Are We Going Forward Or Backward With Telemedicine In EMS?

Telemedicine is the wave of future medicine. Telemedicine refers to the use of communications technology to help deliver medical care regardless of the distance that separates the medical care provider and the patient.

Collectively, the public and private sectors have funded hundreds of telemedicine projects that could improve, and perhaps change significantly, how health care is provided in the future. However, the total amount of the investment is unknown. The U.S. General Accounting Office identified nine federal departments and independent agencies that invested upwards of $646 million in telemedicine projects during fiscal years 1994 through 1996. The Defense Department is the largest investor with $262 million and considered a leader in developing this technology.

Fire departments are involved in several of these projects. Chances are that if you are having a heart attack in Las Vegas or experiencing a medical emergency in San Antonio on or near a highway, you'll be part of these programs, which are examining and exploring the area of telemedicine.

Last January, the Las Vegas Fire Department announced that the National Library of Medicine had awarded a grant to help develop a program to treat heart attack victims in the field. The goal of the program is to improve the treatment of acute myocardial infarctions by using thrombolytics in the field.

Under the proposal, electronic newsgathering microwave equipment will be used to form the backbone of the telemedicine system. From there images and data will be transmitted from the patient's side to the fire department's communications center, which in turn will transmit those images and data to participating hospitals across an existing fiber optic network. Physicians in the hospitals will be able to view patients with high-quality, real-time images with multichannel telemetry data.

The foundation for the system is that physicians will be able to make better informed decisions on a patient's condition. Once better informed on a patient, the hypothesis is that the decision to use thrombolytics, while still in the field, will be made more quickly and patient outcomes will improve.

Initially, the program called for a paramedic to wear a camera on his or her helmet as the method of acquiring data images of the patient. However, this plan was abandoned in lieu of a small unit with a camera mounted on a gooseneck arm and a small two-inch monitor. When paramedics arrive, they will place the unit near the patient, point the camera, then check the monitor to make sure it is centered on the patient. It is suspected that the images will be better than those provided by helmet-mounted cameras.

In another program, the San Antonio Fire Department installed telemedicine systems in some of its ambulances last fall. The program, titled "LifeLink," offers an audio-video connection between the ambulance and the emergency department. Unlike in Las Vegas, where the camera is portable, these cameras are permanently mounted just above the stretcher inside the ambulance. Additionally, each ambulance has an intercom with wireless headsets, and two video screens. One screen shows live video being sent to the hospital and the other shows the video feed from the hospital.

Each camera can be rotated to scan the entire area or zoom in on a specific spot. The use of the telemedicine project is limited to calls in and near the highways since the data is sent through the same fiber optic network utilized by the highway monitoring cameras and sensors.

All this technology is great, but we must be cautious with its application. As we enter into this brave new world abounding with new technology, those of us who practice paramedicine in the fire service must guard against this technology turning us into mindless robots. After all, the hands and brains to treat the patient will still be at the patient's side.

Our comprehensive education, especially with the new enhanced paramedic curriculum due to be released, more than qualifies us to make independent and objective decisions without consulting with a physician, who in many cases will only confirm our findings and recommend treatment which we already know needs to be done.

Almost 30 years ago, those of you who watched the TV show "Emergency" saw paramedic/firefighters who constantly reported every clinical change in the patient's condition and had to have electrocardiograms read for them by the base hospital. We certainly do not want to reverse this profession some 30 years by being tethered on every decision to a base hospital. The use of protocols and written standards of care have helped bring timely and needed care to many patients over the years.

The use of EMS telemedicine is certainly practical in certain situations. Carefully and prudently done, the application of telemedicine in EMS can enhance this profession, not hinder it.

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 has lectured nationally and internationally on fire-based EMS topics and operates The Ludwig Group, a consulting firm specializing in EMS and fire issues. He can be reached at