What Was Old Is New Again

Once again, the wireless industry is reinventing things that have been done in the past, and done well. To be sure, having broadband capabilities this time around will make a big difference, but then times have changed since the early days of paramedic communications.

We live in exciting times for sure. New wireless broadband technologies are coming online by the end of this year (LTE), first from Metro PCS then from Verizon Wireless, and AT&T is not far behind. I have been working closely with the public safety community to help acquire the spectrum and money it needs to build out its own wireless broadband network so for the first time they can have the same capabilities our teenagers enjoy every day.

One of the areas the press has been writing about is the use of wireless broadband for emergency medical responders. They are talking about being able to send vital signs, real-time EKGs, and other information directly from the patient to the emergency room that will be receiving the patient. Many of the companies involved in building the software and hardware for these systems are sending out press releases claiming to be the first to send an EKG over wireless networks, or the first to send vital signs or other information over wireless networks.

Much of the press and many of today’s developers are relatively new to wireless and are not aware of its rich history of the past fifty or so years. Well, I have been deeply involved in wireless since I was a kid with an amateur radio operator license and I have a story to share with you about EKGs over wireless.

I was directly involved with paramedic communications systems in the mid-1970s. I installed paramedic radio systems in 78 cities around the United States and trained I don’t know how many paramedics and ER doctors and nurses, so when I read these releases I laugh to myself. Once again, the wireless industry is reinventing things that have been done in the past, and done well. To be sure, having broadband capabilities this time around will make a big difference, but then times have changed since the early days of paramedic communications.

A Bit of History

In the early 1970s I was working for General Electric Mobile Radio and living in the Cincinnati area. I was responsible for all GE public safety communications products and was able to convert the city police and fire departments from another vendor’s systems to GE’s equipment. During that time, a gentleman from Los Angeles visited the area talking about paramedic communications. We ended up having dinner and I ended up leaving GE and working for him in LA. The company was BioCom, and it had just begun work to develop and refine a radio that would transmit both voice and EKG over radio channels.

LA was just starting with its paramedic program, the first in the nation. The theory was that if patients received care in the field, prior to being transported, more lives could be saved. The issue in those days was that the doctors and nurses did not trust paramedics to make decisions in the field and wanted access to them and the patients’ vital signs before they permitted the paramedics to start an IV or administer drugs in the field.

The BioPhone, as it was called, was specifically designed to bridge the gap between the paramedic in the field and the ER staff. The radio was only half of the system. The other half was a base radio on the hospital roof that was remotely controlled in the ER. The remote had a tape recorder for voice and EKG recording, a scope to display the EKG and a paper printer to print it out, and it was capable of voice communications in full duplex mode with the paramedics in the field.

The orange box, as it was affectionately known, was an interesting product. It used a General Electric PE handheld radio that was taken apart with the transmitter being put into one can and the receiver into another. The transmitter used a TRW UHF power amplifier to increase the output, and the radio was coupled to a duplexer that fed a small antenna on the top of the unit. Both voice and EKG signals were fed into the radio, at first voice or EKG signals and later voice and EKG signals simultaneously. The EKG was a simple 3-lead EKG (as opposed to a full 12 lead) and we started out by modulating the radio at 1800 Hertz plus or minus 100 Hertz per millivolt of signal (more on this later).

The EKGs received at the ER were clear and easy to read, and they were augmented by the paramedics verbally providing vital signs including blood pressure, pupil dilation, and other relevant information. Based on this information, the ER staff then ordered the paramedics to start various medications. Once the patient was stabilized, he or she was transported, usually to the hospital with which the paramedics had been in radio contact.

We also had a back-up for providing voice and EKG over phone lines using an acoustic coupler that would enable the same capabilities over phone lines when the radio was not in range of a base station. The issue we encountered with the 1800 Hz EKG tone was that in those days this tone was used by the phone companies as the disconnect tone. Whenever a patient was flat lining (no heart beat) the phone would disconnect. It took us a while to understand this, but when we did we changed the center audio frequency to 1400 Hz, plus or minus 50 Hz per millivolt, and solved our problem.

You might remember the TV show Emergency that used our BioPhone as one of its props. I worked with the show writers on many occasions to help with their scripts, and this show, more than anything, helped drive the interest of other cities that decided to upgrade their existing ambulance service to full paramedic services. I spent a few years of my life traveling to these cities and explaining paramedic programs to them and how our radio could help them. In most of these towns, the ER folks were skeptical that paramedics in the field could remotely assist those in the ER to help patients in the field and many times we had to demonstrate our radio and its voice and EKG capabilities.

We wired up a “patient” and had the ER doctor look at the EKG. One time we wired up a go-go dancer (not topless) and while she was dancing sent a perfect EKG to the hospital, and I used to carry a tape of the EKG of a rattlesnake with me to demonstrate to doctors who were non-believers. Why a rattlesnake? Because its EKG is exactly the same as a human’s but its heart beats hundreds of times per minute faster.

