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Ambulances to Get Virtual Doctors On Board
nomrniceguy writes "Researchers are developing technology for ambulances to improve communications and perhaps more importantly, place
virtual doctors inside in transit.
A patient's vital signs and other data are beamed in real-time to the closest trauma center, where doctors can not only instruct paramedics in the field, but also prep a room to treat the critically injured once they arrive."
They had a device like this in the old television show "Emergency". They talked into this little thing and a doctor's voice came out of it and gave them advice on what to do. The doctor and nurse at the other end then prepared the trauma center for their arrival.
Looks like they are expanding quite a bit on that idea though. Could be nice for certain rural areas.
Coding Blog
PLEASE make sure his matrix can handle singing, art, and while you're at it, give him a WAY Better attitude. Align the holo-emitters so he can travel outside the prep-room, oh and might as well make sure he has hair for vanities sake :P
Yo Grark
Canadian Bred with American Buttering
In the UK there is a HUGE shortage on doctors and nurses. Having them sitting in a room talking to (fully trained) ambulance crews is all we need.
I can see a use to this but surely the money would be better spent on getting more doctors, nurses and medics. We already have radio systems which work perfectly fine.
I like muppets.
Now all across north america, ambulances will be pulled over, with the occupants in the back playing World of Warcraft. :)
merry news years or something
A little searching brought up this page from the Emergency! Equpment Manifest Dates from the early 70's
Please, give the poor doctor a name. And, on the off chance that an ambulance with one of these on board is stranded in some remote area for years, please make a female one too.
Oh man, that's so geeky.
rejected (19) accepted (0)
Is there a psychological term related to getting your stories rejected on slashdot?
Obviously that wouldn't work in the case of a car wreck or a fire, but if you're having a heart attack or stroke and you are just going to be stabilized and medicated anyway...
---
Yes, I have a blog. Just deal with it :-)
"Please state the nature of the medical emergency?"
`Lex - Find Me Here: Text Appeal
Ambulance Officer: "Ok, so after I've made the incision, what do I do?"
Virtual Doctor: "After that, quickly check for signs of internal bleeding, but whatever you don't-"
Monitor: "You have experienced a fatal error, please restart your Virtual Doctor, if this problem persists please contact your administrator"
(long beep heard in the background)
Ambulance Officer: "Oh crap, not again!"
Anyone want to take bets on how long it's going to be before someone, who hasn't even read the summary, posts something along the lines of "Medical diagnosis is a complicated thing, there's no way a computer could ever do it"?
on since the 1980's. I am an ER nurse. The paramedics would hook the pateint up, and we could watch his heart rate and beat. We could talk to them , and relay treatment plans.
Save a Life. Donate Blood. Please.
Oh, our poor malpractice fees!
Now I have to be responsible for the transport as well? I can run servers looking at data on a screen just fine... but running a code?
Plus, the EMTs are trained to do their job... and now you are going to have little ole me barking orders to these guys who have been doing it solo for years and years.
Does my extra knowledge better for the patient than their physicial being there? They can touch and physicially examine the poor guy... I can just sit there and look at numbers.
When I see the study that shows that this actually saves lives, then I will believe it. Until then, I believe it's just a another tech company trying to stir up interest in investors.
Would you like me to:
* Notify next of kin
* Laugh maniaclly
* Irritate you until you bleed out
* Actually shut up and get on with fixing you
/* FUCK - The F-word is here so that you can grep for it */
When you have Dynamite David Lee Roth as your paramedic!
Is it from the makers of Dragon Quest and Sim Sandwich?
:)
Only true fans will get that one
I THINK YOU GUYS AND GALS WILL LOVE THIS
RIP # 3
ONE QUARTER MILE FROM HEAVEN
Like a guardian angel from four cars back,
Watching Michael & Dale Jr. as they circled the track.
No intention of winning, just holding his place,
So proud of his "boys" now winning the race.
We though it was over, the end was so near.
No time for pain; no time for fear.
We did not know, as there was no sign,
Dale was only one-quarter mile from his final finish line.
Within an instant, NASCAR fans would be facing,
An eternal change in their world of racing.
He was one of the greatest; beloved in his sport,
With a grand career now sadly cut short.
All the crowd noticed was excitement and debris,
But a miracle was happening we could not see.
