Building a National Emergency Medical Platform: Insights from Professor Lü Chuanzhu

Authors: Shen Yuting, Shi Yi

2022, isProfessor Lü ChuanzhuAdherence"Construction of a Large-Scale Emergency and Critical Care Platform under the Integration of Medicine and Engineering"the sixth year.

Since 2017, emergency medicine in China has entered the Era 3.0. In October of the same year, Professor Lv Chuanzhu, the academic leader of the National Key Clinical Specialty Construction Program (Emergency Medicine), undertook a mandatory task assigned by the National Health Commission of China to comprehensively advance the development of a large-scale integrated emergency and critical care platform.

Over the past six years, Professor Lv Chuanzhu has witnessed the rise of China’s Emergency Medicine 3.0 era, during which he has accomplished much and encountered numerous challenges.

Looking back, this already marks Professor Lv Chuanzhu’s 30th year in the emergency medical industry.

During his studies at China Medical University, a teacher’s self-posed question and answer deeply moved him. Within the confined space of the emergency department, the full spectrum of human life unfolds; birth, aging, sickness, and death play out daily. Perhaps only by experiencing the suffering of disease and the parting caused by life and death can one truly understand the meaning of studying medicine. Therefore, the teacher advised students to spend their spare time learning in the emergency department.

Professor Lü Chuanzhu took his teacher’s words to heart during his student days, and heFrequently visiting the emergency department to “observe” under the guidance of attending physicians, It was precisely during those days of shadowing that he gained a deeper understanding of emergency medicine.

In 1988, Professor Lü Chuanzhu rode the wave of the “100,000 Talents to Hainan” initiative and moved to Hainan. Shortly after joining Hainan Provincial People’s Hospital, he was assigned to work in the emergency department, which was not yet formally recognized as a “department.” There, he witnessed a series of dire conditions, including an ad hoc medical and nursing team, rudimentary facilities, and outdated equipment. Finally, in 1995, with the hospital’s support, Professor Lü Chuanzhu establishedEmergency Department with Internal Medicine and Surgery Services, personally serving as the Director of the Emergency Department.

“I was likely the first to change my specialty from attending physician in urology to attending physician in emergency surgery,” Professor Lv Chuanzhu wrote in his autobiography.

However, establishing an emergency department was far from sufficient. In 1995, Professor Lv Chuanzhu launched the “Haikou 120” emergency hotline and established Hainan’s first 120 Emergency Medical Services (EMS) Center. For the subsequent 14 years, he consistentlyConcurrently serves as the Director of the Haikou 120 Emergency Medical Center.

It was precisely this experience that enabled Professor Lv Chuanzhu to see more of the real-world challenges facing pre-hospital emergency care.

First, the development of pre-hospital emergency care in China is highly uneven, characterized by four “gaps”: between rural and urban areas, between central cities and third- and fourth-tier cities, in operational models, and in professional standards across different regions. Second, the operational mechanisms, facilities, practices, and standards of pre-hospital emergency care are not sufficiently standardized and require further regulation and improvement. Third, the pre-hospital emergency workforce remains unstable, facing challenges such as a shortage of professionals, lack of specialized academic training programs, limited recruitment sources, absence of a dedicated professional title promotion system, difficulties in recruitment, and high staff turnover. Fourth, there are shortcomings such as insufficient public awareness and social普及 of pre-hospital emergency care.

In order to save more lives, in 2017, Lü Chuanzhu, together with Professor Yu Xuezhong and Professor Chen Yuguo, jointly proposed to the Bureau of Medical Administration and Hospital Management of the National Health Commission of China that the construction of a large-scale platform integrating emergency departments and pre-hospital emergency care be strengthened. The proposal was approved in the same year.

Over the following six years, Professor Lv Chuanzhu spared no effort in building a national emergency and critical care platform and devoted substantial time to promoting it.

The trumpet of the global digital era has already sounded, with the healthcare industry at the forefront of digitalization. The large-scale emergency and critical care platform spearheaded by Professor Lv Chuanzhu stands as a prime example.

Emergency Care Mega-PlatformLeveraging the “Internet Plus” framework, integrate pre-hospital and in-hospital emergency care through big data, informatization, and blockchain technologies.. Based on the “timeline,” it can be roughly divided into five parts: calling emergency services, remote guidance for first aid, arrival of the ambulance at the scene and initiation of treatment, continuation of emergency care on the ambulance, and hospital-based treatment upon arrival.

From the very moment the hospital receives the distress call from the patient and their family, the emergency care platform is activated. All patient information, including personal details and symptoms, is directly uploaded to the hospital’s information-sharing platform and simultaneously recorded in the patient’s electronic medical record.In-hospital physicians can promptly access patients' complete information., enabling ultra-early trigger warning alerts so that effective emergency measures can be implemented immediately upon the patient's arrival at the hospital.

Meanwhile, dispatchers who receive emergency calls maintain communication with the “first responders” and guide them through first-aid measures via voice or video instructions. This ensures that the patient’s optimal treatment window is not compromised by special circumstances such as traffic delays, thereby facilitating community-based emergency response.

As is well known, timely medical intervention is crucial in emergencies. Statistics show that over one million people in China die from accidents each year, with approximately 70% of these deaths attributable to missing the optimal window for emergency care. Therefore, by establishing a comprehensive emergency care platform, professional physicians can leverage a wider range of approaches,Transforming the first on-scene witness directly into a “first medical responder””, seize the golden hour for emergency care, and offer more patients a chance at survival.

