Crowdsourcing CPR and Other Forms of Emergency Medicine

woman performing CPR while another woman is on cell phone
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The use of smartphone-based tools to manage your health has gotten a lot of attention over the past few years. There are a lot of apps out there to get you to move more, eat better, keep track of your medicines, and monitor your blood pressure and other health parameters.

In fact, the American Heart Association published a detailed scientific statement that recognized the potential of digital tools—such as mobile devices, social media, video media and crowdsourcing—in improving the treatment and outcomes of emergency heart conditions.

Scientific evidence to support the safety and efficacy of these technologies in emergency medicine is still scarce. Nonetheless, new digital strategies bring novel opportunities, and there has been a lot of interest from different stakeholders (funders, health-care systems, consumer groups) to evaluate and develop them further.

How PulsePoint Engages Lay Citizens to Perform CPR

Consider cardiac arrest, which is when someone’s heart stops. One of the most critical treatments that victims of cardiac arrest need is good CPR. Only 7 percent of people who have an out-of-hospital cardiac arrest will survive, and every minute that passes without CPR reduces those already slim chances.

Many patients have not been fortunate enough to have someone nearby who knew how to do CPR. Even when there was someone, it was often a distressed family member who, in all likelihood, was too traumatized and scared to do it correctly.

This is where PulsePoint comes in. PulsePoint is a San Francisco-based nonprofit that helps get willing volunteers with CPR training to the victims of cardiac arrest.

Here is how it works. When the emergency response center gets a call that they recognize as a cardiac arrest, they activate an emergency response team.

Simultaneously, the call goes out on PulsePoint. Nearby volunteers get an alert with the location of the person in need and directions to get there.

According to PulsePoint President Richard Price, volunteers have not only started CPR but have also provided support and encouragement for others at the scene. Not infrequently, he added, multiple volunteers will respond to the same call. Right now, PulsePoint only works if the call comes from a non-residential location, presumably for safety and privacy reasons.

Effectiveness

These types of systems have been shown to be effective. A study in Sweden looked at what happened when they deployed a similar system in one large city. By the end of the study, they had signed up over 10,000 volunteers. Like PulsePoint, this system could be activated when a call came in to the emergency response center. Researchers looked at what happened when they activated their smartphone-based Good Samaritan system versus when they did not and they found that this system could significantly increase the rates of bystander CPR, from 48 percent to 62 percent.

According to Price, PulsePoint recruits heavily among first responders and trained healthcare professionals whenever they are getting started in a new city.

As a result, the majority of PulsePoint volunteers have professional training or experience in emergency response. However, any volunteer with CPR training can sign up.

Challenges

There are some challenges to deploying a system like this in the United States in comparison to Sweden, namely that we have a very fragmented emergency response system. Each city or county has its own emergency response center with its own protocols and its own computer system. According to Price, now that PulsePoint has figured out how to connect with all of the major software vendors, he expects expansion to pick up.

In fact, in 2016, PulsePoint was operating in over 1,500 communities in the United States and Canada, and more than 750,000 users have downloaded the app.

Challenges for optimal utilization of PulsePoint remain, however. For instance, an evaluation article published in the journal Resuscitation showed that only 23 percent of those who received the notification responded. There were different issues that affected better implementation, such as information on the location, audio volume and user density. It has also been noticed that the current activation radius of 0.5 miles might be too large.

Other Benefits of Crowdsourcing in Emergency Medicine

The American Heart Association suggests that a system similar to PulsePoint could help in other situations too, including stroke and heart attack. Furthermore, it could help build a culture of response among the general public. If more people recognized the early signs of some urgent conditions, they could liaise with emergency medical services in a timely manner. Instead of learning what should have been done after the event, real-time notifications and alerts could help design a coordinated response. For example, crowdsourcing of bystanders could help recognize stroke symptoms earlier or ensure a heart attack patient got medications (e.g. aspirin) sooner.

We’ve also seen a lot of attention on training people in effective CPR in recent years.

Part of the reason is that out-of-hospital cardiac arrest is an incredibly difficult problem; it’s a condition where seconds matter but help is often many minutes away. Training more and more people in cardiac arrest care and stroke care will make it more likely that there will be a bystander who knows what to do. This, however, requires some additional funding.

The American Heart Association has used several crowdfunding campaigns to date to raise money for its innovations and projects. For example, The Power to End Stroke campaign relied on financial contributions from online communities. Furthermore, crowdfunding can be used to organize CPR trainings among high-risk communities, fund public automated external defibrillator (AED) programs and spread new ideas and research projects.

These days we crowdsource everything—product reviews on Amazon, earthquake detection, and even the search for extraterrestrial life. Why not crowdsource emergency cardiovascular care and education? 

Sources

Brooks S, Simmons G, Worthington H, Bobrow B, Morrison L. Clinical paper: The PulsePoint Respond mobile device application to crowdsource basic life support for patients with out-of-hospital cardiac arrest: Challenges for optimal implementation. Resuscitation, 2016;98:20-26

Ernst C, Mladenow A, Strauss C. Collaboration and crowdsourcing in emergency management. International Journal of Pervasive Computing & Communications, 2017;13(2):176-193

Khalemsky M, Schwartz D. Emergency Response Community Effectiveness: A simulation modeler for comparing Emergency Medical Services with smartphone-based Samaritan response. Decision Support Systems, 2017;102:57-68

Ringh M, Hollenberg J, Järnbert-Pettersson H, et al. Mobile-phone dispatch of laypersons for CPR in out-of-hospital cardiac arrest. New England Journal of Medicine, 2015;372(24):2316-2325

Rumsfeld J, Brooks S, Aufderheide T, et al. Use of Mobile Devices, Social Media, and Crowdsourcing as Digital Strategies to Improve Emergency Cardiovascular Care: A Scientific Statement From the American Heart Association. Circulation, 2016; 134(8):e87

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