Standoff Patient Triage Tool (SPTT)

Introduction

Triage is the process of evaluating patients to determine degree of injury and is a vital part to pre-hospital care (i.e. in an ambulance) as well as Emergency Room management and patient care. It not only allows organization of patients for evaluation and monitoring by the medical staff but it also provides clinical justice for patients being treated [1]. Valuable time can be lost during triage, especially in multiple person accidents, so a reduction in the time it takes to perform triage would be very beneficial to both first responders and the patients. The Standoff Patient Triage Tool (SPTT) can provide this time reduction and change the way triage is performed. Although the SPTT is still in the preliminary phase of development, this tool would allow medical personnel to quickly evaluate a patient's vital signs from a safe distance. This technology has the potential to revolutionize the how patients are monitored and evaluated in emergency situations. Such a tool is expected to be widely used by those in the Coast Guard, EMPs, and medical personnel on the battlefield.

What is Triage?

The system of triage was developed to determine the status of patients in an emergency room. The patients are assessed then ranked by urgency; who needs help right this second, who can wait an hour and who can wait a day. The process of triage was originally a "nurse instinct" and a triage system wasn't recorded until 1960 [1]. A formal triage scale was developed in Australia a little over 20 years ago, this scale is called Ipswich Triage Scale (ITS). The scale, which is a 1-5 scale, was developed based on the observation of triage nurses. The scale looked as follows:

1.To immediately call for medical attention and commence resuscitation.

2.To assign the patient to the next available doctor.

3.To place the patient's file at the front of the waiting list.

4.To place the patient's file in order in the waiting list.

5.To encourage the patient to seek help elsewhere or at another time.

It could also be interpreted as follows:

This patient should under reasonable circumstances be seen by a medical officer within:

1.Seconds

2.Minutes

3.An hour

4.Hours

5.Days

The use of the ITS was carefully analyzed and showed improvement in patient care and communication between nurses. In 1994 the ITS was accepted as the National Triage Scale (NTS) [1]. The name was later changed to the Australian Triage Scale (ATS) and was used as a basis for standardized triage sacles in several countries around the world. The United States uses a 3 point scale simply stating emergency, urgent and non-urgent [1].

Who is Researching the SPTT

This product is being developed by S & T Tech Solutions, who operate as an office of the US Department of Homeland Security in partnership with Technical Support Working Group (TSWG) and Boeing and Washington University's School of Medicine.

U.S. Department of Homeland Security's Science & Technology Directorate (DHS S&T).DHS S&T works to infuse the nations scientific and technological capabilities together to develop new products and technologyies to better protect homeland security. These new products and technologies are then made available to federal, state and local officials. A major area of focus for the department is terrorism, specifically threats that could result in a large scale loss of life. Science and Technology is thus designed to counter these threats by improvements to current capacities and also through development of new products.

Product Inspiration

The Idea for this new technology was inspired by the amount of time it takes to accurately triage a patient. Particularly during emergencies involving multiple injured people. Director of S&T Tech Solutions, Greg Price, stated "We thought, 'Boy, wouldn't it be nice if a responder, fully clothed in an emergency suit, could have a technology to take vital signs quickly from 5 to 40 feet away?'"

This technology would allow do just that. The SPTT will be able to gather patient’s vital signs such as Heart Rate, Blood Pressure, Respiratory Rate, and Temperature from 5 to 40 feet away, reducing triage time from 5 minutes to 30 seconds. The SPTT is also being made portable so that Paramedics, EMTs, Fire Fighters and other first responders can take the important information they need from multiple patients within seconds. This technology would also allow a hazmat team, fully dressed in hazmat gear, to acquire vital signs from victims of a hazardous material emergency. In the past these victims would need to be removed from the “hot zone” and decontaminated before being triaged.

Product Details

The SPTT utilizes various existing technologies such as Laser Doppler Vibrometry. This instrument uses non-contact vibration measurements of a surface. This technology has been used in cars and aviation for years to gain diagnostic readings without disassembling vehicles and aircraft. Laser Doppler Vibrometry is also currently being used in eardrum diagnostics. The readings taken by Laser Doppler Vibrometry would then be converted into a unit of measurement recognizable by an emergency responder such as blood pressure.

Washington University Researchers have determined the best place to capture a strong vital sign in a person is the carotid artery. However, strong signals have also acquired vital signs from the head, chest, abdomen, and foot.

More testing still is needed to determine if accurate readings can be taken from patients who are in awkward body positioning and in patients with multiple layers of clothing. Although this device will be a large advancement to triage technologies and may resemble the “Tricorder” from “Star Trek”, developers say that the ability to diagnose diseases by scanning the body is still a matter of science fiction.

Research

Laser Doppler Vibrometry has been used in the past to examine anatomical and physiological processes in humans. In one study, derivation dependence, inter- and intrasubject/interest variability, and bilateral differences of the eardrum vibration characteristics were all studied in the human ear using Laser Doppler Vibrometry[2]. A second study dealing with arthritis and effectiveness of joint replacements (arthroplasty) was conducted using a vibrometry technique using doppler ultrasound[3]. This allowed a non-invasive method to determine osteointegration of a total ankle prosthesis.

