Google glass is a wearable pair of glasses with an optical head-mounted display. In short, it is an Android phone that you wear like a pair of sunglasses. The screen is viewed through a display on the upper right lens and the sound is transmitted through a bone conduction transducer. Voice commands normally control the device and it is capable of capturing five megapixel pictures and 720p video.
In urban areas, emergency medical services (EMS) providers often have a choice of several hospitals to which a patient can be transported. Often the decision lies with the level of care offered at the hospital, the patient’s chief complaint/signs and symptoms, transport time, and patient’s preference. In rural areas, however, a transport destination decision is usually limited to one facility. In fact, some areas have no medical facility within their county limits. Oftentimes in rural areas, the fastest mode of transportation is air evacuation. The utilization of air ambulances (helicopters) is an accepted standard of practice for certain types of calls. The problem exists when EMS providers, lacking the benefit of a physician’s consultation and/or diagnostic equipment, make the decision to utilize air ambulances from a scene to a trauma or stroke center. If it is found that the patient is not having a stroke or does not have significant traumatic injuries, they may be discharged from the hospital the following day with what turned out to be no more than a “helicopter ride.” I should mention that those types of helicopter rides are $15,000 to $25,000.
While EMS providers want to first be patient advocates, we also do not want to overburden a patient financially by transporting them to the wrong facility or using an inappropriate — and expensive — mode of transportation. In every response and transport, the EMS provider will work from a pre-established set of guidelines written by their medical director — off-line medical control. At some point in the transport the provider will make contact with a physician via radio or telephone who acts as on-line medical control. From that point the physician makes all treatment and transportation decisions. To do this the provider must describe the patient’s condition in detail to the physician. This description usually involves patient age, gender, chief complaint, vital signs, neurological status, history, medications, interventions performed and estimated time of arrival to the facility. Google glass will ultimately change this process profoundly.
For patients with traumatic injuries, a longer transport time may be more appropriate when the patient needs a trauma surgeon. The late H. Michael Garvin, who was my (and many others’) paramedic course instructor, always said, “The worst thing a bad trauma patient can have is a good paramedic. They don’t need a good paramedic they need a trauma surgeon. Put them in the truck and go to the trauma center. Do everything you need to do while you are going to the trauma center.” That statement is one of the few things in pre-hospital medicine that has not changed over the years. Upon arrival at the trauma center, the trauma team will go through a battery of tests and diagnostic procedures. Google glass could allow the trauma team to interact with the patient, by way of the EMS provider, prior to the patient even arriving at the facility. This will ultimately save time. When the patient arrives at the trauma center, the trauma team will have already “seen” the patient and will be somewhat familiar with the patient’s condition and interventions.
Patients having a heart attack should be transported to the closest appropriate medical facility and that may not always be the closest medical facility. Many departments are sending 12-lead electrocardiograms (ECG) to physicians via cell phone data networks. These ECG’s allow the physician to confirm if the patient is having a coronary problem and to divert the ambulance to a facility with a percutaneous coronary intervention (PCI) laboratory when appropriate. A PCI facility is the definitive treatment for patients having a heart attack.
There are two basic types of cerebrovascular accidents (CVA) or strokes. Hemorrhagic strokes occur when a blood vessel in the brain bursts and leaks blood into the cranial vault. These are less common. Ischemic strokes, which, according to the American Heart Association, account for 87 percent of all stroke cases, occur when an obstruction occurs within a blood vessel supplying blood to the brain. According to the American Stroke Association (ASA), roughly 795,000 strokes occur annually in the United States and primary care and emergency physicians in up to 30 percent of the cases may misdiagnose acute ischemic strokes. The use of computed tomography (CT) and consultation with a neurologist is essential early in the diagnosis in order to determine proper treatment. However, neurologists are a rare amenity. The ASA reported that in 2007, there were only four neurologists available for every 100,000 persons in the United States. While it may be difficult to get the patient to a neurologist, Google Glass will allow us to bring the neurologist to the patient. The ASA already recommends the use of telemedicine — the use of telephone, Internet, and videoconferencing, to exchange medical information from one geographic site to another — particularly in rural, remote, or underserved areas.
