S2:E33 - "Evolving your Stroke System of Care - An interview with Edward Jauch, MD, MS, FAHA FACEP and Dr. Steve McGraw, D.O." Recorded May 3, 2021

In this episode, we welcome Dr. Edward Jauch, the Chief of System Research, at the Mission Research Institute/Mission Health System.  Dr. Jauch served as the Chair of Stroke Council for the American Heart Association/American Stroke Association and was the primary author for the 2013 Acute Ischemic Stroke guidelines. He is a co-author of the flagship American Heart Association / American Stroke Association (AHA/ASA) guidelines for telemedicine use in stroke, primary prevention of stroke, prehospital care of stroke, and stroke systems of care, as well as over 20 other AHA guidelines and scientific statements.  Collectively Dr. Jauch’s efforts have focused on improving access to care, increasing the quality of acute stroke care, and educating both the public and healthcare professionals on developing integrated stroke systems for care for all patients.

Most recently, Ed was the primary author of the 2021 Recommendations for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities from the Prehospital Stroke System of Care Consensus Conference, which is the focus of today’s episode. This consensus paper provides local and regional EMS agencies and stroke advisory committees with guiding principles and recommendations for how to integrate the elements of a stroke system of care in three key regional settings: urban, suburban and rural settings. It also takes into account the differences in resources, hospital certifications, geography, and population density. Additionally, it seeks to inform or update EMS about new models and systems of acute ischemic stroke care, especially mechanical thrombectomy for large vessel occlusion stroke, and how they affect their stroke systems of care. 

In an effort to maximize the power of the recommendations, the AHA/ASA produced a very cool and very useful website full of resources and information directly related to helping EMS develop and or fortify their stroke systems of care.  I highly recommend you visit www.Stroke.org/stroketransportplans and use it to consider evolving the stroke system of care in your community. 

During this episode, Dr. Jauch helps us appreciate what is at stake for stroke patients.  Then, we discuss how EMS can best serve their stroke system and strengthen the stroke chain of survival.  From there, we get into the details of the intent and key recommendations from the consensus paper.  Finally, Dr. Jauch gives his recommendations regarding how EMS systems should use the contents of this paper to improve their Stroke Systems of Care. 

Please keep emailing your questions, comments, feedback and episode ideas to the EMS on AIR Podcast team by email at QI@OCMCA.org.  Visit EMSonAIR.com for the latest information, podcast episodes and other details.  Follow us on Instagram @EMSOnAIR.

Recommended resources referenced in the episode:

www.Stroke.org/stroketransportplans

Contact the episode participants:

Geoff Lassers, Paramedic I/C, AAS
Host, EMS on AIR Podcast
Qi@ocmca.org

Steve McGraw, D.O.
Co-host and Co-Medical Director, EMS on AIR Podcast
EMS Medical Director, Oakland County Medical Control Authority
steven.mcgraw@ascension.org

Edward C. Jauch, MD, MS, FAHA FACEP
Chief of System Research
Mission Research Institute / Mission Health System
Edward.Jauch@HCAHealthcare.com

Transcript

Geoff Lassers: 0:07

Hello and welcome to the EMS on AIR podcast. The mission of this podcast is to keep healthcare providers safe, informed and prepared Today is January 22, 2021. I'm Geoff Lassers and I'll be your host. This episode was recorded on January 11, 2021. In this episode, we will introduce you to Randall Hawkins, the National Sales Director of GD formerly known as general devices. Randall also has a lot of experience as a firefighter paramedic, and as a 911 dispatcher. He was born and raised in the first responder community, and his passion is obvious just listening to him speak. Randall is here to discuss the importance of reliable clear communication between EMS and the hospital. Specifically, we'll compare and contrast traditional ems communication technology and tools versus the new mobile telehealth tech that has been becoming more popular and more affordable over the last 5 to 10 years. Then we'll discuss how the OCMCA is leveling up their game by introducing a new mobile telehealth platform by way of their brand new electronic communications and special study or ECOMS. For short, within the last year, the OCMCA and its regional partners have identified the need to investigate new options to facilitate communication between emfs and our various emergency departments. The current 800 megahertz system is not capable of transmitting any information or data other than an audio signal. In addition, there are rising costs associated with the implementation of upgrades to currently existing systems. On top of that, plenty of our EMS providers prefer to use cell phones to contact the hospital. But even in those situations, it's only being used as an audio communication device he comes is designed to investigate the use of a state of the art HIPAA compliant electronic communication system that facilitates pre arrival notifications for all patients and online medical direction at the request of EMS, as well as act as the telemedicine component for the various OCMCA community paramedicine programs. Essentially, this project is looking outside the box to find a better way for our EMS in hospitals to communicate under all of the various conditions. We all know that a picture is worth 1000 words. So instead of telling the hospital about my patient, why not just send a picture, or a video, why not both? Better yet, if I have a low priority patient, why not just fill out a quick notification form on an app that's on the same tablet that I'm doing my patient care report, I think you know where I'm going here. It's 2021 and it's time to step up our communication tools to match the times. Communication Technology has come a long way and it's only getting better, cheaper and more reliable. Instead of trying to stick to traditional communication tech, the OCMCA is testing out the use of a telemedicine application called ebridge. This application offers several features including video streaming, and voice and text communication. It is also capable of EMS tracking with live eta and specialized burn STEMI stroke, sepsis and trauma functions. They can even customize pretty much any type of alert notification that you can think of. GD's E-bridge also offers seamless integration into carepoint, which is used by many hospitals throughout the nation. This was a great discussion, and I look forward to having Randall back on the show. After we get all of our agencies up and running and show some really great examples of this really cool and effective tool. Please keep emailing your questions, comments, feedback and episode ideas to the EMS on AIR podcast team by email at QI@ocmca.org. Also check out our website emsonair.com for the latest information, podcast episodes and other details. Follow us on Instagram @emsonair. And please whatever podcast platform you're using right now, subscribe to this podcast and leave us a rating and review because it really does help us to grow this project. I can't tell you this enough, everyone, please leave us a rating and a review and help us get noticed on a much bigger scale. Remember the mission of the EMS on AIR podcast is to keep healthcare providers safe, informed and prepared. So increasing our ratings and reviews gets us noticed by more listeners and more sponsors. And that will lead to increasing our reach resources experts and abilities. Bottom line ratings and reviews are vital to our growth. It's currency in 2021. And your contribution will give us what we need to serve those that serve our communities. The only cost to you is a few minutes giving us a rating and a review on whatever podcast platform you use. And right now we really appreciate the consideration. Thank you and enjoy the podcast. Good morning, Randall. How are you today?

