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Hello,
My name is jason friesen. I'm a paramedic and the founder of Trek Medics International, a nonprofit dedicated to the development of emergency medical systems in communities without reliable access to emergency care and transport: http://trekmedics.org

Before i continue I would like to say how much I appreciate your work, and am continually amazed by the wonderful collaboration this community undertakes. While I have had minimal involvement in this community to date, that's largely because I've been waiting to actually have something to say...

Here goes:

For the past 2.5 years we've been developing an SMS-based emergency dispatching software for resource-limited communities. The software is called Rapid Mobile Response Messaging (RM2), and we have recently finished our first round of testing outside the U.S. (you can read more about it here: http://trekmedics.org/programs/rm2-field-testing/)

In brief, RM2 was created to provide emergency dispatching (i.e., 911) in communities that will never be able to afford the exceedingly expensive and advanced technologies commonly used in North American and Europe, yet which have the essential infrastructure and resources needed for dispatching - namely, mobile phones and consistent cell signals. In order to ensure that the software met our three critical criteria - effectiveness, low-cost, and sustainability - we've eliminated pretty much all EMS equipment and technologies regularly used in wealthy countries and slimmed the IT requirements down to three items: mobile phones, USB modems, and a laptop or desktop.

This approach complements our approach to EMS development, as well, as we take great pains to remove the emphasis off of overly-expensive and minimally-effective EMS technologies - including conventional ambulances - and instead place our focus on improving the systems that are already in place, however informal - e.g., taxi cab drivers, unemployed youth with motorcycles, and boy/girl scouts et al.

We are currently looking for groups/organizations/institutes who would be interested in exploring areas for collaboration - and field-testing, in particular.

We are also interested in learning more about others who may have experience in SMS-based emergency dispatch in resource-limited settings.

If anyone would be interested in learning more, or sharing their own experiences, I would be very grateful to hear from you. I have also attached a white paper we wrote for RM2, and here is a link to a short promotional video we put together to demonstrate the software and support fundraising (apologies): https://vimeo.com/69521089

Thank you for your time, and I hope to hear from the community soon.

Keep up the great work,

Jason Friesen, MPH, EMT-P

917-803-5411

Attached resources:

Link leads to: http://trekmedics.org/projects/communications/

Link leads to: http://trekmedics.org/programs/rm2-field-testing/

 
Nicholas Connor
Replied at 11:57 PM, 2 Jul 2013

Hi Jason,
This is an intriguing idea indeed. We are working with several field sites across the Indian Subcontinent and we have an established SMS system which is currently running a large sophisticated referral algorithm for sick neonates - designed with our team at icddr,b. The referral system itself has all of the core elements which you have described, there are many details to work out with regards to context, logistics, health facilities, community engagement and sensitization and finally deployment.
That said, it might be possible to see if someone is interested in a limited field testing in either Dhaka or in Rural Sylhet with local (and international - JHU) partners there. There are also some partnered researchers in areas around Karachi (AKU) who may be very keen to chat on this.
I too have never posted here although I joined in '08 but this piqued my interest, possibly as I used to my previous work in the Emergency Department alongside paramedics. Also, because Bangladesh has some of the most dangerous roads in the world, I also know that BRAC has made an effort to make for better drivers, and may be interested in this.

http://www.guardian.co.uk/global-development/2012/dec/09/world-most-lethal-ro...

Finally, the policy implications of getting the data from your service may be useful, time to care & mortality en route to health facilities - might be able to dispel some of the apathy towards accidents and accident response.
Anyways, keep up the good work. I'll advocate for you here a bit if you don't mind.
Contact me if you think this might be a good match.

Alain Labrique, PhD, MHS, MS
Replied at 1:43 AM, 3 Jul 2013

Hi Nick and Jason,

With the mCARE project currently underway in northern Bangladesh is
expanding just this concept. Over the past year, working with the MOH and
other NGO partners, JHU has developed a government FHW support system that
helps register and track pregnancies, monitor ANC and PNC delivery, but
most excitingly, provides families with the ability to notify the system
when a pregnant woman goes into labor and experiences a live birth. Alerts
built into the system notify the local health worker, and if needed,
mobilize a facilitated referral to the appropriate nearby EOC facility. An
extensive formative phase of the study assessed facility EOC capacity so
that appropriate referrals could be made, if needed. We also tested, with
unexpected success, the labor notification system in this population where
over 80% of birth occur at home -- over 500 pregnancies we were able to
dispatch skilled EOC trained nurse-midwife teams to over 89% of births,
illustrating the possibility of a "911" response system under conditions of
rural infrastructure typical of much of South Asia.

http://www.forbes.com/sites/skollworldforum/2013/05/24/success-in-mhealth-shi...

