E-mergency project report

E-mergency
Better first-aid for all

03Design Engineering | E-mergency
TUTORS
Martin Pärn
Ruth-Helene Melioranski
Janno Nõu
PARTNERS
Ministry of Social Affairs
THE TEAM
Aslı Atalay
Management engineer
Maret Martsepp
Product engineer
Tõnis Voitka
Process production engineer
Holger Mets
UI Designer

Table of Contents
The Future of Health 05
Research07
Research methodology 07
Literary research 08
INTERVIEWS10
FINDINGS12
Observation14
Defining the problem areas 14
Insights14
Existing solutions 15
SUMMARY15
Concept phase 17
Analysis of initial research 17
Journey map 18
Creating concepts - brainstorming 18
Concept generation 19
Evaluation of the concepts 19
Concept Development 20
Current System 21
Proposed system 21
E-mergency23
SMARtphone application 23
FEEDBacK25
Analysis conclusion 26
IDEA for the future 26
REFERENCES and Resources 27

The Future of Health
Nowadays everybody expects a better life quality and related to that a faster and better service in every
field of life. The aim of this project was to find a specific problem or area that could be improved in
healthcare system and to propose a solution for that meanwhile keeping in mind the future of retail.
We focused mostly on finding the right area with what to work upon. After a while it came out that even
these systems that are working properly today could be improved.
Thanks to our research we found a necessary area to improve - existing emergency system. It also came
clear for us that we should leave the retail and selling part out (at least in a context of this Design Studio
project) since it is putting us in a box from where it is difficult to get out.
Research, several interviews, concepts, feedback from different parties and lecturers lead us to our
final result: E-mergency - a service that includes medically trained volunteers in the current emergency
system.

Research
Research methodology
Choosing the subject
We started to look into people groups and wanted to see what
emergencies they have in common. We divided the groups and
started to look for problems that would overlap between these
groups of people. The groups that we came up in the beginning
were the elderly, war veterans, children, people with disabilities
and people with substance abuse. From this started to talk
about that people need something that helps them in a state of
emergency, because all of these problems that we could think of
and people groups had some bystanders that were involved in
the start of the emergency or after the emergency have occurred.
We stated that people do not know how to act when a emergency
occurs and or has occurred and they could need something that
would help them. This led us to the idea of “The magic box”,
which was basically a device that would be for every person and it
could be used as a personal “health pack” for regular bystanders
to help and assist the oncoming ambulance by giving them the
vital signs of the patient
FOCUS AREA
We decided to focus on this area because there’s a need for
getting the patient data to the ambulance and to the hospital.
We stated this from the interview we conducted with Marianna
Ležepjokova. We found out that the lithuanians are using some kind
of text base system with people who have proper medical training,
we also found that the PERH is using a telemedicine system and it
shows the patient to the telemedicine doctor. From this we concluded
that giving the patient data to the hospital and ambulance before the
ambulance arrives into the scene would help the patient.
After digging into it even further we found out that even the
fastest “Delta” type call will not get the ambulance to the patient
fast enough. This is somewhat due to the drive time, but it can be
limited if the bystanders would help and get the patient data to
the emergency workers as soon as possible, because this will give
the patient location and vital signs immediately, this removes the
probability of people giving false information, over exaggeration
or underestimate the situation and gets the ambulance there
quicker, because of the positioning. This is helpful for people who
live in the countryside where there are no street names etc.
The aim of research methodology is to gather information by
using different possible and suitable methods. For our project we
used literary research, a survey, interviews and an observation
Literary research includes the statistics and also the information
about the existing solutions and products. A survey itself was
quite general to get the overall idea what to ordinary people know
about first aid. We made interviews with two doctors- one from
Estonia (Marianna Ležepjokova) and one from Turkey (Ece Kurt) to
get find out what is the situation in Europe (not only in Tallinn). We
also listened an interview with the lead instructor of the red cross
(Ellen Sternhof) at Vikerraadio. For observation we managed to
send one of our teammate to hands on participant to work with
the ambulance.

08
LITERARY RESEARCH
Emergency medical personnel handbook
The emergency medical personnel handbook (Erakorralise
meditsiini tehniku käsiraamat 2013) instructs and explains how a
call to the emergency center is carried out and what information
is necessary for the ambulance. The dispatcher determines the
seriousness of the situation by communicating with the person
calling the emergency service and based on received information
may or may not alert the police, ambulance or other forms of
emergency services. Also initial instructions will be provided by
the dispatcher. The dispatcher will be in constant communication
with the ambulance vehicle and will inform them of any changes
at the scene. In co-operation with the emergency service the
hospitals will be alerted in advance, if the situation is considered
grave enough, so that the hospital can prepare any necessary
procedures in advance before the patient arrives.
Statistics
The following statistics are are based on the first quarter of 2015, according to the Tallinn Emergency Medical Service (TEMS).
The average response time by stations are as follows (measured in minutes):
Response time is considered as the time after the crew is ready to depart in the vehicle and until they arrive at the scene.

