This feature is part of our Paramedic Chief Digital Edition, a regular supplement to EMS1.com that brings a sharpened focus to some of the most challenging topics facing paramedic chiefs and EMS leaders everywhere. To read all of the articles included in the Spring 2017 issue, click here.
By Greg Friese
“Alexa, start medication cross check,” said Paramedic Hal.
“What medication are you administering?” Alexa asked.
“I am giving Zofran,” Hal replied.
“Are you giving Zofran to treat nausea?” Alexa asked.
“Yes.”
“What dose are you administering?”
“40 milligrams.”
“Hal, stop,” ordered Alexa. “The correct dose of Zofran is 4 milligrams, slow IV push.”
Alexa, in this imagined scenario, wasn’t an actual paramedic but a voice activated and controlled device built into the tablet of the ambulance. Alexa responded to the activation of a skill — medication administration cross check — to assist a paramedic treating a patient with nausea.
This scenario is not farfetched and is one of many examples of how voice activated and controlled devices could quickly become a part of EMS patient assessment, care and information exchange.
Consumers have had voice activated search and device control since the 2011 debut of Siri in iOS 5. In late 2014, Amazon untethered voice control from a smartphone when it introduced a stand-alone, voice controlled virtual assistant for music streaming, shopping and home automation. The Google Home device builds off Android and Chrome functionality to trigger similar features as Echo and Siri by saying, “OK Google.”
Developers can add the Amazon Voice Services technology, available in a variety of Amazon devices, into other electronic devices such as coffee pots, refrigerators or alarm clocks. Mobile data terminals, cardiac monitors, tablets for ePCR documentation, intravenous infusion pumps and automatic transport ventilators are all candidates for significant upgrades in user interface and usability. A continuing reliance on analog inputs such as keyboards, dials, buttons and switches is out of sync with how we are all regularly interacting with smart devices.
Here are five ways voice activated virtual partners could become commonplace in EMS.
1. Access the internet with a question
Every EMS provider should know how to find a medication in a drug guidebook, learn about the dangers of a chemical using the Emergency Response Guidebook and search the web to learn about disease conditions. Any of the above questions can be answered with a question to a voice activated device, asked after activating the device with the appropriate “wake” word. These include Alexa, Computer, Echo, Hey Siri or OK Google, which activate the voice controlled device and prepare it to receive a question or command, such as:
“OK Google, what is levothyroxine used for?”
“Hey Siri, look up placard 1203 in the Emergency Response Guidebook.”
“Alexa, what is hemophilia?”
2. Apps become skills
EMS providers increasingly use smartphone apps to ensure protocol compliance, track medications and interventions during cardiac resuscitation and calculate drug doses and infusion rates.
Many of these apps, like the medication administration cross check example, can be converted into skills. Skills on Amazon devices are activated with a voice command and can be used to receive a current weather report, start a timer, set an alarm, receive a news briefing, convert pounds to kilograms or begin a metronome at 100 beats per minute.
3. Use voice command for devices
Voice controls, built into devices already in use by paramedics, could be used to perform automated assessments or interventions like taking blood pressure, printing a lead II EKG strip or ETCO2 waveform or acquiring a 12-lead EKG. It’s easy to imagine asking for a patient status update:
“Computer, what are the patient’s vital signs?”
“Computer, what is your 12-lead EKG interpretation?”
“Computer, deliver a shock.”
Voice command could be taken a step further to initiate transmission of a patient report to the hospital, including vital signs and a 12-lead EKG.
4. Launch a checklist
One of the recommendations of high-performance CPR is to use a checklist, including the delivery of interventions or patient assessments at specific time intervals.
“OK Google, start the CPR checklist.”
“Echo, start the ventricular fibrillation algorithm.”
Once launched, the checklist could remind providers of interventions and best practices for performing skills such as compressions with messages like, “Remember to push hard, push fast,” or “Do you want me to start a metronome at 100 beats per minute?”
5. Enhance patient comfort
One of the top home uses for an Amazon Echo or Google Home is music streaming. Patients and providers with an internet connection have instant access to Pandora, TuneIn, iHeart Radio and Spotify. Alexa can also be asked to play white noise, rain sounds or nature sounds — all things that might help an anxious patient relax or sleep during a long-distance transport.
Interactive games might help a patient, especially a child, pass the time during an ambulance transport. Launch a game of 20 questions, The Magic Door or state capital trivia to distract a child as you perform assessments, provide care or document exam findings.
This is emerging technology
You may have tried some of the commands or skills mentioned in this article. Or you might have been dictating a list of reasons this won’t work to the voice activated assistant in your hand or on your desktop. There are certainly some obstacles to adaption and implementation of this emerging technology to EMS.
The patient care compartment always has at least two voices, a provider and a patient, and can often have additional personnel, who might all be speaking at once, making it difficult for an always-listening device to hear its wake word.
Patients, as we well know, are sometimes very vocal. Ambient noise in a living room, on the shop floor at a manufacturing plant or on the side of the road can be high. Adding a provider yelling, “OK Google,” isn’t likely to cut through the ambient noise easily or make the incident less stressful for all involved. Noise from the HVAC system, mechanical ventilator and tires rolling on the road create a constant level of background noise in the ambulance that might be too high for current technology to hear wake words, questions and commands.
Despite these limitations, imagine the possibilities of voice activated and controlled devices to improve patient assessment and treatment. Share your ideas with me, other EMS colleagues and, most importantly, with EMS product designers and software developers.
About the author
Greg Friese, MS, NRP, is Editor-in-Chief of EMS1.com. He is an educator, author, paramedic and marathon runner. Ask questions or submit tip ideas to Greg by emailing him at greg.friese@ems1.com.
