By Bryant Jordan, News Reporter
It has long been said that “a stitch in time saves nine,” and by saving critical time in emergency situations, doctors and emergency medical service providers can save lives that might otherwise be lost. Hours, minutes, and seconds can mark the difference between life and death. Washington County Regional Medical Center (WCRMC) is now working to help save lives by using mobile system telemedicine as part of the Prehospital and Ambulatory Virtual Emergency Services (PAVES) network.
Michael Padgett, Director of EMS at WCRMC, explained that this project is funded through a grant called the “Southern National Disaster Response for FEMA region 4, which comprises the Southeast, from the Mississippi River in the West, Kentucky in the North, all the way to the Eastern seaboard.” Padgett described how the grant for this project had been written by Dr. Michael J. Carr, MD FACEP FAEMS, when he was “sick with Covid and stuck in his bedroom for two weeks.” During that time Padgett described how Dr. Carr “sat down and got to thinking about it, and wrote this grant in his bedroom.”
Dr. Carr is an associate professor in the Department of Emergency Medicine at the Emory University School of Medicine, and is also Medical Director for Air Methods / Air Life Georgia. Dr Carr’s profile on the Emory University School of Medicine notes that he currently oversees “six helicopter bases in the Atlanta metropolitan area,” in addition to serving as “project director and principal investigator for the Emory Rural Tele-EMS Network (ER-TEMS) a Health Resources and Services Administration (HRSA)-funded project that works to expand telehealth capabilities to ambulances throughout rural Georgia.”
According to Padgett, “the telemedicine system is installed in our trucks to be able to communicate truck to truck, truck to WCRMC ER, and we are in the process of placing this at Wellstar MCG in Augusta.” Padgett stated that “Once the system is implemented at Wellstar MCG, the WCRMC ED staff can use the system to communicate via video chat with Wellstar MCG when transferring a patient hospital to hospital. The medical staff at Wellstar MCG had been using the REACH system, which is “a system for stroke patients that was developed years ago which allows a neurologist to see a patient in the local ER via video chat. Padgett states, “It’s kind of a similar technology, but this is a new platform that will streamline communication between EMS-to-hospital and in the near future, hospital-to-hospital.
There are numerous and significant ways that a telemedicine link between the ER or Emergency Department (ED) and EMS teams who may be traveling to a hospital can be extremely helpful and lifesaving for patients. Currently, there is a nationwide shortage of Paramedics. Paramedics are the only level of EMS practitioner that are trained to interpret 12-lead EKGs. According to Padgett, “we are often required to interpret a 12-lead EKG when treating a cardiology patient on advanced life support, but Paramedic shortages leave some EMS teams without the practitioners to interpret this test, and then administer the proper medication.” EMTs and AEMTs can obtain 12-lead EKGs but are not trained to interpret them. Through the use of mobile telemedicine, Padgett explained that a “physician in the ED can interpret the 12-lead EKG in real-time via the video feed and direct the EMS staff to give certain medications.”
The link between ED and ambulance is also important when a patient is being transferred from one hospital to another. “If we encounter a problem with a patient during transport and the closest facility is 60 miles away with no alternatives enroute,” explained Padgett, “we can connect to our ED or the receiving ED and have our clinician or the receiving clinician guide us.” Padgett also noted that “there are times when mass casualties or motor vehicle accidents overwhelm our system quickly.” Padgett described how “by positioning tablets at the scene, at other hospitals and connecting with larger health center networks, we can expand the amount of care we can provide to patients during these critical moments when all of our onsite resources may be tapped.”
Similarly, Padgett described how during a recent tropical storm, there had been a Chatham County unit that was located at a hurricane shelter. Because of this particular unit, Dr. Carr was able to use telemedicine to give medical orders to the EMS personnel treating the patients staying at the shelter. This allowed the doctor to see the patients through the video feed, giving orders to EMS personnel, allowing them to treat the patients on scene. This is important because it allows EMS personnel to treat the patients on scene rather than having to transport those patients to an already overwhelmed ED during a disaster scenario. Padgett explained that “with this new technology, we are able to streamline almost any kind of disaster response or mass casualty incident.”
Looking towards the future, Padgett stated that as the project grows, and they begin to partner with more hospitals, the system will only be improved. “Now that people have seen what it is capable of,” said Padgett, “and where it could go with the right direction and with multiple partners, this will be huge.” According to Padgett there are more and more services in the state that are becoming a part of the project, including Chatham County in Savannah, as well as Habersham County in North Georgia.
Padgett pointed out, “we are the only service in region 5 – which is our EMS region – that is part of this program.” Padgett then explained that the telemedicine system uses Wi-Fi through internet service provided by the Georgia Trauma Commission, whom Padgett described as being “very impressed with the system,” and who are “wanting to update the modems in our trucks to be able to support the system even more.” This goal of working towards updating this system, stated Padgett “is extremely important, especially in rural areas.”
With all of the potential that this telemedicine system holds for the future, Padgett noted that “there is new technology that is becoming available that will benefit all of our patients. In particular, this will help expedite our treatment of stroke patients. Padgett described how when enroute to a hospital, EMS teams can “get the patient registered and ED staff can see the patient and communicate without the EMS personnel having to stop patient care and call a report. We can just press a button and continue working on the patient while we are coming in, which saves time for patient access, but also improves patient outcomes.”
Another example of how advancing technology is improving patient outcomes is through the use of artificial intelligence guided ultrasounds, which Padgett described as allowing doctors and EMS teams to see if a patient is experiencing internal bleeding. An example of this would be a patient experiencing internal bleeding following a traumatic abdominal injury. These types of injuries are not always obvious or visible to the naked eye. However, this serious condition needs to be identified and transported to a Level 1 Trauma Center as quickly as possible. Padgett said that “once this technology is improved, it will provide us with an important tool to help guide our transport decisions. We will be able to transmit these findings through the telemedicine system that we have already implemented.”
“Who knows what the future may hold with this system,” said Padgett. “It’s very exciting, and I am proud to have it in Washington County for our citizens. While we are pioneering this system, the improvement it provides our communication will lead to better outcomes for our patients and the community as a whole. Padgett stated that “the goal of the system is to cover the state of Georgia, then expand nationally.” WCRMC’s CEO, Pam Stewart, is grateful for Michael Padgett’s dedication and perseverance with enhancing rural EMS healthcare in Washington County.