Accidents are no film set

Author: Thijs Gras

Published in: Spring 2019 Edition of Ambulance Today Magazine

EMS staff have enough to deal with when responding to a call, the last thing they need is members of the public making harder work of it. In this column, Thijs Gras explains the difference between ‘innocent inquisitiveness’ and ‘sick sensationalism’ when it comes to the scene of an accident.

We got a call: probable resuscitationin a tram. When we arrived we founda man of about 70 years lying on the ground in a tiny space inside the tram. It was cold and rainy, so carrying him outside was not an option, at least not without proper preparation for which we had no time. The police were already performing CPR, all the passengers were out of the tram. We pulled the man a little under to create a bit more space and took over the resuscitation. While I was ballooning the man I suddenly noticed someone on the outside, looking curiously through the window of the tram as to what we were doing there.I was amazed and so were the police. After this guy was chased away, only a couple of moments later a woman took over. She gazed inside.

Now I must admit I have a certain degree of understanding, people being inquisitive when something happens involving lights and sirens. Mankind is naturally curious. In my younger years hearing the fire service acceleratedmy heartbeat and if I knew where they were going to, I went as well. A fire is fascinating to see. Smoke and flames, lights and sirens attract attention, which generally is okay, as long as you do not come too near or hamper rescue and/or fire fighting operations.

Labelling it positively, one could referto this as interest in the community, in society, in other people. The attraction could even have an evolutionary use: it is a way to mobilize help and assistance. It is only relatively recently that rescue and emergency medical care outside the hospital is professionalized and trusted to specially trained people from dedicated organizations and services. But even nowadays we value first responders and bystanders because they have one big advantage over the professionals: time. Professionals need to be informed there is a problem,find out where it is and who shouldbe handling this, and then alert the required units to rush to the scene. All these steps take time, so having people around to extinguish a fire, control a bleeding or perform CPR may be of great value.

But there are boundaries. Some people prefer filming to rendering first aid.This is ridiculous of course. Even after emergency services arrived on the scene and are doing their job, people may come very close, sometimes too close for comfort. Being a historian, I went through a lot of pictures of accidents. One would be amazed by the number of people watching accidents on some of the older pictures. Apparently this is of all ages. In the Netherlands we call this ‘disaster tourism’.

But do not forget, it may be dangerous! Even in The Netherlands we had a nasty experience in this field with the big explosion of a firework factory in the town of Enschede in May 2000. Among the 22 fatalities (including four fire fighters) and about 950 injured, were a number of people that had come to the incident just out of curiosity.

In recent years cell phones and iPhones have taken sensationalism a step further; everything is filmed nowadays. You make your own reality TV and broadcast it among your friends or nasty news channels. With a bit of luck your footage goes viral.

Last year in August there was a big collision on one of the Dutch highways. One person was so seriously injured he had to be resuscitated. People were filming everything. They bashed through the accident scene trying to get the best pictures, destroying important marks for the police investigation. They used lanes, marked with red crosses. A car even stopped on the opposite side of the motorway to film the accident, almost causing another accident with an oncoming lorry. Police noted as many registration plates as possible to give these people a big fine. Will they learn?

There are thin lines between innocent inquisitiveness, caring curiosity,sick sensationalism and pathologic papparazionism. The first two are relatively okay and can be dealt with, the other two are not okay and refutable.

As ambulance crews we ask the right honourable members of the public not to film patients and victims. And if you are struggling against the temptation, just reflect before you film: “What if this was me or my mother or my father? Do I want to go viral?” Accidents are no film sets. . .

‘MDA Teams’ App

Technology applied to the health sector has made immensely positive strides saving lives in the smartphone era – the proliferation of mobile phones within communities has resulted in faster response times than ever before. Emergency services can be notifiedof incidents significantly quicker with mobile phones than compared to landlines. Smartphone applications have offered the ability to pinpointthe location of callers with a clickof a button so that ambulances can arrive on scene as quickly as possible. Now, smartphones can even minimize unnecessary waiting times at the ER during emergencies.

