Emergency Medical Services in PG County, Maryland Integrate New Media Technology Such as GPS and Tablets Into Ambulances in Effort to Streamline Patient Care

• Emergency medical workers and firefighters began using radios in the 1940s, and still use a similar form of communication to this day

• Modern ambulances within the Prince George's Fire/EMS Department are equipped with radios, CAD technology, and GPS to decrease response time and improve patient care

• Advancements are being made both locally and nationally to equip EMS workers with more innovative forms of communication, like tablets and Google Glass

When EMTs and Paramedics in Prince George’s County, Maryland are dispatched to the scene of a medical emergency, they do not respond to the call for help alone. To improve the responder’s knowledge of the call conditions and location of the emergency, they are equipped with an arsenal of advanced communication devices. On a typical call, the average Basic Life Support (BLS) team will bring with them a radio, a GPS device, computer aided dispatch (CAD) technology, a laptop, and a personal cell phone.

Together, these devices allow the EMTs to maintain a constant link with a central communications center, and provide a secure form of communication between responders in the field and medical professionals in the emergency room destinations. However, the use of these different forms of technology in emergency medical services is not new to the 21^st Century, and date back as far as the mid 1940s. As media technology innovations in the modern digital age continue to progress, EMS agencies must decide how they will incorporate these new technology into patient care practices.

The History of Fire/EMS Communication Technology Dates Back to the 1940s, and Employs Some Techniques That Are Used Still Today 

According to a report by the United States Fire Administration, the use of communication technology by emergency workers began in the mid 1940s when fire departments in the United States began to utilize single-channel, two-way radios to communicate between fire and EMS personnel on the scene of an emergency. Before this, the only viable form of communication was face-to-face, which required firefighters and EMTs to be within “shouting” distance of an officer or incident commander.

A drastic improvement in communication technology came in the late 1960s, when fire departments began issuing personal, multi-channel radios. Almost 50 years later, these multi-channel personal radios are still the primary medium of communication for firefighters and EMTs when responding to calls. In a survey given to 30 active EMTs and Paramedics in Prince George’s County, MD, a vast majority listed personal radios as the #1 tool used to establish and maintain communication during a medical emergency.  




Ambulances in within the PGFD Department are equipped with radios, CAD technology, and GPS to decrease response time and improve patient care

While radio communication continues to be the communication medium of choice for emergency medical workers in the field, fire and EMS departments certainly have not ignored the technological advances that have been produced over the past several decades. One of the most important and revolutionary innovations to the communications side of emergency medical services has been the introduction of Computer Aided Dispatch (CAD) technology.  These CAD systems allow emergency personnel to access a plethora of information provided by the central communications center. For example, when an ambulance is dispatched to a medical emergency, the EMTs can access all the information about the call, view a GPS map that finds the quickest route to the destination, and view information about other Fire/EMS resources in the area.

A screen shot of the Computer Aided Dispatch (CAD)
system from the base station computer at 
Branchville Volunteer Fire Department

Firefighter/EMT Steven Hamrick of
Branchville VFD checks information about
an EMS call on the CAD

Much of the information presented on the CAD systems is made possible because of recent innovations to technology within the 911 call receiving facilities. Within the past 15 years, a system known as E911 (or Enhanced 911) has been integrated into most emergency communication centers. When an emergency call is placed from a cellphone, the E911 system allows 911 call-takers to automatically access two vital pieces of information: the phone number and GPS location from which the call was placed.  The implementation of these new technologies over the past few decades has allowed EMS responders to access more information about the medical emergency in a much shorter period of time, which in turn has lead to decreased response times and increased patient survival rates.

In addition to radios and Computer Aided Dispatch technology, the Prince George’s County Fire/EMS Department has also equipped each ambulance with a ToughBook field laptop. This device allows EMTs and Paramedics to generate an electronic patient care report (ePCR) that records all the medical information about the patient and tracks all pre-hospital medical procedures that are performed.  The implementation of these laptops has greatly increased the efficiency of field documentation, which is important for both legal purposes and ensuring the continuity of patient care between EMS and hospital staff.

Both local EMS departments and those across the country are incorporating new and innovative mediums of communication to provide for EMTs and Paramedics

As the modern technological era continues to produce new ways in which we can communicate and remain connected in more efficient ways, the leadership of Emergency Medical Services departments must decide how new technologies will be incorporated to improve patient care. According to Assistant Chief Spiro Dimakas, the Prince George's Fire/EMS Department plans to unveil two major innovations within the next three years. 