09
As illustrated on the graph, generally as an average it takes 9,9 minutes for a complete response, from receiving the call until arriving
at the scene. If a call is identified as “Delta”, the time is decreased to 6.9 minutes, since that is the highest level of emergency that can
be assigned to a situation.
A human body is capable of surviving without any additional oxygen for 5 minutes before irreversible damage occurs, after which
generally it is unadvised to resuscitate.
VITALMOTE
In 2006 John Hopkins Advanced Physics Laboratory was
developing a system to improve the way emergency care in
prehospital situations is handled, by introducing the Advanced
Health and Disaster Aid Network (AID-N). By combining wireless
networking and medical sensors the research resulted in a
potential prototype, that would simplify tracking real-time patient
monitoring by integrating vital signs sensors, location sensors,
ad hoc networking, electronic patient records and web portal
technology to allow remote monitoring of patient status.
They defined as their “example scenario” was as follows:
“Patients at a disaster scene can greatly benefit from technologies
that continuously monitor their vital status and track their location
until they are admitted to a hospital.”
The technology-based solutions consisted of the following
components:
• Electronic triage tags with sensors
• A wireless ad hoc mesh network
• Prehospital patient care software
• A secure web portal
• A handheld PDA
The electronic triage tags continuously monitored the vital signs
and locations of patients until they are admitted to a hospital.
To assess the vitals the patient is strapped with a wristband,
placed a finger sensor on the patient’s finger and assigned a triage
category on the electronic triage tag. All of those would actively
relay transmit data to the medic’s tablet PC. The sensors would
provide three types of noninvasive vital signs sensors: a pulse
oximeter, a blood pressure sensor and a three-lead EKG providing
heart rate, blood oxygenation level, blood pressure and electrical
activity of the heart. It also includes two types of location sensing
capabilities - a GPS to provide geolocation and an indoor location
detection system.
Johns Hopkins APL Technical Digest, Volume 27, Number 1 (2006)

10
Survey
We conducted an online survey. In total we got 180 answers. From
this 39% were men and 61% were women. 46% of the people were
in between the age group of 18-23, 51% were between 24-44 years
of age. Out of this 180, 19% of people have had an accident and 20%
have been a bystander at a the scene of an accident. For people who
have been a bystander in an accident the most common emergency
situation was a car crash, heart related issues, drownings and burns.
People who have been in an accident have had mostly car crashes and
hearth related issues and cuts with household appliances.
From the survey it shows that majority of the people who answered
have had previous medical training, either in driving to school or
have had some special training courses. All of responders said
that if some kind of an emergency situation happens, then they
will call the ambulance and/or start giving first aid themselves.
From all of the answers we concluded that there’s a high chance
for a person who has been a bystander or has been in an accident
will start to give first aid to the best of his or her knowledge.
Radio interview
On 16th of October at 7:35 AM there was an interview on
Vikerraadio with lead instructor of the red cross - Ellen Sternhof.
She gave an overview about the first aid course that was given the
day before at Ülemiste shopping mall.
The medical training people taught people at the shopping mall
how to resuscitate on a mannequin for three hours. All together
they managed to train around 60 people and about half of them
were estonians. This was a pretty good number, so they counted
that event as a success.
In general people don’t understand the importance of the issue.
They don’t believe that they actually ever need to give someone
first aid. And even if they do want to learn and do that, they can
not or do not want to apply their skills in real life. People are afraid
to put a hand on anyone, touching the other person may be at
risk, and therefore preferred to stick to one side (especially if it is
a stranger), and then the question remains, what are the benefit of
training. Still it is important to share the knowledge. You might never
know when your hands are going to save someone else’s life.
Method
Follow-up questions, probing questions, specifying questions and
interpreting questions were included in the interviews in order
to collect the information that is wanted. Most of the questions
were prepared before the interviews and some of them were
created during the interviews according to interviewee’s answers.
Therefore, the interviews are semi-structured interviews.
Each interview was recorded and then transcribed.
After that, all of the interview transcripts were read and re-read
for data analysis. Furthermore, it was analysed by using deductive
research approach which is more suitable for more structured
interviews.
For data analysis and coding, firstly a set of themes were created.
Then, the interview was divided into chunks of data thanks to
underlined sentences and paragraphs. After that, these chunks of
data were categorised and sub-themes were created. Lastly, the
relations between the sub-themes and themes were formed.
INTERVIEWS