It is only fitting that Israel’s (thestate affectionately nicknamed the ‘Start-up Nation’) national emergency medical, disaster, ambulance andblood bank service Magen DavidAdom (MDA) represents the pinnacleof this trend of life-saving devicesand applications. Dating back even further than the State of Israel itself, the organization continues until today as a global leader in EMS innovation, including through the development of smartphone applications that provide simple yet innovative solutions to some of the greatest challenges of modern ambulance services.

One of the Israeli organization’s most innovative and recent technological infrastructures is the ‘MDA Teams’ mobile application. With the goal of minimizing any unnecessary waiting or consultation times before ST-segment elevation myocardial infarction (STEMI) treatments, the app streamlines direct communication between field paramedics, responding ambulances, Magen David Adom dispatch centers, on-call cardiologists and receiving hospitals.

With the click of a button, MDA Teams transmits ECGs and patient vitals, combining the main methods used to bypass the time-consuming emergency department in cases of patients suffering acute myocardial infarction ECG showing ST-segment elevation: utilizing automated ECG/ computer interpretation of the ECG and easy transmission to the on-call cardiologists.

For an organization that boasts a 7.6 minutes average response time for ambulances (and half that time forFirst Responders) it is no surprise that Magen David Adom is also working to cut down on the vital minutes between diagnosing the patient and transporting them to any necessary procedures. Developed in collaboration with the intensive cardiac care units, the Magen David Adom technology has shortened the time from symptom onset to catheterization by nearly 40.3%.

The technology also represents a better process to record and document events securely and directly via the smartphone application. First, on-call cardiologists activate their app to indicate they are on-call. When a mobile intensive care unit is calledto a patient having a STEMI, the paramedic can choose the receiving hospitals from a list of hospitals with ICCU and cath labs available. Then, the paramedic can take the ECG and send it securely through the system, also eliminating the risk of a wrong ECG being transferred. The ECG is uploaded via cellular connection from the monitoring device to the patient’s file on the server. The app then sends the ECG directly from the patient’s file to the cardiologist.

Listed in the application are on-call cardiologists, event date and time, ambulance number, main complaint, nearest hospital, urgency level, region and address of the call and patient destination. App features also include documented calls between the paramedic, regional dispatch, medical consult centers, hospitals and on-call cardiologists, along with ECG record and mapped ambulance tracking during transport with the estimated time of arrival. In keeping with privacy standards, no phone numbers are shown on the dialing server.

According to Eli Jaffe, PhD, EMT-P, director of training, PR, volunteer activities, marketing and international relations for Magen David Adom, before the application’s development, Magen David Adom paramedics “used mobile phones to orally describe the patient, symptoms and the ECG. Since smartphones are currently widely used, transmission of the ECG is possible through personal messaging applications such as WhatsApp.”

But this method is not without risks, he noted. “The paramedic may accidentally send the wrong ECG from an earlier patient to the on-call cardiologist, or the paramedic could transmit the ECG to the wrong person, which could lead to a breach in patient confidentiality.”

Additionally, photos taken by phone when in a hurry transporting the patient often results in transmitting a blurry ECG. “These methods are neither effective, secure nor documented”, said Jaffe. “For a true reductionin the symptoms-to-balloon time, EMS-to-balloon time should have a secure, well documented and effective infrastructure.”

Given the grave importance of quick coronary intervention during the deadliest type of heart attack, the combination of clinical diagnosis by trained paramedics and streamlined transportation of the ECG and patient makes the process fast and efficient, substantially decreasing the chance of severe complications, neurological damage, disability and death.

With new smartphone technologies such as the MDA Teams application, such infrastructure is now available to emergency medical teams, yet again highlighting the advantages of mobile tech devices in effectively and efficiently saving lives.