For any Emergency service providers, giving their service efficiently and effectively in least period of time reflects their best performance. Hospital’s Emergency department will be at their best if the ambulance reaches the site in Golden hour where life of the critical patient or injured persons can be saved. Ambulance uses the road network to reach to the patient or the accident site. Today there are many GIS based systems being developed for routing of ambulance using GPS and other real-time technologies. These systems are useful and play a major role in solving the routing problem. But now roads are so congested that it is difficult for the Ambulance drivers to travel and reach to the Patient or the accident site and from there to the nearest Hospitals.
Medisys Ambucare system has come up with a solution to this problem. Medisys Ambucare system automates the Ambulance Management System to manage the ambulance services provided by the Healthcare Organization. This module keeps track of the ambulances available for the service and also manages ambulances services ordered from external vendors. This module helps to manage the scheduled as well as the emergency services of the ambulance. It also helps to maintain the basic life support facilities provided in the ambulance if available. The availability of ambulance Rapid Response Team (RRT) or the Ambucare Team and drivers are scheduled and efficiently managed with the Real-Time Physician Communication and Coordination from the Ambulance itself using this module.
The time after receiving a call from a patient or a medical mishap if used optimally serves as a measure of the effectiveness of any ambulance service provider system. For a minimal loss of life recovery actions should be taken in time. In spite of advancement of technology in today’s world, the service providers are not well equipped. Also, problems like routing problems and traffic congestions hinder their speedy recovery action in real time. In case of an Emergency Medical Situation, medisys Ambucare System facilitates the Admin to Raise the Alert which in Turns Alert all the nearby Available Ambulance. Our aim is to save maximum number of lives in an emergency by reducing the reaction time by various means.
Medisys Ambucare system’s Registration and extracting the real-time location helps to reduce the reaction time. Another approach is by providing the shortest path to the ambulance driver in the real time.
Medisys Ambucare system allows the user to book an ambulance in minimum time frame with just a few clicks. The system will allocate the nearest ambulance by checking the constraints set by the user. The nearest hospital will be allocated to the ambulance considering real time traffic data in mind. The shortest path will be provided to the ambulance driver by the system. In case of extreme emergency, the traffic control room will be notified about the path details to clear the traffic as much as possible. The system strives to improve the system efficiency, with a particular focus on reducing the response time.
In the current system the operators respond to the requests through the phone. This system takes a lot of time and human efforts to gather all the necessary information regarding the patient and location details. Even though the emergency cases have increased, increasing the number of operators is not profitable and feasible.
3.2 . Location Accuracy:
Many a times the location provided by the caller to the operator is not accurate, which may result in increased delay. The caller may try to provide a location using any popular landmark that the operator may not know. This might also happen if the ambulance driver doesn’t not know the location or the shortest path with real time traffic to reach the given location or Hospital.
3.3. Managing Large Group of Caller:
In an operator centered scenario, when the number of callers increases at a particular time, it becomes difficult for the operators to respond to all of them. In such scenarios the efficiency of the system degrades due to the decrease in the number of customers served.
3.4 Report Generation and Analysis:
As the system is paper based, interactive weekly or monthly report generation will require lots of human efforts and time. Analyzing the reports and efficiency is difficult. Also, we cannot backup the data and hence in case of disaster the data will be lost.
4. The Main Objective of the Medisys Ambucare System:
The main objective of the Medisys Ambucare System is to automate The Ambulance Management System into a new Era of patient care delivery. The application is developed to automate the Emergency Care services in the ambulance (online/offline), the process starts from receiving the call till the patient reach to the hospital and beyond.
5. The Main Features of the Medisys Ambucare System:
6. Medisys Ambucare Workflow:
The core structure of the medisys Ambucare System comprises of four basic Roles, namely, Call Registration & Assigning Ambulance, The Ambucare Team and The Physician. Besides, there are Integrated Staffs scheduling System, Stock Control & Inventory and Maintenance of the Ambulance which will be used by the Admin Panel.
Medisys Ambucare System has Two Options to register a request for an Ambulance.
Upon receiving a call for an Ambulance – The Operator will register the call as a request for an Ambulance. Any call to the Call Center or the Operator will be registered by the System. The caller’s Location, NID and Contact Number will be saved in the system. When the Patient Location or the Case Location is entered in to the system, System will calculate and display the estimated distance and Time required for the nearest available ambulance to reach to the patient location or incident site by En-routing the shortest possible way using the GPS to reach to the location. And Thus, Medisys Ambucare system helps the Ambucare Team to serve maximum cases efficiently by minimizing the response and en-routing time.
