Pete
r Hufn
agl, Tro
ng
Pete
r Hufn
agl, Tro
ng-- N
ghia N
guye
nNghia N
guye
n-- D
obinsky
Dobinsky
Charité
Charité
--Univers
itäts
medizin
Univers
itäts
medizin
Berlin, Telemedicine C
ente
rBerlin, Telemedicine C
ente
r
Telemedicine
Telemedicine ––
Emerg
ency Serv
ice for Airplanes
Emerg
ency Serv
ice for Airplanes
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2
OverviewOverview
Problem description
Current situation
FlyNet, broadband with CbB, brings motion in AC telemedicine
Lufthansa, Charité and Global Health Care cooperate
System requirements
Prototype and test flights
Design
Conclusions
Video test flight
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Problem: In flight Medical EmergencyProblem: In flight Medical Emergency
Medical problem
Logistic problem (diversion y/n)
Possible regress demands
in case of false treatment
In flight medical emergencies may influence the entire flight,
passengers, flight attendants, physician, captain.
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Number of Reported Medical EventsNumber of Reported Medical Events ProblemProblem
0
200
400
600
800
1000
1200
1400
1600
1800
2000 2001 2002 2003 2004
Total
Long-haul
Number of in flight medical events based on Lufthansa flight reports.
70% cardiac
20% acute abdomen
10% neurological
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Future DevelopmentsFuture Developments
Aging society (Europe, America, Asia)
Longer flight times (over 16 hours),
airlines installed already cooling boxes
Larger AC (e.g, A380 with until 1000 passengers)
ProblemProblem
The number of in flight medical emergencies will increase in
the future with respect to:
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Medical Equipment and SettingMedical Equipment and Setting
Flight attendant kit
Oxygen
Defibrillator (AED)
Current SituationCurrent Situation
Flight attendant
Experienced physician
Physician without expertise
No physician or unwilling
Doctors kit
Physician
Diagnosis, therapy, logistic decision, monitoring, ...
Telephone call to ground
Vital sign transmission to ground
PassengerPassenger
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„„Costs“ of Medical DiversionsCosts“ of Medical Diversions
Diversion
CurrentCurrent SituationSituation
Medical
decision
True
False
Yes No
OK OK
Unnecessary
costsRegress ?
Correct medical diagnosis saves life's and money!
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FlyNet FlyNet BroadbandBroadband Solution Solution byby CbBCbB in 2004in 2004
D-ABTE Test Aircraft
Use of telemetricdevices withinboard network
Medical AssistanceData Center
IP Networkin Aircraft
Internet
Transmit Receive
Satellitenantenne
Connexion by BoeingNetwork Center
Satellite
FlyNet is designed primarily for Internet access of passengers!!! (No QoS)
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Test of Test of TelemedicalTelemedical Technology Technology byby Lufthansa and DLRLufthansa and DLR
Several telemedical systems have been tested – not successful
Catalogue of requirements was established
Creation of a telemedical group within Lufthansa
Look for partners for future development
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Cooperation Lufthansa, Charité and GHC Global Health CareCooperation Lufthansa, Charité and GHC Global Health Care
Goal: Development of a new solution for telemedical emergency care
which fits the requirements:
Physician from the ground should be virtual in the AC
Start 2004
Funding of the Berlin Future Fonds in 2005
Charité University MedicineCharité University Medicine
Campus Wedding
Campus Buch
Campus Mitte Campus Steglitz
Largest clinical center of EuropeLargest clinical center of Europe
3500 Beds
15000 Employees
Broad telemedical experience
Telemedical provider
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GHC Global GHC Global HealthHealth CareCare GmbH BerlinGmbH Berlin
Technology spin-off of the Charité
Develops technology for telemedical services of the Charité
Founded 2001
Located at Charité high rise
Intensive medical cooperation with Charité clinics
Technical cooperation with Technical University Berlin
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Medical RequirementsMedical Requirements
ECG (12 lead)
Blood pressure
Pulsoxymeter
Thermometer
Minilab (Blood sugar)
Defibrillator
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Definition of RequirementsDefinition of Requirements
Functional RequirementsFunctional Requirements
Stable videoconference (camera with free choice of position)
Remote control from call center
Print of findings and protocol
Automatic connection to call center
Identification via chip card or biosensor
Wire less communication (WLAN)
Synchronization of streams of video, audio and data, minimal delay
Guidance of users/ help system
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Definition of RequirementsDefinition of Requirements
Requirements on HandlingRequirements on Handling
Emergency capable user interface
Any handling possible by 1 person
Robust and suitable for aircrafts
Fixation at seat is possible
Stable position on ground
Miniaturized medical sensors
Variable user modes (physician, flight attendant)
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Definition of RequirementsDefinition of Requirements
Application Areas in AC
Seat
Galley
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Test System used in Test FlightsTest System used in Test Flights
Laerdal© patient simulator
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Sending appropriate images live Sending appropriate images live –– but how?but how?
