RU2673373C1 - Method of public automatic external defibrillation - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medical equipment, namely to emergency medical care. Method of public automatic external defibrillation, in which during an acute heart attack that occurred in out-of-hospital conditions, a volunteer who was close to the victim, transmits from his mobile radio emergency call to the operator of the emergency medical center, containing information about the cause of the call and the approximate location of the victim, after which the volunteer transmits identification information about the victim’s identity on the basis of documents obtained from the victim and/or on the basis of photographing or videotaping his face through a mobile radio terminal to an operator of the emergency medical center, who searches them in the “risk group” patient data bank and identifies the victim, at the same time, the emergency call is carried out through the service operator 112, which forwards the information to the mobile communication terminal of the operator of the emergency medical center serving the territory, where an emergency situation is recorded, after which the operator of the emergency medical center determines the location and identification number of the automatic external defibrillator (AED) nearest to the victim and transmits this information to the volunteer’s mobile radio terminal, at the same time, he simultaneously generates, through the central controller for the collection and processing of information of the emergency medical center, and sends a command to turn on the sound notification of the specified AED, and also begins sending to a volunteer mobile radio terminal instructions for performing cardiopulmonary resuscitation (CPR), after which the volunteer conducts CPR and after delivering the AED to him, proceeds to the automatic external defibrillation procedure, herewith, after identifying the victim, the operator of the emergency medical center performs a selection of physical parameters from the database, including body weight, height, skin conductance, anamnesis, and from the ECG database of the victim, performs a selection of data to adjust the settings of the parameters of the defibrillation discharge, including amplitude, form and duration of the defibrillation impulse, on the basis of which corrective actions for the specified AED are calculated and formed, and until the start of the defibrillation discharge the specified corrective actions are transmitted on the specified AED and received by the built-in AED wireless interface, however, these corrective actions are automatically entered into the control unit and, before the volunteer presses the key of the defibrillation discharge, the amplitude, shape and duration of the discharge pulse are changed, at the same time, the volunteer, following the voice and visual prompts from the dynamics and graphic display of the AED, imposes electrodes on the surface of the victim’s chest, waiting for the end of the discharge energy accumulation process, consistently performs one or more defibrillation discharges, and after the discharge process is completed, visually assesses the patient’s condition and, based on the results of this assessment, returns to CPR procedure, or proceeds to the next defibrillation cycle, while carrying out visual monitoring of the physical condition of the patient until the arrival of the ambulance service.EFFECT: use of the invention makes it possible to increase the efficiency of saving the life of a cardio patient in out-of-hospital conditions.1 cl, 4 dwg

Description

The invention relates to methods of electric current therapy conducted through contact electrodes using a system for transmitting alarm signals to a central station about the need for immediate electrical defibrillation due to the risk of death from sudden cardiac arrest (BOC).

The known technique of the so-called "early defibrillation", adopted in a number of developed countries, mainly in the USA, which, in fact, is in a number of critical situations the only chance to restore hemodynamically effective heart contractions and save a person from death. The term “early defibrillation” was supplemented by the instructions for resuscitation of patients adopted by the American Association of Cardiology in 1991 (S.G. Hugaev, “World Experience in Implementing the Concept of Early Defibrillation Using a Publicly Available Defibrillator-Monitor: Immediate and Long-Term Results”, Cardiovascular Research Center A. N. Bakulev Vascular Surgery RAMS, Moscow, 2006), Based on these instructions, the concept of early defibrillation using a public defibrillator was developed and put into practice (hereinafter - public defibrillation). Public defibrillation means placing automatic defibrillators in crowded places or in areas where a large number of people live with a high risk of sudden cardiac death. The essence of the types of defibrillators used for this - automatic external defibrillators (AIDs) - is that they allow even an unskilled user to provide first aid to a patient with cardiac arrest before the arrival of the resuscitation team or rescue team. The use of publicly available AIDs is currently seen as a key and decisive moment in assisting in stopping blood circulation. The main advantage of these modern, easy-to-use devices is their ability to analyze heart rate, that is, to recognize and treat ventricular fibrillation when used in accordance with special instructions.