System facilitates Auto Assignments of Ambulance Team which is nearest to the location as well as having the facility to manually assignment of the Ambulance by the Operator.
If the Caller doesn’t want to reveal his identity, System has an option to register the request as unknown with just a click.
The Operator has the facility to monitor All the Available Ambulance, Ambulance Occupied with the Patient, Ambulance Needs to be Sanitized and Not Available Ambulance – which are displayed in his screen by the System with color coding and can be seen from the same screen.
The Medisys Ambucare Android App helps to improve the situation assessment of the operators by relying less on oral communication. The emergency situation is monitored by the pre-registered information and real time location [4]. An Android App is designed from which the Patient can register a request for an Ambulance. User needs to provide the location by enabling GPS in his device and allowing the system to access his/her location or they can enter the location in the given textbox. The system also has the option to enter the severity of the case and in case of a medical mishaps – The caller can mention the number of possibly affected peoples. After completing all the necessary steps the request is sent to the nearest available Ambucare Team by the system. This module uses Google map API [5] to provide the location coordinate by using Geo-coding. Users are notified about the allocated ambulance and the estimated time.
The Ambucare Team – Teams up with the Following personnel:
The Vehicle (Ambulance) should be equipped with life saving device like external defibrillator, Nebulizer equipment, Oxygen Cylinder, Life saving Drugs etc. All disposable items are integrated with the inventory stock control system. The Ambucare Team should always check their On Hand Stock Quantity though the System will display notification to the Team if the On Hand Quantity reached the Re-Order Point. The Team should Refill the Quantity if it reaches to re-order point. Besides, Medisys Ambucare system has option to exchange the stock by requesting and receiving the items using the system and the system will updates their On Hand Quantity and will send a notification to the Admin Stock control department.
Medisys Ambucare System has the facility to Schedule the Ambucare Team with the registered vehicles (Ambulance) and has the option to define the contact person within the Team. All the scheduled Team is available and stands by as per their duty schedule. The contact person is responsible to communicate with the Operator, Patient, Physicians and the Hospitals.
The Team will be equipped with the Android devices where Medisys Ambucare System is preinstalled. The Team is supposed to be always logged-in to the medisys Ambucare App. Usually, The Android device is designed to be used as a wearable in the forearms of the Ambucare Team members.
Once a request for an ambulance is registered by the operator or by the patient himself, Ambucare system will automatically notify the assignment to the available Team who is located nearest to the location. The system will vibrate till the Teams take Actions on the request.
The Team has option to accept or Reject the Assignment. If rejected, cause of rejection has to be selected from the list which will be in turns notified the operator and the Admin.
Medisys Ambucare system has the facility to define the Time Limit for the Team to response if there is a request assign to the Team. If the Team doesn’t respond within the pre-defined time limit, system automatically search for the next nearest available ambulance and will assign the request to that Team.
Once the Ambucare Team – Accept a request, System will En-route the patient location in real-time and display the route on the screen and guide the driver to the patient location. If the Vehicle starts moving from the stationed location – system registered the movement as start for the patient location and records with time-stamped. Once the vehicle reaches to the Patient location, system registers the time as arrived at the scene. The receiving patient inside the Ambulance will also be recorded with the time stamp. After receiving the patient inside the Ambulance system will automatically search for the nearest hospitals and en-route the destination hospital from the patient location.
Paramedics and Nurse will start screening the patient – Medisys Ambucare system has the facility to enter the patient screenings vital parameters like Chief Complaint, ICD-10 Diagnosis, and GCS Coma Score etc.
Fig: Patient Screening Tab
Medisys Ambucare system has the option to enter the patient vital sign manually and as well as automatically if the patient is assigned to the device like defibrillator. In That case device integration will be required and The Medisys Ambucare system is capable of saving and transmitting on line and off line data. Medisys Ambucare System facilitates the Ambucare Team (Paramedic and Nurse) to enter patient Vital Sign into the System and based on the entries system generates the graphical presentation of the patient cumulative vital sign, MEWS Scores and patient status which can be immediately seen by the Physician if needed.
Besides, If any ECG done within the Ambulance – The ECG result (The Image) of the ECG Result can be displayed to the physician and the Triage Level of the Patient can be determined as well using the Ambucare System.
Medisys Ambucare System has the Facility to establish communication between the Ambucare Team and the available scheduled physician. System has the option to transmit all the patient data in available with the Ambucare team to the Physician’s Panel in the real time. System has the facility to chat, exchanging messages, Transfer images and audio-visual conferencing system.
