Here’s a sketch of the new EMSNY uniform patch. Details should be finalized early June 2014.
In a stunning move, today FDNY formally announced they are changing their agency name to EMSNY. This move comes in light of agency audits conducted of FDNY’s call statistics dating back more than two decades. For example, just in February 2014, FDNY ran 4,609 structure and non-structure fire calls, but ran 15,167 medical emergencies (grand total of 38,188 calls)* (330% more than fire calls). FDNY’s EMS division, however, ran 110,154 ambulance calls in February 2014**. (Editor comment: please note the enormous disparity in call volumes for fire suppression and non-medical – 20%, versus medical calls – 80%.) This is a typical monthly example.
FDNY’s Interim EMS Chief, Phil Anselmo, says this name change has been considered for the last three years, but has been put off due to the expense of changing station shirts, patches, and stationary. “Really, this should have happened years ago, as FDNY has run more significantly EMS calls than fire for the last two decades. You know the old adage, ‘150 years of tradition, unimpeded by progress.’”
While the FDNY’s ambulance drivers are lauding the decision which they believe shines a bright light on the department’s most significant investment of time and labor, not everyone is pleased with this bold move. Firefighter/Engineer Terry Glaze believes this will remove firefighters from the limelight. “I have over 25 t-shirts with flames and bulldogs, and my favorite one is ‘Find ‘Em Hot and Leave ‘Em Wet‘. I’ll have to replace them as they won’t be authorized under the new uniform standards,” says Glaze. To pad the egos of the single-function firefighters who may not fully embrace this long-overdue change, the department will allow blue EMS-themed t-shirts that feature the grim reaper, blue flames, and skulls, and references to “cheating death”.
Union vice chairman David Peacock is expected to file grievances against FDNY EMSNY and are considering filing for legal protection of the FDNY department name. As the case is ongoing, no comments were offered by the Union.
Ambulance driver Donnie Hart hopes the city will start spending less money on suppression apparatus and more money on better ambulances. “Honestly, who spends 3/4 of a million bucks on a fire truck? I could buy, like, 10 ambulances for that!”
*** – Legal disclaimers: This post is a spoof article on honor of 01 April 2014. The names used in this article are not intended to reflect actual staff of the FDNY EMSNY. Names and likenesses are purely coincidental, even though they do accurately resemble men known to sport big hair in the 1980′s. If you believe that the nation’s largest fire department, a.k.a. New York’s Bravest, would actually change their agency’s name to reflect the significant majority of work they actually perform, you should consider seeking counseling and researching the word, “gullible” (I hear if you say that word slowly, it sounds like “oranges”). No part of this article should be construed to imply that the author does not appreciate the fine work firefighters perform all over the world everyday and the value they bring in support of the EMS mission. The author himself has even been a firefighter in the distant past. The article is intended to bring light to the dark side of the fire service, gollum.
I read an article today in the DAV (Disabled American Veterans) magazine about “Life’s Parachutes”, a story about Charles Plumb, a Naval Fighter Pilot shot down over Vietnam and was subsequently a POW for six years. Plumb was back in the US dining with his wife at a restaurant when a man walked up to him and said, “You’re Plumb. You flew jet fighters in Vietnam from the aircraft carrier Kitty Hawk. You were shot down.” The man who approached Plumb said he packed Plumb’s parachute. You can imagine Plumb’s gratitude.
This story made me think of how we often take our vehicle stock techs and maintenance staff for granted. They’re packing our parachutes every day so we can go out on our missions to provide EMS to the communities we serve. Their ability to do their jobs correctly and completely ensure we aren’t doing a disservice to our communities or putting us at liability for abandonment or failure to provide adequate care to our patients.
