Doctors Watching EMS Care on Cameras?
I’m all for trying new things. I love to see the new gadgets and ideas that find their way into the prehospital arena. One of my favorite past-times is telling stories about people trying new, cool things. Having said that, some things just set off my skeptic meter. (Some people use a less PC term for “skeptic meter.)
For some reason this next story set my skeptic meter needle into the red. I’d like to know what you think.
Florida tax-payers are funding a $100,000 camera system for various key-west EMS providers that will allow doctors and trauma surgeons to view the prehospital environment remotely from the hospital. Apparently these cameras will be worn by various EMS personnel and be installed in the local transport vehicles to give the hospital a real time view of accident scenes and patient care.
The big selling point being pushed is that, when doctors are allowed to look at the patients on scene, they’ll be better prepared to receive them at the hospital. This visual benefit is supposed to be great enough to justify the tremendous financial, logistical and technological burden of installing, carrying and maintaining all these cameras. I’m not so sure.
Here are a few quotes from the article posted at KeyNews.com:
Before, we were doing this verbally through radio communications. With this, I can let the doctor view the patient, who might be trapped in a car, for instance, and that doctor can make a lot of determinations then and there, before that patient has been removed or is even in the air.
-Key West Rescue Supervisor, Steve Simonaitis
OK…what? What determinations can the doctor make right then and there that he couldn’t have made based on my reported description of the incident and the patient? I guess “a lot” would imply a whole list of medical determinations. I can’t think of a single one. I’d like to hear an example of a single determination that a physician feels they might make differently if they could see the patient on scene as opposed to hearing me describe the patient on scene.
I saw a guy in the field deliver babies using this system,” Erwin said. “I’m talking about guys not trained on how to deliver a baby getting direction from a doctor miles away.
Key West Rescue paramedic supervisor Dave Erwin
I can certainly see how that would be useful, if I was delivering a baby and I hadn’t been trained in how to deliver a baby. But since I have been trained fairly extensively on how to deliver a baby, I think it would just be an annoying distraction to have a doctor looking through a camera, asking me to adjust my camera angle and telling me where to clamp the cord.
I thought that was the reason I was trained to go out and deliver babies…so that a doctor didn’t have to be available to go deliver the baby. If someone calls 911 and says, “My baby is coming.” They don’t send a doctor, they send me. What’s the point of sending me with a camera on my head so that a doctor can stop what they’re doing, look through the camera and deliver the baby by talking in my ear? Why not just send the doctor?
Dave was also quoted saying that it’s nice to have a surgeon looking through the camera and telling him when he needs to control arterial bleeding. Really? You need a surgeon to tell you that you need to stop arterial bleeding? I don’t agree.
I don’t want to pick on Dave too much but he ends the article saying, “Trust me, a picture is worth a thousand words.” Let’s put that to the test.
Me: Littleton hospital this is medic 42 enroute emergent to your facility with a trauma alert let me know when you’re ready to copy.
Them: Go ahead medic 42.
Me: I’m enroute emergent with an ETA of 12 minutes, on board a 32 year old male, restrained driver of a mid-sized vehicle who hit a guard rail at approximately 40 miles per hour. Air bags deployed. 2 feet of driver’s side engine compartment intrusion. Negative passenger space intrusion. Steering wheel intact. Windshield removed. No loss of consciousness. Patient has a probable left clavicular fracture with deformity. Chest wall intact. Bruising across the epigastrium with pain on palpation to the upper right quadrant and an unstable mid-shaft tib-fib fracture on the left leg. Distal sensory motor and neuros intact. Skin is pale cool and diaphoretic. Respiration’s 26 and shallow with pain on inspiration, pulse 94 and regular. Blood pressure 104/60.
That’s 108 words dedicated to my description of the incident, mechanism and full patient assessment. That report would have taken 20 seconds and cost about $100,000 less to deliver. Explain to me how a picture is going to be 10 times better than that. What things will the doctor be able to do, what determinations will he be able to make by looking at that picture instead of listening to my description?
