Android-based Emergency Medical service in Ethiopian

Health-care Institutions: Using Geolocation Function with

Firebase Cloud Computing

A thesis submitted to federal TVET institute division of electrical electronics

and ICT department of information and communication technology in partial
fulfillment for the degree master of science in ICT management

By
ALAZAR MENGSTAB

December 2020
ADDIS ABABA, ETHIOPIA
 FEDERAL TVET INSTITUTE DIVISION OF ELECTRICAL
ELECTRONICS AND ICT DEPARTMENT OF INFORMATION
AND COMMUNICATION TECHNOLOGY

ANDROID-BASED EMERGENCY MEDICAL SERVICE IN

ETHIOPIAN HEALTH-CARE INSTITUTIONS: USING
GEOLOCATION FUNCTION WITH FIREBASE CLOUD
COMPUTING

A Thesis Submitted to Federal TVET Institute Division of Electrical Electronics

and ICT in Partial Fulfillment of the Requirements for the Degree Master of
Science in ICT Management

By: Alazar Mengstab

Advisor: Professor P G V Surash kumar (PhD)

December 2020
ADDIS ABABA, ETHIOPIA
 FEDERAL TVET INSTITUTE DIVISION OF ELECTRICAL
ELECTRONICS AND ICT DEPARTMENT OF INFORMATION
AND COMMUNICATION TECHNOLOGY

ANDROID-BASED EMERGENCY MEDICAL SERVICE IN

ETHIOPIAN HEALTH-CARE INSTITUTIONS: USING
GEOLOCATION FUNCTION WITH FIREBASE CLOUD
COMPUTING

By: Alazar Mengstab

Name and Signature of Members of the Examining Board

Professor P G V Surash kumar (PhD) __________ _________

Advisor Signature Date

(PhD) __________ _________

Examiner Signature Date
(PhD) __________ _________
Examiner Signature Date
 Declaration

I declare that this thesis entitled “Android-Based Emergency Medical Service in Ethiopian Health-
care Institutions: Using Geolocation Function with Firebase Cloud Computing” is my own work,
all sources of materials used for the work have been duly acknowledged. This thesis has not been
submitted for the award of any degree or diploma in this institute or any other universities. With
guidance and encouragement from my research adviser, I conducted the research independently.

Signature: _________________________

Alazar Mengstab

This thesis has been submitted for examination with my approval as institute advisor.

Advisor’s Signature: ______________________

Professor Surash (PhD)

 Dedicated

To

My Family!

Thanks for your support.

 Acknowledgements

First and foremost, praises and thanks to the God, the Almighty, for his endless blessing and
helping me to complete the research successfully.

I would like to express my special thanks of gratitude to my advisor Professor Surash as well as
our principals who give me the opportunity to do this wonderful work on the ABEMS and the
people which also helped me in doing lots of things I am really thankful to them. I would also like
to thank my parents and friends who helped me a lot in finalizing this thesis.

My completion of this thesis could not have been accomplished without the support of my family
and my classmates thank you for allowing me time with you GASHE. My special thanks also to
Enana, Muligeta, Sami, Ashu, Desia, Yoni and Sofiyan.

I
 Abstract

Every day, people use Information Technology in new ways. Smart phones and computers are
becoming increasingly affordable. They continue to be more dominant as information-processing
tools as well as easier to work with. Individuals are continually becoming dependent on computers
and smart phones devices for carrying out simple tasks like remembering their friends and family’s
telephone number to complex ones like flying a fighter drone. Information and communication
Technology have applications in almost all aspects of our life. Nowadays, Health-care institutions
are becoming highly IT dependent. In most places in Ethiopia, traditionally the ambulances can be
summoned by members of the community (as well as medical facilities, other emergency services,
businesses and authorities) via an emergency telephone number such as Red Cross Society 907
which puts them in contact with a control facility, which will then dispatch the ambulance with a
suitable resource to deal with the situation. Enabling the positioning and tracking of android smart
phones has emerged as a key facility of existing and future generation smart phones
communication systems. This feature offers opportunities for many values added location-based
services and other services offered through a mobile phone. For example, mobile phones are
increasingly employed in vehicle tracking services, ride sharing or taxi hailing and present several
advantages over traditional taxi systems. In this paper, we propose a system that offers a solution
to the problem of Location-Based Emergency Medical Service (EMS) to dispatch ambulance and
emergency incident handling in the area of Gondar. It is based on Android System together with
GeoLocation based system and Firebase cloud technologies which utilize customers the ability to
see their own current location and the nearby EMS ambulance driver’s location thought the internet
using their android mobile phone to provide information. The system's operation is expected to
minimize the emergency response time and there will be a radical improvement in the way
emergency incidents are being handled. This will increase the quality of health services offered to
customers or the people around Gondar. Once a user presses a “Call Ambulance” button using the
application we provide, the users position can be sent to the EMT or EMS providers ambulance
driver via the internet so that the user can get emergency medical service instantly.

Keywords: Emergency medical technician, Emergency medical services, GeoLocation

II
 Table of Contents

Acknowledgements .......................................................................................................................... I

Abstract ........................................................................................................................................... II

Table of Contents .......................................................................................................................... III

List of Acronyms and Abbreviations ......................................................................................... VIII

List of Figures ................................................................................................................................ X

List of Tables ................................................................................................................................ XI

Chapter one ..................................................................................................................................... 1

1. Introduction ............................................................................................................................. 1

Background ...................................................................................................................... 1

Statement of the Problem ................................................................................................. 4

Research Question ............................................................................................................ 5

Objectives ......................................................................................................................... 5

General Objective ..................................................................................................... 5

Specific Objective ..................................................................................................... 5

Scope and Limitations of Thesis ...................................................................................... 6

Application of the Project ................................................................................................ 6

Organization of the Document ......................................................................................... 7

Chapter two ..................................................................................................................................... 8

2. Literature Review .................................................................................................................... 8

Android............................................................................................................................. 8

Cloud Computing ........................................................................................................... 11

Types of Cloud Computing ..................................................................................... 11

Google Cloud Platform (GCP)................................................................................ 12

III
 Cloud Functions for Firebase .................................................................................. 12

Emergency Medical Service (EMS) ............................................................................... 13

Importance of EMS ................................................................................................. 16

Ambulance and First Aid Service in Ethiopia ........................................................ 17

Ethiopian Red Cross society (ERCS) ..................................................................... 17

Tebita EMS ............................................................................................................. 18

Global positioning System (GPS) .................................................................................. 18

Location Based Services ................................................................................................ 19

What is a mobile Location-based service?.............................................................. 20

Real-time locating Systems (RTLS) ....................................................................... 20

how location-based service works? ........................................................................ 21

Location Based Service Emergency Application ................................................... 21

Call System Problems .................................................................................................... 24

Related work .................................................................................................................. 25

Location Based Emergency Medical Services Using Android Mobile OS ............ 25

Emergency management system using android application ................................... 26

Smart hospital emergency system via mobile-based requesting services ............... 26

Ambulance management system using GIS ........................................................... 26

Chapter Three................................................................................................................................ 28

3. Methodology.......................................................................................................................... 28

Methodology .................................................................................................................. 28

RESEARCH DESIGN ................................................................................................... 28

Research Approach ................................................................................................. 29

Study setting............................................................................................................ 30

Sample selection ..................................................................................................... 30

IV
 Data collection................................................................................................................ 31

Data Analysis Strategy ................................................................................................... 31

Reliability and Validity .................................................................................................. 32

DESIGN SCIENCE METHODOLOGY ....................................................................... 32

Chapter Four ................................................................................................................................. 36

4. Data Analysis and Finding .................................................................................................... 36

Introduction .................................................................................................................... 36

Participants Demographic Characteristics ..................................................................... 36

Participants Gender ................................................................................................. 36

Participants Qualification........................................................................................ 36

Participants Job Title............................................................................................... 37

Participants Work Experience................................................................................. 38

Data Analysis ................................................................................................................. 38

Questionnaire Result Analysis ....................................................................................... 38

The Current Practice of Emergency medical Service ............................................. 38

Summary Description ..................................................................................................... 42

Chapter Five .................................................................................................................................. 44

5. System Design Elements and Implementation ...................................................................... 44

Overview ........................................................................................................................ 44

Proposed System ............................................................................................................ 44

Requirements of ABEMS .............................................................................................. 45

Actors ...................................................................................................................... 45

User requirements ................................................................................................... 45

Hardware and Software requirements ..................................................................... 45

Functional Requirements................................................................................................ 46

V
 Non-Functional Requirements ....................................................................................... 47

Assumptions and Dependencies ..................................................................................... 49

General Constraints ........................................................................................................ 49

System Model ................................................................................................................. 49

Use Case Model ...................................................................................................... 50

Use Case Descriptions ............................................................................................ 52

Sequence diagram ................................................................................................... 58

Class Diagram ......................................................................................................... 62

Design Elements ............................................................................................................. 63

Design Goals............................................................................................................... 63

The Proposed System Architecture ............................................................................ 63

System Decomposition ............................................................................................... 65

Hardware/software Mapping ...................................................................................... 65

Chapter Six.................................................................................................................................... 67

6. Implementation and Evaluation ............................................................................................. 67

Overview ........................................................................................................................ 67

Development Environment ............................................................................................ 67

Tools Used...................................................................................................................... 67

Prototype ........................................................................................................................ 72

Emergency Patient Part ........................................................................................... 72

Ambulance Driver Part ........................................................................................... 77

Evaluation of ABEMS ................................................................................................... 84

Usability Test .......................................................................................................... 84

Tasks ....................................................................................................................... 84

Evaluation and results ............................................................................................. 85

VI
Chapter Seven ............................................................................................................................... 86

7. Conclusion and Future Work ................................................................................................. 86

Conclusion...................................................................................................................... 86

Future Work ................................................................................................................... 87

REFERENCE ................................................................................................................................ 88

APPENDIX A: Questionnaire To be Filled by ED staffs ............................................................ 92

Appendix B: Evaluation System Usability Test Questionnaire .................................................... 96

VII
 List of Acronyms and Abbreviations

A&E Accident and Emergency service

AAFEPCA Addis Ababa Fire and Emergency Prevention and Control Authority

ABEMS Android-based Medical Emergency Service system

API Application Program Interface

AWS Amazon Web Services

BaaS Backend as a Service

CAD Computer Aided Dispatching

DALYs Disability-Adjusted Life-Years

DDMS Dalvik Debug Monitor Service

EMT Emergency Medical Technician

ERCS Ethiopian Red Cross Society

ETC Ethiopian telecommunication corporation

GCP Google Cloud Platform

GNU General Public License

GPS Global positioning System

GPU Guided Processing Unit

GSM Global System for Mobile Communications

GURH Gondar university Referral Hospital

IAAS Infrastructure as a Service

iOS iPhone Operating System

VIII
ITN Intelligent Transport Network

ITS Intelligent Transport Service

LBS Location Based Services

MES Medical Emergency Service

OS Operating system

PAAS Platform as a Service

PDA Personal Digital Assistant

PHEM Pre-hospital emergency medical

PSAP Public safety answering point

RTLS Real-time locating Systems

SaaS Software as a Service

SDK Software Development Kit

UI User Interface

UMTS Universal Mobile Telecommunications System

IX
 List of Figures

Figure 3-1 The design science research methodology process ..................................................... 35

