mr graham curry lancashire ambulance service nhs trust 449-451 garstang road...
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Mr Graham CurryMr Graham Curry
Lancashire Ambulance ServiceLancashire Ambulance ServiceNHS TrustNHS Trust
449-451 Garstang Road449-451 Garstang RoadBroughton Broughton
PrestonPrestonLancashireLancashirePR3 5LNPR3 5LN
[email protected]@lancsamb1.demon.co.ukTEL 01772 862666TEL 01772 862666FAX 01772 861003FAX 01772 861003
MOBILE 07711 726960MOBILE 07711 726960
MESA
The 999 Call or MESAThe 999 Call or MESACall 6372Call 6372
ACD Call SystemACD Call System
Call Recording SystemCall Recording System
No CLINo CLI
Recognised telphone numbersRecognised telphone numbers
Pre Arrival AdvicePre Arrival Advice
Caller is asked a series of questionsCaller is asked a series of questions
Responses create a catagory responseResponses create a catagory response
Protocol driven call assistance is offeredProtocol driven call assistance is offered
Stay on the line offeredStay on the line offered
Dispatch ProcessDispatch Process
Incident is shown on mapping systemsIncident is shown on mapping systems
Resources shown on same systemResources shown on same system
Catagory shown decision madeCatagory shown decision made
Computer activates crew Computer activates crew
Mobile Data is used for all callsMobile Data is used for all calls
GPS Sytems Voice Systems Data SystemsGPS Sytems Voice Systems Data Systems
ResourcesResources
Tradional Road AmbulanceTradional Road Ambulance
Fast Responce CarFast Responce Car
Fast Response MotorcycleFast Response Motorcycle
HelicopterHelicopter
Fast Response DoctorFast Response Doctor
First RespondersFirst Responders
Officer RespondersOfficer Responders
TelemedicineTelemedicine
How did we get involved in How did we get involved in telemedicine and why.telemedicine and why.
Health Telematics sectorHealth Telematics sector
Telematics application 4th framework= 898 MECU
Health Telematics sector= 140 MECU (approx £ 100M)
Includes HECTOR project= 7.5 MECU (approx £ 5M)
What is HECTOR ?What is HECTOR ?
HealthHealth EmergencyEmergency CareCare throughthrough TelematicsTelematics OperationalOperational ResourcesResources
What is Telemedicine ?What is Telemedicine ?
The Practical Benefits of TelemetryThe Practical Benefits of Telemetry
The ability to send medical data using anyThe ability to send medical data using anyform of communication interface, from the form of communication interface, from the patient to any other site.patient to any other site.
This typically includes bio medical This typically includes bio medical informationinformationsuch as ECG, Pulse , Oxygen Saturation,such as ECG, Pulse , Oxygen Saturation,Blood PressureBlood Pressure , ,Video Imaging.Video Imaging.
TelemedicineTelemedicine
Standard TelemedicineStandard Telemedicine
Satellite - dependent ( INMARSAT )
Setup involves satellite location
Use during ambulance journey would involve satellite tracking
Setup time augments time at scene
HECTOR TelemedicineHECTOR 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 PilotsTwo Pilots:-:-
•12 Lead ECG’s12 Lead ECG’s•Monitoring of Heart ConditionMonitoring of Heart Condition
•Transmission of the Heart Condition Transmission of the Heart Condition via GSMvia GSM
•Video ImagingVideo Imaging•Transmission of live pictures via GSMTransmission of live pictures via GSM
•Operate throughout EuropeOperate throughout Europe
What is a Myocardial Infartion ?What is a Myocardial Infartion ?
It is just one type of Heart Attack that is becoming more and more It is just one type of Heart Attack that is becoming more and more common place in our modern worldcommon place in our modern world
Primarily an MI as it is commonly known is a blockage of one or 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 more of the arteries that feed the heart muscle. This blockage is in the form of a clot which is stopping oxygenated blood from in the form of a clot which is stopping oxygenated blood from
feeding the tissues.feeding the tissues.
