Mr Graham CurryMr Graham Curry

Lancashire Ambulance ServiceLancashire Ambulance ServiceNHS TrustNHS Trust

449-451 Garstang Road449-451 Garstang RoadBroughton Broughton

PrestonPrestonLancashireLancashirePR3 5LNPR3 5LN

curry@lancsamb1.demon.co.ukcurry@lancsamb1.demon.co.ukTEL 01772 862666TEL 01772 862666FAX 01772 861003FAX 01772 861003

MOBILE 07711 726960MOBILE 07711 726960

MESA

The 999 Call or MESAThe 999 Call or MESACall 6372Call 6372

ACD Call SystemACD Call System

Call Recording SystemCall Recording System

No CLINo CLI

Recognised telphone numbersRecognised telphone numbers

Pre Arrival AdvicePre Arrival Advice

Caller is asked a series of questionsCaller is asked a series of questions

Responses create a catagory responseResponses create a catagory response

Protocol driven call assistance is offeredProtocol driven call assistance is offered

Stay on the line offeredStay on the line offered

Dispatch ProcessDispatch Process

Incident is shown on mapping systemsIncident is shown on mapping systems

Resources shown on same systemResources shown on same system

Catagory shown decision madeCatagory shown decision made

Computer activates crew Computer activates crew

Mobile Data is used for all callsMobile Data is used for all calls

GPS Sytems Voice Systems Data SystemsGPS Sytems Voice Systems Data Systems

ResourcesResources

Tradional Road AmbulanceTradional Road Ambulance

Fast Responce CarFast Responce Car

Fast Response MotorcycleFast Response Motorcycle

HelicopterHelicopter

Fast Response DoctorFast Response Doctor

First RespondersFirst Responders

Officer RespondersOfficer Responders

TelemedicineTelemedicine

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

Health Telematics sectorHealth Telematics sector

Telematics application 4th framework= 898 MECU

Health Telematics sector= 140 MECU (approx £ 100M)

Includes HECTOR project= 7.5 MECU (approx £ 5M)

HECTORHECTOR

What is HECTOR ?What is HECTOR ?

HealthHealth EmergencyEmergency CareCare throughthrough TelematicsTelematics OperationalOperational ResourcesResources

What is Telemedicine ?What is Telemedicine ?

The Practical Benefits of TelemetryThe Practical Benefits of Telemetry

The ability to send medical data using anyThe ability to send medical data using anyform of communication interface, from the form of communication interface, from the patient to any other site.patient to any other site.

This typically includes bio medical This typically includes bio medical informationinformationsuch as ECG, Pulse , Oxygen Saturation,such as ECG, Pulse , Oxygen Saturation,Blood PressureBlood Pressure , ,Video Imaging.Video Imaging.

TelemedicineTelemedicine

Standard TelemedicineStandard Telemedicine

Satellite - dependent ( INMARSAT )

Setup involves satellite location

Use during ambulance journey would involve satellite tracking

Setup time augments time at scene

HECTOR TelemedicineHECTOR 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

Two PilotsTwo Pilots:-:-

•12 Lead ECG’s12 Lead ECG’s•Monitoring of Heart ConditionMonitoring of Heart Condition

•Transmission of the Heart Condition Transmission of the Heart Condition via GSMvia GSM

•Video ImagingVideo Imaging•Transmission of live pictures via GSMTransmission of live pictures via GSM

•Operate throughout EuropeOperate throughout Europe

What is a Myocardial Infartion ?What is a Myocardial Infartion ?

It is just one type of Heart Attack that is becoming more and more It is just one type of Heart Attack that is becoming more and more common place in our modern worldcommon place in our modern world

Primarily an MI as it is commonly known is a blockage of one or 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 more of the arteries that feed the heart muscle. This blockage is in the form of a clot which is stopping oxygenated blood from in the form of a clot which is stopping oxygenated blood from

feeding the tissues.feeding the tissues.

Time is muscleTime is muscle

The main aim is to reduce the time that the heart muscleThe main aim is to reduce the time that the heart muscle

is starved of oxygenated blood and to prevent more tissueis starved of oxygenated blood and to prevent more tissue

from dying.from dying.

How can telemedicine help ?How can telemedicine help ?

With the correct vital signs sent to the hospital viaWith the correct vital signs sent to the hospital viatelemetry the doctors can validate the correct diagnosis.telemetry the doctors can validate the correct diagnosis.

The patient on arrival should be treated much faster than The patient on arrival should be treated much faster than a patient who has not had the use of telemedicine. a patient who has not had the use of telemedicine.

Thrombolytic drugs will be ready as will the cardiologistsThrombolytic drugs will be ready as will the cardiologistswho will be waiting to treat the patient on arrival or who will be waiting to treat the patient on arrival or

arrange for immediate admission to a CCU .arrange for immediate admission to a CCU .

The Physio Control Lifepak 11 The Physio Control Lifepak 11 monitor is able to record both monitor is able to record both 3 lead and 12 lead ECG, then 3 lead and 12 lead ECG, then make a diagnostic suggestionmake a diagnostic suggestion

and store the information as welland store the information as wellas transmit it over the GSM mobileas transmit it over the GSM mobile

telephone system.telephone system.