According to foreign statistics, due to the lack of timely cardiological care as a result of OSI, up to 250,000 people in the USA and up to 700,000 people in Europe die annually. Not more than 1% of people survive from cardiac arrest in community-acquired conditions in Russia (http://cardion.ru/programma-obshchedostupnov-defibrillyatsii) with THIS annually, up to 300,000 people die. With each minute lost from the moment of cardiac arrest to the beginning of indirect cardiac massage and defibrillation, the survival rate is reduced by 7-10%. As follows from the “Resuscitation Recommendations” of the European Resuscituation Council (ERC), ed. President of the Russian National Resuscitation Council Corr. RAS Moroz V.V. (3rd edition, 2015 version) to reduce the time interval between the onset of an attack and the beginning of the defibrillation process (hereinafter referred to as the response time) to such small values is possible only if all measures to save the victim are combined in the so-called "survival chain" consisting of the following sequence of interrelated actions performed in a single circuit in close to real time: “early warning of specialists” - “immediate start of cardiopulmonary resuscitation (CPR)” - “automatic fibrillation "-" emergency medical care with the introduction of the necessary kardiotropnyh drugs. "

The establishment of close interactive interaction between the emergency medical service dispatcher and people performing CPR and cardiac defibrillation, which may include both professional rescuers and non-professional volunteers, is of fundamental importance for the practical implementation of this chain.

People who are near the victim should be able to quickly assess the condition of the victim, first of all, whether he has consciousness, is breathing normally, and then immediately inform the ambulance service. Surrounding people and the emergency dispatcher should suspect cardiac arrest in any patient with seizures and carefully evaluate whether such a patient is breathing normally. If the victim does not have consciousness and normal breathing, then this is a BOC requiring immediate application of CPR procedures and automatic external defibrillation. At the same time, the establishment of an operational link between a volunteer resuscitator and an emergency medical care dispatcher plays an important and sometimes decisive role in the early diagnosis of cardiac arrest and the performance of CPR and external defibrillation.

An equally important role in the implementation of the "survival chain" in practice, especially in community-acquired conditions, is played by the legal support of this procedure. In the USA, Italy, Great Britain, Austria, there are rules of law governing the procedure for publicly available defibrillation. In the US, the law requires the installation of AEDs in all federal buildings and educational institutions. In Brazil, it is recommended that all enterprises with more than 1,000 employees have an IDA. At the same time, in dozens of countries in Europe, the Near and Far East, the use of IDA by volunteers is not regulated by law, but is encouraged by society as the only possible way to save the lives of citizens in this situation.

In Russia, plans to implement the state program of publicly available defibrillation have encountered two major obstacles (www.trimm.ru). First of all, medical staff are entitled to provide medical care exclusively, and all the rest can provide only first aid. Secondly, the current legislation does not spell out provisions on the possibility of using auxiliary equipment and additional equipment for first aid. However, in the near future the situation may change radically. At the beginning of 2013, in pursuance of the federal target program “Development of the pharmaceutical and medical industries of the Russian Federation for the period to 2020 and beyond”, the Ministry of Industry and Trade announced a competition for R&D on the topic “Development of technology and organization of production of a small-sized automatic defibrillator”. At present, the Altonika group of companies has developed the portable ALTDEF® AED, which takes into account all the basic instructions of the aforementioned American Association of Cardiology. ALDDEF® is comparable, and surpasses foreign analogues in a number of indicators (www.altomedika.ru, zelenograd.ru from 02.11.2016). Later, the Ministry of Industry and Trade initiated the development of a “roadmap” for a program of publicly available defibrillation, which implies the creation and widespread use in this program of an ALTDEF® type AED line (wademec.ru dated 12/04/2017). The IDA park should appear in crowded places such as airports, metro stations, cinemas, stadiums, shopping centers, and train stations. Steps are being taken to legislatively authorize the use of AEDs by non-professional volunteers. So, on September 15, 2017, members of the Health Protection Committee initiated a bill in the State Duma on amendments to Art. 31 of the law No. 323-ФЗ "On the protection of public health." Members of the State Duma Expert Council, including representatives of the Working Group on the Development of High-Tech Medical Devices, prepared proposals in the form of an updated version of the aforementioned law, as well as by-laws and regulations necessary for its implementation. The developed amendments will allow creating the necessary legislative prerequisites for solving the problem of expanding the possible coverage of emergency medical care with the use of IDA by allowing their use by an unlimited number of people (www.altomedika.ru).

