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."

Comments

Emergency

[Grax]

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.

Um.. this is called telemetry, and has been going

[Nurseman]

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.

Bad idea

[Dan East]

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

Telemetry in EMS is not new

[plawsy]

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

Re:I don't know

[Long-EZ]

When expert systems were all the rage in the early 1980s, someone had the idea to train a computer using the diagnostic techniques of a bunch of really good doctors. The goal was a "doctor" for every third world village. The computer ordered simple tests and posed diagnostic questions in the proper sequence. A nurse or similarly skilled technician did all the hands-on stuff. They tested the effectiveness of this fairly simple prototype. 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... but not entirely.

We think of doctors as nearly omnipotent. They are not gods. 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. Of course, they have a huge database of medical info that I don't have, but if I had the same info they have, I think I could do a better job of diagnosing medical problems because I'm skilled in the diagnostic process. Google and some online medical sites are rapidly closing the gap.

There is some intuition involved in diagnosing illness, but it's mostly a logical process. Many doctors are good at memorizing and regurgitating information, but not very good at applying that information and thinking logically.

To prove my point that the medical community behaves more as technicians than scientists, I offer the example of ulcers. Dr. Robin Warren tried desperately for almost a decade to convince the global medical community that most ulcers are caused by H. pylori bacteria. He was publically ridiculed. He finally ingested the bacteria, gave himself the worst case of ulcers ever, and then cured himself with antibiotics. The pill pushers who make money with routine patient visits to prescribe various medications to help people cope with the painful condition were finally forced to accept the truth. The antibiotics were already approved for human use, so the entire world needlessly suffered with ulcers for about a decade. Why? Arrogance. The medical community still operates largely as an authoritarian society, rather than an objective scientific meritocracy.

If the medical community would check their egos at the door and do what was in the best interest of their patients, there would be much more emphasis on prevention and early detection instead of heroic intervention, often when it's too late. We are starting to see blood tests that detect early markers for cancer, so hopefully women won't get a pap smear and an "all OK" diagnosis from their doctor, only to be diagnosed a month later with a five pound ovarian tumor. The use of CAT scans and other noninvasive diagnostic tools, coupled with computer image recognition, should allow detection of many problems early enough to treat successfully.

People don't want computer doctors, and our current wetware doctors certainly don't want computer doctors. But I think we'd be a lot healthier and would spend a lot less money if there was a standard expert system responsible for healthcare. Every community could have the same access to GOOD healthcare that now exists only sporadically in larger cities, and there would be almost no malpractice lawsuits because the standard of care would be uniform and very good. Then, if we could just manage to get the insurance companies out of the game, we'd have healthcare nirvana.