11
ESTONIA
We conducted an interview with Marianna Ležepjokova from
Põhja Eesti Regionaalhaigla. The goal of the interview was to
understand better the situation of the Estonian ambulance and
it’s current capabilities with hopes to either identify an obvious
problem or get a better understanding of what challenges they
come by, in terms of technology.
The interview unveiled various issues among the first aid and
ambulance system in Estonia.
Issues, such as the lack of reliable information from the ones
carrying out the emergency call kept circling around during the
interview, revealing that even though the interviewee’s ambulance
department was equipped with telemedicine gear, they represent
only 10% of all ambulance brigades in Estonia, therefore the gear,
due to “exclusivity” and it being overly expensive is too scarce.
Whereas the technology they use, as well as similar gear being
used on smaller islands in Estonia, provides reliable and invaluable
information for all involved parties during a medical emergency.
Also, it became apparent, that in many cases the idea of technical
equipment tends to be more intimidating, than helpful because of
it’s overly complex nature. If gear was easier to use, civilians would
be more likely to take advantage of various equipment if needed.
On many occasions Lithuanian medical system was brought up as
an example of a better and more organized first aid system. The
main example was a phone feature, which enabled quick access
to contacting nearby medically trained people in case of an
emergency, so immediate medical aid could be provided before
the ambulance would arrive. Non-utilizing medically trained
personnel is a grand issue in Estonia, as there is a noticeable
number of people with medical training among civilians, but since
there is no way to take advantage of their training in case of a
medical emergency, the potential help is being unused. But even
having medically trained people on-site would not always suffice,
as medical equipment (in terms of technical equipment or tools) in
public/easily accessible locations is lacking.
TURKEY
We conducted an interview with Ece Kurt from Turkey who works
in Sisli Etfal Hospital’s emergency center in Istanbul.
According to some statistics, as is seen, the death rate from
emergency situations is quite high so the rate of successfully
saving lives is quite low. One of the reason for this situation is
that people generally don’t or can’t do first aid when they face
an emergency situation. Before the interview, this assumption
was kept in mind and the research question was proposed like:
“Why don’t the people perform first aid in case of an emergency
situation? “
The purpose of this interview was to understand the reasons why
people don’t act during these essential times so the insights of
the people who face an emergency situation in which they need
to help were researched. Furthermore, another purpose of this
interview was to understand better the situation of the Turkish
ambulance and its current capabilities with hopes to either
identify an obvious problem or get a better understanding of what
challenges they come by, in terms of technology so the working
processes of the ambulance system and 112 service in Turkey were
unveiled in this interview.
It is understood from the interview that the inadequate knowledge,
sense of responsibility, and inadequate tools are the main themes
of why people don’t act in case of an emergency situation.
Moreover, thanks to those themes, it was reached that there is an
inefficient usage of potential first aid resources since the system
and the tools are not enough for people. Additionally, Ece Kurt
specifically mentioned that there are AEDs in many places and
even though they have an automatic system which explains how
it is used, people don’t use them or people even don’t know
their existence. Therefore, it can be said that people lack the
confidence and knowledge to use the existing technologies for
first aid since the situation is about the health which is a significant
area that people don’t want to take any risk.

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FINDINGS
Lack of confidence
Inadequate Knowledge
People are not confident, they are in panic most of the time and
they don’t know what to do or how to do in case of an emergency
situation. Unfortunately, this situation leads to time wasted during
the waiting time. (waiting time is the time between the emergency
occurs till the ambulance arrives to the emergency place)
“Yeah! I can say that people generally do not care about first aid
knowledge because they do not like to think that they could be
involved in an emergency situation. However, when they face an
emergency situation they recognise how they feel unconfident,
how they feel the panic and how the lack of knowledge causes
bad things.”
“Patients’ relatives generally call the ambulance immediately
and even if they know that they need to do first aid, they are not
confident to make a heart message, ventilatory support or to give
medicine etc…”
So, ordinary people around the patient(s) are potential first
responders for the emergency situations, because they are the
closest ones to the patient(s) and if they could act correctly during
that essential time period, many lives could be saved. So, it can be
said that there is an inefficient use of potential first-aid resources.
Lack of equipment
AEDs
Even though there is access to various AEDs in various public
locations, civilians generally do not feel confident enough, to
use said device. Even though said equipment is literally self-
explanatory with audio-guides and visual indications of how to use
the device. With no training beforehand an AED can be difficult to
use, even among professionals, who are required to train multiple
times every year to maintain their understanding of the device if
need be:
“Even if you try it once, it doesn’t matter, because you will
forget about it. This need some constat training. And for AED-s
this device can sit there, but you have to practice with it. The
ambulance drives to calls each day, but they still have trainings
two or three times a year.”
Sense of responsibility
When people face a situation that they see someone in trouble
because of the emergency situation, they want to help and they
call the ambulance. For some situations, first aid from them is
really needed until the ambulance arrives. However, they generally
don’t try to do first aid because of the sense of responsibility. They
don’t want to damage the patient, because here the situation is
related to the health which is a very significant subject.
“The main problem the civilians do not like to act even if they
assess and know the situation because they do not want to take
the risk, it is heavy for them.”
So, if the people would be sure that they won’t damage the
patient while doing first aid they would be more confident to help.

