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Towards an integrated emergency medical care using 5G networks

Towards an integrated emergency medical care using 5G networks DE GRUYTER Current Directions in Biomedical Engineering 2020;6(3): 20203002 Max Rockstroh*, Julian Suleder, Carsten Bockelmann, Robert Wendlandt, Jan Gaebel, Christoph Georgi, Armin Will and Thomas Neumuth Towards an integrated emergency medical care using 5G networks Abstract: The Interoperability of medical devices and IT smooth access to information, and the presence of medical systems using various technologies in clinics and the expert knowledge. The supply processes mainly base on the preclinical area is still a research topic. The MOMENTUM availability of medical technology resources, such as imaging project deals with the new 5G mobile technology and units, vital monitoring, and breath monitoring, and equipment explores how they contribute to an improvement in for emergency interventions. Currently, these services cannot emergency care. Different applications, as well as various be made available nationwide for emergency medical care. technical and clinical aspects, including IT security, are Due to their complexity and size, many of these modalities considered. Integrated emergency care seems sensible, are not suitable for mobile use. This results in the need to particularly for emergencies outside of metropolitan areas design strategic and technical concepts to implement the and for particularly critical cases. fastest possible emergency medical care and thus improve the treatment processes from the accident site to the clinic. Keywords: 5G, Medical Device Interoperability, Emergency With the introduction of 5G as a new option for wireless Care, Emergency Medical Service, Trauma Team, IT communication and the possibility of using private campus Security networks (at least in Germany), additional options for networking and data transmission are emerging. 5G https://doi.org/10.1515/cdbme-2020-3002 combines a high bandwidth (eMBB – enhanced Mobile Broadband) with the opportunity of low latencies (URLLC – Ultra Reliable and Low Latency Communications) and 1 Current Situation and supports many concurrent communication participants (mMTC – Massive Machine Type Communication). A more Research Focus detailed overview of the technologies and an assignment to the use cases addressed by MOMENTUM can be found in The emergency medical care for patients inside and outside the paper from GAEBEL et.al. the hospital bases on a complex system of interlocking In recent years, intensive research has been carried out on processes with the participation of a large number of different inter-device communication and, above all, standardization, actors such as doctors, paramedics, nursing staff and a large so that today the IEEE11073-SDC standard family offers a number of different medical devices and IT systems. possibility for manufacturer-independent inter-device Treatment outside of specialized medical facilities, among communication [1], [2]. The MOMENTUM project aims to hospitals, medical centers, and doctor's offices, requires the explore the advantages and challenges of 5G communication quick and easy availability of medical technology resources, in emergency care. The focus is on supporting the rescue chain in a trauma emergency but is not limited to this. ______ There is an already well-established project in emergency * Corresponding author: Max Rockstroh: University Leipzig, care, particularly in the area of telemedical support for non- Faculty of Medicine, ICCAS, Leipzig, Germany, medical staff with the “Telenotarzt” [3], [4]. In addition to e-mail: max.rockstroh@medizin.uni-leipzig.de sound and video information, ECG signals are also Julian Suleder, ERNW Research GmbH, Carl-Bosch-Strasse 4, transmitted to enable the remote emergency doctor to assess Heidelberg, Germany Carsten Bockelmann: University of Bremen, Dept. of the patient better. The MedDV NIDA system, in turn, focuses Communications Engineering, Bremen, Germany on the clinical pre-registration of patients with severe clinical Jan Gaebel, Christoph Georgi and Thomas Neumuth: pictures (stroke, heart problems, trauma) [5], [6]. With this University Leipzig, Faculty of Medicine, ICCAS, Leipzig, Germany system, too, individual medical devices can be connected via Armin Will: University medical centre Schleswig-Holstein, a proprietary interface, and the data can be transferred Ratzeburger Allee 160, Lübeck Robert Wendlandt: University medical centre Schleswig- accordingly. Various studies have shown that timely Holstein, Clinic for Orthopedics and