Recent events, such as the COVID-19 pandemic and the Manchester Arena Inquiry, have highlighted concerns regarding the pre-hospital ‘care gap’ or ‘therapeutic vacuum’. This is a delay or inadequate provision of medical diagnosis and/or treatment resulting in adverse outcomes. The causes may be multifactorial; however, technology can play a major role in closing the care gap in various scenarios, as proposed by the NHS Commissioning Authority in the Technology Enabled Care Services Report.
Chronic disease management
Over 60 per cent of patients admitted to hospital as an emergency have one or more long-term health conditions (LTC), such as Chronic Obstructive Pulmonary Disease (COPD) and Coronary Heart Disease (CHD). The use of telehealth can dramatically close the care gap by reducing the need for emergency admissions by proactively and pre-emptively monitoring LTC patients and alert healthcare personnel in the event of a deterioration.
South Birmingham PCT achieved a 58 per cent to 87 per cent reduction in unplanned admissions over a 12-month period across COPD and heart failure patients, across 100 patients. Derbyshire Community Hospital achieved a 68 per cent reduction in unplanned admissions, with a 415-bed day reduction across 187 patients in a six-month period, with a net saving of c£100,000. Bristol CCG monitored 400 patients, within just 30 days of the telehealth service starting the number of contacts reduced by 26% with an 18 per cent reduction in face-to-face time and 40 per cent reduction in telephone contacts. After three months, 54 per cent of COPD alerts and 44 per cent of CHF alerts were being self-managed by the patients.
The ambulance service is well placed to run regional telehealth programmes due to call centre infrastructure, existing relationships with ‘frequent flyers’ and a high level of clinical knowledge. Deployment of the telehealth app onto the patient’s mobile phone is initiated by paramedics if interim monitoring is required following assessment. The greatest benefit is gained by the patient.
Casualty care in mountainous regions presents significant challenges in terms of access, assessment and evacuation. Ascent by mountain rescue teams (MRTs) can take some considerable time depending on location and weather conditions leading to potential clinical deterioration. Air ambulance retrieval is also dependant on weather conditions and access to suitable landing areas.
Great North Air Ambulance Service (GNAAS) has taken an innovative approach by trialling a paramedic equipped with a Gravity Industry Jet Suit, which can fly in adverse weather conditions. The latest Jet Suit runs 1250bhp of micro jet engines, can fly for up to five minutes and cover over a mile a minute, with a maximum range of 4km. Darkness and rain do not prevent use, only wind up to 50mph gusts will prove a challenge. In addition, a lightweight (850g) wireless full vital sign monitoring system has been provided by Black Space Technology for the trial. Andy Mawson, Director of Operations and paramedic at GNAAS, said, “We think these technologies could enable our team to reach some patients much quicker than ever before. In many cases this would ease the patient’s suffering. In some cases, it would save their lives.”
Marauding Terrorist Firearms Attack
The inquiry into the Manchester attack, which killed 22 people and injured hundreds more, has begun looking into ways of shortening the ‘care gap’. Dr Matthieu Langlois gave evidence to the inquiry. He was part of RAID, a French national counter-terrorist armed police unit that responded to various terrorist attacks across France. He told the inquiry that rapid evacuation of casualties from the ‘hot zone’ and getting them to hospital was the biggest priority in responding to any mass casualty incident. He described at the inquest how, ‘RAID worked with the tactical medical triage device (Rapid Triage) that was put on casualties who can be geolocalised at our command post along with all the other information so that everybody will have a map of what the Forward Medical Physician is doing, which triage he is doing, how many casualties there are and their location. The idea is that triage is only done once, and they then go straight to hospital. The only objective is to win a lot of time for the direct evacuation to definitive care.’
The use of such technology has significant advantages over the traditional paper triage system as it provides faster triage, geolocation for rapid evacuation, including track and trace, and real-time interagency data visibility, allowing demand to be matched with the appropriate available hospital resources.