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How might mobile technology help improve access to healthcare?

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Phase: Feedback

Sali. Come Save Lives.

We aim to build a community of lifesavers capable and motivated to administer CPR anywhere and anytime

Photo of Joel Manuel Alejandro
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OUR BIG IDEA: LIFE SAVERS EVERYWHERE

We aim to universalize CPR education and training, leading to a population capable and motivated to administer CPR anywhere and anytime. Through an interactive mobile application that can teach, motivate and guide anyone in administering CPR effectively while providing auxiliary support by connecting the user to a network of fellow life savers who will provide needed help. In such doing, an empowered local community can aid in improving public emergency medical response, eventually leading to an increased survival for Sudden Cardiac Arrest or SCA victims.

Features

  1. Emergency
    • Visual and auditory guides for immersive learning experience
    • Automatic hands-free timer
    • Automated Emergency Medical Service Notifier
  2. Learning
    1. Visual and auditory guides for immersive learning experience
    2. Ability to focus to specific steps for targeted learning
    3. Presence of notes for emphasis on must-knows
    4. Option for trial run which simulates an emergency without its time constraint.
  3. AED locator
    1. Maps out location of AED machines
  4. Surveillance “Bayanihan” System
    • Central hub in gathering SCA cases
    • Sends notifications to nearby users (< 500m)
    • Gives ability to respond to the emergency
      • Roles
        • Obtaining AED machine
        • Body substitute for CPR administration
  5. Social Media Integration
    • FB/Twitter/Instagram posts
    • FB/Google registration
    • User profile
    • Gamification
      • Badges for accomplishment of certain tasks

1. What access to healthcare problem are you trying to solve in your country / local community and how serious is the issue?

The app addresses access to medical information and medical capacity building. CPR trainings are inaccessible to most Filipinos due to its logistical failures, with ~100 training centers accounting for the >100M population and its financial burden, costing a minimum waged Filipino a week's worth of salary. The country also lacks a functional national medical hotline. These two leads to a poor emergency response and contributing to an estimated 60,000 deaths due to sudden cardiac arrest.

2. How would you describe the stage of development of your idea?

  • Conceptual Development

3. What were the biggest challenges when realizing your idea?

In realizing the idea, it is primary to empower the public on their role to their health. Since it deals with an emergency case, most assume it will not happen to them, or to people close to them: leading them to reject preparation.
Since this deals with health promotion, multi-sectoral participation is another hurdle to clear. The public, private, and other sectors must overcome their interests and prioritize public health to make an environment conducive for societal change.

4. How will your idea make an impact and in what way?

Having universally accessible knowledge about CPR, users will be more capable and motivated in cases of emergency. In addition, through automatically activating the EMS and gathering nearby users to respond, the app will help provide auxiliary support the lay rescuer will need. This will not only quicken the emergency response but also increase public participation. By doing such, community health values will be strengthened.

5. Tell us about the scalability of your idea to other communities.

In cases of emergency, civilians are the frontline to healthcare. The need for them to be properly equipped will be present for most communities. With heart diseases being the main cause of death worldwide, this further emphasizes the global need for such an idea.
In developing communities where public healthcare is not as inclusive, the presence of an empowered community minimizes the gap in health status within the population

6. How will winning the Euro 20,000 seed funding move your idea forward?

The €20,000 seed will primarily be used for development and pilot testing. These two tasks will be important in understanding the users and what is valuable to them. In so doing, once there is a full comprehension of the customer’s needs, we may successfully actualize our objective to improve health outcomes. With an established app and an optimal user experience that delivers value to our users, marketing and multi-sectoral partnerships would be more compelling.

32 comments

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Photo of Jasper
Team

Hi Joel,

I've sent you a message in Facebook. Please check your 'other' message folder, with messages from people you are not connected with.

Best regards,
Jasper
http://AEDPhilippines.com

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Photo of Oyin
Team

I like this idea. I suggest you put another word instead of "palpate" something like "check for pulse". This makes it easier for anybody to understand.

"Ask the victim are you okay?" I suggest you include "ask loudly".

Number six. You could include feedback regarding app or a rating system

Great Idea overall.

