PREHOSPITAL DIAGNOSTICS; THE EMERGENCY RESPONDERS’ “DIGITAL ANGEL”

By Dr. Robert Bard | Edited by: The RightWriters research staff | October 25, 2019

The saying “you can’t take it with you” is often applied to points of wisdom about letting go of your worldly possessions at the twilight of your years. In the case of emergency response, an ambulance rig is designed to simulate an ER on wheels, packing a range of life support equipment, devices and drugs for all critical rescue situations.  This includes essentials like breathing and airway clearing devices to scanning & monitoring equipment to dressing & bandaging materials.

Stories from many seasoned EMT or paramedics may include rare rescue situations that fall short of having more advanced resources and on-the-spot access to medical expertise that could have changed the course of the rescue when racing to the ER took too long.  Modern solutions to this dilemma include the expansion of field care through advanced Point-of-Care Ultrasound use and integration of TeleMedicine.  These innovations help rescuers immediately identify complex trauma including any possible ‘land mines’ through portable digital imaging technology while saving valuable time when it comes to file transfers of the patient’s condition electronically to the critical care professionals at the end of the ride.

PRE-HOSPITAL ULTRASOUND USE BY EUROPEAN RESPONDERS

Pre-hospital ultrasound has many clinical applications that may reduce morbidity and potentially improve outcomes for patients with life-threating conditions [3].  Worldwide, responders have adopted the use of a portable non-invasive, non-radiation ultrasound in their rescue rig.   For example, in Germany, the use of ultrasound in the field has focused on the FAST exam and cardiac sonography for non-traumatic patients since 2002–2003.  French prehospital clinicians have adopted ultrasound in certain areas as well, including SAMU (Service d'Aide Médicale d'Urgence). The Italian EMS system began incorporating ultrasound into prehospital care in 2005. [2]

Pre-hospital ultrasound is employed in this setting to differentiate reversible causes of pulseless electrical activity (PEA), assess for pericardial, intraperitoneal, and pleural fluid in trauma, and to differentiate between pulmonary edema and emphysema. In the USA, the focus on rapid transport and limiting on-scene time may have contributed to slower adoption of prehospital ultrasound into clinical algorithms. There is less experience in the routine use of ultrasound on ground ambulances. [2]

THE ERA OF TELEMEDICINE

By: Elizabeth Banchitta and Cheri Ambrose

With the combined use of remote portable ultrasound and telemedicine, the rescue unit raises the chances of the patient’s survival exponentially while significantly reducing the risks of complications during critical care. Telemedicine is the practice of medicine using technology to deliver care at a distance.  [4] Current communications technology and file-sharing allows medical doctors to consult EMTs and Paramedics to work with their patients remotely (through HIPAA compliant conferencing platforms) and software.  This revolutionary upgrade is true evidence of improving public health (and survivorship) and a significant cost reduction in medical care.

CONCEPTS REALIZED FOR A GLOBAL UPGRADE IN EMERGENT RESPONSE

On August of 1985, Mayor Ed Koch pushed a city policy to implement EMS medical control - a communications center where responders have advisory access to a medical doctor.  This originally was intended to eliminate unnecessary ambulance transports. This allowed the responder to determine and/or refuse medical attention on calls that were not actual life-threatening situation.  Koch’s idea was to keep ambulances available for the ‘real’ emergencies “and is not a free taxi service to the ER”. (NYT 7)

2019- Koch’s communications program is still technically in place, but its directives have been reshaped as TELEMED, TELEHEALTH or INTEL Communications- geared to be more about immediate access to doctors' medical guidance and data transmitting.  For the many incidences (such as heavy traffic) where time is truly of the essence, where a patient’s life is slipping away faster than the rig could cut through city streets, arming the responder with higher performance equipment and communication protocols with the ER docs has become the growing trend- or at least the sensible modern concept in motion.

