- First Responders Fail To Check Cell Phones for Medical Information – iHealthBeat – Points to the challenges faces by first responders.
Posts Tagged ‘emergency responder’
First Responders Fail To Check Cell Phones for Medical Information – iHealthBeat
September 18th, 2008 | Popularity: 9% 0 comments | Leave a replyThinking about Personal Health Records beyond the health care system
September 4th, 2008 | Popularity: 25% 4 commentsUpdated 9/10/08: Broken link below fixed (the one that went here).
As I have mentioned previously on this blog, and as is mentioned on the Certification Commission for Health Information Technology Website, I am Co-chair of CCHIT’s first Workgroup covering Personal Health Records this year, along with Lory Wood from the Good Health Network.
As you can tell from the list of members on the workgroup , the expertise represented is very impressive in its breadth, and its national scope, and we have all been working hard to support the first certification process for Personal Health Records in 2009. I encourage anyone interested in PHR Certification to follow its course through CCHIT communications on its web site and other venues; I won’t be discussing specifics of certification here.
What I am writing about is how this process is changing my understanding of the role of personal health records beyond the health system.
A great example is in the case of emergency responders – I recently posted my experience being one. Earlier this year, I commented on the value of a personal health record in another incident I was a part of, and it is interesting for me to look at what I said., which was around the value of a personal health record in preventing emergencies by promoting better patient engagement around their therapies. I still believe in that.
While that’s waiting to happen though, what about the times when an employee might have an emergency at the worksite or a person might suffer a car crash or other incident while traveling? It’s possible that in the incident I responded to earlier this year that the result would be a report back to family that their mother/father/daughter/son/brother/sister had died while co-workers and responders were frantically working to assess their medical condition.
Imagine what it might be like for an employee in a large big-box retailer to be able to identify parts of their medical history to be made available on an emergency basis to their employer, especially if the worksite is large enough that their personal effects are typically very far from where they work. Many of us fill out emergency contact information when we complete new-employment paperwork. Usually this is a piece of paper, and in most cases provides a thin buffer of hope that critical information about us will be available if it’s needed at a worksite emergency.
The same goes for automobile crashes, because a vehicle identification number by itself is often not enough to positively identify a crash victim or provide relevant medical information at a critical time of need. Several states (Florida and Ohio) and the automotive industry have thought about this. As Larry Williams explained to me, manufacturers have thought about the car ownership experience and their desire to provide support at its lowest point by providing methods for consumers to connect identification and emergency contact information to their vehicle IDs. The innovation in health care that comes from industries who are built on serving consumers primarily is interesting, isn’t it.
Both the American Health Information Community and IHE have produced a use case and white paper respectively, relevant to the potential role of a personal health record beyond a tethered connection to a primary care provider, that describe an ability for a person to tie their medical history to their vehicle’s identification number, for positive identification and medical attention. This is where a personal health record might integrate, at the discretion of the consumer.
All of this presumes appropriate privacy protections, of course, such that linkage and management of the information is under the control of the consumer.
This thinking is reinforcing in me the idea that a patient’s medical home is really the place where they live, work, and play. The promise of the personal health record is that people can leverage their personal health information at the right place and time to be enabled to do what’s most important to them, while being supported by a broad diversity of care providers, who at any given time are nurses, doctors, co-workers, emergency responders, families, and communities. This is a good thing to learn.
Being an Emergency Responder in the era of Personal Health Records
September 2nd, 2008 | Popularity: 13% 0 comments | Leave a replyJust I was getting ready to post a conversation I had with Larry Williams, CEO and President of Roadside Telematics Corporation about the view of personal health records from the emergency responder perspective, I became one, again.
This time, it was this morning on a busy Washington, DC sidewalk, where an individual was face down on the sidewalk, in significant distress, with several other people frantically calling 911, and two colleagues with no medical training holding them. There were no other medical personnel around – just me. These were the few minutes before emergency medical services arrived. The person was unable to speak, and his colleagues had very limited English speaking ability. The best I could do was offer some stabilization and protection from people walking by, watch closely for any signs of arrest, and wait, and hope for help.
When EMS arrived shortly after, I identified myself as a physician and gave my presumptive diagnosis. The EMS person said, “Is that what you think is going on?” Even as a physician, in my mystical appreciation of EMS I almost thought the question was sarcastic, but he was genuinely interested in the history I had taken. And my history was limited at best.
The EMS personnel asked the colleagues if the patient had ID. They said, “No ID.” So, no identity and no medical history probably meant a trip to the hospital as as John Doe.
As you walk away from a situation like this, there’s no mistaking the feeling of having your breath taken away for a few minutes. It’s the same feeling I had when I was an emergency responder earlier this year, and several other times on various plane flights (I posted about those events too – they leave a mark – see them here).
The thing I picked up from talking to Larry about myself is identification with the emergency responder role. In my last few events, I always related the meaning to my role as a primary care physician, about how the primary care system could prevent these situations and how patient access would support that in happening. However, that’s going to be some time in coming, and various States and industries (notably the auto industry) are already developing solutions to help people.