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Photo of Joel Manuel
Team

Thank you very much Oyin Okusanya for your excellent suggestions! I will take these into considerations in making the final pitch for the idea. However, can you clarify about the rating system? I find it a bit hard to understand.

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Photo of Oyin
Team

When I wrote rating system, I meant for the user of your app to give you feedback - Five stars, Four stars (It is a way for you to be able to understand how the end user likes the app) :)

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Photo of Kim
Team

I find the idea of having to save someone's life pretty scary as I know that I don't have the foggiest idea about what to do. If your app can help educate people and communities with similar fears to me about the best thing to do in an emergency then precious time and lives might be saved when emergencies do occur.

Definitely look at a gamified or incentives based approach to educating your users

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Photo of Joel Manuel
Team

Hello Kim White ! You are exactly part of the target population for our project. If you can expound on the reasons for your fears/apprehensions with the emergency it will be most at help to improving the project.

As for the gamified approach/incentives, right now we are still considering on putting up one. If you have ideas on how we can add such incentives to the app, we can better able to address this issue.

Im looking forward to your response! Thank you very much for your support.

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Photo of Lebogang
Team

I quite like the idea of decentralized learning to build and army that knows how to perform basic 1st aid and CPR. But like Jason says opportunities for CPR to be used as a life saving tool are rare especially in developed countries- death and life tend to be lost to diseases, reduced immunize systems and malnutrition.

But it it's important to note that the content of the training can be more CPR, you can tailor the content to suit the needs of each of the communities differently.

Good idea though Joel, well done

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Photo of Nana
Team

is this just a social venture or one that seeks to grow with a business model? If a business is intended, how do you monetize this?

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Photo of Eric
Team

I think a partnership/buyout with a service provider might work. They can market it as a free app to show that they are socially conscious and provide compensation for creating it.

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Photo of Joel Manuel
Team

Hi Lebogang Mukansi ! As for the first version of the application we wanted to focus on a specific problem in order to observe a quality impact to our community. I would like to humbly disagree with you about the rarity of these cases. Heart diseases are the #1 cause of death in our country and also worldwide. Jason Friesen is right in saying that CPR is only applicable to specific heart diseases but it was estimated that those diseases happen to 70-80% of all the deaths due to heart diseases. These studies has recommended the use of CPR and activation of the chain of survival as to address these cases by which our project aims to achieve. Do not worry about it being too specific as of now. We would like it too to incorporate more life saving skills in the app within the coming years.

We appreciate your input! We would like to hear more from you!

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Photo of Joel Manuel
Team

Hi Lebogang Mukansi ! As for the first version of the application we wanted to focus on a specific problem in order to observe a quality impact to our community. I would like to humbly disagree with you about the rarity of these cases. Heart diseases are the #1 cause of death in our country and also worldwide. Jason Friesen is right in saying that CPR is only applicable to specific heart diseases but it was estimated that those diseases happen to 70-80% of all the deaths due to heart diseases. These studies has recommended the use of CPR and activation of the chain of survival as to address these cases by which our project aims to achieve. Do not worry about it being too specific as of now. We would like it too to incorporate more life saving skills in the app within the coming years.

We appreciate your input! We would like to hear more from you!

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Photo of Joel Manuel
Team

Hi @Nana Mainoo ! As it currently stands, we intend to make this a sustainable project. With that, we have conceptualized a business model for its implementation. We have the same idea as @Eric in making key partnerships with different communities/businesses/institutions. By doing this we hope to achieve maximum impact. Also, through partnerships, the adoption of the application will be facilitated in order to grow the community.

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Photo of Jason
Team

Hello Joel,
Congratulations on the prize. I know how hard finding support can be and you've clearly been thinking about this a lot, so congratulations on your success so far. I've been working in prehospital emergency care systems for over 10 years, most of which has included working in low- and middle-income countries, and have developed a platform that is somewhat similar to what you're trying to do so I thought it might be helpful to share more with you some concerns/warnings/ideas that will hopefully be of service to you moving forward and also refine your approach. What you're proposing is definitely a great idea, but there's a lot that goes into it, particularly in settings where resources and access to them are limited.

