Making the most of your smartphone on EMS scenes
Your patient takes a medication you aren't familiar with and needs to be treated using a protocol you haven’t reviewed recently; do you have the right apps on your phone to assist?
EMS is becoming an increasingly complex practice of medicine. Providers are generally seeing broadening of their scopes of practice and are being placed in a position to make clinical decisions on a more frequent basis. While many EMS training programs are responding to this change, EMS providers will need to adjust their approach to continuing education in order to stay proficient in this evolving clinical environment.
As patient presentations, co-morbidities and long-term treatments become more complex, EMS providers will be placed in a position of not being able to simply memorize lists of symptoms and prescribed medications if they want to successfully diagnose and treat their patients. One strategy for mitigating risk in a more complex patient environment is to rely more heavily on reference materials to assist in unfamiliar conditions.
Relying on memory vs. reference
While providers in an EMS system should have a working knowledge of the protocols governing their treatment, they will be more proficient with protocols they use frequently. For example, most providers will have a high comfort level with adult chest pain or shortness of breath treatment algorithms as those are among the most frequently used. Pediatric protocols, however, are less often used and represent an area of risk for incorrect treatment and incorrect dosing. Consequently, having a handy reference to review these protocols before treatment (or even on the way to a call) can provide an opportunity to review specifics before patient contact.
Many EMS systems have begun to develop smartphone apps for their local protocols. If your system has such an app available, you should certainly download it. For providers in a system without a specific app developed, consider checking out Paramedic Protocol Provider from Acid Remap. This app is a handy reference to 350 different EMS system protocol sets from around the world and supports downloading protocols to allow for off-line access in areas where cellular coverage may be poor.
The Paramedic Protocol Provider app is available in both a free and paid version. An EMS system can elect to pay to provide access in the free iOS or Android app (iTunes/Google Play) to their systems’ protocols, but additional systems are available in the paid version (iTunes - $9.99/Google Play - $10.00). PPP is updated on a regular basis and is a valuable tool, particularly for reviewing infrequently used protocols en route and on scene.
Mobile drug/medical reference
With increasingly complex patients being medically managed in the outpatient environment, EMS providers are becoming exposed more regularly to patients with underlying conditions that would have required an inpatient stay less than a decade ago. Take, for example, patients with a left ventricular assist device in place. This previously would have required an ICU stay and this patient population is now routinely being discharged back to the community with an LVAD while they await transplant.
These expanding patient populations bring with them unfamiliar medications and treatment regimes. While resources like Google and Wikipedia can be useful in a pinch, there are several apps available that provide vetted information to health care providers of all levels.
One of the most commonly used medical reference apps is Medscape (iTunes/Google Play), which is a free app provided by WebMD. Medscape provides prescription medication and medical condition references as well as a drug interaction checker and a variety of medical calculators. All the articles on Medscape are written by subject matter experts and the material is carefully curated. Medscape does require users to register for a free account when signing up.
Keeping your diagnostic capabilities finely tuned
The 12-lead ECG is a common assessment tool for ALS-level providers. While this is the case, unusual ECGs are not nearly as commonly. Given the importance of correctly interpreting an ECG, it is in the best interest of both patient and provider to practice interpreting abnormal ECGs in order to stay proficient. Increasing EMS provider ability to correctly interpret ECGs can help reduce incorrect cath lab activation and limit overuse of resources.
EMS 12-Lead blog founder Tom Bouthillet has developed a 12-lead ECG interpretation app that provides detailed analysis of 180 different real-world 12-leads. The 12-Lead ECG Challenge (iTunes - $5.99/Google Play - $5.99) focuses on STEMI and STEMI mimic and begins with a patient presentation and the 12-lead obtained in either the prehospital or hospital environment. Users can tackle five, 10 or 20 cases at a time.
Preparing for the worst
When considering infrequently encountered situations, hazardous materials releases should immediately come to mind. While fire and EMS providers are likely required to take an annual hazardous materials awareness course, these skills are rarely practiced. When presented with a hazardous materials scene, correctly assessing the risk and isolating the appropriate distance becomes extremely important. Smartphone apps provide a readily available reference for patient presentations and safety perimeters.
Updated every four years, the Emergency Response Guide app (iTunes/Google Play) is a free reference provided the U.S. Department of Transportation and directly mimics the ERG book located in most of your ambulances and fire apparatus. Hazardous substances can be looked up by name or ID number and initial treatment considerations and isolation recommendations are provided for each substance.
For a more involved incident, the WISER app (iTunes/Google Play) is another free resource that includes substance identification based on patient symptoms and isolation zone mapping with real time weather updates. There is some overlap between the ERG and WISER apps so most providers will only need to keep one after trying both.
Since you were dispatched to a report of a pediatric seizure, you used the protocol app distributed by your medical control authority to review treatment algorithms on the way to the call. You make a habit out of refreshing your memory when you anticipate needing an infrequently-used protocol based on the call information and it has served you well in the past.
After arriving on scene and reviewing Janet’s medication card, you use your medical reference app and find that carbamazepine is the generic name for Tegretol which is commonly prescribed to treat epileptic seizures. Based on this information, you recall that Janet qualifies for treatment under your protocols after a second seizure. Once that second seizure begins, you use the medication calculator in your reference app to calculate the benzodiazepine dose. After performing a medication crosscheck with your partner, you administer the medication and Janet’s seizure stops shortly after.
You and your crew continue monitoring Janet until the transporting unit arrives. By the time she is packaged for transport, Janet’s level of consciousness is improving and she is beginning to converse with the transport crew.
The ubiquitous nature of smartphones means that nearly every EMS provider has an incredible resource available to them while on scene of increasingly complex calls. By selecting a few apps containing validated information, EMS providers can assure that they have the latest reference material available to assist in making the right diagnosis and choosing the right treatment for their patient. Just take care to maintain good infection control practices if you use your smartphone on scene, you definitely don’t want to pick up your phone wearing dirty gloves and then put that phone up to your face later.
What is your favorite medical reference app? Let us know in the comments below.
Note: The author has no financial stake in the apps mentioned above and has not received compensation, monetary or otherwise, for these recommendations.