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The Ride Ahead

The Future of Autonomous Emergency Response

Saving lives with a system of self-driving ambulances and virtual reality.

The American Heart Association (AHA) reported that in 2011 nearly 326,200 people in the United States experienced cardiac arrest outside of a hospital and, of those treated by emergency medical services, only 10.6 percent survived. Brain death and permanent death start to occur only 4 to 6 minutes after someone goes into cardiac arrest. The chance of survival decreases by 7 to 10 percent with every minute that passes without defibrillation and advanced life-support intervention.

To increase the number of people who survive medical emergencies, we must reduce the time it takes for an ambulance to reach patients, and we must get patients into the care of physicians more quickly. Today it takes, on average, 9.4 minutes for an ambulance to arrive on scene in the United States, according to National EMS Information System (NEMSIS), and an average of 36.5 minutes for an emergency physician to assess and execute advanced life-support intervention.

In the future we need to connect emergency physicians with the patient as soon as possible using autonomous and virtual technologies. We could not only improve the response time of ambulances, but also get physician care to the patient immediately. A new Autonomous Emergency Response (AER) system would leverage a fleet of self-driving ambulances that employ data analytics to continuously optimize the position of the fleet throughout a city. It would virtually place an emergency physician on board with the Emergency Medical Technicians (EMTs) and paramedics, who have less training than physicians and are legally prevented from performing certain procedures without physician assistance.

Such a system would allow time-sensitive assessments of the patient and advanced life-support intervention to be carried out immediately on location. In time-critical scenarios, drones would supplement the ambulance and deliver medical tools, treatments, and crucial instruction to good Samaritans ahead of the ambulance and paramedics. Most importantly, AER would result in fewer avoidable deaths by reducing the amount of time from emergency situation to physician intervention.

The-Future-of-Autonomous-Emergency-Response
This vehicle concept explores future-forward solutions for emergency response.

When we set out to design a concept AER system at frog, the most obvious challenge was the time it takes an ambulance to arrive on scene. Typically, ambulances travel from a centralized point to the patient’s location. Furthermore, hospitals are generally located in a bustling part of a city, requiring an ambulance to traverse congested city traffic. If the fleet of ambulances were instead systematically peppered around a city, ambulances would be closer to the randomized points where emergencies occur. Amazon pioneered and implemented a similar system with its distribution warehouses. The Amazon “chaotic storage” system operates on a simple principle: Products are not organized categorically on shelves in the warehouse; they are instead stored chaotically and mapped by a computer. When an order comes in, the computer does all of the thinking and optimizes the fastest route to retrieve that product for shipment.

Our AER chaotic storage system builds on this concept and leverages data that has been collected from medical emergencies throughout a city over the past 10 years. The data include the time, day of the week, location, weather, and concentration of people near the scene of the emergency. The data feed, a predictive analytics program, determines the areas of the city where a medical emergency is most likely to occur and allows the vehicles in the AER systems to continuously optimize and distribute their positions accordingly. In the event of an emergency, an AER vehicle is dispatched — much like an Amazon warehouse worker assigned to pull products for shipping — and follows a computer system’s optimized route. The vehicle communicates with all other autonomous vehicles on the road to ensure a clear path all the way to the patient’s location.

In the future we need to connect emergency physicians with the patient as soon as possible using autonomous and virtual technologies.

Getting to the patient faster is the first hurdle, but once the AER vehicle is on the scene, it needs to empower a remote physician to evaluate a patient’s needs. Timothy Peck, an emergency physician from Harvard Medical School and co-founder of Call9, a healthcare startup, is aiming to reduce the time it takes to see a doctor after a medical emergency to less than one minute. In an interview with frog, Peck said one of the largest issues with today’s ambulance system is that “critical decisions and treatments are not made in a timely manner because EMTs and paramedics are not qualified to do so.” According to the ninth annual comprehensive EMS survey conducted by EMS World, which polls public and private emergency response agencies in the country, 45 percent of those agencies are not legally capable of executing a surgical airway procedure in the field and 41 percent are not allowed to transmit an electrocardiogram back to the receiving hospital. This means that if a paramedic arrives to find a patient with chest pain, they are required by law to bring that patient to the hospital before making an assessment because only a doctor is qualified to determine if the pain is indeed the sign of a heart attack.

