Dangit' Jim, I'm a doctor, not a computer whiz!
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This document discusses new technologies that could impact emergency medical services. It describes several gadgets for notification, assessment, and treatment including apps for dispatching calls, 12-lead EKG monitors, CPR metrics devices, pulse oximetry tools, and devices to assist with circulation and CPR. The document emphasizes that while new technologies may provide benefits, training will be important to properly use devices and ensure they enhance patient care and outcomes. It poses questions about how tools could change practices and whether benefits outweigh costs.
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Dangit' Jim, I'm a doctor, not a computer whiz!
- 1. Dangit’ Jim! I’m a doctor, Not a computer whiz! By Luke Winkelman, NRP, EMS-I
- 3. Considerations • My thoughts are my own • Medical Director involvement • Train, train, train….then train some more • Current practices are not always best practices
- 4. Moore’s Law
- 5. This means more toys!
- 6. Crunch the numbers • What is the benefit? • How many will benefit? • What is the cost? How will it change what we do?
- 7. So what's new for us?
- 9. eDispatches • Dispatcher hands-free • App auto-plays message • Smart phone & flip phone capable
- 10. eDispatches
- 11. IamResponding • Sends message/location as text • Allows navigation to address via app • Requires dispatcher to type & send message • Allows responders to reply
- 12. IamResponding
- 13. PulsePoint • Bystander notification • Alerts CPR trained of nearby arrest • Shows nearby AED’s • Walks bystander through CPR
- 14. PulsePoint
- 15. PulsePoint • Drew Basse – FF • Scott Brawner - Victim
- 16. What does this mean? • Potential for reduced missed pages • WiFi or cellular data required • Care rendered to critical pt’s faster
- 18. 12-Lead EKG • ReadyLink BLS
- 19. CPR Metrics
- 21. Rainbow SET
- 22. SPCO • Saturation % of CO • Same device SPO2 & HR is measured with • Excellent for FF rehab & dif Dx of flu symptoms http://www.masimo.com/spco/
- 23. PVI • Pleth Variability index http://www.masimo.com/pvi/
- 24. SpHb • Continuous total hemoglobin monitoring http://www.masimo.com/hemoglobin/
- 25. STO2 • Near Infrared Spectroscopy • Measures actual deep tissue perfusion vs just O2 in arterioles
- 26. InfraScan • Near Infrared Spectroscopy • Extravascular blood absorbs more light
- 27. i-STAT • Cardiac biomarkers • INR for stroke pt’s
- 28. Google Glass
- 29. What does this mean? • More information • Objective findings • Targeted treatment
- 31. Electronic Protocols • Current EMS protocols on mobile devices
- 32. ResQPod • Impedance Threshold Device • Boasts up to 50% greater circulation during CPR
- 33. ResQPump • ACD CPR • Not yet approved by the FDA • When used with ITD referred to as enhanced CPR (eCPR)
- 34. Lucas 2
- 35. AutoPulse
- 36. KingVision
- 38. What does this mean? • Patient’s receive higher quality care • Less runs QA’d! • Better CPR means better circulation • Greater ABC management
- 39. Questions?
Editor's Notes
- Moore’s law refers to a hypothesis by Gordon E. Moore in 1965, that affordable technology doubles every 2 years. http://www.mooreslaw.org/
- Medicine is not what it was in 377 BC the earliest mention of bloodletting, it has also progressed by great leaps & bounds since the invention of the first string galvometer in 1903 by Willem Einthoven, which earned him the Nobel prize in 1924. All the inventions in the realm of medical gadgets are designed for a common goal: to help the practitioner identify the underlying problem, treat the problem, and restore the patient to as much function in society as possible. EMS is no stranger to this game! From the moment we step into class we are trained in the use of a pocket mask, a mechanical cot, an AED, KED board, strobe lights and so on!
- What new toys are there for us to play with? Time to rip off the wrapping paper and see what new toys are available for us to play with!
- Gone are the days of the telephone tree when it comes to activation of emergency crews, lets look at what new gadgets are on the market.
