Technology to play a transformative role in catering to medical emergencies

An acute injury or illness that poses an immediate risk to a person’s life or long-term health is termed as a medical emergency. These emergencies may require assistance from another person, who should ideally be suitably qualified to do so, although some of these emergencies such as cardiovascular, respiratory, and gastrointestinal cannot be dealt with by the victim themselves.

While the serious medical emergencies may require immediate first aid, emergency room care, surgery, or care by a physician or nurse, not all are life-threatening.

With the advent of various technological means, the medical emergencies can be handled without the physical intervention of doctors. The information technology has made it possible to do faster communication in various healthcare situations irrespective of location. The development of information and communication technologies and the accessibility of mobile devices has increased the possibilities of teaching and learning process anywhere and anytime. Mobile and web application allows constructive teaching and learning models in various educational settings. Mobile phones are increasingly used by more people facilitating interactions and information sharing between people.

As per Dr Samir M, Consultant – Emergency & Trauma Medicine, BGS Gleneagles Global Hospitals, “Web and computer-based interactive and self-learning programs to train people using a micro-simulation are effective in BLS and ACLS skills. Web and computer-based programs include theory, training and self-testing. In a web-based application, students are provided with an account to use the online content. The application consists of sections covering the theory, text, videos, a section for self-assessment, and sections where the trainee can simulate each scenario if any.”

Web-based programs and DVD-based training, have been used trying to improve the acquisition of basic and Advanced Life Support skills. However, the survival rate from cardiac arrest remains poor despite advances in CPR training and therapies while it is a fact that the quality of CPR influences the outcome of cardiac arrest patients, says Dr Samir.

In hospital care, technological influence is seen in advanced monitoring, diagnostic and therapeutic devices. Portable machines for blood tests have made diagnosis at bedside more convenient. These devices can report multiple test parameters with more precise values using less blood sample and in much lesser time than the laboratory. For example, we can test for 32 different blood values including for heart attack, heart failure, kidney failure, lung functions, blood gasses, and coagulation etc.in less than few minutes of arrival to emergency, which could take hours in laboratory.

According to Dr Yathin Thammaiah – Emergency Physician, at BGS Gleneagles Global Hospitals, “In out of hospital care, technology is seen to enhance communication with the parent hospital both by patients and EMS services. Mobile applications could be used for Geo location of the emergency, video chat with medical personnel or receive first hand medical information.”

Technology has created new branches in medicine like Interventional radiology, radiation oncology, etc.. Telemedicine will provide dynamic information and specialist care in medical emergencies in remote areas. Although, technology has deep influence in medicine, it is limited to safety and cost effectiveness. Also, it may not be widely accepted by doctors who resort to conventional practice, said Dr Thammaiah.

Need for ‘Emergency First Responder’ course in curriculum

Whenever, the emergency scenarios arise, it comes usually with a lot of commotion. In this situation if a caregiver is without right exposure and practice, there is a possibility of misjudgement, which may be detrimental to the patient. Therefore, the importance of ‘Emergency First Responder’ courses, is very much required for practise and hands on experience. These courses should be mandatorily included in the curriculum in schools and colleges. By doing so, we achieve in creating awareness of the approach in emergencies and by starting early we can strengthen the right skills.

As per Dr Samir M, “According to The Lancet report more than 2,000 people die each day in Europe and the United States due to out-of-hospital cardiac arrest. The Lancet also estimates more than 100,000 lives could be saved if more lay people learned cardiopulmonary resuscitation (CPR) – beginning with training school children. In countries where CPR education is mandatory in schools, lay resuscitation is done in 60–75% of cases, compared to 20-40% elsewhere.”

“Emergency First responder courses are available at different levels of exposure like nurses, doctors, general population and are directed to a specific emergency, says, Dr Yathin Thammaiah, “This course incorporates a systematic approach in medical emergencies ranging from simple manoeuvres to medications. Although these courses are very essential, it is not obligatory.”

