# Laptops in Ambulances - Advice Needed



## upmm019 (Jan 11, 2010)

Looking for advice regarding the use of laptops in ambulances.

I work for a basic service that has about 700 runs a year, covering about 300 sq miles for the given county.

Our county uses a software that has GIS landowner information and we are considering using this as a tool within our ambulances.  

We currently use our handy maps and such but to get with the times we thought it may be nice and perhaps quicker to have a laptop with such information installed.

That said, are there any folks out there with similar service that does the same?  If so, do you think it has helped or hindered your service?

Lastly, for those who do use laptops... how and what do you use to keep the laptop fully powered?  We have an inverter but those plugs are in the back of the rig for powering IV pumps and such.  Is there a DC sort of thing that is used to keep it fully powered?

Do you set the laptops to hibernate when not in use?

thanks


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## EMSLaw (Jan 11, 2010)

Many services have gone to toughbooks.  If you plan on doing that, you can do your PCRs on the laptop as well - they even come with digitizer screens so that the consent to treat or RMA can be signed on screen.  

You can plug it in back at the station, or some places will have a dock in the front of the ambulance (for CAD/GPS/etc).  Or you can use an adaptor to charge it from the DC current in what used to be called the cigarette lighter.


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## Akulahawk (Jan 11, 2010)

Toughbooks are pretty much the way to go. They're expensive, but they're quite rugged computers. As for powering them, there are adapters for 12VDC as well as 120VAC, mounts to attach them to vehicles...

There are tons of possibilities, and as already posted, you can do electronic patient care reports and with a digitizer on the screen, you can electronically capture consent...


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## EMSLaw (Jan 11, 2010)

I think a new toughbook CF-19 is in the $3500 range.  You can get refurbished 18's for significantly less, depending on how many bells and whistles you want.  You can buy them on eBay for a few hundred, but that wouldn't do for a service that needed to depend on the things reliability.  

But you can run over one with an ambulance and it still works.


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## Fulch (Jan 11, 2010)

*Tough books.*

EMSlaw's not kidding! I worked for a company last year (not EMS related) who used tough-books and I swear we managed to do everything to those things, bar playing hand-granade tennis, and they never got serious damage!! 

However accidently dropping one out of the back of a truck doing 65mph did cause it to hic-up for a while.


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## upmm019 (Jan 11, 2010)

I think a toughbook may be out of our budget at this point.  I think we may pilot an inexpensive but newer laptop.  I'm sure we might learn that a tough book is the way to go but then again, we only run about 700 calls per year.

Can someone tell me more about "digitizer on the screen".. not sure I follow what this is....

Thanks.


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## alphatrauma (Jan 11, 2010)

Ever sign for a package from UPS or FedEx?

It's a similar concept... Digital Signature


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## upmm019 (Jan 11, 2010)

yes, but is it a software or hardware that does that or both?


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## FLEMTP (Jan 12, 2010)

upmm019 said:


> I think a toughbook may be out of our budget at this point.  I think we may pilot an inexpensive but newer laptop.  I'm sure we might learn that a tough book is the way to go but then again, we only run about 700 calls per year.
> 
> Can someone tell me more about "digitizer on the screen".. not sure I follow what this is....
> 
> Thanks.



Go with a toughbook... for what you're gonna spend on the several laptops you're going to go through because they keep getting damaged/broken.. you can get a toughbook and do it right the first time. Look into grants for the computers.. many times the government has grant money available for just this type of situation.


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## MedicSqrl (Jan 12, 2010)

The toughbooks are definitely something to get. I have seen them take some nasty falls and come back like nothing happened.


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## EMT (Jan 12, 2010)

Yeah we use tough books too.


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## resq330 (Jan 12, 2010)

We were issued 4 Tough Books...thanks to a nice donation from the state.  Haven't gotten to use them yet though.


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## EMT (Jan 12, 2010)

resq330 said:


> We were issued 4 Tough Books...thanks to a nice donation from the state.  Haven't gotten to use them yet though.



Ah lucky you! We are privately owned and operated, we buy all of our stuff.


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## EMSLaw (Jan 12, 2010)

upmm019 said:


> Can someone tell me more about "digitizer on the screen".. not sure I follow what this is....



A digitizer is a special layer that's worked into the screen when it's made, that enables the screen to digitize signatures and other handwriting.  You need it for most ePCR applications where you want to have the patient sign the electronic copy (for refusals, consent to bill, what have you).  

Sorry, I'm not really an expert, but that's what it does.  

