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Emergency Medical Services at the Crossroads
ports, such as those from nursing homes to hospitals for medical treatment or from hospitals to nursing homes following discharge. Unlike emergency calls, these trips can be scheduled in advance. With the aging of the population, these trends are likely to continue and may result in increasing call volumes for such transport operations.
Advances in Medical Technologies
Emerging medical and communications technologies are enabling real-time voice and video links between ambulance crews and emergency physicians. Some cities, such as San Antonio and Seattle, have established systems in which ambulances carry portable computers, video cameras, and microphones to transmit information to physicians. The technology allows physicians to view the patient, assess the extent of the injury, and determine possible treatment options while the patient is still en route (Medical Subcommittee of the ITS America Public Safety Advisory Group, 2002).
Many ambulance units are now equipped with technologies that allow for the direct transmission of patient data to hospital EDs. For example, 12-lead electrocardiograms enable physicians to view a patient’s heart readings prior to arrival at the hospital, and this capability has been shown to reduce door-to-treatment intervals significantly (Cannon, 1999; Woollard et al., 2005). In addition, providing this information to the physician allows for the administration of prehospital thrombolytic therapy, which in some studies has been shown to improve outcomes, although relatively few patients are eligible for the treatment (Boersma et al., 2000).
In addition to these emerging technologies, numerous other advances in medical treatment are likely to impact the level of care EMS personnel are able to provide to patients. For example, a study involving 20 level I trauma centers is currently under way to test the efficacy of an experimental oxygen-carrying blood substitute in increasing the survival of critically injured and bleeding trauma patients. Under the study protocol, treatment begins before arrival at the hospital, either at the scene of the injury, in the ambulance, or in an air ambulance. Because blood is not currently carried in ambulances, use of the blood substitute in these settings has the potential to address a critical unmet medical need. The introduction of saline, the current standard of care, helps restore a patient’s blood pressure but does not deliver oxygen, which is critical to preventing damage in the brain, heart, lungs, and other organs.
Emerging communications technologies and clinical treatments should be evaluated to determine their impact on treatment cost, quality of care, and patient outcomes. New technologies are often offered at a high cost that is beyond the reach of many EMS systems across the country. Moreover, there is growing evidence that simpler interventions performed effectively in