Randall Hawkins: 4:56

Morning. Welcome. Thank you.

Geoff Lassers: 4:57

Well, why don't you kick us off by letting Our audience know who you are, what you do, where you do it and why you do it.

Randall Hawkins: 5:04

Well, thank you. My name is Randall Hawkins. I live in the state of North Carolina. I am the National Sales Director for a company called GD or formerly known as general devices. Our company pretty much manufactures and markets, telehealth and communication equipment to hospitals and EMS. In my previous life. I have also been a lifelong firefighter for my local fire department here, my father being the founding member of the very first fire department that was ever formulated in the town I grew up in. So I've worked pretty much my entire life as a firefighter. There also have been an ALS medic for our county EMS 911 system, and l'm a certified 911 dispatcher and communication specialist for 911 dispatch center.

Geoff Lassers: 5:47

That's really cool. So you have a background in this stuff.

Randall Hawkins: 5:50

Yeah, absolutely pretty much have been born and raised in the fire/ems world and working with that handshake, I guess or lack thereof, between fire and ems and the hospitals. And one thing that this job helped me do very well is find ways to help improve that handshake.

Geoff Lassers: 6:06

So tell us a little bit more about that handshake, can you really give us some background on really the importance of reliable clear communication between ems and the hospital and vice versa?

Randall Hawkins: 6:18

I can tell you that one of the things I have learned by being the National Sales Director here for as long as I have is I work with hospitals and EMS agencies throughout the entire United States. And you will find that they're all just as diverse as you would find within your own state or your own city. And I work with EMS systems from Seattle, Washington all the way to the tip of Florida and everywhere in between. But the one thing that is pretty common is that they all do need to find a very reliable way to communicate with their hospitals from ems. And there's a lot of reasons why that needs to be reliable and needs to be clear. Because what you're really trying to do is to as a couple things, number one, give your hospital a pre notification of what you're bringing them so that they can obviously be better prepared to receive that patient once you arrive and get prepared pre arrival. And secondly, it's also utilized for the ems to be able to speak to medical control to sometimes get orders for things that might be outside their standard operating procedures and things of that nature to get direction. So those are two very important reasons why that communication even exists between the pre Hospital in EMS. And EMS doesn't just show up at the hospital. So that has to be very clear and important. And I can tell you that working with the hospitals across the country, a majority of the hospitals in the nation today still pretty much communicate exactly the same way they did 30 years ago. If you think the show emergency and roaring Johnny on squad 51, we pretty much still communicate that exact same way today. And now that technology is starting to improve that tipping point is starting to be reached where we're realizing there are alternatives and even some, in some cases, better ways to communicate.

Geoff Lassers: 8:02

That's a very good flyover where we're adding the the you know, the status of communication with the hospitals. It's funny because you know, I FaceTime all the time, and I don't FaceTime with the physician that I'm bringing a patient in for, you know, so sometimes we all look at that. But you know, there's always these other things like HIPAA compliance, videos, tech, Wi Fi, bandwidth, all these other things. So before we get into really the cool stuff that GD is doing, and some examples of the use of these tools, can you compare and contrast our traditional tech verse, the new mobile telehealth tech that we're seeing now?