Availability of emergency kits

Recently a committee of AIIMS were formed by the Supreme Court to look into the emergency situation faced by the passengers travelling by train. Now all trains and stations have upgraded their First Aid Kit to be ready during the emergency situation. Should such emergency kits be available in all the organizations and institutions until the patient gets the medical help?

Dr Samir M says “Like fire extinguishers and respirators, the AED (Automated External defibrillators) is an important, potentially life-saving device;its effectiveness is determined by much more than simply having the device. A complete program that includes risk assessment, training, maintenance and recordkeeping must be in place. AHA Recommends AED to be available in organisations, institutions, places of large gatherings.”

Dr Yathin Thammaiah agrees. He says, “Yes it is very crucial to have access to basic medical equipment’s in emergencies. Medical emergencies vary from simple, grievous, limb threatening and life threatening injuries. First aid in out of hospital setting will obviously not address all the issues but, it aims at prevention of worsening of injuries and possibly pain relief until one can receive medical help. Therefore, first aid kits should be made available in all the organizations and institutions.  Automated External defibrillator (AED) should also be introduced along with first aid kits, if possible, as cardiac arrests are the commonest emergencies that need immediate intervention. It is essential that the locations of such kits are evident, advertised and easily accessible. Public should be made aware of its content and more importantly its usage.”

Can non-medical staff provide first aid care?

Is there a risk in first aid care being administered by non-medical staff even if the person has been trained through such drives?

According to Dr Samir M, “Even if you’ve never been trained, you can help save a life by calling 108 and initiating hands-only CPR, by following the instructions in the video or app. In some country they are using the drones which carry first aid kits and also provide voice and video instructions explaining on how to do CPR.”

Dr Yathin Thammaiah feels that medical practise is always based around benefit verses risk. “Training courses a structured to deliver best possible care to the patient till medical help is available regardless of medical background with minor variations based on limitations of medical knowledge. For example, in basic Life support courses both medical and non-medical personnel are trained similarly to recognise and initiate treatment of a collapsed individual.

He adds: “Of course, a medical professional would show more precision and broader approach in his first aid care as compared to non-medical personal. But, a trained individual will perform better in comparison to untrained individuals in such high panic state where there is uncertainty, multiple opinions and confused helping hands. Even though the risk in first aid care being administered by a trained non-medical staff may be more than a professional, it is much less compared to an untrained individual who form the larger population.”

CPR in an emergency situation

A sudden cardiac arrest is the most common emergency situation attended by the bystanders. Is it possible for an untrained person to perform Cardiopulmonary resuscitation (CPR) to save the life of the patient?

As per Dr Samir M, “Sudden cardiac arrest is a medical emergency, AHA recommends bystander CPR at the earliest once the victim is unresponsive. It’s important to provide CPR training to people who are interested at large.”

American Heart Association in its 2015 guideline explains the aspects involved in effective CPR. A trainee would learn the rule of effective CPR ‘Push hard, push fast’ with minimal interruptions. ‘Push hard’ means, one has to push the chest wall as hard as 4-6 inches to compress the heart against the bony vertebrae to produce a contraction strong enough to pump blood. ‘Push fast’ implies, the responder has to maintain a heart rate of 100- 120/ min to maintain a sustained blood flow. Minimal interruptions indicate that the time where the CPR is stopped due to various circumstances should be less than 10 seconds.

In CPR, the responder tries to manually play the role of the heart and maintain blood flow. Another important aspect is the time between the collapse, the cessation of blood flow, and CPR. As most vital organs require sustained blood flow, few minutes of stoppage could be detrimental to its functions.

Dr Yathin Thammaiah believes that sudden cardiac arrest is the most common emergency situation attended by the bystanders. “In sudden cardiac arrest, the persons heart stops beating due to various reasons, ceasing the blood flow to all vital organs, resulting in loss of life. In such circumstances CPR is the most important life saving measures that can be performed,” he says.

Training in approach to such patients will help save a life. While an untrained person may be aware of CPR, it is the method of delivery which improves the chances of survival. Therefore, an untrained person will not serve the purpose regardless of the effort.