Suggested by Jack Moore almost 2 years ago

We've spoken to a handfull of directors of Emergency Departments and EMS providers, who have told us that modern EMS providers face some key challenges:

1. They have complex procedures that they need to follow
2. Linked is an example of the North Carolina Standard EMS Protocol
3. State & federal EMS standards are simply recommendations. Ultimately, each county in the US is responsible for determining their EMS procedures. These procedures can, in some cases, vary wildly from other nearby counties
4. These procedures are complex, and EMPs (Emergency Medicine Providers) such as paramedics often have to search through them while on a case (ie in the back of an ambulance)
5. One example - most EMPs report being especially stressed in pediatric cases, as they represent about 5% of EMS cases but require an entirely different set of procedures to be followed
6. Many EMPs can only perform certain tasks, or administer certain medications, with the prior approval of a medical doctor. This requires calling in to an Emergency Department and talking a doctor.
7. The systems the EMPs have in their vans (ambulances) are usually not connected to hospital EHR (Electronic Health Record) systems, and so all information has to be recounted manually by the EMP.
8. Most modern ambulances have wifi hotspots that allow devices to connect to the internet, and some standalone devices do have the ability to transmit via email or fax (fax machines and pagers are still in widespread use in US hospitals)
9. These medical doctors are not always fully aware of the capabilities and resources of the EMPs they're talking to, so they oftentimes aren't aware of the full "menu" of options available to them with regards to medical interventions that can be deployed in the field
10. ex. many EMPs are able to perform cardioversion in the field, but many doctors don't know that. On the other hand, many providers are surprised to hear that EMPs in most states are not allowed to use Ultrasound as a diagnostic tool, a practice that is commonplace in most US Emergency Departments
11. EMPs have to document each encounter, using a standard called SAMPLE
12. Each county has its own rules with regards to when this documentation has to be completed - some say that is has to be done before the end of the shift, others within 24 hours of the encounter
13. Either way, documentation is an essential step, but every ED and EMS director we've spoken to has called out documentation as something that's limiting them to "turning over vans" (getting crews back out on their next case)
14. This can lead to EMPs working on documentation in a moving ambulance, or working on documentation for multiple cases at the end of the day or the end of a shift - a practice that has been studied to result in a higher rate of documentation errors and omissions due to our poor primate brains having poor, error-prone recall, particularly in stressful situations
15. These documentation errors can lead to misses in care downstream of a visit
16. EMS providers often have very limited budgets, as they're often funded by the taxpayer, and their budgets are controlled on a county-by-county basis
17. EMS providers can apply for state grants, but these are competitive and hard to get
18. States can also sometimes issue grants proactively to EMS companies, earmarking those funds for a particular purpose
19. Hospitals will also sometimes pay for technology that interfaces with EMS companies they work with, so long as that technology does something that's useful to the hospital (worth noting, since hospitals and health systems often have more budget than EMS companies do)
20. Selling to local governments and selling to hospitals/ health systems is HARD and Time consuming (for health systems & hospitals, sales cycle can easily be on the order of 9 - 18 months)
21. That said, EMS directors and ED directors we've spoken to seem enthusiastic about solving some of these problems, and the competitive landscape is not as inundated with incumbents as many other areas of healthcare are. That has lead to us seeing less buying fatigue amongst these decision-makers as we often see when discussing healthcare innovations in other areas (such as surgery, radiology, diagnostics, or inpatient)

It's worth noting - many of these same challenges are mirrored to some extent in battlefield medicine, and we've spoken to multiple military doctors who confirm this.

Referencing the SVPG "4 Big Risks" by Marty Cagan

Value: We hypothesize in this space see innovation happening around them, and feel underserved. Further conversations would help us feel more confident in this assertion.

Usability: Ambulances have started to see innovations and technology that make adoptions of new tech possible without being disruptive to their workflows

Feasibility: Generative AI has the potential to solve some of these problems in ways that have not been possible before

Business viability: Biggest risk. Potentially, popularity & "sexiness" of Generative AI might make spending on AI-driven solutions to some of these problems easier to sell.