Dale said goodbye through shining metal and chrome,
As God gave "NUMBER 3" the checkered flag "home".
But forever in our hearts, and in the scheme of things,
We'll picture him circling heaven with black and red wings.
Grinning; telling angels..and even the Creator,
"Look out over there...here comes the "INTIMIDATOR".
"Emergency Medical Hologram reporting for duty, please state the nature of your medical emergency"
k =1278856
http://forums.fark.com/cgi/fark/comments.pl?IDLin
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
There is a similar smart device in use over here in Munich/Germany.
;-) and instruct you with further first aid measures.
(Google translate)
It detatches via remotecontrol, only if you confirm the incident with an expert. Then it "talks" you through the whole process. If it is not a real heartattack the device won't go off (could be used for fun stuff if it would
Not sure if those actually saved lives yet...
Just wait till Clippy detects a lack of funds on the way to hospital.
....
Reads bank account.
Reads heart
Reads
How much can you pay today?
lol, what?
lol, what?
How long til virtual lawyers in the ambulance? It is probably a matter if when, not if.
This exact comment has already been posted. Try to be more original...
Two of my friends are dead because first line medical staff 'diagnosed' their conditions as not serious. In one case, ambulance attendants said that a heart attack wasn't. It was. In the other case an ER nurse missed the signs of a blood clot in the lungs. In the first case the guy died at home because the ambulance wouldn't take him. In the other case the guy died sitting in the ER waiting to see a doctor because the nurse thought his condition wasn't serious enough to warrant quicker treatment.
Anything that improves the accuracy of the first line staff has to be good.
This exact comment has already been posted. Try to be more original...
lol, what?
Goatsex link above mod!
I do this all the time as an EMT and there is always a team of Nurses and Doctors waiting for me as I roll into the trauma room, as I have called ahead and told/showed them what I have.
On a side note, I like the idea of taking the ED to the people, and the USDOT is working on making a standard for a "super paramedic", which like a PA has a bachalor's degree and can suture, write prescriptions for anti-biotics, etc.
So, why should a commercial ambualnce company, in the buiness to make money, spend $250,000 on something they already have? No reason at all, old news..
it's just a med student's blog link. Not "goatsee" or anything.
WARNING: I have a big hammer!!! Look another nail!!!
This smacks of a lack of understanding of the emergency care environment, at least in the US.
EMTs are the most highly specialized and effective professionals. The work these folks do is amazing and unmatched in any area of healthcare. They do not need advice from an ER doc while saving a life.
If given the choice between an ER doc and an EMT at the site if I was ever in a really bad car accident, for example, I would choose the EMT every time. If you know anything about emergency care then you know why.
... "Computer, activate Emergency Medical Hologram"
From working within the EMS industry, I can tell for certain that Paramedics will despise the ides of a doctor riding along, even in just virtually. Sure, the idea would make sense in a perfect world, but in reality, I never see this sort of thing working for an EMS crew situation. Besides the fact that no EMS company is going to want to foot the bill for the equipment, there is the human ego part involved where they don't want what they do second-guessed. They are trained for a reason. (mind you, I am not a paramedic, or even an EMT)
This technology already exists and is called shortwave radio.
Perhaps someone is just trying to raise some VC
money.
It's a blog of a med student that talks about the topical technology.
Can you pay the outrageous bills with virtual money?
Where are you going to get those doctors? I don't qualify, and there are many like me. I'm smart enough, I could (if I studied enough) pass med school. However I don't work well in these situations. I don't like working with people (what do you expect, I'm writing this to slashdot), and I try to spend as much time as needed figuring out the solution before I jump in. Great in a programmer, but when seconds count I'd kill people.
I'm not alone, many people are like me. There are many more who are better in some part of the above, but unable to do something else. (couldn't pass med school or such) Even of those who fit all abilities you still need to add a willingness to do so. I could pass med school, but I'm not sure I'd have studied hard enough to do so if I had entered.
This isn't a guess, I took the first-aid and CPR class at one job and was on our emergency response team. When the few (minor, thank God) emergencies happened I nearly froze. I knew the material, I just couldn't put it into use on the spot.
They're all coming out and posting in this thread...
:D
How long before the lawyers on Slashdot start crawling out of the woodwork?
BEEMED?
Hell, "beem" the patient, scotty.