Randall Hawkins: 8:35

Yeah, absolutely. Well, right now, majority of the communication that's going back and forth between EMS and hospitals throughout the country relies on some type of radio band communication, and that is still very varied throughout the country. The you have UHF VHF 800 megahertz, some 800, digital 700 megahertz. So there's a lot of different communication frequencies that are out there that people are utilizing to utilize that radio. If you've ever used the CB radio back in the day, I'm dating myself a little bit here. I mean, it's the same kind of concept, you're transmitting a radio signal from your antenna to another antenna, if you're a long way from the hospital, there are repeater antennas that are set up throughout the area which are working that repeats that signal. And so that signal has to be able to hit an antenna and then be repeated to another another, so forth and so on to get to the hospital. So sometimes that antenna system to maintain that system and those repeaters and all of that and maintain the radio equipment in the hospital and the antennas there can be very costly and has to be updated on a regular basis. And you know, it's a pretty big web that has to be set up for that to work and work efficiently. So that's a big part of some of the downside to the radio system. Another thing is that you're talking usually over a frequency that's been assigned to that EMS or that particular hospital. So if I'm an EMS agency, and I'm Reach out to a specific hospital. Usually there's either one or two things, there's going to be either a specific radio frequency that you tune to, to talk to the hospital, or the hospital have what's called a private line tone or PL tone that's keyed up when you key your radio for that particular hospital so that they only have to hear the radio traffic, that's for them and not everybody else. Again, the downside to speaking over open frequency like that is that if another medic is transported to the hospital, and he's using that radio frequency, you have to wait until he's finished before you could access that radio frequency. And then you can give your report. So that's one downside, it makes it harder to have multiple EMS communicating the hospital at one time. Another disadvantage is that those are still pretty much open frequencies. As far as the HIPAA compliancy of that goes, anybody with a scanner can pretty much pick up that radio frequency. And they can listen to that communication. If you remember many years ago, everybody used 10 codes, 10-14,10-18,10-29. And you would do that because you knew you were talking about open frequency, and you didn't want people to always know what you were talking about. So because of that we can't give a lot of really in depth information of demographics on that patient, such as their name, their social, any of that kind of information, their address, which doctors could if they had an information, maybe look that up in their EMR and get some background information on that patient before weibel. But due to HIPAA, with the old way of doing things, a lot of that information just can't be shared because you know, it wouldn't be private.

Geoff Lassers: 11:26

Yeah, I think you really highlighted the strengths and weaknesses of that system. as it currently stands. To me one of the biggest strengths is we all know how to use it familiarity is the most comfortable thing in an emergency.

Randall Hawkins: 11:38

Absolutely. Because the last thing you want to be doing is trying to think what do I need to do to make this work, you don't need to be thinking about that it needs to be second nature. Now as a result of that. Also, we started seeing a lot more cell phone being used pre hospital to contact EMS. So they will pick up a cell phone on either their personal phone, which believe it or not, you're going to be amazed is used more than you would realize medics just call from their own personal cell phone to call that hospital.

Geoff Lassers: 12:04

I think it speaks to that comfort zone. Right that naturalised action,

Randall Hawkins: 12:07

I think exactly right. It's something they're used to they're used to doing it, they can put the number to hospital in their speed dial and they can hit the number call the hospital and talk to and of course, medics feel a little bit more secure that they can share a little more information over that more private and quotes. Call there. Because you know, it's not something somebody's going to necessarily be picking up on the scanner or whatever. But the downside of that too is are you using the medics personal phones? Is it a phone that ems has to provide to the medic, there's some of that logistics that gets into that thing.

Geoff Lassers: 12:37

Okay, so I in the field currently use 800 radios and cell phones all the time. I like the 800 mostly because again, that's how I was trained. I even when I was teaching in initial education for EMS, we weren't using cell phones yet. So literally my training made me very comfortable with it. I don't have a lot of reception issues that I'm aware of. So I'm getting my information there. And for me, it works just fine. I do you also appreciate the value of using my own cell phone at times because I know the numbers in the phone are updated. I know my phone works. I know my phone's charged. Right, exactly. But me personally, I'm used to that. But I'm also very open to cool new toys, processes and ways that we can do things better, smarter, cleaner easier. So give me a flyover the new mobile telehealth tech that's out there right now being used by first responders.

