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.
We asked Paramedic Chief contributors and EMS1 advisory board members to imagine the future technologies that will widely impact prehospital care in the next 20 years. Their responses predict improved patient care and safer working conditions as our use of technology changes.
As you read their predictions, consider the specific impacts of distant technologies on EMS providers, leaders and patients. Share your predictions with editor@ems1.com or Paramedic Chief on LinkedIn.
Field labs and imaging
One of the top suggestions was increasing the availability of point-of-care labs and portable imaging to all prehospital providers.
David K. Tan, MD: Field lactate monitors and biomarkers for stroke, STEMI and sepsis will become widespread. I think biomarkers, like finger stick glucose checks, to identify acute stroke from mimics as well as myocardial infarction will revolutionize transport destination decisions and increase lead time for receiving facilities.
Art Hsieh: Portable labs will become less expensive, easier to use and more accurate for field use. If those labs are meaningful to field medicine, I foresee a greater gatekeeping role for EMS providers in terms of destination decisions.
Ryan Greenberg: Rapid testing equipment will allow EMS professionals to run more field tests, including rapid blood work and other patient assessments.
Catherine R. Counts: I expect a large increase in the number of companies that provide applications for streamlining the process to definitive care for more serious conditions, namely stroke and STEMI. It wouldn’t surprise me if integrating mobile technology into the care cascade becomes an accreditation requirement for stroke and STEMI centers.
Dave Konig: I believe augmented reality will have the biggest impact on EMS by allowing advanced diagnostics to occur in the field, increasing data flow between the provider on scene and the command or control center, ultimately bringing many hospital-based assessments to the patient.
Ann Marie Farina: We’ll see tech continue to shrink, but I’m not sure if it will progress to the point where a Star Trek tricorder-like device is FDA approved, cost-effective and better than using the latest version of a cardiac monitor.
Smart, driverless ambulances won’t be in collisions
Driverless personal vehicles are already being tested in the United States. Collision avoidance technology is built into new vehicles and smart vehicle features are likely to become part of the electronics built into new ambulances.
Ryan Greenberg: Imagine the benefits of a driverless ambulance on patient care if two providers can focus on the patient. A driverless ambulance could give EMS providers additional down time while not on assignment, allow providers to review protocols on the way to call or let one provider rest during super-rural, long-distance transports.
Ann Marie Farina: Even if self-driving ambulances become a reality, I don’t think that means we will drop below two-person crews because one person just isn’t practical in most cases.
Doug Wolfberg: Vehicle-to-vehicle technologies will allow for smarter and safer traffic management for emergency vehicles. V2V will transmit advance warning messages directly to the displays of private vehicles of approaching or overtaking emergency vehicles. When V2V is coupled with existing vehicle-to-infrastructure technology, such as red light pre-emption, it will afford a safer alternative to red lights and siren responses.
Tim Nowak: Motorists will receive notification of responding, emergent vehicles via their car radio’s FM broadcast. This may also include “Emergency scene ahead, be prepared to stop” notifications, along with “Alert, approaching emergency response vehicle, be prepared to pull over.”
Nancy Magee: Smart ambulances will have an auto-pilot feature to correct driving errors and avoid hazards. There would probably be no need for sirens and little need for lights other than as an identifier. I would not want time savings from automation to be used to get back in service faster, but to allow time for the provider to eat, use bathroom facilities or call home before redeployment.
EMS providers won’t lift patients
Lifting and moving patients are top causes of on-the-job injury for EMS providers. Eliminating the need to manually lift a patient is an opportunity to reduce operating costs and improve wellness.
Rom Duckworth: Within 10 to 20 years, military advances in the research and design of exo-suits, which are wearable machines for increased strength and endurance, will translate directly into uses for emergency responders. Exo-suits reduce the wear, tear and fatigue of long hours of heavy physical work and boost lifting and moving performance.
Ryan Greenberg: The use of technology will allow an EMS crew to work a “No Lift Shift” — an entire shift without lifting a single patient.
Dave Konig: We will see self-automation becoming integrated within EMS in self-driving ambulances and self-propelled stretchers that will maneuver themselves in a heeled fashion to the provider.
Voice activation
Ann Marie Farina: Voice activated tech could be integrated into current devices. Being able to say “ZOLL, mark event” or “LIFEPAK, start print” could be helpful in reducing equipment contamination and preventing people from standing up when they should be seat-belted.
Kelly Grayson: Why don’t cardiac monitors have Bluetooth and voice-activated event recordings? I can train my smartphone to recognize my voice, type text and carry out simple commands with Siri and Apple CarPlay.
If I can drive down the road and, without picking up my phone, say, “Hey, Siri, plot me a route to Dallas,” and the route immediately comes up on my dash display, why can’t I say, “Hey, LIFEPAK, record a history note?”
Intelligent 911
Activation of EMS is expected to improve from a 911 call to application of communications technology and machine learning.
Art Hsieh: Intelligent 911 will combine data streams so that when someone activates an unscheduled request for assistance, information from the patient’s electronic health record, call location data, routing to the incident and live connectivity between the responder and patient will provide better triage capabilities and more anticipatory care plans.
Tim Nowak: A touchtone dispatch or app-driven 911 software will give callers the ability to dial-in their complaint/request without even talking to a dispatcher, and the app will request the best resource in as little as five to 10 caller selections.
