Prehospital medicine, also referred to as emergency medical services (EMS), is a subspecialty within the medical field that initiates care for ill or injured patients before they arrive at a hospital or while they are in transit to a hospital. As a result of the nature of this unpredictable and ever-changing environment, prehospital clinicians, namely paramedics, must be prepared to handle every challenge thrown their way.
Beyond in-depth medical training, paramedics are supplied with top-of-the-line medical equipment and gear in preparation to face these obstacles. This includes mobile ECG monitors and defibrillators, ventilators, and to some degree, point-of-care blood analysis equipment, among others. However, there is one antiquated tool that has yet to make the jump to EMS readiness: intravenous infusion pumps. Paramedics currently face four infusion challenges: gravity functionality, bulky size, unsuitable for all environments, and insufficient power options.
Gravity-Powered Infusion Pumps — You Just Can’t Put Them Down
More often than not, paramedics can be found using a gravity-powered manual infusion therapy technique. This technique is done by securing the medication to an elevated, upright attachment point and then allowing gravity to move the medication through the IV tubing. Paramedics then need to count the individual drops in a drip chamber controlled by a roller clamp that a patient receives, which correlates to the correct medication dosage.
Considering the advanced, transport friendly technologies available for EMS professionals, this is an obvious impediment to their lifesaving work and a less-than-ideal approach to drug administration. Proper electronic intravenous infusion pumps, designed to regulate infusion to deliver fluids at the correct rate and volume no matter what position the pump is in, are necessary for EMS professionals to provide the right care at the right time. These pumps must, however, be designed with the needs of EMS in mind, which brings us to the next point.
Bigger Is Not Always Better
Today, paramedics that have access to advanced infusion pumps often use hospital-grade multi-channel pumps. These pumps are bulky and built for stable settings, which are unlike most EMS environments. Maneuvering with these pumps can be very difficult, especially in unpredictable terrain. This poses a problem, as prehospital care is often mobile and turbulent, as patients are transported to hospitals via ambulance and helicopter. These tumultuous rides can falsely set off alerts such as air-in-line alarms or cause the inaccurate delivery of medications, problems that can be detrimental to patient care.
To combat this, EMS professionals should be equipped with infusion pumps that are small and rugged so that paramedics can more easily transport this equipment to begin delivering medications and fluids within moments of a recognized need at the point of care — no matter the terrain, surrounding environment, or means of transport (ambulance or helicopter).
Built to Survive the Elements
The prehospital environment is distinctly different from a general-care hospital environment. When paramedics arrive at a medical emergency, the nature of their surroundings is completely unpredictable. External forces, as well as patient health issues, can lead to a rapid decline in patient status. Therefore, it is crucial that the capability to provide appropriate care, as deemed by the paramedic, be available. This care can start at the site of the incident and continue up until the patient has reached physicians at the receiving hospital. Therefore, IV pumps suited for the prehospital environment must be tough enough to withstand unknown factors. Pumps need to be reliable and unperturbed by drops and spills, which are common throughout the pre-hospital environment.
Pumps also need to be transport-rated and approved, meaning that they can withstand drastic temperatures, motion, and electrical interference of out-of-hospital environments. With this approval, the likelihood of equipment failure adversely impacting patient care is decreased. Additionally, pumps need to be equipped with suitable infusion sets and accessories to negate all possible errors that may occur, including air-in-line alarms, to ensure optimal performance during pre-hospital scenarios.
Compatibility and Staying Power
Prehospital care, by nature, is full of unknowns requiring paramedics to always be ready to react to new circumstances. To support this constant state of readiness, tools and equipment used by paramedics must also be able to keep up with the paramedics themselves. As such, IV infusion pumps should be equipped with long-lasting batteries, ideally ones with 24-hour continuous run time, to last through such unpredictable scenarios.
Additionally, IV pumps should come equipped with advanced drug library capabilities and presets to accelerate programming. These functionalities are also helpful in reducing errors in emergency response scenarios.
EMS professionals must be prepared for any and every scenario. However, their life-saving work hinges on the effectiveness and capabilities of the tools and supplies they are equipped with, which can either hinder or facilitate their efforts. Moving forward, infusion pump manufacturers must address these challenges to support paramedics striving to provide care in unpredictable prehospital environments. In doing so, paramedics and EMS teams will be equipped with tools that are as responsive and reliable since their users play a pivotal role in providing healthcare services on the front lines.
This article was written by L.J. Relle BBA, NRP, FP-C, CCP-C, a career firefighter and paramedic serving the greater New Orleans area for over 15 years. He also serves as a consultant to Eitan Group. For more information, visit here .