Randall Hawkins: 13:28

First thing is that when you move from a radioed base communication to even to your cell phone that you're utilizing, one of the things that we see that makes it a little bit easier is that now you can have a bluetooth headset or something in your ear, which helps you be more hands free. So now you don't have to stop and hold that microphone and be keying up that mic and talking to the hospital while you're trying to get an IV started allow you to try and check a blood pressure check feel for pulse or do whatever. So just being mobile actually helps be a little bit more hands on, you know, because you don't have to completely stop giving patient care while you're having that communication. But when you start looking at new tech, now most of the stuff like what we do with our ebridge it is a system that can operate on pretty much any platform such as Android phones, Android tablets, it works on iOS, iPhones, iPads, and also will work on Windows based devices like laptops, toughbooks, and tablets. So that really does open up a lot more opportunity for people to use a lot more different platforms as far as the equipment because and also our system and these new newer systems that are out today, they can run off of not just a cell signal but they can run off of Wi Fi. So if you have a built in Wi Fi in your back of your rig, you know that actually helps you get better Wi Fi connection, you can actually key into that if you're in an area where you don't have a cell signal. Now you can make that communication using the Wi Fi that happens to be in the location that you're at. Maybe it's the patient's home and you tap into their Wi Fi either if you don't have any way of Getting the signal out. And I'll see that happen in a lot of rural ems. Or maybe you're getting called to go to a restaurant for a patient is sick, and they've got Wi Fi, you can keep on to that. But it just gives a lot more flexibility as far as the type of equipment you can use, as well as what ways you can connect. And some people out there may be aware of FirstNet and at&t designate network. So we're part of that network as well, for anybody utilizes that. So it just really gives a lot more operational possibilities, you know, from equipment all the way down, and a combination of both. But when you really get into with now you've got a lot more ability to share a lot more things. You were making a comment a moment ago about facetiming with your daughter, I mean, how many times does your daughter take a photograph of a beautiful scene that sees that or her location or takes a picture of substance? Hey, Dad, look at that and see what you did. I want you to think of that we all do that every day, we'd take photographs of everything. Now some people even post on Facebook a picture of the meal they're eating, I can see it. But we utilize that technology personally in ways we never would have thought we ever did. But why do we do it. Because if somebody's showing you something, instead of just trying to tell you what they're seeing, you get a lot easier and faster and better understanding of what they're looking at them if they're trying to describe that or verbally paint a picture for you. So the same thing is true when it comes to working with a patient. If the doctor can see that burn all that face if he can help determine what level of burnout is if he can see the mechanism of injury out there in the field of that wreck scene to see if there was a burst windshield to see if it was a side impact or a rollover, if they've can actually communicate directly with the patient. The ability to be able to do live streaming video, for instance, as a part of what we do, we could do audio through hours or live streaming video, and video conferencing. Now multiple people can be seeing that scene real time and collaborating. So you can have multiple dots, maybe you're a situation to where it's a mass casualty incident. Now the dots can even help those medics do better triage and actually see what's going on with that patient interact with that patient. I have a physician in Texas just recently that did a live streaming video with ems. And he turned the phone around so he could talk to and interact directly with that patient, the patient can see the physician with a stethoscope in his lab coat and this guy was refusing to be transported and a doc convinced him to come in. And I don't know that that could have happened, just as a voice call over the radio, we also have the ability to store and forward videos. So if a medic wants to record a stroke assessment, or what's going on on that scene right at that moment, and then forward it to multiple people, they can do that. So just having the ability to share more information, then they can over voice makes it faster and makes it a lot more clear for that person to get a better handle on what exactly what they are going to be receiving. When they do get that patient.

Geoff Lassers: 17:53

picture says 1000 words of video says a quadrillion words, I have a situation, I have to tell the hospital and bring them a patient, I fill out a couple of boxes to say what it is maybe I take a couple of pictures videos, send it off that right there relieved me of getting hold of hospital during around talking to anybody worrying about a communication failure. And they have more information in that few seconds and actions that I took than I could ever convey with words, words that express intent and what's going on? Well, I think to show you what's going on, I got a lot more words involved.

Randall Hawkins: 18:25

Well, not only that, you brought up another very good point about being able to just click a few clicks on the screen, we have the ability create customized forms for each situation. So the medic could just hit a STEMI alert button, for instance on their screen, and it will pull up a specific form that is specific to STEMI into heart attack. Or maybe it's a specific form for stroke. Because your physician is going to want to know additional different information on stroke patient then they would on a STEMI patient for instance, is their facial droop is their paralysis. How long has this been going on? When was the last known well, do they have a history of EMI you know, all of these different things vary based on the type of patient so we can even customize the way you send information and what information you quickly send so that you're not scrolling through hundreds of multiple pages to get to that field that you want. You can just pull up that STEMI alert click a couple clicks, as you say, take a photo, maybe have an EKG to help get that EKG to the hospital faster, or transmit that EKG, we even have the ability to work with some of the monitor manufacturers to pull the vitals and the EKG directly into our app. And for that real time along with that notification. So now really you're getting to the core of it is getting the right information to the right person at the right time to be able to do better patient care and doing it a lot faster. Because we talked about the downside the radio, one thing you mentioned to you've got to call that hospital on the phone or even wave radio and wait for them to answer and then when they answer you got to say medic three I'm in route to your location with blah blah blah and It just takes a lot more time. One of my hospital systems in Illinois tracks that how much time their nurses actually spend on the radio, and then how much time they spend on E-bridge. on that particular hospital, about 50% of their interaction with EMS is E-bridge. So they're saving their nurses over 200 or so hours of actual time spent on the radio, that thing can be spent serving other patients and doing other things. So, you know, it's not only getting better information, but it's also like you said, getting it there a lot faster and cleaner. And since it's all HIPAA secure, now you can send that information that you want to say over the radio, what is the patient's name, what is their social.

Geoff Lassers: 20:44

or send pictures of faces not even think about it, I can just convey info in a filtered protected environment in which that I'm just sending you as much as I can about this situation as needed. So Bonnie Kincaid is with us here. She's the executive director of the Oakland County Medical control authority. And as you know, Randall, we have just currently adopted general devices ebridge. And so let's provide an example that shows the use of mobile health tech, like e bridge to really leverage the strengths and weaknesses, opportunities and threats to up our game from just 800 and cell phone use, all the way to the use of this tech. So Bonnie, can you give us an overview of the intent and purpose of the Oakland County map control authorities? He comes study?

