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ANNEX 1 Use-Case Flowcharts Critical medical events in inaccessible areas (part 1 and part 2):

Call 112

112 Dispatcher dispatch EMS team

EMS team reach the emergency site

EMS team make a first medical ascertainment of patients’ status

Primary assessment of vital parameters / first aid procedures

EMD select the nearest hospital available to treat the patients

EMS team transports the patients to the selected hospital

A B C D E F G

Is EMS team able to reach the precise

emergency location with the

ambulance?

Return D.

EMS team leave the ambulance and reach the right location by foot.

YES

NO

EMS team won’t arrive just in time to perform first aid medical procedure.

EMS team will arrive in time to perform first aid medical procedure.

Return E.

FAILURE

EMS team won’t be able to carry all their medical equipment in only one go.

Depending on patient’s health condition:

NO NO

EMS team determines that the emergency site indicated by EMD is not the precise location.

Due to the inaccessible environment, EMS team has to leave the ambulance and move by foot.

Will EMS team need more medical support?

YES

NO

Return E.

EMS team won’t be able to determine their current geographical coordinates (corresponding with the precise intervention site)

The EMS medical support will waste time with searching the intervention site, due to the lack of geographical coordinates.


EMS team will maintain the victims alive until the EMS medical support arrives.

EMS team won’t maintain the victims alive until the EMS medical support arrives.

Is available in the remote area mobile

telephony infrastructure?

YES

Return E.

FAILURE

- no audio interaction with EMD; - no vital parameters transmission to EMD

Is available in the remote area radio communication infrastructure?

- audio interaction with EMD; - vital parameters transmission to EMD

-audio interaction with EMD;

YES

Perform E. The lack of visualization of patient’s / victim’s physical condition will impede EMD on providing a better medical guideline / advice for EMS.

Depending on the in field EMS physician / paramedics experience and competence, and the patient’s health condition:

The first aid medical procedures won’t succed to EMS.

FAILURE Return to F.

The first aid medical procedures will succed to EMS.

Are enough -audio interaction with EMD;

-vital parameters transmission to EMD

in order to receive a good medical guideline / advice from

EMD?

YES NO

EMS team won’t receive medical guideline / advice in

performing the first aid medical procedures from

EMD if they need.

FAILURE

The lack of visualization of patient’s / victim’s physical condition / vital parameters will impede EMD on providing a better medical guideline / advice for EMS.

Depending on the in field EMS physician / paramedics experience and competence, and the victim’s injury condition:




Is enough -audio interaction with

EMD; in order to receive a

good medical guideline / advice from EMD?

NO YES

Perform E.

Return to F.

Return to F.

© Springer Fachmedien Wiesbaden GmbH, part of Springer Nature 2019

C. Vizitiu, Systems Engineering and Organizational Assessment Solutions EnsuringSustainability within Telemedicine Context, Sustainable Management, Wertschöpfungund Effizienz, https://doi.org/10.1007/978-3-658-23538-3

192 ANNEX 1 Use-Case Flowcharts

Critical medical events in accessible areas:

Call 112

112 Dispatcher dispatch EMS team

EMS team reach the traffic event area

EMS team make a first medical ascertainment of victims’ status

Extrication Procedure


EMD select the nearest hospital available to treat the victims

EMS team transports the victims to the selected hospital

A B C D E F G H


traffic event location with the

ambulance?

Return D.


YES

NO



Return F.

FAILURE


Depending on victims’ injury condition:

YES

NO

The victims will be extricated alive.

The victims will be extricated dead.

Return to F.

FAILURE

Is the extrication fast performed?

- audio interaction with EMD based on mobile telephony / radio communication; -vital parameters transmission to EMD based on mobile telephony;




EMD?

Perform F.

The lack of visualization of patient’s / victim’s physical condition will impede EMD on providing a better medical guideline / advice for EMS.

Depending on the in field EMS physician / paramedics experience and competence, and on the victim’s health condition:



FAILURE Return to G.

YES

NO

Return to G.

Traffic events in inaccessible areas (part 1):

Call 112

112 Dispatcher dispatch EMS team (SMURD/SAJ)







Is EMS team able to reach fast enough the precise traffic event location due to the inaccesible,

remote area?

