Ambulance telemetry - Ubonratchathani
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AMBULANCE TELEMETRYJirawat Juengsiragulwit
Sappasitthiprasong hospital, Ubon
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Disclosed
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Outline
• Telemedicine
• Ambulance telemetry
• Ubon model and the key success to ambulance telemetry
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Telemedicine (โทรเวช)
• The use of medical information exchanged from one site to another via electronic communication to improve patients'health status.
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Telemedicine services
•Specialist referral services
•Remote patient monitoring
• Patient data transfer
• Medical education
• Consumer medical and health information
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• Tele-radiology
• Tele-pharmacy
• Tele-dermatology
• Tele-ophthalmology
• Tele-pathology
• Tele-consultation
•Tele-ambulance
• Tele-ACS
• Tele-stroke
• Tele-trauma
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2515 สมเด็จพระศรีนครินทราบรมราชชนนี ทรงพระกรุณาโปรดเกล้าฯให้ดําเนินงานหน่วยแพทย์ทางวิทยุครั้งแรกในประเทศไทย พระราชทานนามว่า...
“แพทย์อาสาทางอากาศ”
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Pass about 40 years
• Advance in mobile device technology
• Advance in social network communication
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ICU mobileอดีต = ICU ติดล้อ +
ปัจจุบัน = ICU ติดปีก +
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Ambulance Telemetry
• Evaluate, Diagnose, Monitoring, Treat
• Patient in mobile bed
• from remote location or prehospital area
• Data roaming via telecommunication
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Lifebot project, under US army development
• Telemedicine life support system
• Texas : $14 million advanced EMS ambulance telemedicine and disaster manage system.
• Important in remote areas where transport times may be prolonged ; act to protect ambulance personal and providers during difficult situations.
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Why ambulance needs telemetry?
• Moving vehicle needs continuous data transmission
• Complex clinical scenearios
• Difficult to interpret EKG rhythms
• Assistance in patient monitoring
• Destination decisions
• Assistance with-non transports
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COMPOSITIONS
• Data roaming
• Medical device
• Encounter management
• Connectivity
• Hardware configuration
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Data roaming
• Text
• Picture
• Voice
• Video
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Medical device
• Lifegain : Defibrillator with Bluetooth.
• Camera set
• Notebook + air card for Internet access
• Workstation computer server
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Encounter management software
• EMS12 MultiviewerDual
• Text/Message chat
• EKG realtime with 2 second delay
• Snap shot picture 2 pics./sec.
• Voice IP
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Connectivity (wireless computer network)
1.Global System for Mobile communication
• General Packet Radio Service
• Enhance Data rate for Global Evalution
2.Code Division Multiple Access communication
3.Wideband Code Division Multiple Access communication
4.WiMAX
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CDMA
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Clinical effectiveness
• Monitoring
• Critical decision and management
• From "what's coming in the door"
To "I knew and I'm waiting you"
Now then "OK, you've already treated."
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Old tradition
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Some private hospital
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UBON
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Megaproject
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Tablet + 3G = วาระแห่งปี
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Brief history of Ubon ambulance transfer
• Zone 13 = 56 Hospitals (อุบลศรีโสธรเจริญ) Cover : อุบลราชธานี, ศรีสะเกษ, ยโสธร, อํานาจเจริญ
• อุบลราชธานี = 25 districts
• Before 2549 : BLS ambulance
• October 2549 : Super ALS ambulance
• October 2552 : mini-telemetry ambulance
• Since April 2553 : full option telemetry ambulance
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UBON model
• 3 fast tract transfers : STEMI, Stroke, Trauma
STEMI was sent as bypass tract
• Advance in specialized patient care have increased the demand for data communication system.
• We first applied in STEMI patients monitor during interfacility transfer
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Upcoming
• Ambulance telemetry protocol
• ICU mobile nurse training program
• Apply social network in advance communication "Referral data registry"
• Add distributive collaboration to online medical control
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Not only EP can be online medical control
• Real time evaluation and management of critically ill patients by multiple specialist.
• Assembly of multiple-victim information
• Assistance in diagnostics
• Transfer of care hand-offs
• Homeland security command and control
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Key to a successful ambulance telemetry
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1. Establish a vision
• How to increase the volume of service?
• Explore overall vision of the organization
• Model approach
- Access to care model
- Cost savings model
- Access to market model
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December 2553
• 501 critic patients was transfer by ambulance telemetry
• 91.42% by overall critical interfacility transfer
• 72% applied telemetry during transfer
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2. Building a long term financial plan
• Set short and long term financial goal.
• Looking for ongoing revenue (long term sustainability)
• You do not always get what you want but you often get what you measure.
• Show clear outcome and how to collect it
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• The death rate in severe traumatic patients who inter facility needed was reduce from 37% to 31%
• Ongoing research
1. Unit cost
2. Compare clinical outcome
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3. Create a convenient and effective work environment
• The sending room : device position, lighting and white balance.
• The receiving room (workstation) : directly to consulting physician's workplace or using forward software to physician desktop.
• Simple as possible to use first, technology should be remain in the background.
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4. Mainstream telemedicine into the standard care process
• Standard protocol for telemedicine as same as non-telemedicine
• Add : equipment protocol, dispatch, documentation, measurement and billing protocol
• The more change that must be adopted the higher the likelihood of failure
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Criteria for activated ambulance telemetry
• Respirator needed
• Impending compromise airway
• Acute coronary syndrome
• Shock or impending
• HT emergency
• Major trauma
• >2 episodes seizure in 30 mins
• AOC protocol
• Obstetric protocol
• Doctor order
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5. Plan and assure effective training
• Communication technology
• Clinical technology
• Diagnostic device user training for both send and receive sites
• Workflow and protocols of care and procedures for use of devices
• Documentation
• Trouble shooting and access to product and technical support
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6. Make sure you have a full time coordinator and an effective leader and cheerleader
• Clear leader in authority and fly cover the program participate.
• Key man : necessary skills, passion and commitment to serve, encourage user, inform management and assure that the program is properly marketed.
• Full time nurse and technician
• Sending sites person
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Key persons
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7. A project plan = manageable milestones = Reasonable expectation
• Roadmap should be simple, manageable and reasonable
• Do not over plan and paralyze the project
• Set 5y plan, 10y plan, 20y plan and meet them
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New project release
• 5yr : ICU mobile hub, Referal data registry
• 10yr : อุบลศรีโสธรเจริญ
• 20yr : 3D, Robot
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8. Horizontal vs. Vertical implementation
• Limited capable but widely use or limited use but super capable
• Consider device option and clinical outcome.
• Telemet needs continuous train and support
• Both tract will reach a future large-scale expansion
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9. Good market is clinical
• Set public expectations
• Tell the world the good things you've done
• Tell the world what is coming next
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10. Publish or perish
• Presenting or publishing the results or status of our program at least once per year
• Posters, teaching and sharing
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