Healthcare innovation is happening at a pace never before seen; technologies that were once science fiction are now a reality. A Department of Homeland Security Science and Technology Directorate video series produced in 2016 included a 15-years in the future speculative look at EMS technology.
The video depicted body wear designed to protect and monitor the health of an EMS provider; a self-driving ambulance connected by video feed to a 911 caller coupled with a patient medical history and remote diagnostics; smart devices to assess, measure, record and transmit patient findings; a hoover type patient stretcher; mass casualty management and triaging software and a host of other technologies. While these seem futuristic, the speed at which healthcare and technology are evolving has already put many of these in our hands.
Like younger children gifted with clothing from their older siblings, EMS continues to enjoy the hospital and Emergency Department innovation benefits. The latest hand-me-downs include whole blood, ultrasound, ECMO, and REBOA. Over time, we’ve learned that bigger, bulkier, and more massive machines used in hospitals are impractical in the field. This has pushed the introduction of handheld pulse oximeters and capnography devices and disposable CPAP and BiPAP. Artificial intelligence (AI) has recently made headway in 911 centers, offering pinpoint accuracy of wireless callers and sophisticated voice analysis capable of accurately detecting cardiac arrests. Drones deliver AEDs to rural and urban cardiac arrest settings, and a miniaturized EEG screening device will shortly allow EMS providers to differentiate types of strokes in the field.
The military lessons from Iraq and Afghanistan showed that early administration of whole blood dramatically improved survival from trauma. Several EMS services are now administering whole blood, including the San Antonio (Texas) Fire Department. While more considerable outcomes have not yet been published, case reports1 suggest significant patient benefits. Ultrasound made a brief foray into the prehospital world in the early ’90s but failed to achieve widespread adoption. With a shift from application from critical, time-sensitive patients to assist in IV placement, assess fetal well-being in pregnant patients, classify types of shock, and evaluate CPR, EMS adoption has again started to take off2.
Albuquerque Fire Rescue (New Mexico) was an early provider of prehospital extracorporeal membrane oxygenation (ECMO), a technology used in Paris since 2011. ECMO and ECLS – extracorporeal membrane oxygenation and extracorporeal life support both use an external pump and oxygenator to provide circulation when the heart and/or lungs have ceased to provide adequate perfusion. Their use is recommended on limited basis for prehospital patients with massive pulmonary embolism or cardiac arrest that fails to respond to standard resuscitative measures. Prehospital ECMO survival is currently ranging from 29–48%, dramatically better than almost certain death faced by these patients without it3-4.
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)5 is a device inserted through the femoral artery to temporarily occlude the aorta. As a type of internal tourniquet for cases of massive internal hemorrhage in the trunk or lower body, REBOA buys time until surgical repair can be accomplished. Currently used in hospitals, REBOA is undergoing EMS trials after having been used by the military to stabilize critically injured soldiers.
AlphaStroke is a screening device being developed by Forest Devices that provides an objective, electronically-determined test for stroke using an electrode containing a skull cap attached to a portable analyzer. It has shown remarkable accuracy in trials to date and could be a game-changer once cleared for marketing.
Corti is an AI cardiac arrest detection app that resides in several European dispatch centers. Corti listens to callers' voices and, using machine learning, detects words and voice patterns that suggest cardiac arrest. In studies, Corti recognized 93.1% of out-of-hospital cardiac arrests compared to 72.9% recognized by dispatchers. It was also faster, spotting arrests on an average of 48 seconds, compared to 79 seconds for humans. Once available in the U.S., Corti could help expedite care.
Rapid SOS was first widely adopted in the United States by Uber when they struggled to pinpoint drivers with emergencies requiring police or EMS assistance more accurately. Unlike cellular 911 technologies that locate callers based on their proximity to cell towers, Rapid SOS uses the calling cell phone GPS information to precisely pinpoint a phone location. Now deployed by 4,800 emergency dispatch centers worldwide, the platform is accurate to within inches of a caller's location, enabling responders to more efficiently reach the scene of any wireless call for help.
Drones have been used since 2006 to deliver AEDs to the scene of rural cardiac arrests in Sweden. This lifesaving technology, coupled with telephone and, on arrival of the drone, camera assisted CPR directions from a 911 dispatcher, have been shown to save lives6. In 2020, the Federal Aviation Administration (FAA) approved 10 U.S. cities to begin flying AED carrying drones below the visual line of sight. The AED drones can fly at speeds of up to 62 mph and hone-in directly on a bystander's cell phone signal. In addition to rural areas with prolonged EMS response times, drones can deliver AEDs to roofs, balconies, and windows in high-rise buildings, another location where vertical response time slows EMS. The studies in progress will inform the FAA on necessary drone rules and regulations and perhaps pave the way to deliver other medical supplies needed in the field (such as blood).
Knowledge is power.
Not every EMS service needs to utilize any or all of these technologies or service delivery models. But every EMS leader and provider, from the chief of department to the newest paramedic, should be aware that they exist. As healthcare changes, we all need to keep abreast of technology and investigate tools that might lower costs, improve safety, and deliver better patient outcomes.
Chief Mike McEvoy, PhD, NRP, RN, CCRN is the EMS Coordinator for Saratoga County, New York, and Chief Medical Officer for the West Crescent Fire Department. He is a nurse clinician in critical care at Albany Medical Center and chairs the IAFC EMS Section. He writes and speaks on technology and innovation in EMS, critical care and the fire service.
1. Merkle A, Schaefer R, How R, Fritz T. Case Report: Prehospital Whole Blood Transfusion by Texas Helicopter Air Ambulance Crew. JEMS. November 21, 2019. On-line: www.jems.com/2019/11/21/prehospital-whole-blood-transfusion-by-texas-helicopter-air-ambulance-crew/.
2. Roantree RAG, Furtado CS, Welch K, et al. EMS Ultrasound Use. [Updated 2020 Sep 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK442034/
3. Marinaro, J, Guliani, S, Dettmer, T, Pruett, K, Dixon, D, Braude, D. Out‐of‐hospital extracorporeal membrane oxygenation cannulation for refractory ventricular fibrillation: A case report. JACEP Open. 2020; 1: 153– 157. https://doi.org/10.1002/emp2.12033.
4. Ellouze O et al. Comparable Outcome of Out‐of‐Hospital Cardiac Arrest and In‐Hospital Cardiac Arrest Treated with Extracorporeal Life Support. Artificial Organs. 2018;1:15–21.
5. Thabouillot O, Bertho K, Rozenberg E, Roche NC, Boddaert G, Jost D, Tourtier JP. How many patients could benefit from REBOA in prehospital care? A retrospective study of patients rescued by the doctors of the Paris fire brigade. J R Army Med Corps. 2018;4:267-270.
6. Cheskes S, McLeod SL, Nolan M, Snobelen P, Vaillancourt C, Brooks SC, Dainty KN, Chan T, Drennan IR. Improving Access to Automated External Defibrillators in Rural and Remote Settings: A Drone Delivery Feasibility Study. JAHA. 4 Jul 2020. https://doi.org/10.1161/JAHA.120.016687.