How Data is Changing the EMS Landscape for the Better
BY: KEVIN MCGINNIS
FEBRUARY 19, 2020
I was blessed to have discovered EMS in the early 1970’s, still in its largely “EMS 1.0” developmental stage as a horizontal taxicab service. I was a devoted soldier in its “EMS 2.0” evolution as a continually improving 911 response system, and in its recent “EMS 3.0” launch as a robust team player in improving appropriate access to health care and overcoming unmet health care needs in our communities*.
My day job over the past 45 years has been to improve EMS systems: as a service chief, emergency department director, regional and state EMS director, consultant, and energetic participant in national EMS initiatives such as FirstNet. My night job has been, for most of that time, in the back of an ambulance seeing firsthand how well I’d done my day job! In the past twenty years, my attention has been increasingly on two elements that I believe will be keys to shaping EMS 3.0 and our future: information communication technology and community paramedicine. As a largely rural EMS professional, I would like to share some thoughts on how those two elements will help us.
Our ability to collect, use, and share information immediately and to the benefit of our patients and colleagues in the field has been limited throughout the EMS 2.0 years by our reliance on the narrowband radio and cell systems that have dispatched us, enabled voice communications, and allowed EKG biotelemetry and other limited data to be communicated. With FirstNet broadband communications** and evolving technology to help us collect, use and share real-time patient and situational awareness information, that no longer needs to be the case.
Community paramedicine (CP) service is simply using EMS personnel and other resources to provide access to health care that a community in a structured way outside of a hospital. There are as many forms of CP as there are different health needs in different communities. The new Center for Medicare and Medicaid Innovation’s Emergency Triage, Treat, and Transport (ET3) pilot model is a version of CP.
I recently visited a small, rural community up an eighty-mile river valley from the nearest community of sufficient size to have a small hospital. They are wrestling with affording after-hours coverage for the rural health clinic. A volunteer ambulance service ride down the hills on the two-lane road to the community hospital is the only other access to health care at those times. Several encounters with deer and a moose caused me to imagine a car crashing off the narrow road and illustrates where we are today and where EMS 3.0 will soon have that town and the rest of us in the near future.
On that valley road it could take 20 minutes or much more to discover that a bad crash has occurred (16 minutes on average in my rural state), another 20 minutes or more for an ambulance to arrive and determine overall crash severity, and several minutes per patient to further determine the severity of injuries and communicate this to other responders and hospitals. Add time required to do extrication, get a helicopter to the scene and then to a trauma center (two and a half hours by ground if no helicopter available), and anyone’s definition of “Golden Hour” is jeopardized.
FirstNet and accompanying AT&T coverage is scheduled to light up towers up and down that river valley soon (also serving a heavy year-round tourist and trucking trade). Advanced automatic crash notification (AACN), such as. On-Star©, automatic response protocols based on AACN prediction of severe injury in a crash, and appropriate data communications through FirstNet and NG9-1-1, change this picture dramatically. So too will community paramedicine telehealth service
Back to the crash, a burst of data from the crashed car can, in seconds****, simultaneously appears on the devices of first responder EMS and ambulance crews, extrication crews, the medical helicopter, trauma center and local hospital teams who react according to protocol. Their device screens show the relevant data points about the crash, the three vehicle occupants, and of those alerted.
In seconds, rather than tens of minutes, the system knows where the crash is and how severe the worst injuries are likely to be.
The medic of the first ambulance on scene initiates a heads-up display streaming video and transmits it into a secure web portal for the incident. Simultaneously, she uses a throat-microphone and voice-to-text app and dictates her findings and actions into the cloud based secure electronic patient medical record. Using a stand-off vital signs monitor, she determines that all three patients involved are alive, but one has life-threatening vitals.
To the severely injured patient, she attaches a multi-vital signs mini-monitor and begins sending data to for the “red” patient to the web portal. Using the patient’s health ID number, sent to a regional medical record repository, she copies the patient’s emergency health record into the portal for that patient. Within 90 seconds or so, the portal has robust patient and incident information and can be accessed by incoming responders or other medical personnel.
The second, “yellow”, patient has vague abdominal complaints with no visible injury or other issues and appears stable. EMTs use portable ultrasound, under the real-time audio-video guidance of a trauma center physician who is interpreting the images remotely. Ruling out internal bleeding, they send the patient via ambulance to the community hospital for further exam while the first patient is transported by helicopter to the trauma center.
The third patient has an abrasion and is sore from seat belt and airbag contact during the crash. A telemedicine two-way video link us established with the physician’s assistant (PA) covering the clinic and treatment in place is provided by the EMTs and the patient needs no further care.
The result? At least forty minutes spared from system response delay, a dozen or more minutes saved in patient assessment and reporting, one patient sent efficiently to lifesaving care, the second patient spared tens of thousands of dollars in unnecessary helicopter and trauma center costs, and the third patient treated appropriately, with minimal delay, and the ambulance reimbursed by Medicare for ET3 “treatment in place.”
Lighting up that rural valley and town with FirstNet is brand new, using technology and telemedicine such as two way video and portable, remotely interpreted ultrasound is new, and the ability for ambulance services to be reimbursed for anything but to transport to an emergency room is new. ? How about telemedicine-supported CP care? What an exciting time to be in EMS!
**** AACN systems will need to evolve away from dependence on people at call centers manually passing call information to 9-1-1 systems to achieve this speed. This is an organizational, not a technological, issue.
About Kevin McGinnis
Kevin McGinnis, MPS, Paramedic Service Chief (Ret.) has been an EMS system builder since 1974. He is the communications technology advisor for five national EMS associations, and program manager for public safety communications, rural EMS and community paramedicine for the National Association of State EMS Officials (NASEMSO).
He received undergraduate and graduate degrees from Brown University and Cornell University in health care delivery systems and hospital administration. Kevin has been a paramedic, a paramedic service chief for volunteer, private, and hospital-based services, a hospital emergency department director, and Maine's state EMS director.
He is the past Chairman of the U.S. Department of Homeland Security's SafeCom Program and continues to serve on its Executive Committee. Kevin is Vice-Chair of the Governing Board of the National Public Safety Telecommunications Council and was bestowed its top honor, the Richard DeMello Award, in 2017.
Kevin has been an energetic promoter of the nationwide public safety broadband network since 2006. In August, 2015, he was named by the U.S. Secretary of Commerce to a second three-year term on the First Responder Network Authority (FirstNet) Board of Directors and termed out in October, 2018. He currently serves as the NASEMSO representative to the FirstNet Public Safety Advisory Committee. In 2018, Kevin received the Journal of EMS “Top Ten Innovator Award” for his FirstNet work. He was named by the Government Technology/Solutions for State and Local Government magazine as one of its 2013 “Top 25 Doers, Dreamers & Drivers in Public-Sector Innovation”.