Figure 5-1: ABEMS use case diagram.......................................................................................... 51
Figure 5-2:User login Sequence diagram ..................................................................................... 58
Figure 5-3: User Registration Sequence diagram ......................................................................... 59
Figure 5-4: Send/Accept emergency request Sequence diagram .................................................. 61
Figure 5-5: ABEMS class diagram ............................................................................................... 62
Figure 5-6: Proposed System Architecture .................................................................................. 64
Figure 5-7: Subsystem decomposition of the system ................................................................... 65
Figure 5-8: Deployment Diagram ................................................................................................. 66
Figure 6-1: Google Cloud Platform window screen shoot ........................................................... 69
Figure 6-2: Login and Registration .............................................................................................. 73
Figure 6-3: Map view of the application...................................................................................... 74
Figure 6-4: Map view of the application....................................................................................... 74
Figure 6-5: Emergency patient Map view of the application ....................................................... 75
Figure 6-6: Manage Profile ........................................................................................................... 76
Figure 6-7: Manage account screenshot ....................................................................................... 77
Figure 6-8: Ambulance driver Login and Registration ................................................................. 78
Figure 6-9: Error Handling ........................................................................................................... 79
Figure 6-10 Ambulance availability status ................................................................................... 80
Figure 6-11 Ambulance driver Map view of the application ........................................................ 81
Figure 6-12 Ambulance driver Manage profile ............................................................................ 82
Figure 6-13 ABEMS app Database Structure ............................................................................... 83

X
 List of Tables

Table 2-1: Features of Android operating system........................................................................... 9

Table 2-2: Major Case of Deaths and DALYs in Medium and Lower Income Countries ........... 15
Table 4-1 representation of Participant’s gender .......................................................................... 36
Table 4-2 participants level of qualification ................................................................................. 36
Table 4-3 Participants job title representation .............................................................................. 37
Table 4-4 Participants work experience ........................................................................................ 38
Table 4-5 Current Ambulance Service ......................................................................................... 39
Table 4-6 Response Time ............................................................................................................. 40
Table 4-7Emergency Patient Communication Assessment .......................................................... 41
Table 4-8 Android-based emergency medical service .................................................................. 42
Table 5-1: Use case description .................................................................................................... 52
Table 6-1 Questionnaire results .................................................................................................... 85

XI
 Chapter one

1. Introduction

Chapter one introduces an overview of the research, statement of the problem, research question,
general objective, and specific objective. In addition, methods of the study, scope and limitation of the
study and application of the research are presented.

Background

Smartphones are the latest generation of mobile phones which in recent times dominate the mobile
phone industry; their emergence over the recent years has already dominated the market due to the
fact that mobile phone subscribers worldwide prefer to use smartphones, equipped with computer
functionalities ranging from the ability to sync more than one email account to a device, a mobile
browser, Internet connectivity or Wi-Fi, GPS and the ability to run multiple applications
simultaneously, programs for reading and editing and the multimedia features like high definition
digital cameras, typically with video capability and sound recording facilities compared to traditional
mobile phones whose functionalities are limited.

In our today’s world the number of smart phone users surpasses 3 billion and is forecast to grow in
the next few years. According to Ethiopian telecommunication corporation (ETC), the total number
of customers in Ethiopia reached 46.2 million during the fiscal year and this was equivalent to 41% of
the total population, an increase of 5.8% compared to the end of the previous fiscal year. Mobile voice
subscribers reached 44.5 Million, the company’s Data and Internet service users have also reached
23.8 Million and Broadband subscribers are 212,200. Last year major and multifaceted advancement
was made on broadband Internet services along with tariff slash, the subscribers reported a 135 percent
rise over the previous budget year. As a result, telecom density has reached 46.1% and the number of
smartphone users also increased [1].

Mobile commerce has been significantly growing with the unprecedented expansion of smartphone
use by contemporary consumers all over the world. in recent years mobile apps are the prevailing
forms of mobile technology to have achieved popularity. In the hospital and health care context,
mobile app has not only penetrated various stages of business but also affect consumers behavior.

1
Many major hospital and health care institutions have launched their own mobile application to help
them with patient monitoring, clinical decision making to enhance their productivity, improve
accuracy and increase efficiency. For busines operator’s mobile app can be employed as an extension
of e-marketing strategies and as a source of competitive advantage for companies. Many major
hospitals and health care institutions have launched their own mobile app. For example, First Aid to
Ethiopian Red cross (ERCS) app provides quick access to the information to handle the most common
first aid emergencies with simple step-by-step advice and videos, and one of US top hospital Johns
Hopkins hospital, in East Baltimore and its mobile apps such as Haiku and Canto. Haiku (iOS and
Android) provides doctors secure and portable access to patient charts, whether they are in practice
rooms, in hospital round-ups or away from work. The app includes chart review, patient lists, schedule
and search, messaging, dictation and capturing of clinical image, on the other hand, Canto provides
Physicians to check schedules, messaging, sends notifications to take medicines , dictate notes and
review lab results from anywhere[2]. Because of their ubiquity and portability mobile apps have
significantly changed consumers consumption behavior. These quality enables smartphone users to
receive and diffuse information much quicker and easier than ever before. For instance, many patients
today use mobile apps to schedule or cancel an appointment, to request prescriptions, easy access to
medical records and provides opportunities to communicate with their physicians and so on.

The use of mobile apps in health care institutions could improve patient experience, especially with
regard to accessing health information, making communication between physician and patient more
convenient, ensuring price transparency in medical care, and improving short-term outcomes. All of
these may lead to good health outcomes. Therefore, We would also promote and encourage the use
and adoption of mobile apps in health care institutions to enhance the patient experience[3].

Mobile applications are defined as software or set of programs that runs on a mobile device designed
to perform specific tasks for the user. Which can usually be pre-installed in smartphone or downloaded
from internet and install it onto user’s mobile device. Mobile app is a recent and rapidly developing
Segment of the global ICT. Mobile applications are easy to use, user friendly, downloadable and
capable of running on most mobile phones, including inexpensive and entry level phone. For its vast
functioning area, the mobile application has widely used for calling, messaging, browsing, chatting,
social network communication, audio, video, game etc. In this case, Emergency Medical Service
mobile apps (e.g. PulsePoint app, SMARTEMS app, Beacon Emergency Dispatch app) can be defined

2
as mobile apps that provide patients or customers with health-related electronic service such as
ambulance and hospital searching, directions, booking and so forth. To operate on mobile devices such
as smartphones and tablets, you can download these from APP STORE or GOOGLE PLAY.

Accident or disaster can be either manmade or natural, and in both cases, the most important issues in
reducing loss of life is the time taken for response. current trend in EMS can face challenges
concerning delay in responding to customers given the centralized nature of the service. An emerging
concept that can help address these issues is android based cloud computing mobile application, which
offers mobility support, increased resilience and scalability. Furthermore, by utilizing smartphone
built-in GPS and GOOGLE cloud Firebase functionality, it can be more affordable and easier to deploy
in ambulance.

Cloud computing is the delivery of computing services including storage, servers, networking,
databases, analytics, software, and intelligence over the Internet to offer faster innovation, flexible
resources, and economies of scale. With a public cloud, the cloud provider owns and manages all
hardware, software and other supporting infrastructure and then you access these services and manage
your account using a web browser. it is the practice of using a network of remote servers hosted on
internet to store, manage and process data on demand and pay as per use. Instead of local servers or
personal computers it provides access to a pool of shared resources.

Cloud functions for firebase let you automatically run backend code in response to events triggered
by Firebase features and HTTPS requests. There's no need to manage and scale your own servers.
After you write and deploy a function, Google's servers begin to manage the function immediately [4].
If you are an app developer you know that the successful mobile app has lots of responsibilities, apps
build on firebase uses authentication feature to sign in users and typically to read and write data to its
real time database. They might also store files in cloud using its scalable storage. It has all great
features building your app but sometimes you can put all your logic inside the app to run on the user’s
device. For example, prying eyes made try reverse engineering and modify your applications code or
maybe you need to change your applications behavior instantly without publishing a new version that
users have to install and sometimes it’s best to have a single place were expensive works is performed.
Traditionally to solve these problems you would deploy your private code to a backend server that you
manage the application with then use API or library to communicate with that server an issue request.

3
However, with cloud functions for firebase you do not need to setup, maintain and scale that backend
to get its benefit. Instead, you can write and deploy code to firebase servers that automatically response
to advance your application. If users just log in the first time you can send a welcome email with the
function. If that user sends a value in to your real time database, you can update right away with the
function. If that user uploads photos to your storage you can analyze and manipulate them all with the
function and also you can send a massage with firebase cloud massaging to that user’s friends and
family so they can know what’s happening right away. With cloud functions you can seamlessly
integrate many features of firebase such as cloud messaging, authentication, real-time Database,
analytics and storage to provide the backend service that your app requires to be fast, secure and
complete. And you can do it all without having provision server upgrade them scaled them up and
scaled them down to meet your user demand. The Google cloud firebase handles the maintenance and
you can write the code so you can quickly build apps without all the ups.

Statement of the Problem

About 1.2 million people die worldwide each year from road traffic accidents. Majority of these deaths
occur in Africa where most of their emergency medical services are underdeveloped [5]. Medical
Emergency Service (MES) or typically known as ambulance plays a very important role in the
probability of mortality of emergency patient and has become an important issue in the world of health
because of the possibility to survival of an injured person in real-time. MES is preserved as an event
occurrence ranging from for patient pick-up in a medical emergency to transfer of patient to hospital,
but the main role of ambulance is to provide quick access to those in need or known as response time
and provide first ide to injured patient with equipped materials and paramedic staffs. Good location
information is essential in ambulance service and traditionally customer needs to call and give them
exact location information to able them to track and reach the customer. Sometimes the customer
might accidentally provide wrong information or the operator might record wrong information
provided by the patient and the result will be catastrophic. The adage "time is money" feels right on
the Medical Emergency Service, where each person is willing to pay any amount to maximize the risk
of death in an emergency. [6] Reveals that the time factor is one of the most decisive factors that a
person will be able to survive, so there is a certain amount of cost or cost that would be willing to bear
someone when in an emergency. According to [7] one second also has a tremendous influence in the
probability of survival in an emergency case. With today's technology era where mostly everything
4
runs on smartphones and apps, the need for quick and efficient services is almost important in every
aspect, especially when it comes to medical services [8]. The creation of a strong ambulance services
network or intelligent transport network (ITN) across the country based on evidences from local study
is necessary for the improvement of medical emergency service utilization.

Research Question

The researcher goals to answer the following research question:

What are the current practices in relation to Medical emergency transport in Ethiopian health-care
institutions from ICT perspective?

What will be appropriate architecture for designing emergency medical service management to locate
the GPS position of emergency patient and ambulance driver to track their current location?

Objectives

General Objective

The main objective of this study is to develop and investigate an android-based prototype for the EMS
by using Geo Location function with Firebase cloud technologies.

Specific Objective

The specific objective of this research:

1. To develop android-based EMS prototype that will be able to locate the GPS position of
emergency patient and ambulance driver to track their current location.
2. To examine or analyze the current EMS practice and its adequacy.
3. To explore the related work in the area of EMS system.
4. To Identify the functional and non-functional requirements
5. To design a system architecture.
6. To Install and test the application in an Android mobile OS.
7. To evaluate the applications performance against that of current systems.

