THE NEED FOR A SMART PHONE APPLICATION FOR THE PRE-HOSPITAL EMERGENCY CARE SETTING

THE NEED FOR A SMART PHONE APPLICATION FOR THE PRE-HOSPITAL EMERGENCY CARE SETTING

Abbreviations
Code 1 - Lights and sirens
Code 2 - Normal road speed
DAPP - Decentralised Digital Application

Abstract
A patient who has contacted an ambulance could greatly assist the treating paramedics by opening a digital application located on their smart phone. This application would contain the patient’s personal details and medical health records and would be able to be transferred over to the paramedics operational iPad. Gaining this digital data would avoid the treating paramedics having to go through the same repetitive questioning such as what medical history does the patient have, allergies, and current medications every time they encounter a new patient. The application would tell the paramedics what hospital the patient normally attends and what medical conditions that hospital has diagnosed the patient with. The application would be most effective when used in conjunction with patients suffering from chronic health conditions. But would probably be of limited benefit to those with acute life-threatening injuries who are normally healthy and have no medical history. Queensland has an aging population and for many years now has seen a rise from interstate retirees coming into the state. These retirees bring with them more age-related diseases such as cardiovascular disease, hypertension, osteoporosis arthritis, dementia and many more. (Elizabeth Tilley, The Courier-Mail 2017). Currently when a paramedic is contacted to treat these patients for non-life threatening chronic conditions the paramedic is required to go through a series of repetitive questioning in order to gain the relevant medical history. It is sometime unreasonable for an elderly patient to remember all of their medical conditions or for them to fully understand what their doctor has diagnosed them with or why they have been prescribed a certain medication. Like any digit system the risk of personnel information being hacked or compromised is high, therefore I propose that this medical application is run on a blockchain platform making it a DAPP running on an Ethereum type platform or whichever platform best suits the DAPP to run on and is able to scale the data in a reasonable time frame.
Introduction

This paper has been written with the aim to highly light the possible roles that a medical smart phone application could play in assisting a paramedic in treating a patient in the pre-hospital care setting. Some of this information contained comes from my own personal on road experiences of being a paramedic for the past 10 years. At the end of 2019 it was estimated that twenty million Australians owned a mobile smart phone with that figure continuing to rise every year from now. (Number of mobile phone users in Australia from 2011 to 2019). By 2030 the 5G phone network will have become firmly embedded with our infrastructure, all electronic devices within our homes will be connected to the internet, our cars, TV, microwave, fridges and even light bulbs will all be connected and the so called “internet of things” (IoT) will have arrived. (Our predictions for 2020 and the decade beyond). The IoT will clearly open up new opportunities for private companies and government services. However, we don’t have to wait until the year 2030 as the technology that I’m proposing is already here. Even the lowest end model of smart phone is capable of running applications (apps) on either the Apple or Android operating systems. The major hurdle in the way that I can see is the problem of securing patient’s private information and therefore ensuring patient confidentiality. If a criminal was able to steal or hack into a patient’s smart phone then they would have complete access to all of that patient’s personal and medical records. Although still an evolving technology Blockchain could solve these security problems by making a system where data is transferred from one computer to the other completely independent from a third party.

Blockchain technology
Bitcoin was the first ever cryptocurrency launched 2009. It acted as a proof of concept that one Bitcoin can be transferred on blockchain technology to computers anywhere in the world and to the best of my knowledge the bitcoin blockchain has never been hacked or failed in anyway. Other Blockchain projects such as Ethereum aim to widen the capabilities of Bitcoins blockchain by effectively allowing much larger data volumes to be sent over the blockchain. If a medical application is run on an Ethereum type platform it will become a Decentralised Digital Application (DAPP) therefore making it unhackable. When the paramedic wants to access all of the data on the DAPP the patient will have to simply scan a QR bar code located on the paramedics iPad using their own smart phone. This QR code will then show up on the patient’s smart phone as a public key address. The patient then sends all of their medical records to that same public key address which matches the public key as the paramedics iPad and so the transfer of the patient’s medical records over the Blockchain network is completed much the same way how a Bitcoin is sent from computer A to computer B with out any data compromised.