Lifepak 11 Monitor SystemLifepak 11 Monitor System

What actually happens ?What actually happens ?

• 10 Leads on Body10 Leads on Body• Aquire DataAquire Data• Analyse DataAnalyse Data

• Produce ReportProduce Report• Analyse ReportAnalyse Report

• Transmit ReportTransmit Report

HOW DOES IT WORKHOW DOES IT WORK

Lifepak 11Lifepak 11Hospital / Hospital /

Receiving StationReceiving Station

GSMGSM

Monitor and Receiving StationMonitor and Receiving Station

The system is designed with strobe warning lights toThe system is designed with strobe warning lights toinform the staff of an incoming ECGinform the staff of an incoming ECG. .

When the data arrives a senior medical officer is able to When the data arrives a senior medical officer is able to diagnose exactly the problem and produce an accurate diagnose exactly the problem and produce an accurate

diagnosis of the cardiac conditiondiagnosis of the cardiac condition

TREATMENTTREATMENT

• Cardiac Condition DiagnosedCardiac Condition Diagnosed

• Thrombolytic Drug AdministeredThrombolytic Drug Administered

• Time to Needle is reducedTime to Needle is reduced

AMBULANCE AMBULANCE UTILISATION UTILISATION Blackpool July/Aug/Sep Blackpool July/Aug/Sep 19971997Arrivals by Ambulance 1.July - Sep 30, 1997 Top Ten categories

219

233

243

259

260

271

323

383

536

652

0 100 200 300 400 500 600 700

unspecif ied

convulsion

unw ell

laceration

overdose

abdo.pain

dyspnoea

inj.head/scalp

collapse

chest pain

The Video Imaging Pilot

Vehicle Specification.

The vehicle contains very sophisticated telemetry facilities.The vehicle contains very sophisticated telemetry facilities.

Four cameras for all aspects of emergency and casualty trauma.Four cameras for all aspects of emergency and casualty trauma.

Transmission of live video images using standard GSMTransmission of live video images using standard GSM mobile telephone system with total World Systems compatibility.mobile telephone system with total World Systems compatibility.

The system has the ability to monitor live pictures on boardThe system has the ability to monitor live pictures on boardthe Ambulance.the Ambulance.

The system can be fully automated for easy usage.The system can be fully automated for easy usage.

Ambulance FacilitiesAmbulance Facilities

• It can provide four viewsIt can provide four views•rear viewrear view•internalinternal•helmet and microwave linkhelmet and microwave link•dashboarddashboard

•plus a small colour internal plus a small colour internal monitormonitor•4 way split screen with zoom4 way split screen with zoom

VIDEO IMAGINGVIDEO IMAGING

A typicalA typicalinstallation oninstallation onan Ambulancean Ambulance

Dashboard CameraDashboard Camera

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

Rear View CameraRear View Camera

Situated on the rear top of the vehicle next to brake Situated on the rear top of the vehicle next to brake lights, this camera is built into lights, this camera is built into an external housing unit an external housing unit disguised as a reversing ordisguised as a reversing or spot light. spot light. It was disguised toIt was disguised toprevent the public from beingprevent the public from beingunduly concerned. unduly concerned.

Internal CameraInternal Camera

Situated directly above the patient on a swivelSituated directly above the patient on a swivelflexible arm for adjustmentflexible arm for adjustmentand can be used to view anyand can be used to view anypart of the patients body.part of the patients body. The camera has a zoom lensThe camera has a zoom lensinside which can be operatedinside which can be operatedby either the paramedic or anby either the paramedic or anexternal computer operator.external computer operator.

Helmet CameraHelmet Camera

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

Colour Viewing MonitorColour Viewing Monitor

Situated above the patient for comfortableSituated above the patient for comfortableviewing by the paramedic, this viewing by the paramedic, this TFT colour display unit has abilityTFT colour display unit has abilityto display split screen imagesto display split screen imagesviewing the four camera images viewing the four camera images at once or singular. It has buttonsat once or singular. It has buttonson unit for camera selection. Theon unit for camera selection. The user can also zoom in anduser can also zoom in and out the internal camera. out the internal camera.

This GSM is also fitted with a hands free facility to This GSM is also fitted with a hands free facility to enableenablethe Paramedic to talk with Doctors and other people the Paramedic to talk with Doctors and other people whenwhenthe video system is not in use.the video system is not in use.

The system is designed also to be either enabled by The system is designed also to be either enabled by the control center by a single button push on a the control center by a single button push on a computer console computer console although this operation is password protected to although this operation is password protected to prevent prevent unauthorized access..unauthorized access..

GSM Cellular TerminalGSM Cellular Terminal

The receiving station consists of a standard P.C. with a pentium 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 processor ,16 Mb of ram and at least 40 Mb of hard disk space and a standard 28000 bits per second modem .a standard 28000 bits per second modem .

