Ambulance Telemetry• Evaluate, Diagnose, Monitoring, Treat• Patient in mobile bed• from remote location or prehospital area• Data roaming via telecommunication
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.
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
COMPOSITIONS• Data roaming• Medical device• Encounter management• Connectivity• Hardware conﬁguration
Medical device• Lifegain : Deﬁbrillator with Bluetooth.• Camera set• Notebook + air card for Internet access• Workstation computer server
Encounter management software• EMS12 MultiviewerDual• Text/Message chat• EKG realtime with 2 second delay• Snap shot picture 2 pics./sec.• Voice IP
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
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
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
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
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
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
December 2553• 501 critic patients was transfer by ambulance telemetry• 91.42% by overall critical interfacility transfer• 72% applied telemetry during transfer
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
• 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
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.
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
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
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
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
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
New project release• 5yr : ICU mobile hub, Referal data registry• 10yr : อุบลศรีโสธรเจริญ• 20yr : 3D, Robot
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
9. Good market is clinical• Set public expectations• Tell the world the good things youve done• Tell the world what is coming next
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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