Medical Control is a recorded line between the mobile unit and the hospital personnel awaiting the ‘delivery’. Thanks to TELEMED, they're there to help the responder interpret data collected and transmitted to them. Based on their findings, they may direct the rig to a specific hospital with the appropriate resources to best treat the patient. This also decreases the amount of time that will be spent on the patient running tests in the ER that could have been done during transport. For many cases, time is of the essence. TeleMed also helps responders administer certain tasks to keep patients stable from a life-or-death situation.  TeleMed also facilitates calls for a second opinion or orders allowing emergency personnel to administer additional doses of medication. There have been countless situations where ambulances are caught in terrible traffic or unforeseen road blocks that meant needing to act fast on a patient’s increasingly critical situation.  Having the doctor “present and available” (virtually) gives the responder real-time instructions on what to do.

For the sake of response time, New York City is probably one of the most densely populated areas with the highest number of hospitals and level 1 trauma centers.  But this is not the case for many areas in the country.  There are regions that experience up to an hour drive to the hospital making a patient's “golden hour” much more difficult to achieve. EMS refers to the golden hour as the time from when the incident happened to the time that the patient gets definitive care at the hospital. Getting the ball rolling by identifying exactly what is wrong with the patient during longer transport times can increase the possibilities of survival. This is where the need for additional life support technology is at its highest. 

A growing number of EMT’s in the country are allowed (and trained) to take glucose for unconscious or altered mental status patients. Some have CT Scans for possible strokes and CPAP for patients suffering from CHF or other respiratory failures. Resources like the use of EKG’s on patients that are experiencing chest pain or having heart attacks. Where proximity defines the standards, these devices and protocols may not apply for responders and units everywhere. Many of these devices are part of a “pilot program” and does not apply to all towns.  

The idea of a portable hi-powered PreHospital ultrasound that can identify traumas (including a transcranial Doppler to detect oxygen and blood flow in the brain) is something that the military and helivacs are equipped with now- and to integrate that with our com link to the doctor is such a vital game-changer as far as upgrades go!  To use that travel time to see what's going on so much earlier and transmit this data over to the doctor can be a powerful addition to the emergency response. Also, by having access to the doctor to interpret this data helps make crucial decisions such as ‘which hospital, precinct or resources would be best for handling this? Or do they need a trauma or a stroke center? Some places have certain staff members on call 24 seven whereas other hospitals do not. These are the additional directives that can change the overall direction of patient care.

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PREHOSPITAL ULTRASOUND: EMERGING TECHNOLOGY FOR EMS

by: Dean Meehach   5/15/2019  - Source: EMS1.com 

Point of care ultrasound for prehospital
applications. (Photo/Greg Friese)

Clinical applications for field ultrasound to assess, treat and monitor critically ill patients
Prehospital ultrasound is a form of medical imaging that is portable, non-invasive, painless, and does not expose the patient to ionizing radiation. With proper training and education, prehospital providers can use ultrasound to obtain immediate anatomical, diagnostic, and functional information on their patients.  In recent years, ultrasound devices have decreased in size and cost while producing images of enhanced quality.   For example, prehospital focused abdominal sonography for trauma (FAST) exams have the potential to provide valuable information in abdominal trauma with high reliability leading to more appropriate transport destination decisions. In addition, field ultrasound images can be transmitted enroute to the emergency department to facilitate further evaluation by ED physicians and trauma surgeons to expedite care ... READ MORE

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Next issue: TELEMED FOR COLLABORATION BETWEEN PROVIDERS

CONTRIBUTORS /EDITORIAL TEAM:

ROBERT L. BARD, MD, PC, DABR, FASLMS - Advanced Imaging & Diagnostic Specialist
Having paved the way for the study of various cancers both clinically and academically, Dr. Robert Bard co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- www.CancerScan.com) uses the latest in digital Imaging technology has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered Sonograms, Spectral Doppler, sonofluoroscopy, 3D/4D Image Reconstruction and the Spectral Doppler are safe, noninvasive, and does not use ionizing radiation. It is used as a complement to find anomalies and help diagnose the causes of pain, swelling and infection in the body’s internal organs while allowing the diagnostician the ability to zoom and ‘travel’ deep into the body for maximum exploration.

