The Smart Magazine About Medical Technology Innovations
Autonomous vehicles, drones, precision medicine and artificial intelligence could soon change emergency medical services.
In this new edition of MedicalExpo e-magazine, we talk about the EMS Agenda 2050, an American initiative that is trying to shape what emergency will be like in the second half of the century.
What if drones could save lives? While they were originally developed for military purposes, aerial drones are now being used for blood deliveries that can save rather than take lives. A service is already available in Rwanda.
What if drones could save lives? While they were originally developed for military purposes, aerial drones are now being used for blood deliveries that can save rather than take lives.
A fix-winged drone, known as a Zip, takes off like a shot from a droneport in Rwanda in East Africa with a life-saving cargo.
In the US, the EMS Agenda 2050 is trying to shape what emergency medical services (EMS) will be like in the second half of the century. Guided by technical experts consisting of EMS directors, professors of emergency medicine and fire chiefs, it is supported by various federal institutions. MedicalExpo e-magazine spoke with panel facilitator Mike Taigman about how autonomous vehicles, precision medicine and artificial intelligence will change EMS.
MedicalExpo e-magazine: What is the EMS Agenda 2050?
Mike Taigman:The Agenda 2050 is radically inclusive. Every person involved in EMS in the US can be involved, through every channel—regional meetings, Facebook, Twitter, etc. We are also supported by four federal institutions. This is a US-only project. I’m not aware of similar projects dedicated to EMS in other areas of the world.
MedicalExpo e-magazine: Let’s start with autonomous vehicles. How will self-driving ambulances impact EMS ?
Mike Taigman: Autonomous vehicles should increase safety significantly and reduce the number of accidents. The same will be true for self-driving ambulances. They will be able to move faster, which is key for EMS. At the same time, there may be less call for them. The most time-critical interventions are chest compression and defibrillator use. These interventions are moving away from EMS and into the community. And there’s no need for an ambulance when you’ve got a defibrillator nearby. You also need to think of drones and how quickly they could deploy such devices.
MedicalExpo e-magazine: Another hot topic is precision medicine and the use of tailored, gene-based medications.
Mike Taigman: I can envision a time when your genetic profile will be available with your medical profile and records. With both genetics and an accurate description of your symptoms, a machine might be able to deliver customized treatments.
MedicalExpo e-magazine: How will artificial intelligence change EMS?
Mike Taigman: I remember attending a congress a few years ago where there was a competition between physicians and automated systems concerning abdominal pain assessment. Artificial intelligence is going to completely change the roles. In the future, a patient will plug directly into a panel of experts and explain that he has diabetes, chest pain and is in his seventies. At this stage, the system could connect him directly to an artificial intelligence system. The paramedic would turn into a data acquirer who choreographs diagnosis from a panel of physicians assisted by AI. And the patient would be included in the choice of treatment.
MedicalExpo e-magazine: Robotic helpers like the daVinci are gaining traction in operating rooms. Will they make their way into ambulances?
Mike Taigman: I’m not sure about robotic helpers. Such machines are very large and wouldn’t tolerate bouncing around. That said, some response units are provided with robot-assisted cardiac bypass systems.
MedicalExpo e-magazine: When can we expect to see the EMS Agenda 2050?
Mike Taigman: The whole process is intended to move pretty fast. The preliminary draft will appear in April 2018, with a final EMS Agenda 2050 in August 2018.
Video laryngoscopy (VL) offers striking magnification for examining parts of the airway that are difficult to see with the naked eye. The technique is catching on in prehospital settings, to replace direct laryngoscopy (DL).
Dr. Marvin Wayne is medical director of Whatcom County Medic One, which provides paramedic...
Minimally invasive surgical techniques are spreading rapidly, offering reduced post-operative pain and quicker rehabilitation. Ever smaller instruments enable new diagnostic and treatment techniques, while their market is projected to increase from US$13.89 billion in 2016, to US$ 21.47 billion in 2021.
California-based Sanovas Inc. is a life science technology company founded in 2009. The firm currently holds over 150 patents, and is developing new, micro-invasive intervention tools, from catheters and cameras to tissue collection and localized therapy delivery devices. MedicalExpo e-mag interviewed CEO Larry Gerrans.
MedicalExpo e-magazine: Sanovas has just received a US patent for its Minimally Invasive Nano Oncology System (MINOS). Can you tell us more about it?
Larry Gerrans: MINOS enables clinicians to measure tumor pathophysiology and to reverse hypoxia in therapy-resistant tumors. Localized therapies are delivered to anatomic sites of less than one millimeter diameter in the periphery of the lung and throughout the body, while mitigating systemic toxicities and undesired side effects.
“We want to make inoperable tumors operable.”
Hypoxia is a condition of tumor pathophysiology which limits the impact of chemotherapy and radiation therapy. MINOS allows physicians to measure the partial pressure of oxygen and other biomarkers in tumors, and then deliver hypoxia-reversing, chemo-therapeutic agents directly into the cancerous tissue, sensitizing it to radiation or photodynamic therapy.
