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Filling the Gaps
Emergency responders have needs. The Department of Homeland Security's TechSolutions program exists to help solve them. Established by the department's Science & Technology Directorate, its goal is to identify capability gaps for the various emergency services that can be bridged with research and development efforts in partnership with industry. The intent is to have relatively short turnaround times in developing new products--in the range of 18 months to 2 years.
In February 2009, the directorate created the First Responders Research Development Test and Evaluation Working Group. This group is part of a new Integrated Product Team, or IPT. At the time of the group's creation, the directorate already had 12 other IPTs in areas ranging from border protection to explosives detection and removal. Since the First Responders group's inception, it has met three more times and created four subcommittees: Law Enforcement, Fire, Emergency Medical Services and Emergency Management.
Those serving on the First Responder Working Group are volunteers--nothing is reimbursed but their travel expenses. Members of the group's EMS subcommittee were recommended by organizations like the International Association of EMS Chiefs, National Association of EMTs and National Emergency Management Association. Members include chief officers from some of the largest EMS systems in the country and some of the smallest, super-rural and frontier systems. The subcommittee's chair is Charleston, SC, EMS Chief Don Lundy; the vice chair is Los Angeles Fire Department paramedic Andy Wordin.
Each subcommittee was tasked with identifying technology gaps that could be addressed by the DHS S&T formula. While the Fire Suppression, Law Enforcement and Emergency Management subcommittees each identified 4-6 potential projects, EMS, being the overachievers we are, identified 13.
The next step was more challenging. Each subcommittee had to identify its top three ideas to focus R&D efforts on. More than one S&T facilitator likened this process to herding cats. One item that emerged from each of the four subcommittees, though, was the need for common platforms in areas like radio communications, electronic data transfer and even battery systems. Whatever was developed from the process needed to be out-of-the-box interoperable with other systems already on the market.
The EMS subcommittee's top three identified projects were:
AMBULANCE SAFETY
One thing we know about ambulance safety is that our fellow medics are being hurt, crippled and killed in these vehicles as they are currently designed and configured. Those in the back of the ambulance are the most likely candidates for injury or worse.
We decided to concentrate on Type 1 ambulances first, as this would include Type 3s and have significant crossover to Type 2s as well. One example of what we wanted to look at is the industry-standard exhaust fan system. There is no actual scientific reason for the volume of air movement/exchange in the back of ambulance represented by the current Triple-K purchase standard. It was a wild guess a contractor came up with for the GSA in the 1970s, when it was writing specifications for ambulances purchased by the federal government. Without any understanding of how the threshold was created or whether it actually works, it has become the de facto standard for air exchange/vent fans in the back of every ambulance in America.
However, with today's concerns about pandemic flu and weapons of mass destruction, does the current air-handling standard actually meet the needs of those riding in the backs of our ambulances? If not, what can be inexpensively developed to meet those needs?
An even greater threat to medic safety is vehicle accidents. Attendants in the back are frequently unrestrained. Projectiles can suddenly be created by unsecured equipment flying through the air. Can our ambulances be built and configured in a way that's safer for occupants in back?
Currently horse trailers transport horses at a 45-degree angle because research has determined that a horse handles the vehicular movements, acceleration and deceleration better at this angle than in the forward/backward configuration used in our ambulances. But we still use dangerous side-facing seats. You can also purchase helmets for horses to wear during transport to protect them from head injuries. Is there a similar item available for medics?
For these and additional reasons, ambulance design and safety became the top R&D priority identified by the working group's EMS subcommittee.
PATIENT TRACKING
Currently, at most MCIs, tracking of patients is done on cardboard triage tags and paper forms. We tackled the subject in two parts: The first goal is to develop a single, universal triage tag. Currently there are more than a dozen available on the market. My service carries two sets, one the standard four-color generic triage tag, and a second, far pricier, set for patients exposed to hazardous materials.
The second goal is to develop an inexpensive, interoperable electronic chip system that will identify MCI patients and track their movement through each stage of the triage, treatment and transport process, and on through to the receiving hospital or treatment facility. This information would be shared and updated in real time to each sector's command station, the three Ts and medical group supervisor, and the EOC and receiving hospitals.
Additionally, the chip would broadcast the patient's triage status: red, yellow, green or expectant/deceased. This status could be up- or downgraded as necessary. Thus a hospital may be notified that there is a major incident response, activate its receiving unit and quickly get a real-time picture of how many patients in what categories there are, know how many are coming to their facility and have solid data to make decisions with (such as canceling surgeries for the rest of the day, bringing oncoming personnel in early, holding over existing staff, etc.). That can all be achieved without EMS having to keep the hospitals apprised.
At the incident site itself, this tag will assist the medical group supervisor and command staff with the actual running of the operation and accurate tracking of patients. It will also assist the treatment and transportation sections in keeping families together.
All of this must be affordable, easy to operate and interpret, and operate under austere conditions and weather extremes.
RESPIRATORY PROTECTION
The final project we identified was respiratory protection. We need something that won't become increasingly difficult to use as the filtering component becomes clogged with contaminant, thus increasing the work of respiration and creating fatigue. This was one of the top three projects identified by the Fire subcommittee as well, primarily for switching to for respiratory protection during the salvage and overhaul portions of firefighting.
Once each subcommittee selected its top three technology gaps, the next step was to peruse existing research to see what had already been done and what might be used as a springboard for further efforts.
The working group will meet again this month to evaluate what we've learned from our initial research and map out a practical strategy for the next phase of research and project design. Anyone who has suggestions or ideas they feel the EMS subcommittee may have missed or should be aware of can forward them to us via the DHS S&T TechSolutions website at www.TechSolutions.DHS.gov.
Norm Rooker recently retired as chief paramedic for Ouray County EMS in Ouray, CO. He is a frequent contributor to EMS World.
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