Developing a Location-based Mobile App to Save Heart Patients in Emergency. Durairaj Ponraj, Luo Zhiqiang, Ang Candy. Nanyang Polytechnic, Singapore

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1 Developing a Location-based Mobile App to Save Heart Patients in Emergency Durairaj Ponraj, Luo Zhiqiang, Ang Candy 0649 Nanyang Polytechnic, Singapore The Asian Conference on Education Abstracts One out of three deaths in Singapore is due to heart disease and stroke. Statistics indicate that 70%-80% of heart attacks occur either at home or in public places. The prompt emergency measures, for example performing a cardio-pulmonary resuscitation (CPR) and employing automated external defibrillator (AED), are critical life-saving procedures when attending to a heart attack victim. Hence, we developed a mobile app, called SOSHeart, to assist heart patients to receive prompt assistance when they are suffering from heart attack and possibly a cardiac arrest in public places. This application integrates the mobile and cloud technology to provide the comprehensive location-based services in threefold. First, the one-click SOS assistance allows a heart attack patient to call for help from all relevant parties in the fastest manner in emergency. After initiating such assistance, the patient s location tracked by the global positioning system (GPS) data on mobile phone will be flashed in a city map provided by SOSHeart. All CPR-certified citizens within a 1-km range of the site of the heart attack will be alerted by SOSHeart on their mobile phones where they can also find the patient s location on the map. Second, the on-site guidance instructions can refresh and guide CPR-certified citizens to perform CRP and use AED correctly. Lastly, SOSHeart can share patient s medical data to facilitate the correct treatment in emergency. The system architecture and each component of SOSHeart are introduced too. A pilot test found that the one-click SOS assistance is a reliable means to quickly get attention and help from nearby CPR-certified citizens. Our future work is to simulate several field studies to test the effectiveness and efficacy of SOSHeart to save heart patient in public places. iafor The International Academic Forum

2 1. Introduction One out of three deaths in Singapore is due to heart disease and stroke. Statistics indicate that 70%-80% of heart attacks occur either in the home or in public places (such as shopping malls). Currently, the Singapore s survival rate in cardiac arrest cases away from hospital is between 2 and 3 per cent. It can take up to 20 minutes from the call for help before paramedics arrive. Factors associated with survival from heart attack include patient s age, witnessed collapse, prompt initiation of cardiopulmonary resuscitation (CPR), type of initial arrhythmia recorded at the scene, early defibrillation if warranted, time elapse from cardiac arrest and the arrival of the first rescue team, and the patient s comorbidities [1-3]. Early CPR has been shown to be a vital link in the Chain of Survival [4] for out-ofhospital cardiac arrest and is an important key to improving survival rates. Therefore, the National Resuscitation Council of Singapore and the Singapore Heart Foundation initiate to train one million citizens in CPR by 2020 [5] as these citizens could provide CPR immediately. One gap, however, is the absence of means for a heart attack victim to get the prompt treatment from a CPR-certified citizen. Despite one million CPR-certified citizens, they may not be aware that someone nearby needs CPR. To bridge this gap, the location-based services accompanied with a mobile phone app could possibly be an effective tool. The location-based services (LBS) represent a general class of computer programlevel services that can identify and update the location data. Now the high-speed cellular networks combined with location enable to give the target service based on the current user position [13]. LBS mobile applications have been used in various contexts [14], such as local search, tour guides, mobile games, advertising, and mobile commerce. The location-based service considered in the present project is to track the locations of heart patient and CPR-certified citizens. Thus the heart attack patients can call for help from the nearby CPR-certified citizens and the nearby CPRcertified citizens can also find the location of heart patient in a quickest possible manner. Besides the prompt initiation of CPR, caregivers (including CPR-certified citizens or medical staff providing emergency services) at site of heart attack victims also need to know the patient s recent medical data and drug allergy. Such medical data are usually not available at the scene because sudden heart attack usually happens away from hospital or home. In recent years, hundreds of heart-related applications are available for our smart phones. Many are little more than glorified diaries and a growing number are tapping into the sophisticated technology packed into these phones [6]. For example, Instant Heart Rate [7] measures our heart rate using the built-in camera. Pocket First Aid & CPR [8] from the American Heart Association can guide us through the steps of performing CPR and using the AED. It also includes in-depth information for other health emergencies. Heart4Life [9] from Singapore Heart Foundation can also increase awareness and knowledge of CPR skills amongst the general public. The general app for emergency, such as an ICE (in case of 1319

