Evaluation of M-AID®, a first aid application for mobile phones

doi:10.1016/j.resuscitation.2007.02.004

Resuscitation

Volume 74, Issue 3, September 2007, Pages 487-494

https://doi.org/10.1016/j.resuscitation.2007.02.004 Get rights and content

Summary

Background

When performed effectively, cardiopulmonary resuscitation (CPR) by bystanders reduces mortality due to sudden cardiac arrest. Telemedicine applications offer a means by which bystanders can get specific instructions for handling the emergency situation. M-AID^®, a first aid application for mobile phones, uses an intelligent algorithm of ‘yes’ or ‘no’ questions to judge the ongoing situation and give the user detailed instructions. The aim of this study was to evaluate the benefit of this mobile phone application in a scenario of sudden cardiac arrest.

Methods

One hundred and nineteen volunteers were assigned at random either to the test or the control group. All participants were confronted with the same scenario of acute coronary syndrome leading to cardiac arrest. The participants were either equipped with a mobile phone running the software (test group) or had to handle the situation without support (control group). The participants received a certain amount of credits for each action taken according to a pre-defined protocol and these credits were added to a score and compared between the groups. Participants were divided into subgroups according to their medical and technical experience.

Results

The test group generally achieved a slightly higher average score that was not statistically significant (21.11 versus 19.97; p = 0.302). In contrast, the performance of the individuals in the control group was significantly faster (2.41 min versus 4.24 min; p < 0.001). Use of the mobile phone software did not enhance the chance of survival. Subgroup analysis showed that experienced mobile phone users performed significantly better than non-experienced individuals, but not as well as participants with advanced first aid knowledge.

Conclusions

Experience in the use of mobile phones is a prerequisite for the efficient use of the tested M-AID^® version. This application cannot replace skills acquisition by practical training. In a subgroup with experience in mobile phone use and basic knowledge in CPR, the device improved performance of CPR.

Introduction

Cardiac arrest due to coronary artery disease is a major health care problem in developed countries. In Europe, sudden cardiac arrest occurs in about 700,000 individuals each year.¹ Most patients suffer cardiac arrest at home or in public and their prognosis is poor.² The majority of out-of-hospital cardiac arrests is witnessed by bystanders,³ but the incidence of immediate action on cardiac arrest victims is below 35%.3, 4, 5, 6 Only 38% of those people educated in basic life support (BLS) applied their skills in an actual incident.⁵ The early initiation of cardiopulmonary resuscitation (CPR) by bystanders prior to the arrival of the emergency medical service system has been shown to be associated with a higher survival rate in several studies.7, 8, 9, 10, 11, 12 Therefore, the public should be (1) trained in life saving BLS techniques and (2) encouraged to use the acquired skills when confronted with a case of acute cardiac arrest.

Both skills acquisition and skills retention have been shown to be poor after conventional CPR training and several alternative methods have been tested to optimise training (for review see 13, 14). Telemedicine systems might help to improve the outcome of BLS training and support lay people to act effectively in emergency situations. Several systems have been described in the past,15, 16, 17, 22, 23 but these systems were associated with high technical, organisational and financial requirements and therefore not suitable for widespread public use.

M-AID^® is a Java™-based application for mobile phones which offers first aid support for lay rescuers who encounter people in emergency situations. With an intelligent algorithm of ‘yes’ or ‘no’ questions, the software assesses the current emergency situation and gives the user detailed instructions on what to do. The application can easily be downloaded via a wireless application protocol (WAP) browser from the manufacturer's webpage and runs on most current mobile phones. Therefore, it may be suitable for widespread use by the public. The aim of the current study was to evaluate the possible benefit of this mobile phone application in the setting of an out-of-hospital cardiac arrest.

Section snippets

M-AID^® software

M-AID^® (BiTOS GmbH, Garching, Germany—http://www.bitos.de) is a Java™ midlet based on Java 2 Micro Edition (Sun Microsystems, Santa Clara, CA). It follows the Mobile Information Device Profile (MIDP) 1.0 standard and the Connected Limited Device Configuration (CLDC) 1.0. Most current mobile phones^a are compatible with this standard. The software is installed permanently on the mobile phone and uses about 45 kB of

Results

After a short introduction by the manufacturer, all participants in the test group were able to correctly operate the service on the mobile phones provided. Speed of navigation of the software depended on experience with the use of mobile phones. Three of the four individuals in the test group with advanced first aid knowledge worked without the help of the application, while all others used M-AID^®. During the whole study, no malfunctioning of the software was observed. The rating of the

Discussion

To decrease mortality due to cardiac arrest several criteria have to be met by bystander CPR. First, a large number of individuals have to be trained. Second, these trained individuals must be willing to use their skills in an acute emergency. Third, the skills must be remembered to be efficient when used. M-AID^® may provide positive support for several of these aspects. Today, mobile phones are widely available and therefore, a large proportion of the population can be reached. Moreover,

Conclusions

Our results show that for the beneficial use of the tested M-AID^® version experience in the use of mobile phones is a prerequisite. Furthermore, the application cannot replace skills acquisition by practical training. Implementation of technical innovations in future versions should improve quality and accuracy of M-AID^® instructions and thereby increase its positive impact on bystander CPR.

Conflict of interest statement

Financial support for this study was provided solely from institutional and/or departmental sources. None of the authors received any financial support from other people or organizations that could influence the work inappropriately. Bitos GmbH provided mobile phones running the tested software.

Acknowledgements

The authors would like to thank all volunteers participating in this study, especially the members of the sapper school of the German Army and the following grammar schools: Willi-Graf-Gymansium, Michaeli-Gymnasium, and Rhabanus-Maurus-Gymnasium, Munich, Germany. We are grateful to F. David Fortuin, Mayo Clinic Scottsdale, AZ for helpful comments on the manuscript and Helga Wirnhier and Sabrina Stöppke, Arbeitsgemeinschaft MITI, for their support.

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Citation Excerpt :
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^☆: A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2007.02.004.

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Training and educational paperEvaluation of M-AID®, a first aid application for mobile phones☆

Summary

Background

Methods

Results

Conclusions

Introduction

Section snippets

M-AID® software

Results

Discussion

Conclusions

Conflict of interest statement

Acknowledgements

Ann Emerg Med

Lancet

Resuscitation

Ann Emerg Med

Ann Emerg Med

Resuscitation

Resuscitation

Resuscitation

Resuscitation

Ann Emerg Med

Am J Emerg Med

Training and educational paper
Evaluation of M-AID^®, a first aid application for mobile phones☆

M-AID^® software