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Tele-Ambulance role in Digital Healthcare

 

MedPiper Technologies and JournoMed conducted a Webinar Series on “Digital Transformation in Healthcare” in association with IRIA Kerala, Hospex, Indian Junior Doctors Network, ISA Thrissur City Branch, IMA Thrissur and Instaclinik. The fifth-day webinar discussed Tele- Ambulance Scope in Digital Healthcare and Guidelines for Doctors. The event was held on 26th August 2022.

Dr Dharanindra Moturu,  MD, DM Consultant in Critical Care Medicine at Aster Ramesh Hospitals spoke about the Tele Consultation Guidelines for Healthcare Professionals, Ambulance and Tele-communication system and Installation of Tele- Medicine facilities in Ambulance. A discussion was made on patients’ inter-hospital transfer, how to ensure a safe inter-hospital transfer and optimization of patients during a hospital transfer. 

He deep-dived into the topic of patient inter-hospital transfer in an ambulance where the patient’s condition must be prioritized. 

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Guidelines for Doctors in Tele-Ambulance

  • Doctors usually opt for a few options based on the patient’s medical condition, i.e., drip and ship, stay and play. In the drip and ship option, the patient is stabilized, starts the initial therapy, and the patient is transferred to the referral target centre where the facilities are available to comprehensively solve the patient’s problems. 
  • Across India, doctors find hypotensive patients, patients with proper resuscitation and patients with zero resuscitation in transit being shifted. After observing all these troubles, the hospitals have initiated the tele ambulance project. 
  • The details of the patient’s basic hemodynamic parameters, pulse rate, blood pressure, and SPO2 are noted. When the basic parameters are received, the monitoring becomes easier. Patients’ hemodynamics can be observed.
  • An accompanying doctor needs to take care of the patient based on these vitals. Let’s say, if the patient is suffering from hypotension, the patient is advised to administer vasopressors, to increase the rate of intravenous fluid administration.
  • If the patient vitals are not good, the patient has been subjected to fluids vasopressors, and ongoing resuscitation and simultaneous communication with the ongoing doctors is done. Norepinephrine, a bolus of intravenous fluids can be administered in a few cases. Paracetamol is a quick option for temperature control. The team struggles to resuscitate the patient in transit. 
  • All these important interventions need to be checked as the patient is shifting to the hospital. These interventions improve the patient’s condition. The opportunity is to get the patient alive to the tertiary centre. There will be all support when the patient is at the tertiary centre. Detecting patients’ pathophysiology is the main idea behind the tele-ambulance. 
  • In critical cases, the patient is mechanically ventilated. Despite the treatment, if the patient doesn’t respond, communication with the doctor is done dually. The instructions are being given to doctors on how to give intravenous fluids and how to administer vasopressors. If the patient is 10km away from the main hospital, the patient’s hemodynamics can be observed, and it can be communicated to the emergency room. If the patient is wheel-chaired and sick, the patient requires immediate attention from a multi-disciplinary team to resuscitate and stabilize the condition. The patient clinical details also need to be transmitted to the emergency room. This shows how the tele-emergency room and how the tele-ICU works in synchrony. 

Features of Tele-Ambulance

  • An advanced live support tele-ambulance is equipped in such a way that transmission of patient’s data is done from ambulance to tele-ICU.
  • In an ambulance, the patient is accompanied by medical and paramedical staff. When the patient is being shifted, the vitals are under the monitor. 
  • Tele-ambulance is established with indigenous technology. Installation of PTZ camera which has optical digital zoom and audio-visual capabilities. The cameras are placed at an appropriate location in the ambulance. The entire ambulance bay can be visualized and can communicate with the accompanied doctor. There is a 5G ambulance with advanced technology that ensures safe transfer from a tertiary centre to the periphery. 
  • A specific requirement for handling up the tele-ambulance is that an adequate battery must be present which handles all the tele-core appliances such as a ventilator, camera, electrical connections etc. A separate battery must be available in the patient bay which gives an electrical supply to the monitor, screen, camera and the 4G dongle. 
  • Currently in almost all hospitals, 4G tele-ambulances usage became prominent. The 5G tele-ambulance is the latest innovation in technology. A normal 4G tele-ambulance can be transformed into 5G with the insertion of a 5G capable dongle.
  •  The entire audio-visual data can be stored in the hard disk available in the ambulance. It can store up to 48 hours of footage. After 48 hours, the data from the tele-ambulance is shifted to the cloud hard disk drive of the ambulance. So, after every 48 hours, the hard disk is erased. To date, the Indian Ministry of Health and Family Welfare has provided no separate guidelines regarding tele-ambulance. It only ensures the safe transport of the patients to the health centres. 
  • The resuscitation of the patient remains ongoing even during the transit and the doctors dynamically help the patients to get better even during transit. 

Basic requirements for a tele-ambulance transit

Below are the basic requirements for a tele-ambulance transit on regular basis. 

  • A stock of oxygen adequately filled in a tank. 
  • Emergency equipment such as a ventilator, endotracheal tubes, airways, bamboo bag 
  • Emergency drugs like adrenaline, nor-adrenaline 
  • Ambulance service conditions must be in priority

The mid-scale hospitals can implement tele-ambulance services in their hospitals by acquiring the Advanced Trauma Life Support (ATLS) and Advanced Cardiac Life Support (ACLS) services at the healthcare centres. 

Tele-Ambulance in Digital Healthcare

The ambulance sector had marked its major contribution by delivering its healthcare services even in unprecedented times and during the covid pandemic. Ambulance clinicians are highly involved in outpatient and emergency care. The transformation of digital technologies and the integration of digital and virtual technologies in improvizing tele-ambulance services has marked an impact in improving patient experiences and outcomes. Tele-ambulance ensures that care is provided in closer vicinity i.e., near to home, avoiding hospital admission. Avoiding unnecessary readmission reduces healthcare expenses and ensures that Emergency Medical Services (EMS) are utilized most efficiently

 

 

 

 

 

 

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