I know one of the vendors hereabouts was selling refurbished CF-18s with a 3-year warranty and service for $1800/ea.

Good luck.


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## Simusid (Jan 12, 2010)

We've been using toughbooks for years.  Yes they get dropped, yes they take a beating, yes they survive!  

I'm also going to add a shameless plug (I know the guy that wrote it)for the PCR software that we use.  We have been using AmbuPro EMS for years.  It's comprehensive and pretty easy to use.   I think it helps us generate very high quality reports more quickly.  

One nice side effect is that since it helps us collect so much info, I'm told that we have fewer claims kicked back from insurance companies which means we recover more $$$.


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## resq330 (Jan 12, 2010)

EMT said:


> Ah lucky you! We are privately owned and operated, we buy all of our stuff.




We are a volly organization.  So if we get an opportunity like this we gotta take advantage of it.  B)


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## EMT (Jan 12, 2010)

resq330 said:


> We are a volly organization.  So if we get an opportunity like this we gotta take advantage of it.  B)



Of course, i would as well. What else do they give you guys?


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## resq330 (Jan 12, 2010)

EMT said:


> Of course, i would as well. What else do they give you guys?




Normally they will go 50/50 with us on a grant.  (As they're getting ready to do when we purchase our new $130k ambulance ).  They did this deal with the tough books because they were getting everyone in the state away from paper PCR's.  Now its will all be internet based.  So just about everyone agency in the state that requested them, got them. I'm not sure if it was funded from the Office of EMS or DHS.


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## EMSLaw (Jan 12, 2010)

Do you use EMSCharts?  That's what we're (theoretically) transitioning to when we (theoretically) go paperless in the near future.


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## upmm019 (Jan 12, 2010)

Let me ask another question.....

keeping in mind we are a small bls service (700 runs per year) and we do not do any electronic forms at this point.  I'd like to see if any of you out there have any sort of presentations on how you sold such an idea to move towards tough books, electronic forms, GPS, etc... something that we can work from to present to our administration (guys with the dough$$).

Given the cost of a new tough book, mount, software etc. We could easily exceed $10k.  I know for a fact they will not support this unless we have some really good examples of why it is the way to go.

I know personally the many advantages of having such equipment but I'm probably not the best person to put it to pencil and paper for a presentation to the "suits", if you know what I mean....


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## reaper (Jan 12, 2010)

Depends on where you are. A lot of states in the SE have mandated Epcr's. So, look at what your state requires and go from there. Most small systems will not put out the expense, until they are forced to do it.


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## upmm019 (Jan 12, 2010)

Actually, I'm in Minnesota.  I don't know the mandates about the electronic paperwork.  

Electronic Patient Care Report?? (Epcr)


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## reaper (Jan 12, 2010)

Sorry, Your location did list Southeast. 

You can still find out in your state.


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## resq330 (Jan 12, 2010)

EMSLaw said:


> Do you use EMSCharts?  That's what we're (theoretically) transitioning to when we (theoretically) go paperless in the near future.




We are going to be using software from Image Trend.


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## EMSLaw (Jan 12, 2010)

upmm019 said:


> Given the cost of a new tough book, mount, software etc. We could easily exceed $10k.  I know for a fact they will not support this unless we have some really good examples of why it is the way to go.
> 
> I know personally the many advantages of having such equipment but I'm probably not the best person to put it to pencil and paper for a presentation to the "suits", if you know what I mean....



It's apparently a state mandate for us.  I think sometime this year is the date when everything is supposed to go paperless.  

But a few reasons are: More accurate, more legibile record keeping, times are automatically entered, the ability to transmit a completed PCR to the hospital, the ability to complete a PCR en-route without it looking like it's in a strange foreign language.  It's also faster, especially for those of us in the younger generation who type faster than we handwrite (and have the poor penmanship to prove it!). 

Also, it's much easier to track and find records in electronic form.  If you are a paid organization, it makes billing much easier.  If you're volunteer, you can use the information on names and addresses to solicit the people you've served for donations.  You can also mine the information to find out where and when the majority of your calls are, the nature of the calls, who ran the most on your squad, your frequent flyers, etc.  If someone is a frequent flyer, depending on the system, their medical history might pop up when you enter their name and address.  

 The reports are automatically kicked up to quality control when they're finished.  You can review or work on your reports from anywhere, then once they're locked, they're secure and can't be changed.  They're stored in a central location, and so less likely to get lost.

So, there's a lot of pluses to it.  I'm sure there are negatives, too - the expense being a major one.


