With mobile apps, first aid enters a new era

When 911 dispatchers get a call that someone has collapsed and stopped breathing, they quickly notify first responders. In hundreds of communities across the country, they also send out alerts via smartphone, summoning everyday citizens who have been trained in cardiopulmonary resuscitation.

If those good Samaritans reach the stricken person first, they can start resuscitation efforts until the professionals get there.

PulsePoint, the mobile app allowing this to happen, is just one of a number of apps that rescue workers, hospital staffers and patients are using to improve responses to health emergencies.

PulsePoint has proved valuable in cities such as Cleveland, where about 4,000 people have downloaded the app and where alerts have led to responses from 36 citizens, including one who helped save the life of a man who had collapsed in traffic court.

"Apps used by citizens who want to help give them a way to be part of the structure of the emergency response program," said Thomas Beers, emergency medical services manager at the Cleveland Clinic and coordinator for PulsePoint in the Cleveland area.

Some emergency apps are designed to assist responders in monitoring patients or feeding information to hospital emergency rooms. Others are aimed at helping people alert authorities if they have a health crisis.

A software developer in Falls Church, Va., for example, created the free 911HelpSMS app, which informs a user of where he is located before he calls 911 in a medical emergency. Cellphone towers aren't always able to pick up a caller's location on a 911 call. It is especially useful if the person has been in an accident or is unable to speak or in an unfamiliar place. He taps once to load the app, then a map appears that shows his location on the screen along with a red button to call 911. The app also instantly texts multiple family members and gives them the person's GPS location.

Another free app, EMNet finderER, was developed by Massachusetts General Hospital. It allows users -- including people who have suddenly become sick and emergency medical technicians -- to quickly locate the nearest hospital, whether they're in an unfamiliar part of town or while they're on vacation.

"We've received great feedback from EMTs who have used the app on long transports when the patient gets unexpectedly worse and needs to go immediately to the nearest ER," Carlos Camargo, a professor of emergency medicine at Mass General and Harvard Medical School, said in an e-mail. "We've also heard from parents of children with food allergies, thanking us for creating the app that saved their child's life."

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The PulsePoint app was the brainchild of Richard Price, former fire chief of the San Ramon Valley Fire Protection District in California. It was developed through collaboration between the district and Northern Kentucky University to assist people who suffer cardiac arrest.

During cardiac arrest, the heart suddenly and unexpectedly stops beating, blood stops flowing to the brain and other vital organs, and the victim is unconscious. If not treated within minutes, it usually results in death, according to the National Institutes of Health.

Sudden cardiac arrest differs from a heart attack, in which the blood flow is blocked, but the heart usually doesn't stop beating and the person remains conscious.

Every year, more than 326,000 people experience cardiac arrest somewhere other than in a hospital, according to the American Heart Association. Ninety percent of them die. But if effective CPR is administered within three to five minutes, it can double or triple a victim's chance of survival.

The association recommends that bystanders provide hands-only CPR -- which involves chest compressions but not mouth-to-mouth breathing -- if they see a teen or adult collapse suddenly. The group says that any attempt is better than none until emergency workers arrive.

PulsePoint was released in 2010, and the number of cities that are connected -- including Las Vegas, Orlando and Madison, Wis. -- has grown to nearly 1,200 in 22 states, according to Shannon Smith, spokesman for the nonprofit PulsePoint Foundation.

Here's how it works: Once emergency dispatchers get a call about a suspected cardiac arrest in a public place, they send an alert to PulsePoint app users at the same time they summon first responders. Users are notified if they're within a certain distance, generally about a quarter of a mile.

The app also directs citizen responders to the place where they can find the nearest publicly accessible defibrillator, a device that sends an electric shock to the heart to try to restore its normal rhythm.

The app is free for users, but public safety agencies pay $10,000 for installation and then an annual licensing fee of $8,000 to $28,000, depending on the size of the area's population. Smith said that nearly 12,000 PulsePoint users have responded to alerts.

Among the success stories is that of a 56-year-old Oregon man who collapsed in his car and a 5-week-old baby in Washington state who went into cardiac arrest at a ballet shop where his sister was getting a tutu.

"Being able to arm CPR-trained citizens with a tool to locate someone in distress, as well as the nearest defibrillator, strengthens the person's chance of survival," Smith said.

Jeff Helm, division chief of EMS for Sioux Falls Fire Rescue in South Dakota, said that when his department launched PulsePoint more than two years ago, some people raised questions about potential liability and patient privacy.

Helm said neither turned out to be a problem because responders who assist during a medical emergency are protected from liability under Good Samaritan laws, which every state has enacted, and they're attending to victims in public places and aren't even aware of their names or other personal information.

Emergency responders say they are more than happy that apps are being created to help them do their jobs better.

"We're all for any app technology that can make the process more efficient and effective," said Lori Moore-Merrell, who heads the research division of the International Association of Fire Fighters, which represents about 300,000 professional firefighters and paramedics. "If these apps can get a bystander to engage in CPR or help us get there faster or better communicate with the hospital prior to arrival, we're absolutely supportive of that."

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Unlike PulsePoint, most other apps related to health emergencies don't target just one type of medical crisis. The ICEBlueButton app, which is free, lets people use their smartphone to store information that might be helpful if they have any type of medical emergency. That can include their doctor's name, emergency contacts, allergies, medications and medical conditions. Emergency responders can access this information by scanning a bar code on the lock screen of the patient's phone.

Another app, Twiage, allows first responders to send patient information from the ambulance to the hospital, including photos, videos and EKG results. The information appears on a computer screen at the emergency room, along with the patient's estimated time of arrival.

The app is free for emergency responders. Hospitals that get the data pay a subscription fee, said YiDing Yu, a physician who co-founded Twiage.

Yu said that across the country, ambulances still use radios and phone calls to alert hospitals, a process that can lead to errors and delays in treatment. The app was created to help hospitals accelerate care for patients who have suffered strokes, heart attacks or major trauma.

Moore-Merrell of the firefighters association said that any apps that can improve communication between first responders and ER doctors are well worth it, but she cautioned against overreliance.

"With any technology, we can't be so dependent on it that if it goes down, we're in trouble," she said. "We always need to be prepared to do what we do without technology."

• This story was produced by Stateline, an initiative of the Pew Charitable Trusts.