[Andrés]

A triage system that is supported by the communication among practitioners on site, EMCC and hospitals relies on the quality of service and the security of the communication infrastructure. Nowadays in addition to the use of paging systems is more and more common to rely on mobile apps that use a central server used for the messages that are exchanged among physicians, nurses and other EMS personnel. These messages are sent by means of the encrypted SSL protocol to establish secure data channels between the sender and the receiver. While, to-date, the servers have not been breached, recent notable hacks have demonstrated that even the biggest industry players are vulnerable. A new messaging implementation would eliminate the need for a trusted third party completely. The most basic implementation could use the public-key cryptography already native to Ethereum which uses a secp256k1 elliptic curve.

The demands from EMS practitioners will be coordinated using the Ethereum blockchain and executed using Smart Contracts. Ethereum can be chosen due to its large user-base and continued development of applications to make tracking and spending coins easy for the end-user. The responses and recommendations for the patient are written into an Ethereum smart contract. After the completion of each operation, the role of the practitioner is validated using public token system, and a record is provided immediately. After a certain timeout, if provided, the task expires and the record can be returned to the EMCC via a quest failed transaction.

A physician in the registry of NHS or EMS would send a message by encrypting it with the recipient physician’s public key. Images and videos can be added in case of strokes, heart attacks and urgent emergency responses. This would potentially allow a messaging platform to scale with greater ease to a global level. Though public-key cryptography has existed since the 1970s, Ethereum-type technology is now putting public/private key-pairs into the hands of millions of users. Additionally, this feature has the added benefit of being generic enough that it could contact any physician from anywhere in the world.

[Joachim]

From a historical point of view, an interesting article was published in the “Emergency Medicine Journal” on the evolution of triage systems. It was invented during Napoleon wars, a challenging time for the organisational structure necessary to handle the growing number of casualties.

Three phases of triage have then emerged in modern healthcare systems. First, prehospital triage in order to dispatch ambulance and prehospital care resources. Second, triage at scene by the first clinician attending the patient. Third, triage on arrival at emergency department or receiving hospital.

FUll article is available on https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564046/