GEMSIS, An introduction of Intelligent Information Support System for Emergency and Disaster Medicine

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1 GEMSIS, An introduction of Intelligent Information Support System for Emergency and Disaster Medicine Kunihiko Takamatsu 1, Shinji Ogura1, MD PhD, Satoshi Tamura 2, PhD, Satoru Hayamizu 2, PhD 1 Gifu University Graduate School of Medicine, Department of Emergency & Disaster Medicine, Advanced Critical Care Center. 2 Gifu University, Department of Information Science.

3 Activity of GEMSIS project 2006 Apr. Introduction of GEMSIS Concept on The 9 th Congress of Japanese Society for Emergency Medicine, Morioka. Nov. Presentation of GEMSIS Image on The Congress of Japanese Association for Acute Medicine, Fukuoka Jan. Presentation of GEMSIS Application on The Congress of Japanese Association for Disaster Medicine, Nagoya. Feb. Presentation of GEMSIS Voice Recognition Application on The Congress of Emergency Medicine, Kanagawa. Mar. Presentation of GEMSIS Voice Recognition Application on The Congress of The Acoustical Society of Japan, Tokyo. May. Presentation of GEMSIS Pre-hospital Application on The 10 th Congress of Japanese Society for Emergency Medicine, Kobe. Jul. Presentation of GEMSIS advanced Application on The Congress of Inter-Speech 2007, Belgium.

4 Necessity of Information Sharing Example 1. Current emergency medicine is not sufficient of information sharing. - still round robin style Example 2. JR train disaster in Amagasaki. - tragedy which occurred in two years ago Example 3. An earthquake with a vertical shock by an active fault, same as the Great Hanshin Earthquake. - 50% of active faults in Japan are concentrated into our prefectures (Aichi pref., Gifu pref., Mie pref.) 2007/7/11 4

5 Ordinary way of Emergency Medicine Casualty Problem: Info. Isolated information (hard to share casualty condition with other hospitals) Accident Dispatching depend on paramedic Insufficient preparation at hospital because of Same time reaching patient and information

6 Case analysis The natural disaster which occurs frequently, considering also the type earthquake of especially falling perpendicularly, this time you focused to disaster medical care. Especially, the JR Amagasaki train accident report which occurs 2 years ago was referred in the object of case analysis. Understood with case analysis 1) The medical team not be able to grasp the entire image of accident, heavily the ambulance which conveys the casualty insufficient Medical team mutual communication being insufficient, there is no clear command system 2) Equipment and the dress of the medical team are insufficient 3) With the medical team on site and cooperation of fire fighting and the police is insufficient 4) Not be able to do the collection and storage of Triage-Tag 5) The preparation of staging care at the temporary heliport is insufficient. Because means of communication are not shared, there is no communication with the medical team on of site 6) The selection impossibility of the injured person conveyance by the wide area disaster emergency medical information systems program 7) For traffic procrastination in smooth execution of rescue and emergency conveyance activity hindrance

7 Necessity of Information Sharing Example 1. Current emergency medicine is not sufficient of information sharing. - still round robin style Example 2. JR train disaster in Amagasaki. - tragedy which occurred in two years ago Example 3. An earthquake with a vertical shock by an active fault, same as the Great Hanshin Earthquake. - 50% of active faults in Japan are concentrated into our prefectures (Aichi pref., Gifu pref., Mie pref.) 2007/7/11 7

8 Necessity of Information Sharing Example 1. Current emergency medicine is not sufficient of information sharing. - still round robin style Example 2. JR train disaster in Amagasaki. - tragedy which occurred in two years ago Example 3. An earthquake with a vertical shock by an active fault, same as the Great Hanshin Earthquake. - 50% of active faults in Japan are concentrated into our prefectures (Aichi pref., Gifu pref., Mie pref.) 2007/7/11 8

10 Feature of GEMSIS GEMSIS is 3 layer structure - Overview Diagram GEMSIS is low cost system - Open Source based system - Distributed system Architecture GEMSIS have a speech recognition interface - Voice to Text Conversion system

