Rugged computer lets EMTs gather health data and transmit it en route to a hospital.
By Julia Ferrante
Tampa Tribune (Florida)
Copyright 2007 The Tribune Co. Publishes The Tampa Tribune
A call comes in to Station 20 at Little Ranch Road at 11:18 a.m.: injuries from a fall at a home in northwest Pasco County.
Firefighter-paramedic Paul Baker and David Bouchard, a firefighter and emergency medical technician, jump into the ambulance, a reporter, photographer and a Panasonic Toughbook computer in tow.
They arrive at the scene to find an older man sitting on his back steps, his left leg extended and secured with a makeshift tourniquet. Blood stains his shirt and drips from his pant leg.
Baker guides the stretcher with one hand and holds the Toughbook computer in the other.
“I didn’t want to go anywhere,” the man says. “I slipped on the damn steps.”
Baker deposits the computer on the stretcher, slips on some latex gloves and walks toward the man.
“You have a bad skin tear,” he says, as Bouchard peels away the tourniquet, a saturated sock and shoe with his gloved hands. More blood drips from the man’s leg, forming a thick, deep-red puddle on the stoop.
“I’m on blood thinners,” the man says. “I’m on Coumadin.”
“You’re probably going to have to get this checked out,” Baker says.
“I don’t want to go anywhere,” the man says.
“That’s not going to heal on its own. It needs to be cleaned,” Baker says. “I don’t want this to get massively infected.”
As Baker talks to the patient, Bouchard steps away to the Toughbook and replaces his gloves. Baker hands Bouchard the man’s driver’s license and a card listing close to a dozen medications. Bouchard begins to enter the basics into the computer, forming the beginnings of a report.
SHADY HILLS - Station 20 in Shady Hills in December became the first fire-rescue operation in Pasco County to use Toughbooks and a special program that allows paramedics and EMTs to file reports and transmit critical patient information, including EKG results, to hospitals while they are still en route, Rescue Chief Duncan Hitchcock said. The system also makes it easier to file and review reports, which traditionally have been handwritten.
Officials plan to roll out 30 more computers in April as part of an effort to streamline records and ultimately patient billing. Patient Care Reports by law must be filed within 24 hours, Hitchcock said. Completing them electronically quickens the process and makes the reports easier to understand.
“It’s difficult when you are looking at 400 people’s handwriting,” Hitchcock said of the current system.
The Tampa Tribune accompanied Baker and Bouchard on Wednesday to learn more about how the computers are used in the field. Because of federal patient privacy laws, the newspaper is not identifying the man in northwest Pasco.
The computer and program, called the Toughbook Progress RescueNet Tablet PCR, for patient care report, is distributed by Broomfield, Colo.-based Zoll Data Systems, which also makes defibrillators, Hitchcock said. The software allows paramedics to produce an electronic report and transmit information, including EKGs, via a cellular wireless card.
Hernando County has been using a similar system for about two years, Hitchcock said.
Station 20, which covers areas north of State Road 52 and west of the Suncoast Parkway - including Shady Hills, Brooksville and Hudson - was chosen to test the computers because it is one of the quieter districts. The station averages four or five calls a day, Hitchcock said. A station farther west in Embassy Hills, by comparison, averages 15 calls.
Toughbooks Meet Toughness Test
The Toughbooks cost the county about $4,400 each, said Michael Nurrenbrock, the county’s director of management and budget. Officials plan to purchase docking stations so the Toughbooks can be mounted in ambulances. Automatic vehicle locator equipment also is on tap to allow dispatchers to see on a computer screen where emergency vehicles are to better direct workers to calls. The entire emergency medical system will cost about $495,000.
The Toughbook computers are designed to be rugged and to withstand inclement weather, and Hitchcock put them to the test.
“Before we [chose] this model, I put it in the shower for 20 minutes, dropped it, kicked it,” he said. “I wanted to see how tough it is, because firefighters can break anything.”
The program was selected to help meet state requirements that emergency workers provide basic information when they drop off patients at the emergency room, Hitchcock said.
“We are required within 24 hours to have a complete patient care report,” he said. “The way it is designed, if Paul starts a report, he can fax the report to the ER. When he gets back to the station and finishes, he can fax it again.”
The Station 20 paramedics still are learning the system. Right now, it takes about 10 minutes to hand-write a report, Baker said. On a Toughbook, it can take 15 to 20 minutes, but much of the work can be done in the field. The advantage is getting data to the hospital sooner.
Supervisors also can review the reports right away. Under the current system, battalion chiefs may have to wait until the paramedic is working again, usually three days later, to check information.
Bouchard has not completed his computer training, so he was a little slower on the computer than Baker during Wednesday’s call.
Toughbook In Action
“Paul, what’s the screen for medications? I’m having trouble finding it,” Bouchard says.
Baker walks over and points to a prompt.
Bouchard scrolls through a screen of drugs and checks off each medication on the patient’s list. If the drug is not listed, Bouchard types it in.
He next goes to a medical history page, where he must type in the nature of the call, injuries from a fall, along with vital signs, weight, Social Security number and home address.
“Sometimes it’s a little more time-consuming,” Bouchard says. “The whole thing of faxing it to the hospital is probably the neatest thing about it. The other stuff, you have to learn.”
Baker gently tries to persuade the man to go to the hospital, but still, he is reluctant.
“I don’t want to go to the hospital,” he says. “I don’t like ambulances.”
Baker explains that the paramedics can’t force him, but if the man refuses, he is going against medical advice and must sign a form acknowledging that.
The man speaks with his son on the phone and is persuaded to go to the hospital if his grandson drives him there. Baker makes the call to stay with the man until the grandson arrives.
“I don’t want to leave this guy alone,” Baker says.
Baker and Bouchard help the man into his living room and cover the couch with a towel before he sits down. They prop his leg up and hand him a nebulizer, which the man uses for asthma.
The man agrees to sign a waiver refusing to go to the hospital in the ambulance. Because he has blood on his fingers, hands and legs, Baker signs on the man’s behalf. Bouchard takes his index finger to the computer screen and signs as a witness.
“Normally, we would have the patient sign, but he’s got blood all over him, so we don’t want him touching the computer,” Bouchard has explained earlier. “We will put in ‘patient unable to sign.’”
The grandson arrives, and Baker and Bouchard pack up.
They hop back into the ambulance, and during the 10-minute ride back to the station, Baker writes a narrative on the call.
Back at the station, Capt. Rick Caravona hands Baker a sheet showing the call times, which Baker adds to the report.
“This call was a little quirky,” Baker explains. “Things got a little out of sync because he wasn’t sure he wanted to go. We took our time with him because we really thought he should go. As much blood loss as he had,… we can’t really leave him there if he was going to continue bleeding. It just wouldn’t be moral.”
The report is complete, and Baker sends it to a central server in Dade City.
A firefighter adds the call to a daily logbook, which still is handwritten.