Over the past two years or so, this column has focused on a variety of technologies that are secondary or tertiary to the application of health services to patients. Some of the technologies, in both concept and reality, have gone by the wayside with the collapsing of the Internet bubble. Others have gained acceptance into the stream of healthcare and the business that surrounds it. But nothing I've written about to date has had so much potential for directly impacting the saving of lives as to what is covered in this month's column.

Consider this: According to the Pre-hospital Trauma Life Support, 4th edition, which was released in 1999, 50 percent of all casualties die within the first hour, the Golden Hour, of experiencing trauma. That seems to be a rather shocking percentage when we consider how far the art and science of medicine has advanced in the past decades, and yet, when one considers the technology and resources required to stabilize a trauma patient, perhaps this percentage isn't so high.

Consider the equipment in an ICU: defibrillator, ventilator, monitor, suction, infuser, blood chemistry analyzer, oxygen and the platform. That's an awful lot of equipment to haul over to a trauma site. As most of this equipment isn't very mobile, one would think that a portable ICU isn't a reality. And those that think this would be wrong.

Some of you may have served time in the mountains of Korea, the jungles or paddies of Vietnam, the deserts of Iraq, or other far flung lands where battlefield trauma treatment consisted of little more than staunching the blood flow, injecting morphine and being transported as fast as possible back to the field hospital behind the lines. "While battlefield mortality rates have dropped significantly since the Second World War, due to improved methods of casualty transport, transport time remains the critical component in surviving battlefield trauma," said war historian Ernest Lissabet. In all cases of battlefield trauma, the sands of time fall quickly away and the precious minutes that comprise the Golden Hour diminish.

Imagine this scenario if you will. A battlefield injury occurs and a call for a medic cries out. Within minutes a jeep races over and the soldier placed on a 5-inch thick, 8-foot long platform. Three-channel fluid/drug IVs and oxygen are administered, monitor leads connected and the jeep takes off. If the vehicle has equipment capable of communications, the LSTAT can generate and transmit data to the field hospital, all the while taking into account equipment temperatures, humidity, and barometric pressure, as well as tilt and acceleration. These environmental parameters help caregivers correlate patient health and status with transport events. The field hospitalist can issue orders to the transport medic based on the live data feed. When the patient arrives at the hospital, the platform can be placed on a cart or carried into the ICU and treatment goes on from there, using the platform as a base.

Replace the battlefield scenario with a car accident, earthquake, building fire or any other traumatic event. A fleet of ambulances is deployed, each equipped with the lifesaving platform: mobile ICU units racing around the landscape, reducing the time to ICU treatment by tens of minutes and increasing the odds of survival. Patients arrive in the ER with a staff fully aware of the vitals and trends, the electronic medical record already created and treatment having already begun. And the in-hospital applications are just as compelling: continuous patient care during inter- and intra-hospital transports, and flexibly expanding the size of the ER, OR or ICU. Sounds nifty and almost futuristic, right? Well, the good news is, it isn't. We have this technology available now.

Drop back a decade to the early 1990's. The maker of Stealth aircraft and other complex, integrated systems, Northrop Grumman, began looking for new ways to deploy their technology and systems integration skills. They formed an initiative to seek out intrapreneurs who could re-purpose their knowledge and form new business units. One of the units began work on a mobile trauma pod and in 1994 receives funding from DARPA (Defense Advanced Research Projects Agency), thus giving birth to the Northrop Biomedical Group. The first prototype of the Life Support for Trauma and Transport (LSTAT) was created shortly thereafter and by 1998, the production unit was developed, tested and cleared by the FDA. In 1999, the group was spun off into Integrated Medical Systems, Inc (IMS) and by the end of 1999, the US Army placed orders for four units. IMS has since booked additional LSTAT sales with the U.S. Army, as well as in Asia and the Middle East, and having recently received CE Mark, is leveraging long-standing relationships in the EU to accelerate sales in that region of the world.

