Hospital and emergency ambulance link: using IT to enhance emergency pre-hospital care

Emergency ambulances traditionally inform receiving hospitals of impending arrival of patients only in instances of load and go situations, which on a verage constitute less than 5% of ambulance runs. Information transmitted i s usually sparse. For all other runs, information is made available only on arrival at the emergency department (ED). There have also been numerous li mitations associated with voice transmissions. A comprehensive electronic ambulance case record was created as a pilot pro ject in Singapore between three emergency ambulances and the busiest ED the re. All information captured by the ambulance crew, including vital signs i nformation and ECGs was entered or downloaded onto a ruggardised PC in the ambulance and this complete ambulance record was transmitted to the ED. Tra nsmission was wireless via the public mobile data network. A 3-month analys is of this pilot run revealed the following. (1) It was possible to capture a complete ambulance case record electronica lly at a mean time of 93 s vs 7 min 7 s for the traditional written record. ( 2) Air transmission time for data was approximate to4 s unless ECG wave for ms were also transmitted resulting in transmission times frequently exceedi ng 60 s. (3) At least 68% of data was transmissible in 75% of Hospital & Emergency A mbulance Link (HEAL) ambulances as opposed to only 25% in less than 5% Of n on-HEAL ambulances. (4) Paramedics' time in the ED decreased from 15 to 8 min as a result of HE AL. (5) The waiting time for critical care patients to be seen at the ED decrea sed from 35 to 17 min if brought by HEAL ambulances. (6) The HEAL system was able to effectively prompt paramedics in carrying o ut critical aspects of treatment in close to 100% of instances. (7) The pilot HEAL system was able to demonstrate a limited amount of autom ated audit of specific aspects of ambulance runs. Having demonstrated the feasibility of the HEAL system, it is a matter of t ime before enhanced features such as electronic data collection at patient site, voice activated data entry, transmission of data from site, automated ambulance audits and an enhanced level of professional care in the ambulan ces become common-place reality. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.