By: PICUDoc, MD
Few words capture an EMS provider’s anxious anticipation entering a scene billed with a bad story. A number of apps, such as the Informed EMS Field Guide: Advanced Life Support by Informed Publishing, have emerged in the iTunes store aimed at assisting prehospital providers on difficult calls.
Can these electronic references sway medics’ attachment to the spiral bound flipbooks folks have shoved into cargo pockets and flightsuits for the past 50 years?
Overall, the app is well organized as a set of references and calculators. The reference subjects are divided into appropriate major sections, such as Airway and Poisons. These rapidly branch into subtopics such that information pages are no more than 2-3 clicks from the root menu.
Like the best pocket references, the app material is written pointedly or as bullets to quickly cue you into your training –but at the same time is deep enough that even seasoned medics may pick up pearls flipping the pages.
Focusing on the actual text, the scope of knowledge exceeds what you’d expect from an app. The ACLS section has example EKGs in the decision tree. The Medical Emergencies section has a dermatome map. The Trauma section touches on the neurological basis of decorticate posturing.
Sounds like too much information to navigate? Well, there is an internal search function and bookmarking feature. Now if only you could scribble notes in as you can with books—well actually, a note-taking feature lets you do that too. Appropriate for either prehospital or critical care transport, you might get the most from these references either en route to a scene or at the base when you have some downtime.
On the scene, the well thought out calculators may prove useful. The APGAR calculator has a clock that sounds at 1 and 5 minutes, if you can remember to start the timer of course. There is ample attention drawn to pediatrics, with multiple pediatric calculators allowing dosing calculations based not just on weight but weight estimates from age and length as well.
My only concern with the pediatric calculators is that the system defaults to age based estimation. If a weight is available from parents or bystanders, why not go with that first? There are other features that are more insightful; for example a pediatric endotracheal tube size calculator not only calculates appropriate ETT size, but also sizes for LMAs and nasogastric tubes as well.
That said, this app is not without some limitations. There are some forays into inpatient medicine, such as mention of placing a pulmonary artery catheter in the Acute Pulmonary Edema section, but the focus is of course on prehospital/interhospital management. Therefore the protocols are to the point and more focused on intervention than diagnosis. Arguably there is a little room for more editing, as the ventilator guidelines section does not discuss peak pressure settings and basic vent troubleshooting—this was a little surprising given the breadth of other topics discussed.
Who is this for?
– Prehospital providers, particularly EMTs with advanced training and prehospital medical command
– Transport healthcare providers such as transport paramedics, flight nurses, respiratory therapists, and transport physicians
– Experienced users who have some formal training in EMS
– Well thought out app with comprehensive array of tools and information
– Takes advantage of the smartphone platform with intelligent features, like a button to dial poison control.
– High resolution graphics
– As with all handbooks, could benefit from further refinement of reference material
– Pediatric calculators default to age based estimation.
As a whole the EMS Field Guide is an excellent application and well worth the $9.99 pricetag
PICUDoc is a Pediatric Intensivist with experience as an EMT and Transport Physician. He remains involved in interhospital transport in Pennsylvania.