Abstract:
A system is disclosed for tracking patients. Such systems are especially useful in the emergency or military setting or in the case of a national emergency. In such cases, the patient may be transported far from home or from the site of the injury in order to receive treatment. The system has application, as well however, for patient tracking within normal hospital systems. The system utilizes a passive, unique coding system for each patient. A coded device is associated with each patient in such a way that the coded device cannot be removed or disassociated from the patient without a concerted effort. A reader and encoder is used at the time of application of the coded device, to the patient, to enter pertinent information about the patient into a national database. Such information may be used or augmented as required during the medical care of the patient and return of the patient to normal life. Information gained from the device is also used to assist in prioritizing the patient regarding the order of triage relative to other patients. The reader and encoder communicate with a centralized database to enter information regarding the patient as well as the location of the patient.

Description:
[0001]    This application claims priority benefit under 35 USC § 119(e) from U.S. Provisional Application No. 60/354,430 filed Feb. 4, 2002, entitled “METHOD AND APPARATUS FOR EMERGENCY PATIENT TRACKING” which is herein incorporated by reference. 
     
    
     
       FIELD OF THE INVENTION  
         [0002]    The field of this invention is emergency and trauma medicine.  
         BACKGROUND OF THE INVENTION  
         [0003]    During a time of national emergency or a state of war, large populations may be subject to injury. Since medical facilities in the affected area may be damaged or under-resourced, patients may need to be moved substantial distances in order to accommodate the medical needs of these large populations.  
           [0004]    Current medical transponders are designed to track implants in humans or to track ruminating animals. Typical examples of the prior art in medial transponders include U.S. Pat. No. 4,160,971 to Jones et al., U.S. Pat. No. 5,300,120 to Knapp et al., U.S. Pat. No. 5,652,570 to Lepkofker, U.S. Pat. No. 5,674,288 to Knapp et al., U.S. Pat. No. 5,716,407 to Knapp et al., 5,725,578 to Knapp et al., U.S. Pat. No. 5,732,401 to Conway, 5,855,609 to Knapp, U.S. Pat. No. 5,977,431 to Knapp et al. and U.S. Pat. No. 6,012,415 to Linseth. These patents, all of which are included herein by reference, disclose medical transponders used in a variety of ways, either attached to implants, worn on the wrist, swallowed, or implanted separately from implants. These devices all serve the purpose of tracking patients (animals as in the case of U.S. Pat. No. 6,012,415) or the medical devices with which they are implanted. While transponders are well known in the art, the utility of these transponders for patient tracking in an emergency-situation has not been addressed.  
           [0005]    New devices, systems and methods are needed to track patients, who are being treated at centers that may be remote from their home. Such devices are particularly important in an emergency setting or trauma setting, such as could occur during a national emergency or during military action.  
         SUMMARY OF THE INVENTION  
         [0006]    The system and method described below relate to a medical transponders and systems for tracking patients. The system uses a passive device that allows for patient identification and tracking when used in conjunction with a smart reader.  
           [0007]    During a state of national emergency, hospitals may be elevated to a state of war. A network of hospitals may be enabled to care for the victims because of the immense number of victims, or the hospitals in the vicinity of the disaster may be dysfunctional or nonexistent. Patients may be transported far from their homes to obtain medical treatment within the hospital network. For this reason, patient identification is important to ensure maximum quality of care and to ensure that the patient is routed through the system properly and properly identified throughout the system (or their remains are returned to their families).  
           [0008]    The invention involves use of a passive, unique identification that is associated with the patient. Such identification will contain a unique code, including bar codes, Arabic numerals and the like. The identifying marks are placed on the patient in an area that is not damaged and in an area that is easily reached and obvious to the medical personnel. The identifying mark would, by protocol, be preferentially placed on the head or neck of the patient. Should that area not be available, the mark would be placed at a location of secondary priority, such as the torso, shoulder, arm, or leg. Tertiary locations can also be identified and prioritized by protocol. The code is imprinted in a wrist band, leg band or other medical jewelry that is attached securely to the patient. By using passive identification, the system will not fail should batteries or capacitors become depleted of power. Therefore, the patient is always associated with a unique code.  