I had a significant problem with some supply techs at a previous employer, and was burned a few times, having LSB’s with incomplete straps (when it was still acceptable to use them for all manner of trauma patients), missing a pedi BVM from the cabinet on a traumatic arrest peds (I had my second in the peds bag, but that cost me time to ventilation), etc. I worked with the logistics manager for several months to refine the restock process, implementing a QA process and shrink-wrapped bins through a supply-line, and one of the goals was to ensure every unit in the fleet of 43 ambulances was identically configured for consistency. I got a lot of flack from management for leaving the HQ over an hour late every shift for several months (no overtime was allowed so I couldn’t come in early to complete my checks) as I checked every single piece of equipment and inventoried the entire unit, but there were failures and missing items every day. I made a deal that if my unit was perfect every day for two weeks, I would leave on time and perform my checks in the field on my downtime, but not until then as it was my license on the line. No one would come back to a logistics manager or supply tech and tell them they couldn’t practice supplying anymore, but I could be held liable by the state for failures or missing equipment, and I wouldn’t live with causing harm or not being able to help my patient due to a problem. I still opened every single shrink-wrapped bin (much to the chagrin of supply and management) for another two weeks until I was comfortable with results of the new process, but eventually, I didn’t even need to do that anymore. The deal worked and I never had another supply problem at that agency. It took time to trust, but eventually, I trusted my parachute to open every time without fail and it did. I don’t work for the agency anymore, but I still keep in contact with a few of the supply techs and supervisors. They aren’t nameless, faceless, automatons. Many of them would later move on to becoming field providers there or at another agency. I never made friends with the fleet people, but I didn’t cause them any trouble and when I had an issue, they took it seriously and fixed it the best they could, and I’d like to believe it was due to some mutual respect.
Plumb delivers speeches and presentations now and one of his questions to his audience is, “Who’s packing your parachute?”
I just got word that the Figure 1 app that was previously only available for iOS is now available for Android. I now have an account, and if you happen to be one of the first 1,000 to sign up for a free account, you are in the mix for a $25 Google Play gift card.
Figure 1 is like Instagram, but for healthcare professionals. You can crowdsource a photo to see if you can come up with a probable diagnosis, say for something like a skin rash, or use the app as a way to share a rare encounter with a medical condition. I have seen radiology films and quick smartphone snapshots uploaded through the app. I expect to see a lot of images of dislocations, avulsions, amputations, obvious fractures, rashes, and more.
The Figure 1 apps could also be a great teaching tool to support anatomy and physiology lectures.
You can register for a free account right from the app, and if you are also a presently licensed physician, you can have your account verified. If you are a Paramedic, you should choose “Other Healthcare Professional” and scroll down to “Paramedic”.
If you happen to grab the app, sign up for an account, and connect with Figure 1 on social media (Twitter and Facebook), please let them know that The Unwired Medic pointed you their way.
I have been more than busy with working at three jobs and going back to school to get my Bachelor’s Degree in IT, so I am sorry I haven’t posted much on my blog or social media sites. I’m making a diligent effort to get back into posting regularly. This time, I haven’t had the occasion to test any new apps or equipment, but I have come across a few tech articles that I think are worth mentioning. Be safe out there!
Health data on your smartphone:
Samsung and Cigna are partnering to harness the broad base of users on the Samsung S Health platform (announced on October 28th, 2013). Apparently, when used on the Galaxy S4, the S Health app has the ability to monitor activity, ambient temp and humidity, and allows you to log your food and exercise activity, which for now sounds just like what you can do with apps like Edomondo and others, but it will allow partnering with many other devices, probably like the Samsung Body Scale, a heart rate monitor, probably a pedometer or FitBit, glucometers, blood pressure cuffs, etc., in an effort to bring telemedicine to a cell phone. I hope to be able to bring you much more on this as my full-time job is expecting to replace my iPhone 4S with a Galaxy Note 3 in the next couple of weeks to upgrade me to 4G and a better platform to administrate the Critical Incident Management System (CIMS) I’m in charge of. From what I’ve found, it too will include access to the S Health app. Unfortunately, the price of the Galaxy Gear smartwatch is too high for me to pick up as an accessory, though I’m sure the S Health app will use data retrieved from it too.
From time to time, I write professionally for iMedicalApps.com, providing special project articles on EMS-relevant technology or apps, but I’m not linking to any of my own articles in this post. Instead, I’d like to show you some of the neat things their regular writing staff have come across and evaluated that may be of use to us in the prehospital care arena, and maybe also for some of you branching into Community Paramedicine. Caveat: Not every app or device is free…
Apple is waving the victory banner over the tremendous amount of users who have upgraded their devices to iOS7 or have bought the new iPhone 5c and 5s with iOS7. Truly they have achieved success, but because of that success, they are the target of those who would hack and compromise the security of their devices and software.
