More efficient prehospital emergency care with e-Health – full-scale simulations show the benefits

Prehospital ICT Arena (PICTA), at Lindholmen Science Park in Gothenburg, led the nationwide project, PrehospIT-Stroke – an open arena for cooperation relating to prehospital ICT/e-Health with the aim of increasing the use of ICT for the benefit of patients and healthcare. The project has been financed by Vinnova, as well as 21 participating parties from the Swedish healthcare, business and academic sectors.

The simulation field test was the final stage of PrehospIT-Stroke, in which a recommendation has been formulated to harmonize semantic and technical interoperability at national level, based on established standards and work practices (NEMSIS, Snomed CT, HL7, EHI, etc.). The field test was carried out at the ambulance station at Skaraborg Hospital, where methods for full-scale simulations were drawn up in cooperation with the University Colleges of Skövde and Borås. The simulated event was based on a fictitious region or county council that has ability to provide thrombolysis and thrombectomy treatment, and also the possibility of remote expert consultation. The patient was an advanced simulation doll that could be managed by remote control to act in the desired way. Eleven ambulance stations participated in the field test. 

Professor of Practice, Bengt Arne Sjöqvist, Chalmers, project leader and program manager Prehospital ICT Arena at Lindholmen Science Park, outlines the advantages of simulations compared to a field test in a real care environment with patients:

“Questions relating to patient security, ethics, effects of care, etc., are easily answered and field tests can be done in a shorter time and at a lower cost. It also allows for better opportunities for analysis and follow up, including filming, and potential subsequent tests can then be carried out with better precision.

“This is pioneering work where the results will be available for all parties as we want to create better conditions for more efficient use of ICT within prehospital medical care. Better ICT solutions contribute to quicker processes and the right medical decision for the patient in question. Stroke is therefore an excellent and important example of a situation where quick and correct treatment is just as important as in an acute heart attack,” says Bengt Arne Sjöqvist.

The emergency prehospital stroke medical care chain was chosen as the first to undergo the field test because of the fact that approximately 30,000 people a year are affected in Sweden which leads to significantly increased costs to society and much personal suffering.

Magnus Andersson Hagiwara, Senior Lecturer at the University College in Borås and also a paramedic, has had chief responsibility for the setup of the field test. He was present during the simulations and sees many advantages with the project.

“This a superb way of developing and testing ICT support, and the simulations that we have conducted give us invaluable information to proceed with. This concerns increased patient safety, an area in which I have done a lot of research previously.”

Jonas Åsberg, Faculty Program Director at the Support unit, Ambulance medical care at Skaraborg Hospital has accompanied the ambulance team and adds:

“In the simulation environment, the ambulance team can test and use the technology in different situations. The project gives us opportunities to develop what we believe in and we can take the methodology to a new level.”

In the long-term PrehospIT will contribute to better ICT support in all prehospital medical care processes, as well as follow up, development of operations and quality assurance at both local and national level. 

Watch a film from the simulation

Background Information
Health and medical care is undergoing a digitization process that affects all areas and operations. An important component in this is that all relevant ICT systems (information and communications technology) can communicate with and understand each other – so that there can be semantic and technical interoperability. To solve this may seem easy, however, considerable resources have been invested in this challenge at a regional, national and international level, where a solution still remains to be found and the practicable applications can only be used to a limited extent. The project PrehospIT- Stroke addresses this problem within the prehospital arena with stroke as the first application area, and with the ambition to deliver a recommendation and thus define future direction.

Every year, approximately 30,000 people in Sweden are affected by stroke, and it is the most expensive physical illness in the country, as it leads to several days spent in care at hospitals and hospices than any other physical illness. The annual cost has been estimated in the region of SEK 16 billion. The illness affects primarily older people, over 70, but also many younger people. Studies have shown that approximately 20% die, while 30% become functionally dependent, which means that they require assistance from another person for basic things such as going to the toilet, etc. In terms of size 50% are deemed “functionally independent” but this group can have various levels of neurological disorders. In the case of an acute stroke the time to correct treatment is of great significance and is critical regarding the outcome. Depending on the type and location, different treatments are possible in an emergency situation, for instance thrombolysis or thrombectomy treatment, where the latter is only carried out at a university hospital.

(Factual reference: Stroke a fight against the clock, Karolinska Institute)

During the full-scale simulations ICT support was carried out by five partial solutions from Ortivus, SAAB, InterSystems, Cerner and Lindholmen Science Park who used the prepared recommendation to achieve interoperability. Two different patient cases were managed by 11 ambulance services with and without ICT support - from the emergency call to the pick-up point and the transport to debriefing. During the field test, the entire process was recorded on video and all the information and communication was stored for future analysis.