Prehospital treatments – starting in the ambulancePoul Anders HansenMD, Head of the Prehospital Care Organisation,North Denmark Region.

Different ambulance service

• Ambulance only for transport – non or minimal treatment by ambulancpersonnel

• Treatment in ambulances at different levels (EMT and/or Paramedics) and transportation

• Ambulance is an hospitalbed on wheel

Why is treatment in ambulances necessary ?

Aalborg Univ. hospital

Sygehus VendsysselHjørring

Sygehus HimmerlandHobro

Sygehus HimmerlandFane

Sygehus Thy-MorsThisted

Nordjylland

Midtdjylland

Syddanmark

Sjælland

Hovedstaden

University Hospital

Hospital with emergency departments

Hospital without emergency department

Sygehus VendsysselFrederikshavn

Distance

Timedependent disease

You must have medical support to guide the ambulancepersonnel in treating patients?

You can use– Phone

– ECG, communication

– Electronic prehospital patient record– ECG, vitals, medication, triage, photo ect.

– Video contact with emergency departments and physician– Livestream video of the patient in ambulance

North Denmark Region• Have EMT and Paramedic in ambulances• We use

– Phone– Electronic prehospital patient record– Video conference

The developement plan was designed in a dialog between JUDEX, The Prehospital Organisation and Falck A/S.

There were two defined problems:1) A clinical need to optimize the prehospital care of the patient.

2) A need to optimize the communication between the prehospital staff and the hospital staff, and to improve the documentation in the patients medical record.

Electronic prehospital patient record amPHI

National solution in DenmarkOrganisation:• 5 Regions in Denmark (5.6 millioner inhabitant)

Projekt:• CSC won a national tender for a elektronic prehospital

patient record solution • amPHI in a new version from North Denmark Region

is now implemented in Denmark and it include about 500 ambulancer, Docters cars and 3 helicopters.

• One solution means that any ambulance i Denmark can hand over a patient to any ED in Denmark, giving the same information to the ED personel.

Nordjylland

Midtdjylland

Syddanmark

Sjælland

Hovedstaden

8

amPHI™ evolution

The digital North Jutland

Quality control (Falck)

Feedback from hospitals

Beta test

46 ambulances i The North Denmark Region

Emegency response vehicles (doctor)8 ambulances in marginal areas

Acute Medical Coordination

10 Emergency response vehicles (paramedics)

Tele-ECG

2002

2003

20082007200620052004

2009

2010

Communication with ambulances

Emergency helicopterPrehospital ECG in EPJ

Integration to C-View og EPJ

Wireless transmission from ambulances of sound clinical data, ECG as well as an ongoing video transmission

Prehospital telemedicine ( Doctor at distance )ECG

VIDEO

Internet hot spot

Hot spot

PHONE

RECORD

Dispatch centre

PAS/EPR

Interactive boards

Prehospital record

Central services

1) Tra

nsport

3) Treatment info

2) Patient history

2) Patient history

4) Prehospital record

1) 2) 3) 4)

Emergency solution overview1) Transport information:• Accident and possible patient information

2) Patient history: admission• Person id and demographics• Previous hospital admissions and diagnosis• Critical medical data (i.e. conditions and allergies, medicine)

3) Prehospital treatment information:• Status / diagnosis, treatments, medications• Various scores related to patient condition (i.e. trauma, triage)• Vital signs (i.e. hart rate, blood pressure, pulse) and other

measurements from patient monitor

4) Prehospital record information:• Complete prehospital record• Various scores (i.e. trauma, triage)• Vital signs (i.e. hart rate, blood pressure, pulse)• ECG’s

Dispatch centre

PAS/EPR

Interactive boards

Data flow:• Complete prehospital record to the EPR• Various scores to the ERP• Vital signs to the EPR• ECG’s to the EPR

Prehospital record

Central services

4) Prehospital record

Export to acute EPR

Correct treatment and visitation are the key-words

• ECG is sent directly from the ambulance to the doctor in the cardiology department

• the result can be seen in the electronic journal

128 km between patient and doctor

Mobilt hotspot

Docters terminal

Video konference from location and during transport to hospital

Video based communication between ambulance and relevant medical speciality at hospital

Ambulance

“Doctor at distance”

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