3 emergency [10]) app, let user record name, medical conditions, blood type, allergies, and medical contact information into mobile phone. Thus such information can be used in emergency. The present study aims to develop a mobile app, called SOSHeart, to provide location-based services to heart patients to call for help from caregivers as well as providing the personal medical data and other useful information in heart attack emergency. We propose that the integration of location-based service and medical data on a mobile app at heart patient s hand can assist in prompt assistance and treatment to heart attack victims in public places in emergency. The following sections will introduce the architecture of mobile app first and then present the main features of the app. The result of pilot test on the location-based service will be presented, and followed by the design of field study to comprehensively test SOSHeart. Finally we conclude the present study. 2. Methodology 2.1 System architecture The SOSHeart is an Android-based mobile app with Microsoft Azure cloud support, which comprises two major applications, the application on smart phone and the network service in Azure cloud, as shown in Figure 1. Figure 1. System architecture of SOSHeart 1320

4 There are four layers with the application on smart phone. The first layer is the graphic user interface (GUI) where the user can see and interact with the mobile app. The GUI layer comprises four tabs, Home, Map, Information, and About, to categorize the available functions in fourfold. The second layer is rendering the data and map, accepting the user input, and playing the audio and video files. This layer focuses on the functions responding to user s interaction. The third layer is to store all relevant files. The files include the list of emergency contact, the AED location database, the database to store patient s medical information, and the audio and video files to instruct CPR and AED. The last layer is to implement the communication function of SOSHeart. The communication function is the key component since it helps heart patient to contact the possible caregivers, for example the emergency contact or the CPR-certified citizens. There are four communication functionalities. First, SOSHeart allows user (e.g. heart patient) to send messages or make a phone call to caregivers. Second, SOSHeart records the GPS data of smart phone to track user s location in city and displays his/her location on the integrated city map. Third, a map communication function is available to retrieve OneMap (the local GIS map system in Singapore) data to the mobile phone. Lastly, the Azure communication function is to communicate with the services run in Microsoft Azure cloud. The network services in Azure cloud are the backend services to support all smart phone s location-based services in field. The network services comprise two components, the SQL database hosted in the cloud and the Azure services to communicate with the mobile app. The SQL database will store all user s medical information and the location data in real time. The data are sent from the Azure communication function of mobile app. The Azure services are responding to maintain the SQL database and the communication with the mobile app in real time. Thus the user s current location sent from the mobile app will be received and stored in database in real time. 2.2 Three features for heart attack emergency One-click assistance The one-click assistance with SOSHeart allows a heart patient to call for help in the fastest manner, which provides three options in emergency (see Figure 2). First, the patient can call the ambulance service just by clicking one button without inputting the ambulance phone number (which is 995 in Singapore). SOSHeart can assist the 1321

5 heart patient to give the current location data which can be communicated to the ambulance team for easy location of the patient in a quickest possible time. Second, the heart patient can call and send messages to emergency contacts (i.e. the family member) by one click too. The emergency contact list can include maximum four phone numbers, where the first contact can be alerted by the phone call and message whilst the other three contacts will be alerted by the message only. Since SOSHeart can detect the patient s location, the message content will automatically include both patient s name and current location. Furthermore, if the SOSHeart is also installed with emergency contact s smart phone, they can find the patient s location in the integrated map with SOSHeart. Lastly, the heart patient can choose the one-click SOS assistance, a holistic assistance in emergency, to (1) call for help from the CPR-certified citizens who are within 1-km range of distance to the patient s site and to (2) send messages (the same message content as described above) to all emergency contacts. Specifically, after the heart patient initiates the one-click SOS, SOSHeart will search all CPR-certified citizens within a 1-km range of the site of the heart patient and send an alert message to the found citizens. At the CPR-certified citizen s side, the SOSHeart with their mobile phone will receive the message and then the citizen can respond to the message by confirming his/her willingness to offer the help. Once the citizen confirms to help, the citizen s location will be flashed on the map and he/she can also check out the heart patient s location on the map and to find the direction to the patient s location. Figure 3, shows the display of both heart patient and two CPR-certified citizens on map. Meanwhile, one-click SOS alerts the emergency contacts by sending message to call for help. The emergency contacts can call ambulance to go to the patient s site as well as check out the map to find that any CPR-certified citizens are going to offer help. At the site of the heart attack victim, the patient s medical data will be displayed on mobile phone screen to assist all possible caregivers and the accompanied alarm can catch attention from bystanders to offer necessary help. When the first CPR-certified citizen arrives, he/she can proceed to deactivate the oneclick SOS on the patient s mobile phone. This will inform his/her appearance at the site of heart attack victim to other CPR-certified citizens on the way. 1322

