Monitoring the Monitor: Additional Breakthroughs Predicted

The cardiac monitor is a device that displays a patient’s electrocardiogram (EKG) or heart rhythm as a thin line of light with a peak showing at each heart beat. The defibrillator is a device that sends a charge of electricity through the heart to re-set its rhythm.

Ten years ago, the future of these devices was, in a word, “modularity.” Each and every device was fitted with the basics – and, if an additional capability was needed, a technician simply opened the device, plugged in a circuit board, and uploaded software. Meanwhile, the users picked up and plugged in a new cable, and they were back in service with improved capability. This made the devices of a decade ago considerably robust and in most if not all cases allowed them to avoid obsolescence. Today, though, there is a new future: “connectivity.”

There are different needs within the various types of medical and responder systems involved. First responders such as firefighters, police officers, and basic life support (BLS) ambulances, for example, are equipped with semi-automatic defibrillators, and many public buildings have automated defibrillators in place as well. These devices record and analyze a patient’s/victim’s heart rhythm and deliver a shock of electricity as and when needed. Paramedics and emergency room staff use more advanced devices.

Clot Busters + Long-Distance Connections = Improved QA 

During a heart attack, a clot restricts the flow of blood to the heart muscle. “Clot-buster” medications, which dissolve the clot and restore the flow of blood, usually provide an effective treatment. However, because heart muscle is damaged so quickly, time is often the determining factor not only in a patient’s survival but also for his or her continued quality of life.

When clot busters were first introduced, hospital personnel worked long and hard to increase the speed in which the drug was administered. By connecting the paramedic in the field to the hospital, this time was significantly reduced.

Many EMS systems have been using electronic ambulance reports for more than a decade. These reports often can be downloaded and/or printed out at the hospital.eally, the system should be able to take the ambulance report and connect the patient’s biotelemetry data from the monitor directly to it, making a complete package.

Having this record in hand – combined with all of the data recorded for the patient and stored in a central location – allows more effective system management, in a number of ways. Improved quality assurance (QA) is achieved at both the system level and the individual paramedic level. This allows not only more effective corrective action with the individual patient but also improved planning for later system-wide training and/or adjustment.

Some systems also have the ability to record and transmit data on the specific device being used; that capability allows technical services staff to keep the equipment at top performance.

Today, Tomorrow, and Just Over the Horizon 

All of the preceding is available right now. The future holds even greater promise, though, and the next great leap forward probably will mirror the current explosion in, and derived from, smart cellular technology, with each component connecting through the air to the rest. The first firefighter on the scene, for example, uses a device to upload his/her data, which is then joined with the data provided by the paramedics and the hospital.

This capability provides more effective use of not only current EKG monitors and electronic reports, but additional devices as well. Responders at each link in the chain of medical care are able to review the information collected in all previous steps – and then add to it. Instead of individual reports, there is a stream of data that can be viewed as a medical timeline, in much the way patient information already is recorded in most hospitals and other medical facilities.

The technology already exists to have these devices communicate: (a) on scene, using low-energy wireless such as bluetooth; and (b) long range – to the hospital and/or central server by cellular connection (in the same way that a smart phone connects to the Internet). Fortunately, the manufacturers of current monitoring systems have made their software “open source,” which means that they provide the computer code so that other programs can use it. This allows the manufacturers of other products – e.g., electronic ambulance reports – to design their products to interface with the monitor-technology products.

The last generation of medical monitors became “more than mere EKG machines.” The next generation is very likely to be “more than just a single machine.”

Joseph Cahill
Joseph Cahill

Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.



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