Since that time IMS, located in Signal Hill, California, has generated over $3 million in sales and currently has a backlog of another $6 million. Needless to say, the units are selling like hotcakes and the reasons are many:

- Trauma is the number one cause of death and disability in the first half of life. Every year in the US alone:
--o 100,000 people die
--o 450,000 are permanently disabled
--o 11,000,000 are temporarily disabled
--o $100b is spent for management of trauma patients
--o Trauma centers and ICUs are costly to build, staff, maintain and are immobile. Facilities can
--- deploy five LSTATs for the cost of one new ICU station
--o Today's lower reimbursements makes the cost, labor and space efficient LSTAT more
--- economically feasible for facilities of all sizes

Truth be told, the concept of mobile ICU pods isn't new, and other firms, such as Georgia-based Ferno Aviation, have had similar systems in use for several years now. For example, Ferno's Model 5 unit contains some equipment similar to that of LSTAT (but without LSTAT's integrated data gathering, storage and transmission capability). However, the similarities end there. The Model 5 can be considered a "cabinet" or "rack and stack" approach that has a stretcher on top with racks below that house equipment. The LSTAT is a single, integrated and miniaturized system. Depending on equipment options, the Model 5 weighs in around 225 pounds whereas the LSTAT is a trim 162, which meets the Army's 4-person carry limit. Additionally such "cabinet" style products, whose devices are susceptible to physical, audible, and electromagnetic interference, are generally only approved for aviation use because the FDA patient safety and effectiveness concerns give way to the FAA's flight safety for air-based care units.

"LSTAT is approved for ground and air use and is the most electromagnetically silent suite available," says Dr. Matthew Hanson, IMS' vice president of business development. Of course, this should come as no surprise given IMS' access to the Stealth technology. Finally, from a physical size standpoint, you could practically stack 5 LSTATs on top of each other and just reach the height of the Model 5.

These differences should not be construed to mean that the Model 5 is an inferior system: in fact, it has widespread use around the globe and in Japan, the Model 5 has become the standard for Fire Fighting and Disaster Response (FFDR) for 15 prefectures. With a history spanning over 45 years, Ferno has grown into manufacturing high quality medical products and delivering them to countries around the world.

IMS, on the other hand, has a strong foundation in technology and innovation and by the sheer strength of its incubator, Northrop Grumman, it comes as no surprise that it has developed the most sophisticated, flexible and cost-effective mobile ICU currently available.

The LSTAT represents a fantastic breakthrough in trauma treatment. Backed by a development, medical and management team that reads like a Who's Who in technological innovation and trauma care, Integrated Medical Systems has developed a system that saves space, money, time and lives. For more information on IMS and the LSTAT, please visit www.lstat.com. For more information on Ferno and the Model 5, please visit www.ferno.com. And, as always, I have no fiscal or fiduciary relationships with either company mentioned in this column.

Quick Anti-Virus Advice
By now many of you have heard of, or been infected by, the Nimda virus. Unlike the Love Bug and Melissa viruses, which spread themselves by having users double click on a file attachment, this one is particularly savage as you can be infected by web sites that use Microsoft's IIS server platform. If you visit a compromised Web server, you will be prompted to download an .eml (Outlook Express) email file, which contains the worm as an attachment. You can disable "File Download" in your Internet Explorer's Internet Security zones to prevent this compromise. Equally savage is Nimda's ability to auto-execute itself (i.e. infect your system without you doing a thing) when you receive it via email. If you're using Microsoft Outlook or Outlook Express, please obtain information regarding this security hole at http://www.microsoft.com/technet/security/bulletin/MS01-020.asp.

I cannot strongly urge you enough to update your anti-virus software. In fact, if you're a regular user of email and the Web, consider updating your software daily right after you connect to the net, each and every day. If you use Zone Alarm Pro or another firewall, make sure it is set to not allow your email program to access the Internet without your explicit approval. It takes less than one minute to update your system and can save you much frustration and anguish…unless you're like my mother, who's response to potentially getting a virus is, "So what? I'll throw the computer away and buy a new one!"