The first change will come as a replacement to the ToughBook laptops that are currently used to document calls and generate electronic patient care reports. The county plans on equipping each ambulance unit with a touchscreen tablet that will be used as a more efficient method of documentation. The tablets will be preloaded with an advanced program that should be able to account for any possible situation that could happen during a medical emergency. By creating a system in which the care providers choose from a series of predetermined options, the need for a laptop and keyboard will be practically eliminated. The addition of a touchscreen tablet will also provide a simpler method for acquiring patient consent signautures and 'transfer of care' signatures from Emergency Room nurses; both of which are vital steps in the legal side of emergency medical care. 

The second change will be the addition of "Automatic Vehicle Locator" technology, which will be applied to every emergency vehicle in the county. The Automatic Vehicle Locator (AVL) is simply a GPS device that is placed in the vehicle's engine compartment and links directly to the central communications of the county. By gaining the ability to track the precise location of emergency vehicles within the county, dispatchers will be able to assign the closest physical unit to an emergency call. The goal of implementing this technology is to drastically decrease the time it takes for certain units to respond to calls, and optimize the allocation of emergency resources through the physical space of the county. 

While local Fire/EMS departments in Prince George's County try to enhance patient care with these new technologies, other departments across the country are trying new and exciting ways to incorporate technology into their practices. One of the more innovate ideas comes from Emergency Medical Services in Chicago, Illinois. According to an article posted by mobihealthnews.com, Chicago EMS will be equipping their EMTs and Paramedics with Google Glass, a technology that allows video to be shared from a camera integrated into a pair of glasses. The idea behind this technology is that video taken by the Google Glass wearers will be streamed directly to hospitals so the Emergency Room staff can get a first person view of what is happening in the ambulance. This would give the doctors and nurses a better opportunity to prepare for the patient, as well as give medical oversight and instructions to the EMTs and Paramedics.

Although this innovation provides a lot of advantages to the process of responding to medical emergencies, many EMS personnel are responding to it with negative feelings. In the same survey discussed earlier of EMTs/Paramedics is PG county, 51% of respondents stated they were either neutral or opposed to idea of incorporating Google Glass into their patient care practices. It is interesting to see this level of negative response, considering 100% of respondents stated that current EMS technologies (radio, CAD, cellphone, GPS) either moderately improve or greatly improve patient care. 

Perhaps a reason for this inconsistency is that some EMS providers feel that the current dynamic of human instinct and technological assistance is working well, and that any new advancements would only further serve to take control away from the trained EMTs and Paramedics. Either way, the trend of meshing modern technology and Emergency Medical Services is something that has been occurring for over half a century, and it seems like it will only accelerate with rapid technological advancement. EMS workers must be willing to train diligently in order to understand and adequately use the new technologies that are assigned to their ambulances. The overall expectation of Emergency Medical Services is to provide the best possible medical care to those who call for help, and with the proper integration of modern technology, that expectation will continue to be met and exceeded.

EPA Green House Gas Emissions - Visualization Submission

EPA Facility Level GHG Emissions  (<---Link)

The link above displays a graphic from the Environmental Protection Agency that provides information about facilities in the United Sates that produce green house gases on a large scale. I had to use this graphic to gather information for a paper in my Environmental Writing class, and I found this interactive useful to be both easy to use and very reliable. The best part about this graphic is that it provides the user with many different customizable options to filter both information and viewing formats in the most useful way. You are able to view facilities by facility type, state, county, GHG emission levels, and several other options. The graphic also provides the option to view the information in the form of a map, list, trend-line graph, pie chart, or bar chart. With all of these different options, the user can easily navigate the graphic and extrapolate whatever information they need in the viewing form that is most valuable. This makes it an excellent resource for those who require information about green house gas emissions.

Scientific Study at Imperial College (UK) Links Interactive Video Game Usage with Rewarding Physiological Response

• A study performed at the Imperial College School of Medicine found that video game users experience increased levels of dopamine release during gaming. 
• Findings produce evidence to support claim that the "media ecology" of video games can have a greater influence and impact on users than less interactive media. 
• Debate continues over the role that violent video games can play in adolescents becoming predisposed to anti-social and violent behavior.

Gamers use a variety of simulated environments, from warzones to sports games 

to puzzle-solving in order to synthetically stimulate reward centers in the brain. 

Researchers find increased dopamine release during video game usage 

A study performed at the Imperial College School of Medicine in London has significantly linked video game usage with an increase in activity in the brain's reward center. These findings show that playing video games can have a more significant physical and physiological impact on gamers than less interactive media like watching television and or using a computer.

