field survey report passion data collection app project · 2019. 6. 28. · passion data collection...
TRANSCRIPT
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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