Distant clinical partners
Telemedicine is already showing promising application for assisting in stroke patient assessment and transport destination decision-making. Two-way video communication and near-real time exchange of monitoring data will allow telemedicine to broaden its utility to more patient presentations.
Nancy Magee: A reliable wide-scale communication system with the ability to transmit information on every patient transported and with a physician or paramedic available by telemedicine at all times is a priority.
Ryan Greenberg: A distant paramedic or other clinician, linked to EMS crews in the field, will provide an additional ALS evaluation on complex medical calls. In rural areas, linking a distant paramedic with an on scene EMT will allow for use of expanded protocols. A distant paramedic could also add a mental health professional with video conferencing to assessments of patients with behavioral emergencies.
Tim Nowak: EMS-to-ED communications will enable face-to-face videoconference with a smartphone or tablet on any 911 response, interfacility transfer or community paramedicine encounter.
Catherine R. Counts: A handful of the community paramedicine programs are pushing the envelope of telehealth, in which the EMS agency acts as a conduit to definitive sources of care without the need to physically move the patient from their environment. In many cases patients don’t need to go to the hospital in that moment, but they do need to be evaluated and receive instructions.
Ann Marie Farina: I wonder how much of the EMS tech will be technology that replaces EMS. How long will it be before an in-home medical kiosk can assess vitals, do an EKG, draw blood and take X-rays, all run remotely with two-way video to a doctor or a nurse behind a desk? Add that in with self-driving cars and we’d be about 90 percent redundant.
Dave Konig: Patients will no longer be taken to the hospital, even for what today would be considered complex issues. Home care management via telemedicine will become normalized and preferred, largely due to its cost-effectiveness.
Connecting patients to technology
We are hopefully a long time away from removing humans from patient care. Effectively applying technology and inputting information almost always requires the emotional intelligence of a caregiver.
Nathan Stanaway: When considering machine learning, I believe the larger role health care providers will play is to facilitate information exchange between patients and software. I think a not-insignificant role for EMS providers will be the emotional connection and help that humans will provide beyond the capability of software.
Nancy Magee: EMS is a people care profession. New technology should be used as an adjunct to enhance the capabilities of an educated, compassionate human being. The focus needs to be on what needs to be done for the patient, not what can be done to the patient.
How distant technology becomes actual EMS tech
Some of the impacts of technology are specific, while others will require fundamental shifts in the profession and in the expectations of the public.
Ann Marie Farina: I’m not sure some of our predictions count as distant tech, since it could probably be accomplished in the next couple years with the technology already in our smartphones and in devices like Amazon’s Echo.
Art Hsieh: For EMS providers, more education and training are needed. For EMS leaders, creating policies and procedures that protect both providers and agencies, while proving the value of such services for reimbursement is the priority. For patients, new technology means better care, lower cost and better outcomes.
Dave Konig: Providers will have an expanded range of care they are able to provide, while simultaneously their educational requirements will drop. Augmented reality ambulances will give step-by-step instructions, requiring only rudimentary knowledge by the technician. This will place EMS of tomorrow in a similar workforce category as the fast-food industry worker of today.
Ryan Greenberg: Increased safety with the use of technology that allows for greater career longevity and greater patient outcomes from integration of providers who are experts with specific medical conditions will yield improved patient outcomes and patients getting the right care, at the right time, in the right place.
Catherine R. Counts: I expect that as the technology within the prehospital setting increases, the integration between the care provided by EMS personnel and those in brick-and-mortar facilities will also increase.
Nancy Magee: EMS needs to be careful about the public thinking that humans are replaceable. Artificial intelligence is no substitute for emotional intelligence.
About the contributors:
Catherine R. Counts is a health services researcher completing her doctorate at Tulane University School of Public Health and Tropical Medicine.
Rom Duckworth has more than 25 years of experience working fire departments, hospital health care systems, and public and private emergency services.
Ann Marie Farina is a paramedic in Washington state. Ann Marie is the founder of The Code Green Campaign and a member of the EMS1 Editorial Advisory Board.
Kelly Grayson, NRP, CCEMT-P, is a critical care paramedic and educator in Louisiana. Kelly is a member of the EMS1 Editorial Advisory Board.
Ryan Greenberg has spent the past nearly 20 years working in EMS from EMT to chief of EMS. Ryan is a member of the EMS1 Editorial Advisory Board.
Art Hsieh, MA, NRP teaches at the Public Safety Training Center, Santa Rosa Junior College. Art is a member of the EMS1 Editorial Advisory Board.
Dave Konig is a New York City-based EMS provider and author. He has worked in the private sector, as a 911 provider, and as a volunteer.
Nancy Magee, MEDIC Training Solutions, combines a businesswoman’s perspective on marketing, efficiency and customer service with an EMS volunteer’s heart.
Tim Nowak is a paramedic and founder of Emergency Medical Solutions LLC. He has worked in fire-based, municipal-based and private nonprofit EMS systems.
David K. Tan, M.D., FAEMS, is associate professor and chief of EMS in the division of emergency medicine at Washington University School of Medicine. David is a member of the EMS1 Editorial Advisory Board and provides medical direction to the EMS1 Academy.
Nathan Stanaway, BS, NRP, has experience in a variety of health care organizations. Nathan’s passions are improving EMS through education, marketing and leadership.
Doug Wolfberg is a founding partner of Page, Wolfberg & Wirth and one of the best-known EMS attorneys and consultants in the United States.
