To be a provider of medical care in an austere environment often means making ones tools and knowledge stretch the most. A very useful tool in this modern age of technology can be found in your pocket.

The author of this is Ken Young. Ken was a friend, coworker, and colleague who killed himself in November of 2017. He was posthumously awarded the Fellowship of the Academy of Wilderness Medicine.

I met Ken when he volunteered as a patient for a course I was instructing. Ken had been through the course previously and loved it so much he wanted to come back to support it as a patient. His enthusiasm for remote medicine was seemingly endless. He and I stayed in contact after the course and when he was leaving his position as a Vessel Medical Officer on the Kodiak Enterprise he recommended that I take his place. He and I chatted at length before I took the position and continued to chat while I was on the vessel. We had planned to work together in the future.

I have no idea what was going through his mind in the final moments he was alive, but I don’t believe those thoughts reflect who he truly was. Ken had a lengthy military career that brought him an immense amount of pride and went on to work as a remote medical provider in a variety of capacities. In the weeks before he died he deployed to Puerto Rico to provide aid. As with most suicides his death came as a shock to those around him.

My intention in reposting his writing is to help remember the Ken that I knew. The guy who was deeply passionate about many things including remote medicine.

If you are in crisis call the suicide prevention hotline at 1-800-273-8255. Alternatively, call a friend or call me at 315-484-8087.

If his estate now holds the copyright on these writings and wishes them to be removed I will do so.

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Originally published on LinkedIn

To be a provider of medical care in an austere environment often means making ones tools and knowledge stretch the most. A very useful tool in this modern age of technology can be found in your pocket. Almost everyone has a smart device today, an iPhone, iPad, or Android based pocket device. There are different ways these tools tie into medical care, including hardware specifically designed to aid in the diagnostic process or software applications that can aid the remote provider.

To be fair, in this article I’m sharing the majority of software applications and hardware components that I personally use on my iPhone and iPad. This is not to say that the Android market lacks these tools. Take it upon yourself to research what works for you, but you can use these suggestions as a guideline. Often hardware & software companies release their product on both iOS and Android markets.

Starting off with software, the amount of medical apps on the market seem endless. Yet, there are a few that I find very useful as a remote provider. Here is the top of my list:

Merck Pro. For decades the Merck Medical Manual has been the go to reference for medical providers around the world. Contained within its pages has been a wealth of information, and it’s now in an app for your smart device. It has Medical Topics, Clinical Calculators, even Procedural Videos. It works with or without internet access (But be sure to download the videos you want while you have network).

McGraw-Hill Medical’s Diagnosaurus®, from Unbound Medicine. When you need to consider all the possibilities. Whenever I pass a chart up to my telemedicine team I have to make sure I did all my homework on a patient first. That includes considering all possible differential diagnoses that a condition could be.

Lab Values from Hipposoft, LLC. Whether you’re lucky enough to have an iStat® with you, or are using urine dipsticks for your labs this app will remind you where the normal ranges of various test should be, and gives you a list of possible triggers or conditions for raised or lowered results.

DrOnDemand, a doctor in your pocket. Within minutes you can have a digital video medical consult with a physician. I would suggest already having a designated provider who knows your supplies available, and be ready to provide a patient evacuation plan if needed.

Bates’ Pocket Guide to Examination and History Taking, again from Unbound Medicine, get your assessment as complete as you can to streamline your telemedicine consult.

Finally a word must be said about the abundance of SOAP note apps found in the market today. Find one that works good for you. Personally I’m fond of the ones produced by NOLS and Solo. Regarding references, a great resource is Unbound Software. They have a myriad of useful reference material in app form to assist you.

Dropbox for Business. I must add a word about Dropbox. The business version of Dropbox is completely HIPAA and HITECH Act compliant. This is a great tool to store your medical reference material and even other data. Make sure you contact them to ensure that you are saying with the compliance standards. They will work with you.

The hardware applications range from basic health tools that will aid users in tracking their own personal biometrics to advanced EKG’s and digital microscopes that attach to the lens of your smart device to assist in lab work if your so trained.

