Over a year ago, I wrote about a product called LifeBot. This technology provides a way to join the ED and prehospital teams as they work on patients. This involves special monitoring equipment in the ambulance (cameras and other telemedicine equipment), a special tablet computing system for data input and imaging, and equipment at the ED base station.
Using the original LifeBot system, medics could relay vitals and EKG data to the base station in real time, receive orders from emergency physicians, and send video feeds and photos from the ambulance.
LifeBot Technology has now released LifeBot 5, the next generation of this system. The unit is now portable, and can be taken out of the ambulance at the scene. It is ruggedized and weighs only 15 pounds, which isn’t bad for field medical equipment. The system now includes a web interface that can mesh with some electronic medical record systems.
Expect to see more improvements (a defibrillator is slated as the next addition) as well as competing products soon.
What does it cost, you ask? A lot! As always, it’s tough to get exact numbers. The LifeBot 5 should be about $20,000. However, this does not include equipment cost for the base station, which is at least that much, if not more!
Bottom line: Expect further progress in blending the prehospital and emergency department environments. More products like this will become available, extending the senses of emergency physicians and providing additional assistance to prehospital providers.
When I was at Penn 25 years ago, I was fascinated to see that police officers were allowed to transport penetrating trauma patients to the hospital. They had no medical training and no specific equipment. They basically tossed the patient into the back seat, drove as fast as possible to a trauma center, and dropped them off. Then they (hopefully) hosed down the inside of the squad car.
Granted, it was fast. But did it benefit the patient? The group now at Penn decided to look at this to see if there was some benefit (survival) to this practice. They retrospectively looked at 5 years of data in the mid-2000’s, thus comparing the results of police transport with reasonably state of the art EMS transport.
They found over 2100 penetrating injury transports during this time frame (!), and roughly a quarter of those (27%) were transported by police. About 71% were gunshots vs 29% stabs. They found the following interesting information:
The police transported more badly injured patients (ISS=14) than EMS (ISS=10)
About 21% of police transports died, compared to 15% for EMS
But when mortality was corrected for the higher ISS transported by police, it was equivalent for the two modes of transport
Although they did not show a survival benefit to this practice, there was certainly no harm done. And in busy urban environments, such a policy could offload some of the workload from busy EMS services.
Bottom line: Certainly this is not a perfect paper. But it does add more fuel to the “stay and play” vs “scoop and run” debate. It seems to lend credence to the concept that, in the field, less is better in penetrating trauma. What really saves these patients is definitive control of bleeding, which neither police nor paramedics can provide. Therefore, whoever gets the patient to the trauma center in the least time wins. And so does the patient.
Wartime experience has shown that rapid transport from the battlefield scene of injury to definitive care dramatically improves survival. This has been translated into civilian trauma care by making helicopter transport to a trauma center more widely available. But this resource is still somewhat limited, and very expensive compared to ground EMS transport. Is this expense warranted, or in other words, does it improve survival?
Many have tried to answer this question. Several of these studies did show improved survival with air transport, but most had significant flaws that made their conclusions hard to interpret. The current issue of JAMA has published an article from MIEMSS and Johns Hopkins that tries to do it right.
The authors used the National Trauma Data Bank (1.8M records) and whittled it down to 223K by using pertinent exclusion criteria. About 25% were transported by air and 72% were taken to Level I centers (vs Level II). A sophisticated regression model was used to adjust for missing data and clustering by trauma centers.
They found that there is roughly a 1.5% survival advantage in taking patients to trauma centers by air. About 65 patients need to be transported to a Level I center, or 69 patients to a Level II center, to save a life. There are some issues with the statistics, primarily due to the nature of the NTDB data, but overall the paper is nicely done.
Bottom line: It looks like helicopter transport of seriously injured trauma patients conveys a very small survival advantage. However, this does not mean that everybody now needs to be flown in. This is not an ideal world, and not everybody is in an area that can provide such transport. Furthermore, in many areas ground EMS is still faster than air. And finally, air transport is much more expensive than the incremental survival increase may be worth. We will have to come to grips as a society to figure out what we can really afford.
Reference: Association between helicopter vs ground emergency medical services and survival for adults with major trauma. JAMA 307(15):1602-1610, April 18, 2012.
Ambulance 2.0: The “Super Ambulance” of the Future
Lifebot Technology has been working to upgrade the prehospital environment and connect it more closely with trauma professionals in the trauma center. They have done this by developing a so-called “super ambulance.” These ambulances are outfitted with new variations of tried and true technology. This includes a special Hewlett-Packard Slate tablet computer, multiple cameras inside the ambulance, cameras that are wearable by medics, and a state-of-the-art telemedicine system.
The Slate tablet allows for hand-held patient monitoring, GPS positioning, high resolution imaging via its built-in camera, patient medical record charting, and connection to the trauma center base station. At the base, the emergency physician or trauma surgeon can view monitoring information, control any camera in the ambulance to focus in on the action, and even draw on the Slate’s screen to show the crew areas of interest (telestration).
The system is pricey ($50,000 US), but is extremely valuable in rural areas where the nearest trauma center may be quite far away. In theory, a doctor could walk a medic through a procedure to resolve a problem that may kill their patient before they can get to the hospital. The system is already in use in select areas in Arizona, Florida and Texas.
Reference: Displayed at the HIMSS 2011 (Healthcare Information and Management Systems Society) annual meeting, February 20-24, 2011 in Orlando, FL.
Disclosure: I have no financial interest in Lifebot Technology or Hewlett Packard
The Trauma Professional's Blog provides information on injury-related topics to trauma professionals. It is written by Michael McGonigal MD, the Director of Trauma Services at Regions Hospital in St. Paul, MN. Regions is a Level I Adult Trauma Center, and has partnered with Gillette Children's Specialty Hospital to become the first Level I Pediatric Trauma Center in the Upper Midwest.