ELIZABETH BANCHITTA, Technical Contributor / EMT

Elizabeth is a New York State certified EMT-B and a two-time recipient of the St. Catherine's of Siena Award for excellence of written and verbal communication to receiving hospitals. She is the current President of GiveKindness* Organization (a partner of Quinnipiac University, Hofstra University and Farmingdale State College) dedicated to implementing Annual Food Drives for Island Harvest Food Pantry and fundraising for Sloan Kettering Cancer Center. She is currently a graduating student (with honors) of Farmingdale State College with concentrations in Bioscience and Chemistry.  She is also a current volunteer in the NY Cancer Resource Alliance as a communications assistant to the president and an assistant publisher of the monthly newsletter and educational awareness quarterly magazine-The Journal of Modern Healing.

CHERI AMBROSE, Co-editor/outreach coordinator for NYCRA
Cheri is the associate editor for various publications such as PinkSmart News, the Journal for Modern Healing and First Responders Cancer News.  She is a patient advocate for many cancer-related programs and often contributes her time in cancer research fundraising events.  As the communications director for the NY Cancer Resource Alliance, she manages community outreach, partnership missions with other cancer foundations and research organizations and attends educational functions for cancer awareness. Her latest public projects include the launch of ImmunologyFirst.org and ImplantScan.org.  She stands as the current President of the male Breast Cancer Coalition (MaleBreastCancerCoalition.org).

References:

1) https://www.health.ny.gov/professionals/ems/pdf/9814

2) https://www.sonosite.com/education/sonosite-institute

3) Int J Emerg Med. 2008 Dec; 1(4): 253–259. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657261/

4) Jems.com: Point-of-Care Ultrasound in the Prehospital Setting as the patient is being transported to the nearest hospital. https://www.jems.com/2018/02/01/point-of-care-ultrasound-in-the-prehospital-setting/

 5) What’s the difference between telemedicine and telehealth? https://www.aafp.org/media-center/kits/telemedicine-and-telehealth.html

6) https://www.healthleadersmedia.com/innovation/4-ways-telemedicine-changing-healthcare

7) Ambulances, Under A New Policy, Pick Up Only Emergency Patients, NYT: 8/1985-

https://www.nytimes.com/1985/08/15/nyregion/ambulances-under-a-new-policy-pick-up-only-emergency-patients.html

Also see: (Coming soon: Part 2) TELEMED FOR COLLABORATION BETWEEN PROVIDERS



Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The AngioFoundation / the NY Cancer Resource Alliance /  IntermediaWorx inc). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.

Awareness TRULY Saves Lives- “Yes, Men Get Breast Cancer too”

Written by: Darleen Garza / TheRightWriters editorial staff

Ten years ago, if you inquired about male breast cancer at your annual physical, most doctors would likely dismiss your fears by responding about “how incredibly RARE, or improbable it was to contract this”.  This lack of public information is a common testimony from many male breast cancer survivors- the same dilemma that is now recognized as a main contributor to the expansion of this silent epidemic.

The term “RARE” is often misleading and alluding to something reversible and of little concern. When it comes to any health disorder, the limited numbers of cases showing are only the ones reported but are often skewed due to the ‘real’ count that would constitute a baseline- from the individuals that have not come forward to be counted.  According to the CDC, for any disease to capture EPIDEMIC proportions, it must “rises above the expected level, or baseline… where there is a [sudden] increase in the number of cases in that population in that area.”

