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The Scottish Ambulance Service, the University of Aberdeen’s Centre for Rural Health, NHS Highland and satellite technology supplier ViaSat have embarked on a trial of satellite broadband connectivity as a means to improve the quality of patient care whilst in transit.
The SatCare project is exploring the potential to use ultrasound scans to gather information on a patient’s condition while in the ambulance and transmit it to the Highlands’ only acute accident and emergency (A&E) department at Raigmore Hospital in Inverness, so that patients’ conditions can be assessed, relevant advice and guidance passed back to paramedics, and doctors can prepare to mobilise the necessary resources or specialists at the hospital.
Satellite connectivity comes into play because due to the remote nature of the Highlands, 4G mobile networks can rarely be relied upon, as Robert Farquhar, area service manager for the Scottish Ambulance Service, explained.
“We would normally communicate through our Airwave radios [which operate on a terrestrial trunked radio or Tetra network], but for transmitting ultrasound data we had to look at other ways,” he said. “Mobile networks can be 2G up to 4G in some places but 2G is quite the norm in the Highlands.”
Five ambulances have now been kitted out with both new ultrasound scanning equipment and ViaSat’s satellite broadband comms system running on the KA-SAT high-throughput satellite network that it runs as a joint venture with Eutelsat.
For ViaSat’s head of space and communications, Neil Fraser – a former commanding officer and satellite comms expert in the armed forces, who witnessed the technology being used at first hand in field hospitals while serving in Afghanistan – the key aspect of the trial will be to enable better care within the so-called golden hour, the critical first 60 minutes after a major medical emergency when a successful clinical intervention is most likely to prevent death.
“One thing that a satellite brings is where there are not-spots or where you need extra resilience, generally you can access some kind of satellite communications,” said Fraser. “This trial will prove satellite broadband can provide value for clinical and operational outcomes in terms of prioritising where you send patients, journeys, and life-saving on the spot activity, and whether satellite is something the medical industry is ready for,” he said.
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The supplier is currently developing its next generation of satellites, ViaSat 3, which it claims will be able to deliver a terabit of capacity when complete, covering Europe with a standard ultrafast 100Mbps broadband service.
Therefore, said Fraser, proving that the Scottish Ambulance Service can make the ultrasound technology work on a current connection – which averages 4-5Mbps – will help it prove that the tech can scale to hundreds of ambulances and justify future investment.
There is also potential to explore using satellite technology to augment the future 4G Emergency Services Network (ESN), the costly and troubled replacement for the Airwave Tetra network that is currently being built by EE.
“There’s no recognition [in government] yet of the not-spot issue and resilience issue, and if you’re taking down a network like Airwave’s to rely on a network with reasonable population but less reasonable geographic coverage, there is a gap, and one traditional role for satellite is to infill gaps,” said Fraser. “A vehicle could in future provide a 4G node backhauled to satellite.”
Ultrasound crucial for diagnostics
The scans themselves should take a paramedic less than five minutes to record and package with a video summary of the patient’s overall condition, and, according to Leila Eadie, research fellow at the University of Aberdeen’s Centre for Rural Health, the system provides diagnostic quality images virtually all the time with a minimum of training.
“Previous studies have shown the biggest barrier to practical use of pre-hospital ultrasound is interpretation of the scans: images can be acquired with basic training and SatCare communications technology will facilitate expert assessment of images in the field. We want to maximise the benefits of having ultrasound available without requiring paramedics to undertake extensive sonography training,” she said.
Eadie explained that there were many possible uses for ultrasound scans – more usually associated with pregnancy in the popular imagination – in an emergency situation.
“In a lot of cases you’re looking for blood where there shouldn’t be blood, or the lungs, are both taking in air, has one collapsed?” she said.
The SatCare trial will focus on using ultrasound to gather information on five critical factors in a patient’s condition, said Eadie. These are breathlessness, chest pain, abdominal pain, major trauma, and non-trauma shock (unexplained low blood pressure). There is also potential for it to be used for stroke victims in the future, although for the trial’s purposes the team selected easier metrics.
“Point-of-care ultrasound, telemedicine and remote decision support have all offered potential over the years to improve care for our patients, but have often failed to secure the kinds of rigorous and substantial research platforms that allow firm conclusions to be made about efficacy,” said Luke Regan, an emergency consultant at Raigmore Hospital.
“The SatCare trial aims for the numbers, methodological rigour and rural patient base to offer a real prospect of informing the debate on these interventions positively for years to come. For us, this is ground-breaking,” said Farquhar. “There is so much potential in this for the benefit of the patients.”