5G and smart ambulances: The future of emergency healthcare

The fuzz and buzz of two drones that hover around a smart ambulance draws everyone on the aisles of the exhibition floor to attention. 

They’re flashing red forward-facing lights, as though in an actual emergency scene, to remind everyone that emergency healthcare has moved to the next phase of rapid advancement.

The rotors then slow down, and the spinning blades slacken as the drones, carrying packets of medicine, enter an emergency room in the vehicle. Welcome to the Internet of Medical Things (IoMT).

At the Riyadh Tech Expo in Saudi Arabia earlier this month, attendees gathered round the ambulance, awestruck by the sophistication of medicare technology and religiously listening to two experts who never got tired of re-expounding how the entire combination of magic works.

“It’s all powered by 5G technology,” says director of engineering at Irish smart mobility company Acetech Valdas Bockus. 

There is reverent silence when he explains that the smart ambulance has the capability to conduct on-scene emergency treatments as all required hospital equipment are in the vehicle and doctors can video call directly into the ambulance and assess the condition of the patient via smart cameras.

“If the emergency condition is not grave, then the patient can be treated virtually. If it is too serious, the treatment can start in the ambulance,” Mr Bockus illustrates. 

5G, the fifth generation of mobile networks, offers low latency and high-speed connections. It provides higher data bandwidths and spectrum utilisation to cope with high internet data traffic. A 5G connected ambulance provides an innovative new way to connect patients, ambulance workers, hospital equipment and remote medical experts in real time. 

The doctor at the hospital is therefore able to perform an emergency surgical procedure remotely through an immersive combination of 5G-enabled technology.

A smart camera in the ambulance transmits high-definition footage to the doctor with close to zero latency. Using a Virtual Reality headset and a joystick, the doctor can then remotely guide a paramedic through a series of procedures based on haptic glove technology and attend to the patient conclusively. 

The vehicle is linked to and shares live measurements of clinical data such as the patient’s heart rate as well as their medical records. Through a robotic glove, the paramedic’s gestures can be guided via vibrations triggered by the joystick.

All these allow the doctor to recognise vital signs, access medical records remotely and ultimately respond much faster, compared to the traditional way of sending a cardiac arrest patient on a two-hour traffic-filled journey to hospital.

“To improve the efficiency of healthcare, we need to understand that not everyone needs to come to the hospital,” says Tom Clutton-Block, clinical director at University Hospitals Birmingham. 

“With this technology, we can decide a lot better whether a wound should be healed on the spot, or if it requires further assistance.”

For extremely complex emergency cases whose medicine is not available in the smart ambulance, smart drones are sent to pharmacy stores to fetch the required medicine in advance. 

And while this sounds more of science fiction than reality, it is happening in many parts of the world, and people with heart attacks, strokes, fractures, burns, deep cuts, electric shocks, seizures, breathing difficulties have all been saved from the jaws of death by such technologies.  

In the United Kingdom, for instance, a smart ambulance service has been rolled out to serve stroke patients. With millions of brain cells dying after every blood clot in the brain, immediate attention becomes key to saving the lives of stroke patients.

“Imagine the difference it would make if you could start treatment in the ambulance. Every 15 minutes a stroke is untreated takes three years off someone’s life,” says Alan Lowe, chief executive of Visionable, the UK video call platform that runs the smart ambulance system.

As CT scanners decrease in size, they’ve become portable and the presence of a 5G internet connection means huge chunks of live medical data can be transmitted within seconds while the ambulance is on move, which helps doctors in ICU units make decisions on patient care beforehand. 

IoMT denotes an amalgamation of medical devices and applications that can connect to health care information systems using fast internet. Emergency response intelligence is designed to assist first responders, paramedics and hospital emergency department care providers.

In 2015, the United Kingdom, Spain, Netherlands, Finland, Denmark and Portugal started a smart ambulance project that has now become a European procurement system for emergency facilities.

It allows them to demonstrate, evaluate and deliver new models of in-community healthcare delivery, with the primary objective of avoiding unnecessary hospital attendances and the associated patient distress and hospital costs. 

A study from the project blueprint suggests almost half of emergency cases can be handled on the spot without the need of hospital care. 

Medics can now give an accurate early diagnosis in the so-called ‘golden hour’ after an incident that could decide the fate of the patient.

Declan Henegan, editor of Ambulance Today Magazine says most smart ambulances are equipped with modern technologies, so the ambulance crew can actually work with people inside the hospital.

“That also means that the quality of the diagnosis made on scene within the ambulance is more accurate and the patient goes to one particular hospital instead of another,” he says.

Malaysia’s emergency medical services operator, First Ambulance, is transforming its entire fleet into smart ambulances by utilising the built-in WiFi in the vehicles to transmit critical patient data such as electrocardiograms and ultrasound images to hospitals while the patient is still en route.

“It gives us a bird-eye’s view of the entire fleet to help us make timely decisions each day to optimise our operations,” says Steven Penafort, First Ambulance director.

Institut Jantung Negara (IJN) emergency department manager, Dr Farina Mohd Salleh, says the solution has enabled IJN to reduce its door-to-balloon time by half for stroke and heart attack patients. Door-to-balloon time means the time between the arrival of a patient in the emergency room until the time that a balloon is inflated in the occluded, culprit coronary artery. “The service is helping us save lives.”

In Thailand, where the mortality rate of patients in emergency care remains high, the smart ambulance solution seems to be the only way out.  Smart ambulance rescue teams in the country wear Augmented Reality (AR) glasses that send images back to hospitals in real-time. 

