amPHI™ - ambulance record-keeping system John Gade a, Michael Dahl b, Per Thorgaard b, Flemming Knudsen b a Judex A/S, Aalborg, Denmark b Sector of Anaesthesia, Northern Jutland, Aalborg, Denmark

43 standard ambulances: emergency turn-outs per year Special baby ambulance: 100 transfers per year (neonates and babies) Special trauma ambulance: 800 transfers per year (adults) Northern Jutland county

Future health care Many small emergency units are closed down. Centralizing medical treatment (re. DANAMI-2). Increasing duration of transports. Increasing number of inter-hospital transfers. Need for pre- and inter-hospital “EHCR” and Increasing demands for collaboration between ambulances, pre-hospital care and hospitals. Increasing demands for documentation and quality assurance.

At the site of accident and in the ambulance: Continuous registration of patient data. Quality assurance of the registration. Access to information from IT-systems at the hospital. Guidance of the paramedic team. Access to emergency doctors at the hospital. At the hospital: On-line access to the ambulance record. Booking of tests and clinical experts. Structured communication between paramedics and hospital. Structured documentation: Data for research, education, etc.. amPHI™ functionality

The Alarm EVA2000 Alarm112 Emergency - dial 112 Alarm central (Police) Dispatch central (Ambulance service)

Alarm GPRS Equipment and communication WLAN Site of accident In the ambulance amPHI™ database Hospital IT-systems Hospital intranet EVA2000 (Falck) XML MPLS Bluetooth

Demographic data Allergies Chronic diseases Previous contacts (incl. diagnoses) Integration with the hospitals IT-systems Access to ”critical medical information”: More knowledge  Better treatment

The ambulance service prepares the hospital ! The hospital supports the ambulance service ! Updated patient status

Electronic ambulance record Transport Patient data Previous diseases Treatment before arrival Status on arrival Wounds Treatment Medicine Observations Glasgow Coma Score Trauma evaluation Notes Divided into logical sections according to the existing paper- based record (Falck) and other supportive sheets:

Electronic ambulance record Evaluation of the patient status in the ambulance.... :

Electronic ambulance record.... and at the site of accident:

On-line access to the ambulance record: Hospital intranet

Pilot projects Since the beginning of 2004 amPHI™ has been used in one emergency ambulance (amPHI™ Emergency) and in the special baby ambulance (amPHI™ Transfer). Printers are installed at 5 gates at 3 hospitals in North Jutland county for printing of the ambulance case report. The ambulance crew was given a short introduction to the system and was told to use amPHI™ for all patients admitted to one of the 3 hospitals. Data from amPHI™ Emergency for 1 year was analyzed.

Results amPHI™ Emergency: 486 high-priority turn-outs to hospitals with printers. amPHI™ was used in 377 turn-outs (78%). In Q3+4: 210 turn-outs of (82%). In 143 cases (38%) the patient ID was sent from Alarm112. In 210 cases (56%) the patient ID was entered by the crew. 24 patients (6%) were not identified. 318 patients (82%) had previous hospitalizations in the county. Critical medical information was available for 35 patients (9%).

Conclusions amPHI™ Emergency: The ambulance crew is satisfied with the system and do not want to revert to the paper charts. The access to the patient’s medical record is very helpful in the emergency cases. The ambulance crew uses amPHI™ to get patient information for most patients admitted to other hospitals. There is still areas where the coverage of the GSM network is insufficient for data communication.