Please swipe patient's insurance card to continue.
That's our life, the big wheel of shit. - The Fat Man, Blue Tango Salvage
Please state the nature of your emergency.
This is one of these ideas dreamed up by someone outside of the healthcare industry. I've worked in EMS / Emergency Department for a decade, and can tell you this will not be utilized or be useful for a number of reasons.
Anyone remember the Emergency! TV show back in the 70s? The paramedics would always send telemetry back to the ED, where a physician (with nothing else better to do than to sit by the 'phone' waiting for someone out in the field to call in) would take a look at the ECG and tell the paramedic what to do. Well, fortunately we've gone far beyond that - those in the field are trained to identify dysrhythmia and treat it properly. Even a Cardiac Tech (here in Virginia), which is below a paramedic, can utilize every drug in the drug box. What is proposed in this story would be a complete step in the wrong direction, taking us back 3 decades.
Two other reasons - ED docs are plenty busy enough taking care of patients that are sitting right in front of them. They need to delegate caregiving to others. Often times we have brought patients into the ED and they were so busy that we (EMS) helped treat other patients in the ED!
Liability. No doctor would put their neck on the line and tell someone that is not certified to do something beyond their training. That is what this is all about, putting a virtual physician in the ambulance. Physicians cannot make decisions without lab work, 12 lead ECGs, radiology, etc.
About a year ago Slashdot carried a story about cars getting "black boxes" like the flight recorders on airplanes (can't find the story using Slashdot's search). The industry (ie insurance industry) claimed that would help physicians treat patients that had been in car wrecks. At the time I posted how absurd that was - patients are treated the same regardless of what may or may not have happened to them. The worst should always be assumed (spinal injuries, etc). We've seen people killing in minor (low-G) wrecks, and people walk away unscathed (after we cut them out of the car) from vehicles that were twisted into a pretzel. This sounds like another case of technology misapplied by an industry out of touch with the needs of those they are supposed to be helping.
Dan East
Better known as 318230.
In civilized countries REAL doctors ride shotgun on ambulances! Where did you say you lived . . . ?
I already meet soo many virtual nurses on yahoo chat ;-)
I'm much more funny, interesting and insightful than the moderators think
I think I agree that telemedicine in the field is a great idea for certain things (especially weird ALS interfacility transfers between hospitals), but the whole point of "prehospital medicine" is to get the patient to definitive care in one piece, correcting life-threatening problems as they go, preferably in better shape than when they found the patient. EMS is there to "fix big problems that can't wait," according to pre-established patient care protocols. Also, just for purposes of clarity, EMT != paramedic.
If you look at the article, it talks about geographical considerations in the rural area around Pittsburgh that prevent them from making contact with physicians with conventional radio and cellular methods. Paramedics routinely call physicians at hospitals and say "this is what the patient looks like, these are the vital signs, this is the treatment i've rendered so far," etc. Rural EMS presents more of a challenge, but if "communications" is where the system breaks down, fix it with improved communications, not an unproven bazillion dollar system that takes more effort and cost to implement than just treating the patient as well as we do now.
The biggest problem with this (as I've mentioned above) is that this isn't really what paramedics are there for in most cases. Paramedics think in terms of chief complaints, not truly in terms of differential diagnoses. There's a much smaller universe of things you can definitively treat in the field versus starting down a path of treatment as one might in the emergency department. Sometimes there are disease processes (heart attack, stroke, and apparently sepsis) that can benefit greatly from definitive early treatment. However, the appropriate way to address this is by changing treatment protocols to tell paramedics "if you see X, Y and Z, treat THIS way" or "contact medical control" or something. Frequently, when there are new meaningful findings that can result in improved patient outcomes, continuing education and common knowledge will tell us to call for online medical control so we can immediately intervene instead of just treating with O2, IV of normal saline, and an EKG.
The second biggest problem with this is the price tag. No EMS system in its right mind is going to pay $250,000 for something that hasn't demonstrated that it's more effective at reducing morbidity and mortality than "conventional" paramedics with existing equipment and a slightly upgraded communications system.
Generally, paramedics are very good at recognizing patients who present as "yikes, this guy is sick, and I don't know why" and calling a physician. We have plenty of tools at our disposal with fancy whistles and bells to help give us a big picture of what's going on with the patient. And to be honest, physicians don't WANT paramedics bothering them at the emergency department for every incoming patient.