5
 Scope and Limitations of Thesis

This application is to support the patients or customer in times of emergency situations such as
Obstetric, Cardiac and Circulatory, Gastrointestinal, chocking, Trauma and Illness, Infections,
Environmental and other domestic accidents by providing useful and necessary information to the
EMT staff to get a nearby ambulance for fast medical treatment. In the event of an emergency when
the patient presses the “ CALL AMBULANCE ” button in the application to make a quick request and
share information between ambulance drivers or EMT, a list of nearby ambulances using the latitude
and longitude of the current location are fetched from the internet using Google maps API and
displayed on the screen of the android smartphone, using this information the EMT staff or the EMS
ambulance drivers can accept the incoming request from the patient and track the patients location at
the accidental spot. Along with this function, a service will also be provided in this application let the
patients know when the drivers arrive to his location or the accidental spot which is a distance less
than 100 meters. In general, the scope of this work is to develop Android-based Emergency Medical
Service system for Gondar University Referral Hospital (GURH) in which:

• Emergency Patients are able to send emergency request from their Android smartphone.
• EMT or ambulance drivers manage and handle patient’s emergency request easily at their
android smartphone.

The researcher selected Gondar Health-care institutes and private MES providers because like Addis
Ababa, Gondar is also one of the biggest cities in Ethiopia and home for several health care institution
and ambulance service providers.

Application of the Project

The study is about the process of creating Android-based Medical Emergency Service system
(ABEMS) for the Gondar university Referral Hospital (GURH) and tries to examine the current
practices that are related to EMS in Health-care institutions, ICT in focus because a well designed,
developed and tested EMS android application is a guarantee for EMS providers when things go wrong
with their customers in a disaster date or accident.

Emergency medical technicians and ambulance drivers with android mobile phone ABEMS app
installed on it, can open the application to accept emergency patients’ requests, emergency detail and
6
send their detail back to the emergency patients’ android mobile phone so that ABEMS apps accessed
through the internet. The proposed system automates the current emergency medical service of the
GURH to offers a solution to the problem of Location-Based Emergency Medical Service to dispatch
ambulance and emergency incident handling so that a real-time updated location information is
available for tracking emergency patient’s location that helps to minimize the emergency response
time. ABEMS enables to access, store and update a geospatial data (longitude and latitude) for each
emergency request occurring so that it can be displayed on the Google map. Using the system, a user
can also manage their account and profile that can be used by EMT or ambulance drivers which would
help to increase the quality of health services offered to customers or the people around Gondar.

A comprehensive EMS android application guides health care institution in making adequate
preparations in dealing with lifesaving and Ethiopian governmental Health-care institutions and
private MES providers will benefit the outcome of this research by recognizing experiences in the
current practices of EMS process, because they are ready to achieve high productivity and become
more efficient and effective.

Organization of the Document

Including chapter one this project report document contains six chapters and organized as follows.
Chapter Two covers literature review and related works that are related to this thesis. Chapter Three
presents the system analysis of Android-based Emergency Medical Service system. In Chapter Four
we will discuss system design of ABEMS of GURH. The evaluation and prototype of the proposed
system are discussed in Chapter Five. Finally, Chapter six is about the conclusion made on the thesis
result, some possible future work of the system and the contribution of this research are presented.

7
 Chapter two

2. Literature Review

To get a deeper understanding of the current problem, research on different resources is needed to
ensure the reliability of the current system. Here, we will examine the description of the problems and
the proofs. This chapter deals with review of related literature on android-based EMS. It starts among
concepts and issues reviewed are: Android, cloud computing, Emergency Medical Service (EMS),
Global Positioning System (GPS), eCall, Call system problems and Ambulance and First Aid services
in Ethiopian Health care institution, presenting core concepts in location-based service using android
phone built in GPS module and related work dives deep into emergency applications.

Android

Android is an open-source Operating System based on Linux kernel. it is designed primarily for
touchscreen mobile device. Touchscreen devices include smartphones and tablet computers. Android
was developed by the Open Handset Alliance, led by Google, and other companies. Android offers a
unified approach to application development for mobile devices which means developers need to
develop only for Android, and their applications should be able to run on different devices powered
by Android. The first beta version of the Android Software Development Kit (SDK) was released by
Google in 2007, whereas the first commercial version, Android 1.0, was released in September
2008.On June 27, 2012, at the Google I/O conference, Google announced the next Android version,
4.1Jelly Bean. Jelly Bean is an incremental update, with the primary aim of improving the user
interface, both in terms of functionality and performance. The source code for Android is available
under free and open source software licenses. Google publishes most of the code under the Apache
License version 2.0 and the rest, Linux kernel changes, under the GNU General Public License version
2 [9] .

As smart phones and tablets become more popular, the operating systems for those devices become
more important. Android is such an operating system for low powered devices that run on battery and
are full of hardware like Global Positioning System (GPS) receivers, cameras, light and orientation
sensors, Wi-Fi and UMTS (3G telephony) connectivity and a touch screen. Like all operating systems,

8
Android enables applications to make use of the hardware features through abstraction and provide a
defined environment for applications [10].

Android has become a favorite for many customers and developers due to its open nature. as Android
is an open source, it has become the fastest growing mobile operating system. Moreover, app
developers can easily change, modify and incorporate enhanced functionality in it to meet the
requirements of the new mobile technology. Users and software developers are able to build their own
apps for a wide range of devices due to Its Powerful development framework. Some features of
Android operating system are: stated in Table 2-1.

Table 2-1: Features of Android operating system

No Feature Description

1 Alternate Keyboards Android supports multiple keyboards and it can install easily.
The Swift Key, Skype, and 8pen apps can change up the
keyboard style quickly. In other mobiles, the OS doesn’t allow
extra keyboard.

2 Infrared Transmission A built-in infrared transmitter can be supported by the Android

operating system. It allows the phone or tablet to use as a
remote control.

3 No-Touch Control Wave control is an application that is used on Android phones

which can control the calls, music, and videos by just waving
the hand over the phone. And here the touch is not required.

4 Battery Swap and Android phones hold individual hardware capacities. Google’s
Storage OS makes it possible to shift and improve the battery which
does not hold a charge for a long time. For expandable storage,
Android phones have SD card slots.

5 Resizable Widgets Widgets are resizable, so users can expand them to show more
content or shrink them to save space. Apps are flexible, but
sometimes we need data at a sight instead of having to open an
app and wait for it to load. Android widgets allow you to see

9
 the weather apps, music and also remind you of the forthcoming
meetings or deadlines by a notification on the screen.

6 Custom ROMs The Android system is open-source. The developers can

remove the current OS and develop their versions, which users
can download and install in place of the stock OS. Some are
packed with articles, while others change the look and texture
of a device. Thus, Android provides a host of choices that are
not found in the competitive mobile operating systems.

7 Beautiful UI Android OS basic screen provides a beautiful and intuitive user

interface

8 Connectivity GSM/EDGE, IDEN, CDMA, EV-DO, UMTS, Bluetooth, Wi-

Fi, LTE, NFC and WiMAX.

9 Media support H.263, H.264, MPEG-4 SP, AMR, AMR-WB, AAC, HE-AAC,
AAC 5.1, MP3, MIDI, WAV, JPEG, PNG, GIF, and BMP.

10 Multi-touch Android has native support for multi-touch which was initially
made available in handsets such as the HTC Hero.

11 Multi-tasking User can jump from one task to another and same time various
application can run simultaneously.

12 Multi-Language Support single direction and bi-directional text.

13 Tethering Android supports tethering, which allows a phone to be used as

wireless/wired Wi-Fi hotspot. Before Android 2.2 this was
supported by third-party applications or manufacturer
customizations.

14 Java support While most Android applications are written in Java, there is no
Java Virtual Machine in the platform and Java byte code is not
executed. Java classes are compiled into Dalvik executables
and run on Dalvik, a specialized virtual machine designed

10
 specifically for Android and optimized for battery-powered
mobile devices with limited memory and CPU. J2ME support
can be provided via third party applications.

15 (NFC) Neer Field It is the short-range wireless connectivity. It is supported by

Communication several Android devices. It permits electronic devices to
communicate quickly across short distances. The main aim of
NFC is to perform the payment option quickly than carrying
cash and cards.

Cloud Computing

Cloud computing is the on-demand delivery of IT resources over the Internet with pay-as-you-go
pricing. Instead of buying, owning, and maintaining physical data centers and servers, you can access
technology services, such as computing power, storage, and databases, on an as-needed basis from a
cloud provider like Amazon Web Services (AWS). Organizations of every kind, scale, and industry
are using the cloud for a wide range of use cases, such as software development and testing, disaster
recovery, data backup, mail, big data analytics and virtual desktops. For example, healthcare
institutions are using the cloud to improve a number of healthcare-related functions such as
telemedicine, virtual medication adherence and to develop more personalized treatments for patients
[11].

Types of Cloud Computing

The three main types of cloud computing include Infrastructure as a Service, Platform as a Service,
and Software as a Service. Each type of cloud computing provides different levels of control,
flexibility, and management so that you can select the right set of services for your needs[11].

A. Infrastructure as a Service (IAAS)

IaaS contains the basic building blocks for cloud IT. It typically provides access to networking
features, computers (virtual or on dedicated hardware), and data storage space. IaaS gives you the

11
highest level of flexibility and management control over your IT resources. It is most similar to the
existing IT resources with which many IT departments and developers are familiar.

B. Platform as a Service (PAAS)

PaaS removes the need for you to manage underlying infrastructure (usually hardware and operating
systems), and allows you to focus on the deployment and management of your applications. This helps
you be more efficient as you don’t need to worry about resource procurement, capacity planning,
software maintenance, patching, or any of the other undifferentiated heavy lifting involved in running
your application.

C. Software as a Service (SaaS)

SaaS provides you with a complete product that is run and managed by the service provider. In most
cases, people referring to SaaS are referring to end-user applications (such as web-based email). With
a SaaS offering, you don’t have to think about how the service is maintained or how the underlying
infrastructure is managed. You only need to think about how you will use that particular software.

Google Cloud Platform (GCP)

Google Cloud Platform as the name implies, it is a cloud computing platform that provides
infrastructure as a service (IaaS), platform as a service (PaaS), and serverless computing environments
for users to build on top of. Google Cloud Platform is a provider of computing resources for deploying
and operating applications on the web. Its specialty is providing a place for individuals and enterprises
to build and run software, and it uses the web to connect to the users of that software. Google Cloud
Platform is essentially a public cloud-based machine whose services are delivered to customers on an
as-you-go basis, by way of service components. A public cloud lets you leverage its resources to
empower the applications you build, as well as to reach a broader base of customers. GCP can be set
as a collection of entire computing resources of google which are made available to the users as a
cloud integration services, some of the commonly used Google Cloud services include :Computing
and hosting, Storage, Databases, Networking, Big data and Machine learning [12].

Cloud Functions for Firebase

Google Cloud Functions is Google's serverless compute solution for creating event-driven
applications. It is a joint product between the Google Cloud Platform team and the Firebase team. For
12
Google Cloud Platform developers, Cloud Functions serve as a connective layer allowing you to
weave logic between GCP services by listening for and responding to events. For Firebase developers,
Cloud Functions for Firebase provides a way to extend the behavior of Firebase and integrate Firebase
features through the addition of server-side code. Both solutions provide fast and reliable execution of
functions in a fully managed environment where there's no need for you to worry about managing any
servers or provisioning any infrastructure.

