Innovations in Front Line Medicine

There have been several recent cutting-edge innovations in Front-Line-Medicine, Austire Medicine, Emergency Medical Services (EMS), and Paramedicine, including:

Telemedicine: This technology allows paramedics to communicate with physicians in real time, which can be critical in emergency situations. Current gold standard practices for the majority of EMS agencies in the United States are based on off-line medical protocols and when and where necessary either radio or telephone contact to the receiving Emergency Department Physician for On-Line Medical Direction for advice and direction beyond protocols. Telemedicine would allow for face-to-face contact between the EMS crew and the physician and would allow the physician to "lay eyes" on the patient, cardiac monitor, 12-Lead ECG, and other assessment findings, instead of only having a verbal report from the Paramedic en route to the facility.

Point-of-Care (FAST) Ultrasound: Focused Assessment with Sonography for Trauma (FAST) scan is a point-of-care ultrasound examination performed at the time of presentation of a trauma patient. Five regions are scanned with the patient in a supine position:

1. Pericardial View: Commonly referred to as the subcostal or subxiphoid view, to examine the pericardium, the liver in the epigastric region is most commonly used as a sonographic window to the heart the potential space between the visceral and parietal pericardium is examined for a pericardial effusion. If anatomical factors preclude epigastric probe placement, parasternal or apical four-chamber views may be used.

2. Right Flank View: Commonly referred to as the perihepatic view, Morison pouch view, or right upper quadrant view. Four potential spaces are sequentially examined for the accumulation of free fluid. The hepatorenal interface (Morison pouch) is first identified, with subsequent assessment of the more cephalad subphrenic and pleural spaces. Visualization of the inferior pole of the kidney, which is a continuation of the right paracolic gutter, defines the caudad extent of an adequate view.

3. Left Flank View: Commonly referred to as the peri splenic or left upper quadrant view. Four potential spaces are sequentially examined in an analogous fashion to the right flank, albeit the splenorenal interface is assessed on the left.

4. Pelvic View: Commonly referred to as the suprapubic view. This space is the most dependent peritoneal space in the supine trauma patient. A transverse sweep, using the bladder as a sonographic window, the pouch of Douglas or rectovesical space is explored for free fluid.

5. An extended FAST or "eFAST" scan is now standard of care and is performed by incorporating two views assessing the anterior thorax: Anterior Pleural Views: The anterior pleura is assessed for the presence or absence of lung sliding as a sensitive, but non-specific, indicator of traumatic pneumothorax. The probe is placed in a sagittal orientation in the midclavicular line between the clavicle and diaphragm. Anterior and lateral interrogation of intercostal spaces 5-8 bilaterally is recommended.

Mobile Stroke Units: These specialized ambulances are equipped with a CT scanner and other technology that enables on-site diagnosis and treatment of stroke patients, which can be critical in saving lives and reducing the risk of disability.

Mobile ECMO Units for Refractory V-Fib Arrests: The Minnesota Mobile Resuscitation Consortium's Extra Corporeal Membrane Oxygenation (ECMO)-facilitated resuscitation program successfully demonstrated that patients who experience an Out-of-Hospital Cardiac Arrest, specifically a Refractory V-Fib Cardiac Arrest, can substantially benefit from rapid ECMO. From December 1, 2019, to April 1, 2020, 63 consecutive patients were transported and 58 (97%) met the criteria and were treated by the mobile ECMO service. The mean age was 57 ± 1.8 years; 46/58 (79%) were male. Program benchmarks were variably met, 100% of patients were successfully cannulated, and no safety issues were identified. Of the 58 patients, 25/58 (43% [CI:31–56%]) were both discharged from the hospital and alive at 3 months with CPC 1 or 2. The national average for Out-of-Hospital Cardiac Arrest, survival to discharge from the hospital remains low at approximately 10%. A 33% increase in discharge was realized during the Minnesota Mobile Resuscitation Consortium's research.

Drone Delivery of Medical Supplies: Drones can be used to quickly deliver medical supplies to remote or hard-to-reach areas, which can be critical in emergency situations.

Automated External Defibrillators (AEDs): These devices are becoming increasingly common in public places, and can be used by anyone to quickly provide life-saving treatment to someone experiencing cardiac arrest.

Community Paramedicine: This model of care focuses on providing preventative care and education to underserved communities, which can help reduce the need for emergency services in the first place.

Overall, these innovations are helping to improve the speed and quality of emergency medical care, and are saving lives as a result.