METRO Emergency Medical Services (EMS) forms part of Western Cape Government Health and provides emergency care

to 5.3 million people in the Western Cape, utilising a fleet of 467 vehicles and 1,700 personnel. On average every month, Metro EMS receives 40,000 calls, rescues 200 patients and travels 1 million kilometers by road and 10,000 by air.

The Challenge
METRO EMS relies extensively on a computer-aided dispatch system and two-way radio communication to dispatch rescue crews to emergency scenes. Once the crews arrive on the scene, a high volume of information was further traditionally captured by completing paperbased forms by hand, which were later processed at the base. Due to the inefficiencies of the paper-based incident capture system, gaining insights from incident data was highly cumbersome and error-prone. The paper-based system was perceived as very passive in the dynamic and fast-paced emergency care environment.

According to Dr Shaheem de Vries, Clinical Manager: Medical Support Services, the biggest shortcomings of the paper-based system were the poor quality of the records, the lack of contextual information and the difficulty experienced in analysing the data. This meant that the reports were often cumbersome to review/query and rendered any detailed analysis of the data near impossible. The absence of photographs and performance data (response times, arrival and mission times) also meant that data integrity was a concern.

Key Results Achieved

Access to real-time information Combining different sources of information including photos, GPS coordinates and signatures in a single view Rapid reporting cycle Time to report on incidents cut from up to 37 days using a manual process to 1 day using an automated process Insights from historic data Wealth of incident data can be analysed to facilitate service improvement RiMS consists of two components: a mobile app, and a web portal. The mobile app has a workflow for each type of incident, which consists of detailed reports of patients and vehicles, and other technical information relevant to the incident. A key consideration for the mobile app is that the time spent capturing data in initial phases of an incident response is kept to a minimum, and the bulk of the data capturing done after the rescue has been completed. Many of these phases consist of capturing events such I am en route to the scene, I have arrived, and so on, along with timestamps and odometer readings. The

The Solution
Medivate, an ICT company specialising in creating solutions for the healthcare and emergency services sector, envisioned harnessing the potential of mobile and web technology to streamline incident management significantly, and subsequently utilised the technology platform from Embark Mobile to turn their vision into reality. The Medivate solution, now known as Rescue Incident Management System (RiMS), was deployed to various rescue crews at METRO EMS Vehicle Rescue, Technical Rescue (sea, high-angle, trench, swift water, etc.) and Wilderness Search and Rescue (WSAR).

Rescuer capturing data on scene

mobile app governs the incident capturing process through business rules that help to ensure that data is captured correctly. Detailed information that is required when the practitioners arrive on scene referred to as METHANE (major incident, exact location, type of incident, hazards, access / egress, numbers of vehicles & patients, emergency services present or required) is radioed to the base and captured by the operational staff at the command centre using the web portal. The web portal further provides access to processed incident reports (allowing for a base commander to review and approve all submitted reports for quality purposes), as well as creating and managing incidents that are in progress. Individual incident reports which can be used as legal documents can be exported as PDF, including photos and map data, as well as an aggregated regional statistics report which details operational performance. Extra operational features include daily and fault reports for equipment. The rapid development made possible by Embarks technology platform allowed Medivate to focus solely on applying its domain expertise in order to realise the solution, separating the business processes from the technical complexities of developing the mobile and web components.

Command Centre utilising real-time data from incident scene, including photos
Mortimer, Managing Director of Medivate, The command centre now has access to mission-critical information in real-time, which is tremendously powerful. Data velocity is now instantaneous compared to a laborious process in the past. Capturing incidents in real-time also offers more flexibility for the crews, as Elvin Stoffels, Rescue Practitioner, explains: You no longer have to wait until you arrive back at the base to complete the paperwork for your incidents, you can do it on scene or en route. taken on the scene, the command centre dispatchers have a better understanding of what is taking place operationally, says Stoffels. Francois de Kock, Shift Officer, adds: The photos from the scene can give the officer an indication of the challenges the rescuer can come across, and can also be used to look at different scenarios in order to give advice to the rescuers if needed.

