Early Intervention is the Foundation of Community Health

Dec 18th, 2014 | By | Category: EMS Research

Cities will Transform Endemic Risk into Premium Life Safety

The singular goal when introducing a life safety protocol into a major facility or city block is to enable early intervention, continuing here with Elevaed’s Tandem AED/EMS safety architecture. This protocol introduces mediation options that address wider medical and community crises than just cardiac emergencies.

Let’s review the procedure
LifePad Protocol

Life Safety Protocol

The ‘event’ alert begins when a patient senses an oncoming medical emergency, and presses an icon on their cellphone. This calls the LifePad™ safety phone at the security station/front desk of the building, and transmits a pre-programmed text and/or a voice call  to the monitoring EMR (emergency medical responder), who immediately attends that suite.

The stark simplicity of the protocol, which is designed to be leak proof against time delays or excuses, provides the shortest possible route to intervention.  The clock starts when the phone rings, and the EMR is going to be alongside the patient inside 3 minutes – but other wheels are turning at the same time.

That ‘panic button’ utility on the patient’s phone has also called 911 concurrently, and this conversation is joined by the EMR as a 2 or 3 way conference call.

Attending suite 1311, 2 minutes” he may say, to inform the  911 dispatcher. “She has disclosed diabetic and cardiac issues” he might add, while reviewing the volunteered information for that person and the suite occupants.

Alert utility

Button alert utility

This telephony programming is supported by the Blackberry network infrastructure, widely viewed as secure, and it is preconfigured for every registered resident or worker in that facility, as part of the network service. The block as a whole participates, not individuals, so health equity in a life crisis is assured for all occupants. Visitors can also benefit from the protocol if a suite occupant sends an alert, or if they are reported to Security.

Note that the protocol does not replace calling 911, which may be illegal. On the contrary, it provides dispatchers with welcome ‘boots on the ground’ to filter calls and to distinguish acute emergencies from less urgent events. If EMS does attend 10+ minutes later, they can consolidate the rescue, provide after care and transport the patient to hospital.

Relieving municipalities and EMS of unwarranted calls is precisely the sort of help they need, as they struggle to maintain reliable services with limited budgets.

Covering the bag

So within the first minute, the responder has entered the facility’s access control room to acquire a key to the suite, and to pick up the paramedic bag securely stored there. This protocol anchors AED deployment, which has always been defibrillation’s major issue – because like taxis, AEDs never seem to be there when you need them.

14-71421QQ_103250212_1bAj6NGx534724The AED in this medical kit hasn’t been sitting in a drawer or enclosure somewhere for years on end, and is fully charged and serviced.

In a complex with multiple buildings, a patient can still be reached within a 3-4 minute radius by sneakernet (on foot) and be given near-optimal treatment. An entire city block is shielded by a single on-duty EMR with one well-stocked paramedic bag.

Depending on medical direction, the paramedic bag will contain an AED, oxygen, naloxone for opioid overdoses, glucose, bandages, tourniquets etc. as with any advanced first aid kit. It may also contain trial treatments whose outcomes feed valuable data into ongoing medical surveillance studies. Discoveries begin here, with everyone contributing.

On the Phone to Dispatch

The telephony (phone programming) supports all major cellphone operating systems, and conferences the call if the patient remains conscious and capable. If not, the victim may nonetheless have enabled their own survival, with one desperate push on the icon during the event’s onset. The deep value of the protocol becomes evident, when an estimated 85% of cardiac arrests go ‘unwitnessed’ – this patient has been afforded a chance most will never get.

If EMS has a deep, dark secret, it is that the public is not aware of this endemic absence of early intervention in high rises (which take 2-3 minutes longer to access patients). This risk factor is needless when one EMR can protect a city block with 1000 residents.

