded in healthcare for NEMT rides to curb missed appointments. Other ride-hailing startups like Circulation, Kaizen Health and Veyo also branched out to help patients reach hospitals in a secure and reliable manner. Circulation even claims to reduce no-shows by 68%.
Still, on the topic of transportation, the development of driverless cars holds the potential to turn cars into points-of-care. The technology can take some strain off emergency services so that patients receive better care. Already, some governments are considering driverless ambulances. 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.
However, it might be less comfortable for people to get into a driverless car to go to the hospital at first. Could you imagine sending your wife in labour to the emergency unit in a driverless ambulance? We’ll probably have to get used to the idea!
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. With the widespread adoption of these tools, critical care patients can receive assistance in a timely manner that wasn’t possible before. And with the emergence of advanced technologies, emergency services will become more efficient and patient-focused in the near future. To help visualise this, the U.S. Department of Homeland Security published an imagined scenario of the tech-powered future of first response:
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 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!
Karin Casares, is a Market Analyst, Clarity 360 EMEA, based in Valencia
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