The Defibrillation History Archive ..., published by the National Resuscitation Council in 2017 (http://www.defibrillation.ru/patents.html), contains most patents for inventions, utility models and industrial designs of defibrillators and their main components registered in Russia, Belarus and Ukraine, from 1958 to the present. A study of these documents shows that most of the technical solutions presented in them are aimed at increasing the efficiency and safety of using this resuscitation device, which is still used in our country only in resuscitation departments of hospitals and the ambulance service. In this case, mainly foreign models of Life-Point AIDs from METsis Medical Ltd., Turkey (www.automateddefibrillator.com) are used. Philips Hearts Start FRx, Holland (Insemter.medical.philips.com), Power Heart AED G3, Cardiac Science, USA (www.reepl.ru) and others. Almost all modern AEDs are equipped with autonomous self-testing tools that allow you to block the device in the event of a malfunction detected in any of its nodes, for example, in the case of a discharged power source. This can significantly reduce the risk of electrical injuries to the patient’s tissues as a result of exposure to defibrillation impulses, the energy parameters of which go beyond the boundaries acceptable for a given person. However, at the same time, the risk of not providing the required cardiological care to the patient significantly increases due to the defibrillator's inoperability at the right minute, which ultimately leads to death for the patient. The most likely causes of AED inoperability are uncontrolled battery discharge and defects in the storage capacitor and diodes in the high-voltage defibrillator unit. Since in practice the average frequency of the possible use of the considered class of AEDs is not high (less than once a year) and basically these devices are stored, maintaining the entire required fleet of defibrillators in working condition can result in a serious technical problem.

The technical solution for the utility model patent RU No. 169266, A61N 1/18, G08B 13/196, H04N 7/18, which describes one of the promising models of the aforementioned ALTDEF® AED, is indicated for its solution. The indicated AED contains a power source, equipped with a generated energy control unit and two current buses, between which a high voltage unit is connected, as well as therapeutic buses connecting the high voltage outputs of the high voltage unit with defibrillation electrodes. The AED also includes a control unit made with one measuring input and several control outputs, while the measuring input of the control unit is connected to the measuring output of the high-voltage unit, one of the control outputs of the control unit is connected to the input of the generated energy control unit, and the other control outputs with the corresponding switching inputs of the high voltage unit. The main difference between this device and other AED models is the presence of a radio communication channel in it, consisting of a serial communication interface and a radio modem with an antenna, while the control unit is made with additional communication and additional control outputs, the first of which is connected to the input of the communication interface, and the second - with the control input of the radio modem. The radio modem included in the indicated device can be made in the form of a transmitting module of a standard wireless communication network: GSM, Internet, standard Wi-Fi, or as a “short-range device” used, for example, in “security radio alarm devices”. A distinctive feature of this class of devices is the use of megahertz transmitters operating on unlicensed radio frequencies in the ranges 433 and 868 MHz, the unregulated use of which is allowed by Decision of the State Commission on Radio Frequencies (SCRC) dated 07.05.2007 No. 07-20-03-001 (appendices 1 and 3, respectively) and Decree of the Government of the Russian Federation dated 12.10.2004 No. 539 (as amended on 07.25.2007).

The introduction of a radio communication channel into the IDA was a prerequisite for linking the multiple IDs into a single geographically distributed complex controlled by the territorial testing center. The specified technical solution is protected by the patent for invention RU No. 2636862, A61N 1/18, G08B 13/196 of the enterprise-developer of ANDT "ALTDEF®" (www.altomedika.ru).

The testing process of the AED park in the specified system is divided into two stages:

self-diagnosis carried out in each defibrillator using the built-in multi-channel self-diagnosis unit;

external testing conducted in the territorial center using the remote control panel installed in it.

A multichannel self-diagnosis unit connected to the main nodes of the high-voltage defibrillation pulse generating unit operates under the control of an internal testing program installed in the multichannel microcontroller. In particular, this program allows you to detect the absence of the necessary contact with the patient’s body of the defibrillation electrodes, a drop below the permissible voltage level of the power source, a breakdown in the high voltage capacitor and / or diodes in the high voltage unit and other possible malfunctions. Using a preset self-diagnosis program, a multichannel microcontroller periodically polls all the monitored AED nodes. The values of the monitored parameters are sent to the multi-channel self-diagnosis unit, where they are compared with pre-set thresholds. When a malfunction is detected in any of the monitored units in the multi-channel self-diagnosis unit, an alarm message is generated containing the identification code of the functional unit in which the malfunction is detected and a malfunction code. This message is sent to the multi-channel microcontroller, which converts it into the standard message format used in the radio channel. These messages are received, respectively, in the near radio channel of the GHz range based on, for example, a WiFi modem or in the far channel based on the transmitter of the MHz range. In the hospital area, the IDA is, as a rule, in the range of the WiFi network, which ensures the interaction of the defibrillator with the standard hospital computer network. If the tested defibrillator is outside the coverage area of the hospital computer and WiFi networks, for example, on the territory of an airport or a large railway junction, where there is an external testing console, then the near channel is blocked and the MHz channel channel transmitter is turned on. The range of action is increased several times. Such adaptive control of the near and far communication channels can significantly increase the life without recharging the batteries in the AED.

