Fad or future: Streaming video from the squad to the ER...

[PRPGfirerescuetech]

[web:22dff938c9]http://www.cnn.com/HEALTH/index.html[/web:22dff938c9]

Tucson has developed a wireless video stream, to allow ER receiving doctors to see patients while enroute to ER's.

What implications does this have for our future?

[medik8]

I've read several articles on this technology over the last few months in JEMS and EMS magazine. A lot of the bigger cities already have the technology...I believe I read...areas in New York, and California, as well as a few others.

The idea is that a lot of information and pictures can be sent directly to the ER from the truck. For example, pictures can be taken of MVAs at intersections or whatever and transmitted back to the docs to show the mechanism of injury, give an idea of what kind of situation the patient has been involved in. If a woman is in labor and is having a complicated childbirth, an obstetric team and/or her perinatologist can view video from the back of the truck to assess the patient's appearance, as well as what's going, and can direct us regarding interventions that are more complicated in these situations.

I know that a lot of people are looking at this like, "big brother is watching"...and that crossed my mind as well. However, these cameras are not an ongoing mandatory technology. They are meant to be used in certain situations, not in all...and on an as-needed basis, if you choose to need to do so, or if the doctor requests. It's virtual medicine...in a sense. I think once we get used to it, it will seem second nature.

Personally, as long as they don't take it too far, and use it as a tool to help patients and not to take control of our jobs, I think it's an excellent idea. After all, I'm all for advancing the EMS business. If this is what is takes to allow MD's to see the kind of situations we are in, and possibly for us to have our level of practice expanded even further, under their direction, then let's go....I'm ready.... If it spins us in a more positive direction with more room to further our playing field, then I think it's great. It's what EMS needs.

Not to mention...maybe it will help eliminate some of the rude, non-compassionate and unprofessional asshole caregivers who won't want to be discovered on camera. Hmmmmm....

It will be interesting, at the least, to see where this goes. I'm for trying it out....I think it's exciting...and a lot of docs are talking very positively about it. One even referred to it as "the cutting edge of the future of emergency medicine and technology"...going on to give Paramedics and EMTs actual credit "gasp" :shock: for what we do and the situations we are in...and realizing that we ARE on the "front lines" of emergency medicine and where it all begins...

WHOOOOO HOOOOOOO!!!

SAY CHEESE!!!!!!!!!!!!!! :mrgreen:

xoxo

Luv, 8

[Ridryder 911]

It all depends on how it used and utilized. Like telemetry, there is some good points as well as bad ones. But, as I have prophesied for years the role of the Paramedic will be changing, immensely. The days of transporting everyone will be soon gone, as well as transporting every illness. The chest wall pain, or angina may soon be monitored at home. Rapid response from EMS, with a XII lead and bedside cardiac blood markers, as well as U/S, and now possible 3 way video conferencing with the EMS, Medical Control, and the PCP may determine on what the treatment or no treatment will be.

I foresee, us performing a very in-depth examination and testing, and consulting with the above physicians, then placing a continuous (Holter type) monitoring device on the patient as well as "panic button" for easy accessibility. I know they are testing "talk-back t.v. with 24 hr coverage for nursing, that the patient has problems can "turn to a certain channel and there is a camera and direct link to a emergency nurse".

With the population of the baby boomers rapidly increasing in age and the health care not being able to meet the demands as well as cost, alternative ways will be developed to these with the ever increasing technology developed.

Be safe,

R/r 911

[AZCEP]

The system in Tuscon is directed more to the outlying agencies that use Tuscon Medical Center for medical control. I can see this as a definite benefit if, and it is a big one, the medical control physicians don't restrict providers from doing their job until they are in the back of the ambulance, where they can be monitored.

At the same time, "lipstick" cameras are available that can be pinned to a uniform that would allow constant, real time viewing of what is happening.

The biggest hurdle is the cost. If you can't convince an administrator that you need less expensive equipment, like KED's or 12 lead cardiac monitors, how in blue blazes are you going to talk them into spending five to six figures for this?

[medik8]

The biggest hurdle is the cost. If you can't convince an administrator that you need less expensive equipment, like KED's or 12 lead cardiac monitors, how in blue blazes are you going to talk them into spending five to six figures for this?

THAT...is a very good point, AZCEP. It's going to be interesting, at the very least...

xoxo

8

[Doczilla]

I frankly don't see much clinical utility here. Honestly, what am I going to see as the doc staring at the monitor? Is the resolution good enough to provide any real clinical information? One major issue I have with these supposed technologies is that the doc is looking at a less-than ideal picture (even if it's HDTV, it's still a one-dimensional picture), and cannot palpate or auscultate anything. I still have to rely on the medic's examination skills in this regard. So what have I gained by being able to look at the patient? Furthermore, is that visual information received really going to affect care? I'm not cutting that patient loose before I can lay my hands on him and get my own history. That process would be so cumbersome and time-consuming that I see no benefit in sitting down away from my other patients to do it. Then to discharge him from care based on someone else's physical without my own physical and lab results? No way.

I'd rather spend the money on overtime to get the medics in for more regular preceptorship in the ER.

'zilla

[Dustdevil]

My thoughts exactly, Zilla. I just don't see any clinical justification for this thing. It simply does not offer any significant benefit to the doctor. And even if it did, would they really want to sit in front of a television in their busy ER and watch a patient that was already being watched by a paramedic? I really doubt they have the time or the inclination.

That leaves me with three possible theories here:

• 1. Some technology company who hasn't the slightest clue about EMS is trying to sell us a bill of goods and justify it with spurious claims of medical benefit.

2. Some EMS systems who do not trust their medics abilities are trying to compensate for poor education with additional oversight. After all, this is ultimately cheaper than educating their medics better.

3. Some EMS systems who do not trust their medics behaviour are trying to justify putting big brother in the ambulance on medical grounds so as to not incurr the wrath of the idiot unions who would oppose it otherwise.

• I just don't believe anybody promoting this idea is doing so out of any sincere concern improving medical care. There is an ulterior motive.

[AZCEP]

The idea is more to provide a point of care view of the patient and allow the progression to be viewed. Instead of explaining a mechanism of injury, you can show a picture of it. Instead of describing the injury, you have a picture.

Like I said before, the remote agencies that use Tuscon Medical Center as their medical control are using this to help in triaging which patients need an hour plus flight to Tuscon, or can be adequately managed in a local setting. Yes a little more education would help, but the technology should be considered helpful in some cases.

[AnthonyM83]

I agree DocZilla that it was low practical patient care benefit.

One good benefit, though, can be taking a step in the direction of more technologically advanced distance patient care. This might not have a real use, but maybe next we can work on improving camera with great zoom, maybe transmitting stethoscope sounds with the video (so doc can see stethoscope placement & accompanying sounds real-time), and so on.

It's like that darn voice activated technology. It sucks....but it's better then when it first came out...and twenty years from now it'll be a lot better than it is today. Some advancement start from ideas with no real purposes other than to see if we can pull it off.