Save your tax dollars and mine. Spend it on more staffed ambulances and better training for paramedics, not cooler toys.
Arguments -
Sequelae of, for example, a heart attack may need some specialist kit and/or personnel to be dealt with effectively. Medicine is all about resource management in the end. Whilst I think it sounds rather good to have a lot of high tech kit in medicine, it is also necessary to have the human resources to go with it. Hospitals are necessary for more efficient 'herd' management of ill people. The reality is that well trained paramedics in ambulances can be as effective as doctors in critical/emergency care situations. Nice sounding tech, but unnecessary bollocks in my opinion. IAAD.
Like I said in my earlier comment, this is nothing new. Paramedics can give nitrates for chest pain, draw bloods for analysis at the hospital, administer oxygen, perform endotracheal intubation, interpret life-threatening heart rhythms, etc. In most cases, we can already do this without calling a physician and asking permission.
This is basically "offline medical control" in the form of standing orders. Physicians get together, decide what's best for the patient and a particular geographic area, and allow paramedics to practice under their indirect supervision.
Sometimes, a patient doesn't meet the right criteria for treatment, or a patient needs an intervention that needs a direct physician order (like morphine for chest pain/congestive heart failure) - in these cases, paramedics are very skilled at and comfortable with giving a very fast rundown of what's going on with the patient and asking the physician's permission to give a particular intervention.
That's in place now, it works, and it can be improved by improving the radio/communication system. I'm all for trying new things out, but I fail to see how putting expensive equipment in the back of an ambulance is going to make a difference or improve care from what could be administered by a properly-trained paramedic.
For some time in the late 1990s and even into 2001 or so (and there are occasional rumblings even today) a segment of the EMS field pushed for a higher level of paramedic care that would do just that - "treat and street" as someone posted in this thread.
The biggest problem was the way that Medicare treats ambulance service. Except in very limited circumstances under the "paramedic intercept" code, in order to bill Medicare for an ambulance call, you have to actually transport the patient in your ambulance. If the wheels don't turn on your ambulance with a patient in the back, you can't submit a claim for it.
While private insurers and HMOs aren't bound by Medicare's decisions, they certainly do follow suit a high percentage of the time.
The reason that this doesn't work philosophically is that paramedics are trained from day one how to spot immediate life threats and intervene while on their way to the hospital. They don't think about horses and zebras, they think in terms of ABCs, trauma care, defibrillation, and early ACLS.
Besides, the nursing lobby is too strong to allow the laws to change in "favor" of paramedics anyway. I've criticized many in the industry for heading down this path before, and have felt for a long time that we should improve on what we're doing (emergency care and transportation of the sick and injured), not try to break out in a whole new area (definitive care).
If you want to treat patients, go to med school. Personally, I'd rather sleep in my ambulance at my assigned intersection until you call me for your stubbed toe at 2am.
Before anyone screams that we need damage caps on medical malpractice awards, we should remember cases like this. You can be sure that as soon as Ambulance Company X or Hospital Y had to pay out a $5 Million pain and suffering award, they changed their pathways and policies to be sure that it would never happen again.
Telemetry in EMS was started in the 1960s and was widespread by the 1980s (cf. Jack Webb's "Emergency!"). The cardiac monitor was set up to modulate a 1000 Hz tone that was transmitted via radio or landline. Newer systems use fax to transmit 12-lead EKGs.
Turns out, though, that Paramedics can be just as good at reading EKGs as MDs, so in a lot of places, "sending a strip" is rarely done.
Adding the ability to send other vitals (O2 sat, T/P/R, BP, etc) is a fine idea, but all they seem to be doing here is sending the telemetry via satellite instead of VHF/UHF (or cellphone).
Given that most rural areas can barely afford to field a Paramedic-level ambulance, I don't think we'll be seeing too much of this at $250k/unit.
It *is* a good opportunity to show that a tiny %age of the miltary's budget goes to things that don't actually kill people.
Peter
ex-NREMT-P
I used to be an EMS director... and I have reservations about putting certain things too far out in the resuscitation chain.
That said, I agree with you; Early treatment is arguably better for many things... assuming that early treatment saves more lives than it costs.