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Telemedicine as a luxury
“We have the thing that others dont - telemedicine. In total there
are about 10 ambulance centeres in estonia and from this 10 we
are the only one that uses this”
Even though information/data real-time relay should not be
considered new technology, it is apparent, that there is a distinct
lack of telemedicine devices in Estonia. Especially among the
different regions’ ambulances the gear varies vastly. For Marianna’s
brigades, using said equipment is natural and considered a part
of natural equipment, it is still leaps ahead of what others have.
Civilians, who in many cases would require said gear, are unable
to access a telemedicine device and are left with partial assistance
or provide imperfect or limited vital information to the emergency
services, who in turn relay said information to the ambulance or
hospital.
“It would be good to have a telemedicine doctor with your phone,
where you could call, maybe you don’t need an ambulance”
In many cases, having access to beforementioned device would
prevent or reduce situations, where civilians request an ambulance
unit, even though a doctor could determine, that there is no such
need, had he been provided the necessary (reliable) information.
Misused Medical Personnel
In Lithuania the ambulance has developed a first responder
system where they train regular people to be responders on
the accident site. They use some app that would let them know
where the situation is happening and who need help. From this it
is understood that there are misused medical personnel in Esto-
nia –such as voluntary defense league medics and men and
women who have served in the defense forces as a conscript or
as a paid soldier.
“For example in Lithuania, they train volunteers for first responders.
They have some kind of and app in their phones, they have a push
notification if something happens and they will get an address and
will go and help.”
Transportation between hospitals
In Estonia, there are 10 bigger hospitals and all patients are
divided between them according to their illness or the severity
of the trauma. Normally children are taken only to children’s
hospital, elsewhere only for specific operations that could not be
done there.
For transportation, normal hospital cars are used, but in a case of
a greater emergency and unstable patient a next level emergen-
cy car will be used (reanimobiil). This would be used in two cases
mostly – to transport the patient from the accident place to hos-
pital or to transport the patient from one hospital to higher stage
hospital. Furthermore, when a patient is stable and is sent to
higher stage hospital to get some operation or otherwise when a
patient is sent to a lower stage hospital for after treatment, a
normal hospital transportation car is been used. But then again, if
the case is about severe accidents, it can be different.
“if its a small trauma, then the patient is taken to the closest
hospital, if it’s a harder and specifical think then the patient is
taken to the higher hospital and if its a child, then to the childrens’
hospital.”
“If the situation isn’t critical anymore, i mean if the patient has
been in treatment for example in the central hospital then he or
she is taken to the county hospital where the patient is closer to
his or her personal doctor. “
“…sometimes carried to the nearest hospital and from there a
next level ambulance car with a doctor moves to a higher stage
hospital.”
Necessary general vitals
“Usually they measure the patient vitals such as blood pressure,
saturation, pulse, heart rate is monitored, EKG is done when they
need a bigger picture, in most cases a heart monitor is used to
check the patient.”
It is clear, that no two accidents are the same, but understanding
in what condition human body is after a trauma or an accident/
situation, the medical personnel can determine the wellbeing of
the patient based on the four vitals. While there is no one device
to reliably deliver those numbers, the need for said information
remains.

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Observation
Defining the problem areas
Insights
We did a 24 hour shift with the ambulance workers. During which
there were five calls of which one was the highest priority call,
“Delta”. The brigade consisted of 3 persons (driver, nurse and
head-nurse) and one observer.
We had 5 calls from which 4 were charlie calls and one delta call.
Two of the charlies turned out to be stomach aches out of these two,
one was hospitalized, the other received medical care at home. The
delta call was for a person who was sleeping on the grass and wasn’t
communicating. When we got there it turned out only to be a case of
alcohol misuse and then we drove the person home.
We expected the emergency workers to react more quickly
to calls, but in fact it all varied on a specific call. For example a
person with poisoning case will not be reacted so quickly to as for
example a person with breathing problems.
What came out from talking to the ambulance workers was that
too often the exact location of the patient is questionable. They
have the address from the emergency call center, but it turned out
to be completely wrong street or even in the wrong part of town.
After the research we realized that there are mainly three different
problem areas, that we could focus on:
Emergency center (location wise)
Based on our research we found out that communication between
the bystander, emergency center and ambulance is not working as
well as it could. Often mistakes occur while specifying the location
of the patient and that means spending more time on searching
the right place for ambulance and that time should be spent on
helping the patient.
Too long time before ambulance arrives
If a bystander has called to the emergency center then from that
moment until ambulance arrives to the accident place, something
could have been done.
Unreliable information flow between the person who calling to
an emergency center
Bystanders are rarely objective while describing the situation.They
over- or underestimate their or someone else’s medical condition
due to various factors, such as panic or simple lack of knowledge.
That often leads to ambulance being requested in a situation
where it clearly isn’t an optimal use of said resource.
Our key stakeholders are the patient(s), bystanders, energency
center, first responders, ambulance and medical personnel. With
the help of our researches we tried to understand the insights of
our key stakeholders.
Time is essential for each key stakeholder
Since all of the stakeholders try to help the patient on time, they
need to react as fast as possible. The more the key stakeholders
help the patient the bigger the chance of survival is.
Location information is essential for the 112 and the ambulance
Reliable information regarding the location of the patient is
greatly needed by the 112, since they would be relaying the
call to the ambulance brigades as soon as the required data is
received. Based on research, it is quite regular for the caller to be
in a state of panic and therefore unable to provide the necessary
information in a timely manner.
Information about the vitals is essential for the ambulance and
medical personnel
The information about the vitals are taken by the 112 who assess
and categorize the situation from “alpha” up to “delta” situation.
Then the categorized alert-level is send to the ambulance so the
ambulance reacts depending on the alpha or delta situations. For
instance, the delta situations have the priority for ambulance.
Morality is essential for the bystanders and first responders
According to our research, it is found that people don’t or can’t
act during the emergency situations even though they want to
help. Why they don’t or can’t help was explained in this report.