Once the Patient has been received by the Team – System Automatically records the receiving time and display the nearest hospital as the destination. System will en-route the destination and displays the map and with estimated duration to reach to the Hospital.
For some reason, the nearest hospital is not equipped with the treatment facility require for the patient, the Ambulance Driver can change the destination hospital.
Besides, the Physician and the Admin also has the option to suggest the destination hospital specialized and equipped with the facility to provide the required treatment for the Patient. In that case, the Ambucare Team will receive a notification from the Physician or Admin. The notification displays the suggested hospital to the Team. Once accepted the notification, the system Re-routing the Destination Hospital with the shortest distance and display route of the suggested hospital in real time by using GPS.
Medisys Ambucare System is fully compatible to integrate with any HIS developed maintaining the HL7 standard. If the Ambucare system is integrated with the HIS, system is capable to transmit all the Patient information, Screening results, GCS, Vital sign info, Triage level, ECG result etc. to the Hospital’s HIS prior to reach to the Hospital.
When the Ambulance reaches to the Hospital, system displays a notification to the Ambucare Team regarding the Arrival at the Hospital and records the Arrival Time.
The Ambucare team handed over the Patient to the Hospital Emergency Department by discharging the patient from the Ambulance with Discharged Summary Notes. System records the discharged time.
Fig: Discharge Patient from the Ambulance
If the Ambucare system is integrated with the HIS, system is capable to transmit all the Patient information, Screening results, GCS, Vital sign info, Triage level, ECG result etc. to the Hospital’s HIS prior to reach to the Hospital and thus helps the Emergency department Rapid Response Team (RRT) to be ready and equipped with the lifesaving intervention.
After Patient Discharged, The Ambulance departs from Hospital to the base Station. In the Station, The Ambulance may need to get sanitized which might take some time. There is pre-defined time limit to get a Team Ready. Otherwise, the Admin can notify the Team if takes more than the pre-defined time limit to get ready.
Medisys Ambucare system Records all the Events of the Team with the Time-stamped.
Fig: Depart From Hospital, Arrived at Station & Ready for Next Request Event
The Medisys Ambucare System has option to schedule the Physician duty Rota and the scheduled Physician will be available always On Line and using the Application. The Physician can see the detailed list of the Patients in Each Ambulance with the Team Details and can initiate the communication with any Team.
The Physician’s has to option to simultaneously communicate with the multiple Ambucare Team. They can see the Patient details of Each Ambulance and once communication between the Physician and the Team established, they can see all the medical details like Patient screening results, Vital Sign with the Graphical presentation, ECG Results, Medication administered to the Patient and the devices connected to the patient etc.
The Medisys Ambucare Communication Panel between the Ambucare Team and Physician has been designed and developed to initiate communication in the Real-Time between the Ambucare Team and the Physician. All the Patient Data entered in to the System will be seen by the physician with the color coding and if the Physician Ordered Any Medications, or to provide any services to the Patient – The System displays those Orders in a separate color in the Ambucare Team’s screen and if the Ordered are administered the Physician can see the status of his Orders.
Medisys Ambucare System Admin Panels has Option to Track and Monitor all the Activities of the Operator, the Ambucare Team, and the Physician Panel. The Admin Panel has the Access to all the Setups and Security Access related setups.
The Admin Panel is responsible for testing the efficiency of the Ambucare Team and as well as the System. Monthly/periodic reports will be generated. These reports will consider the number of requests received, not of shortest path provided, number of requests processed, Number of lives saved, Total cost, overall ratings and review by the clients. Pie charts, graphs will be generated monthly. Let the total Number of requests be N and the Number of requests processed be P, then Request Acceptance Ratio (Ar) = P/N The Request Acceptance Ratio (Ar) will be between 0 and 1. For higher efficiency it should be as close as possible to 1. Let the Number of shortest path allocated be S, and Number of times ambulances reached in expected time be T, then Efficiency of the system = (P*T*100)/(S*N) Efficiency will be in percentage. If the efficiency of the system in initial month is higher than 85%, then it can create a possible difference using technology for social good.
Various challenges faced by the existing Ambulance Management system and the difficulties faced by them in day-to-day life are considered and to overcome those challenges The Medisys Ambucare System has been developed. The medisys Ambucare System’s newly designed user-friendly interface and easy to use system will help this sector to reduce to the reaction time of processing request and increasing the accuracy of the system. The Ambucare system makes use of Google map Api for shortest path, provides better allocation strategies and coordinate with Traffic control room in cases of extreme traffic. Thus, it allows the system to serve maximum users and thus save lives.