During this time, we watched as ER staffs became more comfortable with the paramedics and their capabilities. We went from having to have a doctor issue an order for a drug to where there were “standing orders” that permitted paramedics to act on their own and follow the doctors’ guidelines but without having to talk to them directly. This was a big shift in the paramedic programs and because of our technology, doctors were more inclined to trust paramedics in the field.

So I have to laugh to myself when I see a press release that claims a company has successfully sent the first EKG over broadband wireless. I am really amused when I see the wireless community excited about these “new breakthroughs.” We were operating on 8 radio channels in the 460-MHz band. Each was a pair of channels 25 KHz wide (a long way from broadband), yet we provided complete EKG information from anywhere in the field back to a hospital and paramedics saved countless lives.

Today’s paramedics are better trained than in the 1970s and ER staffs are more comfortable with letting them operate on their own in the field. With these new broadband capabilities, hospitals will know more about what is coming their way and they can make sure they have the appropriate staff in place when patients are rolled through the door. The advanced wireless data will help to better prepare them and they will be better equipped to handle each case, but the bottom line is that the early technology provided the emergency medical services industry with the tools it needed to convince ER staffs that those in the field who have undergone extensive paramedic training know how to treat patients in the field without having to consult the ER doctor at every turn.

New Again

It is no wonder that those touting these “new” technologies to send patient vital signs back to a hospital are trying to make it sound like a first. If we did anything at all, it was to prove to the medical community that the dedicated paramedics in the field were capable of making decisions on the fly and were as concerned about the patient as ER staff. These new developments seem like firsts because between the 1970s and now the relationship between the hospital ER staff and those in the field has changed. Paramedic training has greatly improved, and ER staffs no longer question the paramedics’ every move.

Today most paramedics operate through the use of standing orders (orders that are pre-approved by medical personnel and that can be administered in the field without having to send information to an ER). For many years there have been devices available to enable paramedic to hospital communications, including cell phones. Like other firsts this decade, the use of voice and telemetry by paramedics in the field were pioneered in the past, but many of those working on today’s communications links were not around at the time the original work was being done.

The intent of this COMMENTARY is not to take anything away from those working on devices and wireless communications systems today. Their work is important and the types of data that can be sent to the hospital now, including video, are far superior to anything we were able to accomplish on narrowband voice channels. Our EKG transmissions were 3-lead as opposed to today’s multi-lead transmissions and vital signs were transmitted by voice after having been taken in the field. Today, data transmissions include all of this information in real time and are an important contribution to the wellbeing of the patients.

Paramedic to hospital communications is only one of the areas in which wireless services are being applied to medicine. We are now able to monitor patients in real time as they go through their daily lives, checking their glucose levels, heart rhythm, blood pressure, and more. This type of monitoring is a giant step forward and has been made possible by the advances in devices and wireless services. One of the most exciting ways in which medicine and wireless are being married together is enabling doctors to remotely diagnose and treat a patient who might be 100 miles or a continent away and is not near a staffed medical facility.

The new breed of wireless broadband communications will enable paramedics and ER staffs to better serve their patients, but the fact remains that wireless communications was the tool that was used to help both the paramedics and the ER staff learn to trust each other. Today, wireless will be used to help these two groups save even more lives, and that is as it should be. Wireless is a tool that if used properly can further advance how these professionals work together.

Andrew M. Seybold

3 Comments on “What Was Old Is New Again”

  1. Well–I should have gone further back in the history of Parmedics and communications. I know that there was activity prior to the LA system and this was pointed out to me by a long time friend and early paramedic Mel Samples. Here is what he had to say:

    It was really Dr. Eugene Nagel in Miami that first used telemetry associated with the domestic paramedic program. Shortly after that, Dr. Ronald Stewart launched the pilot paramedic program in LA County.
    In between the two, there was a “HEART” Ambulance program that operated out of 3 hospitals – Daniel Freeman, Centinela Valley Community, and Hawthorne Community and was manned by McCormick Ambulance. We (yes, I drove “HEART 50” for a while) were in a “bread truck” – a Chevrolet Step Van.
    We picked up an ICU nurse to go on runs that were called in by physicians. The equipment was so portable that we had a 50 foot extension cord that we could plug in at the patient’s house in order to run the equipment and we had an inverter onboard as a backup to the extension cord! We had no telemetry, but we did have an IMTS phone so the nurse could talk to the doctor or ER while we were on the scene – no priority, really bad coverage, no HIPAA.

    Some of the initial training for the new “paramedic firefighters” was performed on “HEART 50”.

  2. Thanks for the entertaining and detailed account of early medical wireless. I had never considered how EMS wireless communications created the trust between ER and paramedics needed to enable the paramedics to use their training and abilities to their greatest extent in the field to save lives.

    I’m glad to see the level of innovation in mobile health, too, and hope that these tools help to solve the medi-gap between urban/rural and developed/developing communities.

    Thanks for your contributions to our emerging wireless medical future.
    – Laurie Lamberth

  3. Laurie–thanks for the comment, those were indeed exciting times, there is much more to tell but glad you enjoyed it and I too am glad to see that the health care industry is embracing the broadband technologies which will only help to close the medi-gap you refer to.


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