1. In the wealthiest countries, positive CPR outcomes usually range around 4-10%, depending on where you live (Detroit vs. Seattle, in general), but when you take into account positive neurological outcomes, it drops down to about 2-3%, and this is also considering that these systems have a fleet of ambulances that can respond in less than 10 minutes (in cities); are staffed by paramedics who are able to provide advanced life support (ALS) including the full regimen of cardiac arrest drugs and equipment; and that all hospitals are able (and willing) to provide post-resuscitative care.

2. Compressions-only CPR works very well for newborns, drownings, choking, and overdoses. However, the majority of cardiac arrest cases seen by prehospital providers in resource-limited settings are typically owing to traumatic injuries and strokes, for which outcomes are 0% because the underlying problem has nothing to do with the effectiveness of the heart. In these cases, CPR in fact quickens death because the compressions pump blood out of the veins, away from the heart, and into the body and/or brain. The 4-10% that survive are mostly made up of witnessed arrests for patients in Ventricular Tachycardia and/or Ventricular Fibrillation, where a bystander administers CPR and applies an AED within two minutes, and then paramedics get on-scene within 10 minutes to administer ACLS medications. This is problematic for less wealthy countries for a number of reasons, but especially because of their overwhelmingly young populations that are dying from car accidents, complicated childbirths and other infectious diseases that CPR cannot address.

3. In order for CPR outcomes to reach their ceiling of 10%, a few other things need to happen: 1) AEDs need to be literally widespread, and given how expensive they are, that seems a big obstacle if they aren't already available; 2) CPR training needs to be literally widespread to happen before they'll start to see improvements in outcomes (and I mean tens of thousands of people trained), and 3) You mentioned "networks of fellow life savers." Do those already exist, or are you planning on building them too? To be completely frank, the "chain of life" networks present in wealthier countries were not built overnight, and CPR is undoubtedly one of the most expensive and wasteful components of our emergency care systems. We do CPR as often as we do in the US not because it works but because we don't want to get taken to court -- in the end, doing CPR is cheaper than a lawsuit, and the belief by most EMS agencies is that if CPR doesn't work, no problem because they were already dead. Not trying to be provocative, just trying to demystify what the marketing departments tell people. In reality sustaining these networks through refresher training, restocking supplies and paying for AED maintenance, among other things, is really really expensive - particularly when your best-case scenario is maximum 10%.

4. Your plan relies on a smartphone app. This will introduce a range of potential problems that all limit access: i.e., if you don't have a smartphone, and the app, and an internet connection, you're excluded from access. Additionally, you will have to spend a lot of time figuring out how to scale the app. Sending one alert to a group of people is straightforward; sending multiple requests for different patients to the same group of people is not.

5. Asking bystanders to read instructions while a patient is in cardiac arrest will likely negate the fact that they got on scene quickly. Without mincing words, if the responder doesn't know how to do CPR when faced with a person in cardiac arrest, they are not going to resuscitate them. As both the American Heart Association and the European Resuscitation Council drills into students' heads during classes, if CPR is going to have a chance of working, it has to be started immediately after the patient goes into arrest, and must be done without interruptions until paramedics arrive on-scene. Therefore, asking them to read instructions will either lead to delays in administering compressions and/or result in interruptions during compressions, both of which ultimately lead to very poor outcomes.

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Photo of Jason
Team

(Sorry for the long note, but there's a lot you'll need to consider)
6. Are you certain that the general public will understand that CPR is truly an intervention of "last resort", and that the chances of it working are very low? We have seen very tragic outcomes when people have limited understanding of CPR and what is and isn't possible - including families selling possessions to pay for hospital bills for family members who are in a permanent vegetative state and have no chance of recuperation.

The point of this is not to discourage you from moving forward, but rather to give you some perspective on what you're going to face. CPR is not what it is made out to be. It undoubtedly saves lives, but it's much more complicated than just giving compressions. There is truly an entire "chain-of-life" of which each link needs to be working optimally to even give the patient a chance to get pulses back. In 1996 a study was published in the New England Journal of Medicine comparing CPR outcomes in real-life to those seen on TV. You can read it here in full - http://www.nejm.org/doi/full/10.1056/NEJM199606133342406 - but you can probably guess the outcomes. "the portrayal of CPR on television may lead the viewing public to have an unrealistic impression of CPR and its chances for success. Physicians discussing the use of CPR with patients and families should be aware of the images of CPR depicted on television and the misperceptions these images may foster."