Trauma Surgery, Lübeck, information of clinics can improve the outcome [7] [8]: Germany Open Access. © 2020 Max Rockstroh et al., published by De Gruyter. This work is licensed under the Creative Commons Attribution 4.0 License. Max Rockstroh et al. Towards an integrated emergency medical care using 5G networks — 2 The support by the MOMENTUM can be divided into the 5. Connection of the medical devices to a 5G network and following concepts: integration of a drone-based repeater infrastructure 6. Creation of requirement profiles for communication Medical information technologies for mobile medical applications based on Distribution of information about the patient across generally strict requirements for medical devices and institutional boundaries and merging of information. comparison of these with the 5G requirement profiles Integration of the emergency data set and provision at the discussed in the 3GPP point of care, for example via augmented reality 7. Mapping of the requirement profiles on 5G services and implementation of selected medical services using 5G Monitoring and reporting technologies Transmission of the examination results and medical device 8. Development and technical specification of strategies data both within the ambulance and to the clinic to be treated e.g. for network slicing for medical technology later. Allow a better assessment of the patient by the trauma applications in the context of 5G data communication Leader and his team. Generate a consistent record of the 9. Performance analysis for 5G Release 15 technologies of entire emergency treatment based on the transmitted device the physical and medium access layer data and the manually entered information. 10. Development of communication technologies of the physical layer for Release 16 and beyond for the Emergency medical diagnostics transmission of data of different medical applications Support for new examination methods (e.g. mobile using the 5G services (eMBB, URLLC, mMTC) ultrasound). Due to the possibility of transferring large amounts of data with low latency, the sensors on-site can be separated from the complex calculation. This also opens up 2 Basic concept opportunities to use methods of image analysis and to implement intelligent control systems. To achieve an integrated communication infrastructure, sufficient mobile radio reception, and access to Emergency medical therapy in the clinic communication networks or the internet is the main Continuation of the treatment in the clinic and the prerequisite. This can be ensured for the building of critical combination of various information entities about the entire infrastructure, where emergency command centers and course of the treatment from emergency admission to ambulance vehicles might have to operate in areas with little discharge to no reception. First, MOMENTUM will create an ambulance vehicle equipped with its own radio cell. In an There are several scientific-methodological and medical- area with bad reception, the ambulance will itself be able to technical innovations across the four application areas that establish a radio connection and therefore connect all parts of are addressed in the project: the critical infrastructure. 1. Development and evaluation of suitable technical Second, the same radio technology will be used to methods for networking emergency medical treatment interconnect all medical and data-generating devices. Relying along the process chain from the place of use to the on 3GPP releases 15 (and above) allows data to be hospital communicated fulfilling medical as well as technical 2. The first provision of location and time-independent requirements. Data from medical devices, e.g. ECG or medical technology functionalities respirator, can be collected with required frequency and 3. Development of a common communication tolerable latency. Inside the ambulance, all medical (and infrastructure for the integration of patient data, technical/non-medical/ organizational) data will be bundled information, video, and audio data as well as the to present a comprehensive electronic emergency record establishment of an emergency medical telemedicine anytime data is needed. This comprises of organizational connection with a focus on device data via aspects that describe operational information that might heterogeneous communication technologies concern the emergency command center, technical aspects 4. Use of imaging diagnostic procedures and direct (e.g. metadata from medical devices), and, of course, medical evaluation using state-of-the-art analysis methods aspects and the aggregation of every information entity that is