Example of a QR bar code which would result in the public key address of where to send the medical records to).

Below is a very basic example of the type of information that the paramedic would need to access when treating a patient for the first time.
Basic example of a smart phone application
Patients Personal Details:
Name: James, Peter, Smith
Date of Birth: 09/12/1942
Address: Brisbane, Queensland.
Past Medical History:
Acute Myocardial Infarction in 2017
Coronary artery bypass in 2017 at the Logan Hospital.
Cholecystectomy in 2010 at the Logan Hospital
Osteoporosis diagnosed in 2012 by Doctor White.
Hypercholesterolaemia diagnosed in 2012 by Doctor White.

Allergies to medications:
Penicillin (Warning penicillin causes an anaphylaxis reaction)
Medications Taken:
Panadol Osteo (Analgesia pain relief)
Lipitor (For high cholesterol)
Aspirin (To stop the blood from forming clots)
Warfarin (To stop the blood from forming clots)

Number of contacted ambulances and why:
01/01/2017: Chest pains, paramedic crew administered 300mg of Aspirin, 0.4 mcg GTN, 5mg of Fentanyl. Patient transported to the Logan hospital. Logan hospital diagnosed the patient with an Acute Myocardial Infarction. Patient was admitted and a coronary artery bypass surgery was completed on 02/01/2017. Patient was discharged on the 03/01/2020 with a prescription of lifelong aspirin and warfarin.
01/01/2018: Mechanical fall from standing height to the fall. Paramedic crew lift assisted the patient to their feet. Transport refused by the patient, no treatment from the paramedic crew, no diagnosis made.
01/01/2020: Chest pains, paramedic crew administered 300mg of Aspirin, 0.4 mcg GTN, 5mg of Fentanyl. Patient transported to the Logan hospital. Logan hospital diagnosed the patient with unstable angina. Patient is referred to a cardiologist for and awaiting an echocardiogram on the 01/02/2020.
This section is for the patient’s own information which allows them to understand and take an interest into their own health.

What are your medical conditions?
• You suffered an Acute Myocardial Infarction in 2017 or more commonly known as a heart attack. This means that the muscle around your heart was not provided with enough blood supply which is rich in oxygen and is now unfortunately a lot weaker it originally was.
• After the acute myocardial infarction, you had an operation called a coronary artery bypass in 2017 at the Logan hospital. This means that the Cardiologist Doctor took a vein from your right leg and placed it into your heart to bypass the blood supply so that this blood supply can still continue to perfuse the muscle around your heart.
• On 03/01/2017 you were discharged from the Logan Hospital and prescription of lifelong aspirin and warfarin. This is to stop your blood from clotting so that a clot does not occlude a blood vessel in your brain causing a stroke.
Patients normal GP:
Doctor David White, located at Brisbane medical centre, contact number: 12345.

Body of review
The strain on the public health system is becoming more apparent every year despite large amounts of government spending. My personal opinion is that the Queensland Ambulance Service should be utilising already existing technologies to improve efficiencies which would cut costs. Governments sectors should always be collecting data on their populations in order to better understand their current needs and using this data to make services more efficient. The medical phone application that I’m proposing is aimed at people within Queensland who suffer from chronic health problems and the elderly who are continuously contacting ambulances. The transfer of medical data would greatly reduce the time that a paramedic has to stay on scene with the patient and would assist the paramedic and hospital to build up a better treatment plan for the patient. For example, if a patient contacts an ambulance because they have pain in their right shoulder once the paramedic has access to that patient’s medical records via the app they will be able to see that the patient was diagnosed with chronic right sided bursitis and therefore an AMI is highly unlikely. Once a person has been discharged from a hospital a medical receptionist will update their application either by them manually in putting the new data in to the patient’s phone or the data could be blue toothed across using the hospital system.