In addition, the large-scale emergency care platform will also leverage big data to dispatch the ambulance that can reach the patient most quickly to the scene. Once the ambulance arrives, the site of care is transferred to the ambulance itself.

With the comprehensive deployment of 5G networks, ambulances are no longer merely tools for patient transport. Onboard 5G-enabled ambulances, a range of physiological data—including patients’ medical history, electrocardiogram (ECG) readings, and blood pressure measurements—are transmitted in real time to hospital-based physicians’ computers. This enables in-hospital doctors to collaborate immediately with paramedics or physicians on-site to diagnose the patient and provide treatment recommendations.Directly transforming ambulances into “mobile ICUs.”

Once the comprehensive emergency care platform achieves widespread adoption, many diagnostic and emergency interventions that previously required in-hospital settings can be shifted to the pre-hospital phase. Meanwhile, this expansion broadens the reach of high-quality medical resources, accelerating the sharing and improvement of healthcare conditions across urban and rural areas, thereby enabling patients in rural regions and even remote mountainous areas to access premium medical services during emergency care.

Of course, the role of the large-scale emergency care platform is not limited to pre-hospital care. As Professor Lv Chuanzhu stated, “The large-scale emergency care platform adopts a horizontal and vertical treatment model.”

“The vertical axis” spans from the moment a patient makes a phone call to their entry into the hospital’s information system, while “the horizontal axis” focuses on compressing the time spent navigating internal hospital processes.

After patients are transferred to the hospital via ambulance, they typically must navigate a series of cumbersome and complex procedures, including registration, emergency triage, and laboratory testing. In large hospitals, different administrative steps often need to be completed on different floors or even in separate buildings, leaving patients and their families exhausted and delaying medical consultation.

The large-scale emergency care platform necessitates a reconfiguration of hospital layouts by centralizing relevant facilities, enabling patient treatment within a single integrated platform. By leveraging blockchain and big data technologies to streamline workflows on a unified digital system, the time from admission to entry into the operating room for trauma patients is reduced to under 60 minutes.

At this point, Professor Lv Chuanzhu couldn’t help but lament: “All that I have learned in my life is for these 60 minutes. The goal of the large-scale emergency care platform is to realize a treatment model where ‘rescue begins upon the call for help, and hospital admission starts upon boarding the ambulance.’ As long as we streamline the treatment process further, patients will have a greater hope of safe recovery.”

By the end of 2020, the national pilot program for the Emergency and Critical Care Grand Platform had been launched. The first batch of “Emergency and Critical Care Grand Platform” pilot sites was established.59 companiesunits, on this basis, China again has157Grade III, Class A hospitals and1,451 institutionsCounty-level hospitals have reached an agreement to jointly promote the development of a unified large-scale platform.

Currently, the Emergency Center of Deyang People’s Hospital in Sichuan Province is establishing a multi-center, one-stop resuscitation platform and is undergoing capping design; Tianjin Chest Hospital is setting up a tiered diagnosis and treatment emergency command center; Zhanjiang Central People’s Hospital is pioneering the demonstration of large-scale platform construction...

However, the promotion of the large-scale emergency care platform has not been smooth, and there are still some issues that need to be addressed.

First,The departmental and floor layouts of most hospitals cannot be easily modified., the time required for consultation and treatment may still be prolonged as a result. Currently, the architectural layouts of many hospitals in China have become fixed. Retrofitting them all to align with the design model of a comprehensive emergency and critical care platform would require extensive construction, consuming significant time and effort while incurring unnecessary costs. However, if the layout cannot be modified, patients will inevitably need to move between floors, regardless of how much the comprehensive emergency and critical care platform streamlines its processes.

Secondly,Medical informatics is still in its early stages of development, with many issues yet to be improved.Professor Lü Chuanzhu told VCBeat’s Orange Fruit Bureau, “If we liken the large-scale emergency and critical care platform to the human body, then the vertical information platform serves as our nervous system, while the horizontal hardware layout constitutes the skeleton. The most challenging aspects lie in repairing and building this ‘nervous system.’”

With the integration of blockchain and big data technologies, every medical action taken by healthcare professionals will be recorded as a node. While this "highly transparent" model of medical informatization enables clinicians to more conveniently access patients' historical health data, it also imposes significant pressure on healthcare providers.

This demands exceptionally high professional standards from healthcare personnel. Given the immense psychological pressure faced by medical workers in the current social environment, if the platform further causes physicians to act with undue caution during consultations, it would deviate from the original intent behind designing this information platform and hinder the advancement of healthcare informatization.

Finally, public awareness of emergency care still needs improvement. Incidents of sudden cardiac death and accidental fatalities occur almost daily, yet public attention appears to be disproportionately focused on prevention, while neglecting the critical importance of post-event emergency care.

Professor Lv Chuanzhu told VCBeat, “If we place greater emphasis on the development of emergency care, we can save more lives. Therefore, I will continue to dedicate myself to upgrading and promoting the comprehensive emergency care platform. I believe that as long as we continue to advance the construction of this platform, the number of accidental deaths in China can be reduced by 10% annually—a figure that underpins the well-being of tens of millions of families.”