BEYONCÉ'S DAD BRINGS "NEW AMMO" TO MALE BREAST CANCER BATTLE

Survivor Michael Singer (L) gives appreciation to Mathew Knowles (R) at
Dr. Oz show for going public with his breast cancer- bringing global
awareness & advocacy

Recent data reflecting actual cases about male breast cancer has finally reached the tipping point in the visibility scale as more news coverage from advocacy groups and victims finally ‘going public’ have filled the media.  Thanks to survivors like Mathew Knowles (music producer and father of Beyoncé) who elected to publicize his breast cancer significantly contributed to public awareness, identifying this issue as a serious threat to public health. 

“One of our main objectives at the Male Breast Cancer Coalition is to publish all survivor stories to alert the men at large that this is not a cancer to ignore… it’s not so RARE or IMPOSSIBLE to contact,” states Cheri Ambrose, president. “Learning about Mr. Knowles’ story from the newspapers and Good Morning America, and then sharing airtime with him at Dr. Oz was such a powerful sign of support to our advocacy mission because he elected to use his own story and his celebrity to get people to pay attention. This is the kind of generosity that can truly save a lot of lives just on pure awareness alone!” (See: Dr. Oz episode w/ Mathew Knowles interview)

In an October interview with the American Heart Association News, Mathew Knowles shared his new mission of advocacy and awareness hoping to save more lives from a disease that has now captured headlines as a global health alert. He detailed his rare gene mutation called BRCA2 as what the medical community identifies as the main cause for this cancer and possibly others. Sharing the entire road of discovering the first symptoms to having undergone a mastectomy on his right breast, Mr. Knowles has forged a national commitment to speaking out about breast cancer in men.   "My opportunity is to help people have awareness of the BRCA gene (mutation) and of male breast cancer…things happens for a reason. I'm grateful for this opportunity to save myself, hopefully save my family and hopefully impact the world in an extremely positive way."

“GET CHECKED NOW!”

The First Responders Cancer Resource was established in 2017 by a partnership between 9/11 survivors and medical experts in conventional and advanced cancer care. Their flagship catch-phrase “GET CHECKED NOW!” was partly designed for the many potential cancer targets in the firefighter community who needs to take a more proactive stance at annual exams and awareness about how cancer truly performs. Ms. Ambrose and the many ambassadors of MBCC adopted this tagline because of a similar dilemma among men who are either slow to act when it comes to finding anomalies like lumps on the chest area.  

Click to enlarge and print

“By now, we all know that dealing with cancer has everything to do with TIME… the sooner you detect it, the better the likelihood of reversing the problem,” states cancer imaging expert Dr. Robert Bard. “Where women have been conditioned to do self-exams regularly, finding irregularities (like lumps under the nipple or abnormal discharge) are not often part of a man’s health regimen.  Meanwhile, the medical community has a defined set of factors that help identify an increase in risks for breast cancer including age (60+), exposure to estrogen, obesity and liver diseases as this increases female hormones in men. The good news is that technologically, we have much more than the conventional mammograms… the cancer imaging community is equipped with new innovations such as the high-speed Advanced 3D Ultrasound that’s far more accurate and completely comfortable especially for men.”

Where the stigma of men having breasts and getting mammograms often sits awkwardly with the typical male ego, more and more victims are now sharing their stories at the MBCC website (and throughout mainstream media) with the hopes of waking up the men to GET CHECKED and accept this disease a major reality.  According to the American Cancer Society, 1 in 800 men will be diagnosed in their lifetime… and an estimated 500 men will die of breast cancer this year. From a recent interview, Dr. Stephen Chagares (breast surgeon) detailed how Male Breast Cancer is often identified and points to early detection for the best chance at survival.  “It’s either spotting a mass somewhere in the chest area or a strange discharge or a bloody nipple drainage… it’s better if you find these symptoms at an early enough stage but unfortunately it becomes actual breast cancer because they’re not identified until longer down the road.”

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Special thanks to the MALE BREAST CANCER COALITION

Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The AngioFoundation / the NY Cancer Resource Alliance /  IntermediaWorx inc). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.