Emergency Health Care

System in the
21st Century
Dr. dr. Muhammad Isman Jusuf, Sp.S
Ketua Ikatan Dokter Indonesia (IDI)
Cabang Kota Gorontalo

Diadaptasi dari
Presentasi Jim Holliman
 E.M.S. (Emergency Medical Services) in the
21st Century : Lecture Outline
 Ideas on the future of E.M.S. (or "prehospital care") :
Vehicle-based computer communication systems
Electronic patient monitoring units
Telemedicine
Patient care

Business and Education

Robots

Simulator training
Field lab testing and radiographs
Provision of primary health care services
Public education, illness and injury prevention
Home environmental assessments
Why is the Future for E.M.S. Bright ?
 Lots of energetic and enthusiastic personnel
 Support by the public
 Recognition of importance by the government
 Caseload should not decrease
Increasing population
Increasing percentage of elderly patients
 Potential to further utilize existing technology
 Multiple roles and responsibilities
 "Core" component of national health care system
 Advanced Vehicle-Based Computer
Communication & Monitoring Systems
 Perhaps the most important and greatest potential
advance for E.M.S.
 All motor vehicles can be equipped with small
electronic monitoring & communication devices
 Should be made standard required equipment
Continually monitor vehicle position via GPS (Global
Positioning System, satellite based)
Activate in event of vehicle collision
Then automatically send report to central

communications facility
Information Relayable from Vehicle
Monitoring Sensors
 Type and severity of vehicle damage
 Vehicle GPS location
 Condition of humans in the vehicle
Mental status and major injuries
 Environmental hazards or conditions
 Use of Relayed Information from
Vehicle-Based Sensors
 The receiving communications center can then send
the closest EMS unit to the scene
Can inform EMS units of victim numbers and
conditions
 Other types of units can be mobilized if needed
Fire, police, heavy rescue, HAZMAT
 Prearrival instructions can be sent to the vehicle
occupants
 Advantages of GPS Devices on
EMS Vehicles
 Allows central control facility to monitor exact
positions of all vehicles at all times
 Dashboard computerized maps allow crews to
determine fastest ingress and egress routes to
scenes, and avoid getting lost
 Supervisors can also monitor speed of vehicles
 Allows more effective Systems Status Management
 Pemanfaatan GPS

Sumber: Andi Sunyoto, 2007

 Electronic Medical Monitoring
Units for Patients
 Small sized units can be carried by patients with
recurrent or chronic illnesses
 Monitor patient's geographic position using GPS
 Activate if patient has sudden illness or incapacitation,
and then send location & condition message to
communications center
Center can then send EMS unit directly to patient
 Could also be used for emergency remote treatment :
External defibrillation if dysrhythmia sensed
Medication injection for other sensed conditions
 Computerized Communications
Between EMS Vehicles and E.D.'s
 Hand held or voice activated computers can send detailed info
from scene to E.D. (via cell phone transmission)
Hand held P.D.A.'s also useful as references for protocols &
medical reference info
 E.D. can then print the info to be part of the patient's medical
record
 This saves the need for the EMS crew to do any other
documentation
 Continuous 2 way info from E.D to EMS units allows updating
on E.D. bed availability & hospital condition or capacity
One type of hand-held computer for recording EMS patient
information
Ambulance vehicle – mounted computer system
Advantages of Computerized 2-Way
Communications Between EMS & E.D.'s

 Allows better management of multicasualty

situations
 Helps avoid overload of any one receiving
facility
 Patient medical information can be transmitted
much more quickly & completely than can be
done verbally
 Enables more rapid turnaround of EMS units
after delivering patients
NATO nurses transporting patient on military “mini-ICU”
stretcher
U.S. military stretcher with built-in ICU equipment
 Telemedicine in the Future of EMS
 Miniaturized television (TV) cameras can be carried on
helmet, hat, or uniform of EMS personnel
 Sending live video images of the scene to the
communications center helps determine need for
additional responding resources
Helps manage multicasualty situations & terrorist
incidents
Also allows monitoring for scene dangers not noticed
by the EMS crew
 Other Telemedicine Uses in EMS
 Allows hospital-based doctors to assist field EMS
personnel to make diagnoses & treatments
 Allows hospital physicians to direct EMS personnel to
do medical or surgical procedures
 Can be used for followup visits or "checkups" for
patients with chronic illnesses
Can obviate need for "face to face" meeting with
doctor
 Telemedicine with Robot Units

 Video camera equipped robot units :

Can search dangerous environments for victims :
Building fires


Buildings at risk for collapse



Possible chemical, biological, or radiation contamination



Boat or submarine robots can search water areas for



victims
Can have chemical detectors
Can perform remotely directed medical or resuscitation
procedures
 Telemedicine for Video
Conferencing
 Limits travel time & expense for business
meetings or educational conferences
 Video based training & education materials are
easy to transmit & update
 Allow personnel to conduct training or receive
education in "down time" between calls
 Having personnel log on to on-line training
programs allows supervisors to monitor
completion of training & conduct tests
Use of Simulator Training in EMS

 Computerized mannequin patient simulators can be

used for more realistic clinical training
 Allows demonstration of student's ability to recognize
problems & take action
 Allows more accurate testing of students
 Requiring completion of extensive simulator training
prior to licensing is protective for the public
 Vehicle driving simulators can improve driving skills for
low cost
Ambulance vehicle driving simulator
 Field Laboratory Testing by EMS

 Hand held miniaturized devices can rapidly measure a

wide variety of blood & body fluid components (using
only small amounts of blood)
 Permits broader & more accurate prehospital
diagnoses
 May obviate need to transport patient to E.D.
 Results may determine type of receiving facility (such
as cardiac enzymes or toxin levels)
 Radiographic Equipment for EMS
 If more portable & less costly radiographic equipment
is developed, this may be utilizable by EMS units
 Transmission of images back to hospital emergency
physician or radiologist could be done
 Interpretations may obviate need to transport patient to
hospital, or permit early thrombolysis
 Can be used for verification of endotracheal tube
placement
 Ultrasound may help with intravenous line placement
 EMS in the 21st Century
Lecture Summary
 The future for EMS in the 21st Century is very bright
 Expanded use of present technology will allow
improved & more efficient EMS care
Vehicle monitoring systems
Telemedicine and robots
Simulator training
Field lab & radiographic studies
 EMS can provide more primary & followup care
 EMS has much research potential