While you’re thinking it over, note that the picture still doesn’t replace my assessment and report. I still have to give this report. The doctor can’t feel cool skin or check distal pulses or listen to lung sounds or palpate a chest or abdomen by looking at a picture. For all these things, my report is much, much better than a picture.
That’s possibly the most overlooked fact with this system. Seeing is a small fraction of assessment.
This is a fun idea and I imagine the folks in Florida will have a good time playing with this new technology. I commend them for putting themselves out there and trying something new. I doubt this will do anything to improve patient outcomes. I suspect it might just complicate matters significantly.
Now it’s your turn: What do you think? Would you like to use this kind of system? Do you think it will be useful? Leave a comment and let us know.
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There are many pursuing this kind of care now. There are considerable reference materials and details, videos, etc. regarding EMS Telemedicine and teletriage at http://www.lifebot.us.com
Roger Heath
You failed to mention the color of the car in your entry note. I’m pretty sure inquiring doctors want to know.
Instead of giving us cameras to communicate with a doctor, how about making sure we can get through to med control? I can’t see a whole lot of use for cameras, ESPECIALLY if there’s no one to look at them on the other end.
Shortly we won’t even require training we will just be robots operated by doctors who in most cases already have there hands full. A huge part of succesful patient care is communication and the ability to empathize with patients, how is a doctor looking at a tv screen directing the practioner going to do anything but potentially delay transport, cause confusion and strain working relationships.
Advancement is one of the most exciting components of this industry but to me this is taking steps in the wrong direction we should be expanding what we can do without medical control not requiring it on even the most basic calls.
AJ beat me too the punch line. I was going to suggest you didn’t report if the driver was wearing shoes or boots.
I read the whole article. Seems the supervisors will be the ones with the units per se. I agree that if your BLS or ALS you shouldn’t need a surgon to tell you to stop the bleeding, UM ABCs anyone?? I could see this in some extreme cases such as building collapse where the rescuer can not reach a patient and needs to see thier condition and having a hospital team as backup would help. As far as a car accident I would trust the eyes and ears of the medic over a video feed. Are they using digital stethascopes that can be patched in to the audio? I still dont see what the benifit is though of the surgon or doc seeing ahead of time. They can not intervine during the hour flight anyways and I dont forsee a medic or flight nurse doing a surgical intervention enroute.
If Key West medical needs a doc to advise them on the ABCs I think retraining is more necessary then a camera system. A passive system for keeping everyone on the up and up (molestation or assault cases) I could see. But needing input for what should be your normal protocols sounds fishy to me. I guess only time will tell.
As far as the Hati case they mentioned I can see that there where proper medical teams may not be readily available and adivise could be hard to come by. i know they had surgical teams and navy corps men along with our fellow brothers and sisters but I think you know what I mean, with limited resources sometimes this may be benificial.
The Army discription is fine. Not every squad goes out with a corps man I believe so having one on your shoulder can mean life or death. Especially if immediate interventions are needed and the team is not trained. Battlefield medicine follows its own rules from what I hear.
Just my two cents…
This is such a bad idea on so many levels that as my brain tried to decide where to begin my “skeptic meter” short circuited and my head exploded…
Okay, lets just start with the incredible waste of …
Hmmm I was going to say resources, but lets just put it out there… MONEY!
Money that may organizations struggle with the lack of. Money for needed training, training and more training. Money that could upgrade equipment, Money that could (oh my god dare I say) pay a decent wage to those who’ve chosen this as a profession so retention of said providers might not be so difficult.
Most of my other concerns have been described above I would only add Hey ! the emperor has no clothes on. What a stupid, Stupid, STUPID idea.
My skeptic meter soared when I read this as well. Not only is it an incredible waste of money that could be put to use for much better things, but it opens a huge avenue for lawyers to nit-pick you apart, even if what you did was perfectly acceptable. In this sue-happy world, anyone is looking for any excuse to get your money, so you just spent incredible amounts of money in order to dole out more money to the lawyers.