Tomorrow I’m going to post what I learned about emergency responders, interoperability, and the role of PHRs in helping people in emergencies, as well as in preventing them in the first place.
In the meantime, I think it’s useful to think about all of the times you are somewhere, in public, in a workplace, in your car, on a plane, where people who are strangers to you (co-workers, fellow travelers, the EMS system) might need to help you in an emergency. Would you want there to be a way for them to have access to medical information about you if they needed it to help you?
In the air, health emergencies rise quietly – USATODAY.com
March 12th, 2008 | Popularity: 25% 0 comments | Leave a replyThis article is very interesting to me, because I seem to be living the statistic:
In the air, health emergencies rise quietly – USATODAY.com
I have been on several flights in the last 2 years with medical emergencies on them. On the last one, there were so many doctors on the flight, that the flight attendants actually turned people away from assisting. On two I have been on, I was the only physician on the flight, but not the only allied health professional (nurses are as important as physicians in these situations).
I’m glad this is being reported on, because I think that this issue should be recognized and there are some opportunities for us to do some things:
- Establish helpful guides for patients deciding whether to fly or not. For example, a person recently discharged from a hospital with a new medication regimen may be at risk on a transcontinental flight
- Establish helpful guides for airline personnel for working with in-flight physicians and nurses. This includes seeking out the right expertise, and maybe a 30 second coaching session on procedures like using the air to ground radio and what is available and not available on board (and there’s usually a medical kit with a lot of useful things on board).
- A guideline about intervening on a flight plan. One thing that was confusing for me in the times I assisted surrounded landing a plane in an emergency – this is the kind of thing I don’t want anyone to be guessing about. If a patient is critically ill, there should be an option to order a plane down to get help, and maybe scripting that goes with this. What’s possible though – how long does it take to land a plane and is it better to continue on and bring medics on board? Sometimes, it’s the humane thing to do to get help quicker.
- A guideline for medical providers to prepare documentation and work with flight crew to maximize their talents in an emergency. Maybe an introduction as to who has medical experience and what they can do (perhaps as part of the 30 second orientation I spoke of).
- Maybe, a guideline for patients and providers. In an in the air emergency, people encounter very intense moments and form something of a bond. I think it is therapeutic in some cases for the provider to connect with the patient/family after the incident is over, or with the patient’s regular provider in some cases. I did this with one family and it was really special.
I also have to make a broader societal call for our profession to engage in making medication reconciliation a norm in all parts of care, and in involving patients in their care by giving them access to all of their medical information (as I did in this blog post about a medical emergency I attended to on the ground). Informing and empowering patients throughout the process of care prevents a devastating outcome in these situations. None of us wants a family member in distress in a situation where they do not have accurate information about their health care regimen that they can either tell someone or have written down from their physician.
An in-air medical emergency is both an intense time and a time when people come together to do the best they can to help another person. I am a big fan of creating a process where everyone can maximize their talent and minimize their anxiety during a life or death situation.
If anyone else has attended on an emergency or seen one in the air, let me know your thoughts. Comments are open.
“Is there a doctor available?”
February 26th, 2008 | Popularity: 22% 2 commentsThese were the words I heard overhead while I was having dinner with a friend recently. Within minutes I was ushered into a back room and encountered a true medical emergency, with confused and concerned bystanders. They ultimately showed excellent judgement by activating the emergency medical system and reaching out for help locally in the interim.
I have answered several public calls for a physician in the past few years, and each situation makes my heart sink out of compassion for both the unwilling patient and the people around them, who want to do whatever they can to help.
As it so happens, my friend found me as I was pondering the situation. He asked, “Ted, how would a patient having their medical records accessible to them on the Internet make a difference here?”
I didn’t have well formed answer then, but I do now. It could have made a big difference, and not because we would bring up a web browser and start surfing.
A physician who practices with the knowledge that their patient is a partner and will see everything they do is more likely to produce records that are (a) accurate (b) involve the patient in treatment planning (c) at the patient’s health literacy level (d) involve family members in assisting in ongoing care needs. Patients can carry accurate diagnosis and medical lists and learn more about how treatment impacts their daily living.
So it’s not about the web site, it’s about the way we respect patients when we involve them and their families in care. When I think about the types of very powerful compounds we prescribe patients and the amount of information we give them (in one study, only 62% of prescriptions were fully explained to patients, 26% of the time even the name of the drug was not told to patients), it is possible to think about how many of our friends or family could be in a situation like this against their will. Prepared, knowledgeable, patients may be less likely to have emergencies in the first place. I know for certain that this was the cause of one of the emergencies I responded to about a year ago. No one leaves their home in the morning hoping to ride in an ambulance later in the day.
As my friend and I parted for the night, it seemed that the story had a happy ending as the patient received the help they needed and life went on in the environment we were in. But just like the physician in “A Fortunate Man,” even if everything turned out just fine, I would still be sad.
Each time this happens I can’t help asking the question, “Why did this happen? And why didn’t the health system prevent it?” When I think about the answers, I become just a little bit more restless to change things.
