When an individual calls 911 in distress and requires an ambulance to be dispatched, it’s most likely because of a critical health condition. These individuals are potentially experiencing a frightening and debilitating medical emergency, or they’ve experienced a traumatic injury that requires immediate medical attention.

However, the first individuals interacting with them often aren’t physicians or specialists. First, professional or volunteer Emergency Medical Services (EMS) personnel must stabilize and transport them to a medical facility where they can receive specialized care. Unfortunately, their condition can deteriorate in the time it takes to stabilize and transport a patient. Worse, the waiting physician has little transparency into what occurs in the transport window.

“When people are calling 911…they have highly concerning symptoms…or they’ve suffered a life or limb-threatening injury. Getting to them quickly and providing care efficiently is absolutely critical…” explained Dr. Christopher Russi, an Emergency Medicine Physician at the Mayo Clinic. “But that transport window is where we have a black box. It’s a data vacuum. We have no idea what’s happening with those patients during that transport window.”

According to Dr. Russi, this further delays care, as physicians spend valuable time acquainting themselves with the patient and their symptoms. “Traditionally, EMS systems don’t call the hospital until they’re really close. They give a very brief report, and they give you one set of vital signs,” Dr. Russi said. “When the patient arrives…we have to gain situational awareness and understand what just came through the door, put our team together and effectively start fresh...”

The delay in care during the transport window can be significant in more rural areas of America, where a large, well-equipped medical facility may be hours away. Unfortunately, that window of time can often be the difference between life and death. As Dr. Russi explained, “That’s a long time for the patient’s physiology to change. [The condition of] these patients can change well before arriving at the tertiary center. Patients show up to us often completely different than how we thought they were coming…”

If physicians could get eyes on these patients sooner, there is reason to believe that their outcomes would be improved and that more lives could be saved. This would eliminate the “black box” of the transport window, keep doctors from having to start over when patients arrive and ensure more rapid access to care for patients experiencing medical emergencies. That’s precisely what a recent pilot program spearheaded by the Mayo Clinic and their partners, OPTAC-X and Kymeta, looked to prove.

Technology enables eyes on the patient

Working hand-in-hand with the Mayo Clinic, the telemedicine experts at OPTAC-X leveraged advanced assisted reality headsets from Real Wear and connectivity provided by Kymeta to create a turn-key solution that would allow physicians to be more active participants in the care delivered during the transport window.

“To enable communication, we mounted a Kymeta terminal to the top of the Mayo Clinic ambulance. We then utilized two different headset solutions for redundancy purposes,” said Dr. Patrick Fullerton, the CEO and Founder of OPTAC-X. “EMS would wear the headset, and the physicians [at the Mayo Clinic] would be able to see what they see, hear what they hear and be able to communicate.”

The physicians on the other side of these telemedicine calls were provided workstations in which to respond to these telemedicine emergencies. However, OPTAC-X also enabled them to utilize their personal mobile devices to ensure that someone was always available, and to add another layer of redundancy to the solution. “Part of our PACE (primary, alternate, contingency and emergency) plan for the physician workflow included a cell phone so they could answer those calls from anywhere when they weren’t at a workstation,” Dr. Fullerton said.

While telemedicine, itself, is nothing particularly novel – especially in a post-COVID world – this solution offered something truly revolutionary – telemedicine on the move. However, unlike other telemedicine services and solutions, where a stationary patient interacts with a stationary physician, the solution delivered to the Mayo Clinic by OPTAC-X required constant connectivity and communication while in transit.

Considering the sensitive nature of the use case, connectivity must be assured, or lives could be lost. Fortunately, advancements in terminal and antenna technologies are making this level of always-on, redundant and assured communications possible.

“…it’s important, for this sort of critical scenario, to have more than one [connectivity] option and more than one data source. It was critical to have more than just GEO [satellite capacity] supporting this,” said Stephanie Morato, a Marketing Manager at Kymeta Corporation. “Our Kymeta Hawk u8 GEO enabled the Mayo Clinic to seamlessly switch between 4G LTE connectivity and GEO satellite capacity. This network redundancy added resilience for their connectivity while on the move…”

“The electronically scanned array [ESA] terminals revolutionized what is possible in telemedicine on the move,“ said Dr. Fullerton. “ESAs that detect latency or interference and can switch between different satellites and different orbits, or can switch to LTE as well, didn’t exist before. Without that [capability], a lot of failures happened.”

But today’s terminals offer more than just flexibility and redundancy in connectivity options. They also have evolved to better suit comms on the move use cases, including deployment on vehicles like ambulances.

“Most of our customers operate in life-and-death situations. Our systems, by their nature, have no moving parts, [giving them] inherently long meantime between failures,” said Frank Armstrong, a Senior Product Manager at Kymeta. “The high reliability of an ESA is beneficial to this application.”

The lack of moving parts also delivers other benefits important for this particular use case. “Our terminals operate with low power, [enabling them to] operate on any vehicle,” said Morato. “[This also makes them] easy to operate for first responders.”

With the ability to seamlessly switch between cellular and GEO satellite connectivity, the OPTAC-X telemedicine solution had the assured connectivity it needed to operate in even remote locations. But would EMS personnel use it? And would the introduction of this new capability improve outcomes for patients?

Surviving to the hospital

While this telemedicine solution has only been used in a limited number of cases as part of the OPTAC-X’s pilot program with the Mayo Clinic, the early results have been overwhelmingly positive. One of those cases, in particular, involved a patient who had gone into cardiac arrest.

“A case came in where a lady was in respiratory arrest that turned into cardiac arrest. Mayo Clinic’s ambulance services got the call and rolled out with medics that were trained and capable of using the technology,” Dr. Fullerton recalled. “CPR was started before they got there. When the medics arrived, they started cardiac resuscitation on-site. Cardiac arrest has about a 10 percent survival rate outside of the hospital, so this was a great example of OPTAC-X technology making a life-changing contribution at a critical moment.”

“What was unique about this case was the ambulance was outside the patient’s home, and the paramedic was dismounted and away from the vehicle. While they were inside the patient’s house - in the patient’s basement - the doctor could see and hear what was happening with the patient,” said Dr. Russi. “The doctor was able to talk with the paramedic about what to do. They were able to say, ‘Let’s try these things.’ And the patient survived to the hospital.”

This is just one of the more than 30 cases that the telemedicine solution has impacted. While this is too small of a sample size to determine its success, the anecdotal evidence has Dr. Russi convinced that the technology could help improve patient outcomes.

“We’ve only done about 30 to 40 cases, and to claim an absolute reduction of mortality is going to be difficult at this point. We need a much larger trial,” said Dr. Russi. “But, I feel comfortable saying that if you bring a doctor who’s a specialist to the patient in the field for emergency and critical care before they get to the hospital…we will be able to enhance the care already delivered and change outcomes.”

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