I'm not trying to say you have an "unrealistic impression of CPR", but I promise you the public will, and when their expectations aren't met, there need to be qualified, trained medical professionals nearby to vouch for you -- or at least have some ample Good Samaritan protections in place.

Myself and two colleagues wrote an article specifically on this topic that you may find helpful, and you can find the abstract here: https://doi.org/10.1017/S1049023X14001265

If you'd like to read it please send me an email at jfriesen[at] http://trekmedics.org and I'd be happy to send you a copy and talk more about your plans. If you're looking to focus on a CPR-only smartphone the best we can do is share with you some lessons learned, but if you're willing to consider a wider network of prehospital emergency care for road traffic injuries, complicated childbirths, overdoses, or first aid in general to stabilize and transport critical patients to the hospital, we could probably do a lot to help, including lowering the costs of software development.

In summary, we've found that CPR is very low-impact and very high-cost, and opportunities to make it work are rare (even in the wealthiest countries), so for that reason we try to avoid it and keep the system focused on skills that can be used often and create demonstrable impact.

Again, I'm not trying to discourage you - I'm just looking to share what we've learned over the past 10 years and shed some light on some of the unknowns you're likely considering.

Congratulations again on your award, and best of luck to you moving forward!
Jason

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Photo of Joel Manuel
Team

Hello Jason Friesen ! Thank you very much for a very insightful feedback! It is really nice to hear from someone who has expertise on the field we are setting into.

Just to clarify, our objective is first and foremost to educate the Philippines about CPR. Being informed about CPR and more aware of what can be done, can make the person more capable and confident in handling these emergencies. Comparing CPR administration in the USA vs. the Philippines, the coverage here is a lot less than that of the US. It is worth mentioning that the CPR administration in the USA is still low at 36%. This being said, there is still a need to inform Filipinos about CPR and what can be done in a sudden cardiac arrest emergency. Be it the huge information gap, the lack of CPR trained individuals or the low administration of CPR cases.

I agree with you that the chain of life networks present in developed countries were not built overnight and I honestly see this as the window of opportunity to facilitate that network building. It won’t be easy, but I think my country could start from here. This could be done by improving the chain of survival of sudden cardiac arrest victims by strengthening and empowering lay rescuers who are the frontliners in these emergency incidents. Furthermore, the platform is flexible enough to absorb the existing system with it as current medical practitioners and institutions are expected to be integrated within the network.

We also agree with you in saying that CPR alone cannot solve the problem. As you can see in the app we have integrated basic life support skills, like recognition of sudden cardiac arrest cases and location for AED defibrillators. Though currently our government is working on providing the AED machines and other auxiliary support in cases of emergency, we believe that in time we will get there. More importantly, the recognition of these cases is paramount for the project’s success. This is the first step in activating the chain of survival and as such is to be emphasized in the learning module of the app. This would address the focus of the project which are sudden cardiac arrest patients, not stroke or heart attack cases which do not necessarily need CPR administration.

For the scalability of the system, we are currently working with developers to make sure the stability and reliability of it. So far, they have expressed optimism in achieving all the features that we are preparing to do.

With regards to the resources you have cited, I will reply to you once we are able to go through all of them. Be assured that I will send you an email to request for more resources.

We are look forward for more insights from you. We are excited to engage with you in improving the idea even further.

Best

Joel

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Photo of Ben
Team

Joel -- I have a few questions.

1. When in emergency mode, can the CPR administrator keep their hands off their phone completely, and dedicate their hands to working with the victim? Have you considered how to prevent the screen from going into sleep mode or otherwise cutting off visual signal if there is no active touch?

2. How do you plan to encourage people to use this application for training and learning purposes, rather than use it for the first time when an emergency occurs? In the latter scenario I imagine they would be overwhelmed with the emotion of an emergency and such emotion might make it difficult to navigate a previously unused app.

Keep creating!

Ben

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Photo of Joel Manuel
Team

Hello Ben Toscher !!