Bonnie Kincaid: 21:28

Absolutely. So we figured this would be a great way to at least test what Ebridge can actually do for us when we went through COVID 1.0. And we started using it in the field with a couple of our agencies through telemedicine and I was thinking why can't this work and replace our radio system. And so right now we have Oh, probably 14-15 agencies using it. And just about every one of our hospitals using it to some degree, everybody is doing the training, we're starting out with baby steps, we're just sending in a priority three notification at basically click a couple of buttons. And it's off to the hospital that you're taking the patient to priority threes, you don't need to call you don't have to communicate hospital says received, you know, and it can actually track how many minutes out they're going to be if you want to set it up that way, they can do so many different things. Also, you could do like Randall was talking about a video call, I'm on a scene of a trauma we have 15 minutes of extrication to do you can actually show the physician medical control back on the other end what you're dealing with on a video call, you can just do an audio call as a we are you know, a priority one trauma, that type of thing that quickly and communicate with that hospital. So lots and lots of great things coming to add on to like Stroke alerts, STEMI alerts, that type of thing as well. But we're going to start off small and build on it.

Geoff Lassers: 22:54

So right now for those agencies that are currently in our e-com study, what is available to them when they go on calls? Can you give me a few examples of what specific alerts are available to Oakland County providers.

Bonnie Kincaid: 23:06

So right now, the ability to use the bridge from whatever LSA is one of the 14 LSA's that are currently signed up and using it to some degree, the priority three notification form has been developed and put into play in a bridge, they click on this, they just fill out a couple of lines, a lot of it's just like a drop down and you choose any send to the hospital. It's that simple. You're right back to patient care, and you put an ETA in there and you're done. Hospital receives that they get a room ready, they know you're coming. And everybody's happy. No video call no audio call no radio call. And it's super simple.

Geoff Lassers: 23:45

Now say that your radio calls typically 60 to 120 seconds. Yes, right? Give me a breakdown of like, how much time am I saving? Do you think in your estimate right now,

Bonnie Kincaid: 23:55

the priority three notification for probably takes 15 seconds to fill out. So that's how much time you're saving, you know, then if something happens, and this is the beauty of this was if something happens in route and you're going oh, this is no longer just a priority three, we're upping it to a two or a one, you can then just do a video call or an audio call with that hospital and say we just did a priority three notification. Now we have this happening or that happening. And we are upping it to a priority of one. And then you can give as much detail as you want just like a radio call. But you're saving all that time on all those priority threes. Because most calls as you know Jeff and Randall, the most calls that you go on are priority 3's/ So if you're saving that much time and doing more patient care, it's a win win. It's a win for the patient. So when for the medic,

Geoff Lassers: 24:44

that sounds very quick, very easy to fill up that information. But if I wanted to send pictures or video, I kind of have the ability to send them like I would like in a cell phone right I can send the information or I can live chat. I think that's a big difference to distinguish here and for our providers. What is available to them? You just said you have a priority three patient, let's say, Oh, they just circled the drain on me, they're now a party one. And can I just take a quick video and send it? Or are you saying I always have to be face to face like FaceTime?

Randall Hawkins: 25:12

I'll address that one if you don't mind. But yes, you can take a store and forward video, or you can even do a voice recording with our system. So if you're in the heat of battle, and you say is changed, maybe this patient has gone to CPR in progress, you know, it's gone from a STEMI to a CPR in progress. Well, now you got to have a lot of hands working with that patient intubating doing CPR doing all that, you could literally have this a tile or an icon on ours, it says voice message and just say, this is medic 54, our patient has now gone into cardiac arrest where CPR is in progress eta to be updated, and then just hit send, then not even have to wait for someone to answer to have that communication. It could be a video clip. As you've stated, if you want a video to seen right quick and send it any of that information can be done on any of these. And one of the things I love about the way telehealth and stuff has now been introduced is so configurable. So we can configure those tiles will those quick shortcut icons differently for EMS person to hospital, I've got a system in West Virginia that has a single one press icon on their E-bridge for EMS in distress. If they find themselves on scene, there's an active shooter on scene or whatever, they can now click one button and it just automatically sends to their 911 dispatch and their hospital that they are in distress, they need help. And that's just click a button. And so there's just a lot of things that you can do and configure this to make it very simple and easy. But one thing I do want to mention is that you were talking about getting on that scene, how fast can you do this, and Bonnie hit on this too, like a wreck scene or a motor vehicle accident, I think how much time we spend on scene sometimes, you know people always talk about Well, yeah, my transport times are only about five to 10 minutes. But we may spend 10 to 15 minutes on scene, if you can hit a button that says trauma alert, snap a photo of that mechanism of injury and then just hit Send and then start working with the patient, the hospital can now get that information before you even left the scene way before you even got the patient extricated from the vehicle. So they've got a lot more heads up than you would have if you're waiting to make that phone call.