15
Furthermore, why people want to help is another question, they
want to help because of the morality concept which exists in the
human being.
Unused medically trained first responders
Therearemanymedicallytrainedpeoplewhocouldbeusefulforthe
patient(s) as a first responder. However, unfortunately these people
are unused most of the time because they don’t know that there
is a first aid need somewhere even if the need is at the next door.
SUMMARY
Existing solutions
During the development phase we need to overcome the waste
of time derived from the lack of medically trained people at the
scene, by utilizing and making informing nearby medically trained
people easier while not adding any additional actions or steps
to the action-flow of the person making the emergency call. It
also should not influence or distract the ambulance and it’s crew
in any way. The solution itself should be taking advantage of
technological factors, while not subjecting the users to using any
new technology. While providing such means the user experience
should be kept in mind in the sense of taking into account all factors
that might affect a person in case of an emergency (eg. panic)
At the given moment, there are no solutions that could match our
proposal to match 100%. There are similaritys between all of the
existing solutions, but at the same time they are not the same as
what we propose. Just to be more clearer, here is the comparison
of similar solutions
VitalMote - It is a device that combines wireless networking and
medical sensors. The research resulted in a potential prototype,
that would simplify tracking real-time patient monitoring by
integrating vital signs sensors, location sensors, ad hoc networking,
electronic patient records and web portal technology to allow
remote monitoring of patient status. The biggest disadvantage
is that it’s ment for hospital situations Voluntarius - It is a NGO
that is based in Lithuania, Kaunas. They seem to be a voluntary
organization that has members who have gone through a medical
training and are able to provide help when they are contacted via
TXT message.
United Hatzalah - Israeli based organization that is coverd mostly
by volunteers. Volunteers carry a GPS guided phone and when
they reviece a message, they are obligated to react and go to
the site. The volunteers are given the equipment nessecary to
provide first aid. They are in some cases a replacement for the
existing ambulance and in some cases they are co-existing with
the ambulance. Some people may even do it as a replacement for
mandatory military service.
Scanadu scout - A medical device that scans your vital signs.

Concept phase
Analysis of initial research
We started to look into all possible stakeholders or groups of people that could be our “customers”,
we wanted to see if there were any similaririty’s in them. We pointed out the elderly people, people
with disabilitys, war veterans, substance abuse etc. We scheduled meetings with the ambulance work-
ers, to get more insight form their perspective. We ended up meeting with Marianna Ležepjokova,
who is the head of the nursing department. From the interview we concluded that there is a need for a
volunteering system. We started to look more into the volunteering or growdfunding options, we saw
that there are bystanders that are present at each emergency.
We wanted to find a way how to use those people, by for example giving them the tools neccesary
to help the patient, but as we dug deeper we decided to do a online survery where we found that
people who have been in accidents or have witnessed accidents tend to help as as much as they can
and people who have not been in accidents think they would help. But as it turns out, people lack
the proper and neccesary medical training and most of the time are more afraid of hurting someone
rather than providing life saving medical treatment.
So that’s why we decided to focus on people who have medical training, such as doctors, nurses,
paramedics, ambulance workers, red cross volunteers etc. From here, we started to talk to ambulance
and call centers - they gave us the green light for the project and were even willing to help us to give
proper training to the volunteers.

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Journey map
Creating concepts - brainstorming
IDEA GENERATION
With the help of our research, we understood the problems of
the existing first aid system deeply and this understanding created
an opportunity for us to improve the existing system: there is an
inefficient usage of potential first aid recourses.
Therefore, we started to do brainstorming by considering the
different scenarios in order to see the different ideas which could
be a part of our concept.
Firstly, we considered different emergency scenarios such as an
alone middle age man having a heart attack at the shopping
centre, multiple car accident, a girl having kidney stone trauma in
the airport, a drunk woman on the street etc.
We analyzed these emergencies by creating history lines and
timelines so that we can reach the problems for each step of the
emergency service.
Problems
Patients and the bystanders mostly lack the first aid knowledge
and generally they do not know what to do in case of an emer-
gency except calling 112.
Ambulance arriving time to the sight is sometimes too long
(depending on a situation).
Finding the correct location of the call takes time.
There are pointless delta calls which are wasting the ambulance
time.
After that, we tried to find small ideas to solve those problems
and listed them.
UNEXPECTED HEALTH ISSUE
AMBULANCE
PASSING
OUT
INJURY /
WOUND
HEART
RELATED
ISSUE
STROKE
HOME
STREET
TRAFFIC
PUBLIC
LOCATION
WORKPLACE
REACTION
TIME
NOT
NEEDED
(33%)
UNKNOWN
ASSISTANCE
PROVIDED
WHAT TO DO?
CPR
CHANCES OF
SURVIVAL
DECREASING BY 20%
EVERY MINUTE
CHECK
VITALS
ASSESS
SITUATION
NO GEAR
AVAILABLE
CALL 112
DIFFICULTY
EXPLAINING
LOCATION
VITALS
CHECKED
(AGAIN)
PHONE LOW
ON BATTERY NO ACTIONS
TAKEN
WRONG HELP
PROVIDED
CHANCE OF
SURVIVAL
DECREASED
INCREASED
DAMAGE TO
PATIENT
ON-SITE
PROCEDURES
EN ROUTE
TO HOSPITAL
INFORMATION
TRANSFER TO
HOSPITAL IMMEDIATE
HELP
REQUIRED
NO TRAINING/
EXPERTISE
HOSPITAL
FUTURE
HELPING
LIKELINESS
CLOSE TO ZERO
PANIC
FEAR OF CAUSING
HARM
LACK OF KNOWLEDGE
/
UNSURE
MANUAL
METHODS
AUTOMATED
EXTERNAL
DEFIBRILLATOR
PATIENT/
VICTIM
OBSERVER
/BYSTANDER
MEDICAL
PERSONNEL

