The web has penetrated just about every sphere of human interest and using information from the web has become ubiquitous among different categories of users. Medicine has long being using the benefits of modern technologies and without them it cannot function. This paper offers a proposal of use and mutual collaboration of several modern technologies within facilitating the location and communication between persons in need of emergency medical assistance and the emergency head offices, i.e., the ambulance. The main advantage of the proposed model is the technical possibility of implementation and use of these technologies in developing countries and low implementation cost.
In developing countries the emergency medical services are not equipped with modern information and communication technologies that could contribute for the emergency situations to be treated rapidly and efficiently. In many cases of emergency interventions the time plays a decisive factor. If it comes to a heart attack or stroke, as well as a traffic accident with the consequences of bleeding injuries, the minutes of quicker intervention can save lives. Ambulance vehicles face a number of traffic problems while responding to a call. One of the key objectives of the ambulance service is to locate and get to a place where you need to perform the medical intervention as soon as possible, and transfer the patient to the hospital if necessary. In developing countries, the communication of individuals requiring medical attention, or individuals who indicate to the need for medical help, the phone as a means of communication is mostly used. When communicating, various difficulties can occur for individuals wishing to describe the exact location of the accident:
People can find themselves on locations that are unfamiliar to them, parts of the city where they rarely go, locations in another city where they do not live, touring the country roads outside the town, the picnic areas, rural roads, fields, etc., and for them it’s very hard to explain their location to the emergency services.
Due to the confusion and the shock of the injured or the difficult situation in which the patient is, the situation and condition of the place where they are located are difficult to explain.
Witnesses who call emergency services are often themselves in a state of panic, shock and fear, especially if they are connected in some way with the people who need to be provided immediate medical assistance.
There are many examples where due to bad communication and slow intervention the outcome was disastrous. For example, Udtke, G. describes a terrible mistake of a fire service in Germany, where they were sent to a specific address, but in a completely different city than where they were supposed to be. A similar example is described in the Canadian newspaper, the Herald Canada, where an ambulance due to the difficulty in communicating between the parent whose child stopped breathing and the emergency dispatcher, went to completely wrong address.
The paper entails the advantage of using the Open Source services, technologies, tools and trends that support freedom of access and use of information in all forms, their exchange and usability independently or as a part of other services and applications. These services should use and be based on advanced web technologies such as AJAX and XML. They should use the specifications and proposals of OGC organizations for exchange and use of geodata, services and formats. Information stemming from a web map services should be interoperable and usable in other services and applications as much as possible. These services should be transparent with high level of free availability and divisibility of data files they create or are created for the citizens and other subjects at the city level.
Interoperability is an essential pre-condition for open, flexible delivery of services, so that the proposed map services should follow the recommended European interoperable frameworks such as the “European Interoperability Framework” (EIF). This use should enable collaboration between different administrations and services at the city level. The development of services at the city level, which would cover the services related to health, should be based on following the action plans and directives issued by the EU, such as the “EU i2015 eGovernment Action Plan”, the “Malmö Declaration” as well as the European project INSPIRE, which all together certainly put an emphasis on the use of modern, multifunctional, interoperable and transparent services, based on Open Source tools and technologies, and oriented towards citizens.
2 Materials and methods
The idea is to use the free services and technologies that are available without additional compensation, which would certainly reduce the cost of deployment and maintenance of the model to be introduced in the paper. With the development of freely available Web Map system and the GIS services, the use of maps on the Web has received its full expansion. The possibility of localization maps and the use of external information sources that could be displayed on the map, led to the fact that the maps are used today in almost all fields of human interaction. In regard to the use of maps in order to save lives, unique map platforms for emergencies have been developed that have successfully confirmed their role in locating and faster rescue of the individuals who were struck by natural disasters in Haiti and the Hurricane Katrina . These platforms are Ushahidi and Sahana. These are open platforms that enable integration of data from various sources and present those data on maps.
In the Netherlands, as part of the city municipalities, is implemented a number of services that are based on the use of the free map service, GPS and mobile devices, and which use integration with other services in order to achieve better efficiency and higher usability value. Such projects are Burgernet , SMS-Alert , AMBER Alert as well as NoiseTube.
