Digital Workspace

EMS Agencies Turn to Tablets to Meet Challenges in the Field

Mobile devices help technicians render medical care, track cases and capture photos and videos.

Twitter

Calvin Hennick is a freelance journalist who specializes in business and technology writing. He is a contributor to the CDW family of technology magazines.

Houston first responders field about 800,000 calls to their 911 center annually and cover an area of more than 600 square miles, making it critically important for the city to use vehicles and personnel as efficiently as possible. But, like most fire and emergency medical service agencies, the Houston Fire Department is bogged down with nonemergency calls.

The city tried a few different approaches to solve the problem, but those efforts still resulted in ambulance transport for most nonemergency calls. Then, in 2014, the city rolled out the Emergency TeleHealth and Navigation (ETHAN) Project, a first-of-its-kind collaboration among Houston and several tech companies. The result is an on-the-spot triage system powered by mobile devices and 4G connectivity.

The use of tablets in EMS was relatively new when Houston deployed the Panasonic FZ-G1 Toughpad to support ETHAN, but departments today increasingly rely on the devices to support an array of applications ranging from telemedicine and patient charting to drone piloting.

“The value of a tablet for patient reports is that you can take it out of the vehicle and fill in that information as you’re talking to the patient,” says Matt Hinds-Aldrich, program manager for data and analytics at the National Fire Protection Association. “And although laptops and tablets both have their merits, some departments prefer tablets because they can often buy three devices with protective cases for the price of one ruggedized laptop.”

Houston Saves Time and Money with Tablets and Telehealth

Today, Houston EMS professionals use the ETHAN system thousands of times per year, saving the city millions of dollars in the process.

“Really, there are multiple benefits,” says Dr. Michael Gonzalez, ETHAN Project program director and associate medical director for the Houston Fire Department. “We avoid ambulance transports when they’re not medically necessary, and that saves either the patients or their payer significant money. From a larger perspective, we’re trying to save the overall healthcare system money. And we really wanted to make our operations more efficient, so we can respond to emergencies faster and better.”

We’ve had almost every major city in Texas come through with the idea of trying to do something similar. So the idea is definitely catching on.”

Dr. Michael Gonzalez ETHAN Project Program Director, Houston Fire Department

When Houston first responders suspect that a patient may not require an ambulance transport, they can initiate an ETHAN call on a Toughpad, using 4G connectivity and Cisco Jabber to communicate directly with an emergency physician.

The doctor can assess the patient’s symptoms remotely and can even schedule a clinic appointment and taxi ride for the patient if an ambulance ride isn’t necessary. Most ETHAN calls result in alternatives to ambulance transport, saving hundreds of dollars per call and getting Houston’s first responders back in action more quickly.

“We’ve had almost every major city in Texas come through with the idea of trying to do something similar,” Gonzalez says. “So the idea is definitely catching on.”

First Responders Use Tablets to Gather and Transmit Information

The Sherborn Fire Department, in the Boston suburbs, deployed tablets as a way to meet a state mandate requiring first responders to capture patient information electronically. At first, the department rolled out a single ruggedized laptop for the entire department. But that solution was expensive, and it required first responders to pass the device around to gather information from multiple people — slowing down incident response.

About three years ago, Sherborn switched to Microsoft Surface Pro tablets with ruggedized cases, eventually rolling out four of the devices. “Tablets are more scalable,” says Lt. Klaus Ullmann, a firefighter and emergency medical technician with the department. “Now, each one of our crew members can gather information from multiple people simultaneously.”

In Berkeley County, W. Va., officials have deployed about 150 Durabook R11 tablets to police, fire and EMS vehicles. Like Sherborn, Berkeley County is using the tablets for mobile charting. But the devices also interface with the county’s 911 system, and first responders can see dispatchers’ call notes on the tablets in real time, helping them to better prepare for incidents.

89%

The portion of emergency medicine physicians who say they are willing to use telehealth solutions

Source: American Well, Telehealth Index: 2019 Physician Survey, April 2019

“Before, they may have waited 30 seconds or up to a minute before they got the call from dispatch,” says Gary Wine, IT director for the county. “Now, the responders are saying, ‘We’re getting out the door quicker because we know what we’re dealing with instantly.’”

Both Sherborn and Berkeley County are exploring additional ways to leverage their tablets. In Sherborn, officials are encouraging first responders to use their tablets to take photographs of traffic accident scenes. And Berkeley County is starting to use tablets for other government offices, helping to reduce paper use for public meetings and equipping inspection teams with the devices. Wine says he hopes that tablets will add even more value when the county eventually has access to Next Generation 9-1-1, which allows callers to send text messages, photos and videos.

“If we receive a video of a fire or other emergency, that video could be passed right to the tablet in the ambulance,” Wine says.

EMS Agencies Need to Solve IT Challenges with Tablets

New devices require maintenance and support, and first responders don’t have time to troubleshoot connectivity problems when they’re responding to calls.

“Anytime you increase the number of devices you have, you’re increasing your IT workload,” Ullmann says. He notes that his department had to purchase anti-malware solutions to protect data and applications, in addition to the patient record software.

Berkeley County uses software from NetMotion that helps to create a persistent connection between its dispatch center and first responders’ tablets. If a 4G connection is temporarily dropped, the solution ensures that data resumes flowing as soon as possible. As a result, Wine says, first responders usually can’t even tell when their tablets briefly lose connectivity during a response call.

In Houston, the rear-facing speakers on the Toughpads occasionally make it difficult to hear physicians, and the city has used Bluetooth-enabled speakers and headsets to solve the problem.

Gonzalez notes that there aren’t currently any off-the-shelf solutions that replicate ETHAN’s functionality. However, he says, individual departments — or even tech vendors — could design their own solutions that build off Houston’s work.

“If I’m a municipality and I say, ‘I want to do this,’ there isn’t anybody that I know of who can just implement it and turn it on next week. To me, there’s no reason that can’t be done. So, I think there’s plenty of room for innovation out there, especially because a lot of the technical challenges have already been solved,” he says.

Emergency Telehealth Tech Delivers Real Results

A team of researchers writing in the Journal of Emergency Medical Services (JEMS) in April found that Houston’s ETHAN Project has already saved the city millions of dollars, and recommended that other metropolitan EMS agencies adopt similar initiatives.

Nationally, EMS workers respond to nearly 40 million incidents per year. Between 20 and 40 percent of EMS incidents aren’t urgent and could be more effectively managed in a primary-care setting.
More than 60 percent of all healthcare institutions use telehealth.
Houston EMS workers utilized telehealth nearly 20,000 times over a four-year period, resulting in a substantial reduction in incidents requiring ambulance transport — from a baseline of around 50 percent to under 12 percent.
On average, ETHAN calls resulted in a time savings of 47.7 minutes, compared with usual care.
ETHAN calls saved an average of $229.69 in direct costs per patient interaction.
Over four years, ETHAN saved Houston approximately $4.7 million.