In a medical emergency, the value of time becomes tangible. Minutes can make the difference between life and death; disability and recovery. By lessening the time it takes to diagnose and treat a patient, smart, internet-connected devices will lead to fundamental improvements in emergency medical care.
“Internet connectivity will, among other capabilities, allow previously disparate medical devices to interact with one another, passing data back and forth and providing more intelligent decision support for care providers inside and outside the hospital,” says Kristina Furlan, group product manager of data solutions for Physio-Control, a global company specializing in medical emergency products. “One huge challenge,” she continues, “is to be sure to take advantage of data and connectivity in ways that are proven to enhance and improve patient care—while remaining easy to use and delivering clear, actionable wisdom to care teams.”
By far, the two most common causes of death in the world are coronary heart disease and stroke, so it’s in these areas that the Internet of Things (IoT) will have the greatest opportunity to prove itself useful. Every year worldwide there are 32.4 million heart attacks and strokes that lead to 14 million deaths. The sooner stricken individuals are treated, the less likely they are to die or be left with long-term disabilities.
Stroke can be caused by a blockage in an artery that feeds the brain (ischemic stroke) or by the rupture of a weakened blood vessel that sends blood spilling into brain tissue (hemorrhagic stroke). About 85 percent of strokes are ischemic, and these patients can be treated within the first 3 to 4.5 hours with tissue plasminogen activator (tPA), an enzyme that breaks down clots and improves the chances of recovering from stroke.
However, tPA can cause more bleeding and even death in patients who are having a hemorrhagic stroke. The two types of stroke present similar symptoms, so a CT scan is needed before tPA can be given. Unfortunately, many stroke victims don’t arrive at the hospital within the necessary timeframe. If emergency medical personnel had a way to differentiate ischemic from hemorrhagic stroke in the ambulance, tPA could be started sooner, leading to more lives saved and less long-term disability.
Enter Strokefinder, a clear plastic helmet fitted with antennas that surround the patient’s head. The antennas transmit and receive microwave pulses that scatter off the different tissues in the head in recognizable patterns. These patterns enable Strokefinder, which includes a laptop that uses sophisticated signal-analysis algorithms, to differentiate between a clot, bleeding, and healthy tissue.
Strokefinder is being developed for use both in hospitals and ambulances, and is the brainchild of researchers from Chalmers University of Technology, Sahlgrenska Academy, and Sahlgrenska University Hospital in Sweden. The device has been in three separate clinical trials and is currently in the process of being CE marked for use in Europe, which the developers expect to happen late this year.
“Emergency services, hospitals, and medical doctors will decide how the technology we are providing fits into their care processes and what role they are prepared to let Strokefinder play,” says Mikael Persson, professor of biomedical engineering at Chalmers University of Technology. “My expectation is that Strokefinder will provide important decision support that, together with other means of triage, will lead to the introduction of tPA in ambulances.”
Persson explains that the Internet will be used for communication with hospitals where, in most countries, decisions regarding treatment will be made. He says that in addition to this technology enabling the administration of tPA in ambulances, he expects it will lead to more patients receiving tPA in hospitals within the stipulated treatment time frames. “Internet communication from the Strokefinder system to the hospitals will then be important in helping them to prepare for the incoming patient,” he says.
Messages straight from the heart
When it comes to heart attacks, Physio-Control is on the leading edge of the revolution in pre-hospital emergency care with LifePak 15, a portable defibrillator/heart monitor that can transmit EKG data over the Internet. In addition, the device uses algorithms to monitor a patient’s EKG, alerting emergency personnel to significant changes.
“Lifepak has software that’s pretty intelligent about being able to interpret the EKG,” says Dr. Liudvikas Jagminas, M.D., vice chair of emergency medicine at the Yale School of Medicine. “Paramedics can review the machine’s interpretation. If it says ST segment elevation consistent with acute MI [heart attack] and that looks correct, they can bypass the ER and take the patient straight to the nearest cardiac catheterization lab for a balloon procedure, saving valuable time.”
The LifePak 15 can send patient data through direct server-to-server integration to a hospital’s secure health-care-information system. The data can be included in the patient’s electronic record and reviewed by ER physicians, who can determine whether the patient will be treated in-house or must be referred. For the medical team that’s going to treat the patient, knowing the diagnosis in advance enables them to mobilize the needed resources and prepare more efficiently.
“It certainly helps to look at an EKG before the patient arrives in hospital, particularly in places where transport time is long, like in more rural areas,” says Dr. Jagminas. “If some area hospitals can’t do life-saving procedures like balloon angioplasty to open up an artery, then it becomes really important. The sooner you recognize heart attack and get them to a hospital that can perform the needed procedure, the better for patients.”
The LifePak 15’s connectivity also enables data collection for patient-care analysis and equipment monitoring through web-based tools. Equipment managers can manage setup options, update software, and receive notifications about potential device issues. “Defibrillators are mission critical technology,” says Physio-Control’s Furlan. “When you need them, you absolutely need them, and they must be ready and in working order.”
Saving lives and livelihoods – the best use yet for the Internet of Things.
Photo courtesy of Gunilla Brocker