Dr. Brian Sebastian experiments with Google Glass when seeing patients in Sonoma, California, on Thursday, October 17, 2013. Photo: Liz Hafalia, The Chronicle
Transmitting medical data is not new. In addition to the aforementioned ECGs, you will likely be surprised to read that many of your X-rays and MRI scans are beamed electronically overseas to places such as India, New Zealand, and Australia where they are read or enhanced by physicians there. In fact, a colleague of mine has a father who lived in Virginia. His father had a pacemaker installed that contained a transmission device, which allowed continuous monitoring of the pacemaker’s functions. In one instance, his father’s cardiologist, while on vacation in Europe, was able to evaluate his father’s heart rhythm in Virginia.
Telemetry only gets us so far. Ask NASA. Prior to the discontinuation of shuttle missions, the National Aeronautics and Space Administration would use telemetry to monitor the space shuttle’s systems. However, nothing replaces the ability to see and talk to the astronauts on board. Consider the ill-fated Apollo 13. Telemetry initially showed multiple failures associated with the explosion that occurred. Many technicians on the ground thought that the reported failures had to be a computer error. But when the Apollo 13 Commander reported via radio the famous words, “Houston, we have a problem,” it was clear to everyone that the problem was real and not computer generated. Likewise, we can transmit ECGs and describe patient conditions via radio, but having the physician see exactly what the EMS provider sees can provide a level of care higher than any previous time. Under normal conditions, the EMS provider figuratively serves as an extension of the physician’s hands. With Google Glass, the EMS provider literally becomes an extension of the physician’s hands. The physician can order the EMS provider to manipulate the patient, ask the patient questions, or perform a particular intervention and immediately evaluate its effect on the patient.
Not only will Google Glass benefit EMS providers and patients, it will also benefit hospitals. Hospitals everywhere struggle to support those who overuse its services. According to studies, these “frequent fliers” or the “frequent emergency department user population” accounts for five to eight percent of the patients, but account for up to 28 percent of emergency department visits. These re-admissions cost Medicare alone an estimated $17.4 billion in 2004. The Affordable Care Act has established hefty penalties to hospitals that have readmissions of the same patient within 30 days of discharge. This means that hospitals will be very interested in having patients follow up with their family physician in lieu of being re-admitted to the same hospital. Where there is no family physician, Google Glass may again bridge the gap. Glass will allow for EMS providers to visit the patient in their home and have the doctor perform an evaluation, using the EMS providers, to insure that the patient is compliant with their medications and has no complications from their hospital admission. As governments have found in several jurisdictions across the country, the only way to prevent “frequent fliers” from frequently visiting the hospital is by implementing a community para-medicine program whereby EMS providers visit the patient in their home, before they have a chance to visit the hospital. Google Glass will make the home visit an evaluation by a physician instead of solely EMS providers, who are normally required to transport the patient to the hospital upon request.
The use of Google Glass does not end with pre-hospital medicine. There are a myriad of other emergency functions in fire-rescue organizations where Glass is a game-changer. Patrick Jackson is a Rocky Mount, North Carolina firefighter and Google Glass developer. He is already using Glass to display navigation and routes to incoming emergencies, dispatch information, floor plans of buildings, closest hydrants, and vehicle schematics for auto extrications. Additionally, he notes that pictures and videos can be recorded to aid in investigations and incident critiques. Video can also be streamed real time to increase situational awareness from multiple perspectives at the incident.
Imagine being able to use voice commands to recall information such as hazardous materials properties, the closest hydrant, and how long it takes the capacitors that store energy to deploy the airbags of a vehicle to discharge once the battery is disconnected. Imagine a physician seeing what you are seeing and guiding you through treatment directly. Imagine a trauma team seeing whether a pleural decompression improves the patient’s status, while you are still 25 minutes from the trauma center. Imagine your stroke patient being evaluated by a neurologist in the field and guiding you to an appropriate stroke center. Imagine a physician authorizing the use of air-evacuation based on the mechanism of injury and patient condition that they see through Google Glass.
Imagine the future. In fire-rescue and EMS, the future is Google Glass, and the future is now.