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What is visible from the ground?What is visible from the ground?
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CoreCore Technology Technology -- GoalsGoals
TelemedicalTelemedical
EquipmentEquipmentMedical Medical
CallCall CenterCenter
MedicalMedical
DBDB
DoctorDoctor
DistributedDistributed
Medical Medical
ModuleModule
NetworkNetwork ConnectionConnection
PassengerPassenger
Flight Flight
AAttendantttendant
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Problems Problems withwith Standard TechnologyStandard Technology
PassengerPassenger
Flight Flight
AAttendantttendant
TelemedicalTelemedical
EquipmentEquipmentMedical Medical
CallCall CenterCenter
MedicalMedical
DBDB
DoctorDoctor
DistributedDistributed
Medical Medical
ModuleModule
Video/Audio Video/Audio ChannelChannel
ECG ECG ChannelChannel
RemoteRemote ControlControl ChannelChannel
DataData Transfer Transfer ChanneChanne
StaticStatic Image Transfer Image Transfer
ChannelChannel
......
Varying Bandwidth Varying Bandwidth
Communication BreakdownCommunication Breakdown
Varying Requirements Varying Requirements
dependent on Medical dependent on Medical
WorkflowWorkflow
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Solution Solution –– ChannelChannel TechnologyTechnology
PatientPatient
HeadsetHeadset
TelemedicalTelemedical
EquipmentEquipmentMedical Medical
CallCall CenterCenter
MedicalMedical
DBDB
DoctorDoctor
DistributedDistributed
Medical Medical
ModuleModule
Video/Audio Video/Audio ChannelChannel
ECG ECG ChannelChannel
RemoteRemote ControlControl ChannelChannel
DataData Transfer Transfer ChanneChanne
StaticStatic Image Transfer Image Transfer
ChannelChannel
......
ChannelChannel
TechnologyTechnology
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ChannelChannel TechnologyTechnology
ChannelChannel
TechnologyTechnology
Bandwidth Management
Quality Management
Priority Management
Synchronization
Privacy
Security
Dependent on the medical workflowDependent on the medical workflow
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TCS TCS –– AnimationAnimation
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DeDesignsign
Videoconference
Diagnostic modules
Therapeutic modules
Documentation
Authentification
Emergency optimized user guidance
The Tele Care System TCSThe Tele Care System TCS
The TCS integrateThe TCS integratess
to a to a telemedicaltelemedical multi diagnostic device for acute multi diagnostic device for acute
treatment of medical emergencies on board of treatment of medical emergencies on board of
aircraftsaircrafts
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DeDesignsign
User modesUser modes
Used by the trained flight assistant
Redundant communication ways
Basic medical functions
Intuitive handling
Standard modeStandard mode
Started by a separate button
Extended medical functionality
Clinical diagnostics and therapy
Special user interface
Medical database
Integration of the other medical board equipment
Doctor‘s modeDoctor‘s mode
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More safety for passengers and crew
Improvement in critical situations for crew, passenger, physicians
Decisions on diversions are clearer for the captain
Less diversions (with collateral damages)
Clear, well documented decisions (insurances)
Important element for mobility of patients with chronic diseases
Ideal completion of existing emergency equipment
Benefit for AirlinesBenefit for Airlines ConclusionConclusion
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VideoVideo
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