The results of this study are presented in an article in Nature entitled "Evidence for Striatal Dopamine Release During a Video Game". The article describes the experiment in which researchers used a scanning process known as positron emission tomography (PET scan) to map the brains of test subjects while they played a variety of skill-based video games. Eight male test subjects were used in this experiment and were observed while staring at a blank screen (control) and then while playing an interactive computer game in which the player had to navigate a map for monetary reward. The PET scanners allowed researchers to measure activity in different areas of the brain and extrapolate information about how the gamers were physiologically responding to the interactive media. The results of the experiment (see below) show that completing a task or level in a video game produces a significant physiological response in the brain.

Specifically, the PET scans showed decreased levels of dopamine binding at D2 receptor sites when the subject was playing the video game. When a human being completes a task or performs an activity that the brain perceives as positive, it will release a reward chemical known as dopamine into the neural synapses, which produces feelings of happiness, pleasure, and gratification. After dopamine is released, it binds to D2 receptor sites, which cause the rewarding feelings to subside. If decreased levels of D2 binding are seen in in PET scans (as was the case in this experiment) then the dopamine chemical was able to stay in the neural synapses for a longer period of time, producing a longer and more intense feeling of pleasure. The results of the experiment show that, not only was more dopamine produced during video game play, but the level of D2 receptor binding was also significantly decreased.

 

Figure 1 and Figure 3, taken from the article "Evidence for Striatal Dopamine Release During a Video Game", show 

both graphically and visually how video games can increase dopamine release and decrease D2 binding in the brain.

The "ecology" of video game usage elicits greater response than less interactive media

To interpret this information and compare the findings to other forms of media, we can use a theory known as media ecology to analyze the environment in which the media was produced, marketed, and consumed by an audience. According to the definition in the Converging Media textbook, the media ecology theory "examines how media environment influences our thinking... and how specific types of medic affect our perceptions because of the medium used" (pg. 360). A major proponent of media ecology, Marshall McLuhan, went on to state that the medium used to transmit a message was for more important than the actual message or content itself.

While the basis of media ecology had some fundamental flaws, we can still use its general concepts to help understand how video games create a different effect in an audience than other media. As stated above, playing video games can produce a physiological response in the brain the releases chemicals to reward the player for completing a task. This physiological behavior stems from a primal system within the brain to reward someone for completing an evolutionarily positive task. Originally, this system was designed to create a reward when someone was able to find food, shelter or a means of reproduction. However, with the creation and innovation of hyper-realistic video games in the 21st century, we are able to synthetically stimulate these reward systems.

The fact that you are physically interacting with the simulated environment via a controller or keyboard allows your brain to be tricked into releasing and maintaining higher levels of dopamine. While other media such as television and online reading are able to hold your concentration and elicit emotional responses, they do not allow the level of interaction and immersion that is seen in video games.

For example, let us compare a similar message experienced through two different media: Call of Duty vs. Saving Private Ryan. While Saving Private Ryan is an extremely realistic war movie that evokes strong emotional responses from the audience, you would most likely see higher levels of dopamine activity while playing the war-based video game Call of Duty. Because the immersive video games allows you to physically interact with controllers and complete tasks as you move through the levels of the game, your brain is tricked into producing more of a response than if you were sitting on a couch and watching a movie. From this example, we can see how two similar messages, transmitted through different media, can create different reactions in an audience. This ties in well with McLuhan's perspective on the theory of media ecology, and his assertion that "the medium is the message". 


The big picture 

After discussing the differences in physiological effects that interactive video games can have on the human brain compared to other forms of media, some may be asking, "who cares?". The question is valid, considering the study that is referenced in this article is more than fifteen years old. However, over the past several years, this country has seen horrific instances of young people performing violent acts of murder and terror at schools, colleges, and movie theaters. These terrible acts of violence have sparked a debate as to whether exposure to immersive, violent video games could have contributed to these individuals creating violence in the real world. There are many different sides and perspectives to this debate, which remains heated and ongoing in the public arena. 

However, when applying the topics discussed in this article to the debate, we can see how the argument of violent video games contributing to violent behavior may hold some merit. We discussed how the experience of interacting with video games could cause individuals to produce a high levels of physiological response. Using this information, it could be argued that individuals who are already susceptible to violent and anti-social behavior may be affected and/or influenced further by video games. We must keep in mind, however, that this simply speculation, and much more research and study is required to accurately determine a correlation between video games and violent behavior. 

References:
- Koepp, M.J., R.N Gunn, and Lawrence A.D. "Evidence for Striatal Dopamine Release during a 
            Video Game." Nature 939.6682 (1998): 226. 
            http://www.ncbi.nlm.nih.gov/pubmed/9607763. Web.
- Pavlik, John V. "Chapter 12: Media Theory and Research." Converging Media. a New Introduction 
             to Mass Communication. Oxford: Oxford UP, 2014. 343-69. Print.

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