Remote Treatment of Emergency Victims

From Medgadget:

A severe car accident takes place… a few minutes later the ambulance shows up… the severely injured and barely breathing driver is placed in the ambulance with all kinds of medical equipment around him/her but no medical expertise until the ambulance arrives in the hospital …

Well now a system for remote treatment could help improve survival rates in such instances.. An IST (Information Society Technologies) funded DICOEMS project “has developed a wireless technology platform enabling doctors in hospital emergency rooms to remotely manage treatment of accident and other emergency victims. With specially equipped handheld computers or smart phones, paramedics and other emergency personnel first on the scene can send images and critical patient information, including vital data such as pulse, respiration, and ECG, to specialists at hospital emergency departments. Doctors can monitor the patient’s condition via streaming video from the ambulance, make a diagnosis and provide detailed medical procedures for paramedics to follow.”

“DICOEMS could significantly improve survival rates for victims of accidents or other medical emergencies by reducing the chance of inappropriate treatment,” says Matteo Colombo, a technical specialist at Synergia 2000, the Milan-based project coordinator. “The system will improve decision support, diagnosis and risk management in critical situations occurring far from hospital emergency rooms,” says Colombo.

Validation of a Rule for Termination of Resuscitation in Out-of-Hospital Cardiac Arrest

From the New England Journal of Medicine:

Background We prospectively evaluated a clinical prediction rule to be used by emergency medical technicians (EMTs) trained in the use of an automated external defibrillator for the termination of basic life support resuscitative efforts during out-of-hospital cardiac arrest. The rule recommends termination when there is no return of spontaneous circulation, no shocks are administered, and the arrest is not witnessed by emergency medical-services personnel. Otherwise, the rule recommends transportation to the hospital, in accordance with routine practice.

Methods The study included 24 emergency medical systems in Ontario, Canada. All patients 18 years of age or older who had an arrest of presumed cardiac cause and who were treated by EMTs trained in the use of an automated external defibrillator were included. The patients were treated according to standard guidelines. Characteristics of diagnostic tests for the prediction rule were calculated. These characteristics include sensitivity, specificity, and positive and negative predictive values.

Results Follow-up data were obtained for all 1240 patients. Of 776 patients with cardiac arrest for whom the rule recommended termination, 4 survived (0.5 percent). The rule had a specificity of 90.2 percent for recommending transport of survivors to the emergency department and had a positive predictive value for death of 99.5 percent when termination was recommended. Implementation of this rule would result in a decrease in the rate of transportation from 100 percent of patients to 37.4 percent. The addition of other criteria (a response interval greater than eight minutes or a cardiac arrest not witnessed by a bystander) would further improve both the specificity and positive predictive value of the rule but would result in the transportation of a larger proportion of patients.

Conclusions The use of a clinical prediction rule for the termination of resuscitation may help clinicians decide whether to terminate basic life support resuscitative efforts in patients having an out-of-hospital cardiac arrest.