Chris Netherton, M.D.

Creating the Digital Ambulance

New technology is set to revolutionise the design and operation of our ambulance fleet, leading to better connected care for patients and the development of a new kind of digitally-enabled paramedic.

Lord Carter recently published his in-depth review of the way in which ambulance trusts in NHS England currently operate. He estimated that £300m a year could be saved by cutting unnecessary transfers to hospitals and that a further £200m saving could be achieved by adopting more efficient operating models. (For example, across the country there are now 32 different types of ambulance in use, a situation which his report describes as “simply unacceptable.”)

One of the key thrusts of the report was the way in which digital technology should be used more effectively to assess and treat patients at the scene or on their way to hospital. As an IT specialist, there were two points raised in this area that immediately leapt out at me.

The first point was Lord Carter’s call for digital patient records that paramedics can access at the scene. Lord Carter wants these to be made much more widely available. This is a technology that is still in its infancy within the ambulance service.

Regular readers of these blog pages will be aware that I have long believed that digital patient records, which have been so successful in GP practices, should be rolled out to other parts of our care system, as a crucial tool for providing timely and ‘joined up’ treatment for patients.

Microtest’s Guru patient record software provides a secure system that allows GP records to be shared with ambulance services, hospital emergency departments, urgent care clinics and many other healthcare providers. This kind of technology improves quality of care and helps to save lives. So it was good to see Lord Carter adding his voice to those calling for its wider adoption within our ambulance service.

The second key point was Lord Carter’s recommendation that the NHS accelerates the development of the ‘digital ambulance’. The technology exists to begin treating and monitoring patients at the scene, but this is currently not always possible, due to our ageing ambulance fleet. Again, it makes perfect sense to me that this type of technology should be a priority for development. Just think of the number of time-critical conditions, such as strokes, where early intervention has a huge impact on the quality of outcomes.

But what could the Digital Ambulance of the future look like? Well, a good place to look for an example is in Australia. The impetus to develop this kind of ambulance has been stronger in Australia because of the issues caused by a population that is dispersed over such a wide geographical area. In the Northern Territory, the average waiting time for an ambulance is 25 minutes, while in Tasmania this rises to 31 minutes.

As a result, Australia created a concept prototype for the Digital Ambulance over two years ago. The ambulance is WiFi enabled allowing key equipment to be in constant contact with the hospital. Vital patient information, such as ECG readings, can be monitored in the ambulance but also transmitted to the hospital on a continuous basis.

This means that the receiving emergency department will be able to track changes to the patient’s condition in real time. The ambulance is also fitted with video cameras, allowing the hospital team to view the patient and to have an ongoing dialogue with the paramedic team as they are on their way to the hospital. By the time they arrive, the medical staff will already have a detailed overview of the patient’s condition and will be developing action plans, thus saving vital time from the triage process.

All this will mean that the paramedics of the future will need to be highly trained in the use of these types of modern technologies and also empowered to make decisions about a patient’s urgent care needs. This will require new thinking about care pathways and the role of the paramedic or first-responder. It will also require a balanced, long-term approach – investment in new technology must be matched by investment in the skills training required to ensure it is used to its full potential.

There are many challenges ahead before the Digital Ambulance becomes a reality in the UK – but this aspect of patient care appears to be moving in a very exciting direction.