scanner, to accelerate stroke care and improve the ability to diagnose and treat stroke prior to ED arrival. Trauma Trauma care is an area that can benefit greatly from EMS innovation. The National Academy of Sciences, Engineering and Medicine recently concluded that, in order to improve our civilian and military trauma systems to eliminate preventable death EMS should be considered a key component of the health care system rather than being viewed as a transport mechanism. To improve trauma care the Academies also recommended incorporation of EMS data into trauma registries; amending the Social Security Act and the CMS Ambulance Fee Schedule to detach reimbursement from the requirement of transportation; making HHS responsible for EMS; and conducting a national EMS needs assessment. 16 Some EMS innovations are already being used in patient management. The inclusion of imaging technology, especially ultrasound, on ambulances is gradually becoming more common. Telehealth will further improve diagnostics and pre-hospital care, and may improve education by connecting EMS providers with EMS physicians or trauma specialists for debriefing and coordination. Myocardial Infarction The last 10 years have seen a great deal of improvement in the prehospital care of patients with acute myocardial infarction. Since 2007, when the American Heart Association began recommending EMS to balloon time of less than 90 minutes and began encouraging the use of prehospital electrocardiograms (ECGs), there has
been a proliferation and dissemination of the technology required to not only perform an ECG, but also to transmit it to the hospital prior to a patient’s arrival. 17 However, prehospital activation of the cath lab is still not practiced in every hospital, and the logistics of performing the prehospital notification and the quality assurance and clinical feedback mechanisms to the prehospital providers associated with these cases is still rudimentary. New telecommunication technologies and HIPAA compliant sharing of information is available and may greatly advance the quality of care provided. The next frontier for prehospital management of chest pain may include point of care lab testing with troponin levels and performance of simple, yet potentially impactful interventions like remote ischemic conditioning. 18 In addition, there has been an explosive proliferation of personal monitoring devices and implantable medical devices that could provide useful data to EMS providers. The installation of technology that can read the data from a pacemaker or other implanted monitoring device, and either interpret or transmit that data for remote interpretation, may significantly augment the care of patients in the field. Emergency Management The core of EMS has always been its public safety role supporting a community’s emergency management and disaster preparedness responsibilities. While there have been improvements in the level of integration and coordination of EMS and other branches of public safety, there is still a need to improve coordination
16 National Academies of Sciences, Engineering, and Medicine. A national trauma care system: integrating military and civilian trauma systems to achieve zero preventable deaths after injury. National Academies Press, 2016. 17 Antman, E. M., M. Hand, P. W. Armstrong, E. R. Bates, L. A. Green, L. K. Halasyamani, J. S. Hochman, et al. “2007 Focused Update of the Acc/Aha 2004 Guidelines for the Management of Patients with St-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration with the Canadian Cardiovascular Society Endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the Acc/Aha 2004 Guidelines for the Management of Patients with St-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee.” Circulation 117, no. 2 (January 15, 2008): 296-329. 18 Martin-Gill, Christian, Max Wayne, Francis X. Guyette, Oladipupo Olafiranye, and Catalin Toma. “Feasibility of remote ischemic peri-conditioning during air medical transport of STEMI patients.” Prehospital Emergency Care 20, no. 1 (2016): 82-89.
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
Made with FlippingBook - Online magazine maker