Doctors can monitor patients’ symptoms such as stroke, internal injuries due to accidents, trauma wounds or electric shocks. 

Using mobile CT scans and mobile x-rays, including mobile ultrasound on the ambulance to speed up the scanning process by 30 minutes, the solution is expected to save thousands of lives.

The state-run Nopparat Rajathanee Hospital treats 3,000 patients per day so the ambulance assistance could be as important as an emergency room. 

Chalermpon Chairat, chief of the hospital’s emergency department, says the hospital’s ambulances have now been converted into smart vehicles over the 5G network, where CCTV cameras can live stream all activity in the hospital in what is called the ‘Smart Intelligence Network.’

Another smart piece of equipment is the ventilation system that pushes air out of the vehicle and wards off the risk of infection, which is particularly very critical during the Covid-19 pandemic.

The new smart ambulance model is helping Thailand improve diagnostic and treatment procedures as well as the communication between paramedics and doctors to finally ensure their better preparation before patients are taken to the hospital.

UK’s ambulance manufacturer, WAS, says it develops 1,300 vehicles a year using the latest developments in technology to ease the handling of patients and care. 

The vehicles use a variety of virtual onboard “assistants” to ensure the highest efficiency during rescue operations. 

The WAS smart assistant takes an automatic inventory of all onboard medical consumables and equipment, giving medics real-time information on expiry dates of medicine, usage, maintenance and intervals.  

Using advanced Radio-frequency identification (RFID) technology, this can be monitored on the move.  Meanwhile, the WAS Door Assist System erases excess noise by ensuring all the doors in the WAS box body close quietly.  

The paramedic guides the door to the first latch on the closing device and the door is then automatically pulled into the seals, quietly and without producing any vibrations.  

In Britain’s streets, Artificial Intelligence (AI) is being used to help direct traffic light management systems to speed emergency crews through congested city streets. 

Liverpool-based tech firm Red Ninja has developed an algorithm called Life First Emergency Traffic Control (LiFE) that enables paramedics to use real-time data about congestion to manipulate traffic.

Through extensive analysis of data around the way traffic lights are used to control congestion, the Red Ninja team realised that they could manipulate traffic in real time.   

Clear path

They then employed an algorithm that could create a clear path through the traffic. This enables ambulances to reach emergency cases more quickly by integrating ambulance route-finder applications with city traffic management systems.  

“We try to understand the problem we’re trying to solve,” says the company founder Lee Omar.

Last month, an autonomous drone helped to save the life of a 71-year-old man who was suffering a cardiac arrest.

The drone delivered a defibrillator to a doctor helping the man, who became ill while shoveling snow outside his house in Trollhattan, Sweden. 

“It’s important to understand that there’s a chain of events saving the person’s life, and the drone is a very critical part of how that system works,” says Mats Sallstrom, chief executive of Everdrone, the manufacturer of the drone.  The drone system is electronically integrated with the emergency dispatch system and can get ready to fly as soon as an emergency call suggesting a cardiac arrest is received. 

Software and apps with different modules have now been developed to cater for the admin, hospital, ambulance and patient. The admin module handles the entire system of assigning ambulances on their respective posts. It can also view all information in the hospital, ambulance, and patient modules.

The hospital one monitors the hospital facilities and relays information to the ambulance operator. This way, they can save time if any of their facilities are unavailable as the patient can be sent to another facility.

Ambulance module

The ambulance module takes care of the patient upon receiving them – it will pick up the patient from location, use sensors to check the patient’s condition, treat or send them to hospital using the app itself.

The patient module is where the patient can book emergency services. They can also import their basic health information to assist the healthcare facility, including their name, age, blood type, and if they have any existing health condition. 

According to a market research report published by Global Market Estimates, the Global Smart Ambulance Market is projected to grow by 9.5 per cent by 2026 globally owing to increasing integration of IoT with healthcare services and devices. 
 
The global IoMT market was valued at Sh5 trillion in 2018 and is expected to grow to Sh26 trillion by 2026 globally, according to AllTheResearch. More than 500,000 medical technologies are currently available, according to a recent Deloitte report, and IoMT connected infrastructure of medical devices, software applications, and health systems and services. 

In 2020, the use of smart ambulances saved National Health Service (NHS) East of England trust an estimated Sh2 billion. Goldman Sachs estimates that IoMT will save the global healthcare industry Sh30 trillion annually in expenditures primarily through remote patient monitoring and improved medication adherence.

But one stumbling block lies on the path of adoption of smart ambulance models – low 5G penetration across the world. 

Despite a global rush to install 5G base stations, only the United States, China, South Korea and the UK have reliable 5G networks that can run instantaneous emergency medical surgeries via VR headsets.

Too close yet too far for Kenya to make such strides in emergency healthcare? Time will tell. 

Safaricom plans to go live with 5G internet connectivity towards the end of this year and Compland, a local startup, is already reducing the emergency response duration from hours to five minutes. It runs Swift Response app, which uses machine learning algorithms and real-time geo-location data to determine which ambulance to dispatch for emergency services.

Kisumu County government, like Ghana, is in the final steps of unveiling its drone vaccine delivery project in partnership with Zipline. 

Makueni County, on its part, is now deploying blockchain to secure patient data over cloud, one critical step towards ethical health services automation.

With a high smartphone penetration rate and a relatively affordable mobile internet, in less than five years, smart ambulances could be saving lives across Kenya’s urban and peri-urban centres. Then, Africa at the end of this decade. It’s technology to the rescue of humankind. 

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