           [0009]    Additional apparatus suitable for identifying the patient includes RF ID transponders that are attached to the patients wrist, neck, leg or to their ear via an earring. The transponder could also be placed subcutaneously using an injector. Again, according to protocol, the transponder would be placed at locations of descending priority, depending on the medical state of the patient. Typical locations for a transponder are in the abdominal, shoulder or thoracic area.  
           [0010]    The information encoded by the system would minimally include a unique identifying number. This number is associated with that patient only and is the key to a larger database of information about the patient. Additional information could also be added to the transponder, tattoo or jewelry.  
           [0011]    The person applying the coded transponder, mark or jewelry, hereinafter called the coded device, would receive the number from a centralized database that assigns such numbers so that duplicates would be avoided.  
           [0012]    The information flow between the medical provider and the centralized database is facilitated by satellite uplink, cellular telephone system or other wireless communication system.  
           [0013]    At the time the coded device is applied to the patient, certain data will be collected by the medical provider using a data encoding system. This data encoding system will include a timepiece to automatically record time and a GPS system to record exact location of pickup as well as a pre-assigned code for the medical team performing the initial triage and coded device application. A data input system will be provided to allow for input of vital medical data including patient temperature, ECG, and blood data. Additionally, a dictated statement regarding the patient&#39;s condition, circumstances of the patient, triage status and known and/or suspected injuries. This information will be sent to the centralized database and be associated with the patient.  
           [0014]    In accordance with another aspect of the invention, a method is described to provide patient triage and management in a state of emergency. This method includes the steps of applying a coded device, with a unique code, to a patient, associating certain patient, geographic and time data with the unique code, and transmitting this information to a centralized database for future use in treating the patient.  
           [0015]    In yet another embodiment of the invention, the patient status is ascertained using an ultrasonic instrument to determine and diagnose such things as, but not limited to, the status of such things as heart rate, blood pressure, ejection fraction, respiratory rate, quality of the breathing, respiratory volumes, and the presence or absence of a pneumothorax or tension pneumothorax. The device also provides a painful stimulus, preferably non-penetrating or non-invasive, to the patient, to determine cognitive status and/or the ability of the patient to localize the painful stimulus. Using this information, the device of this embodiment of the invention, evaluates the patient status and provides a numerical score regarding triage status that can be used to prioritize treatment of the patient relative to other patients who have sustained injuries. The triage status is based on-cognitive status, cardiovascular status, pulmonary status, and/or a combination thereof. The patient triage score is preferably based on consideration to those who have the highest probability of survival post-treatment, in a mass-casualty situation. This triage status and priority, as well as the data supporting the status and priority, are optionally transmitted to the centralized database. Phase-shifted calculations are used to look at probable mortality of the patients. Using this system, the mid-level casualties are the first to be moved, rather than the most-severely injured, because the most severely injured people will most likely die.  
           [0016]    The present invention distinguishes over the cited prior art because it requires a uniquely coded device to be attached to the patient and it uses a specialized data encoding system to provide medical data to a centralized database, associated with the embedded code in the coded device on the patient. The invention is most useful during civil emergencies or military situations, when large numbers of patients require treatment, often at remote sites, and patient identification may be lost.  
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0017]    [0017]FIG. 1A illustrates a diagram of the coded device using a bracelet, according to aspects of an embodiment of the invention.  
         [0018]    [0018]FIG. 1B illustrates a diagram of the coded device using an implanted transponder, according to aspects of an embodiment of the invention.  
         [0019]    [0019]FIG. 1C illustrates a diagram of the coded device using a tattoo placed on the patient, according to aspects of an embodiment of the invention.  
         [0020]    [0020]FIG. 2 illustrates a block diagram of the data encoding system, according to aspects of an embodiment of the invention.  