Overview of GEMSIS Higher Layer @Hospitals Network Middle Layer @Connection Network Lower Layer @Disaster

11 Overview of GEMSIS Higher Network Middle Network Lower Area City A Connection Server Mobile Server Medical Commander City B Paramedic Doctor@CCS Loading

12 Scene of GEMSIS Movie Animation Ver.1 Ver.2

13 Focusing on Pre-hospital support Data gathering in Triage process - merit of RFID (wireless IC-Tag) - development of RFID Read/Write device Synchronizing Casualty and Information - historical triage info. Management - in case of system trouble (offline mode) GEMSIS have a speech recognition interface - hands free data input interface -voice memo

14 Triage-Tag Image

15 Triage Tag Data Structure # name type length In detail 1 Triage card ID numeric 4 2 Casualty Name character 20 <20 3 Age numeric 3 4 Sex numeric 1 0:M 1:F 5 zip code numeric 7 6 Address character 20 7 Phone number numeric 10 8 Triage date date 8 YYYYMMDD 9 Triage time time 6 HH:MM:SS 10 Triage officer ID numeric 6 ID table 11 Transporter organization ID numeric 6 ID table 12 Transported hospital ID numeric 6 ID table 13 Triage place ID numeric 6 GPS info. 14 Vital sign: consciousness numeric 2 GCS(E,V,M) total score 15 Vital sign: respiratory rate numeric 3 16 Vital sign: heart rate numeric 3 17 Vital sign: systolic pressure numeric 3 mmhg 18 Triage category numeric 1 1:Green, 2:Yellow, 3:Red, 4:Black 19 Special mention character 50 <50 20 Voice memo binary - TBD 15

16 Ad Hoc Area mobile Layer Connection Layer RFID-R/W Wireless Router Bluetooth Mobile Server RFID PDA + RFID-R/W Layer

: 60-120 Breathe: 30 Primary survey: Voice memo: Application Image on PDA@CCS Casualty ID: GCS

17 User Interface Image 1 Category: severe Status: waiting Hospital: A01 Age: 20 Sex: male GCS Score: 15 Blood Pres.: Breathe: 30 Primary survey: Voice memo: Application Image on PDA@CCS Casualty ID: GCS Score: 15 Blood Pres.: Breathe: 30 Status: waiting for transportation Application Image on PC@ Hospital, Mobile Phone Profile Info. on IC-Tag for paramedic, doctor, etc.

18 Animation: IC-Tag Application on GEMSIS

19 START(Simple Triage And Rapid Treatment) Can Walk? YES Green NO Can Breathe? YES Respiratory rate? 10~29 CRT time? NO <=9 or >=30 2 sec. 2 sec. Black Red Yellow Merit: 1. No need to bring medical equipment, such as sphygmomanometer 2. Being able to handle without professional medical experience

20 Demonstration on May as one of solution example for Pre-hospital support system on The 10 th Congress of Japanese Society for Emergency Disaster area RFID-R/W as standalone device Wireless Router Bluetooth Mobile Server RFID PDA + RFID-R/W Layer

21 RFID Memory Map (Multi-functionality) Program A (ex. FMIO) Write data Sector 0-3 (Triage data) Read data Program A (ex. FMIO) Program B (ex. hospital) Sector 4-6 (Vital data) Program B (ex. hospital) Program C (ex. appli.) Standardization? Sector 7-9 (Meta data) Sector (Reserved) Program C (ex. appli.) (Reserved) CopyrightGifu University All Rights Reserved.

22 Schedule in Future (TBD) 2007 Aug. Disaster drill in Gifu city with DMAT team - evaluation of pre-hospital support sub-system (lower layer) 2008 Apr. Higher Layer sub-system will be tested - evaluation of data connectivity at least two cities Dec. Higher Layer sub-system will be tested - from higher to lower layer sub-system with dummy data 2009 Jan. Open Source development activity(?)