For instance, Thrombolytics for stroke. I find very few patients actually qualify for that particular intervention, either because they ignore their symptoms and miss the 3-hour window, or because they have contraindications. Despite the NINDS trial, I still have reservations. Maybe in the aggregate we do more good than harm, but in my personal sample size, I've seen a awfully high percentage of intracranial bleeds. This isn't something you could even consider moving out to the EMS world, if only because we don't have mobile CT yet.
RSI is another example. Rapid Sequence Intubation with paralytics is practiced in very few EMS systems, if only because it's so very difficult to keep people trained to a sufficient standard where they can use it safely. Truth be told, even some physicians can't use it safely.
The other issue becomes protocols and medical control (which is what this system appears to augment). Do your paramedics have sharp enough skills to be your remote H&P? I know more than a few physicians who'd have serious reservations about ordering a high-risk intervention based on somebody else's history and exam, particularly in this high-liability era. Remember... liability falls on the medical control or medical director physician. Even if the paramedic is just following protocols... who writes those protocols? It's usually the EMS director.
Telemedicine is definitely here to stay; teleradiology has proven that. It just remains to be seen how far we feasibly take it.
BTW, do you know Davak?
Even if a man chops off your hand with a sword, you still have two nice, sharp bones to stick in his eyes.
And to be honest, physicians don't WANT paramedics bothering them at the emergency department for every incoming patient.
I don't know what kind of ERs you deal with, but I'm usually very unhappy if a squad is inbound with a really sick patient and they DON'T call. That call gives me extremely valuable prep time, like calling for the difficult airway cart, getting my monster 8.5F subclavian trauma introducer ready, or opening a chest tube tray. If they just "roll in the door" with a pregnant-with-twins-and-seizing patient and they didn't call (and they weren't right around the corner), I guarantee we'd have a discussion/teaching session out in the ambulance bay.
Otherwise, very little in your post to argue with.
Even if a man chops off your hand with a sword, you still have two nice, sharp bones to stick in his eyes.
Ooh! Can I touch him?
"You've got leprosy. Goodbye."
If Nalgene water bottles are outlawed, only outlaws will have Nalgene water bottles.
That's a big step in the wrong direction.
I spent 10 years as a Paramedic in Pensylvania. During that time, the trend was to REDUCE the amount of base communications. There is a reason the old caridac telemetry systems (like the old "Emergency" show) disappeared. It turns out that it is far more effective to have the person who is nose to nose with the patient making the treatment decisions in the field. ("Treat the patient, not the monitor")
As a result, paramedics have been tethered less and less to the base hospital and generally call in only for permission to use highly restricted narcotics and to request special facilities be prepared. It is relatively rare that a paramedic calls in for advice.
One of the best ways to spend an extra $20K has been found to be to upgrade the EKG equipment in the field so that the paramedic can do all of the preliminaries in the field for thrombolytic drugs (which are too fragile to keep in the field) can be administered the moment the patient hits the ER instead of the typical 90 minutes.
hmmm.
if real, live "doctors [are] instruct[ing] paramedics in the field," then they aren't exactly virtual.
Now hospitals will be able to check on the ambulances to make sure the EMT's are doing their job and not stopping at their girlfriend's house on the way to an emergency scene.
6 23208&tid=158&tid=126
Sound familiar? http://yro.slashdot.org/article.pl?sid=04/12/30/1
It is impractical in a 'real-world' environment. When I am working on a patient who is having a critical medical emergency, I am working my backside off. I don't have the time to dial-up a computer, enter data, etc. I'm busy... REALLY BUSY!!
The larger problem here is the degradation of the basic EMT instruction that began to occur about 8-10 years ago. When modern 'EMS' first came into existence, there was a significant amount of instruction placed on the 'Why' things occur in the human body. Why lungs sounds like 'rales' occur, why certain types of shock happen, etc.
Then the philosphy changed from understanding 'why' to a 'see this, do this' format. If the patient was having trouble breathing, just put them on an oxygen mask at 15 lpm and go. It is not important to understand why. In fact, the term 'fracture' was replaced with 'swollen, brusied and deformed extremity.' The field provider was told you don't diagnose, only a physician can do that.
Now we have (not due to any fault of their own) a generation of EMTs who don't understand (unless they continue their education on their own) why things occur. This lack of foundation is hurting prehospital medicine. Let me give you an example.