Time is muscleTime is muscle
The main aim is to reduce the time that the heart muscleThe main aim is to reduce the time that the heart muscle
is starved of oxygenated blood and to prevent more tissueis starved of oxygenated blood and to prevent more tissue
from dying.from dying.
How can telemedicine help ?How can telemedicine help ?
With the correct vital signs sent to the hospital viaWith the correct vital signs sent to the hospital viatelemetry the doctors can validate the correct diagnosis.telemetry the doctors can validate the correct diagnosis.
The patient on arrival should be treated much faster than The patient on arrival should be treated much faster than a patient who has not had the use of telemedicine. a patient who has not had the use of telemedicine.
Thrombolytic drugs will be ready as will the cardiologistsThrombolytic drugs will be ready as will the cardiologistswho will be waiting to treat the patient on arrival or who will be waiting to treat the patient on arrival or
arrange for immediate admission to a CCU .arrange for immediate admission to a CCU .
The Physio Control Lifepak 11 The Physio Control Lifepak 11 monitor is able to record both monitor is able to record both 3 lead and 12 lead ECG, then 3 lead and 12 lead ECG, then make a diagnostic suggestionmake a diagnostic suggestion
and store the information as welland store the information as wellas transmit it over the GSM mobileas transmit it over the GSM mobile
telephone system.telephone system.
Lifepak 11 Monitor SystemLifepak 11 Monitor System
What actually happens ?What actually happens ?
• 10 Leads on Body10 Leads on Body• Aquire DataAquire Data• Analyse DataAnalyse Data
• Produce ReportProduce Report• Analyse ReportAnalyse Report
• Transmit ReportTransmit Report
HOW DOES IT WORKHOW DOES IT WORK
Lifepak 11Lifepak 11Hospital / Hospital /
Receiving StationReceiving Station
GSMGSM
Monitor and Receiving StationMonitor and Receiving Station
The system is designed with strobe warning lights toThe system is designed with strobe warning lights toinform the staff of an incoming ECGinform the staff of an incoming ECG. .
When the data arrives a senior medical officer is able to When the data arrives a senior medical officer is able to diagnose exactly the problem and produce an accurate diagnose exactly the problem and produce an accurate
diagnosis of the cardiac conditiondiagnosis of the cardiac condition
TREATMENTTREATMENT
• Cardiac Condition DiagnosedCardiac Condition Diagnosed
• Thrombolytic Drug AdministeredThrombolytic Drug Administered
• Time to Needle is reducedTime to Needle is reduced
AMBULANCE AMBULANCE UTILISATION UTILISATION Blackpool July/Aug/Sep Blackpool July/Aug/Sep 19971997Arrivals by Ambulance 1.July - Sep 30, 1997 Top Ten categories
219
233
243
259
260
271
323
383
536
652
0 100 200 300 400 500 600 700
unspecif ied
convulsion
unw ell
laceration
overdose
abdo.pain
dyspnoea
inj.head/scalp
collapse
chest pain
Vehicle Specification.
The vehicle contains very sophisticated telemetry facilities.The vehicle contains very sophisticated telemetry facilities.
Four cameras for all aspects of emergency and casualty trauma.Four cameras for all aspects of emergency and casualty trauma.
Transmission of live video images using standard GSMTransmission of live video images using standard GSM mobile telephone system with total World Systems compatibility.mobile telephone system with total World Systems compatibility.
The system has the ability to monitor live pictures on boardThe system has the ability to monitor live pictures on boardthe Ambulance.the Ambulance.
The system can be fully automated for easy usage.The system can be fully automated for easy usage.
Ambulance FacilitiesAmbulance Facilities
• It can provide four viewsIt can provide four views•rear viewrear view•internalinternal•helmet and microwave linkhelmet and microwave link•dashboarddashboard
•plus a small colour internal plus a small colour internal monitormonitor•4 way split screen with zoom4 way split screen with zoom
Dashboard CameraDashboard Camera
Situated on the Situated on the dashboard dashboard of the Emergency of the Emergency vehicle,vehicle,this can provide this can provide viewing viewing of an emergency event of an emergency event uponuponarrival and the camera arrival and the camera can be directed can be directed towards the incident.towards the incident.