I agree that using it as a tool during lengthy building collapse calls and similar type incidents is a good tool, but mostly, I see it as a path that completely phases out the EMT or the paramedic. And there is only certain things you can see through a lens. I’d be interested into seeing how far this goes, and how long it takes for these cameras to be removed. I know that I, for one, would not want to be toting around a camera during a call. And I’m not sure about other hospitals, but right now, our own hospital doesn’t have enough doctors or time for them to sit and watch a video screen.
I guess I don’t see the point of this…. sounds like a tremendous waste of money. From my limited experience as an EMT Basic student, the ER staff doesn’t listen to our verbal reports half the time anyways… so why on earth would they watch a visual report?
To borrow from The Happy Medic, Key West needs ‘A Letter in The File’
~Brad
@EMTGoose
I can’t believe anyone on the EMS side, didn’t shout ‘WHOA’ very early on in the project. This adds nothing at all in improving patient care. Even at a building collapse, are medics or corpsmen going to do a remote field amputation? Of course thay are not.
Telemedicine has the potential to really improve medical care to remote communties or those without access to specialists. This is wasting money which could be of benefit elsewhere. I’m not sure why no one has thought to point out the obvious flaws. It is funny how the media just lap it up, without asking questions.
I’m not an ER doctor but I work with them often. My involvement with trauma is limited to doing the ultrasound fast scans and interpreting the CTs and radiographs for the trauma patients.
I will admit that when interpreting the images, if I have been provided of a history of bad trauma, I will look very, very carefully for even the smallest injury – maybe even reviewing my checklist twice.
If I am given a relatively benign history, I will not feel the need to look so carefully. While I don’t think this means I am prone to miss more injuries of patients who were involved in low-mechanism accidents, I wonder if it would be true for the ER docs who can’t otherwise visualize (I mean with eyes, not vitals) what is going on in the patient.
If the ER doc sees an accident with little scene damage, what should that mean to them? Should they relax and casually work up the patient on arrival? I would prefer that they approach all the patients with the same high level of suspicion for life threatening injury, regardless of what the scene looks like.
On the other hand, it might be worth a try. More information could help in ways that I am not thinking of or might come to light after implementation. What is really needed here is a clinical trial and statistical significance.
FYI: The closest TRAUMA CENTER is 150 air miles from Key West. Therefore ALL of our Trauma Alerts are flown to Ryder Trauma Center in Miami. (Ryder is also the sponsor of the Trauma Camera program). Once the patients are PROFESSIONALLY assessed, treated and prepared for air transport there is no VISUAL access to injuries. The Trauma surgeons have one chance to see the injuries before they receive the patients an hour later.
The flight RN and Medic are given a detailed patient assessment and the patients are re-assessed before flight.
Key West Rescue Medics ARE NOT using the camera vs treating patients. IF the supervisor on scene is not treating other patients then he can use the camera. Otherwise it can simply be given to a firefighter or PD officer to use.
We have had several successful uses of the system since its inception.
The $100,000 cost is the TOTAL cost of the program split between many rural systems throughout FL. The cost also includes the many hospital based systems capable of receiving and sending video data throughout the system.
This access enabled a Lower Keys Medical Center ER physician to perform micro surgery on a patients hand with a Trauma surgeon watching and consulting, thus negating the transport to Miami and saving the patient thousands of dollars as well as time.
Key West’s system amounts to about $3,000 for the equipment and support.
@Steve Thanks for giving some additional information about the camera system. However, even with your additional description and added emphasis on words like “all” and “visual”, I still see nothing in your description that makes me think that this is necessary or even helpful in the prehospital arena.
Whether the person filming is a cop or firefighter or medic, it’s a complete waste of that person.
Your description of the system being used for remote microsurgery is awesome. That is a great use for this kind of thing. I’m glad they’re doing that in the hospital. But that isn’t the point.
Regardless of cost or flight times or helicopters or anything else, I still don’t need a doctor looking into a camera and telling me how to treat my patient. I still don’t need a camera to help me describe a patients injuries. Unless you’re going to give me a new, more advanced, skill set that I can only perform while the doctor is directing my hands (like your ER surgeon)…this system is a waste of time and money.