Return D.

The victims will be found dead.

YES

NO

YES

NO



Return to F.

FAILURE

Is the extrication fast

performed?

Is available in the remote area mobile

telephony infrastructure?

A B C D E F G H

FAILURE

Is available in the remote area mobile telephony / radio communication infrastructure?

YES

NO

EMS team will submit the victims’ status to EMD.

EMS team will submit the victims’ status to EMD.

EMS team will receive more medical support if they needed.

FAILURE

Return to F.

EMS team won’t receive more medical support if they needed.

Is available in the remote area radio communication infrastructure?



-audio interaction with EMD;

YES YES NO NO

193

Traffic events in inaccessible areas (part 2):



EMD if they need.

The lack of visualization of patient’s / victim’s physical condition / vital parameters will impede EMD on providing a better medical guideline / advice for EMS.

Depending on the in field EMS physician / paramedics experience and competence, and on the victim’s injury condition:




FAILURE

Perform F. The lack of visualization of patient’s / victim’s physical condition will impede EMD on providing a better medical guideline / advice for EMS.

Depending on the in field EMS physician / paramedics experience and competence, and the patient’s health condition:







EMD?

YES NO


EMD; in order to receive a

good medical guideline / advice from EMD?

NO YES

Perform F.

Return to G.

Return to G.

Traffic events in accessible areas:

Call 112

112 Dispatcher dispatch EMS team (SMURD/SAJ)







A B C D E F G H


traffic event location with the

ambulance?

Return D.


YES

NO



Return F.

FAILURE



YES

NO



Return to F.

FAILURE

Is the extrication fast performed?

- audio interaction with EMD based on mobile telephony / radio communication; -vital parameters transmission to EMD based on mobile telephony;




EMD?

Perform F.

The lack of visualization of patient’s / victim’s physical condition will impede EMD on providing a better medical guideline / advice for EMS.

Depending on the in field EMS physician / paramedics experience and competence, and on the victim’s health condition:




YES

NO

Return to G.

ANNEX 1 Use-Case Flowcharts


Mountain and Cave Rescue and Assistance Events:

Call 112

S&S is dispatched to the emergency site

S&S team reaches the emergency site

S&S team reaches the victims


Planning the evacuation route

S&S team transports the victims to the nearest hospital / to the nearest EMS team

A B C D E F G

- audio interaction with EMD based on mobile telephony / radio communication;


EMD; in order to receive a good medical guideline / advice

from EMD?

Perform E.

The lack of visualization of victim’s physical condition / of monitoring the victim’s vital parameters will impede EMD on providing a better medical guideline / advice for S&S.

Depending on the in field S&S physician / paramedics experience and competence, and on the victims’ health condition:

The first aid medical procedures won’t succed to S&S.

The first aid medical procedures will succed to S&S.


YES

NO

Is the S&S team medical equipment comprehensive for first aid medical

procedures?

Perform E.

S&S calls out specialised EMS teams

YES

NO

Specialised EMS teams won’t arrive in time to save the victims.

Specialised EMS teams will arrive in time to save the victims. Return F.

FAILURE


YES

NO

Is the S&S team medical equipment functional even if it hits hard surfaces /

get contact with water?

Perform E.

The equipment won’t function at all / will function with errors.

YES

NO FAILURE

Return to F.

Return to F.

Return to F.

The found casualties are situated far away from the established mountain / cave tracks.

Will S&S team need more medical support?

NO Return to E.

YES

EMS team won’t be able to determine their current geographical coordinates (corresponding with the precise intervention site)

The EMS medical support will waste time with searching the intervention site, due to the lack of geographical coordinates.


S&S team will maintain the victims alive until the EMS medical support arrives.

S&S team won’t maintain the victims alive until the EMS medical support arrives.

Return E.

FAILURE

195

Medical Assistance for Natural and Industrial Disasters:

Disaster Management Commands alert EMD

EMD dispatches EMS teams to disaster area

EMS teams reach the disaster area


Medical triage


EMD selects the nearest hospital / temporary medical unit available to treat the victims.

EMS team transports the victims

A B C D E F G H

Are EMS teams able to make make a chemical / nuclear

/ pandemic contamination assessment?

