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Digital EMS Program Overview. Larry Flournoy Interim CIO Texas A&M University System Health Science Center Associate Director - Academy for Advanced Telecommunications and Distance Learning 6 May 2002. DREAMS TM Research Areas. Focused on improving the recovery of civilian and military

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Digital ems program overview

Digital EMS Program Overview

Larry Flournoy

Interim CIO Texas A&M University System Health Science Center

Associate Director - Academy for Advanced Telecommunications and Distance Learning

6 May 2002

Dreams tm research areas
DREAMSTMResearch Areas

Focused on improving the recovery of civilian and military

personnel subjected to trauma


Basic and Clinical Sciences

Focused on detection, identification, and remediation of

biological & chemical agents


Biological and Chemical Warfare

Create virtual presence by the physician to enable

earlier intervention into the medical emergency


Digital EMS

Digital ems
Digital EMS

The Problem

How to overcome the negative impacts of increased time and space during a medical emergency.

The Approach

Use high quality video and physiological telemetry to create an adequate level of situational awareness for physicians to telementor emergency medical personnel onboard the ambulance.


  • Managing high bandwidth applications in a wireless environment.

  • Providing a common user interface while integrating many systems related to medical monitoring and diagnostics.

Design philosophy
Design Philosophy

  • The well-being of the patient is and will always remain our top priority.

    “Saving lives is the only motivation for this project.”

  • System design will emphasize “graceful degradation” of onboard systems.

    “The total failure of all Digital EMS systems leaves EMS personnel with the same capability that they have currently.”

  • Digital EMS systems will be designed to aid EMS personnel and make them more effective without introducing a large training requirement.

    “A large part of this project involves the development of user interfaces that are as simple as possible and can easily be integrated into current EMS personnel’s procedures.”

  • Frequent interaction with the user is essential to the overall success of the program.

Defining the mission space

“Scoop and Run”

  • Augmentation for traditional ambulance missions (esp. rural areas)

  • Physician intervention sooner


  • Monitor patients while transporting from one treatment facility to another

  • Army field ambulance mission

Defining the Mission Space


  • Lowest common denominator

  • Especially useful in medically underserved areas

Disaster Relief

  • Command center during mass casualty situations

  • Facilitate triage

System components

Ground Ambulance

Primary Hospital

Man Portable Systems

Air Ambulance

Secondary Hospital


Existing Infrastructure

  • Includes both civilian and military prototypes

  • Full implementation of Physician’s Workstation

  • Includes Medicam, Xybernaut, and WARP

  • Hermann Life Flight

  • Less than full implementation of Physician’s Workstation

  • Physicians, EMS personnel, and system maintainers

  • Integration into current practices and procedures

System Components

Current system


Current System

  • Vital Signs

  • Monitor



  • Driver’s License

  • Scanner

Campus Fiber

  • Physician

  • Workstation

  • Portable Ultrasound


  • Digital

  • Physiological

  • Data



  • Paramedic

  • Workstation

  • MedicCam

  • Wireless HMD

  • Run Record

  • Database

  • Xybernaut

  • Wearable

  • Computer

  • Electronic

  • Patient

  • Record

  • Database


  • PTZ Cameras

  • GPS Receiver

Wisenbaker Engineering

Research Center

  • Video Capture


  • BreezeCom

  • Base Station

  • Microphones

  • & Speakers

  • CDPD via the

  • Internet


  • BreezeCom

  • Wireless Network

  • Ambulance

  • Communications

  • Bridge



  • CDPD Modem


  • MedicCam

  • Receiver

Parallel activity
Parallel Activity

Satellite Antenna Development

Decision Support Systems

Standards and Policies

Digital EMS

Systems Integration

Security (HIPAA)

Digital EMS Breakthrough Technology Areas

  • System Level Impact of Digital EMS

    • A unique collection of digital technologies will create a virtual presence by the physician and permit a remote mentoring environment.

    • This virtual presence will enhance current life-saving protocols by involving the physician sooner.

  • Intelligent Communications Processing and Management

    • A “smart” communications manager using software agent technology that can balance bandwidth requirements versus bandwidth availability will be developed.

    • Multi-modal communications will be treated as a single channel with dynamically varying capacity.

  • Multi-Channel Real-Time Video/Audio Processing

    • Dynamic management of multiple video/audio streams will permit a high level of on-board situational awareness by physicians at remote locations.

Intelligent communications manager
Intelligent Communications Manager

  • Linux-based middleware that “multiplexes” both heterogeneous and homogeneous communications paths to facilitate management as a single pipeline.

  • Phase 1 - Complete data stream sent over selected path

  • Phase 2 - Packet level management for selected path

  • Rule-based approach

where n is the number of communications paths available

Intelligent communications manager1
Intelligent Communications Manager




Data Radios

Cellular Modems


Virtual Pipeline

(all communications systems operational)


Cellular Modems



Data Radio

Virtual Pipeline

(after loss of satellite and one data radio)

Technology transfer
Technology Transfer

  • Where possible, existing or newly developed technology should be shared between the Army and the Digital EMS project (bi-directional).

  • Two candidate Army programs for integration into Digital EMS:

    • Medicam

    • Life Support for Trauma and Transport (LSTAT)

U s army field ambulance
U.S. Army Field Ambulance

  • Feasibility studies have begun to look at requirements for transferring Digital EMS technology to a U.S. Army field ambulance.

  • Digital EMS team willing to outfit and field prototype anywhere in the world based upon desires of U.S. Army.

Standards in dems
Standards in DEMS

  • Open standards

  • De facto standards

  • Internal standards

  • Hardware

  • Software

  • Development

Standards in dems1
Standards in DEMS

  • Adopt

    • Existing standards where they exist and the standards meet our needs

  • Adapt

    • Existing standards where feasible

  • Develop

    • Internal standards as needed

  • Drive

    • Development of new standards with SDOs

Standards in dems2
Standards in DEMS

  • Tracking an erratically moving target

  • Using IEEE, ASTM, HL7 approved or draft standards

  • Working within several SDOs to influence the development or revision of standards


  • Lack of Medical Equipment Standards

    • Electrical and Power

    • Network Protocol Support

    • Web and Programming APIs

  • RF Noise Suppression

  • Acoustic Noise Suppression

  • Shock and Vibration Isolation