Paramedics are the final digital frontier

Patient handovers from ambulance to ED remain an analogue process. A lot could be improved with better data sharing.

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As the Omicron variant of covid surges around Australia and the world, ambulance ramping is commonplace, and paramedics can queue for hours in hot PPE while they wait to hand over an endless stream of inebriated, injured, sick and distressed people to hospital staff.

But despite the advent of paperless hospitals and the inexorable adoption of electronic medical records, patient handovers from ambulance to ED remain an analogue process, involving at best a printout of patient vital signs, treatment and trends, and the call details from 000 – but usually perhaps just a verbal summary to an admitting nurse or doctor.

“Over the 20 years that I have been a paramedic, the information flow in this job has barely changed,” says Gary Wilson, secretary of the Australian Paramedics Association (NSW).

Wilson says that 000 call-takers record the call, sending details to the ambulance mobile data terminals (MDTs) – and the quality and quantity of that information varies widely.

“Sometimes there’s a lot of information, which can be overwhelming when you’re driving with lights and sirens responding to a scene – other times you have hardly anything to go on.”

Information desert

It’s unsurprising when stressed-out callers don’t give thorough details on an emergency call – but Wilson says that, paradoxically, there’s barely any information given for patient transport jobs, where hospitals have extensive patient data.

And once a patient has been delivered, there’s zero feedback, he adds; and in a job that involves constant exposure to trauma, a little bit of acknowledgement can go a long way.

“Yes, knowing a patient had a better outcome because of what we did could be good for our mental health,” he says. “But it could also help to get feedback in cases where we were uncertain about the diagnosis, or we could have given different treatment – that has the potential to improve our skills and help future patients as well.”

Despite NSW having the third-largest ambulance service in the world, the service uses software repurposed from Victoria’s fleet that can’t communicate with state hospital systems, so bits of paper and verbal handovers remain the norm.

“ED staff can see what happened in another hospital or previous visits, but though we record patient blood pressure, pulse and respiration, and treatments including restricted medications, that data won’t appear on the hospital system unless staff physically re-type; it’s only on the paper we print out and the verbal handover we give.”

Wilson agrees that seamless data transfers between ambulance and hospitals could ease pressure on paramedics, potentially reducing errors in EDs, and this data could be used with existing modelling technology to better prepare emergency services.

National Ambulance Data a valuable resource

First-responder data from ambulance services across Australia is already harnessed in a valuable world-first project that crosses ambulance data siloes to monitor suicide, violence, and alcohol and drug use harms.

The project is a collaboration between Monash University, Eastern Health Vic and addiction research centre Turning Point, and was awarded a $1.2 million grant by Google in 2019 to develop AI to help code suicide-related ambulance attendance data.

The team, headed by Associate Professor Debbie Scott, developed the National Ambulance Surveillance System to collate and code monthly ambulance attendances data from ambulance services in NSW, Victoria, Tasmania and the ACT, funded by the Australian Institute of Health and Welfare.

Patient clinical records are extracted and de-identified, and then more than two dozen trained research assistants read and annotate each record, getting through half a million records a year.

“This data can help us evaluate whether policy and interventions are effective, and understand what happens on the ground after events like major bushfires, or how people respond to lockdowns, in terms of violence, drug and alcohol harms,” Scott says.

Scott says the rich data that paramedics collect every day has shone a light on harms like suicide, mental health and violence and immediate triggers for these.

“We hear all the time about the meth epidemic, which is a huge problem – but our data shows that at a population level, meth pales into insignificance compared to alcohol,” she says.

“For example, we’ve found a direct link between family violence attendances and the number of liquor licences in a given area.”

Scott says this data can ultimately help support system change to reduce harms in the community.

“It might not improve ambulance response times at the moment, but if we can reduce the number of calls for alcohol-related harms, that’s going to free up paramedics to respond to heart attacks and strokes, and car accidents,” she said.

“If we can free paramedics up from preventable harms, the response times will improve.”