Meanwhile, a recent report from Stockholm demonstrated that a mobile-phone positioning system that dispatched CPR-trained lay volunteers was associated with significantly increased rates of bystander-initiated CPR. 136 Similar benefits are expected from PulsePoint, a U.S. mobile phone app that locates layperson rescuers as well as proximate AEDs, though early results were hampered by a lack of specificity. 137 The location and mapping of AEDs is also being supported through innovative crowd-sourcing techniques, 138 and not surprisingly there is enormous interest in making these life-saving devices more available. There is little doubt that mobile applications and social media will play an increasingly valuable role in the early care of time-critical conditions. They may also be leveraged to encourage EMS innovation. A recent Defibrillator Design Challenge asked volunteers to vote for AED designs and share designs on social media, attracting 119 submissions that were shared over 48,000 times on Facebook and Twitter. 139 TELEHEALTH Telehealth promises to dramatically expand expert direct medical oversight for both acute and chronic EMS conditions. Local and state governments could dramatically improve the environment for innovation across a variety of sectors by enabling
direct mobile telehealth in the form of voice, text, data, pictures, video clips and live video between EMS providers, physicians and hospitals. The Houston Fire Department Emergency Telehealth and Navigation (ETHAN) project is being funded by a Section 1115 Medicaid waiver, which is expected to generate nearly $12M to the program over 5 years. Board-certified emergency physicians are linked with Houston Fire Department EMS providers via tele-video (currently 180 hours/week, with double MD coverage during some peak times) to manage 9-1-1 calls that do not involve acute conditions. The physicians are able to schedule next-day appointments at 19 community clinics, including providing the necessary transportation. Follow-up is performed by Houston Health Department social workers and care managers. To date, the program is generating high patient satisfaction, lowering EMS transports and ED visits. Of note, ETHAN receives substantial funding from Houston’s Pay-or-Play Fund, a pool of money paid to the City of Houston as a result of a legal provision requiring companies that do business with the city to either provide health insurance to employees or pay a penalty. 140 There are many other examples how HIT will be employed to augment EMS care. For example, it is feasible that real-time ultrasound images can be transmitted to stroke neurologists to diagnose and perhaps even treat acute stroke. 141 Further, immersive
136 Ringh, Mattias, Mårten Rosenqvist, Jacob Hollenberg, Martin Jonsson, David Fredman, Per Nordberg, Hans Järnbert-Pettersson, Ingela Hasselqvist-Ax, Gabriel Riva, and Leif Svensson. “Mobile- phone dispatch of laypersons for CPR in out-of-hospital cardiac arrest.” New England Journal of Medicine 372, no. 24 (2015): 2316-2325. 137 Brooks, Steven C., Graydon Simmons, Heather Worthington, Bentley J. Bobrow, and Laurie J. Morrison. “The PulsePoint Respond mobile device application to crowdsource basic life support for patients with out-of-hospital cardiac arrest: Challenges for optimal implementation.” Resuscitation 98 (2016): 20-26. 138 Merchant, Raina M., David A. Asch, John C. Hershey, Heather M. Griffis, Shawndra Hill, Olivia Saynisch, Alison C. Leung et al. “A crowdsourcing innovation challenge to locate and map automated external defibrillators.” Circulation: Cardiovascular Quality and Outcomes 6, no. 2 (2013): 229-236. 139 Merchant, Raina M., Heather M. Griffis, Yoonhee P. Ha, Austin S. Kilaru, Allison M. Sellers, John C. Hershey, Shawndra S. Hill et al. “Hidden in plain sight: a crowdsourced public art contest to make automated external defibrillators more visible.” American journal of public health 104, no. 12 (2014): 2306-2312. 140 “On-the-Scene Video Consultations with Emergency Physicians Reduce Unneccessary Ambulance Transports and Emergency Department Visits, Connect People to Medical Homes.” Agency for Healthcare Research and Quality. Last modified December 16, 2014. https://innovations.ahrq.gov/profiles/scene-video-consultations-emergency-physicians-reduce-unnecessary-ambulance-transports-and 141 Hölscher, Thilo, James V. Dunford, Felix Schlachetzki, Sandra Boy, Thomas Hemmen, Brett C. Meyer, John Serra, Jeff Powers, and Arne Voie. “Prehospital stroke diagnosis and treatment in ambulances and helicopters—a concept paper.” The American journal of emergency medicine 31, no. 4 (2013): 743-747.
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MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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