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1 Pennsylvania Data Analysis and Strategy Development for Improving Emergency Response to Rural Highway Trauma Emergency Medical Services Office Peggy Trimble, Director (717) ECC b.ppt (1)
2 MOTIVE EMS is faced with many challenges... challenges that, in part, can be met with use of advanced technology But technology is rapidly advancing and its hard to decide what to choose and how to implement it One goal of the State EMS Office is assisting regions to employ technology in a sensible and reasonable way ECC b.ppt (2)
3 EMS STRATEGIC PLAN Key elements of the strategic plan included to specifically address advanced technologies Section II-EMS Research Section VIII-Communications Section XIII-Information ECC b.ppt (3)
4 PROJECT TASKING Study EMS pre-hospital trip report data Identify concepts for use of technology Provide recommendations for potential benefit statewide ECC b.ppt (4)
5 THE PENNSYLVANIA RURAL HIGHWAY TRAUMA PROJECT Joint project between Penn State University s Applied Research Laboratory, Penn State Geisinger Health System, Pennsylvania Department of Health, and the The Pennsylvania Department of Transportation to Develop in-depth event scenarios for rural highway trauma Determine how limited dollars and resources can best be used to maximize benefits and reduce risks Conduct field trials Implement strategies where/if feasible ECC b.ppt (5)
6 WHAT IS RURAL According to the most recent census, Pennsylvania has the nation s largest rural population with over 3.6 million residents or 31% of it s population considered rural. 42 of Pennsylvania s counties are considered to be rural. Both municipal and county level definitions, developed by the U.S. Census Bureau, have been adopted to determine rural areas At the municipal level, rural is defined as a municipality that is less than 50% urbanized. An urbanized area consist of a central city/cities of a metropolitan area and the densely settled areas surrounding them. At the county level, rural is defined as a place with a population less than 2500 and not contiguous to a built-up urbanized area. If 50% of the residents in the county fit this description, the county is considered to be predominately rural. ECC b.ppt (6)
7 WHY IS RURAL HIGHWAY TRAUMA AN ISSUE There is increased risk to the victim due to several factors: Time to initial accident discovery Slower dispatching procedures Longer response times Fewer medical facilities Lower level of medical care ECC b.ppt (7)
8 KEY ELEMENT AREAS OF RURAL HIGHWAY TRAUMA Crash Discovery and Response Notification Identification Verification Location Response Medical Intervention Assessment Diagnosis Stabilization Treatment Transport ECC b.ppt (8)
9 RURAL HIGHWAY CRASH RESPONSE SCENARIO Pre-Crash Pre-Crash READINESS TRAINING PROTOCOLS Crash Crash Notification Notification DETECTION IDENTIFICATION COMMUNICATION Crash Crash Response Response DECISION MAKING DISPATCH MONITORING Crash Crash Scene Scene Management Management Tiage/Treatment ASSESSMENT COMMAND/CONTROL Medical Transport Medical Transport TELEMEDICINE ENROUTE GUIDANCE Hospital Treatment Time INFORMATION TRANSFER Readiness Training Protocols Detection Identification Communication Decision Dispatch Monitoring Assessment Command/ Control Telemedicine EnrouteGuidance Information Transfer ECC b.ppt (9)
10 TECHNOLOGY IMPACT ON RURAL HIGHWAY TRAUMA Technologies can play a role in addressing risk areas but it is uncertain as to exactly how Already being investigated Untapped area Most efforts to date have addressed early portion of the crash response scenario Travelers advisory systems Crash avoidance systems Mayday systems Less attention has been given to the remaining portions of the scenario Enhanced communications and decision making Selective use of assistive technologies for assessment and treatment Rapid victim transportation Telemedicine ECC b.ppt (10)
11 PROJECT METHODOLOGIES A detailed understanding of rural highway trauma response events and activities is necessary in order to determine how improvements in emergency response can be made... Existing data sources provide foundational information Pennsylvania Department of Health EMS trip reports PSAP/911 Center service request cards Pennsylvania State Police accident reports Penn State Geisinger trauma treatment reports Minimal information available on specifics of crash scene management and medical transport Arrival...departure...arrival times No reporting requirements Difficult to measure due to emergency event dynamics ECC b.ppt (11)