EMS Dispatch

EMS Dispatch

As the dispatcher and the responder update each other as to the status of the call, the suite is entered and the situation clarified. The EMR assesses the patient, and checks for an airway, breathing, and a pulse. Other signs may indicate stroke, diabetic or allergic reactions, overdose, trauma, bleeding…. on hearing suspicions of any of these the dispatcher knows to get help there fast, possibly via an ACLS ambulance.

In many cases the crisis may be locally manageable, or in need of other resources. Examples may be injuries that do not require ambulance transport, symptoms that cleared themselves and should be discussed with the patient’s doctor, domestic disputes, addiction issues, temporary distress etc.

Some patients are ‘familiar faces’ who need not have called 911 or this ‘life safety number’ – these callers may benefit from the paramedic’s rounds and look-ins, and find help outside of the EMS system. Here the protocol can contribute a triage factor, by moving many EMS incidents back into the realm of everyday community health.

A modest cost for premium medical safety

Facilities can terminate their emergency number onto a single LifePad, and its ability to receive MMS text messages. Then any licensed EMR can monitor that phone number, and give treatment without delay.

LifePad Safety Phone

LifePad Safety Phone

The EMR registers the occupants of the building, along with their volunteered medical conditions, onto the LifePad website, and assists with configuring and testing the ‘panic button’ utilities on their cellphones.

The system is now on the network,  no GPS triangulation scheme or registry is required to locate the patient, the AED or anything else. Just pick up a key, the medical bag and get there – now.

Clearly, early intervention is affordable to all parties, when the cost of an unmediated cardiovascular event, our major killer, or cerebral injury can be so disastrous to patients, families and stakeholders.

Property owners will share the cost with municipalities, and advertise the value. The public may come to simply expect it – and deservedly so. Cities will greatly benefit, and a lot of the acrimony over EMS response times will be resolved through early, onsite intervention.

Paramedics passing on experience

An experienced paramedic can mentor multiple EMRs, passing on real insight into resuscitation and actual patient scenarios. The EMRs get a real world ‘practicum’ about what it takes to be a health care professional.

imagesParamedics will welcome this late-career option, if they have grown tired of running the stairs or the pressure of lights and sirens. The median wage of a US paramedic is estimated at just $30,000 annually. An independent career option supervising EMRs would be attractive, and in keeping with how free enterprise can deliver community health care economically and to the highest standard, simply by leveraging cellular communications.

Block Paramedicine

Elevaed’s Block Paramedicine™ model integrates paramedicine to autonomously protect 1 to 5 city blocks. These high density communities of 1000+ occupants become island villages with early intervention-based community safety. The system employs one on-duty EMR/paramedic 24/7, in three shifts. All the workers are licensed EMRs, likely paramedicine students being mentored by the supervising paramedic.

3 blocks

Central with Adjacent Blocks

Filtering out unwarranted 911 calls and acting as community health workers and advisors, they preclude the need to roll fire trucks, e.g. as first and sole responders, a welcome change for big cities. Dispatchers have eyes and ears on that block, and can call the site, which is an interesting reversal.

This is how crowded city blocks become oases of shared safety, bringing some calm and order to EMS. Property managers will find that their security costs are lower, and lease market values higher, which helps offset the modest costs. Cities will then recognize their participation with minimal assessments, and a new level of care is established.

Eventually these measures will emerge in some part as LEED or coded standards, and be adopted for these areas of very high density. They recognize that, as with fire, within minutes a crisis can become irretrievable, and only a local response can prevent major loss. Leaving 1000 people to resolve crises remotely and ad hoc is not good governance, given cellphones and definitive treatments that otherwise time out.

Enfranchising onsite EMRs to complement ambulances and 911 as a ‘last mile’ solution enables routine early intervention, and provides a human attendant for tending ancillary services such as remote patient monitoring (RPM) and telehealth.

These techniques will need exploration and integration within public and municipal health policy, as pilot projects. We can then let them loose and watch paramedicine bear much of a health authority’s load, from emergency to long term care.

Here is a Sample Pilot Project Outline Block Paramedicine and Early Intervention

 

 

 

 

 

 

 

 

 

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