already during initial care and patient transport created or might be requested from users. The transparent Max Rockstroh et al. Towards an integrated emergency medical care using 5G networks — 3 logging of treatment data is the basis for further use, e.g. for interfaces between communication flows of different areas of quality assurance. trust. Therefore, a communication flow spanning various Since this sophisticated system involves multiple areas of trust crosses at least one trust boundary. Examples communication partners from different organizational concerning trust boundaries and areas are processes on an entities, an elaborate security concept is needed to ensure that operating system, apps on mobile platforms, network device connections are safe, encrypted and access-controlled. interfaces, but also organizational limits and areas with different privileges within one application. Any data crossing IT security concept a boundary must be validated, and measures to preserve the cybersecurity protection goals must be implemented. The The cybersecurity concept aims to ensure cybersecurity diagram in figure 1 shows an early stage of an abstract model protection goals such as the often-cited confidentiality, of the communication system designed in project integrity, and availability but also authenticity, transparency, MOMENTUM showing respective trust areas and trust and non-repudiation. It guides beginning with the design boundaries as well as appropriate checkpoints. phase right through to the technical implementation and The concept's measures bases on the seven security best phrases particular cybersecurity requirements based on practices of access control, segmentation, isolation, functional requirements and a detailed system model and hardening, encryption, visibility, and secure management. As architectural design. a consequence, this framework allows a definition of specific and extensive but feasible functional, as well as non- functional security requirements. Furthermore, a step-by-step refinement and concretization of the system design without specifying far-reaching limits is possible. The technical realization is verified by penetration tests and code reviews to close the feedback loop. 3 Conclusion The MOMENTUM project is dedicated to data acquisition, forwarding, and processing in emergency treatment. It evaluates the extent to which 5G communication inside the ambulance vehicle and emergency room, as well as between these functional units, can contribute to better data processing/integration and safer treatment of the patient. Possible fields of application for an integrated, 5G-based system are in development with specialists from emergency care. The results of the requirements analysis are considered during the architectural planning and the designing of the overall system. Besides, the mentioned requirements regarding IT security also deal with regulatory aspects. From the regulatory point of view, there is currently no bandwidth allocated to private mobile networks or emergency services in general. A private band similar to the campus networks in the 3.7-3.8 GHz range, which are now available in Germany, would be ideal. Furthermore, the ongoing discussion about Figure 1: Abstract model of the communication system designed the spectrum in the 450 MHz range does not address the in project MOMENTUM including the trust areas discussed private networks and offers rather small bandwidth, probably insufficient for the required services. In In this model, where all components, as well as their consequence, there must be agreements/arrangements with communication relationships, are represented, trust the network operators and network agencies to equip boundaries and areas are determined. Trust boundaries are ambulances with a local and mobile 5G small cell. Max Rockstroh et al. Towards an integrated emergency medical care using 5G networks — 4 11073 SDC“, Journal for Computer Assisted Radiology and The previous discussions also showed that a system like the Surgery, 2017. one presented in this paper could also be of great interest to [3] R. Süss, C. Dewenter, A. Ekinci, T. Laslo, und S. Fleßa, „Das the nursing sector, especially in rural areas outside of the Telenotarztsystem – Potentiale für die präklinische metropolitan regions. Nursing staff, e.g. working in a Notfallversorgung im ländlichen Raum“, Gesundheitsökonomie & Qualitätsmanagement, Feb. 2020, retirement home, would greatly benefit from telemedical doi: 10.1055/a-1100-2639. support and the ability to have remote physicians help them [4] D. Ä. G. Ärzteblatt Redaktion Deutsches, „Telenotarzt in case of