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## upmm019 (Jan 12, 2010)

I know our hospital system uses DocZ.  Now, other than knowing what it is called that is far as my knowledge goes with it....

When you do this electronic Epcr how do you make it available to the hospital?  Is DocZ a commonly used medical software which will allow the transmission of Epcr?

I agree, there are many benefits.  However, each one comes with a certain amount of cost.  Ideally, it would be nice to knock out the easy ones first, namely the ability to run GIS software.  

That has the least amount of road blocks for us.  However, I struggle with how to bet articulate the benefits to the level that a CFO person would understand that it would have it's benefits.


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## FLEMTP (Jan 13, 2010)

resq330 said:


> We are going to be using software from Image Trend.



Image Trend is what we use in my dept.. I love it.. very quick and easy to complete a PCR. I can complete a detailed PCR, whether it be a BLS transport to a cardiac arrest, in about 15 minutes


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## FLEMTP (Jan 13, 2010)

upmm019 said:


> I know our hospital system uses DocZ.  Now, other than knowing what it is called that is far as my knowledge goes with it....
> 
> When you do this electronic Epcr how do you make it available to the hospital?  Is DocZ a commonly used medical software which will allow the transmission of Epcr?
> 
> ...



If your agency bills for transport, try using the idea that EPCR's will increase collection revenue. When you go from a handwritten PCR to electronic, they are completely legible.. and you can set certain requirements for your PCR's so they cannot be completed unless they have all the required information, billing info, signatures, etc. Our dept saw a significant increase in collection revenue from EMS billing after switching to EPCR's. depending on your agency's run volume that could easily justify the purchase of toughbooks with all the software and chargers and programs, not to mention it is a NEMESIS compliant software.

The program we use, Image trend, uses a web based system to write and submit our EPCR's. You can either opt to print them out at the ER, or you can post them to a webpage that the ER staff can access AS SOON as you submit your run so they have instant access. They also have scores on each PCR that tell us if we are missing any important data, and what data we are missing. We also electronically have patients sign for billing. Its a great program and I can complete a full PCR in 15 minutes or less. 

Also, you can access and print your own PCR's any time down the road you need to, which is great if you get called into court. It also allows online editing of your report, so if you need to add an addendum, etc its very easy. Also has the ability to make QA/QI a snap, making a more efficient EMS agency. You can also track and trend skills, and billing and collection rates quickly and easily for future tracking and auditing.

All of these points are important things to mention when creating a presentation for EPCR's. Hope this helps!


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## NomadicMedic (Jan 13, 2010)

upmm019 said:


> yes, but is it a software or hardware that does that or both?



It's the touchscreen that ToughBooks (and some other laptops) come with.

I second the Toughbook option, They are designed to take the abuse that comes from being hard mounted in a vehicle and they can take far more "bumps and bangs" than a traditional laptop.


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## upmm019 (Jan 14, 2010)

FLEMTP.. thanks for the informaiton.  That was really good.

Well, can you guys point out what brand/model tough books you guys use?

Also, how does this EPCR stuff work, is there a software site that I could see a demo on?

Since I live in Minnesota we already do electronic reporting after the fact. our paper reports get keyed into the MNStar Ambulance Reporting System.

Our hospital uses the DocZ program so if we could find a software that is integrated with one or both that would be great.

This link is to the PCR that we currently use...
http://www.emsrb.state.mn.us/docs/EMSRB_PCR_-_Elements_Required_-_Optional_April-2006-11.pdf


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## Scout (Jan 15, 2010)

Keep in mind other people make ruggidized laptops too, getac demoed their range to me and they have a serious offering + 5 YEAR WARRANTY


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## EMT (Jan 15, 2010)

resq330 said:


> Normally they will go 50/50 with us on a grant.  (As they're getting ready to do when we purchase our new $130k ambulance ).  They did this deal with the tough books because they were getting everyone in the state away from paper PCR's.  Now its will all be internet based.  So just about everyone agency in the state that requested them, got them. I'm not sure if it was funded from the Office of EMS or DHS.



We still are rocking old school with the paper PCR's. You guys must have a good amount of calls for them to fund that much?


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## FLEMTP (Jan 16, 2010)

upmm019 said:


> FLEMTP.. thanks for the informaiton.  That was really good.
> 
> Well, can you guys point out what brand/model tough books you guys use?
> 
> ...