In our jurisdiction, we instituted an upgraded EMT protocol. Basic EMTs were allowed under standing order to administer 2.5 mg albuterol nebulizers for asthma, as well as utilize the epi autoinjector for severe asthma and anaphylaxis. They could also call Med Control for orders for nitro for patients in CHF (This is only a couple of the upgrades).
The problem was the vast majority of EMTs did not know the difference between the two. They had always been taught "Trouble Breathing - give oxygen" without understanding what was going on. To get our EMTs up to the task, we spent a significant amount of time teaching A&P, something that EMTs use to get in thier initial training.
Now in this one area, we have seen a dramatic decrease in the number of asthmatics who are in a critical condition when the ambulance arrives at the ED. One physician remarked he hasn't had to tube an asthmatic brought in by ambulance in over a year. It use to be at least a weekly experience.
This is a low tech response that has a real impact in patient outcome. New technology of this type just isn't the answer.
Bob Austin,
NREMT-Paramedic
Please state the nature of the medical emergency.
Yeah--that's a good point. We have been able to hook up the LifePack's to a cell connection and transmit patient information at something like 1200 bps to a receiver station at the hospital.
There's no place like
They had a device like this in the old television show "Emergency". They talked into this little thing and a doctor's voice came out of it and gave them advice on what to do.
Uhhh, that "little thing" they talked into is called a two-way radio. Duh.
If you skip the misleading portions of the article, you'll find that the only new thing here is using a maritime satellite for the connection. They're already putting EMTs in direct contact with doctors at the hospital they're going to and sending data from the ambulance to the hospital. The problem is that they go through places without cell reception and where point-to-point links are blocked by terrain.
does NOT work.
It was *way* better than the average American doctor at diagnosing illness and injury and recommending appropriate treatment...
Tin foil hat time: We don't hear about this project anymore. Why not? The evil AMA (probably in league with those guys in the black helicopters) suppressed the technology. OK, I'm mostly joking
I'm glad to hear you're joking... because I'd have see some serious proof of that claim. Remember, you're talking about human lives here... and the lawyers will be watching, so you'd better be right.
Believe me, managed care companies have tried cookbooks. They have tried like crazy to make everything into a decision tree, such that less-extensively-trained personnel (read "cheaper") could diagnose and treat. Know what? I'll take a trained and experienced diagnostician every single time... and I say that not because I am one, but because I think the care is simply better. Want to do it better and cheaper than me? By all means, be my guest... but you're going to have to prove the "better and cheaper" claim with some serious data.
I also think you're underestimating the varied presentations of illnesses. Problem is, most people don't read the book on their illness before contracting it (ie. they present with atypical symptoms, or a less-than-classic history).
From my experience, half of them function as trained technicians. I feel that my engineering background has made me a better diagnostician than most doctors...... If the medical community would check their egos at the door...
You're joking, right? You're an engineer claiming to be better than most doctors, and they have the ego problem? This in the same breath where you erroneously state that we do pap smears to detect Ovarian Cancer? (Paps actually screen for Cervical Cancer).
You don't have bad ideas (prevention, screening, evidence-based medicine, etc)... but the implementation is always rougher than the conception.
No offense intended.
Even if a man chops off your hand with a sword, you still have two nice, sharp bones to stick in his eyes.
...will they be able to get permission to use Robert Picardo's likeness?
Coder's Stone: The programming language quick ref for iPad
Background: I was an EMT in Charlottesville, VA in the late 1970s, where we had a program to provide telemetry to the University of Virginia ED. I have been an emergency physician at a Level I Trauma Center for about 20 years. I helped write chunks of three different editions of the DOT EMT-P curriculum.
The idea of telemetry is not new, and has been used both experimentally and in the field by the military. However, I think this is a solution looking for a problem. What defect in the existing EMS system will this fix? I would estimate that only about one of every 200 "command calls" I get from EMT-Ps actually allow me to provide some advice to paramedics. This is usually by providing some background on the particular medical (or more likely, medicolegal "Can this drunk sign a release and we leave him in the custody of police to take him home?") situation. I can estimate on the fingers of one finger the number of times having a camera in the back of the ambulance would have helped.
For even more severe situations, such as cave rescue, some of our cave rescue commo geeks (I can say that because I are one too) wanted to set up slow-scan TV cameras for medical direction. I told them to forget it and use the cameras to monitor water levels upstream or something.
