Emergency Telemedicine in Indoor Multiple Dwelling Environments Edward Mutafungwa, Comnet / Aalto University

1. Emergency Telemedicine in Indoor
Multiple Dwelling Environments
Edward Mutafungwa and Zhong Zheng
Department of Communications and Networks
Aalto School of Science and Technology
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2. Outline
Background on emergency telemedicine
Why focus on indoor operating
environment?
Example case studies
Introduce femtocellular approach for
emergency telemedicine
– Limitation of existing networks
– Potential benefits
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3. Background
UBI-SERV Project WP Structure
Ref: http://www.ubi-serv.org/
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4. Positioning of Emergency Telemedicine
Health Continuum
Care by Emergency care, Pre-
Professionals hospital trauma care
Elective care
Home care, Ambient
Assisted living
Disease management, Elevated Risk factors,
Rehabilitation
Wellness
management
Fitness
Self Care
Proactive Reactive
Ref: http://feelgood.vtt.fi/ Healthcare Provisioning Continuum
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5. Emergency Telemedicine in Indoor
Environments
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6. Emergency Telemedicine in Indoor
Environments
Prehospital care for cardiac arrest, Accident and Emergency
Department, Queen Mary Hospital, Hong Kong (1999)
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7. Helsinki EMS Case Study
Serve over 0,5m people
– Handle over 40000 emergency
calls per year
Introduced Electronic Patient
Records (EPRs) January
2007
– Merlot Medi system (Logica)
– Rapid information sharing
between paramedics at scene
and hospital
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8. Helsinki EMS
Case Study
Helsinki EMS EPR system
Ref: Kuisma et al.
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9. Helsinki EMS Case Study
Current possible setup at emergency site (data info)
Mobile networks (GPRS)
USB, Bluetooth, WiFi (IEEE 802.11x),
IEEE 1394, RS232 etc.
Vital signs monitor
Portable printer
Paramedic’s Tablet PC
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10. Some Examples of Multimedia Services for
Emergency Telemedicine
Southern Arizona Teletrauma and Telepresence Program (SATT)
Ref: Latifi et al.
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11. Helsinki EMS Case Study
Possible future upgrade (data Mobile networks (3G or
beyond)
plus images and video)
USB, Bluetooth, WiFi (IEEE 802.11x),
IEEE 1394, RS232 etc.
Vital signs monitor
Portable printer
Paramedic’s Tablet PC
Image/video capture Portable
device ultrasound
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12. Indoor Emergency Telemedicine via Mobile Networks (Macrocellular)
Subscriber and Location Centers,
Equipment Registers Application Servers
MGW/
GGSN Mobile Operator Core Network
MGW/SGSN
Internet, PSTN, EUE Uplink Connectivity Options
Other Mobile Network
EUE uplink via MBS
RNC
Emergency Site
MBS EUE
Patient Records, Resource
Planning, Decision Support etc.
Physician/ Paramedic
Emergency Department
MUE
MUE
Medical Facility,
Remote Consultation Site
Notes: EUE = Emergency User Equipment, GGSN = Gateway GPRS Support Node, GPRS = General Packet Radio Service, MBS = Macrocellular Multiple Dwelling Unit
Base Station, MGW = Media Gateway, MUE = Macrocellular User Equipment, RNC = Radio Network Controller, PSTN = Public Switched Telephone
Network, SGSN = Serving GPRS Support Node.
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13. Requirements Imposed on Mobile System
by Emergency Telemecine App
Performance
– Coverage/availability
– Accessibility and prioritization
– Perceived user experience
• Throughput (kbps), video/picture quality, service
outage/retainability etc.
Mobility
Usability/convenience
– Automatic service discovery
– Automatic service configuration
Security
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14. Performance Limitations in Mobile Networks
Achievable throughput (kbps) < advertised throughput
Poor coverage in indoor environments
For emergency telemedicine
– Intolerable interruptions or delays in information transfer
– Reduced video/image quality (possible clinical errors)
Ref: Kim et al.