emergency. Overall, supporting medical dirigiert Rettungsdienst“, Deutsches Ärzteblatt, Okt. 04, examinations and emergency treatments with sophisticated, https://www.aerzteblatt.de/nachrichten/80690/Telenotarzt- integrated information systems shows its strengths where dirigiert-Rettungsdienst (zugegriffen Nov. 26, 2018). operation distances are long and the availability of [5] P. Eder, B. Reime, T. Wurmb, U. Kippnich, L. Shammas, und emergency doctors poor as well as the occurrence of a large A. Rashid, „Prehospital Telemedical Emergency number of injuries and the associated need for prioritization. Management of Severely Injured Trauma Patients: A Systematic Review“, Methods of Information in Medicine, Bd. 57, Nr. 05/06, S. e1–e1, Nov. 2018, doi: 10.3414/ME18-05- Author Statement This work is funded by the German Federal Ministry of [6] S. A. Munich u. a., „Mobile Real-time Tracking of Acute Education and Research (BMBF) with grant number Stroke Patients and Instant, Secure Inter-team 16KIS1030. The statements made herein are solely the Communication - the Join App“, Neurointervention, Bd. 12, Nr. 2, S. 69, 2017, doi: 10.5469/neuroint.2017.12.2.69. responsibility of the authors. [7] S. Zhang u. a., „Prehospital Notification Procedure Improves The authors state that they have no conflict of interests. Stroke Outcome by Shortening Onset to Needle Time in Chinese Urban Area“, Aging and Disease, Bd. 9, Nr. 3, S. 426, 2018, doi: 10.14336/AD.2017.0601. [8] J. Nam, K. Caners, J. M. Bowen, M. Welsford, und D. O’Reilly, „Systematic review and meta-analysis of the References benefits of out-of-hospital 12-lead ECG and advance notification in ST-segment elevation myocardial infarction [1] M. Kasparick u. a., „OR.NET: a service-oriented architecture patients“, Ann Emerg Med, Bd. 64, Nr. 2, S. 176–186, for safe and dynamic medical device interoperability“, 186.e1–9, Aug. 2014, doi: Biomedical Engineering / Biomedizinische Technik, Bd. 63, 10.1016/j.annemergmed.2013.11.016. Nr. 1, S. 11–30, Feb. 2018, doi: 10.1515/bmt-2017-0020. [2] M. Rockstroh u. a., „OR.NET: Multi-perspective qualitative evaluation of an integrated operating room based on IEEE http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Current Directions in Biomedical Engineering de Gruyter

Towards an integrated emergency medical care using 5G networks

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Abstract

DE GRUYTER Current Directions in Biomedical Engineering 2020;6(3): 20203002 Max Rockstroh*, Julian Suleder, Carsten Bockelmann, Robert Wendlandt, Jan Gaebel, Christoph Georgi, Armin Will and Thomas Neumuth Towards an integrated emergency medical care using 5G networks Abstract: The Interoperability of medical devices and IT smooth access to information, and the presence of medical systems using various technologies in clinics and the expert knowledge. The supply processes mainly base on the preclinical area is still a research topic. The MOMENTUM availability of medical technology resources, such as imaging project deals with the new 5G mobile technology and units, vital monitoring, and breath monitoring, and equipment explores how they contribute to an improvement in for emergency interventions. Currently, these services cannot emergency care. Different applications, as well as various be made available nationwide for emergency medical care. technical and clinical aspects, including IT security, are Due to their complexity and size, many of these modalities considered. Integrated emergency care seems sensible, are not suitable for mobile use. This results in the need to particularly for emergencies outside of metropolitan areas design strategic and technical concepts to implement the and for particularly critical cases. fastest possible emergency medical care and thus improve the treatment processes from the accident site to the clinic. Keywords: 5G, Medical Device Interoperability, Emergency With the introduction of 5G as a new option for wireless Care, Emergency Medical Service, Trauma Team, IT communication and the possibility of using private campus Security networks (at least in Germany), additional options for networking and data transmission are emerging. 