Emergency medical services (EMS) teams are often the first responders for patients having emergency health issues. When timing and accuracy are of utmost importance, they must be exactly sure of what each patient needs. Some medical events require expertise best provided by a specialist. Depending on the distance to a medical facility or emergency department (ED), patients rely on the treatments given in the ambulance or at the scene. Rural areas are especially challenging due to longer distances between patients and EDs. Delaying patients’ access to critical treatment can affect outcomes and recovery times.
A partnership between Emory University and the Washington County Regional Medical Center (WCRMC), with a grant from the U.S. Health Resources and Services Administration (HRSA), has produced the PAVES (Prehospital and Ambulatory Virtual Emergency Services) program. Spearheaded by Michael J. Carr, MD FACEP FAEMS, this program was designed to expand and improve the quality of emergency care for residents in Georgia, especially those in rural areas, to eliminate the access disparity and to bring it on par with emergency care in urban cities.
PAVES brings EMS-focused telemedicine services to emergency medical technicians (EMTs) and paramedic staff treating patients across Georgia. Ambulance staff can remotely diagnose, triage, treat and route patients to the closest local care facility best able to care for the patient.
Telemedicine brings the specialists to the patient
WCRMC is a rural hospital located in Washington County, Georgia. By providing telemedicine services supported by the PAVES network, WCRMC doctors and specialists can better support EMS staff and patients by directing care decisions while the patient is en route to their facility.
A mobile system connects medical professionals in the WCRMC ED and specialized medical experts in the region with the EMS first responders. By using video and audio, the EMS staff can leverage the support of the remote medical consulting teams to most accurately and safely diagnose patients and begin their treatment. The use of video has dramatically improved the quality of emergency care and depth of information available, without adding to EMS staff workload.
The technology:mobile decentralized paramedicine
The WCRMC hospital ED connects to EMS staff through rugged medical tablets mounted within the ambulances. The 313MD medical tablets from DT Research are antimicrobial, fanless and military-grade rugged with responsive, robust sunlight-readable touchscreens for detailed imaging. The tablets have front and back cameras to capture video and images. An Axis M5075-G PTZ pan-tilt-optical zoom camera added in the ambulances provides a hands-free visual feed to clearly show patient status to remote medical personnel. The medical tablets use Microsoft® Windows® IoT Enterprise operating systems, which streamlines integration with the ED system and swyMed telemedicine software, with strong encryption and high-quality audio/video capabilities for mobile point-of-care wherever the patient is located.
The swyMed software connects through the Microsoft Azure Cloud to medical tablets at other area hospitals, providing the mobile audio and visual connection from within the doctor’s office to the ambulance. This system provides EMS teams, physicians and other ED healthcare practitioners, as well as medical subject matter experts in separate locations, the ability to view, interact with, diagnose and help treat patients as if they were in the same room.
Improved patient outcome in any location
The PAVES program and mobile telemedicine system have not only improved patient care no matter the location, but they also bring other benefits. According to Michael Padgett, Director of EMS, WCRMC uses the mobile telemedicine system to fill gaps in practitioner availability. Now the hospital can connect the physician in the ED or any location to help, for example, EMS staff interpret an EKG or authorize them to initiate certain medications.
This technology system accelerates crucial medical intervention for stroke victims, explained Tetra Jenkins, a registered nurse and Stroke and Trauma Program Coordinator at WCRMC. Timing is critical to provide essential treatment within a three-to-four-hour window to save a stroke victim’s life or preserve their quality of life. “With this technology, we can kickstart the treatment process in the ambulance,” she said. “The ED physician can remotely initiate a comprehensive stroke scale to assess the severity of the stroke and, for instance, help guide EMS staff in managing the patient’s blood pressure before arriving at the hospital. Starting this process while en route helps stabilize the patient sooner, so when they reach the ED, our medical team can immediately begin other critical life-saving treatments.”
Another key benefit is that the mobile telemedicine system can be used in the field where there are mass injuries. Rather than overwhelming an ER, EMS personnel can treat and stabilize patients on scene, which reduces the urgency of transport. They can quickly set up a field exam room with a connection to doctors at a nearby city or major medical center. Positioning medical tablets at the scene and at other hospitals and connecting with larger health center networks optimizes the level of care provided to patients during critical moments when resources are stretched.
Quality healthcare for all
With the vision to expand and improve the quality of emergency care for all residents, PAVES has illustrated a path for other healthcare providers. By bringing in technology to create a decentralized mobile telemedicine system, they have leveled many of the disparities in medical care experienced in rural environments and during patient surge events. This distributed telemedicine technology enables first responders and EMTs to consult with a variety of subject matter experts, toxicologists and specialists from anywhere to provide the specific expertise needed for rapid, effective responses.
The WCRMC example demonstrates how effective telemedicine – using purpose-built rugged medical tablets and telehealth software – can significantly reduce time to care, expand the number and type of practitioners available to treat patients and improve patient care overall.
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