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Peter Zell

Portable HPLC on the truck?

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I'm helping a chemical instrument maker who is developing a portable HPLC* system, and I have questions for the EMS community, particularly the rare birds with lab chemistry experience.

We are prototyping a very small HPLC instrument. No crazy glass bottles and little tubes, it is all self-contained and quite rugged. We hope the consumables and method of use will be as trouble-free as pretty much any of your life-support gear on the truck, like defibrillator, vent/airway, vascular, etc. A probe will simply be dipped into the sample and then screwed by hand into the device, and a typical elution should run between 1 and 5 minutes, depending on the procedure. It ought to have no trouble running as a telemedical device. And so let's assume for argument that the technical hurdles are all overcome.

We're not so concerned about whether the tool will have applications, only whether it will have applications in EMS. It seems to me that the main interest, or at least the sweet spot, will be for (a) life-threatening circumstances that (b) can't really wait for transport, and for which (c) multiple possible medical responses exist, at least one of which could exacerbate the patient's condition if misdiagnosed.

And so, some springboard questions; feel free to digress:

  • We know about glucometry. Are there any other existing tests (I assume chiefly body-fluid tests -- urine, blood, mucosal swab) that EMT's are already routinely or occasionally performing? Are there any routines that could benefit from a better or more reliable method?
  • Has the industry identified the need for certain tests that do not yet exist due to the obviously impossible time involved in the lab test cycle, but that would be very useful in EMS?
  • Obviously, some test results can be interpreted easily by an EMT, while others will require upload and interpretation by medical control. Certain sensitive tests, and borderline or inaccurate results, will really need to be evaluated with great care. Bearing in mind that this is all initial discussion, can anyone think of which tests might fall into the EMT category, which into the MD category, and based on what standard?

*For those who don't know, HPLC is high-performance liquid chromatography. It's a longtime tool in analytical chemistry for testing for the existence and quantity of compounds. You can see a simple experiment that shows the basic operation on Youtube. Because of the large, costly equipment and the difficulty of operating and maintaining it, HPLC has been limited to big labs.

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Such tests already exist and are in limited use in EMS but wide use by ERs.  Abbott makes an i-stat point of care devices.

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