Rear View CameraRear View Camera
Situated on the rear top of the vehicle next to brake Situated on the rear top of the vehicle next to brake lights, this camera is built into lights, this camera is built into an external housing unit an external housing unit disguised as a reversing ordisguised as a reversing or spot light. spot light. It was disguised toIt was disguised toprevent the public from beingprevent the public from beingunduly concerned. unduly concerned.
Internal CameraInternal Camera
Situated directly above the patient on a swivelSituated directly above the patient on a swivelflexible arm for adjustmentflexible arm for adjustmentand can be used to view anyand can be used to view anypart of the patients body.part of the patients body. The camera has a zoom lensThe camera has a zoom lensinside which can be operatedinside which can be operatedby either the paramedic or anby either the paramedic or anexternal computer operator.external computer operator.
Helmet CameraHelmet Camera
Highly miniaturized colour camera with housing Highly miniaturized colour camera with housing to blend with helmet. Lens to blend with helmet. Lens system positioned at the frontsystem positioned at the frontwith signal processing unit at rear.with signal processing unit at rear.Coiled connection to Microwave Coiled connection to Microwave video transmitter to send live video transmitter to send live pictures back to the vehicle .pictures back to the vehicle .
Colour Viewing MonitorColour Viewing Monitor
Situated above the patient for comfortableSituated above the patient for comfortableviewing by the paramedic, this viewing by the paramedic, this TFT colour display unit has abilityTFT colour display unit has abilityto display split screen imagesto display split screen imagesviewing the four camera images viewing the four camera images at once or singular. It has buttonsat once or singular. It has buttonson unit for camera selection. Theon unit for camera selection. The user can also zoom in anduser can also zoom in and out the internal camera. out the internal camera.
This GSM is also fitted with a hands free facility to This GSM is also fitted with a hands free facility to enableenablethe Paramedic to talk with Doctors and other people the Paramedic to talk with Doctors and other people whenwhenthe video system is not in use.the video system is not in use.
The system is designed also to be either enabled by The system is designed also to be either enabled by the control center by a single button push on a the control center by a single button push on a computer console computer console although this operation is password protected to although this operation is password protected to prevent prevent unauthorized access..unauthorized access..
GSM Cellular TerminalGSM Cellular Terminal
The receiving station consists of a standard P.C. with a pentium 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 processor ,16 Mb of ram and at least 40 Mb of hard disk space and a standard 28000 bits per second modem .a standard 28000 bits per second modem .
If a laptop computer is used the same specification is required butIf a laptop computer is used the same specification is required butalso a PCMCIA data card and a GSM mobile telephone .also a PCMCIA data card and a GSM mobile telephone .
The system also requires dedicated software to operate the system.The system also requires dedicated software to operate the system.
Receiving StationReceiving Station
The receiving station can also change the view of any The receiving station can also change the view of any screen and it can also zoom the camera in and out via screen and it can also zoom the camera in and out via the keyboard.the keyboard.The views are updated every 4 seconds in colour or The views are updated every 4 seconds in colour or every 2 seconds if mono is selected. The system can every 2 seconds if mono is selected. The system can also send the pictures to another station any where in the also send the pictures to another station any where in the world. world. The whole operation is also copied to a slow scan video The whole operation is also copied to a slow scan video recorder .recorder .
Receiving StationReceiving Station
TrainingTraining
The video image system is recorded via a slow scanThe video image system is recorded via a slow scanvideo recorder. These videos can be used to assistvideo recorder. These videos can be used to assistParamedics by validating their existing protocolsParamedics by validating their existing protocolsand assist managers in analysing actions of controland assist managers in analysing actions of controlmanagers.managers.
The videos can also be used to show new recruits real The videos can also be used to show new recruits real and actual events and how they were handled.and actual events and how they were handled.