1. The plan is for the app to function like that so that the user can act faster to the emergency. As for preventing the screen from dimming or turning off it can actually be programmed in the app itself. If you notice how when using YouTube or other video apps the screen remains on for prolonged period of time. It will be similar to that.

2. Thank you very much for a wonderful question. This is one of the pitfalls of producing an emergency application. However this can be prevented by careful marketing and angling it towards an education app rather than just a one-time emergency guide. To further complement this, the idea of Elvin Blankson of integrating quizzes and monthly exercises can improve the learning experience of the user.

If you have more questions don't hesitate to ask. I hope to hear more from you!

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Photo of Maria Cristina G.
Team

This is a jolly good idea. I hope you win the contest! You may need to incorporate an indicator if one of the crowd with the app has already called 911 so the system won't be inundated. and how do you address the usual reaction, somebody must have gone there, so those with skill won't anymore respond to it. If it is too far advanced down the line, that is fine. This app at this stage would me most helpful to much of the Phil population who have very little training on emergencies. It is useful for training for emergencies, including sports people, local government sports' organizers. Well done!

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Photo of Joel Manuel
Team

Hello Maria! Thank you very much for the wonderful insights! An indicator will be mostly helpful to the primary respondent as to collect himself knowing that help is coming. We will integrate this in our next iteration of our concept!

As for enticing respondents to the emergency, an reward system similar to Mohamed Shuraih 's project may be implemented. This way, the psychological hurdle of helping is lessened with a practical benefit to the respondent.

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Photo of Joost
Team

Hi Joel, it is a really good idea! i have a few thoughts and questions for you;
is there a particular reason to focus on CPR? you do mention a large number of cardiac arrest deads. However, are there other areas where first aid skills could be applied?

I would suggest to focus on all first aid skills, where CPR is just one of many skills which can be learned. For example, do you know what cream and badage to apply when someone burns himself? and is there someone nearby who can administer this help? Of course CPR is very important and because of the possible outcome when not applied has a high priority. However it would be a miss to ignore other skills.

Then if you take it to firstaid in emergencies, you may also look at a supply category. Therefore, firstaid skills, and firstaid supplies could be two categories which you can locate using "sali"

regarding the access to learning cpr and other first aid skills. It is sad to hear that it costs money at all. In my home country we got it at school when i was 10 or 11 years old. Is there a way the app could identify people who can hold workshops too? complementing the on mobile education with a physical workshop would go along way giving people confidence that they can apply their learned skill.

Therefore registered users who are self rated to be at an expert level could possibly also be identified and asked to provide training in schools? or communities?

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Photo of Joel Manuel
Team

Hello Joost!The main reason why we focus on CPR is that CPR was proven to have a high impact on the mortality of these cases. In our country, out of hospital cardiac arrest patients only has 4% survival rate. CPR, along with a proper emergency response, can lead up to 30% survival rate for these cases and that is about 8 fold increase for survivability.

As for adding other first aid skills, right now we see it that it would be difficult to integrate everything within the time period that we have. However know that we are not discounting the value of other first aid skills as it was shown with those you have cited that these skills are important. Currently, we are thinking similarly to what @gabriel giguere has proposed wherein these skills may be added further down the development of the app.

For the addition of first aid supplies, that would be a very good addition to go along with the first aid trainings. It would function similarly as our AED locator and would fit nicely with our surveillance (bayanihan) feature wherein responders may obtain these items for the emergency.

For the physical workshop, yes I think that is also a welcome addition to the idea. This will go around the assumption that once they have more knowledge about the technique that they will be enticed to undergo workshop/certification. This is something that we may need to validate within our pilot communities and if this is indeed true, we are more than happy to provide this service.

As for the self rated experts, we are a bit worried for such practice as other CPR training organizations may express their disagreement with it. Especially since legally, these users are not authorized to do such things for they dont have any certification to prove their expertise. We will be open to this if we decide to be a substitute to current CPR certification procedures and push for in-app CPR certification. But as of now, we are more inclined to be a complement to CPR certification and concentrate on spreading CPR knowledge.

I highly encourage for more discussions regarding your ideas!

Thank you for sharing your time and ideas!

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Photo of Joost
Team

Hi Joel,
 great to see how you have thought of things and are incorporating feedback. Elvin Blankson is with the red cross, as was my mother. If you get this of the ground, perhaps the red cross could organize larger scale workshops, or perhaps your local government or training institutes, who can then also certify the app users!

