Fire Service EMS In The Future: What Will It Look Like?

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The year is 1969. It's a typical hot summer night around 1 o'clock in the morning. A teenager who has had one too many beers is on his way home from a party, driving his new Corvette. He rounds a curve and the inevitable happens. He smacks a tree head-on. Not an uncommon scenario 30 years ago. He suffers significant head trauma and has a distended abdomen and a severely fractured left leg. He is unconscious, has a blood pressure of 90/50, pulse of 130 and labored respirations of 18. He is not doing well.

A car following the same road comes across the accident. The driver stops, sees that the teenager is in bad shape and continues on to call for help. (Remember, there were no cellular telephones 30 years ago.) The Good Samaritan comes across a closed gas station, but finds a pay telephone on the outside wall that lists the seven-digit number (there was no 911 system 30 years ago) of the local funeral home ambulance. The driver dials the number and after several rings, a sleepy voice answers the phone. The Good Samaritan relays the information about the accident, but is not sure where he is or where the accident is located because he is not from the area. (Remember, no 911.)

Thankfully, the Good Samaritan is able to tell the attendant at the funeral home that he is at Joe's Filling Station on Highway 88. The attendant from the funeral home indicates he knows the locations and will be on his way as soon as he gets dressed. Twenty minutes later, the attendant, by himself, arrives in a Cadillac ambulance. He has no medical training, although he took a basic first-aid course as a Boy Scout. He carries no medical equipment, no backboards, no extrication equipment - nothing except a stretcher and an oxygen bottle.

No Happy Ending

Without immobilizing the victim's neck, spine or broken leg, or worrying about the airway, the Good Samaritan and the funeral home attendant move the victim from the smashed car to the stretcher. The victim, who is still unconscious, is rushed to the closest hospital, a 75-bed facility where the single nurse in the emergency room must awaken the moonlighting dermatologist to the arrival of the critical patient.

The physician, after getting dressed, makes his way to the emergency room, where he does the best he can to stabilize the patient. In the meantime, the switchboard operator attempts to contact members of a surgery team at their homes to report back to the hospital. While waiting for the surgery team to assemble, the patient dies in the emergency room.

Unrealistic? Hardly, 30 years ago.

Now, let's go 30 years into the future with the same scenario. The year is 2029. A Ford Longbow Model 270 is traveling along the same road. But this time, alcohol is not involved. In the future, automatic sensors in cars will determine the presence of alcohol on a person and put him or her through a complicated series of events in order to start the car. If the person cannot get the sequence of events right, the car will not start.

This time, the patient is hypoglycemic. She has passed out at the wheel of the car after suffering an insulin reaction. She crashes into a tree with injuries similar to those of the victim in the first scenario. But this time, the driver's injuries are not as severe because airbags deployed not only from the steering wheel, but from the sides, the rear and from the roof, almost creating a cushioned cocoon for the driver.

Satellite Link

When the airbags deployed, a signal was sent to an orbiting iridium satellite. The iridium satellite, through global positioning, located the scene of the accident, as well as the closest 911 center and level-one trauma center. The iridium satellite sent a message to the 911 center and the trauma center informing them that an automobile accident has occurred. (Interesting - note that nobody has even called 911).

The computers in the 911 center immediately display computerized maps that locate the accident scene. The computers also recommend the closest emergency apparatus, based on global positioning satellites and sensors in the bay floors of engine houses. Computers in the 911 center also interface with the Street Department's computer, which monitors all vehicle movement on the streets and highways.

Based on current traffic flows and conditions, the 911 computer also prints out a map at the engine house recommending the best route to the accident scene. Onboard navigational systems on the engine and the ambulance also assist the paramedic/firefighters getting to the scene.

Once on the scene, the paramedic/firefighters establish a "telemedicine" link to the trauma center, which was alerted to the accident. The paramedics also place special monitoring devices on the patient to monitor critical vital signs, including enzyme and oxygen saturation levels. These vital signs are also transmitted back across the telemedicine link on an iridium satellite to the level-one trauma center. The information that is being transmitted across the telemedicine link also interfaces with a computer database with millions of patient records.

Based on the patient's vital signs and information stored in the computer resource database, the paramedics receive information back that their patient has a 98.3% chance of a pneumothorax and an 84.2% chance of a spleen injury. The computer recommends decompression of the affected lung side.

Keeping The Patient Alive

To confirm the spleen injury, the paramedics scan a special instrument over the spleen. The reading is made by a doctor 500 miles away in a center specializing in radiology. The doctor confirms a spleen injury and orders several dosages of a "resurrection" drug to control internal bleeding until arrival at the hospital. (Resurrection drugs will be developed by the year 2029 to keep people alive until more definitive medical treatment can be rendered.)

The paramedic/firefighters also download patient information from an imbedded chip just below the patient's wrist. The downloaded information shows the patient is a diabetic. The onboard ambulance computer scans the license plate of the crash victim and interface with many other computer including the Department of Vehicle Registrations' computer. It shows the car is registered to a known diabetic.

Based on the additional information, the computer recommends the administration of D50. The patient is transported to the level-one trauma center and makes a full recovery.

Police computers also determine that this is the third accident within the last two years at this exact location and recommends a geographic analysis of the accident site to prevent future accidents. Engineers review the site and place work orders for preventing future accidents.

It Could All Come True

Does this all sound unrealistic? Hardly. Many of the products or scenarios described in this future event have already been produced, in laboratory research, or can be found on the drawing board. Remember, making predictions about the future is easy. All you have to do is go out and create it. Next month, more on the future.


Gary Ludwig, MS, EMT-P, a Firehouse® contributing editor, is the chief paramedic for the St. Louis Fire Department and is the vice chairman of the EMS Executive Board for the International Association of Fire Chiefs. He holds a master's degree in management and was awarded Missouri's EMS Administrator of the Year for 1998. He can be reached at GaryLudwig@aol.com.

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