You should use Cloud Functions for Firebase if you're a developer building a mobile app or mobile
web app. Firebase gives mobile developers access to a complete range of fully managed mobile-centric
services including analytics, authentication and Realtime Database. Cloud Functions rounds out the
offering by providing a way to extend and connect the behavior of Firebase features through the
addition of server-side code. Firebase developers can easily integrate with external services for tasks
like processing payments and sending SMS messages [13].

Emergency Medical Service (EMS)

An emergency is the resulting state that calls for immediate action or an unforeseen combination of
circumstances. The word medical means the practice of medicine related to or concerned with it.
Service refers to the work or task of helping, serving, or a contribution to the well-being of others. An
emergency medical services is the planned configuration of community resources and personnel
necessary to provide immediate medical care to patients with sudden or unexpected illness or injury.an
EMSS can be local, regional, or statewide [14].

Emergency medical services (EMS), more commonly known as paramedic services or ambulance
services, are emergency services that provide urgent pre-hospital treatment and stabilization for
serious illness and injuries and transport to definitive care. Now a days, when people see ambulances
and medical helicopters responding to incidents, they can quickly recognize EMS. EMS may also be
known as emergency squad, first aid squad, ambulance squad, or by other initialisms such as EMAS
or EMARS is an essential public service, but EMS is much more than emergency response and
transportation. EMS is part of an intricate system of agencies and organizations; communications and
transportation networks; trauma systems, as well as hospitals, trauma centers, and specialty care
centers; rehabilitation facilities; and highly trained professionals including volunteer and career
prehospital personnel, physicians, nurses, therapists, administrators, government officials and an

13
informed public that knows what to do in a medical emergency. Each player in the EMS system has
an essential job to perform as part of a coordinated system of care [15].

An Emergency Medical Service (EMS) can be described as a comprehensive system providing the
arrangements of staff, equipment and facilities for the coordinated, effective and timely delivery of
health and safety services to victims of sudden injury or illness. The main aim of EMS focuses on
providing timely care to victims of sudden and life-threatening injuries or emergencies in order to
prevent needless mortality or long-term morbidity. The function of EMS can be simplified into four
main components; accessing emergency care, care in the community, care in route, and care upon
arrival to receiving care at the health care facility[16].

Emergency medical conditions typically occur through a sudden insult to the body or mind, often
through injury, infection, obstetric complications, or chemical imbalance; they may occur as the result
of persistent neglect of chronic conditions. Emergency medical services (EMS) to treat these
conditions include rapid assessment, timely provision of appropriate interventions, and prompt
transportation to the nearest appropriate health facility by the best possible means to enhance survival,
control morbidity, and prevent disability (see Table 2-2).

The goal of effective EMS is to provide emergency medical care to all who need it. Advances in
medical care and technology in recent decades have expanded the parameters of what had been the
traditional domain of emergency services. These services, no longer limited to actual in-hospital
treatment from arrival to stabilization, now include prehospital care and transportation.

Despite the best efforts of primary care providers and public health planners, not every emergency is
preventable. Emergency medical care is needed in diverse circumstances: prospective patients range
from rural farmers or fishers whose most com-mon mode of transportation may be canoes or animal-
drawn carts, to factory workers living in densely populated urban slums, to residents of high-income
cities and suburbs. Actual provision of emergency care may range from delivery using trained
emergency professionals to delivery by laypeople and taxi drivers. Developing strategies to meet the
range of needs posed by such diverse circumstances will require innovation and a reorientation of
public health planning [17].

In recent years, the provision of emergency medical services is beginning to attract attention as an
important public health challenge in developing countries. Table 2-1 shows the major causes of death,

14
and also DALYs (Disability-Adjusted Life-Years), in ascending order of frequency in middle- and
low-income countries. With early intervention, the highlighted conditions have been shown to be
treatable. In other words, conditions that account for one-third of the major causes of death in
developing countries (the total of the highlighted conditions is 33.8%) can be treated by emergency
medical services. The issue against that disease may differ in each developing country according to
the stage of development with early intervention; the highlighted conditions have been shown to be
treatable. [18]

Table 2-2: Major Case of Deaths and DALYs in Medium and Lower Income Countries

Cause of death % of all deaths Cause of loss of DALYs % of all DALYs loss

Ischemic heart disease Lower respiratory infection

Cerebrovascular disease (Stroke) Perinatal Condition

Lower respiratory infection HIV/AIDS

HIV/AIDS Meningitis

Perinatal Condition Diarrheal disease

Chronic Obstructive pulmonary Depression

disease

Diarrheal disease Ischemic heart disease

Tuberculosis Malaria

Traffic accident Cerebrovascular disease (Stroke)

Malaria Traffic accident

Hypertension Tuberculosis

Measles Congenital abnormalities

Lung cancer Chronic Obstructive pulmonary disease

Suicide Measles

15
 Hepatic cirrhosis Hepatic cirrhosis

Ambulance utilization level is low in Addis Ababa and emergency patients are instead being
transported by taxi or private car. Perceived longer ambulance waiting time and language barriers may
have contributed for low utilization. Findings of this study suggest an action to improve access by
improving ambulance availability while simultaneously enhancing the public’s knowledge and
perception of EMS in Addis Ababa.[19]

These issues will be addressed by the EMS. Importance and responsibility will help to identify what
is important and equally important in saving lives, and using and improving this system will make the
community safer and less concerned with the service provided by the health care institutions and
private EMS providers.

Importance of EMS

People don't usually think of the worst happening at any moment, on an average day, but then a sudden
pain fills your chest, when you get up in the morning and your brother or sister slummed in the chair,
he or she suffer from emphysema and you can’t even wake him up, a family member has an asthmatic
episode, your father might have had a little bit of a stroke, his speech has gone and his face is sloping
to one side or maybe someone close to you begins to have an allergic reaction. Emergency Medical
Services’ job begins after you call to the nearest PSAP. When the most serios emergency strikes the
ambulance has 8 minutes to respond, in the control center every single one needs a split-second
decision, who need an ambulance quickest, is so critical and who must wait.

Certain situations in life require immediate medical care and a fraction of a second delay can
drastically change somebody's life. The ambulance service and paramedics are very important in
society as they save hundreds of lives daily by responding to emergency calls. They operate from
ambulance stations located in various areas with control centers that respond to emergency calls and
dispatch them when needed. Whether the patient is in rural retreats, busy seaside resorts or large urban
conurbations, they reach the emergency scene within minutes of the call. The emergency ambulance
service crew includes a technician and a paramedic. Once the paramedics arrive at the emergency
scene, they evaluate the situation and the condition of the casualty and decide whether to take them to

16
the hospital or just treat them there. One of the important roles of the ambulance crew is to stabilize
and treat patients quickly to prevent any mishap before the patient reaches the hospital. They provide
immediate and effective life-saving care in a safe and clinical working environment with maximum
mobility. They are well trained in first aid skills to be able to deal with profuse bleeding, crush and
fall injuries, cardiac arrests, road accidents, and much more [20].

During a mid to large scale event such as religious ceremony, sporting event, political demonstration,
music concert, or public exhibition, any mass gathering of people is subject to numerous risks, having
at least one or more ambulance on-site is important. If we look to pass tragedies, where the presence
of large groups resulted in chaos and horrible human losses, we can just how many of these incidents
could have been avoided with timely medical intervention with ambulances at events.

Ambulance and First Aid Service in Ethiopia

Addis Ababa Fire and Emergency Prevention and Control Authority (AAFEPCA), along with few
private companies, provide the major pre-hospital emergency services care for the city. Under their
authority, there is one central dispatch center for fire and pre-hospital services, eight ambulance
stations, and about 32 ambulances.

The authority provides free pre-hospital care, including scene to health facility and inter-facility
transfers. A free ambulance phone number (939) is used for access by the public. The care providers
are nurses with short term pre-hospital patient care training. Although the pre-hospital service has
existed for over 10-years, the epidemiology of patients using ambulances and the appropriateness of
this usage remains unstudied. This study aims to examine patients’ clinical characteristics and reasons
for ambulance use in Addis Ababa [21].

Ethiopian Red Cross society (ERCS)

Ethiopian Red Cross Society (ERCS) Ambulance and First Aid services delivery started 1952 G.C in
Addis Ababa and considerably diversify throughout the country. Ethiopian Red Cross Society has now
delivered Ambulance and First Aid services with in all regional branch and two city administrations.
Ethiopian Red Cross Society developed its own Ambulance Management Manual and revised for third
time to incorporate important and current imputes.

17
All ERCS Regional/Zonal branches and woreda coordination office strengthen their emergency
response capacity and deliver Ambulance and First aid services, for any emergency call, provide free
of charge service, for 24 hrs. An ambulance and First Aid service is supported by trained youth
volunteers and professional volunteers. ERCS has now 215 Ambulance stations, 308 Ambulance
vehicles and can able to deliver annually more than 300,000 beneficiaries. The Annual service
operational cost excides more than 50 million birrs yearly allocated from service partners. ERCS is
working on the development for national ambulance service based on its long-term objective to
transform from emergency transport service to coordinated pre hospital emergency ambulance service
by deploying professional volunteers and equip ambulance vehicles with basic service delivery
materials. Ambulance and First Aid services being supported by standard web based database
management system accessible for all concerned staffs [22].

Tebita EMS

Tebita Ambulance Pre-Hospital Emergency Medical Service (TEBITA) is the first private ambulance
and emergency service provider of its kind in Ethiopia. Established in 2008 by a professional
anesthetist, TEBITA provides a range of services including remote emergency care for multinational
companies, 24-hour emergency response in Addis Ababa, peace of mind services for companies and
missions in Addis Ababa, emergency training for health and non-health professionals and emergency
medical supplies including first aid kit. TEBITA is now internationally recognized as the leading
emergency care provider in Ethiopia. [23]

TEBITA ambulance aims to provide the highest quality emergency ambulance care and pre-hospital
services, create awareness on first aid and health safety through formal trainings, and advocate for the
development of well-organized emergency medical services management. In fact, TEBITA
Ambulance has received numerous awards from local and foreign governments and development
organizations for its lifesaving services. The company is licensed by the Addis Ababa Health Bureau
and has achieved ISO 9001:2008 certification in quality management systems [24].

Global positioning System (GPS)

To put it simply GPS is the system that has three basic parts satellite’s, ground stations and receivers.
satellite’s today is like the stars in constellations that our ancestors to use to find out their location,
there supposed to be in a certain place and in a certain time and this is important. ground stations use
18
radars to find out if the satellite’s really are where supposed to be, a receiver in your phone or in your
car is following signal from the satellite to determine how far is from there, when it finds how far you
are from four or more GPS satellites it can tell exactly where you are with in accuracy with in feet or
even inches.

Nowadays global positioning system and wireless communication system became the most usable
techniques all over the world, due to their many advantages and applications. Wireless technology
also introduces the principles of mobile communication that can be also be used in some applications.
In this paper [25] Khraisat and M. Al-khateeb discus about two important Parts:

• GPS Navigation Device.

• GPS Tracking Device

The GPS Navigation device is a PC required system that will display position information to user; this
Position information can be put on Google Maps or any mapping software. In order to make this part
we used the GPS module and connect it to PC. The GPS Tracking Device is a small device which
plugs into mobile phone to make a GPS tracker .The Tracker responds to text message commands,
and sends you its exact position in SMS (or Email) mode, ready for Google Maps or your mapping
software, in order to make this part we used GPS module that provide the position data which was
processed by a microcontroller, this microcontroller is connected to a Motorola phone that sends the
position information to the observer by an SMS [25].