The transmitted alarm message about the presence of a malfunction in one of the AED nodes arrives at the receiver installed in the external testing console. In it, using the interface, this message is converted to the format used by the remote control panel. The end result of the remote control panel is the detection and identification of a malfunction in any of the defibrillators served by this external testing console. After that, the corresponding notifications are generated in the block for the generation and distribution of electronic notifications (in the form of e-mails or SMS messages), which are sent via the appropriate standard communication networks to the persons responsible for the health of this fleet of defibrillators.

Thanks to the proposed external testing system, the medical services of airports, railway junctions, metro stations and other crowded places are able to continuously receive, with a given periodicity (for example, once a day) information on the degree of working capacity of all members of the operated IDA fleet, which ensures availability the use of a specific defibrillator from the AED fleet maintained by the system, thereby achieving the technical result of this invention.

However, maintaining the fleet of geographically distributed AEDs is only one of the necessary (but far from sufficient) conditions for ensuring the effectiveness of public defibrillation. The main problem of increasing OSI survival in community-acquired settings is, as already noted above, ensuring close interactive interaction between the emergency dispatcher and volunteers performing CPR and cardiac defibrillation.

A known method of publicly available automatic external defibrillation according to the patent US 2013179188, G06Q 10/10, G16H 10/60, in which in case of an acute heart attack occurring in a hospital environment, a volunteer who is near the injured person transmits an emergency call from his mobile radio terminal to the operator of the emergency center medical assistance containing information about the cause of the call and the approximate location of the victim, after which the volunteer transmits identification information about the victim’s identity based on those found at the victim of your documents and / or on the basis of photographing or video shooting of his face through the mobile radio terminal to the operator of the emergency medical center, who searches through them in a database of patients from the “risk group” and identifies the victim.

The disadvantage of this method is the absence in it of a number of operations and elements necessary to ensure a single interactive process of resuscitation of a victim of an acute heart attack in an out-of-hospital environment, which is close to the real time, bearing in mind that the entire cycle of actions taken to establish a diagnosis and impact on the patient should not exceed 5 minutes, and the harmful effects of such exposure should be minimized

The present invention is aimed at solving this problem by implementing such a complex of technical means and actions that would allow saving the life of a cardiac patient in a community-acquired environment by removing him from a critical and terminal state with the least possible damage to the vital organs of the patient in these situations.

The technical result of the proposed method of publicly available defibrillation is, therefore, increasing the efficiency of saving the life of a cardiac patient in a community-acquired environment.

This technical result is planned to be achieved due to the fact that in addition to the well-known sequence of actions in which, in the event of an acute heart attack occurring in a community-acquired environment, a volunteer who is near the victim sends an emergency call from his mobile radio terminal to the operator of the emergency medical center, containing information about the cause of the call and the approximate location of the victim, after which the volunteer transmits identification information about the identity of the victim to based on the documents found on the victim and / or on the basis of photographing or video recording of his face through the mobile radio terminal to the operator of the emergency medical center, who searches the database of patients from the “risk group” and identifies the victim, the emergency call is made through the service operator 112 , which forwards information to the mobile communication terminal of the operator of the emergency medical center serving the territory where the emergency is recorded then the operator of the emergency medical center determines the location and identification number of the automatic external defibrillator (AID) closest to the victim and transmits this information to the volunteer’s mobile radio terminal, while at the same time it forms the emergency medical center through the central controller for collecting and processing information and transmits a command to enable sound notification of the specified AED, and also starts transmitting to the mobile radio terminal

of a volunteer for cardiopulmonary resuscitation (CPR) instructions, after which the volunteer performs CPR and after delivery of the AED, he goes to the automatic external defibrillation procedure, and after identifying the victim, the emergency center operator selects physical parameters including body weight from the database , growth, skin conductivity, anamnesis data, and ECG database of the victim data for adjusting the settings of the defibrillation discharge parameters, including the amplitude Therefore, the shape and duration of the defibrillation pulse, on the basis of which corrective actions are calculated and formed for the specified AED, and before the start of the defibrillation discharge, the indicated corrective actions are transmitted to the indicated AED, they are received by the wireless interface integrated into the AED, and the indicated corrective actions are automatically entered into the unit control and, before the volunteer presses the keys of the defibrillation discharge change the amplitude, shape and duration of the discharge pulse, while voluntarily the finger, following the voice and visual prompts from the speaker and the graphic display of the AED, imposes electrodes on the surface of the victim’s chest, expects the discharge energy accumulation process, sequentially carries out one or more defibrillation discharges, and after the discharge process completes, visually assesses the patient’s state and, based on this, assessment either returns to the CPR procedure, or proceeds to the next defibrillation cycle, while exercising visual control of the physical condition of cents until the arrival of the ambulance service.

