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.
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 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 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 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
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 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!