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Field Survey Report Passion Data Collection App Project Global South eHealth Observatory Fondation Pierre Fabre Collecting patients’ data Géraldine Fischer, Fondation Pierre Fabre March 2019, Vientiane, Laos

Field Survey Report Passion Data Collection App Project · 2019. 6. 28. · Passion Data Collection App Project Global South eHealth Observatory ... driving skills, ... Each volunteer

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Page 1: Field Survey Report Passion Data Collection App Project · 2019. 6. 28. · Passion Data Collection App Project Global South eHealth Observatory ... driving skills, ... Each volunteer

Field Survey Report

Passion Data Collection App Project

Global South eHealth Observatory

Fondation Pierre Fabre

Collecting patients’ data

Géraldine Fischer, Fondation Pierre Fabre

March 2019, Vientiane, Laos

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A. How did all this begin?

Vientiane Rescue was founded in 2010. This emergency service is attached to the "Foundation for

Assisting Poor People of Lao PRD", created in 2005. It was created through the joint action of seven

volunteers, including Sebastien Perret, a French volunteer fireman settled in Laos. Their aim was to

do something about the lack of ambulance services in the country and thus improve patients'

chances of survival in emergency situations.

They are able to intervene in all kinds of situations: fires, road accidents, births, floods, drowning

incidents and landslides, thanks in particular to specialist teams (fire-fighters, divers etc.) and cutting-

edge equipment. One example is their hydraulic saw, powered by a small mobile generator and

installed in one of their vehicles.

B. And what's happening today?

At present, 90% of "pre-hospital emergency care" interventions in Vientiane are provided by VR,

which is the only reliable and free service, with almost 20 ambulances and 4 stations distributed

across the city. The team has recently expanded by opening two stations in the provinces: one in

Pakse (2017) and one in Vang Vieng (2019). This service is available most of the time, every day of the

year, both day and night.

It is modelled on the Anglo-Saxon "pre-hospital" emergency services (as opposed to the Franco-

German system). These services take the patient to the doctor, rather than taking the doctor to the

patient. The idea is therefore to make the patient safe and take him/her to a hospital of reference as

soon as possible.

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The Vientiane Rescue teams work in partnership with the main hospitals in the city: Mittaphab,

Mahosot and Setthathirath. Trauma cases are sent to Mittaphab, which is the reference hospital. In

all other cases, the patients are referred to the nearest hospital.

The teams stationed in Vientiane carry out 500 interventions per month on average. Variations are

observed depending on the time of year (for example, a steep increase during the Lao New Year

festival, reductions during the Buddhist Lent period).

In addition, international collaborations have already been successfully carried out, such as during

the intervention in Thailand in 2018 to rescue the young footballers trapped in the cave after a

sudden rise in water levels.

C. Who are the volunteers?

In 2019, more than 500 volunteers are working with VR. Most of these volunteers are very young

(between 17 and 25 years old).

When they first meet the VR teams and express a wish to join one of the teams, the volunteers

undergo a week of training provided by the most experienced volunteers, those who have been

through the "Emergency Medical Technician" training in Thailand. This second level of training is

offered to the volunteers who are most involved, with 2-3 people trained every year.

In order to ensure continuity of service, "station managers" are in charge of various base points in

VR. They are chosen for their seniority, leadership and experience in field work and management.

They are also the ones who manage the daily expenses (petrol, vehicle maintenance and

consumables) and ensure that the volunteers respond properly when needed.

Some volunteers are also appointed as ambulance drivers if they show the level of collectedness,

driving skills, control of the vehicle and knowledge of the Highway Code required.

Each volunteer has their own uniform. A uniform awarding ceremony is held after the volunteer has

completed six months' work with VR.

D. What about the application solution?

Until now, all the information on interventions has been written on paper forms. These forms are

shared with the other emergency medical aid services and the hospitals.

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Vientiane Rescue now wishes to introduce a mobile/tablet application for recording cases directly during the intervention: patient data, place of intervention, severity of injuries etc. A pilot version of this system is already being used in cases of road accidents.

As well as making the input of data easier, it would allow all information to be sent to the hospital of

destination immediately on leaving the accident site. Through a direct connection to a computer and

printer in the hospital, all the information would be together on a form similar to the one currently

being used, and would be printed automatically. Thanks to the computer tool's location function, the

journey time could be calculated. This would allow the medical team to make staff and suitable

equipment available, especially in cases of serious injuries. This system would only be used for

serious cases. At present, however, it is not yet being tried out.

In the longer term, the application will have many benefits:

- Increased efficiency of the Vientiane Rescue service

o Continuous training of volunteers to fill gaps made evident by analysis of the

information input into the application (for example, no additional oxygen with O2

saturation levels at 70%)

o Ensuring preparation of hospital teams beforehand, in order to provide the patient

with the best possible treatment.

- Introduction of statistics collection systems. The current method of collection does not allow

optimal analysis of data because of lack of time and qualified personnel. However, obtaining

accurate data has many positive aspects:

o Purchase of suitable technical equipment according to frequency of specific

situations (e.g. specific splints for treatment of tibial fractures).

o Circulation and transmission of data consistent with reality (government data is

about one seventh as good as the data from Vientiane Rescue).

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o Increasing public awareness.

o Applying to the authorities for a change in regulations (dangerous junctions or

routes, compulsory wearing of crash helmets etc.).

It is planned to share this application and provide suitable equipment (tablets) to other emergency

medical assistance services in the city. This will especially involve the Lao Red Cross, which currently

has five ambulances.

E. And how does it work exactly?

I was able to accompany the VR teams to find out how this emergency service works. I went to one of

the newly refurbished bases. Here, the volunteers have two rest rooms (two containers), a kitchen

and a washing area (showers and toilets).

