Technology Improving Patient Care, Operational Efficiency

Sept. 07--At the start of the shift at Cumberland Goodwill EMS in Carlisle, an EMT or paramedic can check the contents of the truck and then get the necessary refills without doing inventory by hand.

That wasn't the case a number of years ago.

Previously, EMS personnel had to check off what they had, find out what they needed for the shift and then get each individual item. Upon retrieving the items, they would have to mark down everything they took to keep track of the inventory.

Instead of that process, each person now can enter all of that information on the truck's iPad, which is connected to a company-wide network that tells Robert Pine, the chief, when things need to be reordered. The reordering is also simple; a click of a button leads to the order going to the supply company.

Nathan Harig, the assistant chief of Cumberland Goodwill EMS, said technology is making everything a lot easier and is also helping the patients fare better.

"The only reason we're doing any of the technology stuff we're doing now is for data," he said. "Because (it's) based off of data, we make better patient care. So everything that we're doing with the iPads, our supplies, it is geared towards making sure that we can measure how good of a job we're doing with patient care because again, the big challenge with EMS is we're looking into the health-care realm. The only way you're going to get paid for it is if you prove your value in doing all that."

Along with the iPads, the ambulances at Cumberland Goodwill are hot spots, so they can connect to the Internet and transmit certain information to doctors before the patients even get to the emergency room. That information can give a doctor a heads up on a patient's condition so they are better prepared by the time the ambulance gets to their doors.

West Shore EMS Executive Director Paul Christophel said their trucks are also wireless hot spots, so they can transmit 12 leads to the doctor ahead of time. One of the hardest things Christophel said he sees with technology is that they have to update more often as new advancements become available.

The new technology that exists will only get better and more sophisticated, but as it does, it will get more expensive and will have to be replaced more frequently.

Equipment and software

Harig said he often keeps up-to-date on new programs and equipment because it can only make the job easier. Something so simple, such as an application that allows someone who is CPR certified to be alerted when someone near them is in cardiac arrest and where the closest AED is, can help save lives. This application is in the works, but not yet in the Midstate.

Right now, the biggest technological changes to the way Cumberland Goodwill runs have been the iPads, as well a device that allows someone performing CPR to know if it's the right depth on the person's chest. They also have a device that can do the communication. The new devices seem simple, but they can help increase the survival rate of the patients, Harig said.

At West Shore EMS, Christophel said they are also using the CPR assist tool that Cumberland Goodwill uses. However, they also have a monitor that can measure the exhaled air from a patient, which can give them a better indication of that person's condition.

They also have the ability to start an IV in someone's bone instead of a blood vessel, which is easier to do in a moving vehicle and less painful for patients who either have really small veins, or when it's a dire situation and no one can get the standard IV started.

For a company newly offering advanced life support like Shippensburg Area EMS, Sharon Boyles, a volunteer EMT, said technology is making everything both more efficient and more complex. With computers that can gather a lot more data and updated techniques, there is a lot to see over the past 10 to 15 years.

"There's (been) an awful lot of technological changes," Boyles said. "On the way to the hospital, we used to give compressions for a while and then switch so we had fresh people doing compressions. But now you put a tool on and it gives perfect compressions all the way to the hospital, and it never gets tired."

There are many different ideas out there, but everything costs money and requires training to implement, officials said. In order to get the funding for new programs, it has to be proven to be successful -- and in order to do that, each new advance has to be tested. That and Cumberland Goodwill Chief Robert Pine will not approve a change to technology unless it's been proven to help increase survival rates.

"There are definitely times when I'm resistant to change because I want to see if it's actually proven before we make that leap," Pine said. "Sometimes you dump all this money into it, and if it's not going to make the patient walk out of the hospital, why are we investing our money and resources in this? Because ultimately our money and resources need to go into making sure those patients are walking out of the hospital, and until we can prove that, I'm very, very hesitant to spend our money."

Dispatch

While there are a number of improvements in how ambulance companies communicate and personnel do their jobs, only so much can change given that everyone has to be compatible with the county's dispatch system. Megan Silverstrim, communications specialist for Cumberland County, said EMS starts when someone calls 911 and connects with dispatch.

She said technology has helped make it easier to dispatch a call, but it can be difficult to implement because it can't change at just one level everyone has to be on the same wavelength.

"We have to make sure that everyone is able to provide the same service, everyone is talking the same language, everybody is using the same equipment, so that we're meeting the public's expectation and so we're also meeting the first responder's expectations," Silverstrim said. "As far as technology being able to help, you know, somebody can call and tell us an ambulance is in service -- it's a couple of clicks in a computer and it is available for every dispatcher in the 911 center to know. It's actually kind of made that process a little better."

Silverstrim said previously the dispatchers had to write down what was in- and out-of-service in the county, which made it easier to miss something. But now that the county has an electronic system where anyone in dispatch can see what truck is in service, it's easy to map out what the county's emergency response system looks like.

"Not only is it a rat race for EMS, but it is for us as well," Silverstrim said. "A lot of technology is changing that changes what an ALS unit and what a BLS unit can do, so we have to keep up with that. Technology is moving at a crazy-fast pace, too. Whether it be the technology we use to interact with the field units or the technology that they're using on their ambulances to assist people, it's changing at such a rapid pace and we're trying to keep up with it. Keeping up with it is very difficult for us because you don't know what change is coming next or what technology is going to stick around -- and technology is expensive."

Dispatch has to keep everything in check so EMS personnel use the same language and the same type of equipment.

"We have to keep that piece in check so that everyone knows what they're getting and what it can do," she said. "We determine how they're classified (and) what they're called ... As far as other technologies, too, we tell them what kind of radio systems they can use because they have to communicate with us. We tell them what kind of paging device they can use because that's how we're alerting them to incidents. Our CAD system that prints out reports and times to them is through us, so that they can do their (reports). So there's a trickle-down effect in that sense ... and when we decide to change it, they have to change with us."

Starting in January, the entire county will go to an electronic records system. Instead of everyone filling out charts manually, dispatch's information will be pushed into the chart that the responding unit has to fill out, Pine said. This change is something that they are eager to see, Harig said.

Harig said because he is always looking at how to improve the way the job is done, he sees a lot of possible technology that he wants to use or would be helpful. But, since that would affect how the county dispatches, Cumberland Goodwill can't switch on its own -- it has to wait and use what everyone else is using.

"Just because we love something and it works for us, doesn't mean they can necessarily do it," Harig said. "With all of the technology that we use, it should be easy for us to click a button and put our trucks in service. We completely understand their funding and challenges, but for what we see in the area (it would work)."

Copyright 2014 - The Sentinel, Carlisle, Pa.