6 Figure 2. The three options of one-click assistance offered in SOSHeart Figure 3. Displaying the positions of both heart patient and the CPR-certified citizens on the integrated map 1323

7 2.2.2On-site emergency guidance The on-site emergency guidance with SOSHeart stores the step-by-step audio instructions to prompt CPR-certified citizens to correctly perform CRP. Such instructions are very helpful in performing CPR correctly, especially for the new CPR trainee or even bystanders [12]. The audio instruction will be recorded in an mp3 file and be played by a CPR-certified citizen when performing CPR. The emergency guidance also includes the pictures with step-by-step instructions to guide in the correct use of AED. When using AED, the audio guidance will prompt the user to do each step. But AED can t determine whether the user correctly implement the task of each step, for example, attaching the two pads to the correct positions on patient s body. The AED only has a simplified indication figure which may not give the user a clear guidance. Thus a picture showing the two pads on a real human body will be much helpful to correctly do this task. SOSHeart also includes a database storing AED locations in Singapore, which can help the CPR-certified citizens to locate and get a nearest AED as soon as possible Medical data for better decision support. The medical data included in SOSHeart is for the ambulance team and medical staff at hospital to quickly determine the heart patient s recent medical conditions and then render the right treatments. The medical data are classified into four categories: the patient s medical conditions, medication taken recently, drug allergy, and medical records. The medical data will be stored on both heart patient s mobile phone and the remote Azure database. The patient can input medical conditions related to cardiac illness, like IHD, heart attack, hypertension, Diabetes and hyperlipidaemia. The onsets of these medical conditions are required to be keyed in. The current medications used are also useful to the treatment, where the patient needs to input the name of medication. The common allergic drugs list will be included in SOSHeart for the heart patients to just choose. The patients can also input the names of other drugs he/she may be allergic to. The recent medical records are crucial for medical teams to make decision to render correct treatment to the heart attack victim in emergency. The medical records consist of the blood pressure, electrocardiogram (ECG) report, echocardiogram report, blood test report, and other relevant past surgery. Heart patients can input these medical records simply by taking a photo of these reports obtained in clinic checkup and saving the photo in SOSHeart. 1324

8 Figure 4. Four categories of medication data with SOSHeart: medical conditions, medications, drug allergy, and medical records. 2.3 Pilot test A pilot test on SOSHeart was conducted with four subjects who are students from the Nanyang Polytechnic, Singapore. The objective of this pilot test is to test the reliability of one-click SOS assistance with SOSHeart to call for help from the CPRcertified citizens around the patient site. In this test, one student played the role as heart patient to initiate the one-click SOS assistance with his smart phone; two students played the role as the CPR-certified citizens; and the fourth student played the role as the patient s emergency contact. The test was conducted in the urban area of city where the speed of mobile network is good. The pilot test found that both two CPR-certified citizens and one emergency contact could receive the SOS message from heart patient within five seconds after initiating the one-click SOS assistance. Furthermore, all subjects could see his/her own and others positions on the map in real time. The integrated map can guide the CPR-certified citizens and the emergency contact to correctly and easily arrive at the location of the heart patient. 1325

