When emergency responders pick up a pediatric patient from Cincinnati-area hospitals to transfer the child or adolescent to the Cincinnati Children’s Hospital Medical Center, time truly is of the essence and ideally a physician would be present on each trip. Since it’s not possible to have a doctor attend each patient pick up, Dr. Hamilton Schwartz and his team at the hospital sought a way to provide the same high level of critical care to each child — and telemedicine helped make that a reality.
“A big driver for us was how do we provide a critical care physician’s input almost identically to them being there in person, how do we provide that to a fleet of ambulances?” said Schwartz, the medical director of the hospital’s Critical Care Transport Team.
To address the challenge, Schwartz turned to technology and a basic staple of patient transport: the stretcher. He didn’t want the system to be tied to the ambulance, so by making the device stretcher-mounted it could go into the hospital during patient pick up and virtually bring the patient to the doctor. “So when our team goes to pick up a child at another hospital, from the moment our team is at their bedside while still inside that other hospital, our doctors can begin evaluating them,” Schwartz said.
The immediate interaction between doctor and patient is critical, Schwartz said, because stabilizing the patient and ensuring that the correct diagnosis has been made usually occur within the first 10 to 15 minutes that the transport team is with the child.
The system mounts to stretchers with a standard IV pole and includes: a touchscreen tablet computer, two high-definition cameras, a 3G aircard, a microphone, a ClearSteth Stethoscope and a Bluetooth wireless keyboard with headset. The doctor at the children’s hospital awaiting the patient transfer connects to the equipment through a standard PC outfitted with special software and can control a camera that’s attached to a mechanical arm and can move 360 degrees to view the patient. “The other camera is on a retractable cord and one of the team members would use that to direct the physician’s attention to certain things,” Schwartz said. The patient population includes micro-premature babies and the retractable camera can be fed through port holes in the incubators that they’re housed in during treatment.
The doctor can also use the digital ClearSteth Stethoscope, which allows him or her to listen to lung and heart sounds among other internal body noises. Schwartz said that aside from the software, noise-canceling headphones are the only other special equipment the doctor needs to evaluate a patient.
Although the system has been many years in the making, it has been used in the field for the last year as part of a pilot project, Schwartz said. Hospital staff teamed with private company GlobalMedia to develop the TransportAV system. “They know the technology and we know the medicine, and we worked well at putting these two things together,” he said.
Each of the hospital’s four ambulances is already outfitted with the system and he expects that it will be used with every patient transport beginning in the next six months.
The telemedicine system is not only benefiting patients, but also the public and emergency responders who do the transports. “Normally an ambulance would go racing with their lights and sirens on because the team themselves conveyed that a patient was really, really ill, but with physicians actually being able to see the patients oftentimes they’re able to say, ‘Yes, the person is ill but they’re not deathly ill. I don’t think you need to turn the lights and sirens on and drive fast,’” Schwartz said.
The significance, he said, is that when ambulances get into vehicle accidents they are almost always driving quickly with their lights and sirens on. Using the system has decreased the frequency that patients must be rushed to the children’s hospital.
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