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Wednesday, October 1, 2008

Military Spin

Steve Colby

Getting Patient Data To the Treatment Center

COMMERCIAL | EMS

If you’ve flown rescue or medevac, you’ve experienced listening to or parrotting the medic’s patient-condition report to the receiving hospital or command-and-control dispatch center.

What’s common to most of these transmissions is, first, a requirement for line-of-sight communications and, second, some means of getting treatment instructions back through the radio from an M.D. if the patient is critical or crashing. An alternative means of moving patient vitals and doctor instructions in near-real-time is long overdue and worthy of examination, further development and technical implementation. When one thinks how simply our children communicate with text messages on their cell phones, it is easy to see a need for a simple means to harness that connectivity for our patients’ in-flight treatment.

To beat these systems one must plan backward from the objective to the starting point.

Patient-monitoring systems, whether from Zoll, Phillips, Medtronic, GE, Hewlett-Packard or other another manufacturer, are capable of detecting, recording and reporting significant patient vitals. Necessary vitals would be those most commonly seen on patient monitors/defibrillators, such as blood pressure, pulse, respiration, O2 saturation, electrocardiogram readings, plus a free-text area for injury descriptions and medic assessment. Getting those vitals to the trauma center or dispatch may seem like a simple case for verbal brevity on the radio. For seriously injured patients on recoveries whose flight times may exceed the golden hour, the ability to send and receive vital, life-saving information may be compromised.

An over-the-horizon or cellular-phone means of moving that data in a bandwidth-thrifty waveform is ripe for development and installation. Setups like this may already be designed for aeromedical evacuation or cargo aircraft, though they are seldom size- or weight-conscious enough for helicopter applications. What is needed is a lightweight system that can take the monitor readings at a predetermined interval, package them as a compressed digital movie or a compiled, matrixed spreadsheet that summarizes the key vitals. These files would be encrypted for (in the U.S.) Health Insurance Portability and Accountability Act (HIPAA) compliance and uploaded to a satellite communications or cellular system whose downlink provides a connection to the Internet. This connection should populate a secure Web-based server that the treatment center can use to access and evaluate data, and a response pipe through which treatment instructions may be sent.

What are some of the challenges? Design investment, certification, weight and cost are the greatest obstacles to a civilian variant. The first hurdle that comes to mind is airworthiness certification. For this type of system, an supplemental type certificate would likely be the route, since regional signoffs for aircraft modifications are becoming a thing of the past for EMS modifications. Structural analysis and engineering design for most medevac platforms would be a costly, but necessary step in marketing the product to the community at large. Electromagnetic interference testing would be required, and FAA certification would be the result. The system would have to be developed in concert with the monitor manufacturers for standardized output formats and packaged data. But airworthiness certification and standards aren’t the only hurdles.

The patient data must be protected for privacy and liability considerations, which brings in HIPAA concerns. Lastly, there must be software developed to receive, process, respond to and store all the communications for documentation and, again, legal reasons. As I write this, it becomes clear why the civil sector hasn’t pursued this technology. The hurdles seem unconquerable when analyzed in comparison to the value of the data stream...unless you’re the patient.

Envisioned here is a system developed for military medevac whose technology could spin off to civil or public helicopter services employing either commercial satcom or cell-phone connections. The key is to not get hung up on the transmission pipe and waveform but more appropriately focus on standardized formats for patient data, treatment-instruction phraseology and data compilation. Encryption services and database protection are also paramount.

The benefit to extending the medic’s reachback is incalculable. Ask one if he or she ever had a case where they would have appreciated a doctor’s treatment advice during a touch-and-go patient transfer. If experienced, they probably have had a case or two like this under their belts. The value of a network, said Bob Metcalfe, inventor of the Ethernet, is proportional to the square of the number of users in the system. Networking the trauma unit with the first-response caregivers is a value difficult to quantify but easy to justify.

Similar to my challenge to industry for a lightweight civil GPS/INS system last year, I again challenge industry and military requirements writers to codify the need, develop the technology and fill the niche for this necessary information path. This concept dovetails perfectly with the development of the Global Information Grid. Let’s hear from the medics in the field if they believe this is a useful piece of kit.

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