The Development of a Region-Wide EMS Telemedicine System Fully Integrated With Day-to-Day EMS and Disaster-Related Activities

BR Med-Connect Update

Background

In late 2008, the City of Baton Rouge, Louisiana decided to trial an EMS Telemedicine System, which was to be called BR Med-Connect.

The project came about because of Mayor Melvin “Kip” Holden’s, and Dr. Cullen Hebert’s farsighted vision for an advanced EMS/ED system that would improve the delivery of health care throughout the region.

The plan was that the trial would be conducted in the city of Baton Rouge, and, if successful, the system would then be extended to cover the entire parish of East Baton Rouge, an area of 472 square miles, comprised of an urban, suburban and rural population. For the pilot phase, General Devices was contracted to supply the city with the e-Bridge Telemedicine System, which was installed in two city ambulances.

A General Devices CAREpoint Workstation was installed in the ED of Our Lady of the Lake Hospital, which was to serve as the hospital ED end of the system. The goal of the system is to be able to bring advanced forms of emergency care to the region by means of an EMS Telemedicine System that would also provide for the regular day-to-day activities of EMS and the activities of the Baton Rouge Office of Emergency Preparedness (OEP).

Phase 1 - Pilot System Testing

For the pilot period, a broadband wireless system within the City of Baton Rouge provided high-speed connectivity between the ambulance and hospital, allowing the bi-directional transmission of video, voice and data. On March 12, 2009, the system was inaugurated and the event was televised on three area TV stations and was noted in the major EMS journals.

Over the course of the year, the system was tested and found to meet the operational requirements outlined by the city’s EMS agency. The success of these tests allowed the project to begin to move forward toward its longer term objective of a parish-wide system. This objective was to be attained in two additional steps, the first being to equip all five of the regions hospitals with the ED elements of the system. These hospitals are: Our Lady of the Lake; The Oschner Clinic; The Blue Bonnet and the Mid-City campuses of the Baton Rouge General Hospital; and Lane Memorial Hospital. The Baton Rouge Office of Emergency Preparedness was also provided with a system to address disaster related issues. The third phase of the project is to equip all of the parish’s ambulances with the mobile parts of the telemedicine system (cameras, Rosetta-VC controllers, etc.).

Phase 2 - Where BR Med-Connect is Today

In mid-2010, funding was approved to equip the area hospitals’ EDs and the OEP with: CAREpoint Workstations, Rosetta-DS for 12-Lead report transmission, and the e-Net Messenger secure messaging system. Once installed, this system would immediately be put to use managing all day-to-day EMS activities, 12-Lead ECG report transmissions as well as disaster related activities. For communications, the system would use existing radio and landline & cellular telephones. 12-Lead reports would be sent from existing ZOLL monitors using existing laptop PCs running Rosetta-DS.

The reports would be received, displayed, archived and reviewed on the CAREpoint Workstation and then forwarded by e-Net Messenger to the Cath lab or physicians’ office (or mobile phone). When the cardiology groups were initially asked if they were interested in receiving 12-Lead reports from the field they were skeptical because of concerns about the possibility of mix-ups without using some type of identifier as a clear way of identifying 12-Lead reports. Once the cardiologists understood that the Rosetta/CAREpoint system allowed a secure, fast and simple means to allow the medics to include their EMS Crew #, they quickly lent their support to the program. e-Net Messenger was chosen to distribute the reports because of its security, speed, surety of delivery, and tracking and message arrival notifications. The equipment was fully installed, tested and operational by the end of February, 2011 and is now being phased into full use. The scope of the project was considerable, requiring the coordinating of installations and testing equipment at 5 locations, the training of EMS, ED and OEP staffs at the various EMS agencies, the 5 hospitals and the OEP as well as the training of the ED physicians and multiple cardiologists.

The initial training of hospital and EMS personnel was accomplished by General Device’s personnel using a combination of on-site and WebEx “train-the-trainer” sessions to train EMS and hospital supervisors and staff trainers who in turn, trained all their staff personnel. The use of WebEx proved not only convenient to all concerned, but also extremely well received. To date, all day-to-day EMS operations in the Parish and the 5 EDs are managed on BR Med-Connect’s CAREpoint Workstations, with all calls automatically documented by the system’s digital logging recorder.

East Baton Rouge EMS has completed the training of their medics in acquiring and sending 12-Lead reports from their ZOLL monitors and has just begun to implment the program. When the system is fully implemented, 12-Lead reports will be sent from Rosetta-DS over a cellular system, through the GD Net secure server and to the ED’s CAREpoint Workstation. After review by an ED physician, they will be electronically forwarded by e-Net Messenger to the cath lab and/or other destinations as needed. Upon the 12-Lead report’s arrival in the cath lab, an audio/visual alert will notify cath lab personnel of the incoming 12-Lead reports and the ED will be automatically notified when the report is opened.

Should the report not be opened, the ED will automatically be alerted to this as well. In addition to managing the regular activities of EMS, the system’s e-Net Messenger also provides for interfacility messaging for everyday and disaster related communications. This allows ED personnel to quickly and easily send fully encrypted text, voice, data and images to any or all of the other hospitals, to the OEP or to other destinations, and be notified when these messages arrive. This capability is of particular importance in Baton Rouge because of the constant threat of man-made as well as natural disasters that may affect the enormous petroleum and gas facilities in both Baton Rouge and the outlying regions. The region not only possesses the largest oil refinery in the United States, but it is also the distribution point for all the major gas pipelines coming from the Southwest. The ability to use a secure messaging system allows for improved coordination of multi-agency activities ranging from complex disaster related activities to simple everyday tasks such as locating and securing supplies.

Phase 3 - Next Steps

Funding is presently being sought to allow implementation of the balance of the system which, when operational, will represent the largest deployment of EMS Telemedicine in the world. The many applications that the system may be used for include: physician guided and fully documented treat-and-release; advanced forms of early stroke assessment; firefighter rehab; documented refusals; physician involvement in difficult cases; paramedic protection from false claims, burn patient assessments, etc. It is hoped that in the coming year, despite the many budget cuts we are seeing across the nation, we will nonetheless see the system fully implemented and EMS Telemedicine applications identified, implemented and studied. It is expected that the improvement in EMS, disaster response and related ED activities already seen from the system will be expanded to include the full benefits of EMS telemedicine and that this system will become a model for others to learn from and follow.

Related Article: Telemedicine Information Service for EMS Pre-Hospital Organizations

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The Development of a Region-Wide EMS Telemedicine System Fully Integrated With Day-to-Day EMS and Disaster-Related Activities

 

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