Geoff Lassers: 27:18

Yeah, and especially if you have like, in my situation where I work, let's say you have an accident scene. And a lot of times we'll have at least one engine with a rescue for personnel, you can always call for more. So let's say we have two engines and a rescue, well, somebody can be free to walk around with the iPad, taking pictures while people are doing patient care. So this does open up your options. Okay, so we have the priority three notification with additional abilities on any situation for any type of video, audio picture sending, or in the moment facetiming essentially, because I can't think of a better word face to face digitally. So Bonnie, what other immediate tiles or procedures are going to be immediately available during our e commerce study with the use of E bridge.

Bonnie Kincaid: 27:56

Once we get beyond this and everybody's started up and everybody's comfortable with the priority three notification or making an audio or video call to the hospital and everybody gets comfortable with that there's other things that we're going to be able to add, we'll be able to add like a STEMI alert, and you'll be able to send the picture of that strip showing an active STEMI right to the hospital to the doctor, a stroke alert. The cool thing about that, as you know, Geoff is that we could actually put the FAST-ED Form in there. So they could actually fill that out that goes right to the hospital. It's Click, click, click, click, click all the way down the FAST-ED Form and it's off to the hospital, they got it before you're even there, then they'll know exactly what they have coming. And obviously you can do a video with that you can show the doc the patient, which is you know, worth 1000 words just to show them what you're actually looking at as a patient. So those two are coming. We'll be doing trauma alerts as well. And like we talked about that crash scene where you're extracating. And you're showing the doc at the hospital, what the car looks like, what impact what happened with that car, what the patient looks like, at that point, they can actually say, hey, do this, do that and or suggest other things that you might be able to do while you're trying to do the extrication. So there's a lot of other things and I'm sure Randall can come up with even more because that's just scratching the surface of E-bridge.

Geoff Lassers: 29:18

So it sounds like we're really gearing up to manage the known incidents that we go on a lot. We see a lot of semies we've seen a lot of traumas, we see a lot of strokes. And this is on a county wide system. So we're certainly seeing a situation where it's like, Okay, how can we best support that get everybody up to speed and then advanced towards, you know, hey, Randall, what's next man? What's if once I get good at all that let's push that boundary a little bit. What's that next progression for us then?

Randall Hawkins: 29:42

Well, that kind of gets into what I refer to as use cases. You know, you have all this capability and then find the use cases for it. I purchased an iPhone for my 83 year old mother last year for Christmas. And here it is a year later and she's still pretty much uses it to make phone calls. You know, I'm trying to get her to text And all that. But it's just adopting and getting comfortable with the technology. And then once you do, then the sky's the limit. So one of the things that we're starting to say people for use cases is even use this for mental health evaluations. Now you can actually start to look at that situation if it's an opiate overdose, if it's a mental health patient, the docs can see what's going on there. EMS a lot in some areas, even document refusals. If you've got a patient that's refusing transport right now you have them sign a refusal. Sometimes I don't want to sign that. So now you can just video that and say, Hey, Geoff, I'd like you to acknowledge that you're refusing to be transported and treated by us against our medical advice. And then you say something like, yeah, I'm not going to the hospital. Perfect. Now you've got that recorded. So now we get into a whole nother thing of documentation. So one of the things that the E-bridge does already for Oakland and for you guys, is it also gives the hospital real life GPS tracking of that ambulance as it's in route that's not tracking on any other time like Big Brother. But when you send one of those alerts, it also says to the hospital, your eta and your tracking information. So they can literally sit and look at a computer screen and see that time of arrival updated every 15 seconds, just like you look at your Uber driver and seeing him come in. So now that also helps Doc's be able to say okay, well, they're 15 minutes out, I can finish what I'm doing before I go over there and wait. So it saves time for them that they're not standing around waiting for you to come in. Now they know when you're going to get there. And it gives alerts. So that documentation helps free these docs up sometimes like How many times have you heard a cardiologist call down to the ED from the cath lab that's been activated and go, Hey, we're waiting. Where are these guys? Well, they said they were 10 minutes out, and I'll call you an update. Now you don't have to do that, you know, when they won't arrive. But all of this information, as we've said, is about trying to quickly and easily get as much information as we can to people to be better prepared to transfer that patient once they get there and get them to the cath lab or CT or wherever they need to go. But then you got to think about the backside. One of the biggest advantages to this type of telehealth and one of the things our E-Bridge technology can do, it also has what's called D scribe x, that D scribe X Server now allows you to go back and pull any of this data if you ever want to pull back, you can go back and look and see how many STEMI alerts you got this week, how many trauma alerts, how many of them did you get EKGs from you can pull those EKGs later and look at them, you can go back and watch those live streaming video calls, playback those audio calls for QA, QI, billing purposes, litigation, whatever. So it's not just that we're helping you easier and faster, get information to people. But now we're giving you a really strong reporting tool on the backside so that you can go back and start to look. And when you start doing that, that's when you start finding ways to reduce those door to needle times. Well, why did it take so long to get this patient to the cath lab? Well, the doc didn't get the EKG in time or this didn't happen. So now you can go back and really do QA UI on that. Look at that. And if God forbid, if there was ever a litigation situation, they say, now it's no longer a he said, she said, Now the hospital has immediate access to that recording, they can go back and pull that and look at that later and really start to run those reports and look at those trends and those metrics.