We want to make inoperable tumors operable, without violating surrounding nerves and vasculature. MINOS can be used when open surgery or external beam radiation would be detrimental or even contraindicated for the patient.
ME e-magazine: How will your Nanovas system improve localized tumor therapy?
Photodynamic therapy killing oxygenated cancer cells / Courtesy of Sanovas
Larry Gerrans: The Nanovas suite of drug delivery systems, such as our patented nested balloon catheters, allow clinicians to deliver targeted, tumor-specific treatments through the creation of chambers within a highly specific region of the anatomy. This holds the potential for overcoming one of the greatest hurdles to chemotherapy—systemic toxicity. I’d say we’re about one year out from the market with this kind of technology.
ME e-magazine: Sanovas recently announced its expansion into China. Why this move?
Larry Gerrans: We will establish a venture capital fund and Innovation Center at the Suzhou Institute of Nanotechnology and NanoBionics. This will see upwards of US$75 million invested in the development and growth of our work across a range of disciplines. Minimally invasive surgery (MIS) has become the gold standard for Western societies. With access to innovative capital severely restricted in the US, this investment will help us in our mission to bring cutting edge, portable, affordable surgical tools to the market, making MIS accessible on a global scale.
Defense-sector radar designed to see through walls is now used in a vest that detects congestive heart failure long before patients become symptomatic.
In the United States, 5.7 million adults are living with heart failure, and half of them return to the hospital because their condition is not well managed. Excess fluid in the lungs is far and away the most common cause of readmission.
We ask patients to weigh themselves and look for signs and symptoms. But these are late-stage manifestations, when the horse is already out of the barn. There is an urgent need for techniques that permit earlier detection of excess fluid to keep patients out of the hospital.
Using Radar to See Behind the Chest Wall
Sensible Medical, an Israeli firm, may have found the solution. Its SensiVest™ uses the company’s ReDS™ radar technology to identify excess fluid in the lungs of heart failure patients. This permits early intervention and reduces hospital readmissions. The vest can be used at home or in a medical facility.
Courtesy of Sensible Medical
The radar-based technology was developed by the military to see through walls or search for survivors in the rubble of collapsed buildings. Sensible miniaturized the system and adapted it to identify the build-up of excess fluid in the lungs.
Abraham has been using the vest at his medical center. “The vest shows us when the lungs are becoming too wet, permitting us to adjust a patient’s medication before the patients are aware of symptoms.”
Testing for excess fluid requires donning the vest for just 90 seconds a day. Readings are uploaded automatically to a cloud server. When readings cross a threshold, providers are notified so that they can make medication changes. Abraham added,
This could give our heart failure patients a far better quality of life than they have with current technologies.
Clinical Trial Underway
Abraham is heading a national, randomized clinical trial of the FDA-approved vest at 40 sites across the United States. The goal is to see if it effectively monitors and manages lung fluid, reduces hospitalizations and improves quality of life. Patients using the vest will take daily readings at home. So far, 50% of the 380 patients targeted for recruitment have been enrolled. Sensible Medical compensates Abraham for his time as trial chair.
Avoiding Hospital Readmission
SensiVest™ could provide economic advantages. Preventing hospital readmissions for heart failure patients is of great interest to Medicare, the public medical insurance program for Americans over 65 years of age. In 2011, congestive heart failure was the leading cause of readmission for Medicare patients. According to a study by the Agency for Healthcare Research and Quality this resulted in total costs of $1.5 billion.
A study recently published in the journal Resuscitation shows that the use of extracorporeal cardio-pulmonary resuscitation (ECPR) in a pre-hospital setting significantly improves survival rates in out-of-hospital refractory heart attack victims. Such victims are those who show no signs of renewed circulation after 30 minutes of traditional resuscitation attempts.
ECPR involves inserting femoral vein and artery cannulae in the patient’s groin area. These are connected to a machine which circulates the blood and ensures the necessary gas exchange, replacing both heart and lung functions. Such systems are commonly used during open-heart surgery.
Mobile emergency medical service teams in Paris, the SAMU, initiated the study in 2011. Between November 2011 and December 2014, 114 patients were treated using ECPR either before or after arrival at the hospital. During the second phase, covering 2015, 42 victims were first treated by a dedicated mobile ECPR team. Patient screening limited study participants to those under 70 years of age whose attack had been witnessed and on whom traditional resuscitation attempts had been begun immediately. Other criteria covering the patient’s medical history, type of heart attack and the victim’s chances of neurological recovery were also applied.
This second, more aggressive strategy showed benefits when used on victims within 60 minutes of the initial attack. Today, survival rates among French patients suffering from a refractory heart attack are less than 5%. Pre-hospital ECPR reduced the period of low blood flow in victims by 20 minutes. When strict patient selection was added to aggressive, pre-hospital ECPR intervention, the survival rate climbed to 38%. The researchers concluded that using “ECPR in specific settings in the management of refractory OHCA is feasible and can lead to a significant increase in neurological intact survivors.” However, they cautioned that their data must be confirmed by a large-scale random controlled trial.