Technological advances mean that air ambulance services and healthcare providers have more innovative tools at their disposal than ever before. A vital link in the emergency care delivery chain is communications systems (comms) and, courtesy of telemetry, data can be automatically measured and then wirelessly transmitted from an air ambulance in the sky to a hospital on the ground. This makes it possible for air ambulance medical professionals to monitor a patient’s vital signs and transmit this data to the receiving hospital in real time, enabling the hospital to prepare for an incoming patient.

For example, East Anglian Air Ambulance (EAAA) utilizes a portable ultrasound device that can perform patient scans and share these via a secure cloud-based server to clinical experts. The bottom line of such innovations in air ambulance comms is improved patient outcomes. “If a hospital receives incoming patient information (time to arrival and patient status/medical information) in advance, the hospital / shock room can prepare in advance and further improve response time,” summarized an Airbus spokesperson.

Fine-tuned comms

Air Ambulance Victoria MICA Flight Paramedic Educator Andrew Allan provided a tangible example of how air ambulance to hospital comms can expedite healthcare delivery: “For patients experiencing heart problems – such as a heart attack – who may be a candidate to go directly to a cardiac catheterization laboratory (cath lab), the patient’s electrocardiogram (ECG) can be transmitted from the cardiac monitor directly to the hospital, utilizing a mobile phone as a hotspot for transmission of data.”

He added: “This can be performed both on the ground and in flight. At the hospital, emergency department doctors, in consultation with the cardiology team, can then decide the patient treatment pathway prior to arrival, which may include calling in a cath lab team overnight.”

Speed and accessibility are always crucial for helicopter emergency medical services (HEMS) and air ambulance teams and, for certain patients, time truly is of the essence. In these circumstances, telemetry provides a vital link between the helicopter and hospital that ensures smooth, uninterrupted healthcare delivery.

Part of the beauty of telematics is the ability for data to be transmitted from remote sources, and air ambulances are no stranger to remote rescues. Many air ambulances are equipped with satellite phones in order to maintain a link with the hospital, even in remote locations.

AirMed and Med-Trans are Global Medical Response (GMR) companies. AirMed provides patient care onboard fixed-wing aircraft and Med-Trans provides care onboard rotor-wing aircraft.

“On the AirMed fleet, satellite phones are utilized for communication,” confirmed Amber Payne-Gregory, Director of Medical Operations, AirMed.

Lyle Butler, Clinical Director at Med-Trans, said that onboard Med-Trans’ rotor-wing aircraft, ultra-high frequency (UHF) and very-high frequency (VHF) radios are the most prevalent form of communication. “It essentially involves speaking to the referring agency/facility and receiving facility to get or give patients’ updates. We can give a detailed patient report if orders are needed from the receiving physician. This is especially important for the time critical diagnosis patients (TCDs), such as trauma, stroke and myocardial infarction,” he stated.

This allows the HEMS crew to directly speak to the receiving emergency department nurse and provide an updated report

Kelley Holdren, Administrative Director and Chief Flight Nurse at University of Chicago Aeromedical Network (UCAN) said: “The aircraft have air to ground radios (UHF, VHF, 800/900MHz) that have the receiving hospital emergency communications registered nurse (ECRN) frequency preset as a choice for each receiving hospital. This allows the HEMS crew to directly speak to the receiving emergency department nurse and provide an updated report. The ECRN then types a standardized text-page to the receiving team to relay the updated report.”

5G or not 5G?

The next generation of wireless technology is 5G, which has the potential to assist air ambulance teams. 5G networks allow healthcare professionals to treat patients remotely, so why not in the sky?

The continued improvement in mobile network performance naturally increases the capability of telemedicine, especially for high-bandwidth requirements such as video streaming

“From an original equipment manufacturer perspective, the continued improvement in mobile network performance naturally increases the capability of telemedicine, especially for high-bandwidth requirements such as video streaming,” said an Airbus spokesperson. A spokesperson for the Scottish Ambulance Service also highlighted how improvements in 5G will assist in the use of certain apps. “Wider availability of the 5G network coverage, particularly in remote and rural areas, will enhance the usefulness of GoodSAM Instant Help, giving the ability to access bystander/reporter video of the incident scene,” they said. “The GoodSAM Instant Help platform is used primarily to assist with tasking but also supports early hospital alerts for significant incidents.”

Using GoodSAM's Instant Help platform, emergency callers can share location and video, and stream this to the call receiver. This was found in a recent study to expedite outcomes and reduce average call times.

Another useful app is the Flight Vector app, which enhances comms. “For information taken from the original request call, the UCAN Communications Specialists will enter mission specific data into the Flight Vector software program,” said Holdren. “This information will then be sent out through a text-page notification through the Flight Vector app. This tells the crew the patient age, weight, pickup/drop-off locations, and any pertinent information to the call such as number of continuous drips, and whether or not the ventilator or other equipment is needed. The crew will receive this notification prior to lifting so they can gather supplies appropriate for the transport.”

From a Power Apps solution that enables medical teams to create and distribute digital checklists, to an app that reduces dispatch time, apps are helping air ambulance teams to streamline and enhance their life-saving capabilities and, with 5G becoming more widespread, there will be room for speed and efficiency to be enhanced further still.