Geoff Lassers: 33:16

Yeah, I like it, because I find it that it just provides more details to the layers of which the care that I provided, I consider myself to go out there and do the best that I can every day. And I try to follow as many protocols that I'm aware of the latest science that I'm aware of. And I always based on what I know today, that's what you're going to get the best of. And I feel like the more tools that can capture that in the moment only help the patient because it might capture something with the technology like this, it might transmit information to the hospital that I didn't realize I was transmitting directly, a lot of times they're basing on the words coming out of my mouth during an 800 or a cell phone. But when I'm sending pictures, even though I didn't mention the spidering of a windshield, they'll pick up on that deformity of a dashboard little nuances that may slip by my visual cortex during an incident that I might be dialed in and zoned in on a patient or two or three, and I might miss something. So the conveying of this information passively. It's a much wider hose, the volume of information is going through and it's also more precisely done. And it's very cool to think about the implications moving downstream as we really get more and more people involved. So Bonnie for our agencies that are currently in the E-coms study, what is it costing them time, money, resources, personnel.

Bonnie Kincaid: 34:30

So the medical control authority purchased E-Bridge so our providers do not have to pay for any service whatsoever. What they have to have on their end is a tablet, a phone, something a laptop, pretty much any kind of device to put the app on and then they communicate through that device. So if they have Wi Fi in the ambulance, they could use a tablet or a laptop and be able to hit the hospital every single time on a cell phone, they're gonna be using cell coverage. So that's kind of cool, too, you could actually take that into a house, you could take that out on a crash scene, whichever and be able to just automatically get right into the hospital. So really, the time and resources for the LSA is just that it's having that device and training them, which really takes about five minutes to show somebody how to do it. Now, you could go through the lecture that we provided on our website, which is probably about a half an hour, 20 minutes to half an hour. But you don't really have to do that you can and it shows you all the details. But you could just show somebody that is going out on their shift and say this is how you use this in less than five minutes. Most people are going to pick that up, especially anybody under the age 60, I would say would pick it up in about five minutes.

Geoff Lassers: 35:50

Yeah, let's be real here. We're talking about an app. Yep, we're talking about an app that communicates what I'm dealing with right now to a place and like every other app in the last 10 years, you put in very simple information that is very intuitive. And then you send it and a lot of times, I'm guessing, Randall, you tell me, you guys probably spend most of your time in r&d, figuring out how to make things Uber obvious and fireman proof, I mean, dummy proof and one of the same, right? Correct as when I'm allowed to say that. I'm sure that this is not so much the hurdle here isn't so much learning the tool so much as using the tool like any other tool and becoming very good at it, and just putting it into your practice. Now, I always tell people that like, Oh, it's a new device. And it's like, it's it goes on a cell phone, I go, do you even remember how your last cell phone work? That was a different model? No, because in two weeks, your brain is totally into the new one. And I'm willing to bet whatever cell phone or device you have, on your EMS rig, you probably have something like that at your house you use all the time. So this is not something that's very foreign to people, we're not teaching EKGs, or teaching how to tell the doctor or the ED that we're on the way and this is what we got. And we're doing it in a better way. So as a hospital, what type of investment Do I need to make as a hospital to be involved with this,

Bonnie Kincaid: 37:06

the hospital and they just have to have a Life device, they could use a computer, a Windows based computer, they could have that open, and then they get the notifications and the sounds and all the buttons and bells and whistles, they could use a tablet, an iPad or an Android tablet. And some hospitals, this is kind of cool. Some hospitals are putting it on their PC, and then also on cell phones for the docs to be able to answer it no matter where the docs are in the ED. So you don't need a doc to the radio anymore, the radio goes to the doc it's in his pocket or her pocket. That's the cool part. So we're just gonna keep building with this as we go along like baby steps, and then walk in and then running. And then the running part is also going to include disaster scenarios. We're going to try to do a disaster exercise this summer, if not by fall, and actually practice using ebridge. Once everybody's comfortable with it for an actual disaster, work through all those kinks so that we can actually use it talk unit, the unit seem to transport you name it in a disaster scene, what can we do? Where could we test it? How could we see if it'll fail or work or what we might have to do to make it better? So those are the things are coming up?

Geoff Lassers: 38:19

Very cool. So it sounds like we're have a very proactive approach to moving on to the next level of this isn't just adopting it, but then to expand its capabilities matching to our capabilities. Randall, did you have something?

Randall Hawkins: 38:29

Well, I was going to call it reiterate one of the things that Bonnie was talking about, as far as the ability to be able to get this information where it needs to go quickly, of course, we know is very important. But our company spends a lot of time on our research and development like you were speaking of Geoff, on one thing, making it simple, because we all know if it's a lot of buttons to click a lot of things to do, you're not going to use it. A lot of the EMS defibrillator monitors that are out there on the market today. Do you have the capability of putting that patient's name into that monitor before you capture that? 12? lead? Yes. Do people do it? No, why is not very easy to do. It's not very user friendly. Now, I'm not throwing water at any of the EMS defibrillator companies. But I'm just saying that's why people don't use it a lot. So we spend a lot of time on research and development on that particular thing. And to use the whole Southern phrase for you guys in Michigan, you know, we eat our own dog food. So we use this ourselves.