Location Based Services

The Location Based Services (LBS) include a wide range of services that provide information to the
user based on its physical location. Under LBS umbrella, there are number of platforms which offer
some sort of service, even for information purposes, to a device – and then to its user – depending on
its physical location.

The description is very broad in itself because the possible Location Based Services are many: from
weather forecasts to navigation for vehicles, signaling from the surrounding points of interest in the
identification of nearby contacts. Nowadays, the services that can be offered through a smartphone
due to its geo-location through the GPS sensor. These mobile services are also mainly of three types:
Navigation (interactive maps, calculate routes, etc.), for the information (reporting of places of cultural

19
interest, news, events, contacts, etc.) and marketing (marketing proximity, in-store actions, targeted
promotions, etc.) [26].

What is a mobile Location-based service?

Mobile location-based services use a personal handset's geographic location – such as a Personal
Digital Assistant (PDA), tablet, smart phone or navigation device – to either improve existing
applications or allow new applications. These services can use either embedded satellite navigation
receivers or network-based technologies (such as cell identification or triangulation to determine
position from the base station transmission cells). Such applications cover nearly every aspect related
to human mobility. They can be grouped into three main categories: Applications for consumer,
enterprise and public safety.

The combined use of wireless communication, location determination, GIS and mobile devices opens
the way to develop new or improved information, social networking, personal navigation,
entertainment, mapping, security, geo-advertising, and law enforcement tracking services, among
others. As mass-market applications many of these services will depend on a high degree of accuracy
for their positioning requirements [27].

Real-time locating Systems (RTLS)

Real-time location system refers to any system that accurately determines an objects or person’s
location and is used to identify and track the location of people and item in real time automatically,
usually within a buildings or other contained area, real-time location system is not a specific type of
technology or system, but rather is a goal that can be done with a variety of systems for locating assets
and also known as real-time tracking system. Wireless tags are worn by people or attached to objects,
and in most RTLS, fixed reference points receive wireless signals from tags to determine their location.
Some examples of real-time location systems include child tracking, employee tracking, vehicle
tracking through an assembly line, locating pallets of merchandise in a warehouse, or finding medical
equipment in a hospital.

A real-time location system solution is a positioning system that pinpoints the location of an object or
person indoors and outdoors and can also be deployed to track the physical movement of patients to
help ensure their safety, particularly in the case of Alzheimer’s and dementia patients. RTLS

20
applications in healthcare can be used to quickly locate staff in large facilities when a patient or other
member of staff summons assistance during a medical emergency, RTLS uses a combination of
software and hardware to produce a global system that allows businesses to provide end services to
their customers with a variety of different applications. A real-time location system enables hospitals
to achieve their goals such as increasing patient satisfaction, improving efficiency and reducing time
and cost considerably. However, the implementation of RTLS project is facing a lot of technological
challenges. Accordingly, regarding the organization’s requirements, novel technologies such as
Internet of Things (IoT) and cloud computing or a combination of these two technologies can be used
to design the real-time location system in order to overcome the existing constraints and shortcomings
[28].

how location-based service works?

Location-based services (LBS) use real-time geo-data from a mobile device or smartphone to provide
information, entertainment or security. Some services allow consumers to "check in" at restaurants,
coffee shops, stores, concerts, and other places or events. Often, businesses offer a reward prizes,
coupons or discounts to people who check in. Google Maps, Foursquare, GetGlue, Yelp and Facebook
Places are among the more popular services.

Location-based services use a smartphone's GPS technology to track a person's location, if that person
has opted-in to allow the service to do that. After a smartphone user opts-in, the service can identify
his or her location down to a street address without the need for manual data entry [29].

Two broad categories of LBS can be defined as triggered and user-requested. In order to get the
location of the device, the Location-Based Service should use the real time positioning method. The
spatial location is widely using the coordinate system or being understood as latitude-longitude-
altitude. Latitude is a measurement of the angle at the Earth’s center, north or south of the equator
while for Longitude is a measurement of the angle at the Earth’s center, east or west of the prime
meridian which runs pole to pole through Greenwich [30].

Location Based Service Emergency Application

One of the important advantages of Location Based Services is utilizing the ability to locate an
individual calling to Emergency Service providers (911 in US, 112 in EU) Who is either unaware of

21
or unable to reveal his / her exact location because of an emergency situation. Based on this spatial
information to Emergency Medical Service providers such as ambulance can provide help in a quick
and efficient way [31].

eCall

Botezatu attempts to discuss the system eCall and how does it work. The European Union is promoting
eCall to reduce the number of roadway fatalities by minimizing the response time when an accident
has occurred. eCall is a combination of an In-Vehicle System (IVS), a device with a GSM cell phone
and GPS location capability, and a corresponding infrastructure of Public Safety Answering Points
(PSAPs) Intelligent Vehicle Safety Systems use Information and Communications Technologies for
providing solutions for improving road safety in particular in the pre-crash phase when the accident
can still be avoided or at least its severity significantly reduced. With these systems, which can operate
either autonomously on-board the vehicle, or be based on vehicle to vehicle or vehicle-to-
infrastructure communication (co-operative systems), the number of accidents and their severity can
be reduced. Location-enhanced emergency calls like in-vehicle e-Call have their primary benefit to
society of saving lives and in offering an increased sense of security. The article presents the system
eCall and how does it work [32].

The European Union is promoting eCall to reduce the number of roadway fatalities by minimizing the
response time when an accident has occurred. eCall is a combination of an In Vehicle System (IVS),
a device with a GSM cell phone and GPS location capability, and a corresponding infrastructure of
Public Safety Answering Points (PSAPs) Intelligent Vehicle Safety Systems use Information and
Communications Technologies for providing solutions for improving road safety in particular in the
pre-crash phase when the accident can still be avoided or at least its severity significantly reduced
.With these systems, which can operate either autonomously on-board the vehicle, or be based on
vehicle to vehicle or vehicle-to-infrastructure communication (co-operative systems), the number of
accidents and their severity can be reduced. Location-enhanced emergency calls like in-vehicle e-Call
have their primary benefit to society of saving lives and in offering an increased sense of security.

eCall electronic safety system that automatically calls emergency services in the case of a serious car
accident is ready to be deployed across Europe. Even if you are dead or injured seriously and
unresponsive, the system will inform rescue workers of the crash sites exact location, and the

22
ambulance will be on its way within minutes. eCall will save valuable human lives and reduce the
severity of damages. The technical development of eCall is completed. The Commission is stepping
up efforts to accelerate the implementation of this life-saving technology, with the goal of having a
fully functioning EU-wide service in place by 2015. There is now a need for concerted action by
Member States, car manufacturers, telecom operators and emergency centers to ensure that this
program can operate smoothly in all of Europe by this time [33].

Cars that 'DIAL' 112 (E112)

As soon as your car's eCall system detects a severe impact in an accident, it will automatically call the
closest emergency medical center and send the exact geographic location of the accident spot and other
data to the call center, for example; witnesses to an incident can also make eCalls manually, by
pressing a button. Whether the call is made automatically or manually, there will always be a
connection between the car and the medical emergency call center in addition to the automatic data
link. This way, any car occupant capable of answering questions can provide the call center with
additional details of the accident [33].

Enhanced 911

Enhances 911 (E911) is a system used in North America that links emergency callers with the
appropriate public resources to automatically provide the caller's location to 911 dispatchers.
Emergency dispatchers on North America have a new tool to help locate callers if they are in trouble.
Previously, when someone called for help from there cell phone and they didn't know their exact
location, all the dispatchers had to go on was the location of the nearest cell tower. But now there is
new technology that pinpoints your exact coordinates that emergency crews will now be able to get to
you faster when you need help the most.

The three-digit emergency telephone number originated in the United Kingdom in 1937 and has spread
to continents and countries across the globe. Other easy dial codes, including the 112 numbers adopted
by the European Union in 1991, have been deployed to provide free-of-charge emergency calls.

In North America, where 9-1-1 was chosen as the easy access code, the system tries to automatically
associate a location with the origin of the call. This location may be a physical address or other
geographic reference information such as X/Y map coordinates. The caller's telephone number is used

23
in various ways to derive a location that can be used to dispatch police, fire, emergency medical and
other response resources. Automatic location of the emergency makes it quicker to locate the required
resources during fires, break-ins, kidnappings, and other events where communicating one's location
is difficult or impossible. In North America the incoming 9-1-1 call is typically answered at the Public
Safety Answering Point (PSAP) of the governmental agency that has jurisdiction over the caller's
location. When the 9-1-1 call arrives at the appropriate PSAP, it is answered by a specially trained
official known as a Telecommunicator. In some jurisdictions the Telecommunicator is also the
dispatcher of public safety response resources. When the call arrives at the PSAP, special computer
software is used to display the location of the caller immediately upon arrival of the call. The system
only works in North America if the emergency telephone number 911 is called. Calls made to other
telephone numbers, even though they may be listed as an emergency telephone number, may not
enable this feature. Outside Canada and the United States this type of facility is often called caller
location, though its implementation is dependent on how the telephone network processes emergency
calls[34].

Call System Problems

One of the key roles of emergency call center receivers is to obtain accurate information about the
patient's location and their complaint. Automatic tracing of calls to their source will determine exactly
where most patients are. Nonetheless, getting information about the patient's condition depends on
effective communication between the call maker and the call receiver.

Higgins, Wilson, Bridge, & Cooke aimed to determine the nature and extent of communication
problems encountered during 999 calls according to the level of urgency for medical treatment and to
provide first aid advice EMS services in the UK now use priority dispatch systems to categories calls.
The safety and effectiveness of priority dispatch has been evaluated; however, it has not been
determined whether call receivers are capable of accepting accurate and reliable information.

Calls from mobile phones and pay telephones generated a higher rate of communication problems
compared to land-line problems. Mobile phones, which are increasingly being used, may help to
reduce the time taken to notify the emergency services providers but the advantages of this must be
weighed against the high rate of communication problems. The occurrence of communication
problems associated with the caller's emotional state highlights the need to train call recipients in

24
dealing with people in emotional states. The use of medical / technical terms, some of which can cause
considerable confusion (e.g., "unconscious"), as well as speaking too quickly and without clarity, have
been identified as areas where call receiver training is required [35].

Throughout Addis Ababa the level of ambulance utilization is poor and emergency patients are
transported by taxi or private car instead. Perceived longer waiting time for ambulances, and language
barriers may have led to low use. Findings from this study indicate an initiative to enhance access by
increasing the availability of ambulances while at the same time enhancing the public’s awareness and
understanding of EMS in Addis Ababa [19].

Related work

Location Based Emergency Medical Services Using Android Mobile OS

The Location Based Emergency Services is a better application to search the emergency services, as
it provides both dynamic and static data for the user, dynamic being online data search results and
static being offline search results provided with the app. It provided many services and you can use all
this in a faster way even if you lack an internet connection because static data is present. If we can add
custom navigation, more services can be added too.

Our project, i.e., Location Based Emergency Medical Services Using Android Mobile OS, helps the
user to find the nearest hospitals, medicals, ambulance numbers, police station numbers, and all the
necessary medical services on your mobile app. This app not only provides the online data but also
provides offline data so that when you lack internet connection so still can search for emergency
services

in this project, the main aim is to provide a better interface to the user so that he can access its location
for better purposes than just entertainment. In this project, user will be able to find its precise location
information, he will be able to search results from the static data that is provided along with the
application if he lacks an internet connection, dynamic data for online searches, and he will be able to
search emergency services like nearby Hospital, clinics, etc. Offline maps will also be provided along
with Google markers for better placement of the static location.