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Photo of Joel Manuel
Team

Great idea Joost ! We aim to partner with them (red cross, local government) in the further implementation of the plan to obtain the greater population of the community. By any chance, does your mom or Elvin Blankson know someone in red cross by which we can present the idea to?

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Photo of Joel Manuel
Team

Great idea Joost ! We aim to partner with them (red cross, local government) in the further implementation of the plan to obtain the greater population of the community. By any chance, does your mom or Elvin Blankson know someone in red cross by which we can present the idea to?

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Photo of Elvin
Team

I must say this is a great idea. The more skilled people there are out there to handle medical emergencies. the greater the chance of survival for accident victims. The reality is that in most emergencies, people want to help. but without the appropriate skills, may tend to be more harmful than helpful, so learning the proper skills cannot be over emphasized.
As a member of the Red Cross who has undergone such training, my primary concern is how you will ensure that the trainee is has acquired the right skills without experienced supervision and continued refresher courses. Perhaps a short Q&A at the end of each course might help, or a randomized unscheduled Q&A to test recall.

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Photo of Joel Manuel
Team

Hello Elvin!

We understand the concern you have raised. That being said, we see the need to improve the Learning feature of our app to better address this. Your recommendation is actually quite helpful in doing that as similar to class quizzes, these increase the mastery of the knowledge. The unscheduled Q&A more specifically can be implemented as a monthly notification to encourage them to use the app even without an emergency and act as an invitation for them to refresh their knowledge and explore the app more. If ever, we are excited to have these tested in our pilot communities and know of these might make the effect that we want it to achieve.

Thank you so much for this wonderful idea! Feel free to leave more feedback!

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Photo of Gabriel
Team

Great idea Joel Manuel ! At first, if you allow me to make a parallel, like Amazon, you could start by a single product (CPR), test it, grow it exponentially, and maybe add some other health problems that could be done by citizen nearby. Just thinking if it could be a more general health-assist app or something. Keep up your good work ! Gabriel

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Photo of Joel Manuel
Team

Thank you very much Gabriel!

Linking to what Joost has shared, we agree to your plan for integrating other first aid skills during the expansion of the app. We see to it that by focusing on one thing before expanding we can better be able to capture the market and make meaningful change within our communities and hopefully the world.

Is it possible for you to expound on what you mean by general health-assist app? If Im guessing are you asking on how we can integrate other first aid skills in a single app? Currently, a possible solution to this would be to have an emergency situation description when the emergency feature is launched. This would give the user a list by which he/she can pick is what best describes the emergency (seizures, burn, poison, etc). However, the interface for such would be difficult as if we present it as a list it might appear out of place but if we do it in boxes it may be too numerous to appreciate. This is a serious concern as in an emergency, time is of essence and a simple user experience would go a long way in achieving this.

If you have more wonderful ideas, we are encouraging you to share them more! Your help is greatly appreciated.

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Photo of Aldric
Team

I personally think this is a great idea that not only works for CPR but even for other emergencies. Sort of like a crowd sourced 911. The challenges I see are user adoption, and preventing fake calls.

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Photo of Joel Manuel
Team

Hello Aldric!

To address the challenges you mentioned, for user adoption, we see to it that partnerships with different organizations will be critical for them to download the application. With that, we are focusing on specific groups mainly students and service sector workers for the first phase of the implementation. They are to act as base population regardless of the public adoption. The students will be accessible through partnerships with schools and the Department of Education. A newly legislated law RA10871 or the "Basic Life Support Training in Schools Act" will be instrumental in building these partnerships.

For fake calls, the current solution that we have is to provide stricter guidelines during the account registration in the application. By implementing an account activation step, we are hoping to prevent fraudulent accounts within the network. However, an additional problem is induced by this method wherein unregistered users who would only use the application during an emergency will not be able to respond to the emergency. If you can recommend a better solution, we are glad to incorporate it.

Thank you for your feedback!

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Photo of Janrick
Team

This app has the potential to save a lot of lives!

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Photo of Joel Manuel
Team

Thank you very much for your enthusiasm with our idea!

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