Page 120 - JSOM Summer 2022

The Future of Prehospital Critical Care

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Adam Johnson, BS, NRP, CCP ; Max Dodge, BS, NRP ;
Andrew D. Fisher, MD, MPAS *
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ABSTRACT
As technology improves, the capabilities of prehospital pro- autonomous driving and augmented driving technologies
viders increase. Innovations and realizations from military present an opportunity to preserve the lives of the rescuers.
counterparts are being transitioned to civilian emergency care Extending this idea to a mass casualty scenario, self-driving
with the same hopes of increasing survivability of patients. ambulances could decompress the scene while maximizing the
Looking to the future, the incorporation of drone aircraft in usefulness of every trained medical provider. Artificial intelli-
the critical care field will likely impact the way medicine is gence enabled driving software that is able to communicate
practiced. Education is the key to improving outcomes in the with receiving facilities could make destination recommenda-
prehospital setting. tions based on reported patient loads.

Keywords: innovations; prehospital; EMS; emergency medical Delivery of Care
services; drone; transportation; military; future; technology Autonomous transportation platforms can also be used to
provide medical supplies and necessary equipment to aus-
tere settings. Drones are currently being used to move blood
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products from blood banks to treatment facilities in more
Introduction
resource-constrained countries. Domestically, drones have
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There have been many advancements in the last 50 years of been utilized to deliver donor kidneys in transplant surgery,
prehospital medical practice. We have seen the expansion of bring automated external defibrillators to patients in need,
medical knowledge reflected in our scope of practice. Civilian and transport fluid samples to the laboratory. Despite some
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critical care programs have incorporated a great deal of the US regulatory hurdles, both military and civilian health systems
military’s medical lessons learned in the wars of Afghanistan, may benefit from the use of unmanned material transport to
Iraq, and Syria. Equipment such as tourniquets, medications in- decrease mortality.
cluding ketamine and tranexamic acid, low titer group O whole
blood, and treatment frameworks such as massive hemorrhage, Equipment and Patient Care
airway, respiration, circulation, hypothermia (MARCH) and The future of equipment in prehospital critical care has
remote damage control resuscitation (RDCR) have all bene- evolved from cravats to commercial tourniquets, and from
fited from massive data collection and analysis performed by very high frequency (VHF) radio systems to telemetry patient
military medical research organizations. Likewise, the US mil- interventions and evaluations. Training simulators have ad-
itary has put forth a great effort to align its standards of care vanced from cardiopulmonary resuscitation (CPR) manne-
with modern medicine using civilian best practices. 1 quins to full-body systems that allow uncontrolled bleeding
and surgical procedures. Medical training centers also incor-
A substantial effort is underway to build a more robust na- porate virtual reality simulators, 3D printed ink-filled organs,
tional trauma system and decrease the number of poten- and detailed opaque body parts. These enhancements allow
tially preventable deaths. Until recently, out-of-hospital and for more direct visualization of anatomy and physiology for
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pre-hospital medicine has remained largely untouched by re- training facilities unable to participate in cadaver labs.
search and innovation. As such emergency medical services
(EMS) potentially represents one of the few remaining medical Real-time training simulators improve response times of pro-
fields in which massive advances in professional practice can be viders while shoring up current skills and building on new
made in a short amount of time. This article will explore some ones. This exposure assists providers in developing higher-level
of the advancements we may expect to see in the near future. critical thinking skills in their treatments.
Advancements from the battlefield such as the battlefield-
The Future
assisted trauma distribution observation kit (BATDOK) can
Transportation be adjusted from the point of injury (POI) to the critical care
While transportation does not broaden the scope or practice field to create a completely remote monitoring electronic In-
of prehospital care per se, traffic collisions represent a signif- tensive Care Unit (eICU) system referred to as a tele-ICU.
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icant proportion of deaths for prehospital providers. Existing This can increase monitoring and documentation of necessary
*Correspondence to anfisher@salud.unm.edu
1 Andrew Johnson is affiliated with the School of Public Health, Imperial College London, London, England. Max Dodge is affiliated with
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the University of New Hampshire, Durham, NH. Dr. Andrew D. Fisher is an emergency medicine physician affiliated with the Department
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of Surgery, University of New Mexico School of Medicine, Albuquerque, NM, and the Medical Command, Texas Army National Guard,
Austin, TX.
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