"EMS telemedicine has the promise of opening the door to many opportunities that will broaden the assessment, diagnostic and management capabilities of prehospital providers. Recruiting a distant physician specialist to enhance the medic’s ability to employ increasingly advanced diagnostic analyses—from complex electrocardiographic interpretation to parsing through difficult patient medical scenarios—can only result in a higher level of professionalism and improved patient care. I am looking forward to seeing EMS cross this new frontier." —Raymond Fowler, MD, FACEP
While emergency medical services appears to be the ideal setting for the use of telemedicine for a variety of reasons, some valid and some not, the technology has been slow in gaining acceptance. What does the future hold for telemedicine? What might it mean to the future of EMS? How does one navigate the technical and operational issues associated with wireless EMS telemedicine? This three-part series will bring the reader up to speed on the current state of development and offer some thoughts as to how to approach this technology. Part 1 will outline its basics and history. Part 2 discusses potential applications and essential steps. Part 3 discusses system examples and lessons learned.
Why Is EMS Telemedicine Important?
As with any new technology or technique, particularly disruptive ones like telemedicine, there are reasons both for and against adopting it. The topic of EMS telemedicine is ripe with all of these, and each facet deserves discussion. What should not be lost in the discussion, however, are the potential opportunities telemedicine presents to EMS, such as:
- Improved patient care: "Just as telemedicine is a proven method of healthcare delivery that allows patients to benefit from remote physician evaluations and leveraging physician manpower, for EMS it provides similar benefits by instantly bringing the physician to the field. Providing the right treatment at the right time allows time-sensitive injuries and illnesses to be addressed sooner, lowering complication rates and hospital LOS. The use of EMS telemedicine may also allow EMTs to avert transporting patients who may not have to go to the ED, saving money and reducing ED overcrowding. All of these things represent big wins for all, including the patient.” Dr. Cullen Hebert, Critical Care Medicine Services, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA
- Accuracy of information: “In many cases, and particularly for serious cardiac events, the most important information about the patient’s symptoms, presentation and state of mind is seen by paramedics in the field. This information is vital to the treatment and outcome of the patient in a hospital setting. EMS telemedicine will give a truer picture of a patient’s condition before any stabilization efforts are started, thus giving the physician the opportunity to better plan an effective treatment plan. It also extends the paramedic’s skill set to include getting the most vital information to a hospital to become an important part of the patient’s treatment.” Chad Guillot, EMS Director, East Baton Rouge Parish, LA
- Advances in professionalism: “A properly implemented EMS telemedicine system used for stroke assessment would help make relationships between EMS and the hospital grow tighter with more collaborative practice-based synergy; better opportunities for EMS to be more connected to the team approach to stroke care; provide more advanced care in the field to improved outcomes; increase opportunities for collaborative research; and keep EMS better informed on what’s new or coming down the pipeline.” Dr. Ethan Brandler, EMS Medical Director, SUNY Downstate Medical Center, NY
- Cost savings: "EMS telemedicine would provide an important adjunct to the assessment of non-emergent and low-acuity patients. Now comprising approximately 17% of Tucson's fire/EMS calls and growing, we are managing lower priority medical emergencies at significantly reduced cost using smaller trucks with reduced crew size, each year saving the city $500,000 per truck. The addition of EMS telemedicine in these field units would save even more by assisting us with directing patients to appropriate treatment facilities without further screening in hospital EDs, thus reducing costly ambulance transfers and unnecessary hospital bills." Dave Ridings, Assistant Chief, Tucson Fire Department EMS, Tucson, AZ.