The block diagram mainly consists of five components, they are SQLite DB which will store all the
user’s information, static data will be provide by application to the user, Android Mobile Phone having
25
API 21+, Network Service Provider like JIO, and a working internet connection to fetch data from the
internet, GPS for better location tracking. User will request GPS for its current location, and after that,
it will ask network service provider for sending query to internet block for results.

Emergency management system using android application

Jadhav, Patel, Jain, & Phadhatare provide an architecture that will help people in any emergency by
providing assistance by the rescue team using its android smartphones. It responds to victims’
emergencies and the EMS system meets the need for ad hoc communication between skilled personnel
during disaster times when there is no other means of communication. They present Emergency
Management System (EMS), which enables smart phone-based ad-hoc communications at disaster
times over Wi-Fi. The person on the emergency site in an emergency or anyone else will call the EMS
at avail service. Location Coordinates are sending on each request. The system works on the principles
of client-Server system, wherein the server responds to the requests of the Clients. They implemented
the EMS Client Application, Rescue Application and Server. The EMS Client and Rescue Application
were implemented as an Android Application. The Sever is implemented as a Web Based Java
Application. The application is tested using several real Android Phones with GPS on phone, clients
communicating over Wi-Fi [36].

Smart hospital emergency system via mobile-based requesting services

Al-khafajiy and his collagenous attempts to propose a new system call Smart Hospital Emergency
System (SHES). SHES ' main goal is to save lives by improving communications between patient and
emergency services. Using the latest technologies and algorithms within SHES aims to increase
emergency communication efficiency, while reducing problems with emergency call systems and
making the emergency response process more efficient. Utilizing health data held within a personal
smartphone, and internal tracked data (GPU, Accelerometer, Gyroscope etc.) [37].

Ambulance management system using GIS

In the study by Jadhav, Rehka Patel, Jwalant Jain, Darshan Phadhtare and Suyash it is found how well
the integration of GPS/GSM will be used to find the real-time position of an ambulance on Hyderabad
road network. This position information will be spatially analyzed using GIS. Andhra Pradesh state
government policy towards adopting positioning technologies at the beginning stage but soon it will

26
adopt fully. Now a days GSM is used by everyone in India for mobile communication system and used
to show the current area location of a user on the display screen. At the same time GPS needs some
more time to get established in the Indian market. For implementation of their Ambulance
Management system it should get approved by the higher authorities. This integration of
GIS/GPS/GSM of ambulance management needs to be funded by Andhra Pradesh state government.
In this paper GIS/GPS/GSM based prototype system has been developed for routing of ambulance on
road network of Hyderabad city (AMS). This prototype is designed such that it finds the accident
location on the road network and locates the nearest ambulance to incident site using the real-time
technologies (GPS/GSM) and also Ambulance management system user interface has been developed
using VBA, ArcGIS (network analyst). This AMS has been developed using software engineering
model rapid prototyping model and has been evaluated by GIS users.

27
 Chapter Three

3. Methodology

Methodology

In this chapter the author will focus on identifying the research and system methodology which will
be used for the proposed system “Android-based Emergency Medical Service (ABEMS)” and this
chapter presents the research design and methodologies that the researcher used to analyze the current
practices of ambulance service in The Gondar University Referral Hospital Medical emergency
service. In general chapter three discusses research design, research data, data collection, research
population, research instrument, reliability, and validity and research sample.

RESEARCH DESIGN

Research design is the overall plan or structure for the study and used as a guide to determine what
data is needed, what procedure and method is going to be used to collect and analyze the collected
data. In order to find answers for the research question. A descriptive research studies are those studies
that are concerned on the describing of the existing trend of particular organization. In general, the
main function of a research design is to explain how you will find answers to your research questions.
The research design sets out the specific details of your enquiry[38].

This research has used the descriptive survey, which tries to describe and assess the issues that affect
android based medical emergency service of The Gondar University Referral Hospital (GURH)
emergency department from Emergency medical service perspective. This approach satisfies the
research goal because descriptive research study can be carried out to describe a situation,
phenomenon, problem or issue in order to compare and evaluate the results against with the best
practices. This research conducted in two steps. The first step was to implement an application for
android Smartphones, so that it will be available to android users. The second step was descriptive
survey and it conducted to gather the latest information about Emergency medical service. The
researcher has used survey research method involving the use of android-based emergency medical
service self-administer questionnaire as a fact-finding technique, to collect data in a systematic

28
manner. This will help to gather the information from the patient/customer and the emergency medical
service providers, Data that is necessary to answer the research question were collected and has
quantitative nature because descriptive research uses a quantitative research method by collecting
quantifiable information to be used for statistical analysis of the population sample.

Research Approach

In order to answer the research question and achieve the objective of the study; the author use both
quantitative and qualitative (mixed) research approaches and research design approach. The advantage
of using mixed research approach is that data could not be obtained by using single methods, and is
obtained by both alternate.

The qualitative research methodology is chosen and implemented to get a clear and more in-depth
knowledge regarding the subject mattered: Review existing study by other researchers Several journal,
newspaper, and books were referred in this study. This approach is necessary to determine whether
the chosen topic of study is feasible or not.

The author also uses quantitative research approach because it is best for project that target a large
audience within a short period and quantitative research is an inquiry into an identified problem, based
on testing a theory, measured with numbers, and the approach is suitable to collect, organize and
analyze numerical data using statistical techniques. The goal of quantitative methods is to determine
whether the predictive generalizations of a theory hold true[39].

Quantitative Research method is been used to gather complete and detailed description for the
researching purposes. The data obtained via quantitative data collection methods can be used to test
existing ideas or predictions, learn about your customers, measure general trends, and make important
decision. For instance, you can use it to measure the success of your product and which aspects may
need improvement, the level of satisfaction of your customers, to find out whether and why your
competitors are outselling you, and so on.

Quantitative study designs are specific, well structured, have been tested for their validity and
reliability, and can be explicitly defined and recognized and have more clarity and distinction between
designs and methods of data collection. In qualitative research there is an overlap between designs and
methods. Some designs are basically methods of data collection. For example, in-depth interviewing
29
is a design as well as a method of data collection and so are oral history and participant
observation[38].

Study setting

The study took place at The Gondar University Referral Hospital emergency department. The Gondar
University Referral Hospital is one of the largest governmental hospital in Ethiopia and the oldest
medical training institution in the country located in north Ethiopia serving approximately population
of five million. As indicated in WHO website, currently The Gondar University Referral Hospital is a
400-bed university hospital, which acts as the referral centre for five district hospitals in the area
(Debark, Dabat, Koladeba, Addis Zemen and Woreta) and sees between 400-500 patients each day
and between 100-150 are emergency patients. The GURH has four emergency suites with a triage unit
for distribution. It has a range of specialties including paediatrics, surgery, gynaecology, psychiatry,
HIV care and an outpatient’s clinic. Within its 400 staff it employs 50 doctors, 150 nursing staff, three
pharmacists, 90 care staff and 25 laboratory scientists. As tertiary teaching hospital, it plays an
important role in teaching medical and nursing students.[40]

Sample selection

The target population is Emergency operator, Emergency medical technicians, health information
system employees and managements. The researcher has used purposive sampling. The researcher
purposely took the total population of Emergency operator, Emergency medical technicians, Health
information system employees and management staffs in emergency department. The ED staffs are
the one who implement, monitor and administrate the medical emergency service. Operator and
technicians are responsible for the daily smooth operation of the overall EMS such as driving
ambulances and other emergency vehicles, responding to emergency phone calls, assessing victims,
providing emergency treatment, monitoring and administering medication, pain relief and intravenous
infusions, dressing injuries, transporting patients to hospital and continuing to provide treatment while
in transit, providing hospital staff with patient information including condition and treatment and
communicating effectively with patients. The population of this study is the University of Gondar
hospitals emergency department staffs only, because the targeted population only exists in the
emergency department. The research focused on response time, ambulance dispatching, e-ambulance
(HIS), Infrastructure and EMS management. The researcher selects these departments because their

30
daily activities directly affect the organizations performance and their practices related to Android
based EMS can save loss of life that may happen and help in reducing injury, wound or damage.

Data collection

There are two data forms, primary and secondary. In this research, the researcher used both type of
data. Primary data is a type of data that is collected directly by the researcher for the purpose of this
research. Like, questionnaire that was distributed to the hospital ED staff. Secondary data is a kind of
data collected by other researchers for their research purpose. In order to address the theoretical part
of the study the researcher used secondary sources. Such as books, journals, articles, websites and
technical reports.

In this research the author has used interview and questioner for as a fact-finding technique. This will
help to gather the information from the customers and the service providers, in the same time helps to
reform the problem statement and the proposed ideal system that convenient for both ends. The main
aim of the research is to know what is the main issue faced by the user and the service providers.
Quantitative research generates by large-scale survey research, using methods such as questionnaire
or structure interviews. It is better to reach more people within a short period than qualitative research.

The researcher distributed the questionnaire to the hospital ED staff, and asked their willingness to fill
the questionnaire and then data from the questionnaire was collected. Thirty-nine questionnaires
distributed and thirty-three questionnaires were returned from the hospital ED staff staffs. Therefore,
the total response rate for this questionnaire was 84.6%, which is acceptable response rate. The
questionnaire was developed based on current practices of EMS. Furthermore, some change and
refinements were made. Before the development of the final edition of the questionnaire several
changes were applied and the advisor approved every change.

The hospital ED staff were asked if they are willing to fill in the questionnaire. The process took
several days and staffs were contacted several times to fill the questionnaire.

Data Analysis Strategy

Quantitative data analysis techniques were used for generating frequencies and percentage. The
Statistical Package for Social Science (SPSS) software was used to analyze this research data.

31
Descriptive statistical tests such as percentage and frequency were used to analyze the collected data
and represent the data in meaningful figures.

Reliability and Validity

Reliability is the degree to which an assessment tool produces the same and consistent results. In order
to test and evaluate the research questionnaires consistency level and its results if it will be distributed
several times to the same conditions. Research instruments were derived from international location-
based Emergency management service and best practices. Therefore, the research instrument could
measure what it intent to measure. The modifications and adjustments on the instrument were made
and discussed with my advisor. Furthermore, the questionnaire was refined and improved, and all the
advices were taken to ensure that the research instrument could attain the research objective. My
advisor checked the final version before the research instruments were distributed to hospital ED staff.

DESIGN SCIENCE METHODOLOGY

Design science research is one of the most widely used research approaches in engineering, computer
science, and information systems. Design science research, as conceptualized by [41], focuses on the
creation of innovative IT-artifacts to solve real-world problems. Defined Design science research is a
research paradigm in which a designer answers questions relevant to human problems via the creation
of innovative artifacts, thereby contributing new knowledge to the body of scientific evidence. The
designed artifacts are both useful and fundamental in solving that problem”. DSR, thus, provides new
knowledge through the design of innovative artifacts and the evaluation of performance of these
artifacts.

The aim of this research is to design Android-based EMS application to enhance ambulance service
by reducing emergency response time that will be utilized by the emergency patient and ambulance
driver to send coordinate and user details which will be installed to all the ambulance drivers and
emergency patient android phones, google map hence able them to locate and reach the user in time.
In order to achieve this, the research first analyzed the problem and identified the requirements for the
information architecture and then, designed Android based EMS. Therefore, the methodology
employed in the research is in adherence to the design science research approach. Design Science
Research Methodology is seen as the other side of IS research cycle that creates, evaluates information

32
Technology artifacts intended to solve problems identified in an organization [42]. The procedure that
is applied throughout the research is dealt next.