Thus, the video images of the victim, transmitted over the air to the emergency medical center, are used not only as a means of remote visual monitoring of the volunteer's actions and voice prompts, but also to optimize the parameters of the impulse of the discharge of the AED taking into account the individual characteristics of the patient’s body and its previous

ECG indicators. Due to this, the efficiency of a complex of technical means that implement this method significantly increases its function to ensure resuscitation of a patient in a community-acquired environment with the minimum possible damage to his health from exposure to a powerful electric discharge. At the same time, the actions of a non-professional volunteer become more legitimate, since they are remotely controlled by a specialist who has the necessary license for this type of activity.

A possible implementation of the proposed method of publicly available automatic defibrillation is illustrated in FIG. 1 - FIG. four.

FIG. 1 illustrates the principles of interactive interaction of the main links of a community-acquired "survival chain" formed by an emergency medical center, a mobile terminal (smartphone) of a volunteer resuscitator, and AID.

In FIG. 2 and FIG. 3 presents structural diagrams of the main functional units of the complex of technical means that implements the claimed method - the center of emergency medical care (Fig. 2) and AED (Fig. 3).

In FIG. Figure 4 shows a photograph of the current sample of the ALTDEF® AED.

The following notation is used in these figures: 1 - smartphone; 2 - emergency medical care center; 3 - mobile communication terminal; 4 - AND; 5 - a central controller for collecting and processing information; 6 - a database of patients from the "risk group"; 7 - wireless interface; 8 - control unit; 9 - controller for collecting and processing information; 10 - speaker; 11 - DBMS; 12 - database of passport data; 13 - the base of physical parameters (body weight, height, skin conductivity, medical history); 14 - base of ECG parameters; 15 - base of photographs of faces; 16 - keyboard; 17 electrodes; 18 is a graphical display; 19 - ECG module; 20 - internal memory; 21 - block high voltage.

The set of technical equipment for publicly available automatic external defibrillation (Fig. 1) presented in the figures contains an emergency medical center 2 connected via a mobile communication terminal 3 to a volunteer’s smartphone 1 providing first aid to the injured person and to the wireless interface 7 included in the IDA 4 In this case, the main functional units located in the center 2 of emergency medical care (Fig. 2) are the central controller 5 for collecting and processing information associated with the term Inal 3 of mobile communication, and with a database management system (DBMS) 11 banks 6 data on patients from the “risk group”, which includes a database of 12 passport data, a base of 13 physical parameters, a base of 14 ECG parameters and a base of 15 photographs of individuals . Using standard computer interfaces, for example, a USB central controller 5 for collecting and processing information can be connected to a computer with a set of standard peripherals (keyboard, monitors, printer, etc.). At the same time, DBMS 11 is configured to exchange with external sources of information, such as data banks of other territorial centers of emergency medical care, hospitals, rehabilitation centers and other institutions of the Ministry of Health, as well as data banks and electronic repositories of other departmental institutions, for example, contact and situational centers of the Ministry of Internal Affairs, Ministry of Emergencies, etc.

The AED 4 used in the complex under consideration contains two main functional units — a control unit 8 and an associated high voltage unit 21, as well as peripheral devices — a keyboard 16, a graphic display 18, a wireless interface 7, and an integrated speaker 10. The control unit 8 includes a controller 9 for collecting and processing information, different from the central controller 5 for collecting and processing information with special software, and an associated ECG module 19 and internal memory 20. The communication unit 21 high about voltage with the control unit 8 is carried out by means of appropriate

inputs / outputs of the controller 9 for collecting and processing information. In this case, the speaker 10 and the graphic display 18 are connected, respectively, to the audio and video outputs, and the keyboard 16 and the wireless interface 7 are connected to the corresponding inputs of the controller 9 for collecting and processing information.

The proposed method of public defibrillation is one of the possible options (Fig. 1) for the practical implementation of the idea of creating a "survival chain" described in the "ECR Recommendations" mentioned at the beginning of this description. This implementation has become possible thanks to the latest advances in communication technology, information transfer and information technology.

The main means of implementing the proposed resuscitation process is AID 4 (Fig. 3), the development of which was started at the applicant enterprise several years ago in pursuance of the federal target program "Development of the pharmaceutical and medical industry of the Russian Federation for the period to 2020 and beyond" in R&D under the theme "Development of technology and organization of production of a small-sized automatic defibrillator". This development was successfully completed by the creation of a series of serial samples of the portable ALTDEF® AED, in which there are several models that include radio channels of short-range (WiFi) and long-range (GSM) wireless communication networks (AltDef-0lG, 02G, 03G and 04G) that allows you to effectively use these models of AED in the aforementioned "survival chain".

