NESA (Next-generation Emergency Satellite Assistance) is a system for on-field radiology and diagnosis. It integrates a digital X-Ray apparatus and vital signs devices on-board an emergency vehicle. Data, including X-Ray images, are transferred via satellite for remote analysis. The personnel on the field is in contact with the consulting physician giving relevant therapy instructions. The satellite guarantees global operations. Patients at their residence also can have NESA assistance.
|Current emergency procedures foresee the transportation of all patients to a central emergency department employed in a not optimized way.|
|Thanks to the capabilities provided by the NESA platform, the emergency vehicle can bring patients directly to the most appropriate destination (including the emergency department), optimizing timing and saving resources. In many cases transportation can be avoided.|
The NESA project is focused on delivering immediate assistance to patients in emergency situations. This will be accomplished sending on the scene of the emergency a vehicle and paramedics to:
- Perform remote guided diagnosis, mainly based on X-ray and vital signs monitoring,
- Transport the patient to the most appropriate hospital for selective admission The NESA vehicle, will be an innovative support to the "118" Italian medical emergency telephone number,
- Provide assistance to patients at their residences.
The user community is the "Ovest Vicentino" U.L.SS. 5 emergency operators. The U.L.SS. (Local National Health Unit) n. 5 "Ovest Vicentino", based in Arzignano - Veneto Region, Italy, is a public health care operator, expert in medical attendance, providing assistance for a population of approximately 170,000 inhabitants and operating hospital assistance, emergency assistance, territorial assistance and collective prevention.
The territory, having mountains and plains, is an ideal test-area for satellite telecommunications.
The main benefits are:
- Real time on-field diagnosis,
- Routes and dispatching optimization: patient is directed to the most appropriate structure depending on the pathology diagnosed,
- Reduction of emergency departments congestion,
- Cost reduction for on board crew which can be made of specialized paramedics only,
- Patients' satisfaction improvement.
These goals have been confirmed by pilot operations and the resulting product is immediately available for commercialization. Furthermore the know-how in terms of operational procedures and education needed to set-up the system in a health care organization is the other main asset resulting from ESA and contractors investment.
The product resulting from the NESA project is provided as an emergency vehicle adaptation kit or as an integrated vehicle including:
- Transportable Mobilix X-Ray apparatus and Canon CXDI-50G digital scanner carried on-board. Vital signs sensors are integrated for blood pressure, 12 leads ECG, temperature, hearth rate, and oxygen saturation. Moreover a digital phonendoscope, for cardiac and pulmonary auscultation and a dedicated serial gateway, for digital electro-medical signals acquisition, are provided. Each diagnostic sensor produces digital data which is transferred via satellite to a remote physician, located at the emergency operating site. Two way audio-conference is also available. Devices can be operated on-board, near the ambulance at the accident site, or transported away. In this case data are sent when the equipment is brought back to the vehicle. A W-LAN option is available for the commercial product.
- Globalstar multi-modem enables data transfer and audio conference. The Low-Earth-Orbit Globalstar constellation does not need antenna pointing, enabling fast communications set-up.
- Software Kell J-Hospital" for data storage and management. All clinical records are stored at a service centre operated by Elsacom in Avezzano, using Kell J-Hospital" server. The application automatically builds a patient record from incoming data, and makes data available for real time remote diagnosis and second opinion via Internet.
Medical personnel in charge of patient assistance is then able to access via Internet shared patient data from their location and give instructions on patient's destination and immediate care actions.
The project duration is 24 months, to allocate 12 months for pilot operations. During the first 10 months the system is set-up, the operational procedures established and the system tested.
Then the pilot trials will begin with simulated and then proceed with real emergency operations in the user community territory. The last 2 months are dedicated to project evaluation.
Pilot Trials to validate NESA system have been successfully carried out. They started in December 2004 with personnel education and first test cases and ended in June 2005 with a "live" presentation in Lonigo (Vicenza) to Veneto, Lombardia and Toscana Regional Health Care Administrations.
A total of 65 patients have been successfully diagnosed performing 12 EKGs, other life sign digital exams and 84 X-Ray images carried out by non specialist paramedics, following general regulation on radio-protection. In particular:
- 3 patients were assisted on the road as "green code" emergency cases;
- 62 patients, 17 of which on green code call, were reached at their place. Only in 2 cases (pneumonia and a broken leg of two patients in elderly residence) transportation to hospital was needed. In the other cases, patients were successfully treated at their location, following remote diagnosis. The quality of the images sent was good and the general practitioner administered the most appropriate treatment.
The following diagram show the number of clinical exams performed during Pilot Trials per type of examination:
An interesting analysis on the X-Ray transmitted images (DICOM compressed) per type of exam and image size (byte average), is shown below:
NESA missions have been going on since Pilot Trials termination with 15 patients assisted in July and August 2005. The user community employed the NESA ambulance in a program to relieve elderly people from the hot weather, assisting them at home. This activity was outside the ESA project and it's a spontaneous employment of the system we consider a very promising result.
The NESA target has been fully accomplished.
It has not been necessary, as usually happens, to transport people asking for emergency help to the emergency ward. Patients, many of them being ageing people already suffering for other illness, did not face stretchers, ambulances, bad weather and long wait periods.
The ULSS ambulances trips have been cut to a fraction, allowing the transportation of the most urgent cases and fulfilling requests that should have been delayed, should the ambulance have gone back transporting the first patient. Also the economic saving, secondary scope compared to patient assistance, has been confirmed as expected, and it is reported in the NESA Strategic Plan General practitioners enthusiastically participated to the pilot trials. Their role is enhanced by NESA, as they can be part of the remote consultation leading to a diagnosis. In case of patient transportation and admission they are completely excluded not only from diagnosis but also from the treatment decision process.
After the termination of the pilot trials, when the target number of patients has been reached in June 2005, the ULSS has been compelled by this situation to ask to the prime contractor to continue operations, due to the number of requests reaching the administration from general practitioners and in some cases even from private citizens at their homes.
Other 20 patients have been treated in this framework to the moment.
All patients have tolerated very well the procedures and appreciated the innovation. Paramedics and X-Ray technical specialists collaborated to the project, giving useful advices to improve the quality of the service. The ULSS administration gave all the necessary help, including the adaptation of crew shifts.
We can hence state that not only NESA is useful but necessary for the appropriate assistance given by a modern health care unit, with interesting perspectives also for the private sector.