23 Demonstration: Voice Recognition and Text Conversion for Pre-hospital support

24 Overview of Speech recognition

25 Overview of Speech recognition

26 Overview of Speech recognition

27 Appendix

28 Distributed Coordination system 1.Network Communication Model Traditional<Server/Clients> Hybrid P2P Client Client Client Client Pure P2P S/C +Agent +Agent S/C Information Retrieval Server Information Retrieval Server Information Retrieval Client Data Flow Client Client Data Flow Client S/C +Agent Data Flow S/C +Agent 1.Software Architecture OSI Model Layers Research Target Application-A Application-B Intelligent Appl. HTTP(/S) TCP Intelligent Middleware (Framework) (Collaboration Engine included) IP UDP Ethernet,PPP,IEEE802.3,etc Application Layer Middleware : Research Target Transport Layer Network Layer Data link Layer

29 Distributed GEMSIS Overview HIS? PreHospital info. (Demonstration ) DAMCS AM_DB Agent (Shared Medical Documents) Agent HIS@ Hospital_i Hospital info.? DAMCS Dispatching Information (for DSS) Virtual Database Service Directory (in case of hybridp2p) HIS DAMCS Scan/Convert + MetaInfo. AM_DB (Acute Medical DB) (a sort of expertsystem) Agent Agent AM_DB DAMCS AM_DB GEMSIS: Gifu Emergency Medical Support Intelligent System HIS: Hospital Information System DAMCS: Distributed Acute Medical Cooperation System? HIS

30 Distributed Coordination system Functions Description - DHT (Distributed Hash Table) Development - DRM(Digital Rights Management) Utility - PKI(Public key infrastructure),ca: - Fallback Server Development (not necessary in 24H hospitals) - Backup Server (& Agent Reply Functions) Development - Sub P2P network (bandwidth control) development - P2P groupware development,e-community (2nd opinion for doctors)

31 Architecture if 10 hospitals 100 if 100 hospitals 1000 we may choose Server/Client model we may choose P2P model server client client client D/S

モバイル対応プレホスピタル救急災害医療支援システム病院前医療入力装置 : ( その 1 2) - オフライン Mode 運用 @ 現場救急災害医学分野高松前頁データ項目 #3,4 #12~19 IC-Tag-R/W+PDA( 一体型 ) 手段 1: IC-Tag-R/W PDA 一体型を使った場合 (2Action) 手段 2: IC-Tag-R/W PDA 分離型を使った場合

32 モバイル対応プレホスピタル救急災害医療支援システム病院前医療入力装置 : ( その 1 2) - オフライン Mode 現場救急災害医学分野高松前頁データ項目 #3,4 #12~19 IC-Tag-R/W+PDA( 一体型 ) 手段 1: IC-Tag-R/W PDA 一体型を使った場合 (2Action) 手段 2: IC-Tag-R/W PDA 分離型を使った場合 (4Action) 7 前頁データ項目 #1~19 RFID+Triage-Tag 7 傷病者に付ける RFID にデータを書く 7PDA にデータを転送 Bluetooth 3PDA のアプリで属性データを抽出 4PDA のアプリでメタデータを取得 5PDA のアプリで音声を文字に変換 6Tag 格納形式にデータを再整列 2PDA にデータを転送 1 2~6 前頁データ項目 #8~10 RFID( 事前設定済み ) 1 トリアージ者の RFID データを読む IC-Tag-R/W PDA IC-Tag-R/W 注 ) ここでのメタデータとは GPS 日付時間バイタル等の自動 / 半自動測定データを指す IC-Tag-R/W PDA( 分離型 )

33 災害現場トリアージ軽症者 ( 歩ける ) 中等症者トリアージ軽症者用応急救護所中等症者用応急救護所トリアージ重症者トリアージエリア重症者用応急救護所死亡が確認された人患者さんの状態は刻一刻変化するする静的トリアージから動的トリアージトリアージの機会機会は複数遺体安置所応急救護所救急車搭載所トリアージ

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