5G https://doi.org/10.1515/cdbme-2020-3002 combines a high bandwidth (eMBB – enhanced Mobile Broadband) with the opportunity of low latencies (URLLC – Ultra Reliable and Low Latency Communications) and 1 Current Situation and supports many concurrent communication participants (mMTC – Massive Machine Type Communication). A more Research Focus detailed overview of the technologies and an assignment to the use cases addressed by MOMENTUM can be found in The emergency medical care for patients inside and outside the paper from GAEBEL et.al. the hospital bases on a complex system of interlocking In recent years, intensive research has been carried out on processes with the participation of a large number of different inter-device communication and, above all, standardization, actors such as doctors, paramedics, nursing staff and a large so that today the IEEE11073-SDC standard family offers a number of different medical devices and IT systems. possibility for manufacturer-independent inter-device Treatment outside of specialized medical facilities, among communication [1], [2]. The MOMENTUM project aims to hospitals, medical centers, and doctor's offices, requires the explore the advantages and challenges of 5G communication quick and easy availability of medical technology resources, in emergency care. The focus is on supporting the rescue chain in a trauma emergency but is not limited to this. ______ There is an already well-established project in emergency * Corresponding author: Max Rockstroh: University Leipzig, care, particularly in the area of telemedical support for non- Faculty of Medicine, ICCAS, Leipzig, Germany, medical staff with the “Telenotarzt” [3], [4]. In addition to e-mail: max.rockstroh@medizin.uni-leipzig.de sound and video information, ECG signals are also Julian Suleder, ERNW Research GmbH, Carl-Bosch-Strasse 4, transmitted to enable the remote emergency doctor to assess Heidelberg, Germany Carsten Bockelmann: University of Bremen, Dept. of the patient better. The MedDV NIDA system, in turn, focuses Communications Engineering, Bremen, Germany on the clinical pre-registration of patients with severe clinical Jan Gaebel, Christoph Georgi and Thomas Neumuth: pictures (stroke, heart problems, trauma) [5], [6]. With this University Leipzig, Faculty of Medicine, ICCAS, Leipzig, Germany system, too, individual medical devices can be connected via Armin Will: University medical centre Schleswig-Holstein, a proprietary interface, and the data can be transferred Ratzeburger Allee 160, Lübeck Robert Wendlandt: University medical centre Schleswig- accordingly. Various studies have shown that timely Holstein, Clinic for Orthopedics and Trauma Surgery, Lübeck, information of clinics can improve the outcome [7] [8]: Germany Open Access. © 2020 Max Rockstroh et al., published by De Gruyter. This work is licensed under the Creative Commons Attribution 4.0 License. Max Rockstroh et al. Towards an integrated emergency medical care using 5G networks — 2 The support by the MOMENTUM can be divided into the 5. Connection of the medical devices to a 5G network and following concepts: integration of a drone-based repeater infrastructure 6. Creation of requirement profiles for communication Medical information technologies for mobile medical applications based on Distribution of information about the patient across generally strict requirements for medical devices and institutional boundaries and merging of information. comparison of these with the 5G requirement profiles Integration of the emergency data set and provision at the discussed in the 3GPP point of care, for example via augmented reality 7. Mapping of the requirement profiles on 5G services and implementation of selected medical services using 5G Monitoring and reporting technologies Transmission of the examination results and medical device 8. Development and technical specification of strategies data both within the ambulance and to the clinic to be treated e.g. for network slicing for medical technology later. Allow a better assessment of the patient by the trauma applications in the context of 5G data communication Leader and his team. Generate a consistent record of the 9. Performance analysis for 5G Release 15 technologies of entire emergency treatment based on the transmitted device the physical and medium access layer data and the manually entered information. 10. Development of communication technologies of the physical layer for Release 16 and beyond for the Emergency medical diagnostics transmission of data of different medical applications Support for new examination methods (e.g. mobile using the 5G services (eMBB, URLLC, mMTC) ultrasound). Due to the possibility of transferring large amounts of data with low latency, the sensors on-site can be separated from the complex calculation. This also opens up 2 Basic concept opportunities to use methods of image analysis and to implement intelligent control systems. To achieve an integrated communication infrastructure, sufficient mobile radio reception, and access to Emergency medical therapy in the clinic communication