Hospital and emergency ambulance link: using IT to enhance emergency pre-hospital care
Introduction
Ambulances were for many decades regarded primarily as means for transportation of the sick and wounded from homes, work sites and public places to medical institutions where real treatment usually began. With the advent of cardio-pulmonary resuscitation (as we know it now) in the early 1960s and later electrical cardiac defibrillation by trained crew, ambulances became venues for initiating life-saving treatments.
A number of evolving health care issues have shown the need for diagnoses to be made as early as possible and treatments initiated earlier:
- 1.
Identification of an increasing array of time-sensitive diseases and treatments and the realisation that earlier diagnosis and earlier treatments create the potential for better outcomes and lesser mortality and morbidity.
- 2.
The acceptance that health care is a continuous process from the point of injury/sickness to the hospital and that prompt knowledge of care provided earlier can only enhance the level of care to be given at the subsequent level.
- 3.
The increasing cost of health care especially as provided in institutional settings has meant that health care planners are constantly on the lookout for more cost-efficient ways of providing medical care in out-of-hospital settings.
- 4.
The realisation that ambulance crew (paramedics) can be trained to provide many forms of urgent medical care in ambulances and other pre-hospital environments has opened up the potential for earlier medical interventions to the patient's eventual benefit.
With the increasingly useful role of ambulances and paramedics in the provision of emergency medical care, receiving hospitals are being forced to polish up their acts in ensuring that they review their investigational and treatment processes so as to maximise the benefits of patients arriving in hospital in a medically better condition than previously. While at one time, hospital staff would have known about ambulance transported patients only on arrival at the emergency department (ED), the advancements in voice communication devices has meant that ambulance crew are now able to verbally alert the hospital of impending arrivals. Such verbal communications (radio and cellular phone) have had their limitations in terms of quality of voice transmission, the need to make records of such communication and the technical problems of capturing and transmitting the increasing variety of information that ambulance crew are now able to obtain.
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Historical development
In 1993, the Singapore General Hospital in consultation with the country's National Computer Board first proposed a system linking the Emergency Ambulance Services (EASs) that handled the most critically ill patients electronically with the receiving ED so as to speed up the transfer of information on these patients. The team that began work on this idea had to address the problems of data entry in a moving ambulance, electromagnetic interference by communication equipment in the ambulance on
System availability
Initially, only 69.1% of Central ambulance runs used the HEAL system. By the third month, this increased to 93.9% (set target was 95%).
Transmission times
(a) HEAL runs – load-and-go cases only Transmission Cardiac arrest with pre-arrival information only 3 s Non-trauma with pre-arrival information+vital signs 5 s Trauma with pre-arrival information+mechanism of injury+vital signs 4 s Non-trauma with pre-arrival information+vital signs+ECG 42 s Trauma with pre-arrival information+mechanism of injury+vital signs+ECG 42 s
Discussion
This pilot run of the HEAL system was to our knowledge, the first to be conducted of a comprehensive electronic ambulance case record system that consisted of patient biodata, information on clinical history and physical findings, vital signs data, electrocardiographic data and patient management information. A critical post-implementation review of the HEAL system and the ambulance run workflow resulting from it has revealed the following
Conclusion
The HEAL pilot project that was conceived 6 yr ago demonstrated the feasibility of a comprehensive, electronic hospital and emergency ambulance link with tremendous potential for emergency care. It is also very likely that enhancements using currently available technology and integration of systems that currently exist would pave the way for a revolution in the way information is captured in emergency ambulances, the raising of standards of professional care in ambulances and speeding up of the
Acknowledgements
This article was written with inputs from the various organisations that contributed to the development of the HEAL system, viz. Singapore Civil Defence Force, Ministry of Health, National Computer Board, Singapore General Hospital and Singapore Network Services Pte Ltd.
References (2)
- et al.
Transmission of electrocardiograms from a moving ambulance
Journal of Telemedicine and Telecare
(1998) - et al.
The Lancashire telemedicine ambulance
Journal of Telemedicine and Telecare
(1998)