Content provided by Avive
How often are you en route to an emergency call, and you’re provided with little to no information? You’re traveling Code 3 but forced to drink from a firehose once you arrive.
Undoubtedly, a core component of emergency medical services (EMS) is absorbing intel on the fly and through your patient assessment. You’re trained to immerse yourself with information from reporting parties, witnesses, and of course, the patient you’re treating.
How would things change if you had more insight into what’s happening on the scene as soon as you’re toned out, well before arrival? Could you adjust your protocols and adapt to provide better care?
An upcoming solution from automated external defibrillator (AED) manufacturer Avive Solutions offers a sneak-peek into unprecedented data that can be made available for the most critical of calls – cardiac arrest.
EMS has been trained to respond with limited data from the field – simply because it’s not available with today’s AEDs – so it can almost be difficult to imagine how things might change with this upcoming technology. On the surface, your reaction might be that “protocols are protocols, and I wouldn’t change anything.”
But, when we dive deeper to learn more, it makes you wonder…
Let’s check out how this upcoming solution works.
A bystander witnessed someone collapse. They run up and find them unresponsive and gasping; it’s agonal breathing. They call 911, and the operator dispatches an Avive Connect AED to the scene.
When the Avive Connect AED is en route and in use, the device can wirelessly share incident data to the appropriate 911 call center via WiFi or cellular signals, whichever is strongest. Data including, but not limited to, the geo-coordinates of the AED, the time since activation, the length of time the AED has remained on the current instruction, and specific “state” of the AED, can all be shared with 911 telecommunicators during the rescue.
During the rescue, 911 telecommunicators can wirelessly get access to information from the Avive Connect AED, such as:
-
Whether or not the Avive Connect AED is near the caller or patient,
-
If the AED has been powered on,
-
If the pads have been removed and applied,
-
If the most recent analysis of the patient was shockable or not,
-
The number of shocks delivered.
Next, when you arrive at the patient’s side and replace the Avive Connect AED’s pads with your professional monitor (and power off the AED), the Connect AED is designed to send a Summary Report of the incident, as well as access to a more detailed Incident Report that includes the ECG and heart rhythm analysis segments with timestamps, up to the cloud - as long as cellular or WiFi connectivity is available.
The Summary Report is accessible to you - immediately - by scanning a QR code on the Avive Connect AED’s screen. On the Summary Report page, you can then access a landing page, where you are able to enter an Incident ID number displayed on both the Connect AED and Summary Report screens to view a more detailed Incident Report. Check out the video below to see this in action!
In the future, the Company is striving to make this data also seamlessly transferrable to popular Electronic Patient Care Reporting (EPCR) and communication platforms. Presumably, this would allow for EMS providers to type in the incident ID or scan the QR code displayed on the Connect AED, gathering that rich and valuable data into one patient care record (PCR).
Since the incident data is available in the cloud, it can be more quickly and seamlessly shared with receiving hospitals before the patient arrives. This has the potential to be especially valuable for providers in the emergency department and Cath lab to help them better prepare to receive this critical patient. Imagine how emergency departments and Cath labs could streamline patient care if they receive more insights into what happened in the earliest minutes of a cardiac arrest before the patient arrives at the hospital.
Let’s break down these stages of response in the pre-hospital setting to look deeper into how access to data from the Avive Connect AED can help you and your system:
Dispatched & En Route:
Brandon Carey, a Georgia paramedic, full-time Faculty, Paramedicine Coordinator, and Lead Paramedic Instructor at Lanier Technical College in Forsyth County, Georgia shares his thoughts about using data while en route.
While Carey acknowledges that access to incident data from the Avive Connect AED as he’s en route to a suspected cardiac arrest may not alter his protocols, he feels that the certainty of an arrest, perhaps based on the explicit and confirmed knowledge that the most recent heart rhythm analysis was shockable or that shocks were previously delivered, would allow him to mentally prepare for exactly what he’s going to do when he arrives.
“When I’m en route, my first thought is that this new data could serve as confirmation of an arrest,” shares Carey.
Carey further explained that “this data would help medics determine what equipment to bring in the house, as well as think ahead about which resuscitation algorithm they may have to call upon. It could also allow for the medic to anticipate using indicated drugs and think about their doses before arrival on scene.”