9 2.4 Future field study Several field studies will be conducted in various public places in future to comprehensively test SOSHeart in the simulated emergency situations. The public places will be shopping malls or markets since these are the major places where heart attack happens away from home or hospital. The participants of field study will be students who have received the formal training on CPR and AED. They will be randomly assigned into two groups, using or not using SOSHeart. In each group, participants will play roles either as heart patients or CPR-certified citizens. In the first group not using SOSHeart, the heart patient will call the CPR-certified citizen by dialing phone number; whilst in the second group using SOSHeart, the heart patient will call for help from the CPR-certified citizen through one-click SOS assistance. The experimenters will follow the CPR-certified citizen and record their performance in the study. The performance data of interest is the time spent on each stage of treatment rendered to heart patient. For example, to the first group without using SOSHeart, the time from initiating the phone call to the CPR-certified citizen to the arrival of the called CPR individual will be recorded; whilst, to the second group using SOSHeart, the time from clicking SOSHeart app to the arrival of the first CPR-certified citizen at the site will be recorded too. The distances (less than 1-km) between the heart patient and the CPR-certified citizen are the same in these two groups, and they don t know each other s location before calling for help. We will compare the time spent by the two group participants. Meanwhile, the time taken to get the nearest AED will also be recorded and compared. The overall time taken to reach the location of the heart patient, the time to perform CPR and the use of AED will also be recorded. The accuracy when performing CPR and using AED will be another important data. All collected data will be analyzed statistically by t-test and MANOVA to compare the differences between these two groups. We expected that the group using SOSHeart will perform better than their counterparts without SOSHeart. 3. Conclusion A cloud-based mobile application, SOSHeart, is developed to help heart patients to call for help from caregivers, ambulance team, emergency contacts, and the nearby CPR-certified citizens, in a quick and easy manner. SOSHeart provides the locationbased services to facilitate caregivers to find the location of heart patient from the integrated map. The system architecture and the three main features of SOSHeart are introduced in detail. Our future work is to conduct field studies to test the efficacy and efficiency of SOSHeart to save the heart patient in emergency in public places. 1326

10 Acknowledgement The present project is funded by the Singapore Heart Foundation with the grant application number RG2011 /002. The authors wish to thank Dr Jack Tan from the National Heart Centre, Singapore, for his expert advice and valuable input. Reference [1] Herlitz J, Ekström L, Wennerblom B, Axelsson A, Bang A, Holmberg, S. Risk indicators for, and symptoms associated with, death among patients hospitalized after out-of-hospital cardiac arrest. Coronary Artery Disease 1994, 5: [2] Carew HT, Zhang W, Rea TD. Chronic health conditions and survival after outof-hospital ventricular fibrillation cardiac arrest. Heart 2007; 93: [3] Lerner EB, Sayre MR, Brice JH, et al. Cardiac arrest patients rarely receive chest compressions before ambulance arrival despite the availability of pre-arrival CPR instructions. Resuscitation 2008; 77: [4] Cummins RO, Ornato JP, Thies WH, Pepe PE. Improving survival from sudden cardiac arrest: the chain of survival concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation 1991; 83(5): [5] Straits Times, 2011, Jan 17. [6] The smartphone will see you now, Harvard Heart Letter, October, [7] Instant Heart Rate, Azumio Inc (retrieved at 2012/Feb/20 through [8] Pocket First Aid & CPR, American Heart Association (retrieved at 2012/Feb/20 through yproducts/apps---pocket-first-aid- CPR_UCM_308819_Article.jsp#.T0IVi7SPD5M). [9] Heart4Life, Singapore Heart Foundation, [10] In Case of Emergency (ICE), Donate Life America and LegalZoom (retrieved through 2012/Feb/20 athttp://ice-app.net). [11] Iris A. Junglas and Richard T. Watson. Location-based services. Communications of the ACM, 2008; 51(3): [12] J.F. O Neill, C.D. Deakin. Evaluation of telephone CPR advice for adult cardiac arrest patients. Resuscitation 2007; 74 (1): [13] Anind D, Jeffrey H, Eyal dl, Nigel D. Location-based services. IEEE Pervasive Computing, 9(1): 11-12, [14] Mobile location apps review. (retrieved at 2012/Nov/1 through

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