Burgernet and SMS Alert represent service that require citizen participation and partnership with the local government and the police, who rely on mobile phones and their aim is to promote safety in the home and business environments. These services are promoted and distributed by local governments to their citizens. Citizens are, through these services, used as sensors that make up the sensor network, representing the “eyes” and the “ears ”through their support to the police in their communities. Through these applications that are installed on mobile phones, citizens directly alert the police, but also the other citizens in their neighbourhood, if they notice a burglary, violence or any other violation of the law. By calling the service number or sending an SMS message through android application, the police locates the users on the map and forms a network of citizens markers who are involved in a given event, and based on that and other information received from citizens, creates a more accurate reflection of the very event on the ground. The application has already been installed by more than 1.5 million people.
AMBER Alert is a web service that serves to alert the community, the police and the services in case of loss or kidnapping of a child. Service links a number of different devices. In a case of disappearing of a child, photos, and location on the map where the child was last seen as well as the possible trajectory of the child, are being distributed within 10 minutes and displayed on mobile phones, TVs, the social networks, such as for example Facebook, Twitter, etc., then on the TV panels in the means of transportion, the public displays, the markets etc.[4, 5].
The service named NoiseTube allows citizens to measure their personal noise exposure in the everyday environment by using special software for mobile phones of newer generations, who thus become noise sensors. Measurement locations are automatically sent to a processing center and the mapping zones monitored. Citizens are directly involved in the assessment of urban and environmental sustainability. The service is based on the concept of wireless sensor networks, participatory reading and the idea of people being sensors for various measurements. Acoustic measurements of geo-localized areas and user-generated metadata can be shared across the online community. As a result, each user effectively contributes to the collective noise monitoring and mapping campaign. This service has enabled the creation of noise maps, where precisely can be seen parts of the city that are most exposed to noise, which does contribute to the local government to more easily evaluate and solve these problems .
As seen from the above examples, these map services can be based on different technologies and trends. In the examples above, the role of citizens sending information through central services is particularly visible, where such information are processed which falls under the concept of “crowdsourcing”.
The systems for map displaying get their full value in conjunction with the GPS technology. Directive to the American Senate from May 1, 2000, abolished the selective availability of the GPS signals which led to the expansion of GPS devices, navigation systems and other GPS signal receivers that became available to the civilian population. The very precision and accuracy of the location via GPS signal today does not exceed the error of 6-10 m. . Mass production and the use of GPS technology led to the fact that GPS receivers are found in most mobile phones today.
The number of mobile subscriptions in the world, according to the ITU in 2014 almost reached the number of people in the world and amounts 6.8 billion, which is 96% of the total population. The number of users who use broadband Internet access through mobile operators increased to 2.3 billion.
Research of the mobile market in the last quarter of 2011 shows that 79.9% of produced mobile devices have GPS built-in function , from which we conclude that the trend of embedding GPS receivers increased in 2012 and 2013 and that in 2014, 95% of the produced mobile devices should have a GPS function.
Laws and regulations related to the use of GPS must allow free deployment of such systems in mobile devices. Special regulations may define the legal framework use of GPS signals for special purposes of interest for the community, such is, for example, the case in the state of Massachusetts where have been passed a series of laws and regulations governing the use of GPS devices to monitor the movements of offenders.
The Massachusetts legislation (“An Act Relative to Enhanced Protection for Victims of Domestic Violence”) provides judges with the option of ordering offenders who have violated an order of protection to wear a GPS monitoring device .
As for the European countries, the adoption of these regulations is certainly possible. This can best be seen on the example of the use of eCall. The regulation requires from car manufacturers on the European soil, to, starting from 2018, built in the eCall system which is based on the use of GPS device installed in the car . This system enables automatic dialing 112 in case of an accident on the European soil. The system would automatically go off in a collision of cars, and it is possible to activate the system by pressing special button in the car.
The legal framework for the use of GPS within the framework of this system is defined by the European Commission (EC) which has adopted a proposal in June 2013 to make eCall mandatory for passenger cars in the near future. This was followed in February 2014 by the European Parliament’s Legislative Resolution. The subsequent Council’s General Approach from May 2014 sets out the high level expectation in regard to the automatic triggering of eCall systems: An eCall shall be triggered automatically “in the event of a severe accident, detected by activation of one or more sensors or processors within the vehicle”. This expectation awaits translation into specific requirements for minimum triggering conditions that ensure effective system performance in passenger cars .
If the legal framework regulating this area, allowed the use of GPS in these and similar technologies, it might be expected that the GPS functionalities would be found in a growing number of devices. The proposed technology could be extended to implementation within fixed telephony, where under the same or similar principle a GeoSMS message may be sent from a landline phone from home or for example the pay phones, to make it easier to locate a person who needs help.
