5½ Cool Things at EMS World Expo
Being a rookie attendee at October’s EMS World Expo in New Orleans proved to be an exciting and motivating experience. From the numerous classroom learning sessions to the vast Exhibit Hall, I was impressed with the innovation, improved technology and discourse available. There are many new tools out there that can lead us to better patient care and streamline our jobs as paramedics and EMTs. Here are some worth noting.
1. Pulsara App
The Pulsara app is a secure cloud-based alerting system in the palm of your hand. Pulsara’s app, made for a mobile device like a smartphone or tablet, gives providers the ability to alert the hospital of incoming patients. The app is meant to replace the hospital call-in most of us do over the radio, the data of which often disappears into the great ether. While the app was initially created for STEMI and stroke alerting, Pulsara recently added a feature that allows you to alert the hospital to any type of patient. You can even attach photos of EKGs, IDs or simply the monitor screen in place of inputting vital signs.
The hospital team is notified instantly on their own devices once you submit the patient’s details. Most important, each provider in the continuum of care (neurologist, radiologist, ER physician, RN, etc.) must acknowledge receipt of the notification, ensuring the team is ready when you arrive.
All the data resides in the cloud, and providers can access their own patients to follow up on outcomes. In addition, the aggregate data is kept on a dashboard and uploaded to a spreadsheet for real-time QA/QI reporting.
Backstory: The founders of the company were attending a dinner party that involved not only bringing the standard bottle of wine to the host, but also bringing the “next best thing” that would improve emergency medicine. A few years later, the Pulsara team consists of more than 30 people, including physicians, EMS providers and IT experts. They plan to offer the app for free until April 2017.
2. SALAD Intubation
It wasn’t a hard choice to stop at the Exhibit Hall’s SimLab, where there was a Chewbacca intubation head with a light saber laryngoscope handle eagerly awaiting a demo. After spending some time with its owner, it became clear to me that a Star Wars set-up like this attracts a particular group of medical nerds (which is all of us attending Expo, I guess).
Anesthesiologist James DuCanto, MD, invented a clever suctioning technique as well as a MacGyver-looking simulation table, manikin intubation head and suction machine that generates green slime for the student with the push of a button. The “Vomi-quin” can be constructed using your normal medical equipment: garden hose, table lamp dimmer, xanthan gum and, if you want to be fully automated, a marine bilge pump.
The technique, which DuCanto has dubbed SALAD (suction-assisted laryngoscopy airway decontamination), involves the use of another DuCanto invention, a thumbhole-less rigid suction catheter, which is shaped to fit the oropharynx. The provider simply leaves the SSCOR catheter running in the left side of the patient’s mouth while performing the standard ET intubation on the right side. Presto! No fluid or vomitus clogging up the tip of your laryngoscope camera or the patient’s oropharynx.
3. Mobile Stroke Unit
Excellance, Inc. is behind this ambulance-on-steroids. The unit is meant to provide a system with the capability of scanning a stroke patient on scene. The image is then transmitted to a neurologist, who will consult with the paramedics via telemedicine, allowing the patient to receive the appropriate care for this time-is-brain condition. It seems logical that this new type of ambulance will give rural areas better CT access and likely spur protocols that allow paramedics to administer clotbusters in the field.
This ambulance weighs just a bit more than a standard truck, and it has more intricate power requirements. The unit is equipped with a 60.000-lb. leveling system to ensure that no matter where it is parked, the mobile scanner will be level.
In Chicago, Rush University Medical Center has just announced plans to use the unit for 9-1-1 calls after receiving delivery in January. The mobile stroke unit will respond alongside a “regular” ambulance when there are reports of a patient with strokelike symptoms. The improvement in patient care has already been proven with mobile stroke units used in other parts of the U.S.: Some symptom-onset-to-treatment times have been cut by as much as half.
4. Point-of-Care Ultrasound
The EMS POCUS team is passionate about ultrasound. Advocating an additional tool for our toolbox, these nurses and medics want to spread the gospel that ultrasound in the field is essential. EMS ultrasound should go beyond the traditional FAST (focused assessment with sonography for trauma) exam, and the booth at the Exhibit Hall’s SimLab, sponsored by Terason, was a popular place to get a quick education in how to use sonography.
Running a cardiac arrest and guessing at the H’s and T’s of reversible causes, as we are taught in ACLS, only goes so far. EMSPOCUS wants ultrasound in the field so we can, for example, diagnose a PE-caused cardiac arrest and tailor our care appropriately. They demonstrated the use of ultrasound to successfully establish IVs in the patient who is a “tough stick.” And perhaps the strangest place to put a gel-laden ultrasound probe? The eye. Ultrasound can reveal an increased optic nerve sheath diameter that is a good indicator of increasing intracranial pressure.
5. Concussion Sensors
In his keynote address at the opening ceremonies of EMS World Expo, Ed Racht, MD, chief medical officer of AMR and associate chief medical officer of Evolution Health, explored our desires as providers to solve other people’s problems. Racht’s thesis is that what results from our need to problem-solve is an impressive array of innovations and technologies, especially when it comes to improving public health and safety. He showed the audience one of the latest innovations coming out of concussion research: helmet sensors.
Imagine working as an EMT at a high school football game where the players are wearing these new helmets. If a player sustains a hit or fall that has enough force to cause a concussion, you are alerted on your smartphone app or by a flashing LED on the outside of the helmet. You pull that player from the game immediately and conduct an assessment, potentially identifying a traumatic brain injury using data rather than relying on a young teenager to self-report. For sports that don’t use helmets (soccer, basketball, etc.), companies are manufacturing the same type of sensor to be used in mouth guards.
5½: Chinese Finger Traps
Walking by the ZOLL booth on the exhibit floor with my colleagues, I was distracted by the manikin sitting in a stair chair while strapped to a thumping AutoPulse. But my friends pointed out something much more exciting: They noticed that the manikin's hands were secured with that legendary toy, the Chinese finger trap. Why hasn’t anyone thought of this before? No more cravat knot-tying! No more asking patients not to reach out for the railings when going down the stairs! This is a brilliant idea.
Attention, EMS inventory managers: You can buy 12 of these on Amazon for 95 cents (plus shipping). This purchase will save you money on cravats in the long run; even if many go missing from supply, they’re so cheap it doesn’t matter. None of your providers will pass up the chance to use the finger traps on a patient whose hands need to be secured for transport.
Hilary Gates, MEd, NRP, is a paramedic in Alexandria, VA. She is an EMT instructor and teaches in the School of Education at American University. She began her career as a volunteer with the Bethesda-Chevy Chase Rescue Squad. Gates has experience as an EMS educator and symposium presenter and is involved in quality management and training for the fire department.