How Patients’ Smartphones Can Save Their Lives

Two universal truths in EMS are 1) patient health information is critical to provide good care, and 2) we are always working against the clock. Traditionally medical information is collected in the form of the patient history and transmitted from the patient or a surrogate to the provider via verbal communication (or sometimes a well-worn piece of paper from a purse or wallet). This vital information is intended to guide the care we provide. Unfortunately it is often collected haphazardly due to patient confusion or forgetfulness about their medical issues; these can be compounded by the stress of the situation. In addition, patients may not be able to communicate at all due to their emergency. Regardless, EMS providers are trained to act on even limited information and provide the best possible care for the situation.

Even if EMS is able to gather most of the patient’s medical history, medications and allergies, once they arrive in the emergency department, the game of telephone begins. Between the distractions of the ED and the critical nature of the patient, the handoff to ED staff can be chaotic, and much of the information collected lost. The ED has to collect much of the same information again and may miss key elements that EMS knew about but somehow didn’t make into the EMR.

To complete the loop of insanity, the next time EMS treats the same patient, the prehospital providers will have no idea what was found during the hospital stay and will have to start over collecting key medical information again, setting up the same failures as the first time.

It may sound like a bad “time loop” episode from your favorite sci-fi show, but this is today’s reality in most EMS systems. There is not a reliable way to gather patient medical information in the field, no easy way to consistently pass that information to the ED and little, if any, sharing of hospital patient information back to the EMS system most likely to care for that patient again.

There has to be a better way. While there is no universal solution, current technology can help EMS with some of these challenges.

Improving Patient-Provider Communication

One of the first things we learn in medicine is how to take a medical history. The mnemonic SAMPLE (signs/symptoms, allergies, medications, past illnesses, last oral intake, events leading up to present illness/injury) is commonly used along with other tools (PQRST, DCAP-BTLS, etc.) to collect the patient information needed to provide appropriate care and then turn that information into the written story of the encounter for the medical record.

No matter the level or type of provider, the key information needed is the same:

• What happened today?
• What are the current medications and allergies?
• What is the past medical history (PMH)?
• What, if any, medical decision documents exist (DNR, POLST, etc.)?

Without all of these elements, the potential for patient harm through both omission and commission increases. Although the reason EMS was called changes with every contact, the allergies, medications and past medical history remain fairly constant. Yet these important pieces of information are often the first to be forgotten or minimized. How many of us have had a patient deny any medical problems, then we found their huge bag of medications? And these are the alert and appropriate patients! Maybe we need to ask the question better, or maybe our patients just think we know everything about them: “You know, it’s the yellow round pill.”

Regardless of the reason, the PMH, allergies and medications are all important, and the more time and cognitive energy we use to determine them, the less time and energy we have to address the immediate situation. Traditionally medics are taught to look for physical clues such as empty pill bottles and medical alert bracelets. In today’s world, however, we need to be more aware of the ubiquitous devices in everyone’s pockets. Through native features and third-party apps, smartphones can improve the transmission of medical information from patient to provider, and we in EMS must educate both ourselves and our patients in the ways these features can make medical information exchange more accurate during an emergency.

In Case of Emergency (ICE)

One of the early and simplest uses of mobile phones to help in medical emergencies was the idea of the ICE (In Case of Emergency) contact. Begun in England, the campaign encouraged people to add a desired emergency contact labeled ICE to their contact list. This allows emergency workers to easily access an emergency contact in case the patient can’t communicate due to illness or injury. However, as phones became smarter, they needed to be more secure. With people maintaining financial and other sensitive information on their phones, all smartphones now have a lock screen that cannot be accessed without a PIN or fingerprint. Although a critical feature for any phone, the lock screen inadvertently blocks access to contacts, including ICE, if the PIN is not known. The original simplicity of the ICE contact is now gone, but there are several new options to provide various levels of emergency information with modern smartphones.

Many phones now have some version of an ICE app. These apps tend to come in three forms.

The first and simplest is a native feature for many phones that allows access to an emergency contact through the lock screen. For example, in all Android smartphones with the operating system Lollipop and newer, you can set your emergency contacts into an ICE group that is visible through the emergency option on the lock screen. Other phones, like the Samsung Galaxy phones, allow you to input “owner information” through the lock screen menu. Although straightforward, the information is limited to contact numbers or, at best, creative “names” to relay medical information.

The second type of app is third-party apps. A simple search for ICE through the different app stores will result in multiple choices. Many charge for the app (usually less than $3), although there are free versions. The capabilities of these apps vary. They may be very robust and include multiple layers of health information and contact information for loved ones, and some will even allow EMS to connect with an emergency operator to obtain up-to-date information on the patient. The key for these apps to be effective is that they can be accessed from the lock screen, either through an individual icon or by displaying the relevant information directly on the screen. Although these can be useful, some people may not like the look of the app or information on the lock screen that can reduce usage. In addition, some apps are more user-friendly than others. Finally, EMS providers may not be familiar with a particular app being used and may have difficulty finding and accessing its information.