12 PENNSYLVANIA EMS PRE-HOSPITAL TRIP REPORT Established by legislation in 1985 and activated in Required for all EMS emergency responses. Collected by 16 EMS regions and forwarded to the PA DOH. 45 primary fields and over 200 sub-fields are queried. Over 1 million reports of vehicular accidents received since Over 455,000 reports of vehicular accidents recovered from ECC b.ppt (12)
13 PENNSYLVANIA REGIONAL EMERGENCY MEDICAL SERVICES COUNCILS ECC b.ppt (13)
14 ECC b.ppt (14) EMERGENCY MEDICAL SERVICES
15 ECC b.ppt (15) EMERGENCY MEDICAL SERVICES
16 ECC b.ppt (16) EMERGENCY MEDICAL SERVICES
17 A COMPARISON OF STATE, REGIONAL, & SEVERE RURAL HIGHWAY TRAUMA EVENT SCENARIOS Minutes Notification Response Scene Management Medical Transport ECC b.ppt (17)
18 ANALYSIS OF 10 SEVERE RURAL HIGHWAY ACCIDENTS IN CENTRAL PENNSYLVANIA REGION RESPONSE Notification 5 minutes Responding - 13 Minutes On Scene - 32 Minutes Transport to Medical Facility - 19 Minutes 70 Minutes THE GOLDEN HOUR 60 Minutes Time from Dispatch to Response Time from Response to Scene Time On Scene Time from Scene to Medical Facility Mean Time from Dispatch to Medical Facility 5 Minutes 13 Minutes 32 Minutes 19 Minutes 70 Minutes ECC b.ppt (18)
19 ECC b.ppt (19) Notification 1 minute Dispatch 1 minute Response 2 minutes Travel Time to Scene 6 minutes 11:25 11:30 11:35 11:25 TIME OF CRASH 11:26 PSAP Notification 11:27 EMS Dispatch 11:29 EMS Response 11:35 EMS on Scene 11:40 Triage and Treatment on Scene 35 minutes 11:45 11:50 11:55 12:00 The Golden Hour 12:05 12:10 12:10 EMS Departure to Medical Facility Travel Time to Medical Facility 12:15 Moderate Injuries 12:20 22 minutes 12:25 12:30 12:32 EMS Arrival at Medical Facility Continued Triage and Treatment on Scene 16 minutes Travel to the Trauma Center Life Threatening Injuries 17 minutes 12:35 12:40 12:45 12:50 12:55 13:00 13:05 EMERGENCY MEDICAL SERVICES 12:48 Life Flight Departure to Trauma Center 13:05 Life Flight Arrival at Trauma Center ECC ppt
20 ANALYSIS OF 10 SEVERE RURAL HIGHWAY CRASHES IN CENTRAL PENNSYLVANIA REGION NOTIFICATION 8 calls received within 1 minute of accident at PSAP 7 calls received by cell phone to PSAP 5 calls received by land phone to PSAP 2 calls received by police land line to PSAP 1 calls received by police radio to PSAP NOTE: Number of calls exceeds number of crashes because multiple calls were received for a single crash. ECC b.ppt (20)
21 CONCLUSIONS FROM STUDY OF DATA Potential Improvements possible in areas of: Crash discovery Critical victim information exchanged earlier between EMS and ER Better collection and handling of data for state mandated trip reporting Next area of focus ECC b.ppt (21)
22 A KEY AREA FOR SYSTEM ENHANCEMENT: WIRELESS CELLULAR COMMUNICATIONS Wireless cellular communication is rapidly advancing, more pervasive and affordable Wireless communication involves both VOICE and DATA Question: How can it help? In what way and with what benefit? PennState Geisinger Health Care System and PennState Applied Research Lab teamed together to address these questions ECC b.ppt (22)
23 ECC b.ppt (23) EMERGENCY MEDICAL SERVICES
24 Technology Telemedicine Concept Interface Use of handheld, wireless electronic device to communicate patient health status between EMS Increase effectiveness of communicating patient health status and emergency room physicians between EMS and emergency room physicians web server CDPD wireless cellular modem interface software emergency room doctor E emergency room LAN wireless cellular ECC b.ppt (24) ECC ai
25 ECC b.ppt (25) EMERGENCY MEDICAL SERVICES
26 ECC b.ppt (26) EMERGENCY MEDICAL SERVICES
27 EMERGENCY MEDICAL SERVICES ECC b.ppt (27)
28 INTERFACING THE PALM-TOP WITH OTHER TRIP REPORTING SOFTWARE Palm application is written in an open database architecture and compliant with state requirements Open database architecture means it will interface with standard, commercially available products (and visa-versa) ECC b.ppt (28)
29 ECC b.ppt (29) EMERGENCY MEDICAL SERVICES
30 ECC b.ppt (30) EMERGENCY MEDICAL SERVICES
31 ECC b.ppt (31) EMERGENCY MEDICAL SERVICES
32 PROPOSED SYSTEM CONCEPT Information recorded on hand-held computer Data transferred wirelessly to ER using CDPD and the Internet Easily populate database to complete state mandated trip report ECC b.ppt (32)
33 FUTURE PLANS Integrate hand-held into functional model Conduct field trials to assess feasibility Develop concept of how to incorporate into a state system System use will not be mandated ECC b.ppt (33)
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