The first thing to note is that the volunteers want for nothing. Generally, at least four volunteers are

present in the stations 24 hours a day. Some are there early and others take over when they leave. A

new volunteer arrives or leaves every 15 minutes and overall, there were always seven or more

volunteers on the site that evening.

One of the stations (the first to be created and the largest) also functions as a call centre. The number 1623 is very widely distributed in Laos and can even be seen on the ambulances.

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Every day, different volunteers liaise with each other to provide a response to every call. The

volunteer obtains all the important information (type of treatment requested, the number of victims

and their condition, location, surroundings and specific circumstances) and sends the information by

radio to the station closest to the incident. VR recently replaced its analogue radio system with a

digital system. This new system has several advantages. Not only does it prevent sound irregularities

on the line, but it keeps the information exchanged confidential. Not only that, but these radios are

equipped with a GPS system that keeps a permanent tag on the ambulances' location.

Depending on how many people are at the base, 2 – 4 people go off in the ambulance in response to

calls concerning potential victims. Although they are equipped with revolving lights and sirens, the

teams now have to deal with a new regulation that prevents the use of sound signals after 6pm.

Driver attention is therefore even more essential. Their comprehensive knowledge of the city and its

districts makes these drivers invaluable in the emergency vehicle.

We left that evening to treat a pregnant woman about to give birth. When we left, one of the

volunteers present completed the "Dispatch" section of the application with the information about

the attending vehicle and team (number and ID of volunteers and vehicle type) and the reason for

leaving.

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When we arrived, the team set about treating the patient immediately and placed her in the

ambulance before taking her vital signs. At the same time, a team member took photographs of the

surrounding area and the patient in order to compile the file.

When the ambulance left for the hospital, one of the volunteers had to choose the destination. In the

long term, the selection of this destination should allow key information to be sent to the relevant

hospital automatically in the event of a serious (red) case.

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During the journey, the volunteers were able to complete the "VS" section, for Vital Signs, as many

times as possible in order to monitor changes in the patient's vital signs. One check every 5 minutes

is recommended. On arrival at the hospital, the patient was taken in by the VR team before being

treated by the hospital staff. One of the volunteers was then given the task of filling in the missing

information in the form or application (particularly more accurate information on the circumstances

of the intervention if the team could not do it earlier). The VR team was also given an intervention

number by the VR call centre. This allows the police teams to contact the VR teams in order to

obtain more details on the intervention, if necessary.

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As soon as the VR team, the patient (or the person

accompanying the patient) and the hospital team have

signed the form, a copy of the form is left with the

establishment and the VR team goes back to base to get

ready for the next intervention.

F. Finance and economic model / Partners

VR relies on a number of finance sources which are often isolated payments: Embassies (such as

France, Australia and the USA), donations from private companies from Laos or overseas, and

collection boxes placed in the 49 outlets of the "M Point" supermarket chain in Laos. This last

initiative produces a total of $3000 per month, which represents half of their ongoing costs

(consumables, petrol and vehicle maintenance).

VR also benefits from support from the JIRISS Company, based in Osaka, Japan, which provides

financial resources (most notably for financing the implementation of the geolocation system) and

human resources (engineers for developing the pilot version of the application).

G. Potential developments and needs

VR is constantly developing. We sense that the teams are keen to improve their practices and efficiency levels. VR's coming projects include:

- Writing procedural documents on the overall management of VR and on the treatment of

patients. This will help to standardise practices and train new staff members.

- Setting up a training centre. The training is currently given in Thailand. This is possible

because it is nearby and they speak the same language, but in view of the size and work of

VR, which is growing from day to day, it will soon be necessary for the recognised training to

be given in Laos. This would also help increase visibility and exchanges with emergency

services in the countries in this area, in order to create a real emergency services network in

the ASEAN.

- Extending to other provinces. In 2019, there are plans to open two more stations: one in

the Luang Prabang region and the other in the Bokeo region.

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- Improving data collection processes, hence the wish to develop this application.

The application is currently only in the pilot stage. More work needs to be done on it,

especially on:

- The various items of information requested

(difficult to ask for precise details of the

circumstances of the accident without making the

questions sound like a police interrogation, which

the population may take the wrong way)

- Accuracy of information requested: the

information requested needs to be as accurate as

possible (for example, being able to specifically

choose the foot or leg on the diagram) without

making the volunteers' work too complicated and

important information being hidden.

- The data to be sent to the hospital: what

information should be on the form?

- Statistics: in order to obtain relevant statistics, technical support is needed. This will help extract relevant data in order to provide information, ensure prevention or plead in court.

In addition, the volunteers, who are often all mobilised during an intervention, have difficulty filling

in the application at the same time and need further training to help them understand the long-term

benefits of a solution like this application.

I also noted that the form is not filled in until they arrive at the hospital. However, for essential

information to be sent to the place of treatment, the VR teams need to include them in the

application before the ambulance leaves the place of treatment. Training sessions are therefore

essential.

H. Conclusion

Vientiane Rescue is just about the only pre-hospital emergency service in Laos. Their work is

essential, especially given its context. With their ten years of experience, they are well established

and known to everyone in Vientiane.

Their desire for improvement is very evident, especially in the work already started on the pilot

project of the application. Several uses are highlighted both on a practical level (improvement of

treatment) and in the long term, especially for its advocacy.

This project is also interesting in that as well as financial support, it is technical support that the VR

teams need most of all in order to make the application as effective as possible without making the

volunteers' workload heavier. As VR is the only organisation of this kind in Vientiane, it is not difficult

for them to fund the equipment. However, technical support that could help them with launching the

application looks more difficult to obtain.

They are continually in contact with potential sponsors to finance their organisation.

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