Procedures for design science research Methodology

a. Problem Identification

This research specifies research problems and justifies the need and the importance of setting a
solution and to identify problems by understanding the current status of the digital resource sharing
and management system.

b. Define objectives of a solution

Shows that an attempt is made to creatively solve the problems taking in to consideration the existing
problems. Based on the results of problem identification, the study proposed solutions to the current
problems through creating ways to integrate services from different applications, creating an android
based EMS application for the GURH emergency department community. The objective of this
research is defined as “to design android-based EMS application that enhance ambulance service by
reducing emergency response time that will be utilized by the emergency patient and ambulance
driver.

c. Design and Development

The research design refers to the overall strategy that you choose to integrate the different components
of the study in a coherent and logical way, thereby, ensuring you will effectively address the research
problem; it constitutes the blueprint for the collection, measurement, and analysis of data. The
researcher done this research by using qualitative research design approach for doing perfect study.

In this study, a combination of qualitative and design-oriented research method was used for data
manipulation and to evaluate the functionality of the prototype. Due to qualitative approach focuses
on involving quality and helps in having insight in to problems, more tasks in the study were
qualitative. To show the usefulness of the proposed android based EMS application for GURH
emergency department staffs, design-oriented research methodology was used in this study. Design-
oriented research method is basically a problem-solving model.

33
Android-based applications are becoming business critical, and that this would be reflected in the
organization of the development work. The methodology applied to develop any system greatly affects
the system efficiency in various aspects.

d. Evaluation and Study Validity Method

The main goal of the evaluation is to assess the quality and the usability of the system, so different
tests has to done, not only to see if the system works as it is expected, but also to check whether it
fulfills the requirements from the point of view of the users. Apart from the Android app platform
tests, usability questionnaires were given to different emergency department members which the final
users of the system. From the results of this evaluation, it was possible to rearrange some of the
features, and to make the application ready to be implemented in GURH.

System usability test questionnaire has been prepared to understand the most usability measurement
criteria. For this purpose, we've got taken a time to be used for implementation of the system, testing
of it, and evaluation of it by the emergency department members. Moreover, we've got distributed the
system usability test questionnaire to collect the users’ evaluation of the system. Through the
questionnaire we've got tried to collect some important data that may best evaluate the usability of the
system by the target users. These Includes: -

➢ The usefulness
➢ The ease of use and
➢ Satisfaction

34
 Problem Identification

Define objectives of a solution

Design and Development

Evaluation and Study Validity Method

Figure 3-1 The design science research methodology process

35
 Chapter Four

4. Data Analysis and Finding

Introduction

This chapter presents the findings followed by discussion. The results section report findings of the
study based on the methodology applied to gather information.

Participants Demographic Characteristics

This section introduces the study respondent’s characteristics include their gender, job title,
qualification, and work experience. This statistical analysis was done using the available data in the
study questionnaire.

Participants Gender

Table 4-1 representation of Participant’s gender

Gender Frequency Percent (%)

Male 24 72.7

Female 9 27.3

Total 33 100.0

Table 4-1 shows that (72.7%) of the participants are male, while (27.3%) of them are female. As can
be seen from this result that the proportion of males is greater than that of females.

Participants Qualification

Table 4-2 participants level of qualification

Level of Qualification Frequency Percent (%)

36
 Diploma 13 39.4

Degree 11 33.3

Master’s 5 15.1

PhD 4 12.1

Total 33 100.0

Table 4-2 shows that (39.4%) of the participants hold a diploma, (33.3%) of the participants are having
the bachelor degree, (15.1%) of them having the master’s degree and the remaining (12.1%) of them
are interns.

Participants Job Title

Table 4-3 Participants job title representation

Job Title Frequency Percent (%)

Interns 4 12.1

Nurse 10 30.3

Operators 6 18.2

Paramedics 3 9.1

Management staffs 7 21.2

Emergency Medical Technicians 3 9.1

Total 33 100.0

Table 4-3 illustrates that (12.1%) of the participants are interns, (30.3%) of them are nurses, (18.2%)
of them are operators, (9.1%) of them are paramedics, (21.2%) of them are Management staffs, while
(9.1%) of them are Emergency Medical Technicians. This represents the diversity of participants and
their relationship with the emergency department.

37
 Participants Work Experience

Table 4-4 Participants work experience

Work Experience Frequency Percent (%)

1-5 years 4 12.1

5-10 years 12 36.4

10-15 years 11 33.3

Above 15 years 6 18.2

Total 33 100.0

Table 4-4 shows that (12.1%) of the participants have experience less than five years, and (36.4%) of
them have experience between five and ten years, (33.3%) of them have experience between ten and
fifteen years, while (18.2%) of them have experience more than fifteen years. This clarifies that half
of the respondents have experience less than (10). This means that the respondents have a good
experience in their working field.

Data Analysis

SPSS was used to analyze data obtained through questionnaire. The “Agree”, “Natural”, “Disagree”,
options were used to identify the level of the independent variable practiced by the emergency
department and encoding the questionnaire. The three options are used to indicate the level of the
current emergency management service.

Questionnaire Result Analysis

The Current Practice of Emergency medical Service

We conducted a survey to investigate the current practice of emergency medical service at GURH.
We have carried out the data collection using the methods of questionnaire. Using the questionnaire,

38
we have tried to investigate the current system in emergency department, availability and adequateness
of ICT, CID and GPS enabled device.

Table 4-5 Current Ambulance Service

Current Ambulance Service

No Questions Agree Neutral Disagree Total

1 Is ICT, CAD and GPS enabled device N 5 6 22 33

involved in the ambulance service?
% 15.2 18.2 66.7

2 Is details about the emergency patient N 4 9 20 33

recorded from the conversation?
% 12.1 27.3 60.6

3 Is it possible to track the emergency patient’s N 6 8 19 33

location according to the telephone line used
18.2 24.3 57.6
%
to call the emergency line?

4 Are you satisfied with the current ambulance N 10 6 17 33

system?
% 30.3 18.2 51.5

5 Were emergency patient told, how long they N 7 9 16 32

would have to wait for someone from the
21.8 28.1 50
%
ambulance service to arrive?

6 Did you have trust and confidence in the N 11 8 14 33

current EMS?
% 33.3 24.2 42.4

Average percentage 21.8% 23.4% 54.8% 100%

Table 4-5 shows the participants opinions towards the items of the first section which is current
ambulance service.

39
As shown in the above table 54.8% of the respondents indicate clearly there is no ICT, CAD and GPS
enabled device involved in the current ambulance service, it difficult to track the emergency patient’s
location and they do not have trust and confidence in the current EMS. On the other hand, 18.2% of
the participants partially agree on the availability of ICT, CAD and GPS enabled device involved in
the current ambulance service.

Table 4-6 Response Time

Response Time

No Questions Agree Neutral Disagree Total

1 Has there been a delay in the arrival of N 12 13 8 33

ambulance?
% 36.4 39.4 24.2

2 Did the delay worsen the condition of the N 22 6 5 33

emergency patient?
% 66.7 18.2 15.2

3 Did the ambulance control room operator pass N 13 12 8 33

a call on to a telephone advisor to assess
39.4 36.4 24.2
%
emergency patient situation?

Average percentage 47.5% 31.3% 21.2% 100%

Table 4-6 shows the respondents’ opinions of the second section which is response time. Regarding
the response time 47.5% of the respondents agree that there has been a delay in the arrival of
ambulance and that will worsen the condition of the emergency patient. However, as shown in table
31.3% of the participants partially agree and 21.2% of the participants disagreed.

40
Table 4-7Emergency Patient Communication Assessment

Emergency Patient Communication Assessment

No Questions Agree Neutral Disagree Total

1 Did emergency patient explain their situation in N 9 13 11 33

a way you could understand?
% 27.3 39.4 33.3

2 Is emergency patient give an exact location N 13 6 14 33

information to be able to track and reach on
39.4 18.2 42.4
%
time.

3 Is emergency patient provide correct N 14 8 11 33

information about the situation?
% 42.4 24.2 33.3

4 Do you feel the ambulance service staff listened N 5 13 15 33

carefully to what emergency patients had to
% 15.2 39.4 45.5
say?

5 Did you feel emergency patient were given N 11 11 11 33

enough advice on the telephone about what to
33.3 33.3 33.3
%
do?

Average percentage 31.5% 30.9% 37.6% 100%

Table 4-7 shows the participants opinions of the third section which is emergency patient
communication Assessment. Regarding the emergency patient Communication 37.6% of the
respondents agree that emergency patient did not explain their situation and can’t give an exact
location information to be able to track and reach on time and also the ambulance service staffs can’t
listen carefully to what emergency patients had to say in emergency situation. However, 30.9% of the
participants partially agree and 31.5% of the participants disagreed. However, there is equal number
of “Agree”, “Neutral” and “Disagree” participants for question five “Did you feel emergency patient
were given enough advice on the telephone about what to do?” in Table 4-7.
41
 Table 4-8 Android-based emergency medical service

Usage of Android-based emergency medical service

No Questions Agree Neutral Disagree Total

1 Would you like an EMS application that N 13 13 7 33

would enable emergency patients to contact
39.4 39.4 21.2
the ambulance driver directly with a one-push %
button?

2 Do you think such application will be able to N 13 12 8 33

save lives and time?
% 39.4 36.4 24.2

Average percentage 39.4% 37.9% 22.7% 100%

In this study, we have tried to investigate the availability of such systems as well as we have assessed
the need to establish and enhancing emergency medical service, for this purpose the emergency
department workers were asked about if they would you like an android-based emergency medical
application that would enable emergency patients to contact the ambulance driver directly with a one-
push button and if they think such application will be able to save lives and time. So, 39.4%
respondents of them reported that such application will be able to save lives and time and they would
like an EMS application that would enable emergency patients to contact the ambulance driver directly
with a one-push button.
Summary Description

According to the data collection and analysis in order to identify and specify the requirements of
GURH with regard to emergency management service. Using the questionnaire, we have collected
data about the current practice of emergency management service the ICT usage, CID, GPS, and the
usage of android-based emergency medical to support the current medical emergency service
activities.
GURH Emergency department (ED) is responsible for answering emergency calls, determining the
nature of the emergency and identify the location of the emergency, and provide the equipment and

42
facilities for the timely delivery of health and safety services to victims of sudden illness or injury.
The current medical emergency service doesn’t use any GPS enabled devise that can capture the geo-
reference data of the victim’s location.

Current medical emergency management system is been managed by native way which is engaged by
calling. All of the current ambulance systems rely on calls from the emergency patients who gives
information about any kinds of his/her emergency. operators use traditional based or not computer
aided dispatching to send rescue team or an ambulance. These kinds of service lead to record wrong
information from the caller, or might enter wrong data and transfer into the dispatch system.

Emergency patients’ needs to call the Emergency department (ED) to check for the availability of
ambulance in their area and make a request to deploy one to designated location which reported by
the emergency patients’. All the required information such as emergency patients’ name, location and
his /her emergency type will be collected through conversation. Now a days Computer Aided
Dispatching (CAD) system and (GIS) are the main tools used by developed countries. This kind of
technology are mainly used to track caller by his/her address, availability of resource and status, record
caller information and captures incident related information, visualizes location tracks ambulance &
resources through GPS.

