On February 18, 2005, participants at the prestigious “Gathering of Eagles” Conference (www.gatheringofeagles.us) in Dallas, Texas previewed an advanced EMS Telemedicine system in whichreal-time video images, digital voice communications and physiologicdata were sent from a specially equipped Garland Fire Departmentambulance. The project was a joint effort by General Devices, PhilipsMedical Systems, Motorola’s Mesh Networks Group, the University ofTexas Southwestern, and the University of Chicago. The preview was partof a presentation entitled “Live from Garland”, given by Dr. RaymondFowler, Deputy Directory of the Dallas EMS System. Dr. Fowlerdemonstrated ways in which such a system would enhance EMS patient careas well as address training and medical/legal issues. Dr. RichardCarmona, the Surgeon General of the United States, attended thedemonstration.
Garland and Dallas were selected as the demonstration sites for thistechnology because of the unique combination of a highly advancedcommunications system, a highly proficient EMS System, and theleadership abilities and personal interest of Dr. Paul Pepe, MedicalDirector of Dallas EMS, and Dr. Raymond Fowler, Deputy Directory of theDallas EMS System, both of whom are interested in exploring theapplication of new technologies
Dr. Fowler (www.biotel.ws) presented a series of slides highlighting several key applications for the technology as well as the need for open architecture in EMS communications and data management systems. This was followed by an actual demonstration of the system in which members of Garland EMS enacted three common EMS scenarios. The first two scenarios portrayed a hospital-based physician assisting in the assessment of a patient in the field using real-time physiologic data and real-time video controlled by Dr. Fowler from the CAREpoint Workstation. The third enactment showed how video would be used to respond to, verify, and document the refusal of a patient to be transported to a hospital. In this enactment, Dr. Fowler was able to both view and speak with the patient regarding his decision not to go to the hospital. The entire episode was automatically documented on CAREpoint’s digital logging recorder to provide protection for the medics and the physician against possible medical/legal considerations.
Ambulance & ED Equipment
The EMS Telemedicine demonstration used a prototype of the Rosetta-VC in the ambulance (currently under development at General Devices), and a General Devices CAREpoint EMS workstation at the physician end. Philips Medical Systems supplied a Philips MRx monitor/defibrillator specially modified for this demonstration.
The Rosetta-VC acted as the “brain” of the mobile part of the system, providing connectivity to various communications means used by EMS (Mesh, cellular, radio, landline) and managing image and data transmissions. The Rosetta-VC is specifically designed to minimize the burden to the medics of managing this task by automating many of the actions necessary to establish and maintain communications, control cameras and voice communications and to manage outgoing and incoming data. The system is intended to provide two remotely controlled (pan-tilt-zoom) cameras to view the incident scene – one to view the inside of the ambulance and the other located outside the ambulance. A third wireless hand-held camera may be used for detailed wound assessments within the ambulance, visualize injuries, assess vehicle damage (mechanism of injury), or to view patients outside the ambulance. The Rosetta-VC is equipped with provisions to interface with other EMS field devices, including monitors, ultrasound scanners, laptop computers, chest compression devices, ventilators, etc. The Rosetta-VC was connected to a Philips MRx field monitor, modified by Philips to provide a complete spectrum of streaming physiologic information, including single lead ECG, 12-lead ECG, SpO2, ETCO2, NIBP, and Respiration Rate.
The hospital side of the system consisted of a General Devices CAREpoint EMS Workstation (https://www.general-devices.com/carepoint). In addition to its many features used for day-to-day EMS activities in the ED, the workstation has been designed from “the ground up” as a complete telemedicine platform, providing communications and camera controls, display screens for images and data, built-in digital logging recorder, and many other special features necessary for telemedicine.
Motorola’s MEA (Mesh Enabled Architecture) mesh communications system from Motorola’s Mesh Networks Group (www.motorola.com/mesh), provided wireless communications from the ambulance. The Garland mesh system is one of the largest deployments of high-speed (up to 2 Mbits/sec) digital communications in the country, providing 57 square miles of coverage. The system, still under construction, will eventually employ 900 “access points”, mounted on lampposts and other points throughout the city. The system provides continuous high-speed digital connectivity to both stationary and moving vehicles. Mesh communications technology is currently being studied for public safety use by many large municipalities throughout the country.
In the future, the General Devices’ EMS Telemedicine system will be able to utilize cellular telephone as well as digital and analog radio.
Advanced Applications of Technology
In addition to addressing day-to-day EMS issues, the Garland EMS Telemedicine test site is part of the University of Chicago’s Advanced Biomedical Collaboration (ABC) Testbed project, Dr. Jonathan Silverstein, PI. This NIH/National Library of Medicine funded project will explore the use of advanced tele-collaboration in medicine using the Access Grid (AG). The AG (http://www.accessgrid.org) is a global system of multi-point/multi-image advanced teleconferencing.
According to Dr. Fowler, “the use of advanced communications and computer technology in EMS represents an unexplored area of almost limitless opportunity for both improvement in patient care and the use of new life-saving patient care technologies prior to arrival at the hospital.” Michael Smith, President of General Devices, feels that the key to the acceptance of telemedicine in EMS lies in insuring that it meets medical needs; making it affordable, simple to use and reliable; and providing users with the ability to easily access field data.
For more information contact:
Curt Bashford, General Devices
Dr. R. Fowler, University of Texas Southwestern School of Medicine
Deputy EMS Medical Director, The Dallas Area BioTel System
Dr. Jonathan Silverstein, University of Chicago,
PI: Advanced Biomedical Collaboration (ABC) Testbed,
For more details click: CAREpoint Information
The Rosetta-VC and MRx used in the demonstration are currently not available for sale, pending FDA approvals. This work was supported in part by the NIH/National Library of Medicine, under Contract N01-LM-3-3508
*Content carried over from prior GD website: Published dates may not be accurate.