Looking at the trends and innovations in emergency medicine, it is apparent that the idea of an ambulance as a kind of mobile emergency room that comes to patients, connects them with health professionals and makes a diagnosis en route to the hospital, is gaining momentum. The increased usage of telemedicine plays a big part in this development.
There are two opposing approaches to emergency medical services at the international level. While the Anglo-American realm tends to take more of a "patient to the hospital" approach, the German-French model is likely to embrace the opposite concept of "hospital to the patient". Most European countries actually implement the latter approach: patients are treated on location by a team of paramedics or emergency medical physicians and then taken to the hospital as soon as possible.
The Anglo-American realm tends to take more of a "patient to the hospital" approach, the German-French model is likely to embrace the opposite concept of "hospital to the patient".
Increasing internet access worldwide, as well as the use of cameras and monitors, are already opening up new opportunities for telemedicine in many parts of the world by connecting hospitals with events at accident locations or in ambulances. In doing so, telemedicine also speeds up emergency medical services and optimizes workflow. In the future, the idea is to use telemedicine applications in passenger airplanes for example. An airline doctor on call could then communicate with the crew and the patient via video in case of an emergency. Even a serious medical event like a heart attack in flight could be quickly diagnosed that way.
The TemRas project (Telemedical Rescue Assistance System) also highlights this perspective. This is a former project of the RWTH Aachen University designed to connect paramedics to emergency medical physicians via video streaming by using a so-called InCar-peeq®BOX during ambulance transport. This technology uses antennas that are positioned on the roof of the ambulance. The InCar-peeq®BOX can also be used as a wireless access point, allowing other digital devices to connect. It also includes remote control options for the tele-emergency physician, allowing him/her to use and control the box.
As part of the "Rescue Wave" project, a task force of the KIT has developed a digital triage system, which is designed to treat injured patients in a mass casualty event. The system helps to assess the injured by transmitting all triage data to software accessible to all responsible parties. This data, which can also be accessed on mobile devices, allows decision-makers to act faster and make arrangements with each other. By prioritizing and systematically processing the data, the software assists in dividing the injured into the applicable means of transport.
The "AUDIME" project group of the RWTH Aachen University is likewise developing algorithms that could simplify medical triage of injured persons and support triage decision-making processes. The group also studies how innovative telemedicine support systems might be embedded into existing systems. The potential use of augmented reality technologies and the application of smart glasses and augmented reality in major catastrophic events are another emphasis of the project.
Apps like EmergencyEye offer support in the fight against life-threatening emergencies such as sudden cardiac arrest. EmergencyEye was developed as part of the EU-funded research project RAMSES (Remote Access to Medical Information on Smartphones during Emergencies and Health Crisis) and helps first responders to make a video call (video telephony connection) to experts - in this case via smartphone. First responders can also get virtual live support as they take resuscitation measures.
The increase in portable and miniaturized ultrasound and imaging point-of-care diagnostic devices is making it easier to treat patients already at the scene of the accident or in the ambulance and make a speedy and accurate diagnosis. For example, point-of-care ultrasound (or POCUS) enables emergency physicians to answer initial pressing clinical questions about the patient's condition with the help of portable ultrasound equipment. It quickly allows doctors to detect internal bleeding for example. This miniaturization trend is also making its way to endoscopy and laryngoscopy. Even non-invasive laboratory testing can now deliver lab-quality test results via a handheld device, while the findings can be wirelessly transferred or stored in the cloud. What’s more, a variety of portable and wireless CT scanners can now be used right at the patient’s bedside or while patients are still on the stretcher. This is a huge benefit, especially for patients with traumatic brain injuries.
The future of emergency medicine: an optimized process, based on data and with the clear tendency to bring the hospital to the patient and to relief the rescue teams.
In addition to apps, miniaturized point-of-care diagnostic devices, and telemedicine, it is also conceivable for an ambulance to undergo a transformation in the future. Maybe it will soon be able to make its way to the hospital or a clinical facility without a driver, while it passively measures vital signs and then uploads the collected data to the cloud - as a kind of traveling point-of-care device. Perhaps these driverless ambulances could also relieve emergency medical services by being "medical taxis" that transport patients who are not in a life-threatening condition to the nearest hospital.
Data-based, process-optimized and a clear trend towards bringing the hospital to the patient and relieving paramedics – all of these developments will most likely define the future of emergency medical services.
The article was written by Julia Unverzagt and translated from German by Elena O'Meara.