3 OGC Open GeoSMS
Geo SMS is a classic SMS format with added geo-information. These geo-information often are the coordinates which are taken directly from the GPS receiver from a mobile phone, for example. The coordinates are in a format that is readable to almost all available map services and geographic information systems (GIS) and GPS navigation software that supports OGC standards and specifi-cations. By this an interoperability between different software and devices is achieved, regardless of the platform on which they work.
GeoSMS standard allows pre-defining the form of the original text messages, so they can be sent in a format which is at the moment readable to a specific map service or GIS program.
For an SMS notification to be compliant with the Open GeoSMS specification, the following criteria have to be fulfilled:
The first line of the SMS has to be a URL (Uniform Resource Locator).
This URL has x and y coordinates as the first two parameters;
This URL ends with ‘&GeoSMS’; and
Optional text can be appended for further description, e.g., of an (emergency) event at the specified geolocation and/or sensor readings at that location.
For example, for the OpenStreetMap service it could look like this:
Open GeoSMS can prove extremely helpful in public health emergency notification and management operations, since it works on almost any kind of mobile phones supporting SMS. It is an open standard that aims at enabling interoperability among different platforms. People reporting an incident can (still) make an ordinary phone call or send a conventional SMS message to the emergency services handling such situations, but with OpenGeoSMS, geo-tagged SMS reports can significantly shorten the processing time for incident reports (and possibly save more lives by doing so) .
4 Model application for rapid locating individuals in need of urgent medical help
In this scenario, we assume that individuals in need of urgent intervention have a mobile device equipped with GPS. The model displays an application which is designed for Android system, but it also means that the application has been distributed for other mobile operating systems. To prove this system efficient and very useful for the users, the Ministry of Health in cooperation with the mobile operators could easily distribute this application to the users. Model is based on an open source application called I’am Here, which relies on the OGC Open GeoSMS standard.
User application was designed to be as simple as possible, and the main part of the interface is focused on sending SMS messages with the coordinates to the emergency center in Figure 1.
The user in need of help would send coordinates and an urgent call for help with one click. The application sends SMS with the coordinates on the precisely specified mobile telephone of the emergency head office (Figure 2.). Suppose there is a center which is responsible for receiving such emergency messages and their further diverting of them to the desired ambulance vehicle.
Advanced version of the application would, with the aid of mobile operators and by determining the location through the base stations, redirect the message to the nearest emergency department (Figure 3.). This would grant the most important role to the mobile operators who would mark the use of these kinds of messages as free, because this is important in case the user does not have credit on his account. Accepting the message in the head office is done via computer or other mobile device which has a specially designed software with interface of further forwarding the coordinate to the desired ambulance. The head office would have access to the map where the vehicles are currently stationed and on the base on that, would forward the SMS to the nearest vehicle.
The next version of the software could integrate both voice and message transfer from the head office or the user within one service. The present day communication between the ambulance and the head office takes place via traditional “motorola ”stations, which is a system that is not improved for several decades.
The proposed application model could be implemented with the help of Open Source WorldMap platform map, which was developed at the Center for Geographic Analysis at Harvard University. This is an advanced platform for the development and use of geo-services and associated technologies for the following reasons:
Represents a free map solution that can be modified and adapted to the needs that certain services have when presenting geoelements on maps. Inexpensive implementation is very important factor in developing countries.
WorldMap is a unique platform that integrates geo-data from commercial and free services.
The main objective of the project is to support initiatives for the global exchange of geographic data, such as GSDI initiative (Global Spatial Data Infrastructure) or SDI within the INSPIRE European project.
WorldMap open platform fully supports OGC specifications and proposed services such as WMS, WCS and WFS, as well as standards such as the Open GeoSMS, geospatial metadata and standard formats for maps and geodata.
Within the World Map Project it is possible to combine the resources of various map systems (Table 1), such as for example the substrate maps and geographic information from the following services:
At these maps can be imported geoinformation and layers of the following formats:
GPX (GPS Exchange Format)
|Maps and resources||Types|
|Google maps||Roadmap, Hybrid, Terrain, Satellite|
|ESRI||Light Gray Reference, World Imagery, World Street Map|
|Stamen||Toner, Watercolor, Terrain|
|Bing||Roads, Aerial, Aerial with labels|
|MapBox||Topograpy, Earth, World light, World dark|
As well as data from CSV, Excel, JPEG, PNG, PDF formats.