The obvious solution is to put an emergency physician in the back of every ambulance, but the cost presents an economic impossibility. Our AER vehicle brings the emergency physician on board via virtual reality. The truck is outfitted with an integrated audiovisual and haptic communication system in the cabin, allowing the EMT and the physician to work together to treat the patient. The EMT wears additional audiovisual technology on their head, enabling them to act as the hands, eyes, and ears of the emergency physician. The patient also wears a sensor that transmits vital information to both the EMT and the physician, and together these two professionals are able to provide life-saving care at the scene of the emergency or en route to the hospital.

Another way to reduce the overall time from emergency to treatment is to begin providing care before the vehicle even arrives. The Centers for Disease Control and Prevention reports that there are more than 300,000 ambulatory emergencies for anaphylaxis in children under the age of 18 each year, a serious reaction that requires an epinephrine shot to arrive on scene quickly and to be administered correctly to avoid serious complications, including death. Given that 85 percent of 911 calls come from a smartphone, according to Peck, the phone could begin streaming video to an emergency physician as soon as the call is made. While the emergency vehicle is en route, an autonomous quad copter, outfitted with an articulating camera, could be deployed from the main vehicle. If the emergency requires overly time-sensitive medications or treatments — such as an epinephrine shot — the drone would rush ahead of the emergency vehicle and deliver medication or tools to the patient. The emergency physician would be able to coach the patient or others through administering epinephrine through external speakers built in the drone.

One in three deaths are a result of cardiac disease in the United States — more than all forms of cancer combined. The AHA calculated the direct and indirect costs of heart disease at more than $320 billion in health-care expenditures and lost productivity. Tens of thousands of lives could be spared, and billions of dollars saved in America alone if we reduce the interval of time from emergency to physician intervention. Advancements in virtual technologies, data analytics, and the dawn of the autonomous vehicle will enable the patient to be treated by an emergency physician almost immediately, using EMTs and paramedics as mobile eyes, ears, and hands. The proposed AER system will reduce the average travel time for an ambulance to reach a patient, using a data-driven system for distributing emergency vehicles around a city, an integrated audiovisual system onboard, and a close working partnership between paramedics and physicians. By saving precious minutes, the AER system could save countless lives.

Josh Newby

Josh is an industrial designer in Frog’s San Francisco studio. He thrives on constantly sketching, prototyping and creating unless burritos are involved, in which case he thrives on destroying.

Comments
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Josh, I am a HUGE fan of automated vehicle operations and I too believe it will heavily impact the way in which patients receive out-of-hospital emergency care. That being said, there are some gross misrepresentations about the capability of the typical EMS provider. Thanks for writing an otherwise great piece! It's an exciting future.
Nathan Stanaway, 2016-11-11 17:52:04
then policy needs to be changed to allow paramedics to perform a wider range of functions that are life critical. No point having an expensive physician on board or using VR to instruct paramedics to perform the procedure; that just complicates things further. Police drones exist, so it makes sense for first responder drones to take flight & deliver instructions to bystanders, but putting shifting the responsibility from the drone into the hands of bystanders to administer epinephrine or pills further complicates things. The most that should be instructed is just for the bystander to continuously assess the situation and offer basic comfort for shock. But then that would render the drone useless since you want to mount speakers on it. The other real challenge here is carving out a clear path for the AER to get to the casualty, and little buggies deployed from your main vehicle won't do the job. It's a matter of using your dashboard cam to capture the number plates of every irresponsible driver who doesn't give way. Traffic congestion can be handled by your chaotic navigation system, but that software better be accurate.
john, 2016-03-11 14:21:41
The other end of this is of course the personal drone which could help EMS/rescue find the wearer. Either commanded by the user or commanded by a service or self deployed. The drone providing (health status, images and GPS) could also report conditions, gas leaks etc. I am shocked that the personal drone and the emergency drone have not been combined. A health band monitoring your vitals controls a wearable drone. In an incident the drone takes off hovering calling EMS....providing GPS. mobility could get better location data. Video and snapshots could provide data to the alerted EMS personnel or dispatch. If the situation was violent the events would be documented. In the distant future the drone might also provide personal protection. Deterrence from video surveillance and potentially a taser like defense package. But ultimately the power of the drone is when a person cannot act. And in large scale disasters.....triage may be a secondary but very real use of the personal drone. If I am already dead I certainly do not want anyone searching for me. My drone could account for my personal status. Alive and unconscious or potentially save someone else by saving time for the rescuers.
Dan Salvucci, 2016-03-07 20:10:33

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