You know, if you check out a JEMS buyers guide, they will usually have a list of EPCR vendors in there. The best thing to do is to contact them, tell them what you're looking for in an EPCR program, including which hospital software it needs to interface with, and they should be able to do most of the legwork for you, including creating a presentation for your administration, and tailoring a EPCR program to your needs... remember, you will be their customer, and they want your business!

I know zoll data systems has their own PCR program, and image trend is another, im sure physio-control has a program also, and Phillips. Seems like msot of the manufacturers of the cardiac monitors are getting into the business..

Oh, something else i thought of, with an EPCR program, you can attached your EKG data to your PCR, and actually review it in real time, and see exactly what the paramedic on the call saw, and what they did. its like watching a video almost, pretty neat stuff, the Dr's in the ER's here love it when we can bring them a code and play back the entire EKG from the time we powered up the monitor to the time it was shut off.

If you need any help or advice, feel free to send me a pvt message through here, im always willing to help, and I can always ask some of our Lieutenant's and Captains here for pointers and advice if there is something im not experienced or not sure of.


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## fire_911medic (Jan 16, 2010)

*Computers*

Toughbooks are definitely the way to go.  We had a mounting unit in the front that we could keep it on which displayed all the information very similar to what the troopers had in their cruisers.  Was excellent and had mapping software in it as well that we could put in information and would also give exact coordinates for LZ's.  Worked beautifully.  Also was nice being mounted.  We kept them turned off between runs, but then utilized them during the run for software and had the "docked" when mounted in the truck.  With your low run volume I think a similar idea would work well for you.  We could also connect with the hospital's printer and print our run sheets there with no problem and they had instant run sheets in a great format - no issues with hard to read handwriting.  Complete with drop down boxes and such that generated the narrative for you, and you could add things to it as needed.  Fantastic software - was unique to our dept, but there are several similar out there.  Good luck !


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## resq330 (Jan 19, 2010)

fire_911medic said:


> Toughbooks are definitely the way to go.  We had a mounting unit in the front that we could keep it on which displayed all the information very similar to what the troopers had in their cruisers.  Was excellent and had mapping software in it as well that we could put in information and would also give exact coordinates for LZ's.  Worked beautifully.  Also was nice being mounted.  We kept them turned off between runs, but then utilized them during the run for software and had the "docked" when mounted in the truck.  With your low run volume I think a similar idea would work well for you.  We could also connect with the hospital's printer and print our run sheets there with no problem and they had instant run sheets in a great format - no issues with hard to read handwriting.  Complete with drop down boxes and such that generated the narrative for you, and you could add things to it as needed.  Fantastic software - was unique to our dept, but there are several similar out there.  Good luck !





If I may ask a few questions about your laptop mount....


Is it a RAM Mounting System?  Or what?

How is the arm mounted? (Bolted under the seat?)

Does the arm allow less leg room for the passenger?

Does having the arm in there seem like a safety hazard if there was an accident?


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## fire_911medic (Jan 19, 2010)

resq330 said:


> If I may ask a few questions about your laptop mount....
> 
> 
> Is it a RAM Mounting System?  Or what?
> ...



What we have are the walk through ambulances - however, we have mounted two in the separate box/front style (though those trucks are no longer in operation for other reasons).  What we did was mount them in the center on a swivel style mount between the seats where the passenger could easily access information and did not interfere with leg room at all.  It took a bit of adjustment for the driver to get used to having it in the middle as sometimes an occasional elbow would hit it, but for the most part it was very easy to work around.  

I did go through one front end collision with one, and unless you have significant intrusion, I wouldn't expect too much of a problem other than the toughbook coming loose and become a projectile - but that is with anything clipboards, etc.  However, if you have that much intrusion you have bigger things to worry about than that !  We utilize the walk through ambulances partly for the reason that we can install a clipboard slot in the sides of the doors (and also we don't lose it that way !) and no throwing the clipboard from the front to back, whatever.  Just slip it in there - VERY convenient something I would suggest every service do.  Obviously if you have the split cab/box then it wouldn't work, but walkthroughs it's fantastic.  

That system has worked wonderfully for us.  It does take some getting used to having something in the center and it does interfere with the walkthrough feature of the ambulance - one downside to it.  Can still be done though, just have to have the flexibility of gumby !  However, overall I think the center mount works the best over other mounting systems.  I have also seen them attached to the top of the dash, but that interferes with line of sight while driving so it wasn't well received.  Typically we had the passenger activate the light system (or deactivate) rather than the driver with this mounting system and operate sirens (or we had horn based which was very useful).  There are a few downsides, but I think there's more up than down as it's been quite useful for everything that we've done !


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