On-Scene Data Collection:
Upon EMS arriving on scene, first responders can seamlessly access valuable incident data at a summary level from the Avive Connect AED. In addition, the Connect AED displays an Incident ID that can be communicated to downstream providers, such that they can access more detailed data prior to EMS arrival at the hospital.
Jason Grady, System Manager for Emergency Cardiac Care at Northside Hospital in Georgia, discussed the value of EMS providers being able to quickly extract and deliver data from an AED to downstream providers at the receiving hospital.
Grady shared that, “often the most important information about a cardiac arrest is either not available or lost in various layers of communication. Information such as initial rhythm prior to EMS arrival, first compressions delivered, and a more accurate downtime is crucial to determining immediate treatment, definitive care, and long-term options. Currently, coordinating this communication can be difficult and takes unique individuals with extensive experience and relationships.”
According to Nathan Harig, Assistant EMS Chief of Cumberland Goodwill EMS, an additional and important benefit of EMS being able to quickly access Avive’s Connect AED data would be enabling better quality assurance after the event and deconstructing responses for constant improvement.
Harig shared that, “high performing systems need to be able to measure and improve, and a key requirement of measuring anything is to have access to the data. Every cardiac arrest, when looked at through the QA/QI process, has insights that can be used to save more lives. Are we identifying the arrest early? When did help first arrive? Was an AED used and how long did it take to get that lifesaving shock delivered? Then we can start to measure how well our ongoing or post-resuscitation care is at an ALS or BLS level. How was our cardiopulmonary resuscitation (CPR)? Did we identify and treat all rhythms correctly? What other therapies helped (or failed to help) this patient?”
Harig believes that not only will additional data be a key part of a cardiac arrest incident QA/QI process, but it will also help EMS agencies determine where they need to focus time on community engagement and awareness.
“We can start individual or team improvement projects or even identify where outreach is needed within the communities, we serve to teach bystander CPR and place more AEDs, all because we have measurable data that can be used to improve how the entire chain of survival responds, which can ultimately improve patient outcomes,” said Harig.
Transporting & Transfer of Care
Of course, the benefits of timely data sharing don’t stop when EMS arrives and collects the data; they continue downstream to providers, enabling a real system of care approach.
Once the Incident ID from the Avive Connect AED has been communicated to receiving staff at the hospital (i.e. emergency department and/or cardiology), providers can extract a more detailed Incident Report. This can be achieved by downloading a pdf, which can provide rich and unprecedented data and incident timestamps such as when the AED was alerted by 911, when a bystander responded to the alert indicating they are en route, timestamps for each AED state change, analysis of shockable and non-shockable rhythms, full ECG rhythm strips, and more.
Dr. Benjamin Abella, the Vice-Chair for Research and Director of the Center for Resuscitation Science at the University of Pennsylvania Department of Emergency Medicine, offered thoughts on the value of advanced providers in the emergency department and cardiac Cath lab having quick access to these time-sensitive data from an AED.
One of the benefits Dr. Abella highlighted was the crucial importance of potentially gaining more accurate insights into a patient’s presenting rhythm. Today, presenting rhythms can be a misnomer, as they’re usually based on when EMS applies their professional monitor, which can be well into the timeline of an arrest, often after a change in rhythm. It’s the best data we can glean with today’s technology and response paradigm, but easily-accessible AED rhythms collected earlier before EMS arrival could give providers a better idea of a patient’s “true” presenting rhythm.
Abella shared that, “in today’s practice, since we rarely receive data from an AED, the earliest presenting rhythm we see is usually after first responders arrive on scene and apply pads to the patient. With Avive’s system, there is a potential for the earliest presenting rhythm to be delivered to advanced providers even before the patient arrives at the hospital.”
Dr. Abella went on to explain that without data from an AED (if one was used), hospital physicians often have to fly blind on care decisions.
“Having knowledge of the earliest presenting rhythm, how long it took for an AED to get to the patient and deliver a shock following 911 notification, the number of defibrillation shocks delivered to achieve ROSC, and other data from AEDs are valuable inputs as hospital providers make care decisions for a patient. For example, with data such as an earlier presenting rhythm, we might be able to better understand the root cause of the arrest. And with more detailed insights on how long it actually took to deliver the first shock following 911 activation, hospital providers may have more evidence to confidently assess long-term prognosis and the likelihood of survival.”
To learn more about Avive’s upcoming AED and connected system of care, visit https://avive.life.
*This device is currently undergoing FDA review and is not commercially available for sale in the U.S.