MDA: Leading the way in new technology
Technology and communication in EMS has come a long way since the early days of ambulances merely being patient-transporting vehicles. Today, communication is vital in many directions: between patient and Dispatch Centre; between dispatch and the crews in the field; between the crews and the Emergency Departments; and, more recently, between crews and specific departments such as Cath Labs or Stroke Units.
In Israel, Magen David Adom, the national EMS service, is at the forefront of such advances, leading the way in improving patient experiences and treatment.
Recently, a mobile app called MyMDA was launched. It is available, free of charge, to the general public, and has many valuable functions. Once downloaded, an entire personal and medical history, details such as name, contact details and address, ID number (all citizens have a personal ID number) and medical insurance, as well as medical records and documents such as ECGs can be saved to the app allowing the Dispatch Centre access to information that may prove vital for the crews. Details can be loaded for all members of the immediate family on one phone.
It allows for a quick, one-touch dial to the Dispatch Centre, and if used rather than regular-dialing the 101 number from the phone, automatically locates the caller by GPS, saving vital call-taking time, even when there’s no mobile signal.
The app also allows for a direct video link as well as live photos taken from the scene of the call, allowing the call taker to see as well as hear what’s happening at the scene, making dispatch decisions easier and more accurate. All call takers in Magen David Adom are trained at least to the level of EMT and all have on-the-road experience.
MDA moved several years ago from paperwork to tablets, and the available features have moved along with the technology. Call information is now sent to the crews via a dedicated, secure app (different from the one above), and it allows for direct communication between the crew and the hospital. It’s a long way from the CASMEET days, where priority information was relayed from the busy crew via an equally busy Dispatch Centre over the radio, leading to miscommunications on many occasions. Often the message that was received by the accepting hospital bore little resemblance to that which the crew transmitted.
Today, the crews are able to dial the relevant Emergency Department directly and speak with the nurse or doctor in charge and relay information in a far more accurate manner than communication by radio allows. The vital signs and ECG can also be transmitted directly via either the tablet or the app, reaching the destination in real time and allowing the crews at the hospital to be better prepared for the arrival of the patient.
CCTV cameras have also been installed in the ambulances allowing a live feed, only once patient permission has been received, to the on-call medical team in the MDA Dispatch Centre. This allows for a doctor (there is at least one on call 24/7), to better assist crews who may need extra permissions to allow them to treat outside of the protocols.
The technology allows for direct communication not only with Emergency Departments, but also with specialised units. Most hospitals nationwide have PPCI capability and are now able to receive ECGs directly from the monitors on the ambulances. They are linked via the tablet and the app, then sent to the appropriate receiving hospital where a cardiologist receives the information directly to their smartphone, and can assess the ECG and decide if the patient is a candidate for direct access, or whether they should be assessed first elsewhere. In the majority of cases, the decision has already been made by the paramedic on scene, and the transmission is one of courtesy and to advise that the patient is on the way. It allows for the cardiology team to be confident that they aren’t on stand by for a potential false alarm, but are preparing for a critical patient before they’ve even arrived across the threshold, and are thereby able to reduce further the door-to-balloon time and successfully treat more patients.
The same is now also true for certain Stroke Units across the country. In a programme that is currently being rolled out across Israel, crews who diagnose a suspected CVA or stroke can now contact the nearest Stroke Units, send the patient’s details, vital signs, basic assessment and suspected diagnosis, allowing the hospital staff to prepare the CT scanner and any relevant staff or equipment for a possible procedure.
Magen David Adom is leading the way in the development of new technology, starting from the call taking process, rapidly identifying the location and condition of the patient, and improving outcomes by allowing faster and more accurate treatment, as well as direct access for patients to the level of care that caters immediately for their needs.