AMBULANCE TELEMETRYJirawat Juengsiragulwit

Sappasitthiprasong hospital, Ubon

Disclosed

Outline

• Telemedicine

• Ambulance telemetry

• Ubon model and the key success to ambulance telemetry

Telemedicine (โทรเวช)

• The use of medical information exchanged from one site to another via electronic communication to improve patients'health status.

Telemedicine services

•Specialist referral services

•Remote patient monitoring

• Patient data transfer

• Medical education

• Consumer medical and health information

• Tele-radiology

• Tele-pharmacy

• Tele-dermatology

• Tele-ophthalmology

• Tele-pathology

• Tele-consultation

•Tele-ambulance

• Tele-ACS

• Tele-stroke

• Tele-trauma

2515 สมเด็จพระศรีนครินทราบรมราชชนนี ทรงพระกรุณาโปรดเกล้าฯให้ดําเนินงานหน่วยแพทย์ทางวิทยุครั้งแรกในประเทศไทย พระราชทานนามว่า...

“แพทย์อาสาทางอากาศ”

Pass about 40 years

• Advance in mobile device technology

• Advance in social network communication

ICU mobileอดีต = ICU ติดล้อ +

ปัจจุบัน = ICU ติดปีก +

Ambulance Telemetry

• Evaluate, Diagnose, Monitoring, Treat

• Patient in mobile bed

• from remote location or prehospital area

• Data roaming via telecommunication

Lifebot project, under US army development

• Telemedicine life support system

• Texas : $14 million advanced EMS ambulance telemedicine and disaster manage system.

• Important in remote areas where transport times may be prolonged ; act to protect ambulance personal and providers during difficult situations.

Why ambulance needs telemetry?

• Moving vehicle needs continuous data transmission

• Complex clinical scenearios

• Difficult to interpret EKG rhythms

• Assistance in patient monitoring

• Destination decisions

• Assistance with-non transports

COMPOSITIONS

• Data roaming

• Medical device

• Encounter management

• Connectivity

• Hardware configuration

Data roaming

• Text

• Picture

• Voice

• Video

Medical device

• Lifegain : Defibrillator with Bluetooth.

• Camera set

• Notebook + air card for Internet access

• Workstation computer server

Encounter management software

• EMS12 MultiviewerDual

• Text/Message chat

• EKG realtime with 2 second delay

• Snap shot picture 2 pics./sec.

• Voice IP

Connectivity (wireless computer network)

1.Global System for Mobile communication

• General Packet Radio Service

• Enhance Data rate for Global Evalution

2.Code Division Multiple Access communication

3.Wideband Code Division Multiple Access communication

4.WiMAX

CDMA

Clinical effectiveness

• Monitoring

• Critical decision and management

• From "what's coming in the door"

To "I knew and I'm waiting you"

Now then "OK, you've already treated."

Old tradition

Some private hospital

UBON

Megaproject

Tablet + 3G = วาระแห่งปี

Brief history of Ubon ambulance transfer

• Zone 13 = 56 Hospitals (อุบลศรีโสธรเจริญ) Cover : อุบลราชธานี, ศรีสะเกษ, ยโสธร, อํานาจเจริญ

• อุบลราชธานี = 25 districts

• Before 2549 : BLS ambulance

• October 2549 : Super ALS ambulance

• October 2552 : mini-telemetry ambulance

• Since April 2553 : full option telemetry ambulance

UBON model

• 3 fast tract transfers : STEMI, Stroke, Trauma

STEMI was sent as bypass tract

• Advance in specialized patient care have increased the demand for data communication system.

• We first applied in STEMI patients monitor during interfacility transfer

Upcoming

• Ambulance telemetry protocol

• ICU mobile nurse training program

• Apply social network in advance communication "Referral data registry"

• Add distributive collaboration to online medical control

Not only EP can be online medical control

• Real time evaluation and management of critically ill patients by multiple specialist.

• Assembly of multiple-victim information

• Assistance in diagnostics

• Transfer of care hand-offs

• Homeland security command and control

Key to a successful ambulance telemetry

1. Establish a vision

• How to increase the volume of service?

• Explore overall vision of the organization

• Model approach

- Access to care model

- Cost savings model

- Access to market model

December 2553

• 501 critic patients was transfer by ambulance telemetry

• 91.42% by overall critical interfacility transfer

• 72% applied telemetry during transfer

2. Building a long term financial plan

• Set short and long term financial goal.

• Looking for ongoing revenue (long term sustainability)

• You do not always get what you want but you often get what you measure.

• Show clear outcome and how to collect it

• The death rate in severe traumatic patients who inter facility needed was reduce from 37% to 31%

• Ongoing research

1. Unit cost

2. Compare clinical outcome

3. Create a convenient and effective work environment

• The sending room : device position, lighting and white balance.

• The receiving room (workstation) : directly to consulting physician's workplace or using forward software to physician desktop.

• Simple as possible to use first, technology should be remain in the background.

4. Mainstream telemedicine into the standard care process

• Standard protocol for telemedicine as same as non-telemedicine

• Add : equipment protocol, dispatch, documentation, measurement and billing protocol

• The more change that must be adopted the higher the likelihood of failure

Criteria for activated ambulance telemetry

• Respirator needed

• Impending compromise airway

• Acute coronary syndrome

• Shock or impending

• HT emergency

• Major trauma

• >2 episodes seizure in 30 mins

• AOC protocol

• Obstetric protocol

• Doctor order

5. Plan and assure effective training

• Communication technology

• Clinical technology

• Diagnostic device user training for both send and receive sites

• Workflow and protocols of care and procedures for use of devices

• Documentation

• Trouble shooting and access to product and technical support

6. Make sure you have a full time coordinator and an effective leader and cheerleader

• Clear leader in authority and fly cover the program participate.

• Key man : necessary skills, passion and commitment to serve, encourage user, inform management and assure that the program is properly marketed.

• Full time nurse and technician

• Sending sites person

Key persons

7. A project plan = manageable milestones = Reasonable expectation

• Roadmap should be simple, manageable and reasonable

• Do not over plan and paralyze the project

• Set 5y plan, 10y plan, 20y plan and meet them

New project release

• 5yr : ICU mobile hub, Referal data registry

• 10yr : อุบลศรีโสธรเจริญ

• 20yr : 3D, Robot

8. Horizontal vs. Vertical implementation

• Limited capable but widely use or limited use but super capable

• Consider device option and clinical outcome.

• Telemet needs continuous train and support

• Both tract will reach a future large-scale expansion

9. Good market is clinical

• Set public expectations

• Tell the world the good things you've done

• Tell the world what is coming next

10. Publish or perish

• Presenting or publishing the results or status of our program at least once per year

• Posters, teaching and sharing