The guarantee of the industrial applicability of this AED is the availability of technical specifications for the specified product line (TU 9444-001-14154244-2014) and the corresponding operational documentation, in particular, the operating manual (AVET.941513.001 OM), which describes in detail the procedures carried out using material means (defibrillator) over the material object, which acts as

heart attack victim former patient of a cardiac institution.

The second system-forming part of the complex under consideration is the center 2 of emergency medical care (Fig. 2). To implement the proposed method, it is sufficient to use the structure of a typical call center, the general structural diagram of which includes a central controller 5 for collecting and processing information with which a communication terminal is connected with mobile subscribers (mobile communication terminal 3 in Fig. 2) and a data bank 6 patients from the "risk group", built according to the standard design — DBMS 11 and related factographic databases 12-15 data, among which there is a database of 15 photographs of the faces of patients from the "risk group".

Currently, computer databases of patient data, including personal data, medical history, results of analyzes and examinations using various medical equipment, including ECG, are available in almost all large medical institutions. All of them are covered by a fiber-optic communication network, which allows them to exchange factual information of almost any volume and content, both among themselves and with other departmental institutions. Therefore, the establishment of a person’s belonging to any factual base with the help of his personal data is not difficult and can be carried out in a matter of minutes. An example of this is the database of traffic police, mobile operators, large banks, etc. Recognition by photographs and video images of people's faces is a booming area in which significant practical results have been achieved. So, according to the message tass.ru/msp-reportazhi/3781331, in the FindFace algorithm created by NTechLab, choosing the right photo from 250 million images takes even less than half a second even when using an ordinary computer.

According to http://www.comnews.ru/content/109815/2017-10-02, in 2017 the Department of Information Technologies of the Moscow Government and the company

NTechLab launched a pilot project to use face recognition technology from recordings from video surveillance cameras in Moscow. The solution is designed to significantly increase the efficiency of the search and detention of criminals, control the work of urban services, such as construction of facilities and landscaping. Already, the urban video surveillance system consists of 160 thousand video cameras and covers 95% of the entrances of residential buildings. The algorithm based on neural networks imposes minimal requirements on the images to be analyzed, and can work with shooting faces from almost any angle even in low light. This technology is considered the best in the world in terms of quality of work with the most complex database of images such as wild exploration. It includes photographs of people taken under natural conditions and with different resolutions, and the faces may be partially covered. This scenario is as close as possible to a video stream from city cameras. Therefore, this solution is able to provide high accuracy analysis and search, not only in the "laboratory", but also in real street conditions. Moreover, this algorithm is able to provide the required performance and probabilistic characteristics of face recognition of a motionless lying person, and with a high-quality camera, which is equipped with a smartphone, i.e. practically in "laboratory conditions". Thus, the possibility of practical implementation and "industrial applicability" of the claimed method of generally available automatic defibrillation is not in doubt.

The considered option of building a complex that implements the claimed method of public defibrillation works as follows.

The starting point for the implementation of the "survival chain" in case of an acute heart attack that occurred in a community-based environment is an emergency call to number 112 from a mobile terminal, for example, a volunteer’s smartphone 1, who was near the victim (Fig. 1). Learning from

the volunteer the reason for the call and the approximate (according to local landmarks) location of the victim, the operator 112 sends an emergency call to the emergency medical center 2 serving the territory (district, district, airport, hypermarket, etc.) where the emergency is recorded. From the service 112, an emergency call arrives at the mobile terminal 3 of the operator of the specified emergency medical center 2, which determines the location and identification number of the nearest AED 4 from the cartographic database available to him and transmits this information by voice and / or SMS message to a smartphone 1 called volunteer. At the same time, the operator of the emergency medical center 2 generates and transmits the alert activation command to the indicated IDA 4 and starts sending instructions on CPR to the volunteer’s smartphone 1. In response, either the volunteer himself or someone from his environment is trying to find documents for identification of the victim from the victim, for example, a passport and with the help of a video camera built into the smartphone 1, he photographs or videos the victim’s face and sends all the information about the victim to the emergency medical center 2 help. Then, following the instructions of the operator of the emergency medical center 2 transmitted to his smartphone 1, he starts the CPR procedure. The victim information received by the mobile terminal 3 of the emergency medical center 2 is meanwhile sent to the central information collection and processing controller 5, which automatically generates a command to turn on the sound alert in the closest to the volunteer IDA 4 and sends the information about the victim to the bank 6 data on patients at risk.