Mobile EKG Heart Monitor, this mini single lead ECG that examines the rhythm by using a patient thumbs is a handy device to identify Afib, or it can be a useful tool for monitoring of patients with a known arrhythmia or for those experiencing symptoms of arrhythmia. Not as functional as a 3-4, or even 12 lead. If you want that function, then search out Cardio Card, a 10 lead EKG. 

Thinklabs One Digital Stethoscope, hands down my personal favorite tool. Every medic knows the importance of a stethoscope to the diagnostic process. This small puck is an outstanding standalone digital stethoscope that has the ability to connect to you smart device for recording and transmission to telemedicine providers for their review. With the connection to noise filtering headphones it isolates heart and lung sounds even in a moderately loud environment. Take it from me personally, its great if your examination bed is under a loud ship fan. This device is also ideal for patients in an isolated environment. Teams in Africa would leave the puck in a contaminated area with only the headphones needing to be thrown away after decontamination because they went through the isolation suit. 

iBGStar Glucose Meter, have a patient who’s a know diabetic, or who’s acting strangely and you need to rule out a glucose condition? This device attaches to you smart device and will act as a normal glucometer but stores data electronically and cn submit data to telemedicine and electronic health records.

BACtrack Mobile Smartphone Breathalyzer, need to differentiate between a patient under the influence of alcohol, and one suffering from a diabetic condition. This useful little tool will help.

Oto iPhone Otoscope, take digital ear exams and be able to save the images, transfer them to a patients record or to your telemedicine team.

The best is saved for last. The Clarius Ultrasound. Having handheld ultrasound in the field is no longer a dream. This rugged, secure, wireless ultrasound brings true imaging diagnostics within your reach. 

For a somewhat complete solution, VSee, a company that specializes in telemedicine has various kits available for purchase in addition to their service. One such kit they named “Home Care Kit” has a pulse oximeter, single lead EKG, otoscope, dermatoscope, and a blood pressure cuff that works with iPhones.

So as you can see, help with patient care is as close as in your pocket. Do your research and find out what works best for you. Thanks.

UPDATE 16FEB2017: (Photos to come) Since this post was published I’ve had time to work with and review a new piece of technology and it needs a word added here. I’ve started to use an Apple Watch, and am really impressed by it. There are tons of nursing sides that talk about it’s utility, but I wasn’t convinced. I received it as a gift and began using it, and must say I’m impressed. There are four main apps that I think are useful.

CodeCPR is a tracking app for tracking the events during your patient care. It allows you to rapidly select interventions and time a scenario. For example, your patient suffered cardiac arrest…. You begin the timer, knowing that drugs and shocks are timed two minutes apart. You can select your drugs with a finger swipe, then your shocks, and other interventions.

Crafty First Aid. This useful app creates an audio recording of a patient interaction that can be accessed later for charting purposes. Make sure you let you patient know they are being recorded though.

Drip Infusion. This application aids in the calculation of drip rates for IV therapy. Without a IV Pump, I’ve learned that the rate calculation and timing of drops will be easier with a flip of the wrist and a few button presses.

Medtimer. This program helps one assess respiration or pulse rate by tapping the screen of your Apple Watch. It’s benefits are obvious.

Medical Calculations, Mediquations and MedCalc are great reference apps to assist in patient care.

Finally the hardware. In the beginning the Apple Watch wasn’t as sturdy as the series 2 models. Now water resistant to 50m, one doesn’t have to fear it getting wet when washing your hands between patients. Also with a variety of watch bands available in the aftermarket arena one can adjust the style to meet the enviroment. For a hospital, a clean rubberized finish is perfect. Out in the remote enviroment one may need something more sturdy or useful, including paracord bands with integrated survival tools. Just switch out for the setting.

Alivecor has produced the Kardia Band, a medical quality ECG just like notes above. Not yet available in the US due to pending FDA approval, this looks to be of future interest.

The future is full of technological possibilities to aid in patient care.