Telemedicine Becoming Reality for Prehospital EMS

     Telemedicine is not a new technology. It's been around for years, although it typically hasn't received much attention. Until now. With the growing availability of broadband wireless systems, people across the country are taking notice of a technology that could change the entire face of EMS. One city with a lot of forward-thinking people is Tucson, AZ.

     "We're running two pilot programs: an Alpha truck, which is a social service-type program, and the ER Link program, which is a telemedicine unit," says David Ridings, assistant chief of the Tucson Fire Department's EMS Division. "The ER Link program is a groundbreaking exercise in placing live streaming video in the back of ambulances that will transfer to local hospitals. We're still in the secondary phase of equipping all the ambulances with the video and completing the hospital equipment placement, and there is a training component for all the department's paramedics."

     By the time you read this, the program should be up and running in conjunction with the University Medical Center—the regional trauma center attached to the University of Arizona.

     "We're going to limit the program initially to trauma and expand to medical illnesses later on," Ridings explains. "There will be a video camera on the outside of each ambulance and one in each patient compartment that will include video, audio and data transfer through a wireless mesh network from a moving ambulance to telemetry units at the trauma center via radio receivers attached to traffic signals or light poles within the city limits."

     The primary advantage of this technology, says Ridings, is the ability to better prepare the hospitals for the patients they're about to receive.

     "The hospitals will be able to mobilize their response to trauma based upon what they see in the patient from the field," he says. "They can see and talk to the patient and view the accident scene. The live video on an accident scene will show the degree of damage to the vehicles and how that mechanism was transferred to the patients. They'll have a better look at what the paramedics are seeing in the field."

     A future goal for Tucson is to add telemedicine to the already-existing Alpha truck, which responds to chronic, or frequent flyer, calls to the 9-1-1 system.

     "Instead of the old cycle of alcoholics and system abusers who constantly drain the system by putting demands on it, we hope to add video to the trucks and use doctors as intermediaries to acknowledge that these people don't have to come to the ED if they aren't emergent," says Ridings. "We run about 72,000 calls in Tucson a year, and approximately one-sixth, or 12,000 calls, involve nonemergent medical care, which places a huge burden on the prehospital system. Any tool we have to alleviate that problem is a benefit to us."

Why the long wait?
     If telemedicine can solve so many problems, why is it taking so long to catch on?

     "Much of it has to do with the communications infrastructure and computing power," says Michael Smith, president of New Jersey-based General Devices, a producer of voice and data communications equipment and telemedicine systems for EMS. "Three to four years ago, mesh technology was something people were playing with. Now, those systems are being sold in most U.S. cities and will become commonplace in a few short years. More than 300 large cities have bought broadband wireless, so it comes in at a fairly reasonable cost and it's enormously powerful. Being able to have 700 kilobits per second or 2 megabits per second come out of a moving ambulance is astounding. In Tucson, that means they can be connected anywhere they want to be. With the Internet, anywhere can be literally any place in the world. Second, the cellular system has gotten much better and people are starting to see the capabilities of their cell phones that have cameras in them.

     "The other factor is computational powers," Smith continues. "You can now take a PC and shrink it down to a fairly small size so it becomes a hub inside an ambulance, and that's what we've done. Our CarePoint, which is intended to address EMS needs in the emergency department, can now do the same thing in an ambulance. The applications are limitless. Because it has a powerful computer, that telemedicine system can be used to send ED status reports and handle logistical and supply issues, as well."

     Because telemedicine deals with patients at a distance, it's easy to assume that its best application is in rural areas; however, technology, not distance, is what determines its use.

     "The issues really revolve around how long it takes to get a patient to where he's supposed to be," says Smith. "In telemedicine, that's known as the time-space barrier. We all tend to think of rural as being long transport times, but try to get an ambulance across Manhattan on a snowy day and it's no better. I don't think anyone will really know for a while where telemedicine will best serve. Stroke assessment is one area where telemedicine definitely fits, and I think it's just a matter of time before that becomes as routine within EMS as 12-lead ECGs.

     "EMS leaders are beginning to realize this is coming at them whether they want it or not," Smith adds. "Even those who don't agree with the technology are beginning to see it on their radar screens. Telemedicine is the future of EMS."