         [0021]    [0021]FIG. 3 illustrates a block diagram of the centralized database system, according to aspects of an embodiment of the invention. 
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0022]    [0022]FIG. 1A illustrates a diagram of a coded device  10  of the present invention. The coded device  10  comprises a bracelet  12  and an identifying system  14 . The bracelet  12  further comprises a locking mechanism  16 , an adjusting mechanism  18 , and a bracelet band  24  further comprising ends  20  and  22  (not shown). The identifying system  14  further comprises a code  26  (not shown).  
         [0023]    Referring to FIG. 1A, the bracelet  12  is a linear, bendable band  24  with ends  20  and  22 . The adjusting mechanism  18  is integral to or affixed to the band  24 , as is the locking mechanism  16 . The identifying system  14  is affixed to the band  24 .  
         [0024]    Referring to FIG. 1A, the locking mechanism  16  prevents the device to be removed from the patient, except by deliberate intent. In the preferred embodiment, the locking mechanism  16  is permanent, once locked and the bracelet band  24  must be cut to remove the bracelet  12  from the patient. The bracelet  12  is adjustable by way of an adjusting mechanism  18  that permits the two ends  20  and  22  of the bracelet band  24  to slide longitudinally with respect to each other. Once the correct size has been determined, the one-way locking mechanism  16  is engaged and prevents the bracelet  12  from being removed from the patient&#39;s wrist. The bracelet  12  is fabricated from polymers such as polypropylene, polyethylene, polyvinyl chloride and the like. The bracelet  12  is preferably sized to be placed on the wrist of a patient. Preferably, the bracelet  12  would be of variable size so as to fit a wide range of patient wrist circumferences.  
         [0025]    The identifying system  14  is affixed to the band  24  using adhesives, injection molding, vapor deposition, inkjet printing, lithography or other technology well known in the fabrication art. Preferably, the identifying system  14  comprises the pre-determined unique code  26  that is permanently related to the band  24  of the bracelet  12 . By permanently relating the bracelet  12  to the patient, the patient now retains the unique, pre-assigned identifying number.  
         [0026]    The identifying system  14  utilizes a passive method of identification so that power is not required in order to allow for reading of the code  26 . Typical identifying systems  14  for carrying the code  26  include RF ID transponders of the type used in cars to provide toll road billing information. Such RF ID transponders typically comprise a transponder chip that holds the code  26  and a metal coil that acts as an antenna for the RF input and output and power generation. Other identifying systems  14  include numerical printed codes. Optical character recognition (OCR) readers could easily read these codes. Other code systems include bar coding used on much of the packaging of products today. Bar code readers are readily seen in places like supermarkets and other store check-out lines. These marks would be placed on the bracelet  12  using indelible ink and lithography, inkjet printing, laserjet printing and the like. A transparent or semi-transparent coating or protective layer is optionally placed over the printed code  26  to further prevent it from becoming damaged or suffer from reduced legibility. Such a coating is fabricated from polyurethane, lacquer, or other transparent polymer. The coating may also be fabricated from silica substances such as glass.  
         [0027]    The bracelet  12  represents one form of jewelry that comprises the coded device. In another embodiment, the jewelry is a necklace that is worn around the neck and comprises all the same components as the bracelet except that it is fitted to the neck of the patient. In another embodiment, the bracelet  12  is sized to fit the leg of the patient rather than the wrist. In another embodiment, the jewelry is an earring that is affixed through a hole surgically created in the ear of a patient.  