According to the command received by the wireless interface 7, which is part of the AED 4, the information collection and processing controller 9 transmits alerts to the speaker 10, the task of which is to attract the attention of others to the storage location of the AED 4 and to quickly engage

this IDA 4 into the "survival chain" by quickly delivering it to a CPR volunteer.

At this time, all the information about the victim sent from the smartphone 1 of the volunteer (passport data and face images) and transmitted by the central controller 5 for collecting and processing information to the bank 6 of data on patients from the “risk group”, enters the database management system 11 (DBMS) , which activates the search, identification and recognition of the victim among those at risk. At first, a search is carried out on the basis of 12 passport data. The presence in the message from the volunteer of the victim's passport data allows him to quickly identify him in the “risk group” and establish his unique identification number in the bank 6 data on patients from the “risk group”. Based on this number, DBMS 11 searches the database of 13 physical parameters (body weight, height, skin conductivity, medical history) and the database of 14 ECG parameters of the identified patient from the “risk group”, that is, in the databases of those parameters, the values of which the settings depend on defibrillation discharge parameters (amplitude, duration and pulse shape). The DBMS 11 sends all the found patient parameters to the central controller 5 for collecting and processing information, which converts them into a message format containing corrective effects on the settings of the defibrillation discharge parameters. The specified message through the terminal 3 of the mobile communication is sent to the AND 4.

If there are no documents proving the identity of the victim, then in these cases only the biometric procedure of automatic identification and recognition by the face image can help out. As noted above, the most effective and practically implemented algorithm for implementing this biometric procedure is the technology of neural networks such as FindFace. In the process of implementing this procedure, the DBMS 11 extracts and transfers from the database 15 photos of faces of coded images of the faces of patients included

to the “risk group”, to the central controller 5 for collecting and processing information, in which the specified recognition algorithm is implemented using FindFace software and a single identification number of the victim in the data bank of 6 patients from the “risk group” is established. The implementation of this algorithm, if the message received from the volunteer contains the passport data of the victim, further enhances the probability of correct identification and recognition of the victim in the bank 6 data on patients from the "risk group".

After AED 4 is delivered and placed at the disposal of a volunteer-resuscitator, the defibrillation process itself begins. This process proceeds in the normal mode described in the "Operation manual" of the ALTDEF® defibrillator (AVET.941513.001 OM).

Initially, a volunteer carries out preparatory operations:

1 Opens a defibrillator bag:

2 Turns on the defibrillator by pressing the power key on the keyboard 16 for more than 2 s, and then, following the voice instructions transmitted through the speaker 10, superimposes and connects the electrodes 17, for which:

frees the victim’s chest from clothing;

if necessary, in order to avoid wounds and burns after an electric discharge, cleans the chest from dirt and moisture, using a cloth included in the set of AND 4, or other improvised means;

with a dense hairline in the places of gluing the electrodes shaves the hair in these places with a disposable razor, which is included in the set of AND 4;

opens the bag with disposable electrodes 17, following the instructions on the package;

makes sure that the adhesive on the surface of the electrodes 17 is not dry, and the upper protective surface, wire and connection connectors are not damaged, respectively, the electrodes 17 are suitable for use;

applies electrodes 17, strongly, but gently pressing them to the skin of the chest of the victim according to the drawings on their non-conductive

(non-adhesive) surface: one below the victim’s right collarbone, the other along the ribs along the axillary line below the left nipple.

3 Inserts the plug of the electrodes 17 into the corresponding socket of the defibrillator. The defibrillator immediately after switching on independently using the data entering the controller 9 for collecting and processing information from the ECG module 19 and the internal memory 20, analyzes the victim's ECG and, if it detects ventricular fibrillation, prepares for a defibrillation discharge. At the same time, through the wireless interface 7, corrective actions on the settings in the high-voltage block 21 of the defibrillation discharge parameters taking into account body weight, growth, skin conductivity, anamnesis data and parameters are received into the controller 9 for collecting and processing information of the AED 4 from the emergency medical center 2 previously taken ECG. The totality of these data is processed by the controller 9 for collecting and processing information in accordance with a given program and the initial data recorded in the internal memory 20. As a result, at this stage, the parameters of the defibrillation pulse are automatically adapted to the individual parameters of a particular patient, which can significantly reduce the risk of burns and necrosis tissues under high voltage.

After the preparation of AED 4 for defibrillation, the procedure is as follows:

1 When the electrodes 17 are connected correctly, the defibrillator automatically starts analyzing the rhythm and a message sounds from speaker 10: DO NOT TAKE PATIENT. RHYTHM ANALYSIS. During the analysis, the position of the victim is not changed, because this may lead to incorrect results. The duration of the analysis is from 5 to 15 s.

