One-Two Punch // The “Fire Department” app (pictured) alerts people who know CPR when there is an emergency requiring their abilities nearby. The “CPR Pro” app offers clear step-by-step instructions so that someone who’s never taken a formal course can provide decent CPR until a trained team arrives.
MedGadget.com presents the top 10 smartphone applications that can save a patient’s life … before they get to the emergency department.
No matter how skilled the emergency physician, or heroic his or her efforts, it is too often the case that the patient’s fate was decided before even entering the ED. The most heartrending times are when relatively minor interventions early on could have changed your patient’s future: an escharotomy to prevent compartment syndrome could have rescued a burned child’s legs, early CPR to restore perfusion could have spared a young athlete from a lifetime of brain damage, and a FAST ultrasound to detect an occult pneuomothorax could have saved a mother’s life. These preventable outcomes continue to occur on a daily basis in spite of increased societal awareness, education and resources (e.g. mandatory trainings and AEDs in public areas) and despite tremendous reductions in emergency response times (e.g. helicopter ambulances and real-time, en-route transmission of vital data).
Now there is renewed hope for bettering the emergency response thanks to cell phones that are virtually ubiquitous, even in rural and resource-poor settings. Smart phones and their apps take this one step further and offer unbelievable capabilities. This author combed the Medgadget archives and spoke with executives at Qualcomm, Verizon, Ford, and many other established or startup companies at this week’s mHealth Summit in DC to find the top new or emerging apps that could save your patient’s life before you even see them.
They have been grouped into the four primary categories: workflow, emergency response, vitals, and diagnosis.
Whether your ED is in a bustling metropolis or a rustic town, you have no doubt experienced shifts where you felt like you were the only emergency physician in the city. This has significant implications for patients if they cannot get treated in time. ERtexting (www.ERtext.com; Free) aims to help spread out the workload among EDs by enabling patients or caretakers to find out wait times on-the-go by texting their zip code to “437411” (4ER411). Try it out by texting the zip code “21212” to that number. While many zip codes still need to be added, and though ERtexting is not technically an app, this service promises to improve workflow for your ED.
If the patient is not mobile because of, say, a cardiac arrest, there is still an option to improve their chances of getting treatment early. MyHeartMap (www.med.upenn.edu/myheartmap/index.html) is a mobile app developed by Penn Med EPs and researchers that crowdsources the mapping of all AEDs through a mobile competition launching in January 2012. In the event of an emergency someone can first find the closest AED, followed by the nearest ED.
In the same vein, Fire Department (http://firedepartment.mobi; Free) is an app released by the San Ramon Valley Fire Squad that turns everyday citizens who know CPR into potential first responders by sending them a push-up notification if there is an emergency requiring their abilities nearby. The promotional video and app tag line, “There’s a hero in all of us,” are enough to inspire even the most hardened misanthrope.
For the Fire Department app to be effective, however, the average citizen needs to be able to perform CPR. Apps such as CPR PRO (http://ivormedical.com/products/cpr-pro-app/; $1.99 on iTunes) and Pocket First Aid & CPR (http://jive.me/apps/firstaid/; $3.99 on iTunes) offer clear visuals with step-by-step instructions so that someone who’s never taken a formal course can provide decent chest compressions and breaths to maintain perfusion until a trained team arrives. Like the Notes and Calculator apps on the iPhone, at least one of these first response apps should be included by default with any phone.
Severe burns are another traumatic injury in which acute care provided on the scale of seconds, minutes and hours can tremendously improve the prognosis. Mersey Burns (www.chrisseaton.com/merseyburns/; Free) provides an easy-to-use virtual Lund-Browder chart so that anyone can input the surface coverage and severity of a burn and get a fluid prescription to treat the victim. There is at least one other app coming out of Johns Hopkins University that provides a 3D chart as well as short video guides on burn treatment response, such as when and how to perform an escharotomy. These apps should help a Good Samaritan increase the survival chances of a burn victim even before they can get to an ED
Remember during your cardiology rotation when you had to (attempt to) hear a grade 1 murmur or differentiate between S3 and S4 in a patient with a summation gallop? Well, fortunately (or unfortunately) during emergency situations, such minutiae rarely matter. You need to be able to hear louder sounds, such as bruits indicating stenosis or rubs that tell of pericarditis. The iStethoscope app (www.peterjbentley.com/istethoscope.html; $0.99 on iTunes) converts a smart phone mic and headphones into a stethoscope, though far from a Littman. More of a proof-of-concept or novelty app at this point, it does bode well for a future in which first responders or even average citizens could use their smart phones to hear internal sounds that could help your ED prep for certain procedures before the patient even arrives.
If you prefer numbers to sounds and waveforms, then you’ll be happy to hear about the Phone Oximeter (www.phoneoximeter.org), which promises to bring pulse oximetry to smart phones. The developer team at the University of British Columbia is developing a way to have this information relayed in real-time to the care team, perhaps while the patient is en route to the ED so that the team can take immediate steps to reverse potential hypoxia. Of course this application will require an average user to have a pulse oximeter plug-in, which is plausible for those who want to be ultra-prepared in case of emergency.
One of the most talked about apps of the year also happens to be potentially useful in diagnosing adverse cardiac events. AliveCor’s iPhone ECG (http://alivecor.com/video.htm) brings the powerful technique to the smart phone through both an iCard as well as a case with built-in leads. While catching up with the inventor, Dr. Dave Albert, at the mHealth Summit and trying it out for himself, this author asked him how diagnostically useful the 2-lead approach would be. He shared stories of how the app/device combo has already helped diagnose events in the real-world such as long QT and mentioned that it would be soon be available for $99 in 2012. Qualcomm recently invested $3 million in the company so expect to see the iPhone ECG sooner rather than later.
Anyone who has performed a FAST exam and found an anechoic stripe in Morrison’s pouch, or detected a pericardial tamponade, knows how important ultrasound is in the ED. However, ultrasound machines are often affixed to bulky carts that are disruptive to the flow of the emergency care team. Our final app aims to solve this problem by bringing ultrasound to the smart phone. MobiSante (www.mobisante.com) has developed a lightweight, hand-held ultrasound probe that plugs into the phone and is capable of capturing and transmitting data. This author was sufficiently impressed by the demo he was given by MobiSante’s CTO, David Zar, and Chief Engineer, Nikhil George, at the mHealth Summit. The price point will likely be too high for public use (though it is conceivable that helicopter-parents-to-be may rent or purchase one so they can continuously monitor their unborn babies), but one could easily envision one of these being in every ambulance or ED in the near future.
There are many exciting apps out there and we at EP Monthly are glad to see an increasing number of them being developed to save lives.