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15. Performance Improvement with Femtocells
Home base stations
deployed independently by
subscribers
Benefit for mobile operators
– Performance improvement with
minor CAPEX
Benefit for subscribers
– Performance improvement with
cheaper service fees
Benefit for emergency
services
– Emergency calls for all
– Multimedia services for
emergencies?!
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16. Indoor Emergency Telemedicine via Mobile Networks (Macro- and
Femtocellular)
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17. Performance Studies
System simulation of emergency telemedicine use case
– Model multiple dwelling unit (MDU) building layouts
– Random location of home base stations (HBS) and user
equipment (UE), random interference levels
16
12
meters
8
4
0
0 5 10 15 20
meters
HBS Outer wall
UE Internal wall
Detached houses Light wall
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18. Performance Studies
Study performance improvements enabled by access to
femtocell resources
Outage Rates (%) Experienced by Emergency User Equipment: Case of High-
Rise MDU Building
90
80
70
60
Femto and Macro BS
50
Macro BS
40
30
20
10
0
0.2 0.5 0.8 0.2 0.5 0.8
Home (or Femto) Base Station Penetration
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Cell interior (D = 100 m)
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Cell edge (D = 300 m)
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19. Conclusions
Femtocellular approach shows significant
potential for emergency purposes
More studies necessary to further unlock
hidden benefits of femtocells
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20. Thank you for your attention!
Edward Mutafungwa
Aalto University
Department of communications and networking
P.O. Box 13000
00076 Aalto
Espoo, Finland
Tel: +358 9 470 22318, +358 40 7333397
Email: edward.mutafungwa@tkk.fi
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Comnet

21. References
• M. Kuisma and T. Väyrynen and T. Hiltunen and K. Porthan and J. Aaltonen, “Effect of introduction of electronic patient reporting on the
duration of ambulance calls,” American Journal of Emergency Medicine, vol. 27, pp. 948-955, 2009.
• R. Karlsten and B. A. Sjöqvist, “Telemedicine and decision support in emergency ambulances in Uppsala,” J. Telemed Telecare, vol. 6,
pp. 1-7, 2000.
• R. Latifi et al, “Telemedicine and Telepresence for Trauma and emergency care management” Scandinavian Journal of Surgery, pp. 281–
289, Vol. 96, 2007.
• M. G. Keane, “A review of the role of telemedicine in the accident and emergency department,” J. Telemed. Telecare, vol. 15, pp. 132-
134, 2009.
• C. S. Pattichis and E. Kyriacou and S. Voskaride, “Wireless telemedicine systems: an overview,” IEEE Ant. Prop. Mag., vol. 44, pp. 143-
153, Apr. 2002.
• L. P. Leung and C. M. Lo and H. K. Tong, “Prehospital resuscitation of out-of-hospital cardia carrest in Queen Mary Hospital,” Hong Kong
J. Emerg. Med., vol. 7, pp. 191-196, 2000.
• D. K. Kim and S. K. Yoo and H. H. Kang, “Evaluation of compressed video-images for emergency telemedicine work with trauma
patients,” J. Telemed Telecare, vol. 10, pp. 64-66, 2004.
• D. –K. Kim et al, “A mobile telemedicine system for remote consultation in cases of acute stroke” Journal of Telemedicine and Telecare,
pp. 102–107, 2009.
• J. R. Gállego and A. Hernández-Solana and M. Canales and J. Lafuente and A. Valdovinos and J. Fernández-Navajas, “Performance
analysis of multiplexed medical data transmission for mobile emergency care over the UMTS channel,” IEEE Trans. Inform. Technol.
Biomed., vol. 9, pp. 13-22, 2005.
• Y. Chu and A. Ganz, “A mobile teletrauma system using 3G networks,” IEEE Trans. Inform. Technol. Biomed., vol. 2, pp. 456-462, 2004.
• H. Holma and A. Toskala, WCDMA for UMTS: HSPA Evolution and LTE. John Wiley & Sons Ltd, 2007.
• V. Chandrasekhar and J. G. Andrews, “Femtocell networks: a survey,” IEEE Comm. Mag., vol. 46, pp. 59-67, 2008.
• R. Martin, “3G home base stations: Femto cells & FMC for the masses,” Unstrung Insider, vol. 6, Jan. 2007.
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