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Mobile Devices Speed and Streamline Pre-hospital Care

Analysis  |  By Tinker Ready  
   July 14, 2016

Mobile devices allow telemedicine providers to virtually assess patients, and have the potential to improve stroke care and reduce emergency department traffic.

Smartphones and tablets often come with the promise that advanced technology and more powerful cellular networks will lead to better connections and faster streaming video.

But those promise could mean a lot more in a medical emergency.

Clearer pictures and reliable connectivity are making telemedicine more mobile and more reliable. The result: better tools for pre-hospital providers and the emergency department teams they work with.

In Houston, the city's EMT-trained firefighters now take connected tablets on 911 calls so they can allow a doctor to assess and triage patients via video.

And an ambulance-based tablet system may allow neurologists to accurately diagnose patients with stroke symptoms before they arrive at the hospital. That could speed care to patients, a key factors in better stroke outcomes.

Using an iPad and commercial cellular networks, doctors in rural Virginia and San Francisco were able to perform accurate neurologic exams after connecting with ambulance staff via video, according to a preliminary study in the journal Neurology

The research used simulated scenarios—medical students working from scripts, as opposed to actual patients—to compare bedside and mobile assessments.

Every minute that care is delayed can have an impact on stroke outcomes, says Andrew Southerland, MD, the University of Virginia Health System doctor who led the study.

"So if we can perform pre-hospital telemedicine—virtually putting the neurologist in the back of the ambulance to evaluate patients—then, theoretically, we may be able to decrease the amount of time to get them diagnosed and in treatment," he said.  

And while speed is key to stroke care, so is triage.

A subgroups of stroke patients can now benefit from an endovascular procedure known as "mechanical thrombectomy."  For about 10% of patients, a doctor can use a catheter to access the brain and remove blood clots and limit stroke damage.

Those patients, however, need to be assessed and delivered to a hospital with the capacity to perform the procedure.

Southerland says that requires EMS providers, whether they are career paramedics or volunteer firefighters, to make important triage decisions. The tablet system would allow them to consult with a neurologist first.

The UVA team has been getting calls from other health systems interested in their approach.

Southerland tells them they can try to mimic the program, but he would rather they get involved in the research. Southerland's team is in the process of enrolling patients into the next phase of the research with the hope of eventually launching a multi-site clinical trial.

"We don't want it to be thrown out there without the requisite amount of amount of rigor that we put into it," he said.     

For example, his team spent two years looking the connectivity on the ambulance routes to make sure they had the broadband capacity to make the system work.

Houston's ETHAN

Just five years ago, programs like this may not have been possible, according to Michael G. Gonzalez, MD, medical director of Houston's ETHAN Project (Emergency TeleHealth And Navigation).

The clarity and processing speeds of the current devices, along with the cellular networks make the teleconference encounter virtually identical to an in-person encounter, he wrote in an email response to questions from Health Leaders. His system uses a Panasonic Toughpad

"The physician can direct the paramedic or firefighter on scene to direct the image toward a sprained, swollen ankle, or concerning rash, and the image quality enables the physician to make an appropriate decision regarding the best, most appropriate level of care," he wrote.

For patients who don't need to emergency care, the paramedics offer to set up an appointment with a doctor and pay for a roundtrip taxi. 

"With ETHAN… we have demonstrated that real-time, direct visualization and interview of patients in the pre-hospital setting is not only possible, but potentially time-saving and efficient," he wrote.

"The potential for videoconferencing and similar technologies in the prehospital/EMS world is limitless."

Tinker Ready is a contributing writer at HealthLeaders Media.

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