- $80mo for 25 member station $233mo for whole county
- $80mo for 25 member station $233mo for whole county
- One time set-up $50 $800yr with discounts the longer the contract term (2yr, 3yr) 2.8c per call $600 yr for stations with less than 100 calls per year
- 225,000 emergency responders use IAR
- A 05’-09’ study in Arizona found a SCA victim was twice as likely to survive if bystander CPR was provided. http://deptmedicine.arizona.edu/node/548 Created on a tiny budget of donations and designed by volunteer programmers, San Ramon Valley Fire Chief Richard Price started PulsePoint after he missed a cardiac arrest in the shop next to the restaurant he was eating lunch in. The service now covers over 675 communities across 17 states, and has been downloaded by over 168k users $5000 http://blog.ctia.org/2014/08/14/pulsepoint-cpr/
- May 9, 2014 Tualatin Valley Fire & Rescue firefighter-paramedic Scott Brawner received an alert that CPR was needed at the same location he was at. He discovered security guard Drew Basse in cardiac arrest and was able to provide CPR until EMS arrived. Scott was recognized in Men’s Health magazine as one of their“10 Men who inspired us” of 2014 http://www.nbcnews.com/health/health-news/heart-attack-rescue-theres-app-n121911
- http://www.medgadget.com/2011/08/physio-control-releases-readylink-12-lead-ecg-for-emergency-responders.html http://www.physio-control.com/ProductDetail.aspx?id=2147484151
- Phillips Q-CPR $1,800 http://www.healthcare.philips.com/main/products/resuscitation/products/mrx/qcpr.wpd Physio TrueCPR $1,800 http://www.geekwire.com/2013/cpr-coach-device-measures-chest-compressions-real-time/ PocketCPR $125 http://www.aedprofessionals.com/pocket%20cpr.html ZOLL AED Plus $1,700 ZOLL X Series
- http://circ.ahajournals.org/content/120/13/1241.figures-only http://www.cnn.com/2013/07/10/health/cpr-lifesaving-stats http://www.physio-control.com/WorkArea/DownloadAsset.aspx?id=2147485455 Average CCF 66% http://www.acutecareresearch.org/studies/pittsburgh/roc-effect-real-time-feedback-during-cpr-outside-hospital http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/27159
- More than 7 wavelengths of light identify compounds in circulation not found with simple pulse oximetry that uses only 2 light wavelengths
- 32,396 pts were screened entering large UK ER, 32 were found to have high levels of CO which was not a main complaint 28 published case studies where CO poisoning was identified using SPCO http://www.masimo.com/emscasestudies/index.htm Worth noting, Medicare will as of 1/1/14 reimburse $6.84 for transcutaneous SPCO testing if it is indicated. http://www.masimo.com/pdf/SpCO/LAB4554H_Information_Sheet_CPT_Reimbursement_SpCO.pdf http://www.masimo.com/pdf/clinical/carboxyhemoglobin/Roth%20Prevalence%20of%20Carbon%20Monoxide%20Poisoning%20in%20Patients%20Presenting%20to%20a%20Large%20Emergency%20Department%202014.pdf http://www.thesilentkiller.net/docs/spco_assessment_mcevoy.pdf
- Helps identify pulsus paradoxus indicative of early decompensated shock from low fluid volume or cardiac tamponade http://www.masimo.com/pvi/ http://www.masimo.com/pdf/whitepaper/lab4583a.pdf
- http://www.masimo.com/hemoglobin/ http://www.masimo.com/pdf/SpHb/LAB5760D_Brochure_Total_Hemoglobin.pdf
- Measures tissue oxygenation to a depth up to 14mm (.55 inch) with or WITHOUT a pulse Sold to Seattle VA for $14,850 https://www.fbo.gov/index?s=opportunity&mode=form&tab=core&id=3073650d8eab7e172d9d8d1a30349b7d
- Used in Richmond Heights Ohio, FDA clearance since 2013 $28,000 Used in Cincinatti & Baylor hospitals Double blind study in Italy assessed 122 children with injury at high risk for hematoma, only 1 ended up having hematoma, which was successfully detected. Other studies had a 98%, 89.5%, 93%, 90%, 100%(covered only 11 non hematoma pts) http://www.infrascanner.com/wp-content/uploads/2014/07/Infrascanner-white-paper-summary.pdf http://www.infrascanner.com/solutions/applications/ http://www.mediccast.com/blog/2013/03/25/infrascan-portable-brain-scanner/ 13:00
- Able to assess troponin in 10 min using whole blood or plasma INR up to 5 min Study in 09 found cardiac marker POC testing shortened length of stay in ED by 20 min http://www.cathlabdigest.com/Patient-Side-Point-Care-Testing-Emergency-Department-Enables-Quicker-Treatment-Decisions-Patients-Ch http://www.health.state.mn.us/divs/phl/labep/mmu/istatproductinfo.pdf
- http://www.timesunion.com/local/article/Her-mission-Pick-out-the-bugs-4624747.php
- ROC-PRIMED 4,345 patient study presented at AHA symposium in 2014 found a 75% increase in survivability when ITD was used http://www.medpagetoday.com/MeetingCoverage/AHA/48632 http://www.jems.com/article/patient-care/future-applications-intrathoracic-pressu
- http://www.massdevice.com/news/fda-panel-votes-yes-advanced-circulatorys-new-cpr-tech
- $14,500 http://www.physio-control.com/uploadedFiles/LUCAS2_PriceList_3303775_C.pdf
- $12,000 http://emergencypedia.com/2014/01/17/push-my-buttons-mechanical-cpr/ 12 different studies were combined in 2013 for a meta analysis published in Critical Care Magazine grouped 6,538pts and found pt’s were 1.6 times more likely to achieve ROSC with AutoPulse vs standard CPR, the Lucas had no statistical advantage over CPR. http://www.zoll.com/medical-products/cardiac-support-pump/autopulse/clinical-studies/ A 2006 study published by the AMA was terminated early when no difference was found when using AutoPulse, however a problem with study methodology was discovered http://www.cardiovascularbusiness.com/topics/prevention/resuscitation-circ-trial-hopes-clear-confusion-autopulse-cpr http://www.procamed.ch/pdf/vergleich-mechanischer-cpr-systeme.pdf
- $1,200 https://www.boundtree.com/video-laryngoscopes-subcategorynode-50-0.aspx http://lifeinthefastlane.com/ccc/video-laryngoscopy/