The project is based on crowdsource and collaboration while creating maps, so it now contains over 5000 different layers of geospatial information, created by users and organizations.
5 Results and discussion
For the purpose of the test were used two vehicles and two drivers. The vehicles are equipped with navigation for the purpose of the exact measurement of distance traveled and the time of movement of the vehicle to a specific location. One vehicle will receive a verbal description of the location and the address. This vehicle we will mark as vehicle A. Vehicle B receives exact coordinates which are passed from the head office to the device in the vehicle via the Open GeoSMS standards which we have already explained. In our case, for testing purposes, we have used a mobile device with installed navigation which relies on the OSM maps and data.
In urban conditions where the addresses are well-known to the drivers, the intervention period is almost identical with both vehicle A and vehicle B. The problems arise when intervention is in the suburbs where houses are often not numbered. The farther the intervention location is, the less it is familiar to the ambulance drivers. Then it is crucial to quickly locate people who need help because the arrival time to a remote location is greater.
We have assumed that an individual in the suburb at a specific location is sick with indications of a heart problem and requested a medical intervention. The head office strives to quickly find out the location in order to send an ambulance as soon as possible. Since house numbers in the area are not clearly marked, as often is the case in suburbs, the obtained information is about the nearest neigh-bourhood, the nearest street and a description of how to get to the house. In the communication about the exact location 2 minutes were spent. Experienced ambulance driver knows how to get to the area fast, but the street described is long and the driver can not accurately determine the exact position of the house which is not located on the main road. To the exact location, the vehicle has arrived in 15 minutes with 5.8 km passed. Since receiving the call and arriving at the patient’s location, 17 minutes have passed (Figure 4a).
The scenario for sending the second vehicle is the same, only instead of description of the location, the car received the exact position on the map and the proposed shortest route the vehicle needed to follow. The vehicle started from the same place as the first vehicle. On the exact location the vehicle arrived in 13 minutes with 5.3 km passed (Figure 4b).
Now the drivers swapped the vehicles in order to take into account the skills and experience of the drivers although we assumed that ambulance drivers posses similar driving skills and experiences. We have assumed that an accident occurred on a farm, where the injured has serious injuries with bleeding. Telephone contact was made with the emergency head office and the vehicle departed. On location description one minute was lost, until the ambulance headed off. Since the suburb is in question where the streets are not marked, as often is the case in small towns, the driver has no idea about the exact location of the victim. The ambulance arrives in the area, and at a certain distance they were forced to ask the locals about the exact location of the designated farm. The distance of 7.1 km was passed for 20 min (Figure 5a).
The scenario for sending the second vehicle is the same, only instead of description of the location, the car received the exact position on the map and the proposed shortest route needed to be followed. The vehicle started from the same place as the first vehicle. On the exact location the vehicle arrived in 15 minutes with passed 6.3 km (Figure 5b).
|Scenario 1.||Scenario 2.|
|Vehicle A||Vehicle B||Vehicle A||Vehicle B|
|Distance passed (km)||5.3||5.8||7.1||6.3|
|Time saving||4 min||5 min|
For some injuries and cases, the minutes are vital and arrival time at the location should be reduced to the smallest possible interval.
The primary role of technology in all areas of human activity is to improve and facilitate the work and to raise the quality of life for the people. In medicine, technology plays a very important role. The presented model application is directly related to increasing the efficiency of medical interventions due to shortening the calls for emergency assistance until the arrival of the team on the spot. This time saving can often be a life-determining factor.
The presented model applicationis only the starting point from which a complex system should be developed that is using freely available web map services like Open-StreetMap and opportunities for modification of the maps, which would further precisely georeference the entire area covered by the respective emergency service, and in this way, quickly draw the closest and the most efficient path to the selected location. Advanced versions could include additional services, aiming to retrieve data directly from,for e.g. portals of the local government, such as traffic data, works and other factors that may affect the marked path.
For these purposes, a good solution would be the use of the briefly described WorldMap platform, which allows import of almost all standard types of geodata, following modern trends of crowdsourcing, data interoperability and the possibility of combining them, which is in line with all European directives, plans and initiatives for the creation of advanced, freely available services at the city and state level of the European area.
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© 2016 E. Sukic and L. Stoimenov, published by De Gruyter Open
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