THE EMERGENCY MEDICINE PROJECT: TEXAS
50 paramedics from three different EMS departments in Texas have been using portable ultrasound devices and Trice Imaging’s image sharing and collaboration platform to save time and save lives while trauma patients are en route to emergency departments.
The project is still in progress but the interim results show amazing outcomes and a great potential to influence the way ultrasound contributes to acute medicine.
The Mission
The mission of The Emergency Medicine Project in Texas is to prove that health care providers can provide better quality of care and potentially save lives by providing EMS departments and their medics with technology that shortens the distance to diagnosis and ensures that patients are transported to a facility that is prepared to provide the right expertise and the right treatment at the time of the patient’s arrival.
Cases of severe trauma, especially internal bleeding, require surgical intervention. Complications such as shock may occur if the patient is not managed appropriately and expeditiously. It therefore becomes a priority to transport patients suffering from severe trauma as quickly as possible to specialists for definitive treatment, most often at hospital trauma centers. Because some injuries can cause a trauma patient to deteriorate extremely rapidly, the lag time between injury and treatment should ideally be kept to a bare minimum; this has come to be specified as no more than 60 minutes. After an hour, the survival rate for traumatic patients is alleged to fall off dramatically. The 60 minutes after trauma, when life-saving decisions can be made is, therefore, often referred to as “the golden hour.”
Trice Imaging and Samsung Healthcare provided EMS departments and acute care hospitals with portable ultrasound devices and an image sharing and collaboration tool that maximizes the golden hour and is ultimately providing better quality of care and saving lives in trauma situations.
The project was initiated by the well-known and well-respected Dr. Roy Yamada.
“My mission is to save that one life that no one else could.”
– Dr. Roy Yamada, EMS Medical Director, Dallas/Fort Worth
The hypothesis of The Emergency Medicine Project in Texas is that when electronic scan files are received in advance of a trauma patient’s arrival, an ER can skip the ultrasound examination and admit the patient directly to the appropriate care such as a CT (Computerized tomography), a waiting specialist or the Operating Room – saving 10-15 minutes of the golden hour.
“The ultrasound and the ability to transfer data to hospitals helps us to improve the golden hour and make better care decision for the trauma patient.”
– Doug Pattersson Paramedic DWF Airport
In the Field
The trial is being performed in three EMS departments in the Dallas/Fort Worth region: Hurst, Bedford and DFW Airport. More than 50 paramedics have been successfully trained on the use of the ultrasound system with trauma patients, patients with chest and abdominal pain and heart attack victims, receiving certification from the Chief of Trauma of each participating EMS department.
Many trauma patients have injuries that do not present during the initial physical exam. With an ultrasound, paramedics can identify fluid around the heart and abdominal organs to know if a patient is bleeding internally. In another example, if a patient has a flat line on the EKG and no pulse, the normal procedure is to declare the patient dead after a certain time period. With an ultrasound device, paramedics can detect if the heart is still moving, even if the patient has a flat line and no pulse, and continue with resuscitation.
“This tool gives me peace-of-mind, knowing that I can better help each patient and get better assistance from the hospitals during the most critical trauma cases.”
– Jacob Peoples, Hurst Paramedic
Paramedics are using Samsung PT60 ultrasound devices, which are connected to Trice’s image sharing and collaboration service so ultrasound studies can be transmitted to EMS’ departments and hospitals, directly from the ultrasound device in the ambulance. The image data files are sent via the Mobile Network of Trice’s DICOM encryption application installed on the Samsung tablet.
Once the study is uploaded to the image sharing and collaboration platform the doctor on duty at the destination hospital is alerted on their cell phone. The doctor is then able to open the shared files on a phone, tablet or computer and review the medical images in order to confirm or refute the pre-diagnosis indicators provided by paramedics. This information allows the doctor to provide specific instructions to the paramedics regarding the in-hospital destination for the patient (directly to the operating room, to the catlab, etc.) The doctor is also then able to properly prepare hospital staff for the arrival of the patient.
Our Wins and Findings
The Emergency Medicine Project in Texas is not complete but so far the project has reported some key initial findings.
“This tool has definitely helped us save lives.”
– Lamar Adams, DFW Airport Paramedic
- Trained medics have been able to rapidly access the tablet-based ultrasound to conduct scans while the patient is in transit.
- The Wireless image transmission through the mobile network to medical decision makers has taken as little as 30 seconds.
- The transmission of ultrasound images has enabled medics and/or doctors at the hospital to positively identify internal bleeding/fluids, resulting in faster treatment upon patient arrival at the emergency room.
- Early diagnosis has enabled hospitals to ensure relevant specialists are on hand upon a patient’s arrival.
- Medics at DFW Airport’s Fire Department have utilized ultrasound on cardiac patients presenting no pulse. While the existing protocol has been to contact their medical director to determine whether to cease resuscitation efforts, in several instances, ultrasound has detected heart movement and medics have continued treatment, resulting in return of spontaneous circulation and eventual patient discharge.
“This trial has demonstrated the significant potential for expanded use of point-of-care ultrasound by emergency services medics,” said Dr. Roy Yamada, EMS Medical Director for the Dallas/Fort Worth area. “By transmitting images from the Samsung PT60 in the ambulance to specialists at the hospital in real time, we are able to make critical decisions that can save precious minutes and have a tangible impact on outcomes for trauma and cardiac patients.”
“Time to the operating theater is critical in determining the survival of trauma patients,” added Dr. Raj Gandhi, Trauma Medical Director, John Peter Smith Hospital, Fort Worth. “By receiving ultrasound images from the emergency services personnel while the patient is en route, I can make a more accurate determination if surgery is required and have the patient transported directly to the operating room. This trial points to a significant opportunity to improve our emergency services protocols and the potential to save many lives.”
The Emergency Medicine Project in Texas is due to be completed during the first quarter of 2015.