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Concept generation
Evaluation of the concepts
By combining the possible solution ideas and considering the
related stakeholders, we developed different concepts:
1. Wearable device that tracks your vitals and will alert your
dedicated doctor, who has access to your medical history, when a
medical issue occurs. Wearable device is a preventative method
for people with chronic diseases.
2. Second concept is collaboration between Red Cross and
volunteer first responders who are gathered into one database
based on some special event or location. This provides more
ambulance brigades where there is one medically trained person
and volunteers who obey the given order from that person. In
this concept, bystanders are using an app for getting the reliable
vitals from the patient and send the information to the ambulance
brigade and hospital.
3. World-wide doctor system: An application for people who are
travelling. When they have a trouble, they can see the avaliable
doctors on the portal and make communication with them. The
doctor can see the medical history of the patient and can help the
patient more correctly.
As it is understood from the three concepts that we created,
these concepts are independent. First one which is a wearable
device and the third one which is a worldwide doctor system are
preventative methods for emergency health situations while the
second concept which is collaboration between Red Cross and
volunteer first responders is not only preventative but also helping
the existing system to increase the efficiency.
We evaluated these concepts and decided to continue with
the second one since we think that the value of increasing the
efficiency of the existing system by using the opportunity that we
found is very high. Therefore, we decided to focus the second
concept and improve it.
Initial ideas
An app that you can use when you feel bad and it will send your
location to the hospital and closer relative
Passive wearable device that keeps tracking the vitals of the
person and when the patient has abnormal vital, the wearable
sends the vital to the hospital
DNA Tests to see the genetic diseases
An app, where you can pick the symptom that the patient has and
then shows a video which act out correctly in this kind of situation
Airbag for protection for head before falling down
Wearable AED
Educational board game
Medicine that prevent diseases
Public space BIO-SCANNERS for transmittable diseases
Telemedicine
Medical robots (speaking, making announcement, doing AED…)
Public health kit with voice guidance
TV commercials (increasing the awareness of people)
Air bag floor
After we created the listed ideas above, we evaluated them to
eliminate or combine some of the ideas.
new list of ideas
Something (a device) for measuring vitals without any special
medical knowledge
Something (a device) that sends the measured vitals to ambulance
and hospital
Something (a device) that is letting the first responders know what
and where happened
Something (a device) that enables bystanders and/ or first
responders to use kind of telemedicine with doctors without
having any extra device with them
Something (a device) that could simplify monitoring multiple
patients at once during a emergency situation.
An online first-aid service which you type / select the symptoms (or
the device asks the person) and then it is telling the person what
could be the problem and what should be done in this case
Do-it-yourself tests at home, such as inflammation, low blood
sugar, blood pressure, temperature etc.