An immeasurable impact

The ability to rapidly transmit patient data from the sky to the ground is life changing, enabling hospital-based medical teams to be completely up to speed and make the correct incoming preparations in place for the patient, giving them the best possible chance for survival. “Early information is always a positive thing because it allows for appropriate resources to be activated and readily available at patient arrival,” said Payne-Gregory. “Early activation in resources has proven to improve patient outcomes. Whether that is mass transfusion protocols for trauma patients, early computed tomography (CT) scans for patients with a cerebrovascular accident (CVA), cath lab readiness for patients with a ST-segment elevation myocardial infarction (STEMI) or even surgical teams for medical/surgical emergencies, the early interventions are proven to provide (statistically) better outcomes for patients, with lower morbidity/mortality rates.”

Early activation in resources has proven to improve patient outcomes

Allan agreed that patient outcomes can be significantly improved by timely transfer of information; predominantly faster implementation of major potentially life-saving procedures. “The ability to transmit ECGs from scene to hospital, allowing treatment decisions and planning/preparation to occur for heart attack patients long before their arrival at hospital has resulted in a drastic reduction in the time taken for them to undergo necessary procedures,” he said. “In time, the capability to send further information, such as ultrasound images assessing for internal bleeding, along with real-time patient vital signs will allow hospitals to be well prepared on arrival to manage issues quicker. While Air Ambulance Victoria’s intensive care flight paramedics working on HEMS can work autonomously, the ability to transmit information and seek another opinion or advice from a consultant who has access to real-time data and images can provide enhanced remote decision-making support when needed, while maintaining a lean crewing model on the aircraft.”

Holdren highlighted how telemetry promotes readiness and reduces possible delays in care: “Giving a succinct and brief overview of the patient that we are bringing to the receiving facility provides a real-time update of their status. This allows the waiting team to be ready for any changes that they may not have been aware of during their original transfer report. It also allows the HEMS team to be able to provide additional knowledge of what the patient will need immediately upon their arrival, if anything.”

She continued: “Upon arrival the team provides a standardized patient handoff report. However, if the patient is critical, the telemetric report previously received allows the care to be started immediately upon arrival and there are no delays to initiating care while waiting for an ‘in-person’ report.”

Payne-Gregory agreed, highlighting the importance of continuity of care afforded by telemetry: “Improved information transfer also provides a continuity of care that the patients deserve. By improving that information transfer, patients do not receive redundant measures that may not be of benefit but may cause a delay in definitive treatment.”

Implementing improvements

An important consideration as data transmission capabilities continue to improve is that of privacy concerns. Naturally, patient data is highly confidential and must be protected. Can this be guaranteed when using helicopter to hospital comms?

It’s all about weighing up the pros against the cons, said Allan. “Any future increases in the use of technology to live stream information to hospitals and the time it takes to establish the links and ensure someone appropriate within the hospital is receiving the information needs to be weighed carefully against the benefit to doing so – ie, will the time taken to establish the sending of the information result in an overall reduction in time to definitive treatment? A major barrier is ensuring patient privacy is appropriately protected so that the information transmitted is done so in a manner compliant with legislation,” he explained.

A major barrier is ensuring patient privacy is appropriately protected so that the information transmitted is done so in a manner compliant with legislation

Despite the challenges, the benefits are clear; the bottom line being improved patient outcomes. “As technology, systems and processes evolve, the capability to transmit real-time images and patient data to hospitals or other specialists will greatly benefit patients, as has already been well demonstrated with heart attack patients,” said Allan. “With expanding paramedic skillsets, such as point-of-care ultrasonography to detect internal bleeding, along with other projects, such as developing a portable CT scanner suitable to be carried in an aircraft, the ability to transmit images and information in real time will significantly reduce time to implementation of definitive treatment and contribute to saving lives.”

The sky’s the limit

If digital advances continue to produce more robust and efficient comms technologies, one day we could feasibly see the option to send from helicopter to hospital a clear, comprehensive picture of a patient’s status and stream live video from the sky. “We believe that telemedicine will play an important role in further improving the quality of medical care for patients and the overall improvement of HEMS systems worldwide,” said an Airbus spokesperson.

The project is developing the capability to fit a portable CT scanner into both fixed- and rotor-wing air medical aircraft

Looking ahead to the future, Allan described an exciting project underway: “Air Ambulance Victoria, along with the Royal Flying Doctor Service, South Australia, is involved in an Australian Stroke Alliance project to develop a ‘Stroke Capable Air Ambulance’. The project is developing the capability to fit a portable CT scanner into both fixed- and rotor-wing air medical aircraft when responding to patients in remote areas suspected of having a stroke. The aim of the project is for the air medical team to perform a CT scan of the brain on site and send the images to a consultant neurologist to diagnose the cause of the stroke and provide specific treatment advice. While this service currently exists to support rural hospitals via Ambulance Victoria’s Victorian Stroke Telemedicine service, the ability to extend this so that HEMS paramedics are capable of performing a CT scan of the brain in an aircraft is exciting.”

If every piece of equipment used in an air ambulance could automatically transmit data to receiving hospitals, the impact would be significant, and this might become reality in the future. “I know some aircraft manufacturers and completion facilities are working on systems that will connect with the various pieces of clinical equipment – ventilators, cardiac monitors, balloon pumps etc – and transmit their data via satellite phone,” said Butler.

The communication between air ambulances and hospitals is a significant factor in patient outcomes and if comms can be improved, the number of lives saved can soar. “At the end of the day, the goal is to make sure that the patient receives the highest level of care and gets to the needed resources to have a better quality of life and to be in a better state than what they arrived in,” concluded Payne-Gregory.