Automatic Information Exchange in the Early Rescue Chain Using the International Standard Accident Number (ISAN)

Thus far, emergency calls are answered by human operators who interview the calling person in order to obtain all relevant information. In the near future—based on the Internet of (Medical) Things (IoT, IoMT)—accidents, emergencies, or adverse health events will be reported automatically by smart homes, smart vehicles, or smart wearables, without any human in the loop. Several parties are involved in this communication: the alerting system, the rescue service (responding system), and the emergency department in the hospital (curing system). In many countries, these parties use isolated information and communication technology (ICT) systems. Previously, the International Standard Accident Number (ISAN) has been proposed to securely link the data in these systems. In this work, we propose an ISAN-based communication platform that allows semantically interoperable information exchange. Our aims are threefold: (i) to enable data exchange between the isolated systems, (ii) to avoid data misinterpretation, and (iii) to integrate additional data sources. The suggested platform is composed of an alerting, responding, and curing system manager, a workflow manager, and a communication manager. First, the ICT systems of all parties in the early rescue chain register with their according system manager, which tracks the keep-alive. In case of emergency, the alerting system sends an ISAN to the platform. The responsible rescue services and hospitals are determined and interconnected for platform-based communication. Next to the conceptual design of the platform, we evaluate a proof-of-concept implementation according to (1) the registration, (2) channel establishment, (3) data encryption, (4) event alert, and (5) information exchange. Our concept meets the requirements for scalability, error handling, and information security. In the future, it will be used to implement a virtual accident registry.

Prediction of Occupant Injuries for Improved eCall Efficiency

Especially in emerging markets, no emergency infrastructure is established. In case of an accident, passing road users need to call for help or the ambulance. An automated eCall to friends, family or in future directly to the rescue control with transmission of GPS position, probable injury pattern and injury severity could significantly improve the rescue chain and would save lives in large scale. Initial approaches to the prediction of an injury pattern were investigated in this paper. A simulation model of a reference vehicle and with a hybrid III 50 percentile dummy was built by using the program MADYMO. A large amount of real accident data was processed using an algorithm created in MATLAB. This made it possible to adapt the acceleration data with identical rules and to determine the different restraint system ignition times. The algorithm allows the data to be used in the simulation model. Furthermore, the corresponding accident descriptions were analysed and translated into protection criteria level by means of literature. For the subsequent evaluation, the assessment protocol (Version 8.0.3) of the European New Car Assessment Programme (EuroNCAP) was used. To validate the model, an ordinal rating system was created to compare the ratings of the simulation and the injury descriptions. The results indicate a good prediction of the injury patterns with an agreement of 39.56 percent. Especially considering that a large number of influencing parameters are unknown.

Proposing an International Standard Accident Number for Interconnecting Information and Communication Technology Systems of the Rescue Chain

Background The rapid dissemination of smart devices within the internet of things (IoT) is developing toward automatic emergency alerts which are transmitted from machine to machine without human interaction. However, apart from individual projects concentrating on single types of accidents, there is no general methodology of connecting the standalone information and communication technology (ICT) systems involved in an accident: systems for alerting (e.g., smart home/car/wearable), systems in the responding stage (e.g., ambulance), and in the curing stage (e.g., hospital). Objectives We define the International Standard Accident Number (ISAN) as a unique token for interconnecting these ICT systems and to provide embedded data describing the circumstances of an accident (time, position, and identifier of the alerting system). Materials and Methods Based on the characteristics of processes and ICT systems in emergency care, we derive technological, syntactic, and semantic requirements for the ISAN, and we analyze existing standards to be incorporated in the ISAN specification. Results We choose a set of formats for describing the embedded data and give rules for their combination to generate an ISAN. It is a compact alphanumeric representation that is generated easily by the alerting system. We demonstrate generation, conversion, analysis, and visualization via representational state transfer (REST) services. Although ISAN targets machine-to-machine communication, we give examples of graphical user interfaces. Conclusion Created either locally by the alerting IoT system or remotely using our RESTful service, the ISAN is a simple and flexible token that enables technological, syntactic, and semantic interoperability between all ICT systems in emergency care.

Impact of the SARS-COV-2 outbreak on epidemiology and management of major traumain France: a registry-based study (the COVITRAUMA study)

Background Emerging evidence suggests that the reallocation of health care resources during the COVID-19 pandemic negatively impacts health care system. This study describes the epidemiology and the outcome of major trauma patients admitted to centers in France during the first wave of the COVID-19 outbreak. Methods This retrospective observational study included all consecutive trauma patients aged 15 years and older admitted into 15 centers contributing to the TraumaBase® registry during the first wave of the SARS-CoV-2 pandemic in France. This COVID-19 trauma cohort was compared to historical cohorts (2017–2019). Results Over a 4 years-study period, 5762 patients were admitted between the first week of February and mid-June. This cohort was split between patients admitted during the first 2020 pandemic wave in France (pandemic period, 1314 patients) and those admitted during the corresponding period in the three previous years (2017–2019, 4448 patients). Trauma patient demographics changed substantially during the pandemic especially during the lockdown period, with an observed reduction in both the absolute numbers and proportion exposed to road traffic accidents and subsequently admitted to traumacenters (348 annually 2017–2019 [55.4% of trauma admissions] vs 143 [36.8%] in 2020 p < 0.005). The in-hospital observed mortality and predicted mortality during the pandemic period were not different compared to the non-pandemic years. Conclusions During this first wave of COVID-19 in France, and more specifically during lockdown there was a significant reduction of patients admitted to designated trauma centers. Despite the reallocation and reorganization of medical resources this reduction prevented the saturation of the trauma rescue chain and has allowed maintaining a high quality of care for trauma patients.

An Analysis of the Socio-Economic and Human Life Impact of Implementing the eCall In Vehicle System (IVS) in the Purpose of Ensuring Sustainable, Improved Rescue Operations on European Roads

Ensuring a higher degree of road safety contributes both to the quality of transport services and to the level of the costs involved in rescue operations. The initiation points of managing a rescue operation are situational awareness on accident detection and the appropriate assessment of the required resources. The eCall in Vehicle System (eCall IVS) for passenger vehicles aims to minimize rescue team arrival times to accident sites, and meet assignment needs in the rescue chain. Implementation costs and benefits for the eCall IVS have been investigated, providing implications for rescue operations management. The findings show that the benefits of eCall IVS implementation outweigh the costs, and savings achieved in the rescue operations are obtained by shortening the time to reach the place of the accident and by efficient intervention through a more accurate allocation of the necessary resources, due to timely and relevant information.

Tracheal Transection—A Novel Airway Management

Background Traumatic injury of the trachea is rare, especially complete transection. Its operative revision requires an interdisciplinary approach. Case Description We hereby present a rare case of complete transection of the trachea by accident. To stabilize the patient and to allow for safe surgery, veno-venous extracorporeal support was initiated via the subclavian artery and the femoral vein. The patient was subsequently operated, and the trachea re-anastomosed with favorable outcome. Conclusion This rare case of an accidental transection of the trachea shows the importance of a good emergency rescue chain and the ability to facilitate interdisciplinary approaches in tertiary hospitals.