EMS1 Roundtable: Expert insights on monitor/defibrillator technology
There's been many developments over the years and this creates a gaze into a collective crystal ball for what the future might bring
Perhaps nowhere else in EMS have technological advances been more evident than in portable monitor/defibrillators. Since the first devices appeared in the early 1960s, these literally life-saving units have undergone amazing evolution in size, shape and, most importantly, capability.
In this roundtable, we turn toward the major manufacturers in our industry and ask them to reflect upon the developments we've seen over the years and gaze into their collective crystal balls for what the future might bring.
Meet the Experts
Ward Hamilton is Senior Vice President at ZOLL Medical Corporation. Prior to joining the Company in 1992, Mr. Hamilton previously held a position with the City of Pasadena, California, as a firefighter and paramedic. He has worked in the field of emergency care and resuscitation for more than thirty years.
Mitchell Smith is charged with driving the success of Physio-Control’s current products and setting the direction for future innovation. His team works together with healthcare professionals and scientists to define what new products and services the company should create over the next decade. With over 20 years of experience in medical device development, Mitch has created and managed products and solutions for many areas of healthcare, including critical care, emergency medicine, obstetrics, patient care and medical education.
Matthew Penzone is the field marketing manager at Philips Healthcare. He graduated from Northeastern University with a Bachelor of Buisness Adminstration in marketing and management.
What do you believe are the biggest developments in portable monitor-defibrillator technology in the past five years?
SMITH: One of greatest improvements has been the ability of monitor/defibrillators to move data to multiple locations in ways that improve patient care, system performance and readiness – both at the system level and at the therapy delivery level.
PENZONE: I feel that the most significant developments have been the proliferation of real-time CPR feedback, as well as the ability to view and interpret EtCO2 waveforms as a key indicator of patient's condition.
CPR feedback utilizes accelerometers and/or pressure sensors can help responders administer CPR with the proper rate and depth and better adhere to AHA guidelines. These devices also enable the user to capture data for retrospective analysis.
Combining real-time feedback with an ability to do an in-depth analysis of CPR quality creates a powerful culture of improvement in a department.
HAMILTON: One development is the new communications capabilities that bring the field, hospital and operations closer and closer. These include WiFi and cellular modem as well as ambulances equipped with mobile gateways linking monitoring and therapy to remote locations such as dispatch, cath labs and emergency departments.
Certainly reducing the size and weight of the machines while adding significant improvements in capability is a major development. No one ever asks us to make our devices heavier!
What are some key questions departments should ask of themselves when deciding to replace existing monitor/defibrillators?
HAMILTON: One question should be "What are we going to be doing differently in the years ahead?" The process of purchasing these devices can take a long time, and they will be in service for many years, given their cost and new government policies on device approvals.
I expect that development of new devices will be slower than in the past and more cautious, which will probably slow the rate of new product introductions in the years ahead. So buy with an eye toward the future, both in terms of capabilities and communications.
SMITH: Will this monitor/defibrillator be able to change with me, as protocols and guidelines change? Does the manufacturer have a track record of robustness and upgradability? How easily can I capture critical data for improving patient care during an emergency and for use in improving system clinical performance and readiness? Does this manufacturer favor one ePCR, or will they work with any ePCR I choose now or in the future?
PENZONE: Departments should identify a set of goals when they set out to purchase a monitor/defibrillator. These goals may be clinical, financial or operational and should be measurable in some fashion.
For example, a department may determine that repeated breakage of cables or poorly packaged electrodes are driving up operational costs, or that the user interface on their monitor/defibrillator is complex enough that periodic retraining is required to keep infrequently used skills sharp.
Although monitor/defibrillators are required equipment, each manufacturer offers some differentiating capabilities that can help a department achieve specific goals.
The purchasing process may seem arduous but before making a decision departments should identify their needs, set some goals and perform in-depth research and hands-on training to see what works best for their team.
Where do you think monitor/defibrillator technology is heading?
PENZONE: Healthcare in the United States and around the world is moving towards a more integrated, data-centric model that emphasizes information sharing and quality of care.
With reimbursement structures changing, I think EMS services have an opportunity to become a cornerstone of the healthcare system in the 21st century. EMS agencies assessing, treating and releasing patients and collaborating with physicians in the field may be the next permutation.
Data connectivity to hospital record systems will be a growing trend in the future and monitor/defibrillator technology is going to need to keep pace with the evolution of our healthcare system.
SMITH: Monitor/defibrillators are rich with information, and we will see continued improvements in how customers use that data for quality improvement, for patient flow and for better managing their assets.
Size and weight will continue to improve, but reliability and trust remain the top criteria for monitor/defibrillators. New parameters and new algorithms around time sensitive emergencies are constantly being developed.
The successful monitor/defibrillator will be the one that can integrate these new technologies in a street-ready and robust package.
With the FDA likely to increase the regulatory hurdles for new defibrillation therapies, we will not likely see defibrillator manufacturers increasing their energy or further improving their waveforms for many years.
HAMILTON: We will see increasing integration with electronic medical records in and out of the hospital and additional diagnostic capabilities to support the needs of "community" para medicine and primary care as these concepts evolve as part of efforts to reduce ER visits and lower health care costs. "Stay and play" turns into "stay and stay" as patients are cared for by EMS in their homes.
We even make a wearable defibrillator that can protect patients if they were not transported to the emergency department to reduce the cost of hospital care or avoid readmission.
Looking at AEDs, we have seen them become smaller and lighter over the past decade. What might the future hold in terms of further development?
SMITH: The most important aspect of AEDs continues to be usability and simplicity. Today, some AEDs take minutes for users to figure out, especially if unfamiliar electrode shapes or other components are used.
We will see AEDs become more refined and better address the challenges of time-to-shock and user confidence. On-going improvements in battery technology will continue to improve AED reliability.
PENZONE: While current technological limitations regulate just how small devices like this can get, we'll continue to see significant size decreases and that trend should continue as advances are made in fields like nanotechnology.
In the short term, I believe the focus will be on making AEDs easier to own and access. While today's AEDs are very easy to use in an emergency, significant opportunity exists to improve how users locate, maintain and monitor AEDs. Growing awareness over the need for public access defibrillation will continue to drive this.
HAMILTON: The future focus needs to be on getting more of them out into the community. There are just not enough AEDs in all the places they should be. Ways to facilitate AED use by the untrained and to help users do CPR will guide future development.
Our biggest challenge is still to get more AEDs to patients who collapse suddenly, because many more lives can be saved. Research has shown that having an AED at a collapse can increase the chance of survival by a factor of almost five, but the same research showed AEDs were present at a collapse only 2% of the time.
While we have made progress, we still have more than the equivalent of a daily 747 crash, in the number of people who die of Sudden Cardiac Death every day in the United States. We have a long way to go.
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