2 If ventricular fibrillation is not detected, the volunteer will be asked to perform CPR within 2 minutes. The graphic display 13 will then display the time remaining until the end of the CPR. After the end of CPR, the defibrillator will again go into rhythm analysis mode.

3 If ventricular fibrillation is detected, the defibrillator immediately proceeds to the procedure of energy storage, during which a message sounds from speaker 10: DO NOT TOUCH THE PATIENT. ENERGY STORAGE. On the graphic display 18, the number corresponding to the number of fibrillations will increase by one. After charging is complete, the Discharge button starts flashing, indicating that the defibrillator is ready for defibrillation discharge and a message periodically sounds from speaker 10: DO NOT TOUCH THE PATIENT. PRESS THE DISCHARGE KEY.

4 To confirm the intention to carry out a defibrillation discharge, the volunteer presses and holds on the keyboard 16 the discharge button until the discharge is performed. The defibrillator does not discharge automatically. If the Discharge key is not pressed within a specified time, then the defibrillator will ensure internal operator self-discharge of the stored energy to ensure operator safety and will offer to carry out the CPR procedure again within 2 minutes.

If it is found that ventricular fibrillation has disappeared and a heart rhythm is detected, then internal self-discharge will occur and the defibrillator will again go into rhythm analysis mode.

5 After the end of the defibrillation discharge, the defibrillator, using the speaker 10 and the graphic display 18, will inform that the DISCHARGE IS COMPLETED and will offer to carry out CPR events within 2 minutes. After the CPR cycle, the rhythm analysis cycle is repeated and, if necessary, a repeated defibrillation discharge cycle is performed.

6 The defibrillator is turned off at the end of work automatically if during 10 minutes the electrodes 17 were not connected and the defibrillator control keys were not pressed.

Thus, the complex of technical means described above ensures the reliable functioning of all structural elements in a single interactive process in "close to real time". At the same time, thanks to the technical capabilities already implemented in practice

of these tools and software and algorithmic support, the entire cycle of ongoing steps to establish a diagnosis, CPR and defibrillation can be a few minutes, and the harmful effects of exposure to a patient's high voltage discharge are minimized due to the automatic adaptation of the defibrillation pulse parameters to the individual parameters of the victim.

Accordingly, the expected technical result of the proposed method of publicly available defibrillation is achieved, which consists in increasing the efficiency of saving the life of a cardiac patient in community-acquired conditions.

Claims (1)

A method of publicly available automatic external defibrillation, in which in case of an acute heart attack occurring in a hospital environment, a volunteer who is near the victim sends an emergency call from his mobile radio terminal to the emergency center operator containing information about the reason for the call and the approximate location of the victim, after which the volunteer transfers identification data on the identity of the victim based on documents found in the victim and / or based on the photo rafting or video recording of his face through the mobile radio terminal to the operator of the emergency medical center, who searches through them in a data bank of patients from the “risk group” and identifies the victim, characterized in that the emergency call is made through the service operator 112, who forwards the information to the terminal mobile operator of an emergency center operator serving a territory in which an emergency is recorded, after which an emergency center operator of Qinga aid determines the location and identification number of the automatic external defibrillator (AID) nearest to the victim and transmits this information to the volunteer’s mobile radio terminal, while at the same time it forms an emergency medical center through the central controller for collecting and processing information and transmits a command to turn on the sound notification of the indicated AID , and also starts sending instructions on cardiopulmonary resuscitation to the volunteer’s mobile radio terminal ( CPR), after which the volunteer performs CPR and after delivery of the AED, he proceeds to the automatic external defibrillation procedure, and after identifying the victim, the emergency medical center operator selects from the database physical parameters, including body weight, height, skin conductivity, medical history, and the ECG database of the affected data for adjusting the settings for the parameters of the defibrillation discharge, including the amplitude, shape and duration of the defibrillation pulse, based on which calculate and form corrective actions for the specified AED and, before the start of the defibrillation discharge, transfer the indicated corrective actions to the specified AED, accept them with the integrated wireless interface in the AED, and the indicated corrective actions are automatically entered into the control unit and the amplitude is changed before the volunteer presses the defibrillation keys, the shape and duration of the discharge pulse, while the volunteer, following the voice and visual prompts from the speaker and graphic dis Leia AED, imposes electrodes on the surface of the victim’s chest, expects the end of the accumulation of discharge energy, sequentially carries out one or more defibrillation discharges, and after the end of the discharge process visually assesses the patient’s condition and either returns to the CPR procedure or proceeds to the next defibrillation cycle, while exercising visual monitoring of the physical condition of the patient until the arrival of the ambulance service.

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