Return E.

EMS teams get contaminated.

YES

NO FAILURE

Are EMS teams able to reach the precise disaster

location with the ambulance?

Return E.

EMS teams reach the right location by foot.

YES

NO



Return F.

FAILURE



Is available the mobile telephony

infrastructure?


EMD; in order to receive a good medical guideline / advice

from EMD?



YES YES NO

-audio interaction with EMD based on radio communication

Perform F.

NO

The lack of visualization of patient’s / victim’s physical condition / vital parameters will impede EMD on providing a better medical guideline / advice for EMS. Return to G.



EMD if they need.

Depending on the in field EMS physician / paramedics experience and competence, and on the victim’s injury condition:




FAILURE




Perform F. The lack of visualization of patient’s / victim’s physical condition will impede EMD on providing a better medical guideline / advice for EMS.

Depending on the in field EMS physician / paramedics experience and competence, and on the victims’ health condition:

Are enough: -audio interaction with EMD;



EMD?

YES NO

Has EMD the capability to interact

simultanously all EMS teams requests?

YES NO

Perform F. EMD won’t provide medical guideline / advice to EMS teams if they needed.

FAILURE

Return to G.

Return to G.



Critical primary health-care events in inaccessible areas:

GP reaches the patient’s domicille.

GP provides primary care to his/her patient.

In the comming days other primary care visits to patient’s domicille made by GP.

The patient will be healed.

A B C D E F

Identification of the patient’s ailment through phone interogation.

Depending on the patient’s

symptoms:

GP considers the patient need a primary care. Return to C.

GP considers the patient is in a critical health condition.

In the same time GP calls 112, for EMS teams

A messenger inform the GP that someone needs primary care at domicille.

GP reaches the patient’s location.

GP attempts to give the first aid.

The GP’s minimal medical equipment is not enough for giving the first aid.

Depending on the patient’s health

condition

GP will maintain the patient alive until an EMS team arrives.

Mostly, GP won’t maintain the patient alive until an EMS

iFAILURE


condition



The patient need a primary care.

Return to D.

The patient is in a critical health condition.

In the same time GP calls 112, for EMS teams

Critical primary health-care events in accessible areas:

Patient calls GP

GP reaches the patient’s domicille.

GP provides primary care to his/her patient.

In the comming days other primary care visits to patient’s domicille made by GP.

The patient will be healed.

A B C D E F

Identification of the patient’s ailment through phone interogation.

Depending on the patient’s

symptoms:

GP considers the patient need a primary care. Return to C.

GP considers the patient is in a critical health condition.

GP calls 112, for EMS teams


emergency:

The patient die until EMS team arrives.

FAILURE

The patient withstand until EMS team arrives.


condition

The patient need a primary care.

Return to D. In the same time GP calls 112, for EMS teams



The patient is in a critical health condition.


condition: GP will maintain the patient alive until an EMS team arrives.

Mostly, GP won’t maintain the patient alive until an EMS

i

FAILURE

197

Health Status Screening in Remote Areas:

The people are informed about screening deployment

The targeted people reach the medical unit / caravan to be subjected to analysis/tests.

Tests / analysis are carried out.

The diagnostics are emitted.

A B C D E F G H

-a temporary medical unit is built Or

-a screening caravan is brought in the area

A screening program in remote areas is triggered.

Are the people able to reach the

screening medical unit?

The screening program is not efficient.

FAILURE

Return to E.

It will be emitted false diagnostics

The screening medical staff is not capable to provide domicilliary screening.

Some of tests / analysis are sent to a medical lab to be assessed, or some of them are assessed in situ.

The screening program ends.

YES

NO

Are properly carried out the tests

/ analysis?

YES

NO

Return to F.

FAILURE

Are tests / analysis fast enough

transmitted to medical lab? It will be delayed the tests /

analysis assessments and diagnostics.

YES

NO

Return to G.

FAILURE

The screening program is not efficient.


Documents

References - Springer978-3-658-23538...References Agapie, A. ~ î ì í ì . Si uple fo u of the statio va Ç dist i utio v fo ïd ellula auto uata i v a spe ial ase. Ph Çsi a A ~Statisti