Abstract
Smartphones have become an integral part of our everyday lives but also offer a number of health benefits yet to be harnessed. This article discusses how the phone app GoodSAM has harnessed smartphones as a first aid, life-saving tool.
You have a life-saving device in your pocket. While it can count the number of steps you take, how much you eat and, on a personal level, improve your health, smartphones potentially connect us to a network of trained responders, who can provide life-saving help even before an ambulance arrives.
In 2012, doctors working on London’s Air Ambulance noticed that there was a group of patients who had relatively ‘minor’ head injuries who died prior to ambulance arrival principally because of lack of an airway (unconsciousness allowing the tongue to fall back) or through ‘impact brain apnoea’ (a term denoting the cessation of breathing after a blow to the head). 1 These patients could potentially survive with basic life support if someone had been there in the first few minutes to provide it.
On a greater scale, there are approximately 20,000 out-of-hospital cardiac arrests each year in the United Kingdom, with a survival rate of only around 8%. Yet, in airports where there is an abundance of aircrew trained in cardiopulmonary resuscitation (CPR) and automated external defibrillators (AEDs) placed throughout terminals, survival can be >80%. This reflects the importance of how rapidly CPR is started and how rapidly the patient receives defibrillation. For every minute delay, a patient’s chances of survival fall by 10%. For both trauma and cardiac arrest, the major determinant of outcome is time to treatment – not novel drugs or clever devices – just time to basic airway and resuscitation management. With an ambulance target time for such emergencies of 8 min, however, the damage may already be done. In 2015, an 8-min or less ambulance response was achieved 70% of the time. With limited resources, the prospect of more or faster ambulances is unrealistic.
The solution is harnessing technology to activate the potential first responder community. Analogous to the belief that you are never more than 5 m from a spider, in our cities you are probably never more than 100–200 m from a doctor, nurse, paramedic or someone trained in life support. The population density which the urban built environment supports is a public health asset to be mobilised. Facilitating interaction between proximate citizens is the model of change for many ‘social innovation’ projects, policies and programmes which seek to harness the value of the built environment in supporting health.
The ubiquitous smartphone has layers of technology to alert potential responders to an emergency and enables crisis care. With in-built geo-positioning, communications, gyro and video technologies – this is the most powerful tool anyone could ask for in the pre-hospital environment. GoodSAM (http://www.goodsamapp.org) works by alerting the three nearest trained responders to a life-threatening emergency. It can be triggered either via an alerting app that the public can use (which concurrently dials 999) or directly through ambulance control. In the United Kingdom, there are >8000 responders on the platform. In London, this has been running since summer 2015 and is activated 20–30 times each day, as of summer 2016. Thanks to support from Nesta and the Cabinet Office, this integration with the emergency services is now rolling out across the United Kingdom – and is occurring in Australia and other parts of the world. GoodSAM also acts as a platform to organisations such as first aid charities and police/fire services for whom CPR is part of statutory training. Such organisations can then use the system to message and talk directly with their staff (who can then also be alerted to local cardiac arrests).
The platform is developing to use other technologies: an in-built ‘Life Detector’ displays a heart rate and breathing rate simply by placing the phone on a patient’s chest or back.
The system also enables responders and ambulance services to actually see what is going on at the scene through ‘Emergiscope’ (a system that opens the phone’s camera and streams encrypted video). This can help with resource management, enabling ambulance services to send appropriate resources to specific incidents.
The power of internet-connected mobile technology is evidently huge. As GoodSAM demonstrates, its most potent applications are likely to be those which enable the public to provide care for others locally. In an emergency, this is to bide time before traditional healthcare resources arrive. Such relatively frugal innovations can be as impactful as new high-cost drugs, tools or devices. The technological transformation in public health is only just emerging. By capturing the latent power in social networks, the coming revolution may be as profound as the discovery of antibiotics.