Application security vendor, Cenzic, has discovered a flaw that allows a person to access a locked device without the password using Siri to send Facebook messages posing as the device owner. They have also been able to text, e-mail, and access contacts. The flaws also exist in iOS6, but apparently to a more limited extent. They recommend disabling Siri until Apple fixes the compromised code.
You just made a new contact at the conference. Great! Networking in action! It helps you to find a new job, learn about a new product or training, or catch up with a colleague from years past. Now how are you going to remember their info to get ahold of them later? Yep, they gave you yet another business card. You drop that in the free promotional materials bag right next to the 200 others that are probably meaningless. How in the world are you expected to keep track of all these things? You could write a note on the back of the card. Like so many others’ cards, my cards are UV coated on both sides, so you’ll need a Sharpie. If you have one, my background graphics don’t facilitate legibility. So, this tactic may not work right in all cases.
As for myself, I like to digitize the card. If it’s a routine card exchange, I drop it in the bag and scan it that night when I have a chance to lay out my promo materials and books, and I’m recapping the day. If I think it is really important, I make sure to scan it right away. I’m a geek! When I do that, I leave an impression on the person that I get the card from. Usually, they stop what they are doing or talking about and ask me about what I’m doing. I reply that their info is important and I don’t want it lost in the shuffle, so I’m scanning it. They ask me what I’m using, how did I find the app, and is there one for their smartphone platform. I believe it even adds to my credibility as a customer, information seeker, or colleague as I’m ensuring I don’t lose their contact info. Finally, I , like most other EMS’ers out there, don’t have a bundle of cashola laying around for me to buy every hip device and slick app on the market, so I look for free apps. Sometimes that means “ad-supported”, but I can live with that.
Are there any apps that works across multiple smartphone platforms?
In a word… yes. There are two I found on multiple platforms.
CamCard Free: It’s one I have less experience using, so I’m not terribly sure about all it has to offer… yet. I have signed up for an account and am working on using it’s features, including one called an “AR Card”, which is their specialized digital business card, which can include images of your traditional business card, front and back, but it also can include digital multimedia so you can deliver a custom audio and/or video message to your card viewers. It’s called CamCard by IntSig. I found it on Blackberry, Android, and iPhone. Curiously, they offer it for Windows 8 and RT on their website, but not for Windows Phones [scratches head]. A simple search on the Windows Phone Marketplace revealed it was available and I got it for my Windows Phone 7, so I’m sure it will also work on Windows Phone 8. I guess CamCard’s folks just overlooked adding a link to that app to their website.
Yolu Card Reader: I think it has a few less features than the CamCard Free app, but it is still a decent app overall. It doesn’t support more than 20 languages like some apps, but it does support English, Chinese, and Japanese. It offers two-sided card scanning, as with CamCard. Other features include the ability to drag-and-drop cards between groups and to sync to the cloud backup service in real-time. I also think the interface is easy to navigate and refined, and you can create a digital business card in the app. It’s available on Android, iPhone, and even Windows Phone 8 (sorry Windows Phone 7 users).
What’s available for Android?
Many apps are available for Android. I found only one other than Yolu and CamCard that I thought was worthwhile:
CardToContact Card Reader:https://play.google.com/store/apps/details?id=com.akhmallc.andrd.bizcard
What I like about this card scanning app is that you can select the e-mail account you want to synchronize with, whether it is Outlook or GMail or another account, you can export a card to .vcf format, backup and restore cards across multiple devices, and you can do it in one of 20 languages. Although they don’t offer cloud synchronization through their own services yet, they anticipate releasing that feature soon. Presently, it appears you can save the file to your device or a memory card, so you may even be able to select the file and sync it to Dropbox, SugarSync, or SkyDrive. The app has an easy to navigate, well-laid out interface.
Apps for the iPhone?