20
Concept Development
The initial chosen concept idea was the collaboration between
Red Cross and volunteer first responders who are gathered into
one database based on some special event or location. This
provides more ambulance brigades where there are medically
trained person and volunteers who obey the given order from that
person. In this concept, bystanders are using an app for getting
the reliable vitals from the patient and send the information to the
ambulance brigade and hospital.
This concept idea is analysed, evaluated and improved. The main
point in this concept is to utilize the volunteers, who are medically
trained people, in the existing system. Moreover, here the
bystanders are also being utilized thanks to the application for the
vitals. However, we thought that it is not a really good idea to give
the responsibility to the bystanders who are not medically trained.
Furthermore, we though that only sending the vital information
of the patient through the application is not enough since not
only the vital information of the patient but also other situations
of the patient and location information are critical points that are
needed by the ambulance. Therefore, we approached to this
concept several times to find the best way to utilize the volunteers
effectively without making the existing system complicated.
Finally, we agreed on the areas that we should focus in order to
develop our concept.
Focus areas and strategic decisions about the
concept
Time period between 112 is called and the ambulance arrives
to the patient:
This time period is essential since in the existing system, the only
option is waiting for the ambulance and the ambulance arrival
time is not short as much as needed. Therefore, during this time,
the volunteers should be utilized to help the patient and to share
the needed information with the ambulance.
Informing the volunteers around the patient’s area:
Based on our research, we found that there are volunteer people
who are medically trained so these volunteers should be utilized,
the volunteers are one of the key stakeholders in the new emer-
gency system that we are proposing.
Involving the bystanders without requiring the specific medical
knowledge:
Based on our research, bystanders are generally in panic and
they are not confident since they don’t want to take the respon-
sibility, they are afraid of making the patient’s situation worse.
Therefore, we decided that our concept should not give the
responsibility to the bystanders. In our concept, bystanders will
call the 112, as in the existing system.
Ease the way to find a correct location of the patient:
In the existing system, location information is supplied by the
emergency centre thanks to the explanation of the bystander so
finding the correct location for the ambulance is not very easy, it
takes time. In our concept, location information should be sup-
plied by using the existing location technology which is already
existing but not being utilized.
Getting reliable information about the vitals:
Normally, a bystander call 112 and explain the situation of the pa-
tient. During the conversation, emergency center asks the vitals
of the patient and the bystander try to understand it and give the
information. However, this information which is not certain is not
reliable. Therefore, the vital information of the patient should be
reliable for the emergency center and ambulance.
Avoiding as much subjective descriptions as possible:
Verbal explanations about the patient’s situation brings about
subjective descriptions thus the telemedicine technology should
be included in the concept.
Not adding any additional machinery to complicate the system:
We decided that we are not going to add an additional machin-
ery which could make the existing system more complicated
since we are going to use potential first aid resources to make
the existing system easier.
After we clarified the focus areas, strategic decisions and the opportunity, our concept, which is called e-mergency is created.

21
Current System
Proposed system
When an emergency occurs, first, a bystander will call 112 for help.
The call center person asks certain questions on the phone to
specify the emergency.
After saving the answers, the call will be visible to the logistics
center where the alert will go to the nearest available ambulance
brigade and it will go to the right place as soon as possible.
Additionally, there is a call center doctor working at the emergency
center. If needed the doctor becomes part of the emergency call.
With E-mergeny we are proposing to add medically trained
volunteers to the current system. When an emergency occurs,
the logistics center will not only send out the alert to the
ambulance, but also to volunteers that are nearby. By doing so,
we create an opportunity for people to have proper first-aid even
before the ambulance will arrive. If necessary, a direct contact
between the volunteer and ambulance brigade can be made to
share information about the patient and his condition. If there
is a need, the volunteer can also contact either the hospital for
further guidance or provide information about the incident to the
logistics center employee if the situation is more severe than it has
been initially set as.

E-mergency
SMARtphone application
E-mergency is a service that includes medically trained volunteers
in the current emergency system to provide faster and better
first-aid. E-mergency includes a smartphone application for the
volunteers and callers.
Smartphone application is divided into two groups. First one is the
backround application for the callers and second one is the main
application for the volunteers:
Callers (Backround Application):
E-mergency has a backround application service for callers. When
the emegency center is called, the backround application of the
e-mergency sends the location information of the caller to the
emergency center directly. The caller does not need to do anyting
else except calling 112 as usual.
Thanks to this function the correct location of the patient is found
easily by the ambulance, thus the time is saved.
Volunteers (Main Application):
E-mergency has a spartphone application mainly for volunteers.
Volunteers who are registered in the system use the e-mergency
to go for help for the patient by cooperating with the ambulance,
emergency center and call center doctor.

24
A SCENARIO
If all the alerted volunteers who are nearby do not accept the call,
the logistic center will increase the radius and alert other
volunteers to utilize them. The logistic center will repeat this
process until one accepts the call or the radius is too wide and it is
of no use to involve any volunteers.
As it is mentioned under the proposed system; when an
emergency occurs, the logistics center will send out the alert not
only to the ambulance, but meanwhile also to the volunteers that
are nearby. The logistic center will alert the volunteers who are
nearby through the e-mergency application.
Thevolunteerswhogetane-mergencyalertcanseetheemergency
situation code, location of the patient and the distance. After the
volunteer check that information, he/she can accept the call or
decline it depending on his/her suitability.
If the volunteer accept the call, he/she will arrive to the emergency
area before the ambulance. Then, check the patient’s situation,
make first aid if needed.
Via the e-mergency:
The volunteer can call the ambulance which is on the way and
share the information of the patient with a video talk.
Moreover, if needed,the volunteer can have a video talk with the
call center doctor to have the telemedicine function of e-mergency.
As it is mentioned, the volunteer can call the ambulance,
emergency center or the call center doctor, and vice versa they
can call the volunteer as well.

