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Mr Graham Curry Lancashire Ambulance Service NHS Trust 449-451 Garstang Road Broughton Preston Lancashire PR3 5LN curry

Mr Graham Curry Lancashire Ambulance Service NHS Trust 449-451 Garstang Road Broughton Preston Lancashire PR3 5LN curry@lancsamb1.demon.co.uk TEL 01772 862666 FAX 01772 861003 MOBILE 07711 726960. MESA. The 999 Call or MESA Call 6372. ACD Call System Call Recording System No CLI

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Mr Graham Curry Lancashire Ambulance Service NHS Trust 449-451 Garstang Road Broughton Preston Lancashire PR3 5LN curry

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  1. Mr Graham Curry Lancashire Ambulance Service NHS Trust 449-451 Garstang Road Broughton Preston Lancashire PR3 5LN curry@lancsamb1.demon.co.uk TEL 01772 862666 FAX 01772 861003 MOBILE 07711 726960 MESA

  2. The 999 Call or MESA Call 6372 ACD Call System Call Recording System No CLI Recognised telphone numbers

  3. Pre Arrival Advice Caller is asked a series of questions Responses create a catagory response Protocol driven call assistance is offered Stay on the line offered

  4. Dispatch Process Incident is shown on mapping systems Resources shown on same system Catagory shown decision made Computer activates crew Mobile Data is used for all calls GPS Sytems Voice Systems Data Systems

  5. Resources Tradional Road Ambulance Fast Responce Car Fast Response Motorcycle Helicopter Fast Response Doctor First Responders Officer Responders

  6. Telemedicine How did we get involved in telemedicine and why.

  7. Health Telematics sector • Telematics application 4th framework= 898 MECU • Health Telematics sector= 140 MECU (approx £ 100M) • Includes HECTOR project= 7.5 MECU (approx £ 5M)

  8. HECTOR

  9. What is HECTOR ? Health Emergency Care through Telematics Operational Resources

  10. What is Telemedicine ? The Practical Benefits of Telemetry

  11. Telemedicine The ability to send medical data using any form of communication interface, from the patient to any other site. This typically includes bio medical information such as ECG, Pulse , Oxygen Saturation, Blood Pressure ,Video Imaging.

  12. Standard Telemedicine • Satellite - dependent ( INMARSAT ) • Setup involves satellite location • Use during ambulance journey would involve satellite tracking • Setup time augments time at scene

  13. HECTOR Telemedicine • Uses GSM mobile telephone network • No satellite dish • No need to locate satellite • No need to track satellite • No setup contribution to time at scene

  14. Two Pilots:- • 12 Lead ECG’s • Monitoring of Heart Condition • Transmission of the Heart Condition via GSM • Video Imaging • Transmission of live pictures via GSM • Operate throughout Europe

  15. What is a Myocardial Infartion ? It is just one type of Heart Attack that is becoming more and more common place in our modern world Primarily an MI as it is commonly known is a blockage of one or more of the arteries that feed the heart muscle. This blockage is in the form of a clot which is stopping oxygenated blood from feeding the tissues.

  16. Time is muscle The main aim is to reduce the time that the heart muscle is starved of oxygenated blood and to prevent more tissue from dying.

  17. How can telemedicine help ? With the correct vital signs sent to the hospital via telemetry the doctors can validate the correct diagnosis. The patient on arrival should be treated much faster than a patient who has not had the use of telemedicine. Thrombolytic drugs will be ready as will the cardiologists who will be waiting to treat the patient on arrival or arrange for immediate admission to a CCU .

  18. Lifepak 11 Monitor System The Physio Control Lifepak 11 monitor is able to record both 3 lead and 12 lead ECG, then make a diagnostic suggestion and store the information as well as transmit it over the GSM mobile telephone system.

  19. What actually happens ? • 10 Leads on Body • Aquire Data • Analyse Data • Produce Report • Analyse Report • Transmit Report

  20. HOW DOES IT WORK GSM Hospital / Receiving Station Lifepak 11

  21. Monitor and Receiving Station The system is designed with strobe warning lights to inform the staff of an incoming ECG. When the data arrives a senior medical officer is able to diagnose exactly the problem and produce an accurate diagnosis of the cardiac condition

  22. TREATMENT • Cardiac Condition Diagnosed • Thrombolytic Drug Administered • Time to Needle is reduced

  23. AMBULANCE UTILISATION Blackpool July/Aug/Sep 1997

  24. The Video Imaging Pilot

  25. The vehicle contains very sophisticated telemetry facilities. Four cameras for all aspects of emergency and casualty trauma. Transmission of live video images using standard GSM mobile telephone system with total World Systems compatibility. The system has the ability to monitor live pictures on board the Ambulance. The system can be fully automated for easy usage. • Vehicle Specification.

  26. Ambulance Facilities • It can provide four views • rear view • internal • helmet and microwave link • dashboard • plus a small colour internal monitor • 4 way split screen with zoom

  27. VIDEO IMAGING A typical installation on an Ambulance

  28. Dashboard Camera Situated on the dashboard of the Emergency vehicle, this can provide viewing of an emergency event upon arrival and the camera can be directed towards the incident.

