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The perfect monitor/defibrillator: What would it look like?

The EMS industry needs its own Steve Jobs


It's the one piece of equipment that goes on virtually every EMS call: the cardiac monitor/defibrillator. Sometimes it just takes a blood pressure. Other times it delivers life-saving therapy like defibrillation. Occasionally it is used to transmit a 12-lead ECG to the hospital.

Nowadays it can even tell us when we're getting tired performing chest compressions or that our tracheal tube has been displaced. I would argue it's the most important piece of equipment on the ambulance, and second place isn't even close.

Consumers have high expectations. Building the perfect monitor/defibrillator would be a challenge; maybe even a technological triumph. But we sent man to the moon and back more than 40 years ago. That wasn't accomplished by people who thought it couldn't be done.

Walter Isaacson, author of the biography Steve Jobs, wrote that one of the reasons that Jobs was so successful was his "reality distortion field." He could make others believe that anything was possible and so they would accomplish more than they thought they could.

There was a dark side to Jobs, too. He could be mean, he was thin skinned, and he took credit for other peoples' work. But no one can deny that his emphasis on design and the end-user experience changed the way we view computers and our expectations about technology.

So what would a cardiac monitor/defibrillator look like if Steve Jobs designed it? How would it function if it were not just good but insanely great?

It would be reliable.

A cardiac monitor/defibrillator is a critical piece of medical equipment. We simply cannot afford to have it malfunction or stop working in the middle of call, especially when we need to deliver life-saving therapies like defibrillation, cardioversion, or transcutaneous pacing.

I actually think the current devices are quite reliable. In addition, the batteries are better and smarter than they used to be.

It would be beautifully designed.

Jobs was the first to suggest that a computer should look happy and be friendly. Curved lines were better than straight lines and craftsmanship was everything.

The graphic user interface was especially valued. Colors and fonts were important. No detail went unnoticed.

Jobs continually frustrated hardware engineers with his demands, and he wouldn't hesitate to invent new technology if the thing that he wanted didn't exist yet.

Even the screws on the inside of an Apple computer had to be beautiful; screws that no customer would ever see. It was all part of his pursuit of excellence and perfection.

It would be easy to operate.

Anything designed by Jobs would require a minimum amount of human interaction to perform its required functions. It would be extremely intuitive.

It would know what the end user wanted to do next. The look and feel of the device would be just right; pushing its buttons would feel good, it would be obvious when the device accepted a command, and there would be no lag time between pushing a button and the machine responding.

You'd never have to wonder if the device was connected to another machine, was going to start transmitting, or was unable to complete a task.

You would be able to transmit an ECG with the push of one button or a voice command. "Smart" technology would let the user know if the patient had ROSC, if capture was achieved with transcutaneous pacing, or if the tracheal tube was clogged or dislodged. In short, the technology would be enabling.

It would seamlessly integrate with other technologies.

Jobs was a control freak who was criticized for wanting to control a product's entire ecosystem. This criticism is still often heard from those who prefer the Android operating system.

On the other hand, it's hard to not be impressed when apps, pictures, videos books, music, and contacts are effortlessly shared between Apple devices.

I've often criticized proprietary "solutions" for ECG transmission and encouraged open architecture so that a hospital can receive ECG transmissions from multiple manufacturers without having to purchase multiple platforms or subscriptions.

This has proven to be quite difficult as device manufacturers have little to gain and much to lose when it comes to standardization and interoperability.

It should not be difficult to capture data or move it around. A modern EMS system needs to transmit 12-lead ECGs from the field, attach ECGs, vital signs, and other data to the patient care record, share that record with the hospital, capture data for the purpose of analyzing resuscitation attempts, and also capture system-wide data.

Right now that requires multiple data transmissions and opportunities for data collection are often lost because certain types of data collection requires paramedics to have the monitor in a certain mode at a certain time.

Jobs cared about his products so much that that he worried about everything from the retail environment in which they were purchased to the packaging and how they would look when they were un-boxed.

In his lifetime, he transformed personal computers, animation, music, phones, and mobile computing. He never lost sight of the basic insight that in the last analysis it was all about the consumer.

He may have had the conceit that "people don't know what they want until you show it to them" (he did not condone focus groups) but he realized that you have to start with the end-user experience and work your way back to the technology.

The manufacturers of cardiac monitors and defibrillators would do well to heed that advice today.

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