         [0028]    [0028]FIG. 1B illustrates another embodiment of the coded device  10  using a transponder  50  implanted in the patient. The transponder  50  comprises the code  26  (not shown). The transponder  50  is a passive transponder shaped so as to be implantable. Preferred shapes include cylinders and thin, flat rectangular solids. The cylindrical transponder  50  may be loaded into an injector (similar to a hypodermic needle and syringe) that is used to create a fenestration through the patient&#39;s skin into the subcutaneous area. The transponder is then advanced through the fenestration in the skin and the injector is removed so that the transponder  50  is able to heal in place under the skin. The transponder  50  and the injector are sterile and are supplied in a sterile package so that infection is avoided. In order to further clarify the position of the transponder  50 , a visible mark  54  is left on the patient&#39;s skin in the region of the transponder  50  so said transponder  50  can easily be located. Such a visible mark is created using the technology used for tattooing.  
         [0029]    Though not preferred, the mark  100  may optionally placed into the skin using tattoo technology by injection into the skin or jewelry. Such tattooing technology provides permanent skin marking, and may be beneficial and necessary if the transponder embodiments are unworkable for any reason. FIG. 1C illustrates this embodiment of the coded device  10  wherein the coded device  10  is a mark  100  that is optically or magnetically readable and is affixed directly to the skin of the patient. The mark  100  is a plurality of alphanumeric, bar or geometric figures that comprise the code  26 . In this figure, the code  26  can be visualized because it is a bar code. The mark  100  is of a color that contrasts with the skin or a surrounding background color placed adjacent to said mark  100 . Indelible inks such as those with carbon solvent bases such as alcohol are used for indelible inks. Typical colors for the mark  100  include black, green, blue or colors that only reflect under specialized lighting such as ultraviolet or infrared, so that the mark is not disfiguring or embarrassing or otherwise socially undesirable to the patient.  
         [0030]    [0030]FIG. 2 illustrates a schematic of the data encoding system  150 . The data encoding system comprises a coded device writer  152 , a coded device reader  154 , a global positioning system  156 , a clock  158 , a computer  160 , digital memory storage  162 , a data acquisition system  164 , a communication transmitter  166 , a communication receiver  168 , an optional set of data sensors  170 , a voice input system  172 , a power supply  174 , a case  176 , an alphanumeric keyboard  178 , a video display  180 , a plurality of input connectors  182 , a plurality of controls  184  and an optional protective panel  186 . The voice input system  172  further comprises a microphone  188 . The data acquisition system  164  further comprises optional sensors  170  for detecting and reading parameters such as patient temperature, electrocardiogram, blood pressure and the like. Such sensors  170  are well known in the art. The data encoding system further comprises a unique identifier  192  that distinguishes one data encoding system from another.  
         [0031]    Referring to FIG. 2, the data encoding system  150  is self-contained within its case  176 . The coded device writer  152 , the coded device reader  154 , the global positioning unit  156 , the clock  158 , the computer  160 , the digital memory storage  162 , the data acquisition system  164 , the communication transmitter  166 , the communication receiver  168 , the data sensors  170 , the power supply  174 , the keyboard  178  and the video display  180  are all affixed to the case  176 . The video display  180 , a keyboard  178 , a plurality of input connectors  182 , and the plurality of controls  184  are affixed to the case so that they are accessible by the user. The case  150  comprises an optional protective panel  182  that hinges and covers the video display  180 , the keyboard  178 , the input connectors  182  and the controls  184 . Preferably, either the video display  180  or the keyboard  178  is located on the interior surface of the protective panel  182  so as to minimize the size of the device case  176 . The microphone  188  and the sensors  170  are external to the case and are electrically connected to the case through the input connectors  182 . The unique identifier  192  is maintained in the computer  160 . The unique identifier  192  is maintained in a permanent memory such as a read only memory (ROM) or electrically programmable read only memory (EPROM) that is part of the computer  160 .  
         [0032]    The voice input system  172  allows for entry of critical information on the patient. (This information may also be entered using keyboards or touch screens or other input mechanisms.) This critical information includes, but is not limited to, a description of known or suspected injuries, contamination status, triage status, situation surrounding the incident, proposed treatment plan and proposed patient disposition. The computer  160  stores, in digital memory storage  162 , the information entered through the voice input system  172  in the form of a standard digital recording in formats such as .wav or .mpg. The voice input system  172  and computer  160  optionally comprise a voice recognition system that digitizes the analog voice recording into alphanumeric text and stores said alphanumeric information in the digital memory storage  162 . Various triage parameters such as heart rate, cardiac filling, breathing rate, end-tidal volume may be detected (at least roughly) using ultrasound, and other triage parameters such as EKG, EEG, and gastric rhythm may be measured with appropriate electrodes and analyzers, and these parameters may be entered into the device.  
