“Super Ambulance” Extends Reach of UT Physicians
to Help Hurricane Victims in Louisiana & East Texas
HOUSTON—(Oct. 17, 2005)—Just days after Hurricane Katrina struck, paramedics pulled up to an assisted living facility in a high-tech ambulance that would make it possible for doctors in Houston to provide remote care to patients who had been abandoned at the New Orleans facility.
From the Emergency Center at Memorial Hermann Hospital, Brent King, M.D., professor and chairman of the Department of Emergency Medicine at the UT Medical School at Houston, and James "Red" Duke, M.D., the John B. Holmes Professor of Clinical Sciences, evaluate a patient who is traveling in a high-tech ambulance in a distant county.
One of the first patients the emergency response team came across was a woman who had fallen through a floor in a dark, hot hallway. She was complaining of neck pain. She and the others in the building had been without food, water or medical care for six days. Five were dead.
“The attendants at the personal care home had abandoned their patients. We really didn’t know what to expect,” said Brent King, M.D., professor and chairman of the Department of Emergency Medicine at The University of Texas Medical School at Houston.
“We were able to bring her into the back of the ambulance and assess her injuries,” King said.
Sitting in front of two computer monitors at Memorial Hermann Hospital, 350 miles away in Houston, King was able to see the patient, as well as talk to her and to the Liberty County EMS paramedics. In a matter of minutes, King was able to determine that the woman’s injuries were not severe.
“We could move her out and begin evaluating other patients who had been left behind after the hurricane,” King said.
The interactive digital ambulance is a product of a federally-funded initiative by famed trauma surgeon James “Red” Duke, M.D., and S. Ward Casscells III, M.D., both faculty members at The University of Texas Health Science Center at Houston.
Since its inception in 1995, the collaborative effort with the U.S. Army Medical Research and Material Command and Texas A&M University System has evolved from DREAMS (Digital Relief and Emergency Medical Services) to the Texas Training and Technology for Trauma and Terrorism program.
The current program, known as T5, develops and tests a variety of telemedicine and telecommunication technologies that feature real-time remote monitoring of patients who are in locations where hospital care is not readily available. These technologies are being designed to offer emergency medical care in rural areas, on the battlefield and in disaster areas.
Funding for the T5 project comes from Congressional appropriations administered through the Department of Defense and managed by the Army's Telemedicine and Advanced Technology Research Center (TATRC).
After Hurricane Katrina and, one month later, after Hurricane Rita, emergency medical responders were able to road test these technologies in conditions for which they were developed.
One ambulance—equipped with cameras, patient monitors, cellular telephones and other equipment—was deployed to New Orleans for four days to assist with the medical relief effort after Hurricane Katrina.
That same ambulance returned to its home base in Liberty County and was soon used to help patients in its own backyard who were affected by Hurricane Rita. Area hospitals were without power, and because medical services were limited, the high-tech ambulance became an invaluable resource.
Paramedics from Liberty County EMS operated the digital ambulance in the wake of both hurricanes. They have been leasing and testing the ambulance for the past year. To date, they have transported or responded to more than 624 calls for service.
In addition to the ambulance working in East Texas after Hurricane Rita, Doug Tindall, the Digital EMS project director at the UT Medical School, said remote telemedicine stations were set up in Nacogdoches and outside the emergency room at Liberty-Dayton Community Hospital.
These portable, mini-emergency rooms are similar in capability to the ambulance in that doctors can be called in, see the patient, triage the patient’s condition and authorize potentially life-saving treatments that paramedics otherwise would not be allowed to perform.
Each station, which can run on electricity or battery power, includes multiple cameras, a patient monitor, defibrillator, portable ultrasound equipment and other medical supplies. All of this fits compactly into a portable pack that is about the size of a suitcase.
Because of this technology, under Duke’s supervision, a nurse was able to stitch up a patient’s hand wound in Nacogdoches. “It wasn’t a severe injury, but it needed to be sewn up, and there was no one else to do it,” Duke said.
Duke said the telecommunications equipment in the ambulance and deployable “telementoring” units virtually put the physician ”in the back of the ambulance” with the patient and field responders like Michael Ross, who was operating the Liberty Co. ambulance and taking care of hurricane victims.
“In most cases, you don’t need a physician. Paramedics and EMTs (emergency medical technicians) do a great job and can take care of everything until they get the patient to the hospital,” Duke said. “But when they need help, they need it, and if they are 60 miles away, they can’t wait to get to the hospital.”
When that happens, those operating the ambulance or deployable telementoring stations can ask for assistance. With a few keystrokes and touches of a computer screen, emergency medicine physicians who staff Memorial Hermann Hospital are immediately available to “telementor” paramedics as they insert chest tubes, administer medications and or perform other lifesaving measures.
When every second counts, this intervention could save lives, Duke said.
King said the T5 technology operated almost flawlessly in the wake of the two hurricanes. Its success proved that—even when hospitals in a disaster area can’t provide adequate medical care—doctors in Houston, along with their partnering paramedics in Liberty County, can.
“This technology is really amazing,” King said. “It is so different from talking to someone on the telephone. To actually see the patient with your own eyes and talk to them in real time makes all the difference.”
The technology continues to be researched and refined. Soon, these ambulances and deployable telementoring stations could be commonplace in rural areas and in the military, King said.
“The technology has a lot of capability that we haven’t even explored yet,” he said.
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