You've heard of crowd-sourcing, this is crowd-saving. Think UBER meets EMS lifesaving services. Let's call these people Uber Life Savers.

Especially for a heart attack, literally 5 minutes is the difference between life and death. Just a few minutes of traffic delay means a death. Someone properly trained in CPR being there, if nothing else, will save lives. There are always off duty police, nurses, doctors, firemen, EMTs, or other trained people who could save a life, if only they knew, that a life they could save, is only a few steps away, or just around the corner. So this application solves that problem. Those that want to volunteer, will be notified, if there is an emergency in their immediate area. So these Uber Life Savers can be there, sometimes in a few seconds, and shorten the response for the Golden Hour. But these Uber Life Savers aren't out there by themselves. They are immediately connected to a trauma center physician to oversee the situation, so they have support, instructions and guidance.

---------------------- The Approach -------------------------

My approach is twofold: One, get EMS staff to the patient in minutes to assess and stabilize. Two, bring higher level medical care to the patient immediately (while the patient is traveling to the definitive care.) Delhi is crowded, traffic conditions cannot be predicted, even in the best of cases. There are plenty traffic and routing products (ie. Google Maps w/traffic) available. Delhi has limited resources in terms of finances and resources. So how do you solve a problem with constant traffic congestion, unpredictable variables, traffic jams, accidents and emergencies that can happen anywhere? This application will solve all those problems, and work with limited resources to (1) Shorten First Golden Minutes response times, and (2) Bring definitive care TO THE PATIENT during travel.

Golden Hour --> First Golden Minutes First, I define the First Golden Minutes as the time it takes for EMS staff to reach the patient. Current research shows that the "Golden Hour" concept is not as valid as what is currently thought. Research shows that time to definitive care IS NOT a statistically valid indicator to patient outcome. In fact, response time TO THE PAITENT is a more salient indicator. So allowing response teams to reach the patient quickly, within minutes is more critical. Secondary to that is reaching definitive care. Current standards as to emergent travel is being changed even today, because the risk of traveling with lights and sirens do not buy enough patient outcome benefits compared to the risk of accident. So the first goal is for EMS staff to reach patients within minutes. [Citations At Bottom]

Cardiac Priority One set of conditions that do absolutely adhere to the Golden Hour principle are cardiac conditions (among a few others). So if a cardiac patient is identified, then the First Golden Minutes become literally life-and-death, and so does the follow-up Golden Hour.

To solve this dilemma, there are three levels of EMS Vehicles.

Level 1: Uber Life Savers. These are the trained volunteers (off duty nurses, doctors, firemen, policemen, etc.) who are floating around and in the city, always there, and always ready. Level 2: EMS-Fly-Vehicles are non-transporting response vehicles. They bring care to the patient quickly, but cannot transport patients. These can be cars, and even motorcycles, or scooters that can fit through slow or stopped traffic. They are inexpensive, so the Delhi government will be able to afford many more response vehicles that can reach a patient quickly, and begin assessment and stabilization before a larger transport vehicle can arrive. Also having more fly-vehicles around Delhi will massively shorten response times, and be able to deliver life-saving care and response to patients faster, for less cost. Level 3: EMS Transport Vehicles are traditional EMS response units, but are larger and more expensive to purchase and maintain. Using these vehicles for non-critical responses is a horrible, expensive and deadly waste of resources. Level 4: EMS Cardiac Specialized Transport Vehicles are the most expensive in terms of cost and training. But, having a couple of these in the fleet will save many times more lives for patients who would have died in a standard EMS Vehicle, even if transported within 60 minutes.

So here's how a response happens.

(1) An emergency call comes in. The system first finds the nearest Uber Life Savers and notifies them with directions, and a direct phone line to the trauma center physician managing the situation. The system then identifies the closest EMS Fly-Vehicle, and sends it to arrive in a mere few precious minutes. If the emergency requires transport, the closes EMS Transport vehicle is sent to begin traveling to the patient.

If the call-center, or Fly-Vehicle staff flags the patient as CARDIAC, then the EMS Cardiac vehicle is immediately sent to the patient. In the meantime, the Fly-Vehicle staff is on hand to deliver trained CPR and support to stabilize the patient until heavier equipment can arrive.

(2) The Fly-Vehicle person initiates an INSTANT trauma connection to DEFINITIVE CARE staff. The Fly-Vehicle person initiates a connection to the hospital where trauma staff and doctors are located using their mobile phone. A screen pops up at the hospital computer, and the doctors and staff can immediately begin seeing vitals and other indicators, to begin "seeing" the patient instantly. The on-site staff can initiate a video call, or upload images so the doctors can begin assessment and treatment recommendations immediately. Since each patient is tracked on a single screen, the doctors and staff can manage multiple patients at the same time.

(3) While traveling -- the patient, EMS staff, and doctors (hospital) are constantly in contact, monitoring and treating the patient while traveling. The patient is connected to the first responder's mobile phone. So the Fly-Vehicle person, just hands the phone to EMS Transport staff, and the connection with the patient is continued. Since doctors are monitoring the conditions during travel, they can identify and call for and even direct specific emergency procedures or treatments while the patient is traveling. If conditions warrant, the doctor can initiate emergency travel with lights and sirens.

(4) The patient arrives at the hospital and definitive care. The doctors and staff are already aware of vitals and the history of the patient. Makes hand-off smoother and with less errors. Since the doctors and staff are fully aware of the patient’s conditions during the whole process, they can be completely prepared and ready when the patient arrives.

Additional Technology Used

  • Ford Open CX API via Dweet.IO Geo Locations and tracking of all vehicles are accomplished by tracking and reporting from the Ford API routed through dweet.io.
  • Medical Database Access Since this is a proof of concept, I have connected to rudimentary medline databases giving the doctors and staff lookup abilities at their fingertips. But the code allows for more complete database connections through licensing to medical databases, and even procedural and diagnostic systems and databases.
  • Additional Savings through New Technology I have integrated an API call to connect technology like MC10's Biostamp, which can relay constant medical data back to the hospital, definitive care, and the EMS staff on site. This is an extremely inexpensive alternative for Dehli to issue to their Fly-Vehicle staff and can replace much more expensive equipment. My application simulates and broadcasts to a dweet.io output from a MC10 on a patient at the scene. This can be extended new connected wearable technology for O2 Oximeters, and any new technology. So my app is future tech ready.

Added Benefits The advantage of such a system is that because everything is recorded, in the future, procedures can be refined for better outcomes based on the data received as doctors review what happened, and create new, more efficient procedures. Also the doctor can manage multiple patients without being tied up on a physical call, although the doctor has the option to initiate a physical call anytime. The doctor can select from a drop down, to auto-post procedures to the EMT or patient. The patient or EMS staff can also initiate video call with doctor.

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