Is EMS Finally Ready for Cameras in the Rig?

This is the third in a six-part series examining the potential role of telemedicine and other advanced technologies in the emergency medical services. Find Part 1 here and Part 2 here.

A friend and top healthcare executive who has served as both a military and civilian medic once likened EMS to sausages and lawmaking: That is to say, it takes a strong stomach to watch any of these in-process, and you’re probably better off just enjoying the result. Besides the gore and occasional terror (to say nothing of the painfully mundane), EMS is at once highly protocolized and highly improvised: Rules form the backbone of both the science and the art; yet every situation that calls for an ambulance has the potential to draw a wild card.

How does telemedicine fit into this worldview?

For more than three years, I’ve traveled extensively across the United States and internationally to study the fire and emergency medical services. I’ve interviewed firefighters, medics, nurses, physicians, hospital and municipal administrators, even an Air Force flight surgeon about the technologies they had, wished they had, and loved and hated when it came to patient care and completing post-transport documentation.

Here are two of the most fascinating things I found:

1) The most frequently requested technology feature among EMS professionals was a GPS navigation system that could provide turn-by-turn directions, yet not require an Internet connection (i.e., one that works in outlying rural areas, crowded inner cities and even during natural disasters when the network goes down);

2) The most controversial technology among field providers was the camera in the back of the ambulance that could watch how patients are cared for. However, when asked how they would feel about a camera that could be turned on and off, medics’ reactions were completely different. Most were very interested, as long as local regulations did not specifically forbid the use of telemedicine technology.

Unblinking Eyes

Every so often during these interviews, a practitioner would recall the experience of Arizona’s ER-Link. The nation’s first EMS-based video telemedicine system, it widely deployed cameras and full-scale telemedicine installations in the backs of ambulances. These cameras were advertised as “the wave of the future for emergency medical communications,” facilitating better patient care. But they also helped agency administrators ensure procedures were being followed and that both the public and EMS providers were safe.

As the story goes, however, while the company generated wide publicity for its innovation—plus some $3.8 million to equip just 17 Tucson Fire Department ambulances—the value of this technology in the field became questionable. Why?

The agencies that leveraged this technology won accolades for forward thinking. But according to medics interviewed about the program, within weeks the cameras were smashed by field providers who didn’t like the idea of being watched. Accountability and safety may be admirable, but without trust and safeguards, cameras in the ambulance can be equally conducive to a kind of “gotcha!” management that is far less appealing to medics. Just 3½ years after the program’s inception, TFD Assistant Chief Dave Ridings told the Arizona Daily Star only five trucks still had functional equipment, and that wouldn’t be fixed if it broke or needed maintenance. ER-Link equipment remaining in other trucks was nonworking.

With the advent of on-demand digital media and, perhaps most important, cameras with easy upload capabilities embedded into smart phones and computers, concerns about patient privacy have understandably layered onto thoughts of safety. But there are both clinical and operational virtues to having a “window” of sorts into activities inside an ambulance that, aside from radio and possibly GPS, is otherwise cut off from the world.

Rural emergency response, for example, is a critical area. My business partner suffered a family tragedy several years ago where the ability to provide remote, informed medical direction may have saved his father’s and sister’s lives.

In 2011, when Beyond Lucid Technologies’ interaction design team presented these scenarios to a cadre of medics in Pittsburgh, we received an intriguing response: Every so often, they said, the patient in the ambulance is underage or violent and uncooperative. If you’re ever accused of something, it’s your word against theirs. You need to protect yourself, and having a camera could be very helpful in such a situation. Such events were infrequent, they said, but when they happened, the consequences could be serious enough to justify a helpful technology.

We heard similar sentiments across the country, and laws are now being enacted—including, this past summer, in New York—to streamline the use of telemedical technologies by healthcare practitioners of all sorts, including potentially in ambulances, where they can serve as tools to better document patient care. (HIPAA and other regulations must still be obeyed, of course, and best practices followed to ensure patient data is safe. As of last April, a top EMS legal expert I asked was unaware of any specific case law or regulations permitting or forbidding the use of telemedicine technologies in ambulances in the U.S.)

The key difference between modern approaches to telemedicine in EMS and those of attempts past is that the current crop of products can be turned on and off by practitioners in the field, based on a real-time assessment of the situation or an agency-specific protocol. I believe within a few years, once the fourth-generation LTE cellular network—which is dramatically faster and more robust than the currently widespread 3G network—touches more locations around the U.S., enhanced functions like face-to-face teleconsults with full-speed video will become standard practice, as they are starting to be in office-based healthcare contexts now.

Jonathon S. Feit, MBA, MA, is cofounder and chief executive officer of Beyond Lucid Technologies, Inc., an IT firm committed to connecting first responders with the care facilities they serve using cutting-edge technology. For more see www.BeyondLucid.com.