I have to say the best app I found for collecting business cards digitally is CardMunch by LinkedIn:http://www.cardmunch.com/
It really is a shame this isn’t available for the Android or any other platforms. I have used this app for a year and a half on my iPhone and one of its instant appeals is that unlike MANY other iPhone apps I found for business card collection and scanning, it didn’t have a limit to the number of cards you could scan and save per week. Additionally, after your card is scanned and uploaded to the LinkedIn service, it is cross-checked against the LinkedIn user database and if the card matches to someone on LinkedIn, you are offered a chance to connect with them. I first used this feature at the WebEOC User Conference in Denver in 2012 and it helped me to connect to several of the presenters and people who were willing to mentor me and share their ideas and status boards. If I were job hunting or trying to connect professionally to anyone with whom I exchanged cards, this tool would have to be my most highly recommended. The only drawbacks to this service and app are that it doesn’t offer two-sided card scanning, and processing (OCR or optical character recognition, which is what scans and “reads” the image for text) is not performed on the device at all, so you must have a connection to the internet. It’s a minor issue for me. I’ll continue to happily use the app as long as I have an iPhone (my work is supposed to replace it with an Android phone soon).
Evernote Hello:https://itunes.apple.com/US/app/id484359282?mt=8&ign-mpt=uo%3D4 So there I was, thinking how cool it would be to make one of my BS-IT programming projects into a card scanning app for Evernote, but someone thought about it long before I did. Check out Evernote to be your all-in-one notes taking, organization tool, that now manages contacts.
How about other platforms?
I didn’t find anything else on a simple search of the Windows Phone Marketplace, but I did find one more free app on the BlackBerry World app store, called Business Cards for Blackberry 10:http://appworld.blackberry.com/webstore/content/20399554/?countrycode=US, but since I neither own nor have access to a BlackBerry 10, I can’t tell you anything about the app.
I don’t worry so much about collecting dozens of cards at conferences or national trainings I attend any longer. I accept and even exchange cards, then I snap a photo of their card, I write a note or two in the notes section of the contact card that is generated on my smartphone, I categorize it, and I move on. I hope one of these apps proves to be as beneficial to you as they have been to me!
It is the IT (information Technology) of the medical field. Your standard geek (term used affectionately) with a couple basic Microsoft and CompTIA certifications managing your health information, electronic patient care records (ePCR’s), and medical billing probably isn’t good enough any longer if you want to meet the standard acceptable qualifications. No one is going to come knock on your agency’s door and demand you upgrade your IT department’s qualifications, but, really, you want someone who knows the intrinsic requirements of healthcare-related information management (including knowledge of HIPAA). You’ll want someone who has, at the minimum, training in Health Information Management (HIM). There are accredited programs that help set a baseline of core knowledge to be considered a health information manager. You can learn about what academic programs are accredited here at CAHIIM: http://www.cahiim.org/accredpgms.asp. CompTIA also has created a certification for Healthcare IT Technicians for what they and their members feel is a minimum standard of proficiency for IT techs. You can learn more about that here: http://certification.comptia.org/getCertified/certifications/hittech.aspx
This job field is already obviously growing and analysts predict it will grow very quickly in the coming few years. In recent searches, I have found nearly every hospital with IT openings is looking for someone with HIM qualifications, plus the feds are too, especially at the Bureau of Prisons (BOP) and the VA medical centers.
If you want a quick overview of what Health Information Management is all about, take a look at the following infographic from the U of Illinois, Chicago:
The infographic links back to the UIC website, but they did not sponsor this post and have no affiliation with The Unwired Medic.
My esteemed colleague, Greg Friese, has drawn my attention to an article about a new partnership for augmented reality and CPR with an app called CPRGlass. He posed a question to me, asking what benefit I would see in using Google Glass in EMS. I immediately started running all the scenarios in my mind that I had been thinking about over the last few months since I had heard of this consumer-grade device.
