Between the Olympics and the elections, 2012 brought us plenty of distracting media to consume. Fortunately for patients everywhere, many research labs and companies remained hard at work with the aim of solving problems facing emergency medicine. Here we summarize 12 of the most impressive – or at least provocative – innovations of the year. They are divided into broad categories based on the problem addressed. A hat tip to our friends over at Medgadget for working with us to curate this list.
Accelerating, or eliminating, an emergency response
Anyone who has spent an appreciable amount of time in the ED likely cringes when they see a cyclist sans helmet. Over 90 percent of bicycle-associated deaths and countless other head injuries are due to failure to wear protective headgear, which is often attributed to inconvenience and an aesthetic stigma. In response, a Swedish design firm has come up with an innovative alternative for helmet-shunning riders: Hövding, the first “invisible” bike helmet. Worn as a scarf-like collar around one’s neck, the helmet comprises a curved airbag that is quickly deployed around one’s head when its accelerometers detect impending collision. Though it has a steep price tag ($650), the Hövding sets a precedent for fashionable protective wear that may reduce the overall need for bicycle-related emergency responses.
If that doesn’t work, however, 2012 has brought us a number of quickly-accessible smartphone apps for locating emergency medical equipment (AEDs) and EDs. One such app is the Emergency Medical Center Locator (EMCL; free on the iTunes store) that superimposes nearby medical centers on Google maps and tags them based on six specialties: burn, cardiac, eye, pediatric, stroke, and trauma. If enough people start using apps like EMCL, perhaps we would see a reduction in the accident-to-care window.
The next innovation, digitally-assisted reperfusion for patients suspected of myocardial infarction, has been shown to reduce median response time (medical contact to treatment) from 76 minutes to 32 minutes while simultaneously decreasing false positives. Essentially, it’s a change in work-flow that involves first responders transmitting ECG data to physicians’ mobile phones and, if STEMI is confirmed, administering thrombolytic agents in the ambulance and/or alerting the cath lab to prepare. The results of the Cardiac Outcomes through Digital Evaluation (CODE) trial were published in the Canadian Journal of Cardiology this past summer, and may become standard-of-care, especially given the proliferation of mobile ECG solutions from companies such as AliveCor and AirStrip.
The final innovation in this section is the Golden-i headset with Paramedic Pro software. The system comprises a monocular head-mounted display (Motorola’s HC1) and speech-controlled user interface that enables first responders to quickly access patient data, record and share symptoms, and initiate care – all without taking their eyes off of the patient. While it is very likely that paramedics will use augmented reality systems in the not-too-distant future, it is less clear whether the Golden-i will gain traction before Google, Microsoft, and other tech behemoths release comparable products.
Stopping the Bleeding
Uncontrolled bleeding is the bane of an EP’s existence. Fortunately, 2012 has brought us many new innovations that can staunch the bleeding, especially in hard-to-reach places.
The first innovation is the abdominal aortic tourniquet, which is essentially a wedge-shaped bladder that is placed at the navel level and inflated until the aorta is occluded, shunting blood back towards the vital organs. Developed by two EPs with wartime experience, the tourniquet has received premarket approval by the FDA and may potentially be used in non-military situations such as sudden abdominal aortic aneurysm ruptures.
It’s one thing to occlude the abdominal aorta and stop blood flow to the lower extremity; it’s a whole different issue to occlude a neck injury. Researchers at MIT’s Institute of Soldier Nanotechnologies have developed a nanoscale biologic coating consisting of layers of thrombin and tannic acid (found in tea) that can be soaked into sponges and more effectively stop bleeding. In one experiment, the nano-coated sponges stopped bleeding within 60 seconds whereas a simple gauze patch failed to do so even after 12 minutes. The researchers have filed a patent for the technology and on a similar coating containing vancomycin.
The above two developments hold great promise for fixing external wounds, but what about internal bleeding? There is no effective method for stopping internal hemorrhage at the scene of an injury, which results in too many patients being pronounced dead on arrival. This may soon change due to promising research out of Case Western Reserve University. Scientists have created synthetic platelets comprised of dissolvable polyester spheres that are coated with polyethylene glycol and a peptide that enhances stickiness. With a shelf life that’s twice as long as natural donor platelets, these artificial nanospheres have been shown in animal models to be more effective than factor VIIa in stopping internal bleeding. With any luck, human testing will have similarly positive results.
The last innovation in this section begs the somewhat facetious question – who needs blood anyway? Researchers at Childrens Hospital in Boston have developed a solution of oxygen-carrying microparticles that is 70 percent oxygen by volume and can carry three-to-four times the oxygen content of red blood cells. Infusion of the solution kept test animals alive for 15 minutes without a single breath, and without resulting in embolism, which IV oxygen is prone to do. While the microparticles are not blood replacements, they hold promise as a short-term solution for hypoxia.
Keeping Your (Patient) Cool
The next two developments aim to induce therapeutic hypothermia. The Welkins EMT/ICU Temperature Management System was approved by the FDA in August and consists of a battery-powered cooling helmet that keeps a patient’s core temperature between 30-37 degrees Celsius. The other innovation, created by researchers at Germany’s Hohenstein Institute, is more experimental. It consists of a life-vest with an embedded zeolite cartridge that extracts heat from water in the vest and thus cools the body without requiring any electricity. The researchers hope that this vest becomes a staple in any emergency response kit.
Guiding the Treatment
More so than those in any other specialty, emergency physicians have to race against the clock to provide appropriate care. Unfortunately, faster care often leads to poorer care – for example, intubations may break teeth and central line placement may result in pneumothorax. The last two innovations we’ll discuss aim to correct the inverse correlation between speed and accuracy that plagues emergency medicine.
A team of biomedical engineering students from Georgia Tech gained attention this year for their Magnet-Assisted Intubation Device (MAID), which uses two magnets (one on the intubation tube, and one externally) to more accurately place the tube. Though this is not a novel idea – a patent for a similar system can be traced back to the early 1990s – if the team found a simpler solution that’s more apt to work and be adopted it is good to see it gaining traction again.
The final development of the year that we’ll discuss is the recently FDA-approved AxoTrack needle-guidance system, which uses an ultrasound probe with a virtual needle to improve placements. According to the company, the AxoTrack system resulted in successful vascular access on the first attempt an impressive 99.3% of the time compared to just 37.1% of the time under the standard freehand method.
So now, which of the above innovations are you most looking forward to test driving? Are there any other major developments that we missed? Let us know in the comments or on Twitter @epmonthly