Dr Sandeep Gore, Director-Emergency Medicine, Fortis Hospital, Mulund, Mumbai explains about the technologies which have evolved as empowering tools for emergency physicians
Emergency medicine is one of the most rapidly evolving branches of medicine. Technology plays an essential role by providing endless insights regarding patient care while delivering time bound emergency care to acutely ill or injured patients presenting to the emergency department. Hence, technology is an indispensable part of any modern Emergency Medicine department.
Let us review certain technologies which have evolved as empowering tools for emergency physicians. Firstly, point of care blood testing gives important time bound results of certain blood parameters which propel an emergency physician to produce quick decisions and interventions in patient care. This further benefit and motivates an emergency physician to monitor the response to the emergency care delivered. It enables objective evaluation of effective treatment being delivered by him/ her. Point of care tests consists of highly sensitive Troponin I, Creatinine, Blood Ketone, Blood Gas Analysis, Electrolytes, Lactate, C Reactive Protein and more.
Another important technology that has brought a revolution in Emergency Care is the point of care Ultrasonography i.e., POCUS in Emergency Medicine. Point of Care Ultrasonography works as a visual stethoscope for the Emergency Department. It helps to derive a medical diagnosis in undifferentiated presentations. It can deliver information about the pumping capacity of the heart, lung pathologies and information about the major blood vessels & solid organs.
Additionally, nowadays our smartphone has many medical apps. These help an emergency physician to make decisions regarding patient care. Primarily, these apps assist in the objective evaluation of certain medical conditions. For example, the National Institutes of Health Stroke Scale (NIHSS) in acute Ischemic Stroke helps the clinician to determine the severity of Stroke in an objective manner. The HEART score app discusses clinical probability scoring. It helps Emergency physicians to risk stratify patients with chest pain. To sum up, evolved medical applications have improved the objective evaluation of patients to prognosticate their outcomes.
Well-equipped patient monitors of modern medicine provide around-the-clock critical vitals for patients. These can be recorded, stored, and retrieved, aiding optimal patient care. The stored data can produce trends that can alert a physician to consider possible diagnoses or outcomes. Moreover, equipment with advanced technologies like Video Laryngoscope has augmented patient safety and physician learning during resuscitation.
Another technology that plays an important role in emergency care is the PACS (Picture Archiving and Communication System). Through this software technology, one can view CT or MRI scans from a remote place. This enables physicians to obtain an expert opinion at odd times of the day, before taking clinical decisions regarding patients. The electronic medical record system is another technological advancement in emergency medicine. It enables one to have immediate remote or on campus access to current and previous patient records; this will be immensely helpful for physicians in India.
An emergency physician must multitask regarding patient evaluation, making accurate diagnosis and taking major intervention decisions. Patient communication, counseling and consents are crucial aspects. We strongly recommend having an audio & visual consent taking system in every emergency medicine department. The emergency physician can explain the patients’ provisional diagnosis, condition, treatment plan and possible outcomes. He can elaborate on the advantages and disadvantages of certain treatment modalities. It will serve as a medico-legal support system for the physician and the hospital.
We can also use digital technologies for credentials and privileging of emergency doctors with their service records. Incorporating a digital duty roster will enable the calculation of the exact duty hours of each physician. This will empower the hospital to provide equivalent distribution of job hours and responsibilities. This will enhance the monitoring of each physician’s performance.
Digital technology is likewise important in running pre-hospital medical services through the smart ambulance project. This will help to keep records regarding the ambulance call, dispatch time, tracking of the ambulance, and digitally monitoring patient care through cameras placed in the ambulance. Digital feedback forms from patients regarding different aspects of emergency care will provide a variety of insights for the ED administrator. Also, these various technologies that are being used are helping us get prompt results, thus making it faster to treat patients.
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