networks or the internet is the main Continuation of the treatment in the clinic and the prerequisite. This can be ensured for the building of critical combination of various information entities about the entire infrastructure, where emergency command centers and course of the treatment from emergency admission to ambulance vehicles might have to operate in areas with little discharge to no reception. First, MOMENTUM will create an ambulance vehicle equipped with its own radio cell. In an There are several scientific-methodological and medical- area with bad reception, the ambulance will itself be able to technical innovations across the four application areas that establish a radio connection and therefore connect all parts of are addressed in the project: the critical infrastructure. 1. Development and evaluation of suitable technical Second, the same radio technology will be used to methods for networking emergency medical treatment interconnect all medical and data-generating devices. Relying along the process chain from the place of use to the on 3GPP releases 15 (and above) allows data to be hospital communicated fulfilling medical as well as technical 2. The first provision of location and time-independent requirements. Data from medical devices, e.g. ECG or medical technology functionalities respirator, can be collected with required frequency and 3. Development of a common communication tolerable latency. Inside the ambulance, all medical (and infrastructure for the integration of patient data, technical/non-medical/ organizational) data will be bundled information, video, and audio data as well as the to present a comprehensive electronic emergency record establishment of an emergency medical telemedicine anytime data is needed. This comprises of organizational connection with a focus on device data via aspects that describe operational information that might heterogeneous communication technologies concern the emergency command center, technical aspects 4. Use of imaging diagnostic procedures and direct (e.g. metadata from medical devices), and, of course, medical evaluation using state-of-the-art analysis methods aspects and the aggregation of every information entity that is already during initial care and patient transport created or might be requested from users. The transparent Max Rockstroh et al. Towards an integrated emergency medical care using 5G networks — 3 logging of treatment data is the basis for further use, e.g. for interfaces between communication flows of different areas of quality assurance. trust. Therefore, a communication flow spanning various Since this sophisticated system involves multiple areas of trust crosses at least one trust boundary. Examples communication partners from different organizational concerning trust boundaries and areas are processes on an entities, an elaborate security concept is needed to ensure that operating system, apps on mobile platforms, network device connections are safe, encrypted and access-controlled. interfaces, but also organizational limits and areas with different privileges within one application. Any data crossing IT security concept a boundary must be validated, and measures to preserve the cybersecurity protection goals must be implemented. The The cybersecurity concept aims to ensure cybersecurity diagram in figure 1 shows an early stage of an abstract model protection goals such as the often-cited confidentiality, of the communication system designed in project integrity, and availability but also authenticity, transparency, MOMENTUM showing respective trust areas and trust and non-repudiation. It guides beginning with the design boundaries as well as appropriate checkpoints. phase right through to the technical implementation and The concept's measures bases on the seven security best phrases particular cybersecurity requirements based on practices of access control, segmentation, isolation, functional requirements and a detailed system model and hardening, encryption, visibility, and secure management. As architectural design. a consequence, this framework allows a definition of specific and extensive but feasible functional, as well as non- functional security requirements. Furthermore, a step-by-step refinement and concretization of the system design without specifying far-reaching limits is possible. The technical realization is verified by penetration tests and code reviews to close the feedback loop. 3 Conclusion The MOMENTUM project is dedicated to data acquisition, forwarding, and processing in emergency treatment. It evaluates the extent to which 5G communication inside the ambulance