Beyond this, the information regarding research for the SPTT is very limited due to the fact that this product is still under stages of development.However doppler vibrometry has mainly been seenfor use in humans in ears and, more recently, exploring effectiveness of joint replacements. The main purpose of developing the SPTT falls in the importance of triage and the amount of time it takes to be performed. These two research papers (although not specifically related to triage) may have been good jumping point for researchers to come up with the idea to use this technology to take various vital readings from humans.

Market

The target market for this device at the moment is emergency responders. This product will likely be sold to large EMS and rescue agencies for the use of triaging a large amount of patients during a natural disaster or any other emergency involving mass casualties and multiple victims such as a terrorist attack or industrial accident. In areas with a smaller population, it is likely that this device would be utilized by the National Incident Management System (NIMS) or the Federal Emergency Management Agency (FEMA). Both agencies are responsible for responding to and managing natural disasters. Emergency personnel who serve as Life Guards, those involved in the Coast Guard, and soldiers on the front lines would benefit immensely from technology that would allow them assess wounded civilians and fellow comrades from a safe distance. As the technology is adapted it is anticipated that it will be used on a wider scale and may appear as standard equipment in Life Flight helicopters, Ambulances and in Hospital ERs. In a very brief interview with an associate at S&T Tech solutions, it was revealed that critical steps are underway to make the technology more affordable. In a separate interview with another associate, it was mentioned that the number of units sold will depend on price and the performance of the product at the time of its release. As more information becomes available regarding the price, it will be easier to predict the scale of which this product will be implemented. When asked if a product similar to this exists, the associate responded by stating that "To the best of our knowledge, this is the first time that laser doppler vibrometry has been used to detect vital signs in humans. We expect this technology to revolutionize medical diagnostics".

By doing a rough calculation, if during its first year on the market every FEMA Urban Search and Rescue post, 12.5% of all hospitals, and 5% of all EMS agencies had at least one SPTT it would amount to approximately 2,872 SPTT being sold. However, the number of units sold is expected to increase exponentially as the technology is implemented within the medical field. If over the next 5 years, as the technology was proven to be effective, the number of hospitals that carried the SPTT increased to 50% and EMS agencies increased to 37.5% the number of SPTT sold would be 14,077.

The SPTT is appealing due to its ability to diagnose a patient's key vital signs and medical needs quickly and from a safe distance. It is still unclear whether or not this new device will save medical personnel money. Regardless of the cost, this type of technology may save thousands of lives in the near future, making it well worth the expense.

As the technology improves, and the cost of the product decreases it is not unreasonable to predict that some form of the SPTT would be present in every hospital and ambulance in the United States. Increasing the number of SPTT being sold to 65,052. This calculation has not included Critical Care Transportation such as Life flight and mobile ICUs, Military Personnel, or various types of rescue groups due to a lack of information. However it can be expected that if these agencies were accounted for the number of SPTT sold would increase. The timeframe for such widespread use of the SPTT is unclear.

Information calculated with the understanding that there are: 16640 Hospitals in the US [4], 15,276 EMS services in the US [5], 48,348 Ambulances in the US[5], 28 FEMA urban Search and Rescue Bases in the US[6].

Product Translation

The Department of Homeland Security oversees the development of the SPTT. Tech solutions is currently working in partnership with the Technical Support Working Group, Boeing, and Washington University's School of Medicine. It can be inferred that each organization plays a critical role in the project's research an development. However, the Department of Homeland Security refuses to release critical details pertaining to the SPTT product, and the roles of each company. No comments were available when questioned with regard to current funding. It is estimated that this process has taken nearly 5 years or more to get to the preliminary stages of development. Many skilled engineers and personnel are currently working on the project.

Sources

[1] FitzGerald, G, Jelinek, G, Scott, D, & Gerdtz, M. (2009). Emergency department triage. Emergency Medicine Journal, 27(2), Retrieved from http://emj.bmj.com/content/27/2/86.long

[2] Arechvo I, Lasurashvili N, Bornitz M, Kevanishvili Z, Zahnert T. (2009) Laser Doppler vibrometry of the middle ear in humans: derivation dependence, variability, and bilateral differences. Medicina (Kaunas). 45(11):878-86. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20051720

[3] Dahl MC, Kramer PA, Reinhall PG, Benirschke SK, Hansen ST, Ching RP. (2010) The efficacy of using vibrometry to detect osteointegration of the Agility total ankle. J Biomech. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20189573

[4] American Hospital Association http://www.aha.org

[5] American Ambulance Association http://www.the-aaa.org

[6] Federal Emergency Management Agency http://www.fema.gov

[7] Triage Technology to Capture Vital Signs from a Distance. S&T Snapshots, U.S. Department of Homeland Security, 2009 Retrieved from http://www.emsresponder.com/features/article.jsp?id=9601&siteSection=7