Google Glass isn’t the first viable wearable computer:
The past two years of the Consumer Electronics Show (CES) in Las Vegas, I have visited the Verizon booth and demo’ed two headset computers with camera systems and strictly voice interaction. Like Google Glass, these don’t actually have cell phone WiFi capability, but would rely on you connecting to a WiFi hotspot or via Bluetooth to your 4G smartphone. This is great, since we don’t want the EF radiation from a cell phone right on our heads (unrealized risks of cancer, and all). These systems were designed with the military and public safety in mind, and they are considerably more robust (technically and physically) and expensive than consumer-oriented Google Glass. I tried out two different wearable computers… the Kopin Golden-i (from CES2012) and the Motorola HC1 Wearable Computer (from CES2013), which I am told by the Motorola and Verizon reps is a later evolution of the Golden-i. The Golden-i was the device I was most excited about due to its lighter weight, and it has undergone a couple revisions to make it less military and more industrial, although both models were fantastic and have great potential in public safety and telemedicine. Both models even had interchangeable cameras, so you could switch to thermal imaging and add a second camera type to adapt the system to the mission.
Back to the point:
Well, Google Glass in EMS is the subject of this blog post, so let me get back to it. What uses can I envision for Google Glass in EMS? Let’s start with making it use an app like a HUD for driving in the ambulance to a call or to transport a patient to an ER. One of the distractors we face in EMS is having to navigate to a call or hospital while driving, sometimes without the assistance of a crew member in the passenger seat. Why not feed a GPS map or CAD info into Glass and have it route you without having to take your eyes away from the road? Every second spent looking down at an MDT or tablet, or even a GPS unit is another second you aren’t watching the road for dangers. You can have the vehicle feed info to your eyes to let you know your current speed and compass direction or GPS coordinates (useful when requesting a medevac) or have a smartphone feed GPS data when trying to arrive on foot to a SAR operation. If your agency is tech and safety savvy, then maybe they’re outfitting your rigs with vehicle-mounted FLIR, thermal imaging, or night vision cameras, so that video feed can be piped directly into the headset.
Google Glass Explorer – image by Google
What about arrival on scene?
You walk in to a residence and you see medication bottles scattered everywhere. Why not tell Google Glass to use its camera to catalog the meds. With a simple voice command, you can tell it to capture as you look at each bottle label. That data is then scanned with OCR (optical character recognition – which “reads” the image for text) and adds the Rx to your ePCR (electronic patient care report) under patient meds. You then issue a voice command to cross reference the meds for interactions and discover that two of the meds have serious interaction potential and it wouldn’t have necessarily been caught by the pharmacist, since the meds came from two completely different pharmacy chains. You then locate the patient’s ID and insurance cards and they are captured and uploaded into the ePCR too. You may have just saved hundreds of keystrokes, not to mention the time it would take to input this info. You could also dictate your report narrative to Glass and it could add the text into the ePCR.
Let’s say you are quite a way from your trauma center and you have a vehicle collision with rollover and known ejection. You can start streaming scene footage to the trauma center as you pull up on scene. The trauma team now sees the MOI and extent of damage to the vehicle and where the patient is located in relation to the vehicle. They’ll see your assessment. You can consult right over the air with your trauma surgeon and decide if a trauma team activation is warranted. The team will see all your vitals and interventions. The doctor can provide online medical control. While you were walking around scene, maybe the vehicles’ license plates were captured and their data is being retrieved to help identify potential victims and cross reference that info with previous patient records.
You could use the imaging to collect info about a potential hazmat scene or MCI and have the data relayed back to your communications center or PSAP, so they can put resources on standby and provide the data to the incident commander for up-to-the-minute situation reports.
Glass can give an IC a chance to view sitreps, stream a scene flyover with a drone, track accountability, access WebEOC and other critical incident management systems (CIMS), view CAD data, track patients and triage statuses, see hospital bed availability, and much more.
Connecting it with other technologies and devices:
Modern digital cameras can see into the IR spectrum. It might not be as intensely as a dedicated IR camera, but it can still see into the IR range (try looking at a TV remote control with your cell phone camera as you push buttons on the remote and you should see the LED in the front of the remote illuminate or flicker). Maybe switching to an IR filter would alert you to a dangerous hotspot. The Golden-i and HC1 had an interchangeable camera that had a military/law enforcement-grade spec that would allow thermal imaging and IR to see through residential walls, light barriers, and even vehicle doors. This could alert you to the presence of safety risks (aggressors, fires, IED’s) and unrecognized patients, like the person who was ejected and is out of human visual range. There is even a functional project to detect radiation via Android and iOS smartphone cameras.
