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

1

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

3

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.

4

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

5

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:

6

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

7

„„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!

8

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)

9

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

10

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

11

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

12

Medical RequirementsMedical Requirements

ECG (12 lead)

Blood pressure

Pulsoxymeter

Thermometer

Minilab (Blood sugar)

Defibrillator

13

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

14

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)

15

Definition of RequirementsDefinition of Requirements

Application Areas in AC

Seat

Galley

16

Test System used in Test FlightsTest System used in Test Flights

Laerdal© patient simulator

17

Sending appropriate images live Sending appropriate images live –– but how?but how?

18

What is visible from the ground?What is visible from the ground?

19

CoreCore Technology Technology -- GoalsGoals

TelemedicalTelemedical

EquipmentEquipmentMedical Medical

CallCall CenterCenter

MedicalMedical

DBDB

DoctorDoctor

DistributedDistributed

Medical Medical

ModuleModule

NetworkNetwork ConnectionConnection

PassengerPassenger

Flight Flight

AAttendantttendant

20

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

21

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

22

ChannelChannel TechnologyTechnology

ChannelChannel

TechnologyTechnology

Bandwidth Management

Quality Management

Priority Management

Synchronization

Privacy

Security

Dependent on the medical workflowDependent on the medical workflow

23

TCS TCS –– AnimationAnimation

24

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

25

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

26

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

27

VideoVideo

28