Regards,
Alain Labrique

--
================================================
Alain B. Labrique, MHS, MS, PhD, MACE
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Office: E5543, 615 N. Wolfe St., JHBSPH, Baltimore, MD 21205
Work: +1 (443) 287-4744 Cell: +1 (410) 236-1568
Fax: +1 (410) 510-1055 Skype/Yahoo/Twitter: alabriqu
URL: http://bit.ly/pzXzR5 www.jhumhealth.org
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Director, Johns Hopkins University Global mHealth Initiative
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Assistant Professor
Department of International Health & Department of Epidemiology (jt.)
Program in Global Disease Epidemiology and Control
Bloomberg School of Public Health
&
Department of Community-Public Health
School of Nursing (jt.)
Johns Hopkins University (Baltimore, MD (USA))

Mona Duggal
Replied at 12:23 AM, 4 Jul 2013

Hi Jason,
We are likely to start a project to provide integrated care to HIV positive women with mental health issues in India.( within next few months) We will be using mHealth counseling as an intervention technique. As this is a high risk population (violence, suicide etc.) they need to be monitored closely, your SMS-based emergency dispatching software could complement our efforts to provide 24 hour coverage for this population. Please let us know if you will be interested to field test your software.
Regards
Mona Duggal,MD MHS
Yale University

George Otto
Replied at 1:45 AM, 4 Jul 2013

Looks like a very interesting innovation in emergency medical
response. Many LMIC countries such as where I come from in Papua New
Guinea, many communities have poor access to conventional emergency
response during an emergency that they have become ‘accustomed’ to no
emergency response or have learnt to live with outcomes of an
emergency.
Interestingly, mobile phone use has increased over the last 5 years in
the country and the cell coverage is quite good throughout the
country. I hope that you could collaborate with my organization to
help you trial your new technology here. I belong to a a professional
society and will be happy to collaborate with you or link you up with
an appropriate NGO in the country to help you trial your EMS system
because I think it is what many communities with no access to
emergency response need.
Many challenges of all sorts exists here and potentially result in
emergency. Such innovative technologies will surely be useful.

Jason Friesen
Replied at 8:32 PM, 4 Jul 2013

Hello,
Thanks to all of your very insightful replies - it sounds like there are a lot of exciting programs underway as well as some viable opportunities for collaboration. I will try to respond to each in part, but will also provide a little more context as well. (please feel free to let me know if there's a more "proper" way to do this as I'm fairly new to communities and threads. I've read a bunch, but don't know the etiquette, per se)

EMS in North America, Europe, and other affluent countries is based on the premise that first responders can respond anywhere, anytime, and be able to treat and transport any patient - irrespective of the underlying condition. The main advantage of this is that the community has a single public access number to streamline emergency response. As a result, all medical emergencies - irrespective of underlying condition - are reported through the same number, generally speaking. From the general public's perspective, this is very helpful - having to remember several numbers can create significant obstacles and increase delays in accessing care and transport. This is a characteristic that we've sought to incorporate into our software - i.e., whatever the medical condition is, just text XXXX, and the nearest first responders will be able to locate and transport.

Nicholas - I would be very interested to learn more about your work with referrals. As we've described it, our core capabilities cover prehospital-to-hospital emergency response - i.e., from the scene of an emergency to handover to definitive care in a clinical facility. With that said, our software can just as easily be used for inter-facility transfers (referrals) from one clinical facility to another. Generally speaking, it is a matter of triggering an incident where the location would be a hospital/department as opposed to "The corner of X Street and Y Ave". Your comments about community engagement, sensitization and deployment are also something we are still learning a lot about, so that would also be good to exchange about. One of the solutions we have been designing is a "Speaking Book", that I have used personally in Haiti already with good success, albeit for community sensitization for persons with disabilities - and not emergency response. BRAC is an organization I have read and heard quite a bit about, so would be very glad to make any connections. AKU is similarly impressive in the work they do surrounding injuries and prehospital care, though I have not had any direct contact with them. (Thanks for the link, as well - sadly, the highway-turned-runway problem is rampant. Our program in southern Haiti responds to a road that is very similar to that - safety improvements may likely be a long time in coming, sadly, so our men/women have been proactive about traffic patrols)

Alain - thank you very much for your response, and I am glad to be in contact. I have seen your videos on youtube and have been very impressed by your work. I have also heard of similar MCH projects in Rwanda using RapidSMS - is your work at all linked? http://www.panafrican-med-journal.com/content/article/13/31/full/ I agree that your successes are indicative of the possibility for a more expansive "911" system. Given the specialized nature of MCH programs, and the unique, essential features you built into mCare, do you think it would be feasible to go from Emergency Obstetric Care to All Emergency Care? It seems that mCare's functions demand that it remain focused on MCH, though I may be wrong. In any case, it is a very interesting question as we are both dealing with integrated systems, albeit in different ways: mCare is for integrated Maternal-Child healthcare, of which EOC is a part, while RM2 is for integrated emergency care of which EOC is also a part.

Mona - Thanks as well for your insights. I am very intrigued to hear about your work - HIV-positive women with mental health issues at risk for suicide and violence are patients most EMS systems have experience with, and definitely a demographic that our software would serve. I would be very interested to speak more about your work and see if there are any opportunities to work together on field testing. If you are in New Haven, I'd be happy to meet in person - I am up there fairly often, and used to work for YNHH.

George - what you're describing is exactly the situation that inspired the software from the beginning. Please let me know how we can discuss further.

Thank you again for all your responses, as well as the insights and links. I would be very glad to discuss further, and please feel free to reply here, or contact me directly at jfriesen,at,trekmedics,org - You can also connect via Skype with the username trekmedics

Thanks again for all of your replies.
All the best,
Jason Friesen

Maya Ellis
Replied at 2:31 PM, 5 Jul 2013

A technology included in these kinds of things are quite good, because we can save more life with this, when technology and health comes together they establish a nice atmosphere of health.

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