The Results
ACCESS TO INFORMATION

By far the largest benefit of the RiMS solution has been the access to information that it enables. According to Andrew

command centre now The has access to mission-critical information in real-time, which is tremendously powerful.
Andrew Mortimer, Managing Director, Medivate

Reports are automatically generated, saving up to 30+ days

RiMS makes different types and sources of data available immediately at a single point, including photos, GPS locations and electronic signatures, which would traditionally have been completely disparate. The availability of GPS information has been particularly useful: The GPS coordinates allow us to pinpoint the exact location of where the incident is as soon as a technician arrives on scene, De Kock explains. This is very helpful for helicopter evacuations, or to pinpoint places for further investigation by other organisations. In one case, base officers

Since dispatchers now receive photos from the scene in real-time, they are able to see an incident as it happens from their bombproof command centre. The ability to have eyes on the scene through the use of real time photos and inputs has dramatically improved the Command Centres ability to manage and coordinate the resources on scene whilst a rescue is still in progress, Dr De Vries explains. Mortimer mentions an incident where a rescue practitioner was startled that the dispatchers were able to ask whether the patient was from the red or the white car before they have radioed any details about the vehicles involved. By viewing photos

RiMS enables real-time updates between incident response team and command centre

Western Cape is now EMS beginning to nurture an incredibly rich and diverse set of data that will hopefully start shedding new light on its rescue operations whilst enabling the management team to proactively monitor and evaluate the efficiency of the service.
Dr Shaheem de Vries, Clinical Manager, METRO EMS Western Cape

data that could not be done previously, such as analysing to which hospitals and departments patients are most often transferred.
ADDITIONAL BENEFITS

were perplexed that a collision between a train and a car had flung the car almost 200 meters from the railway crossing, but this was corroborated by GPS locations captured from the mobile app with a horizontal accuracy of 3 meters.
SPEED OF REPORTING

An additional measure that Medivate added after the initial implementation of RiMS was the concept of having the base commander review the captured information with the crew immediately upon their return from the scene. Base commanders were equipped with tablets from which they can access the web portal. Instant review has tremendously improved the quality of the data coming in, says Mortimer. The crew can now immediately see the reporting results of the actions that they performed in the mobile app. De Kock adds: RiMS is an excellent tool for debriefings. Comments can be made at any stage for future use as well as to commend someone for a job well done. In the same context, RiMS has also fostered improved collaboration between the command centre and rescue bases, as De Kock explains: RiMS makes for better working relations; for example, the rescue base can contact the command centre if we see any problems or mistakes, and they in turn contact us. This lets us communicate with each other and understand each others unique challenges. Another benefit of RiMS is the ubiquitous visibility into incident statuses and availability of vehicles and practitioners, which was previously only available to staff who had access to the two-way radios. The fact that all incidents can be monitored at all times is very helpful if you, for some reason, missed out on information relayed on the radio, De Kock mentions.
LOOKING AHEAD

Availability of GPS data helps to expedite helicopter evacuations

the WSAR command and control functionality to other large-scale operations such as Disaster Management, and also providing private emergency care providers with access to the solution.

Velocity of reporting is a key benefit: When paper-based reports were still in use, it could take up to 37 days for an incident to be reported on using a manual process in Excel. With RiMS, reporting can now be generated automatically on a daily basis, and filtered based on various metrics such as area and duration of the missions. Insights can be gained from the

Rescuers can instantly be debriefed upon returning from a scene

Dr De Vries, commenting on the overall impact of RiMS, adds: Medivate is at the forefront of innovative ICT applications for the local health sector and has developed a unique and rich insight into the prehospital industry. As is usually the case with bleeding edge technology, the future strategic value of RiMS is difficult to predict, but the lessons learnt to date is laying the foundation for integration of e-PCR technology into the general EMS operations. Once this is achieved, the vision of a dynamic, responsive and modern EMS can be realised.

The wealth of data provided through RiMS is not only beneficial on a day-to-day operational basis, but also has strategic value. According to Dr De Vries, EMS Western Cape is now beginning to nurture an incredibly rich and diverse set of data that will hopefully start shedding new light on its rescue operations whilst enabling the management team to proactively monitor and evaluate the efficiency of the service. While RiMS has been highly beneficial for METRO EMS thusfar, many possibilities for future expansion are on the horizon, with Mortimer mentioning possibilities such as checklists for equipment taken on board, crew performance management, trend analysis, management of response time SLAs, patient management, generalising

Contact Medivate
Tel: +27 (0)860 222 357 Email: info@medivate.co.za Web: http://medivate.co.za

Contact Embark Mobile

Tel: +27 (0)21 880-8250 Email: info@embarkmobile.com Web: http://embarkmobile.com

Real-time information from a wide variety of sources provided in a single integrated view