If a laptop computer is used the same specification is required butIf a laptop computer is used the same specification is required butalso a PCMCIA data card and a GSM mobile telephone .also a PCMCIA data card and a GSM mobile telephone .

The system also requires dedicated software to operate the system.The system also requires dedicated software to operate the system.

Receiving StationReceiving Station

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

Receiving StationReceiving Station

TrainingTraining

The video image system is recorded via a slow scanThe video image system is recorded via a slow scanvideo recorder. These videos can be used to assistvideo recorder. These videos can be used to assistParamedics by validating their existing protocolsParamedics by validating their existing protocolsand assist managers in analysing actions of controland assist managers in analysing actions of controlmanagers.managers.

The videos can also be used to show new recruits real The videos can also be used to show new recruits real and actual events and how they were handled.and actual events and how they were handled.

AmbulanceAmbulance

HospitalHospital

GSMGSM

HOW DOES IT WORKHOW DOES IT WORK

Control CenterControl Center

BenefitsBenefits

•Faster treatment for Heart Attack victimsFaster treatment for Heart Attack victims•More detailed medical informationMore detailed medical information•Clinical history from point of contact of NHSClinical history from point of contact of NHS•Cost savings to the NHS Cost savings to the NHS •Greater reduction in mortality rateGreater reduction in mortality rate

•Method of injury visually displayedMethod of injury visually displayed•Constant monitoring of patients conditionConstant monitoring of patients condition•Clinical advice available for the paramedicClinical advice available for the paramedic•Resourcing information for controlResourcing information for control•Scene evaluation Scene evaluation •Recorded footage for training purposesRecorded footage for training purposes

BenefitsBenefits

Potential Applications Potential Applications in Lancashirein Lancashire

Trauma multiple injury / trapped patient

major incident command / control

triage to appropriate hospitals

audit / training / debriefing

KEY MESSAGESKEY 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

EMS system model EMS system model

ambulancetracking

(GPS - GIS)

routeguidance

acquisitionof vital signs

& images

emergencyepisodearchive

teleconsultation& telediagnosis

static resource information

resource status updates resource statuslinks to archive

currentposition

destination

routeroute-related

instructions

medicalmultimedia data

medicalmultimedia data

medicalmultimedia

data

logginginformation

resourcemanagement

Citizeninformation

Example of EMS evolution Example of EMS evolution

via PSTN

via RadioTtrunking

via GSM

via ISDNor PSTN

HECC

MICU

Hospital

Voice

Emerg. Clinical Record incl. Biomedical DataEmergency Clinical Record

Hospital Resources

Messages

MICU Status

Status Acknowledge

Activation Data incl. Route Guidance

Emerg. Clinical Record incl. Biomedical Data

Hospital Resources

Voice

MICU Status

RuralPCC

Radiography Data

Video Data

Emerg. Clinical Record incl. Biomedical Data

Emergency Clinical Record

Messages

via ISDN

Mesa Impact on Worldwide Emergency Scene Mesa Impact on Worldwide Emergency Scene

PROBLEMSPROBLEMS Closed SystemsClosed Systems Independent applicationsIndependent applications Lack of coordinationLack of coordination Radio and Phone remote medical Radio and Phone remote medical

assistanceassistance Radio based communicationsRadio based communications Uncertain location of resourceUncertain location of resource Independent Protocols / ScenariosIndependent Protocols / Scenarios Local solutionsLocal solutions Spectrum AvailabilitySpectrum Availability Different interobilitiesDifferent interobilities

SOLUTIONSSOLUTIONS Open SystemsOpen Systems Interoperable applications and Interoperable applications and

integrated Networksintegrated Networks Resource availability shared knowledgeResource availability shared knowledge Image based medical careImage based medical care State of the Art technologiesState of the Art technologies Geographic Positioning SystemsGeographic Positioning Systems Remote Diagnosis FacilitiesRemote Diagnosis Facilities Coordinated Operative PlansCoordinated Operative Plans Continuity of care protocolsContinuity of care protocols New standardsNew standards Trans-World Emergency careTrans-World Emergency care

MESAMESAHECC

HOSPITALECC

Remote

Care

Point

Mobiles

Units

HECCHOSPITAL

ECC

Remote

Care Point MobilesUnits

MESA PROJECT Proposal MESA PROJECT Proposal

- User Requirement DeterminationUsers

Technological Partners

- MESA- Functional Specifications

D.2.2.

D.2.3.

D.3.1.

-Communication Network

Requirement Determination

and designTechnological Partners

New ApplicationsExisting application new interfacesRenewed applicationsShared applications

Consortium

Technological Partners

- Market Prospections

D.4.1.

-Mesa system design

and specificationTechnological Partners

- Training Users

- Validation Plan Users

- Dissemination Consortium

- PILOT SETUP Users

Lancashire Ambulance ServiceLancashire Ambulance Service

NHS TrustNHS Trust

Thankyou for your time. Further details of the project canThankyou for your time. Further details of the project canbe obtained from myself Mr Graham Curry on 01772 862666be obtained from myself Mr Graham Curry on 01772 862666