Ambulance telemetry - Ubonratchathani


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Ambulance telemetry - Ubonratchathani

  1. 1. AMBULANCE TELEMETRY Jirawat Juengsiragulwit Sappasitthiprasong hospital, Ubon
  2. 2. Disclosed
  3. 3. Outline• Telemedicine• Ambulance telemetry• Ubon model and the key success to ambulance telemetry
  4. 4. Telemedicine (โทรเวช)• The use of medical information exchanged from one site to another via electronic communication to improve patientshealth status.
  5. 5. Telemedicine services• Specialist referral services• Remote patient monitoring• Patient data transfer• Medical education• Consumer medical and health information
  6. 6. • Tele-radiology • Tele-ambulance• Tele-pharmacy • Tele-ACS• Tele-dermatology • Tele-stroke• Tele-ophthalmology • Tele-trauma• Tele-pathology• Tele-consultation
  7. 7. 2515 สมเด็จพระศรีนครินทราบรมราชชนนี ทรงพระกรุณาโปรดเกล้าฯให้ดําเนินงานหน่วยแพทย์ทางวิทยุครั้งแรกในประเทศไทยพระราชทานนามว่า... “แพทย์อาสาทางอากาศ”
  8. 8. Pass about 40 years• Advance in mobile device technology• Advance in social network communication
  9. 9. ICU mobileอดีต = ICU ติดล้อ +ปัจจุบัน = ICU ติดปีก +
  10. 10. Ambulance Telemetry• Evaluate, Diagnose, Monitoring, Treat• Patient in mobile bed• from remote location or prehospital area• Data roaming via telecommunication
  11. 11. 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.
  12. 12. 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
  13. 13. COMPOSITIONS• Data roaming• Medical device• Encounter management• Connectivity• Hardware configuration
  14. 14. Data roaming• Text• Picture• Voice• Video
  15. 15. Medical device• Lifegain : Defibrillator with Bluetooth.• Camera set• Notebook + air card for Internet access• Workstation computer server
  16. 16. Encounter management software• EMS12 MultiviewerDual• Text/Message chat• EKG realtime with 2 second delay• Snap shot picture 2 pics./sec.• Voice IP
  17. 17. Connectivity (wireless computer network)1.Global System for Mobile communication • General Packet Radio Service • Enhance Data rate for Global Evalution2.Code Division Multiple Access communication3.Wideband Code Division Multiple Access communication4.WiMAX
  18. 18. CDMA
  19. 19. Clinical effectiveness• Monitoring• Critical decision and management• From "whats coming in the door" To "I knew and Im waiting you" Now then "OK, youve already treated."
  20. 20. Old tradition
  21. 21. Some private hospital
  22. 22. UBON
  23. 23. Megaproject
  24. 24. Tablet + 3G = วาระแห่งปี
  25. 25. 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
  26. 26. 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
  27. 27. 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
  28. 28. 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
  29. 29. Key to a successful ambulance telemetry
  30. 30. 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
  31. 31. December 2553• 501 critic patients was transfer by ambulance telemetry• 91.42% by overall critical interfacility transfer• 72% applied telemetry during transfer
  32. 32. 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
  33. 33. • 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
  34. 34. 3. Create a convenient and effective workenvironment• The sending room : device position, lighting and white balance.• The receiving room (workstation) : directly to consulting physicians workplace or using forward software to physician desktop.• Simple as possible to use first, technology should be remain in the background.
  35. 35. 4. Mainstream telemedicine into the standard careprocess• 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
  36. 36. Criteria for activated ambulance telemetry• Respirator needed • Major trauma• Impending compromise • >2 episodes seizure in 30 airway mins• Acute coronary syndrome • AOC protocol• Shock or impending • Obstetric protocol• HT emergency • Doctor order
  37. 37. 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
  38. 38. 6. Make sure you have a full time coordinator andan 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
  39. 39. Key persons
  40. 40. 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
  41. 41. New project release• 5yr : ICU mobile hub, Referal data registry• 10yr : อุบลศรีโสธรเจริญ• 20yr : 3D, Robot
  42. 42. 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
  43. 43. 9. Good market is clinical• Set public expectations• Tell the world the good things youve done• Tell the world what is coming next
  44. 44. 10. Publish or perish• Presenting or publishing the results or status of our program at least once per year• Posters, teaching and sharing