Geoff Lassers: 39:28

Southern phrases, dude, that's amazing. I don't know what that means. But I'm gonna say five times today to somebody.

Unknown: 39:34

So what that means is that we use it internally, ourselves. When I'm talking to my sales reps, I use E-bridge. I don't call them on the phone. When I'm sending them stuff. I send it to through E-bridge. So we use it ourselves every day so that we see kinks and things that come out. So I'm gonna give Bonnie a little kudos here. One of the new developments that we have been working on for about a year now was the ability for E-Bridge to do just audio only calls, not video and audio But just audio only. And we've never had a lot of people that really had enough interest in that to put it for front. So when Bonnie and them came to us, and they say we really want to kind of get away from radio as much as possible, and sometimes for most parts is going to be a radio call or a just a form, we said, okay, for you, we will put that first front and center. And we did so before they even went live with us. We already had developed that and open you guys are the ones that pushed us to do that. We did that for you now, not patting ourselves on the back. But just to say, we're very nimble in the fact that when people come to us and say, can we do this? Most likely, we probably can. But it's all about making it easy. And so the last thing I'll say when it comes to making it easy sometimes medic say to me, why don't want to have to put this information in here and turn around and have to re enter that information in my EMR. Am I doing double entry, what we try to do is like Bonnie and them are doing is keep that information, they're sending pre hospital to just a few clicks, put this boom, boom, boom, boom, send it thanks. 10-15 seconds. So that's not really re-entering. Because if you think about it, when you're giving all that report over the radio, in some ways that's double entry, because you're telling that whole story for three minutes, and then turning around and having to type it later, when you put in an EMR, we're just making that process even faster and easier. But we are cognitively you don't want to have to do double duty.

Geoff Lassers: 41:18

Fair enough. So it sounds like the only requirement to get into this, if I'm an agency is to have devices that I can actually download the apps. And if I am at the hospital level, it's really the same thing. So if I have the tools, and then I just need to teach myself how to use the app. That's it, right?

Bonnie Kincaid: 41:33

That is it, it's super easy. And you know, we've got a lot of people out there at different levels and stages and what they do and have. So we're working through some of the issues. And I think sometimes it's just like sometimes people want to fight it, because it's change. It's not that easy radio or the easy cell phone. So we're working through those, but mostly it's download an app, put it on, click the button, choose your hospital, send the notification done. Or if you need a call, you can do an audio call or video call. It's very, very user friendly, very simple. And I really do appreciate Randall that you guys went and did the audio call because we don't always need a video call. And that was really the only option before so now we have that audio availability, which is really, really nice.

Geoff Lassers: 42:20

Bonnie, Can people join this at any time? Let's say I'm an EMS coordinator for an agency. I'm so busy right now, I didn't even know this was going on. But one of my providers heard this podcast and like, hey, cap, can we get this? Can they jump in?

Bonnie Kincaid: 42:32

Yes, absolutely. We're taking agencies left and right. They just have to notify us and they want and we just asked them a couple questions. They send us that information. We get it over to GD, and they're in.

Geoff Lassers: 42:44

and who do they email?

Bonnie Kincaid: 42:45

they can email me or Robin. So Bonnie@ocmca.org or ems@ocmca.org.

Geoff Lassers: 42:50

We'll have that information in the episode description. Randall. Do you have any closing thoughts that you want to give to us?

Randall Hawkins: 42:55

Well, I think one of the things that I would like to at least mention is that as other services out there, think about coming into this, if you're concerned that this is going to be difficult to get signed up. No, just like Bonnie said, download the app. Bonnie's group the OCMCA will give you your secure username and login. So it's not like you're going to do something on your device, it's going to be saving information on your phone. So when these photos and videos, all these things that we were talking about, none of that information ever saves on the resident file manager or the photo gallery on the phone or the device that you're using. So don't worry about the security, HIPAA security ever, we have gone to great lengths to make sure that this is a completely HIPAA secure an FDA listed product.

Geoff Lassers: 43:39

Fantastic. Well, thank you very much for coming in today, Randall, I'm sure we're gonna have you back again in the future when we start to expand this thing more. And as I use it more at my agency, and we're just now starting to adopt it. I'm definitely going to have more questions. And I'm going to want to like I don't know, try to break it. Maybe that's just kind of what we do. For sure. I'm not the first person to say that to you from the fire service of let's see what this thing really can do. But thank you very much and have a great day.

Randall Hawkins: 44:02

Thank you very much.

Geoff Lassers: 44:05

That is all for the show today, everybody. Thank you for listening. Thank you to Randall Hawkins for coming by today and spreading your knowledge. We're gonna have you back here real soon. Please keep emailing your questions, comments, feedback and episode ideas to the EMS on AIR podcast team by email at QI@ocmca.org. Also check out our updated website emsonair.com for the latest information podcast episodes and other details. Follow us on Instagram @emsonair and please whatever podcast platform you're listening to right now. Subscribe to our podcast and leave us a rating and review. It would really be nice if you did that. Thank you. Thank you for listening to the EMS on AIR podcast. Stay safe and have a great day.