         [0033]    Referring to FIG. 2, the data encoding system  150  sends a request to the centralized database  200  for the next assignable code  26 . The request includes the unique identifier  192  for the data encoding system  150  and is sent to the centralized database by the communication transmitter  166 . The data encoding system  150  receives the next assignable code  26  through the communication receiver  168  from the centralized database  200 . The coded device writer  152  applies the code to the coded device  10 . The coded device reader  154  next reads the coded device  10  and records the code  26  in digital memory storage  162 . Patient information is gathered through the keyboard  178  by the attending medical personnel. Additional patient information is obtained from the clock  158  and the Global Positioning System  156  as well as a microphone  188  electrically connected to the voice input system  172  through input connectors  182  and information from all three sources is stored by the computer  160  in the digital memory storage  162 . Additional information is received through the data acquisition system  164  by its plurality of sensors  170  and this information is stored in the digital memory storage  162  by the computer  160 .  
         [0034]    Referring to FIG. 2, the information stored in digital memory storage  162  is transmitted to the central database by the communication transmitter  166 . The communication transmitter  166  operates over typical protocols including, but not limited to, CDMA, TDMA, PCI, cell phone or satellite communication protocols. The communication receiver  168  receives information already stored in the central database, relating to the code  26  that was obtained by the coded device reader  154 .  
         [0035]    [0035]FIG. 3 illustrates a schematic diagram of the centralized database  200 . The centralized database  200  comprises a plurality of computers  202 , a plurality of storage devices  204 , a plurality of backup devices  220 , a communication transmitter  206 , a communication receiver  208 , a communication interface  218 , software  210  (not shown) to run the database  200 , a power source  212 , a plurality of uninterruptible power supplies  214 , and data  216  (not shown).  
         [0036]    Referring to FIGS. 2 and 3, the centralized database  200  maintains a list of the already assigned codes  26  (not shown) and maintains the protocol for assigning new codes  26 . When a request comes in over the communication receiver  208 , and is passed on through the communications interface  218 , the next assignable code  26  is generated by the computers  202  based on the data  216  (not shown) already maintained in the storage devices  204 . The assignable code  26  is related to the unique identifier  192  of the data encoding system  150 , then stored in the storage devices  204 , and then processed through the communications interface  218  and transmitted over the communications transmitter  206  to the communication receiver  168  of the data encoding system  150 . Future data relayed to the centralized database  200  will include the unique identifier  192  and the code  26  so that the patient can be tracked and information collection related to the team performing the service through their unique identifier  192 . All such future data relayed to the central database is maintained in association with the code  26 .  
         [0037]    The overall operation of the system will include cooperation amongst many health care providers, all of whom can access the central database and query the transponder or identifying device or mark, and obtain triage information and patient history from the database or transponder. Additionally, at each encounter with a health care provider, patient condition can be assessed and entered into the database, so that population-wide development of a disease, exposure or catastrophic event, to use in epidemiological analysis of the population. Thus, changing symptoms of the patients at each encounter can be tracked and used to determine disease vectors, contamination sources, and the expected spread and future development of the condition. Thus, a vector or origin of contaminants or injury to a patient can be determined upon later encounters with health care providers.  
         [0038]    The present invention may be embodied in other specific forms without departing from its spirit or essential characteristics. The described embodiments are to be considered in all respects only as illustrative and not restrictive. The scope of the invention is therefore indicated by the appended claims rather than the foregoing description. All changes that come within the meaning and range of equivalency of the claims are to be embraced within their scope.