SINGAPORE: A new digital platform will allow paramedics to share a patient's vital signs in real time en route to the hospital, improving the patient's chances of survival.
The platform, called Operational Medical Networks Informatics Integrator (OMNII), will be shared among stakeholders in pre-hospital emergency care (PEC) services, such as the Singapore Civil Defence Force (SCDF) and hospitals.
It will allow them to view, document and share patient data with each other, resulting in speedier patient management, said the SCDF at a media preview of OMNII on Tuesday (Aug 24).
OMNII – a joint project between SCDF and the Ministry of Health (MOH), with the Defence Science and Technology Agency (DSTA) as the project manager – will be launched on Thursday.
Pre-registration of patients will be available for hospitals in the SingHealth cluster – Changi General Hospital, KK Women's and Children's Hospital, Singapore General Hospital and Sengkang General Hospital – during the first phase.
The pre-registration function for the second phase of hospitals, including Tan Tock Seng Hospital, National University Hospital and Ng Teng Fong General Hospital, is slated to happen over the next year.
CHANGES TO EXPECT
Under the current process of attending to a patient in critical condition, nurses in SCDF's operations centre convey information about the patient's condition to the paramedic once they receive the call, explained SCDF.
Due to limited structured information sharing across PEC stakeholders, paramedics have no access to patient's past medical records while in the field, added SCDF in a separate press release.
There is also "no real-time integration" between SCDF and a hospital's emergency department systems, making it challenging to seek medical guidance en route to the hospital.
Additionally, efficiency is an issue, as "physical copies of ambulance case records need to be filled in, with digital transcribing only done later on".
But with OMNII, several crucial steps are undertaken before the patient arrives at the hospital, preserving the "golden hour" for "better patient outcomes", explained SCDF.
These steps include:
- pre-registering the patient
- sending a standby alert to pre-triage the patient
- sharing the patient's vital signs, photos and video clips of their condition
- activating the trauma team in the hospital
- preparing CT and/or X-ray rooms, and
- pre-ordering of drugs
"Having some advanced information can be lifesaving," said a MOH spokesperson.
"For example, you have a drug allergy for a common drug like aspirin, which is what we give when a patient is having a heart attack ... because it helps to open up a blocked artery in the heart. But if you are allergic ... we'd select a different medication that has the same effect."
Currently, doctors are limited because "the ambulance is not linked to the emergency department in real time", added the MOH spokesperson.
"With OMNI, I think there will be near real-time sharing of information, which means that when we have the NRIC, and we know this patient has a drug allergy, we can choose the correct drug for the correct patient."
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- Once the location is known and an ambulance is dispatched, SCDF's operations centre will ask for the patient's NRIC to facilitate access to the patient's National Electronic Health Record (NEHR).
- SCDF paramedics may take photos and/or videos of the accident scene or patient's injury. This will help the hospital to prepare necessary resources ahead of time, as well as help paramedics to accurately convey the patient's condition should they need to seek help from the emergency physician through the telemedicine module.
- SCDF paramedics will pre-register critical patients, sending a standby alert to the receiving hospital's emergency department. This allows the hospital to anticipate and prepare resources before the patient's arrival.
AFTER A 995 CALL
Under OMNII, the SCDF operations centre will create an incident case report and dispatch the ambulance. They will also ask for the patient's NRIC number.
Other forms of identification, such as Employment Pass or Work Permit number, can also be used to access relevant patient data.
On the way to the incident scene, SCDF paramedics will be able to access the patient's selected medical records from the database using the patient's NRIC, allowing them to better understand a patient's medical history.
To ensure the patient's data remains safe, paramedics are only privy to essential details of the patient's health condition.
Once they arrive at the scene, paramedics will capture photos or short videos to send to the hospital's emergency department.
Capturing photos and/or videos of the incident or the patient's injuries "won't compromise patient care", said SCDF, explaining that the team of paramedics will prioritise treating the patient, with an assistant taking the photos and videos.
EN ROUTE TO HOSPITAL
Once the patient is triaged as "critical", the hospital's emergency department will acknowledge a standby alert sent by the paramedics.
They also receive real-time information about the patient, including their vital signs, as well as photos and videos taken at the scene, allowing the hospital to anticipate the required medical resources and interventions to be carried out.
With information about the patient, the emergency physician and trauma surgeon can discuss a resuscitation plan, added SCDF.
At the same time, a team of trauma surgeons will also be activated for critical cases to assist when the patient arrives, reducing the "door-to-treatment" time.
In the ambulance, paramedics pre-register the patient in the hospital's system to start the emergency department's process of receiving the patient. Pre-registration also allows the hospital to prepare controlled drugs, and preorder various procedures, such as CT scans or X-rays.
Presently, information is conveyed verbally over the phone, SCDF shared. With OMNII, it reduces the likelihood of human error, as the emergency physician is able to receive "more accurate information" about the patient's condition.
Should the patient's condition worsen on the journey to the hospital, OMNII allows the paramedic to feed the hospital with immediate updates.
ARRIVAL AT THE HOSPITAL
As the patient's vital signs and information had been relayed to the hospital on the way, patient care is able to "transit seamlessly" to the emergency department, said SCDF.
There is also improved accuracy during handing over of the patient, as OMNII "brings the doctor's eyes to the incident site itself", rather than just verbal communication from the paramedic about the incident and the patient's injury, said SCDF.
The patient's records are then uploaded into the National Electronic Health Record (NEHR), which is accessible throughout their care. Once the case is closed, paramedics will purge the patient's data from the OMNII system to protect their data.
"On average, to get from an accident scene to a hospital in Singapore, it can be anything from five, 10 minutes to half an hour, depending on the time of the day and traffic conditions. The problem is that if we only find out about the patient's condition when they hit the door at the emergency department, that is the first opportunity we get to activate a whole chain of processes," explained the MOH spokesperson.
In a trauma case, hospitals would need to activate a team that includes the trauma surgeon, who might be attending to other cases. They would also need to clear the room for CT scans.
"During that vital period of time ... when the ambulance is en route, this will be going on in parallel at the hospital to get ready for the patient. So once they hit the door, registration is already done, we can order the scans, and the key doctors are already there, they can make the decisions," said the MOH spokesperson.