endotracheal tube (ET) placement, assess
for pnuemothorax, check cardiac function
and volume status in the heart and vascular
system, find fractures and examine unborn
children. Numerous studies have demonstrated that prehospital providers can accurately use ultrasound, but outcome studies
are lacking. 14, 15
There is little doubt in the hospital setting that ultrasound has and will continue
to replace more invasive testing. A nurse
using ultrasound can avoid placing a foley
catheter, saving much discomfort and risk of
infection for the patient. A clinician performing a comprehensive ultrasound exam in an
unstable patient can very rapidly assess heart
function, fluid volume status and visualize
the lungs. These exams, however, take considerable practice and require continued use
to maintain proficiency. Like ETI, the opportunity to perform ultrasound may not occur
often enough to allow prehospital providers
in many systems to develop and maintain
Increasing concerns are arising that clinicians
may become overwhelmed with the vast
amount of data to determine an appropriate
plan of care. To that end, monitoring manufacturers are beginning to develop algorithms
or fuzzy logic systems that analyze multiple
parameters to provide the clinician with an
overall wellness score on their patient. One of
the first entrants in this market was Integrated
Pulmonary Index (IPI) by Oridion. 16 IPI uses
waveform capnography combined with
pulse oximetry to monitor respiratory rate,
EtCO2, heart rate and SpO2, combining these
values into an algorithm that produces a
score from 1 to 10.
This overall pulmonary score doesn’t
replace the need for a clinician to look at each
one of the parameters, but it does provide
early warning about deterioration so the provider can determine which of the measured
parameters is in need of treatment. Although
IPI isn’t yet available on prehospital monitors,
expect to see it soon along with algorithms
from other manufacturers that will help you
more effectively analyze and manage large
quantities of monitored data.
WEARABLE DEVICES & SENSORS
Lastly, pay close attention to the field of wear-
able devices and sensors. As our population
ages, patients are discharged from hospitals
earlier, and healthcare providers look for
ways to more closely monitor their patients
at home, the need for wearable sensors
will explode. Remote monitoring systems,
such as the ViSi mobile monitor by Sotera
Wireless, are rapidly benefiting from minia-
turization, faster and more robust internet
access, more sophisticated Bluetooth tech-
nology and developments in microelectron-
ics and sensor technology.
Mike McEvoy, PhD, NREMT-P, RN, CCRN, is the EMS coordinator for Saratoga County, N. Y., and teaches pulmonary
and critical care medicine at Albany Medical College. He’s
a paramedic, firefighter and member of the International
Association of Fire Chiefs Emerging Infectious Diseases
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