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Mr Graham Curry Lancashire Ambulance Service NHS Trust 449-451 Garstang Road Broughton Preston Lancashire PR3 5LN curry@lancsamb1.demon.co.uk TEL 01772 862666 FAX 01772 861003 MOBILE 07711 726960 MESA The 999 Call or MESA Call 6372 ACD Call System Call Recording System No CLI Recognised telphone numbers Pre Arrival Advice Caller is asked a series of questions Responses create a catagory response Protocol driven call assistance is offered Stay on the line offered Dispatch Process Incident is shown on mapping systems Resources shown on same system Catagory shown decision made Computer activates crew Mobile Data is used for all calls GPS Sytems Voice Systems Data Systems Resources Tradional Road Ambulance Fast Responce Car Fast Response Motorcycle Helicopter Fast Response Doctor First Responders Officer Responders Telemedicine How did we get involved in telemedicine and why. Health Telematics sector Telematics application 4th framework= 898 MECU Health Telematics sector= 140 MECU (approx � 100M) Includes HECTOR project= 7.5 MECU (approx � 5M) HECTOR What is HECTOR ? Health Emergency Care through Telematics Operational Resources The Practical Benefits of Telemetry The ability to send medical data using any form of communication interface, from the patient to any other site. This typically includes bio medical information such as ECG, Pulse , Oxygen Saturation, Blood Pressure ,Video Imaging. Standard Telemedicine Satellite - dependent ( INMARSAT ) Setup involves satellite location Use during ambulance journey would involve satellite tracking Setup time augments time at scene HECTOR Telemedicine Uses GSM mobile telephone network No satellite dish No need to locate satellite No need to track satellite No setup contribution to time at scene Two Pilots:- 12 Lead ECG�s Monitoring of Heart Condition Transmission of the Heart Condition via GSM Video Imaging Transmission of live pictures via GSM Operate throughout Europe What is a Myocardial Infartion ? It is just one type of Heart Attack that is becoming more and more common place in our modern world Primarily an MI as it is commonly known is a blockage of one or more of the arteries that feed the heart muscle. This blockage is in the form of a clot which is stopping oxygenated blood from feeding the tissues. Time is muscle The main aim is to reduce the time that the heart muscle is starved of oxygenated blood and to prevent more tissue from dying. How can telemedicine help ? With the correct vital signs sent to the hospital via telemetry the doctors can validate the correct diagnosis. The patient on arrival should be treated much faster than a patient who has not had the use of telemedicine. Thrombolytic drugs will be ready as will the cardiologists who will be waiting to treat the patient on arrival or arrange for immediate admission to a CCU . The Physio Control Lifepak 11 monitor is able to record both 3 lead and 12 lead ECG, then make a diagnostic suggestion and store the information as well as transmit it over the GSM mobile telephone system. Lifepak 11 Monitor System What actually happens ? 10 Leads on Body Aquire Data Analyse Data Produce Report Analyse Report Transmit Report HOW DOES IT WORK Lifepak 11 Hospital / Receiving Station GSM Monitor and Receiving Station The system is designed with strobe warning lights to inform the staff of an incoming ECG. When the data arrives a senior medical officer is able to diagnose exactly the problem and produce an accurate diagnosis of the cardiac condition TREATMENT Cardiac Condition Diagnosed Thrombolytic Drug Administered Time to Needle is reduced AMBULANCE UTILISATION Blackpool July/Aug/Sep 1997 The Video Imaging Pilot Vehicle Specification. Ambulance Facilities It can provide four views rear view internal helmet and microwave link dashboard plus a small colour internal monitor 4 way split screen with zoom Situated on the dashboard of the Emergency vehicle, this can provide viewing of an emergency event upon arrival and the camera can be directed towards the incident. Situated on the rear top of the vehicle next to brake lights, this camera is built into an external housing unit disguised as a reversing or spot light. It was disguised to prevent the public from being unduly concerned. Situated directly above the patient on a swivel flexible arm for adjustment and can be used to view any part of the patients body. The camera has a zoom lens inside which can be operated by either the paramedic or an external computer operator. Highly miniaturized colour camera with housing to blend with helmet. Lens system positioned at the front with signal processing unit at rear. Coiled connection to Microwave video transmitter to send live pictures back to the vehicle . Colour Viewing Monitor Situated above the patient for comfortable viewing by the paramedic, this TFT colour display unit has ability to display split screen images viewing the four camera images at once or singular. It has buttons on unit for camera selection. The user can also zoom in and out the internal camera. This GSM is also fitted with a hands free facility to enable the Paramedic to talk with Doctors and other people when the video system is not in use. The system is designed also to be either enabled by the control center by a single button push on a computer console although this operation is password protected to prevent unauthorized access.. GSM Cellular Terminal The receiving station consists of a standard P.C. with a pentium processor ,16 Mb of ram and at least 40 Mb of hard disk space and a standard 28000 bits per second modem . If a laptop computer is used the same specification is required but also a PCMCIA data card and a GSM mobile telephone . The system also requires dedicated software to operate the system. Receiving Station The receiving station can also change the view of any screen and it can also zoom the camera in and out via the keyboard. The views are updated every 4 seconds in colour or every 2 seconds if mono is selected. The system can also send the pictures to another station any where in the world. The whole operation is also copied to a slow scan video recorder . Receiving Station Training The video image system is recorded via a slow scan video recorder. These videos can be used to assist Paramedics by validating their existing protocols and assist managers in analysing actions of control managers. The videos can also be used to show new recruits real and actual events and how they were handled. Ambulance GSM HOW DOES IT WORK Control Center Benefits Faster treatment for Heart Attack victims More detailed medical information Clinical history from point of contact of NHS Cost savings to the NHS Greater reduction in mortality rate Method of injury visually displayed Constant monitoring of patients condition Clinical advice available for the paramedic Resourcing information for control Scene evaluation Recorded footage for training purposes Benefits Potential Applications in Lancashire Trauma multiple injury / trapped patient major incident command / control triage to appropriate hospitals  audit / training / debriefing KEY MESSAGES New technology must be relevant to key NHS objectives for successful dissemination  Technology is no substitute for well - trained staff in the right place at the right time  Delegation of key skills to an emerging and evolving paramedical profession appears essential to the objectives of emergency telemedicine EMS system model static resource information resource status updates resource status links to archive current position destination route route-relatedinstructions medical multimedia data medical multimedia data medical multimedia data logging information Example of EMS evolution via Radio Ttrunking via GSM via ISDN or PSTN HECC MICU Hospital Voice Emerg. Clinical Record incl. Biomedical Data Emergency Clinical Record Hospital Resources Messages MICU Status Status Acknowledge Activation Data incl. Route Guidance Emerg. Clinical Record incl. Biomedical Data Hospital Resources Voice MICU Status Rural PCC Radiography Data Video Data Emerg. Clinical Record incl. Biomedical Data Emergency Clinical Record Messages via ISDN Mesa Impact on Worldwide  Emergency Scene MESA HECC HOSPITAL ECC Remote Care Point Mobiles Units MESA PROJECT Proposal Technological Partners MESA Functional Specifications D.2.2. D.2.3. Lancashire Ambulance Service NHS Trust Thankyou for your time. Further details of the project can be obtained from myself Mr Graham Curry on 01772 862666