November 4, 2013
Public health problems are large, various, and generally difficult to solve, both technically and politically. Examples of public health problems are cigarette smoking, bias towards sugar-fat-starch rich foods over fresh fruits and vegetables or the abuse of narcotics. The inclusion of each of these examples as a “public health problem” is debatable – many would argue that people should be allowed to choose to eat unhealthily and that narcotics abuse is a criminal problem rather than a public health problem. I would argue that a public health problem is a health-related problem caused by a combination of convenience/pleasure and social/economic/legislative pressure.
There is ample opportunity for debate about public health problems, not just in which problems to include in the category, but how they can be approached, and in some cases whether any attempt to solve them is an untenable intrusion on individual liberty.
The public health problem I want to look at is the Out of Hospital Cardiac Arrest (OHCA). In the case of OHCA, the generally accepted solution is medical intervention as soon as possible. After a cardiac arrest your survival goes down approximately 10% per minute that you do not receive oxygenated blood flow. Modern Emergency Medical Services (EMS) have a well-defined set of tools to combat the effects of an OHCA, but even the most optimistic response times are measured in minutes. Some researchers in Sweden have been experimenting with a system that uses the mobile phone system to dispatch CPR-trained bystanders to people experiencing an OHCA . Briefly, their work sends a message to any CPR-trained volunteer on the system who’s cell phone is within 500m of the person in cardiac arrest. They arrived before the ambulance most of the time, and in a situation where minutes save lives, this is a way to use technology and a widely-diffused skill (CPR) to earn those minutes.
Reading about this experiment it was immediately obvious to me how this same approach could be used in any high-density environment, like cities and even highways. What occurred to me next is that a similar technical solution could help connect people experiencing an OHCA with an amazing piece of technology, the Automatic External Defibrillator (AED). These are briefcase-sized boxes that can be used to correct an arrhythmic heart through the application of electrical current. They are remarkably easy to use – several models actually give audio instructions when activated and have been shown to be usable by children. The problem is that even as they continually come down in price and are available in more places, when you need one you may not know where one is.
A technical solution is to include a cellular radio in the AED, which can periodically broadcast its location to EMS dispatch, as well as respond to a signal from a bystander cell phone or EMS call. This would mean that the moment EMS is contacted and determines that there is an OHCA, they could issue directions to the nearest AED to the people on the scene. An AED could also be configured to respond to a message from EMS and emit an alarm so that it could be more easily located. It could also be used to ensure that the AED is given proper maintenance, as the batteries and contact pads in these devices degrade over time – if they could send automated messages to an administrator of the AED there would be less chance for a responder to go in search of an AED only to find it inoperable due to improper maintenance.
Certainly this is not a magical solution, but I think it is interesting to look for ways for the advances in technology to serve unaddressed needs. A big advantage of the purely technical interventions is that they are more likely to resist political objections than say, behavioral interventions or changes in laws, regulations and taxes.