  29. Rear View Camera Situated on the rear top of the vehicle next to brake lights, this camera is built into an external housing unit disguised as a reversing or spot light. It was disguised to prevent the public from being unduly concerned.

  30. Internal Camera Situated directly above the patient on a swivel flexible arm for adjustment and can be used to view any part of the patients body. The camera has a zoom lens inside which can be operated by either the paramedic or an external computer operator.

  31. Helmet Camera Highly miniaturized colour camera with housing to blend with helmet. Lens system positioned at the front with signal processing unit at rear. Coiled connection to Microwave video transmitter to send live pictures back to the vehicle .

  32. Colour Viewing Monitor Situated above the patient for comfortable viewing by the paramedic, this TFT colour display unit has ability to display split screen images viewing the four camera images at once or singular. It has buttons on unit for camera selection. The user can also zoom in and out the internal camera.

  33. GSM Cellular Terminal This GSM is also fitted with a hands free facility to enable the Paramedic to talk with Doctors and other people when the video system is not in use. The system is designed also to be either enabled by the control center by a single button push on a computer console although this operation is password protected to prevent unauthorized access..

  34. Receiving Station The receiving station consists of a standard P.C. with a pentium processor ,16 Mb of ram and at least 40 Mb of hard disk space and a standard 28000 bits per second modem . If a laptop computer is used the same specification is required but also a PCMCIA data card and a GSM mobile telephone . The system also requires dedicated software to operate the system.

  35. Receiving Station The receiving station can also change the view of any screen and it can also zoom the camera in and out via the keyboard. The views are updated every 4 seconds in colour or every 2 seconds if mono is selected. The system can also send the pictures to another station any where in the world. The whole operation is also copied to a slow scan video recorder .

  36. Training The video image system is recorded via a slow scan video recorder. These videos can be used to assist Paramedics by validating their existing protocols and assist managers in analysing actions of control managers. The videos can also be used to show new recruits real and actual events and how they were handled.

  37. Hospital HOW DOES IT WORK GSM Control Center Ambulance

  38. Benefits • Faster treatment for Heart Attack victims • More detailed medical information • Clinical history from point of contact of NHS • Cost savings to the NHS • Greater reduction in mortality rate

  39. Benefits • Method of injury visually displayed • Constant monitoring of patients condition • Clinical advice available for the paramedic • Resourcing information for control • Scene evaluation • Recorded footage for training purposes

  40. Potential Applications in Lancashire • Trauma • multiple injury / trapped patient • major incident command / control • triage to appropriate hospitals • audit / training / debriefing

  41. KEY MESSAGES • New technology must be relevant to key NHS objectives for successful dissemination • Technology is no substitute for well - trained staff in the right place at the right time • Delegation of key skills to an emerging and evolving paramedical profession appears essential to the objectives of emergency telemedicine

  42. resource management ambulance tracking (GPS - GIS) emergency episode archive route guidance acquisition of vital signs & images teleconsultation & telediagnosis Citizen information EMS system model static resource information current position destination route resource status links to archive resource status updates medical multimedia data route-relatedinstructions logging information medical multimedia data medical multimedia data

  43. via PSTN Example of EMS evolution Emerg. Clinical Record incl. Biomedical Data HospitalResources Hospital Voice via ISDN or PSTN MICUStatus Voice Emerg. ClinicalRecordincl. BiomedicalData Emerg. ClinicalRecordincl. BiomedicalData EmergencyClinicalRecord VideoData HospitalResources RadiographyData HECC Messages EmergencyClinicalRecord StatusAcknowledge MICUStatus via Radio Ttrunking Messages via GSM ActivationDataincl. RouteGuidance via ISDN Rural PCC MICU

  44. Mesa Impact on Worldwide Emergency Scene Remote Care Point Mobiles Units HECC HOSPITAL ECC • PROBLEMS • Closed Systems • Independent applications • Lack of coordination • Radio and Phone remote medical assistance • Radio based communications • Uncertain location of resource • Independent Protocols / Scenarios • Local solutions • Spectrum Availability • Different interobilities • SOLUTIONS • Open Systems • Interoperable applications and integrated Networks • Resource availability shared knowledge • Image based medical care • State of the Art technologies • Geographic Positioning Systems • Remote Diagnosis Facilities • Coordinated Operative Plans • Continuity of care protocols • New standards • Trans-World Emergency care MESA Remote Care Point Mobiles Units HECC HOSPITAL ECC

  45. MESA PROJECT Proposal • User Requirement Determination • Market Prospections Users Technological Partners • Communication Network • Requirement Determination • and design D.3.1. Technological Partners • Mesa system design • and specification D.4.1. Technological Partners • Training • Dissemination • New Applications • Existing application new interfaces • Renewed applications • Shared applications Users Consortium • Validation Plan • PILOT SETUP Users Users Consortium • MESA • Functional Specifications D.2.2. Technological Partners D.2.3.

  46. Lancashire Ambulance Service NHS Trust Thankyou for your time. Further details of the project can be obtained from myself Mr Graham Curry on 01772 862666

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