AmbulanceAmbulance
HospitalHospital
GSMGSM
HOW DOES IT WORKHOW DOES IT WORK
Control CenterControl Center
BenefitsBenefits
•Faster treatment for Heart Attack victimsFaster treatment for Heart Attack victims•More detailed medical informationMore detailed medical information•Clinical history from point of contact of NHSClinical history from point of contact of NHS•Cost savings to the NHS Cost savings to the NHS •Greater reduction in mortality rateGreater reduction in mortality rate
•Method of injury visually displayedMethod of injury visually displayed•Constant monitoring of patients conditionConstant monitoring of patients condition•Clinical advice available for the paramedicClinical advice available for the paramedic•Resourcing information for controlResourcing information for control•Scene evaluation Scene evaluation •Recorded footage for training purposesRecorded footage for training purposes
BenefitsBenefits
Potential Applications Potential Applications in Lancashirein Lancashire
Trauma multiple injury / trapped patient
major incident command / control
triage to appropriate hospitals
audit / training / debriefing
KEY MESSAGESKEY 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 EMS system model
ambulancetracking
(GPS - GIS)
routeguidance
acquisitionof vital signs
& images
emergencyepisodearchive
teleconsultation& telediagnosis
static resource information
resource status updates resource statuslinks to archive
currentposition
destination
routeroute-related
instructions
medicalmultimedia data
medicalmultimedia data
medicalmultimedia
data
logginginformation
resourcemanagement
Citizeninformation
Example of EMS evolution Example of EMS evolution
via PSTN
via RadioTtrunking
via GSM
via ISDNor PSTN
HECC
MICU
Hospital
Voice
Emerg. Clinical Record incl. Biomedical DataEmergency 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
RuralPCC
Radiography Data
Video Data
Emerg. Clinical Record incl. Biomedical Data
Emergency Clinical Record
Messages
via ISDN
Mesa Impact on Worldwide Emergency Scene Mesa Impact on Worldwide Emergency Scene
PROBLEMSPROBLEMS Closed SystemsClosed Systems Independent applicationsIndependent applications Lack of coordinationLack of coordination Radio and Phone remote medical Radio and Phone remote medical
assistanceassistance Radio based communicationsRadio based communications Uncertain location of resourceUncertain location of resource Independent Protocols / ScenariosIndependent Protocols / Scenarios Local solutionsLocal solutions Spectrum AvailabilitySpectrum Availability Different interobilitiesDifferent interobilities
SOLUTIONSSOLUTIONS Open SystemsOpen Systems Interoperable applications and Interoperable applications and
integrated Networksintegrated Networks Resource availability shared knowledgeResource availability shared knowledge Image based medical careImage based medical care State of the Art technologiesState of the Art technologies Geographic Positioning SystemsGeographic Positioning Systems Remote Diagnosis FacilitiesRemote Diagnosis Facilities Coordinated Operative PlansCoordinated Operative Plans Continuity of care protocolsContinuity of care protocols New standardsNew standards Trans-World Emergency careTrans-World Emergency care
MESAMESAHECC
HOSPITALECC
Remote
Care
Point
Mobiles
Units
HECCHOSPITAL
ECC
Remote
Care Point MobilesUnits
MESA PROJECT Proposal MESA PROJECT Proposal
- User Requirement DeterminationUsers
Technological Partners
- MESA- Functional Specifications
D.2.2.
D.2.3.
D.3.1.
-Communication Network
Requirement Determination
and designTechnological Partners
New ApplicationsExisting application new interfacesRenewed applicationsShared applications
Consortium
Technological Partners
- Market Prospections
D.4.1.
-Mesa system design
and specificationTechnological Partners
- Training Users
- Validation Plan Users
- Dissemination Consortium
- PILOT SETUP Users
Lancashire Ambulance ServiceLancashire Ambulance Service
NHS TrustNHS Trust
Thankyou for your time. Further details of the project canThankyou for your time. Further details of the project canbe obtained from myself Mr Graham Curry on 01772 862666be obtained from myself Mr Graham Curry on 01772 862666