The third option, present with certain phone models, is a native feature of the phone that allows access to medical information through the lock screen. The information is accessed by touching the “Emergency” label in the corner of the screen. This has been an iPhone feature for the last couple of years and now beginning to show up on other phone models (Samsung S7). The information can be input through a native app that comes with the phone (Health app for the iPhone, under the feature Medical ID). One potential advantage compared to third party apps is that there is no image or information on the home screen. The standardization also makes it easier to know where to look for medical information for the EMS provider caring for the patient.  Unfortunately, only certain phones carry the feature and if a person changes phone types, they will likely lose the information.

Many EMS providers are tech-savvy and at this point may feel like they have a good understanding of these apps. That’s great, but ask yourself a couple of questions:

When was the last time you educated a patient or family member on these features?

In today’s healthcare system, EMS increasingly assumes the role of community health advocate and physician extender. Ideally a patient and his or her primary care provider should discuss what information is included on a smartphone app. This is especially important when dealing with complex medical problems, unusual diseases or uncommon medical devices, such as an LVAD.

However, we do not live in an ideal world, and it may fall upon EMS to educate patients about what information to have available in case of an emergency. This can be as simple as a picture of emergency contacts and prescription list stored on the phone, or it can be as specific as an ICE app documenting specific instructions and medication dosing needed to manage the next adrenal crisis. The next time you transport a stable patient with a serious or unusual medical problem, talk to them about it. Take a minute, when possible, to give a quick tutorial on what their phone can do and how to search for the ICE-like apps out there. Not only will their future emergency providers thank you for the extra information, it might help save the patient’s life.

Is it your standard practice to check every patient’s phone?

Just like other EMS skills, if you don’t regularly check smartphones for information when you really need it, you won’t remember to look for it. Make it a habit with every patient to ask if they have medical information or emergency contacts accessible to you. With permission, access their information and confirm with them the accuracy. This not only keeps you in practice but is another patient education opportunity. Who knows? The patient might know about a new feature or app you haven’t seen yet.

Do all of your colleagues know about these features?

Don’t assume everyone in your department knows about the different features available. In our department, every week during CE, an informal survey shows at best a little more than half know about the feature on the iPhone (which our units use), and even less about the other options out there. Even tech-savvy providers are often unaware of what different phones can do. Along with all the other information passed on to providers, simple flyers, e-mail blasts or scheduled notices should include ICE information. Simple awareness training can be incorporated into other planned training events as well. Finally, don’t forget about educating your medical director. They have access to additional providers through the ED and greater hospital and medical communities and can make sure other specialists and primary care providers are aware of these features and can educate their patients. They can also include checking devices as part of their standard operating procedures.

Community Education

Now that your patient and partner both know how this works, it’s time to spread the word further. Often the best opportunity to intervene and educate about health issues, like showing an individual patient the features in their phone, is in the moment. However, it is best to have the information on the phone before the emergency takes place. EMS community outreach is a great opportunity to further ICE-app use. Tables and flyers at local health fairs, child safety seat training, school visits and other EMS public-education events are great chances to pass out information on what should be included, the different options available and even give hands-on demonstrations and training, which can all quickly spread the word and increase use. Partnering with local community organizations, such as Boy Scouts and Girl Scouts, can help educate further. Finally, working with local patient advocacy organizations, particularly those concerned about specific treatments needed by EMS that may not be common, can both empower those patients and advocates and provide valuable information for the EMS responders who treat those patients.

Final Thoughts

There are many ways technology helps with patient care in the EMS world. Modern monitors can link to EMRs, as well as transmit EKGs and vital signs to receiving facilities. GPS location systems can track EMS units at all times of the day or night to help minimize response times. And multiple online and app-based resources are available to help providers with patient care in real time. However, we still struggle to use technology to relay important patient information within the system.

The ultimate goal for any EMS system should be an integrated health information exchange that quickly provides access for all providers to a patient’s past medical history, medication list and allergies, as well as specific treatments that may be required in an emergency. However, with our current fragmented system, this is not the reality in most places.

HIEs are a discussion for another time. One small piece we can work on, however, is to improve our acquisition of patient information through the use of existing apps and phone features available today. EMS providers should become familiar with these, encourage their use with patients, and work with others to spread the word. That way, that the next time the diabetic or a child in adrenal crisis or a patient with an LVAD is found, important lifesaving information can be easily accessed, even if the patient can’t tell you themselves.

Craig Cooley, MD, MPH, EMT-P, FACEP, is associate EMS medical director for the San Antonio Fire Department and director of the EMS fellowship program as well as an assistant clinical professor in the Department of Emergency Medicine at the UT Health Science Center at San Antonio.

Ronnie Ren, MD, is an emergency medicine resident at the UT Health Science Center at San Antonio.