Currently in Queensland when a person wants to contact an emergency service ambulance, they are required to dial 000. The call will then be connected to a comms operator who will start to go through a series of questions with the aim of trying to assistant how serious the medical problem is and what code should an ambulance be sent to the calling patient. During the questioning there are certain key words that the calling patient must answer, and these key words will determine what code the ambulance is sent either code 2 which is normal road speed obeying all traffic rules or code 1 which is lights and sirens with the ability to proceed safely through red lights.
When the paramedics are on route to the incident, the crew are able to gain limited updates about the calling patient such as their name, age and what symptoms they currently are experiencing.
Once the paramedics are on scene and have located the patient the treating paramedic will start to complete their own series of questions. All paramedics will have their own questioning methods but normally all basic questioning will start such as:

Paramedic Basic Questioning:
• Why did you contact an ambulance today and what symptoms are you currently experiencing today?
• When did these symptoms that your experiencing start?
• Have you seeked an appointment with your local GP about these symptoms?
• If you have any pain symptoms have you taken any analgesia to relieve the pain?
These basic questions should be enough for the paramedic to determine whether these symptoms are chronic or acute life threatening.
Discussion
Unfortunately, the vast majority of ambulance call outs are not in my own personal opinion classed as non-emergencies (non - emergencies means that the patient’s life is not presently not in danger). The vast majority are for chronic health problems such as where a patient has already been assessed by their local GP or is already known by a hospital.
Using my own personal experiences, I have come to the conclusion that the general public’s knowledge on the most basic of medical subjects and conditions is extremely poor. I can only narrow this down reason down to 3 factors.

1. Doctors are not clearly explaining to their patients what their medical conditions are in a way in which that the patient fully understands and what type of medical condition that they have being diagnosed with and why. Doctors need to spend more time communicating with their patients so that they fully understand their medical conditions however this is clearly going to take extra time and hospital waiting times are already extensive.

2. The patient will still not understand what they have been diagnosed with even though it has been explained to them. This could be because the patient has a language barrier, the patient is elderly and suffers from confusion, comes from a low socioeconomic region or has a low education.

3. A small percentage of patients are not interested in their own health or are not in touch with their own bodies. People are in denial and do not want to hear what a Doctor has diagnosed them with.

Conclusion
I believe that this DAPP should be made so basic and simple so that any persons can use it. It must be also clearly explained what type of medical conditions the patient is suffering either using clear animations or pictures. This DAPP would have limited uses for a patient’s with acute life threatening injuries. This is because a paramedic has very limited time on scene when treating a dying patient. The paramedic will simply collect the most basic information then transport that patient to the nearest hospital code 1.
Blockchain technology is constantly evolving and is not yet used by the main stream public. However as stated above Bitcoin basically proved that it can be sent from a computer to another and it will never get compromised or fail to the best of my knowledge. Other projects such as Ethereum are working to open up Blockchain technology to send much larger amounts of data faster and there are many other competitors to Ethereum all working on their own blockchains.
Patient confidentiality is always taken very seriously in the medical industry, develops of the DAPP will have to ensure that the DAPP has added security features such as passwords, finger recognition or retina eye scan.
Scaling is the ability for any blockchain to transfer data from computer A to computer B. At this present time the Ethereum blockchain does have problems with its scaling abilities however this has been recognised as one of its key problems and a huge amount of work is currently being conducted in order to reduce the scaling problems. It must also be noted that this DAPP won’t be constricted to just the Ethereum blockchain, it will be able to run on any blockchain which best services the DAPP because it would be very inconvenient and defeat the purpose for a paramedic to have to wait on scene with a patient for 30 min because it took that long for the transfer of the patients data to the paramedics iPad.
The technology that I’m suggesting is already here now however it is still in its infancy and like all new technology cost will also be a huge factor. But like all new technologies it will always be expensive in the beginning but should gradually fall.

Reference List
Elizabeth Tilley, The Courier-Mail (2017) The most popular Queensland destinations to retire. DOI: https://www.sunshinecoastdaily.com.au/news/most-popular-queensland-destinations-retire/3224682/
Number of mobile phone users in Australia from 2011 to 2019) DOI: https://www.statista.com/statistics/274677/forecast-of-mobile-phone-users-inaustralia/
Our predictions for 2020 and the decade beyond. DOI: https://exchange.telstra.com.au/our-predictions-for-2020-and-the-decade-beyond/