25
FEEDBacK
Testing the E-mergency concept is difficult without having
volunteers who are willing to be a base group, and withouth the
application for the volunteers. It also creates legal complications
for us, because we can’t send the volunteer to an actual emergency
site just to test something. In order to test, we need to have
approval from all partys and a working system that can be tested
in real life applications.
Instead we talked with different stakeholders about our concept
and all the partys were really interested in our service -
Emergency center
Emergency center thought that it would be a good solution, if
the ambulance is busy, then the volunteer could be sent to the
site, or the volunteers are close to the emergency site. They
think that there are many situations where the volunteer could be
used, they also believe that a service as such is really needed and
they would use it. Thanks to the emergency center we removed
the function for the volunteer to be able to increase the calls
priority, because of the legal rights.
Ambulance
They pointed out that if the volunteer would be there before
them, they could ask extra information about the patient,
location and other need to know information. They also found
that a service as such is currently missing from the system and is
needed to implement as fast as possible. They also mentioned
that the function for the volunteer to increase call priority is not
important, because they will decide how fast they are going to
drive and do they use sirens and or lights.
Volunteers
For the first volunteer group we are thinking of using defence
league medics and paramedics. These people allready have
gone through the training that would be nessecary to be in our
system. Each year defence league trains about 50 medics and
paramedics that would suit our system. In total there are over 25
000 defence league members who are all our potential volun-
teers.
Volunteers tend to think that they would use it but have ques-
tions about the whole system and the legal sides, are they obli-
gated to respond to every notification or they have no obligation.
They also mentioned that using smartphones in a large scale ac-
cident would be difficult, because of the communication system
would be down. The suggested text message based or pager
type of connection to the volunteer. They are also interested in
knowing who would know how much volunteers are reacting to a
call and how many calls are prognosed for one volunteer to have.

26
Analysis conclusion
IDEA for the future
As it is understood, we have determined, that since time is the
primary issue in most medical emergencies, hence the word
emergency, any solution that would help reduce the waste of
time in such cases would definitely be considered beneficial in
most medical situations that we are dealing with. Our project
would and should try and maximize the use of different useful,
yet unused resources, such as bystanders and medically trained
people.
Currently there is no system in place to utilize medically trained
people, even though they could be considered a valuable asset
in case of an emergency situation by providing on-site assistance
before the ambulance arrives. It is somewhat apparent, that in
many cases people are not being objective when assessing their
or someone else’s medical condition due to various factors,
whether they are psychological or derived from the lack of
knowledge/training.
Since it is not considered sensible nor possible to try and
educate everyone in terms of first aid, the medical volunteers
should be taken advantage of. Often enough the ambulance
is not able to arrive on site fast enough to provide immediate
first aid (in case of a heart-related issue resuscitation must be
performed on the patient before 5 minutes) and the bystanders
(including ones who call the medical service) merely do not
possess the skills to perform the needed actions.
Seeing as telemedicine in various forms is being used on some
of the ambulance vehicles we can presume that the field of
emergency services is capable and willing to take in various
technological improvements to simplify their work processes
and through which even save lives that might not be saved with
the means and methods of today. As smartphones have nearly
become household items and the numbers of smartphones is
on the rise it is also apparent that people are more willing to
accept technological solutions to improve their life in various
ways and the fear of using technology is decreasing among the
population, as long as the devices and systems that are in place
are considered user-friendly and created with that kept in mind.
As a conclusion, we have created the E-mergency which is a
service that includes medically trained volunteers in the current
emergency system to provide faster and better first-aid. Current
ambulance system works well, but sometimes it needs to be
faster therefore E-mergency utilizes the unused potential
volunteers who could provide medical first-aid as an addition to
the ambulance.
After we created the idea of E-mergency, we tested it with the
emergency center, ambulance and volunteers so that we could
figure out the problems in order to create a better E-mergency
service by developing it. For instance, we figured out an
undoable function, which is increasing the priority of the call that
e-mergency initially had and we removed that function according
to emergency center feedback. Furthermore, they all agreed that
E-mergency is needed and we should go on with it.
To sum up, e-mergency is created after the research, concept
development, prototyping, testing and development phases
and we are strongly believe that there is a real need of existing
first-aid systems in the world therefore we are quite enthusiastic
to develop E-mergency further.
Vitals scanner
Vitals scanner is a product which enables the volunteers to check
the vitals of the patient with the use of a certified and verified
technological gadget.
The volunteers use the vital scanner when he/she arrives to the
patient and automatically the vitals information of the patient
is registered in the system where all the key stakeholders (call
center, logistic center, call center doctor, related ambulance) can
access.

27
REFERENCES and Resources
www.jhuapl.edu/AID-N/Section3/Page1.aspx - Vitalmote
www.scanadu.com/products/vitals - Scanadu Scout
www.israelrescue.org/volunteers.php - United Hatzalah
www.tems.ee - Tallinna Kiirabi
www.kiirabi.ee - Eesti Kiirabi Liit
“The Future of Health” PFSK and Boehringer Ingelheim, 2014
“Are consumers ready for retail health care?” Graegar Smith, Chris Bernene, 2014
“Retail Health Care: Update on Trends in Healthcare Delivery” Alexandra E. Page, MD, 2014

E-mergency project report

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E-mergency project report