With the level of skill of miltary medics, with them doing surgical procedures at advanced aid stations, camera telemetry and even Waldos for surgical use may make sense. Without independent-duty medic level training for civilian ambulances, camera telemetry is useless.
But sat radio for those times when radios/cellphones don't work, and comms are really needed-now that would be nice. But if rural EMS systems can't afford a couple of hundred bucks for a vacuum mattress . . .
Haven't you read Larry Niven's "Ringworld" and related works? The http://www.larryniven.org/images/rc/ss65.jpgautodo c is a device that would be conceivabley fit in a large ambulance, and as long as you can crawl inside, or someone place you there, it can automatically diagnois and treat any injury or sickness. Exotic alien species? No problem. Multiple organ transplants and limb amputations? It's got plenty of spare parts available!
As someone downthread posted, my comment was more directed toward online medical control than the quick radio reports we make to say "here we come!"
;)
I'm in complete agreement, and unless we had bizarre radio failure or a less-than-a-minute transport time with weird circumstances, I think it's always appropriate to give the "heads up" call to the ED.
I would just say that when possible, I try to avoid bothering a physician for routine medical treatment, ALS or BLS, that won't require any immediate specialized personnel or equipment when we land at the ED. When I was working in one system, we actually had a computer system that would relay our incoming patients (in text format) to a computer in the ED after we gave a VERY brief report to our own dispatcher (e.g. 27 Female, ankle injury, BLS).
If we had something that wasn't simple and routine, we called it in as a lengthy radio report, including treatment rendered, additional orders requested, and additional resources required upon arrival. I never meant to imply that the ED liked surprises. Sorry for confusing the issue
...usually mistakes on their own have a well-established safety net of anti-malpractice rules, pathways and guidelines to keep mistakes from reaching the patient. Often, when people take shortcuts, that's when malpractice occurs that results in real harm and injury to the patient.
My point is that when people get lazy and take shortcuts, the punitive effects of med-mal suits force them (and other hospitals) to put procedures in place to make sure that shortcut will never be abused again.
and my apologies for what may have come across as an overly critical post.
For the record, I echo your lament about the inadequacy of some of our testing. My kingdom for a better test for Pulmonary Embolus, for instance.
Computer systems may be better at picking pertinent data points out of the noise... but who trains the machine? A fallible human tells the system what data points to count and discard... the system is only as good as its programmer.
The point I was making (in a not completely elegant fashion), is that much of medicine is subjective, and very difficult to program. It comes in through all five senses, and in very subtle ways. The smartest you'll ever be is the day you graduate from medical school... you know more facts at that moment than you'll probably ever know again. Those facts are part of your data bank of signs, symptoms, nomenclature, pathophysiology...
Except experience counts in medicine, and it counts big. For example, it's a VERY poor resident or new physician who doesn't take seriously the suggestion of an experienced nurse. This may seem illogical. After all, you have many times the education of that nurse: you have three times as many years of training in a far more rigorous course of study, you have a far deeper knowledge of pathophysiology and pharmacology... in fact, that nurse can't even give an asprin without your order. Danger, Will Robinson...she's been doing this for 20+ years, and the subjective opinion of that old nurse who calls at 3AM and says "this guy doesn't look good, you'd probably better come and see him" should get you out of bed immediately. She is a less educated (on paper) system, but with a vast experential/subjective knowledge base to draw upon.
I don't know how you train a computer system to do that. I also don't know how you train a computer system to have five sense, and recognize the smell of Pseudomonas, Melena, or Uremia. I've had plenty of patients who looked good on paper, but just looking at them something in the back of my mind said "something's not right, you'd better take another look." That clinical gestalt has saved my bacon (and that of my patients) many times.
As for engineers inventing and doctors getting the credit, I'm not sure how that's really relevant. If it's a new pacemaker, the engineer may have invented it to fill a medical need, but somebody has to implant it... so I'd say it's a team effort. I have no problem sharing the credit...
Even all that aside, I don't generally take credit for "saves" or snatching somebody back from the brink. Frankly, I don't think I really have that much to do with who lives and who dies.
Even if a man chops off your hand with a sword, you still have two nice, sharp bones to stick in his eyes.