Then, Glass could be tethered via Bluetooth or short range WiFi to communicate with hazmat sensors, and when a dangerous level is detected, like carbon monoxide for instance, it would send an alert to Glass. Many defib/monitors have Bluetooth capability today, so Glass could receive a 12-lead, or flash an alert when a lethal dysrhythmia, ST segment changes, or out-of-range vital signs parameter is detected.
On the educational front:
Google Glass can capture and stream video and audio of EMS interns going through scenarios. Using this tool, an instructor can review the call to provide guidance and both positive and negative feedback to the intern so they can grow into a better practitioner. Other interns can critique the call and provide team feedback. The camera goes wherever the intern is looking. Maybe they never looked at a very crucial part of the scene or patient, so they were on the wrong track or suffered from tunnel vision. You can use this to teach them to use more situational awareness or to be aware of tunnel vision when assessing a patient.
I’ve even considered the likelihood of having the instructor wear it to control simulation aids like technology-enabled manikins. That seems less likely as the instructor would have to speak the next action the manikin or sim would take, alerting the interns to what they would need to watch for next.
We’re in a sort-of Star Trek generation. Things that sci-fi has been speculating on for decades are becoming a reality today. This is a fantastic opportunity to expand the role of technology in EMS and frontline medicine. I know many are opposed to the idea of adding even more tech into what we do, but it still doesn’t replace the human practitioner. Nothing should ever replace the human element. What tech does is it provides more tools to get the job done with more comprehensive data and sensory feedback, and it improves the possibility of a better outcome for our patients, and I’m all for that. Maybe next, we’ll be beaming our patients to the ER (or more likely, the ER triage waiting room).
I’d love to hear what you think about the possibilities Google Glass presents for us, and even tell me if you are against the idea of using it and why. Tell me in the comments, or write your own blog post and link to mine. Thanks for reading and considering!
Other Articles on Google Glass in EMS or medicine:
From time to time, I will post a “Mutual Aid Requested” article, where I link to an article on someone else’s blog or website that I found useful for public safety and/or Emergency Medical Services.
Here is a wonderful educational asset I came across today. “Figure 1″ is a photo sharing app, like Instagram for example, but it is strictly for medical images. As an EMS Educator myself, I often find it difficult to get images to add to my presentations and I know having access to this as I was mentoring Paramedic Interns would have been a boon to the teaching process. This app is currently for iOS devices only and it costs nothing. Rather than rewrite the entire article, I’d like to point you over to the article at iMedicalApps.com, here: http://www.imedicalapps.com/2013/07/figure-1-app-review-instagram-physicians/
Figure 1 is working on developing for other platforms and if you visit their website at www.figure1.com and you go to the contact page, you can submit your e-mail address, country, and device platform (Android, Windows Phone, Blackberry, etc.) to be notified when other releases are ready.
Incidentally, in case you haven’t heard the good news, I am now a part-time professional blogger with iMedicalApps.com, so check the site out from time to time, and you might see an article by me. As a disclaimer, I’m not being compensated to bring you any articles hosted on the iMedicalApps.com site, but if I do find something of benefit to public safety and emergency medicine, I’ll be sure to bring it to your attention here at The Unwired Medic.
“If you look in the dictionary, under (insert term, expletive, or insult here), you’ll see (his/her) picture.”
Wouldn’t it be cool to have a website that allows you to upload said person’s photo to that term and have it be viewable by a link you can share? You could enter the term to be defined, place an image and caption it with their name, and write your own definition or use a canned one.
My first nominations would go to Kelly Grayson under “ambulance driver” and “redneck” (terms used endearingly, of course). Maybe next would be Greg Friese under “bookworm” and “educationophile”.
Anyone you’d care to nominate? Share the term and person. Maybe your favorite public safety blogger or EMSBlogs.com personality?