vehicle and emergency room, as well as between these functional units, can contribute to better data processing/integration and safer treatment of the patient. Possible fields of application for an integrated, 5G-based system are in development with specialists from emergency care. The results of the requirements analysis are considered during the architectural planning and the designing of the overall system. Besides, the mentioned requirements regarding IT security also deal with regulatory aspects. From the regulatory point of view, there is currently no bandwidth allocated to private mobile networks or emergency services in general. A private band similar to the campus networks in the 3.7-3.8 GHz range, which are now available in Germany, would be ideal. Furthermore, the ongoing discussion about Figure 1: Abstract model of the communication system designed the spectrum in the 450 MHz range does not address the in project MOMENTUM including the trust areas discussed private networks and offers rather small bandwidth, probably insufficient for the required services. In In this model, where all components, as well as their consequence, there must be agreements/arrangements with communication relationships, are represented, trust the network operators and network agencies to equip boundaries and areas are determined. Trust boundaries are ambulances with a local and mobile 5G small cell. Max Rockstroh et al. Towards an integrated emergency medical care using 5G networks — 4 11073 SDC“, Journal for Computer Assisted Radiology and The previous discussions also showed that a system like the Surgery, 2017. one presented in this paper could also be of great interest to [3] R. Süss, C. Dewenter, A. Ekinci, T. Laslo, und S. Fleßa, „Das the nursing sector, especially in rural areas outside of the Telenotarztsystem – Potentiale für die präklinische metropolitan regions. Nursing staff, e.g. working in a Notfallversorgung im ländlichen Raum“, Gesundheitsökonomie & Qualitätsmanagement, Feb. 2020, retirement home, would greatly benefit from telemedical doi: 10.1055/a-1100-2639. support and the ability to have remote physicians help them [4] D. Ä. G. Ärzteblatt Redaktion Deutsches, „Telenotarzt in case of emergency. Overall, supporting medical dirigiert Rettungsdienst“, Deutsches Ärzteblatt, Okt. 04, examinations and emergency treatments with sophisticated, https://www.aerzteblatt.de/nachrichten/80690/Telenotarzt- integrated information systems shows its strengths where dirigiert-Rettungsdienst (zugegriffen Nov. 26, 2018). operation distances are long and the availability of [5] P. Eder, B. Reime, T. Wurmb, U. Kippnich, L. Shammas, und emergency doctors poor as well as the occurrence of a large A. Rashid, „Prehospital Telemedical Emergency number of injuries and the associated need for prioritization. Management of Severely Injured Trauma Patients: A Systematic Review“, Methods of Information in Medicine, Bd. 57, Nr. 05/06, S. e1–e1, Nov. 2018, doi: 10.3414/ME18-05- Author Statement This work is funded by the German Federal Ministry of [6] S. A. Munich u. a., „Mobile Real-time Tracking of Acute Education and Research (BMBF) with grant number Stroke Patients and Instant, Secure Inter-team 16KIS1030. The statements made herein are solely the Communication - the Join App“, Neurointervention, Bd. 12, Nr. 2, S. 69, 2017, doi: 10.5469/neuroint.2017.12.2.69. responsibility of the authors. [7] S. Zhang u. a., „Prehospital Notification Procedure Improves The authors state that they have no conflict of interests. Stroke Outcome by Shortening Onset to Needle Time in Chinese Urban Area“, Aging and Disease, Bd. 9, Nr. 3, S. 426, 2018, doi: 10.14336/AD.2017.0601. [8] J. Nam, K. Caners, J. M. Bowen, M. Welsford, und D. O’Reilly, „Systematic review and meta-analysis of the References benefits of out-of-hospital 12-lead ECG and advance notification in ST-segment elevation myocardial infarction [1] M. Kasparick u. a., „OR.NET: a service-oriented architecture patients“, Ann Emerg Med, Bd. 64, Nr. 2, S. 176–186, for safe and dynamic medical device interoperability“, 186.e1–9, Aug. 2014, doi: Biomedical Engineering / Biomedizinische Technik, Bd. 63, 10.1016/j.annemergmed.2013.11.016. Nr. 1, S. 11–30, Feb. 2018, doi: 10.1515/bmt-2017-0020. [2] M. Rockstroh u. a., „OR.NET: Multi-perspective qualitative evaluation of an integrated operating room based on IEEE

Journal

Current Directions in Biomedical Engineering – de Gruyter

Published: Sep 1, 2020

Keywords: 5G; Medical Device Interoperability; Emergency Care; Emergency Medical Service; Trauma Team; IT Security

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