Therefore, to solve these problems the establishment of Android-based emergency medical service
that would enable emergency patients to contact the ambulance driver directly with a one-push button
and that identify the nearby ambulance locations in real-time using Google map API’s to save valuable
humans life by creating an interface to Google Map and obtain data is very important to support
emergency technicians’ activities of GURH. The need for such application by the emergency
department members is high because such application will be able to save lives and it can facilitate
medical resource and minimize response time.

GURH emergency department members show high need and willingness to use the android-based
emergency medical service application and participate in such systems because it can be used to
support the traditional or native way of emergency service which is engaged by calling approach.

43
 Chapter Five

5. System Design Elements and Implementation

Overview

This Chapter discusses the functional and non-functional requirements of Android based Emergency
medical Service and the system models such as use case model, sequence diagram and class diagram.

Proposed System

To enhance EMS and minimize response time, an android app named Android-based Emergency
Medical Service (ABEMS) will be utilized by the emergency patient and ambulance driver to send
coordinate and user details which will be installed to all the ambulance drivers and emergency patient
android phones, google map hence able them to locate and reach the user in time. It is essentially an
emergency management or ambulance dispatching app that allow emergency patient to get ambulance
service when an emergency occur, so the proposed system ABEMS is, if you are an emergency patient
or someone you just walking by open up the app and stay where you are, an ambulance driver nearby
can come and say they want to pick you up and taking you to the hospital.

So, we build our version of that and we have an app someone request an ambulance, from the
ambulance driver side they can see somebody is looking for an ambulance, ambulance driver want to
go pick up that person so we make emergency management app or people can request emergency
medical services and other people or emergency medical technician can provide those services, so we
are going be using google map API and firebase as a backend in to this. the app allows ambulance
drivers to go pick emergency patient up they can just tap a button and app will map direction just pop,
the base idea what ABEMS is that you have the ABEMS app you open it up and through the built in
GPS you can tell where you are if you hit a call ambulance button this is we want an ambulance that
then there is people who are ambulance drivers who have the ABEMS app on their phone and they
will see this message, the same someone nearby you wants an ambulance and they get the chance to
ether accept a request or no to that. so, then ambulance driver accepts to a request then the person

44
looking for ambulance get a notification, you know an ambulance driver on your way and the
ambulance driver will come to them, they will meet up and they can make him drive to the hospital.

The proposed system would make EMS much easier, if you often found yourself on the phone trying
to describe where you are to EMS call takers, so you could meet up, and it occurred to you that if you
could see where ambulance driver was, and they could see where you were on a google map.

Requirements of ABEMS

This section contains identify system requirements and design elements of ABEMS to enhance
Emergency medical service and minimize response time which can be used by the ambulance drivers
and members of the community. The aim of system requirement analysis is to describe the
functionality of the ABEMS and providing architectural views of the various system designs. In this
section we will first identify the principal actors of the system, and then explain the functional and
non-functional requirements of the new system, and finally the functional model of the system.

Actors

The main actors of ABEMS are identified and listed below:

a. Emergency patient
b. Ambulance driver

User requirements

It is crucial to know the user requirements and the intended uses of the system when planning to
develop a system. Other requirements such as software requirements, hardware requirements, and non-
functional requirements rely on user requirements because what the user needs to determine software,
hardware, and non-functional needs.

Hardware and Software requirements

Hardware Requirements

For the development of this project, the following hardware requirements have been considered.

• Processor: Intel(R) Core (TM)2 Duo CPU or newer

45
 • 4 GB RAM minimum, 8 GB RAM recommended; plus 1 GB for the Android Emulator
• 5 GB of available disk space minimum,10 GB Recommended (500 MB for
AndroidStudioProjects, 500 MB for. gradle file, 500 MB for IDE + 5 GB for Android SDK
and emulator system image)
• 1280 x 800 minimum screen resolution

Software Requirements

For the development of ABEMS, the following software requirements have been considered.

• Operating System: Microsoft® Windows® 7/8/10 (64-bit)

• Technologies: Java, Android, XML
• Framework: Android SDK Version 3.0
• Google Maps API
• Blue Stacks
Platform and Tools
• Debugger: Android DDMS (Dalvik Debug Monitor Service), Android mobile device
• Network: Mobile network and Internet (cellular 2G, 3G, 4G or Wi-Fi)
• Database: Firebase Real-time database

Functional Requirements

The Android-based EMS supports the following users: The Emergency patient and the Ambulance
driver. The ambulance driver tasks consist of logging into the ABEMS ambulance driver’s app, reject
or accept emergency requests and patients’ detail, and logging out of the system. The Emergency
patient tasks is logging into the ABEMS app to send a request to the ambulance drivers using the
Intranet connection and logging out of the system. This setup leads to the following functional
requirements:

Emergency patient should be able to:

• Sign up or Register before they are allowed to use the App

• log in to the ABEMS Emergency patients App by entering his/her email and password. After
logging in, the Emergency patient shall be taken to the Emergency patients map screen. If users
46
 provide the wrong email or password, the app will prompt out an error message telling the user
to re-enter their email and password again.
• View available ambulance on the map with real-time location updates.
• Send and cancel emergency request
• Receive ambulance driver information
• Edit or modify his/her owns profile information such as name phone, blood group, etc.
• Track the movement of the ambulance in real-time
• Allows user to change email, password or retrieve forgotten password and Log out.

Ambulance driver should be able to:

• Sign up or Register before they are allowed to use the App

• log in to the ABEMS Ambulance driver App by entering his/her email and password in order
to use the app. After logging in, the Ambulance driver shall be taken to the map screen. If
wrong email or password provided, the app will prompt out an error message telling the user
to re-enter their email and password again.
• Turn on and off available ambulance status
• Accept or decline emergency request
• Receive Emergency patient information
• Edit or Modify his/her owns profile information such as name phone, photo, etc.
• Track the movement of the patient in real-time
• Log out

Non-Functional Requirements

In addition to the functional requirements Nonfunctional requirements of the system include the
different requirements that the system should fulfill that have been stated. These requirements and
design elements include the following activity.

Usability

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 • The application should be easy to work with, to operate and learn; using the app does not need
special skills or training
• user does not require training or special skills to use the app.
• Simple design: The user interface should be kept as simple as possible so as not to make the
application too confusing for the user to understand.
• User awareness: For quick help some kind of tip or Note text will be provided.

Performance

• The application should be able to support or handle concurrent requests and should also
respond requests with Short response

Security

• The system should be secure, As the system has different types of users and as the system will
be dealing with user’s current location data (Latitude and longitude), the data should be stored
in a highly secure manner so that there are some levels of authorization, and the authorization
mechanism will block unwanted attempts to access the service and the application will work
with for authenticated users only.

Implementation

• Java and xml should be used for the development of the app
• Firebase app server should be used to deploy the application.
• Firebase real rime database should be used as the database.

Maintainability:

• The requirements and modules explained in this document are enough to satisfy the users needs
and wants. In case of a change or additional demand after completion of the system, the system
should accept the changes without affecting its previous functionality. Since the system is
developed using modular object-oriented tools, the maintainability shall be easily done by
integrating new modules and offering new software functions for the system.

Portability

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 • The system is a web app that provides online service to make the EMS available for the whole
college community used to share and communicate digital resources.

Assumptions and Dependencies

During the course off this study, one needs to consider certain assumptions before understanding
ABEMS.: The android smartphone that implements ABEMS is based on the following assumptions:

• The emergency patient must have an android-based smartphone with ABEMS application
installed on it this study focuses on android application only for ABEMS.
• Both the ambulance driver and the emergency patient must have internet connection along with
in built GPS activate. This is an important assumption, since this would help send the
ambulance driver location to the emergency patients or the emergency patients’ location to the
ambulance driver, so the ambulance driver can view the emergency patient location on map.
• It is also assumed that the emergency patient is not unconscious due to medical emergency and
is in a state that he/she can press the ABEMS application’s call emergency button.
• If the patient is unconscious, an eye witness can press the ABEMS call emergency button to
send a request.

General Constraints

• A network and intranet infrastructure are needed for the full operation of the ABEMS.
• The firebase application server and the ABEMS system shall be available for most of the time
except for some maintenance and configuration tasks are identified.
• Safety, authentication and security considerations: valid user email and password are the main
mechanisms for security authentication issues.

System Model

The functionality of the system is analyzed using Unified Modeling Language (UML) and System
models consist of use case diagram, sequence diagram and class diagram.

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 Use Case Model

Have you ever had an idea that makes perfect sense in your mind, but when you try to explain in to
someone else, they’re completely lost? May be your idea is for a developing a new app, and people
don’t really understand every time you talk about it how they are interacting with the app or what it
would do. A use case diagram is very helpful in this type of scenario. Here is the simple description
of a use case diagram. A use case diagram shows a system or application First; then it shows the
people, other systems that interact with it or organizations; and finally, it shows the flow of what the
app dose. A use case diagram won’t show a lot of detail, but it’s a way to communicate complex ideas
in basic way. In general use cases provide a means to communicate with the end users, capture system
requirements, best to identify the actors and defining how the actors will be able to interact with the
system. The use case diagram shown below illustrates how the emergency patient interacts with the
system by managing accounts, notify nearest ambulance driver, receive driver detail information and
real time tracking of ambulance driver. Similarly, the ambulance driver interacts with the system by
accepting emergency request, receive patients detail information and real time tracking of emergency
patients as shown in the following diagram.

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Figure 5-1: ABEMS use case diagram

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 Use Case Descriptions

The description of identified use cases of the system is provided in this section as follow:

Table 5-1: Use case description

Use Case Name Login

Actors All system users

Description Enables users to get the permission to access the system.

Precondition The user needs to have internet access.

Must be a registered user.

Flow of Events: 1. User opens the system

2. The use case begins when the actor wishes to log into the ABEMS
system by types email and password on the login form and presses
the “Login” button.
3. System verifies the user email and password.
4. System validate the user email and password.
5. System allows the actor to get access.

Alternative Flows: 3a Missing or invalid email and/or password

1. The system displays “sign in error” message.

2. The system prompts for valid email and password.

Use case resume at flow of event step 2.

Post-condition If the use case was successful, User is logged into the system. If the use
case was not successful the system state is unchanged.

Use Case Name Logout

Participating Actors All system users

Description Any user who accessed the system wishes to leave the system.

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Precondition User is logged in

Flow of Events 1. User presses the “Logout” tab.

2. System displays the Login page of the system

Post-condition User is logged out.

Use Case Name Registration

Actors All system users

Description Users who wish to use the system and Ambulance Drivers who wishes to
offer emergency service on the spot must register first.

Precondition The user must have android smartphone, telephone number, internet
access and email address.

Flow of Events 1. User opens the system

2. The use case begins when the actor types email and password on
the registration form and presses the “Register” button.
3. System verifies the user email and password.
4. System allows the actor to get access.

Alternative Flows: 3a Missing or invalid email and/or password

1. The system displays “sign up error” message.

2. The system prompts for valid email and password.
3. Use case resume at flow of event step 2.

3b if user enters short password.

1. The system displays “Password too short, enter minimum 6

character!” message.
2. The system prompts for valid email and password.

Use case resume at flow of event step 2.

Post-condition Login page is displayed

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Use Case Name Manage User Account

Actors All system users

Description Users who wish to use the system must register first.

Precondition The user must have android smartphone, telephone number, internet
access and email address.

Flow of Events 1. System provides account management facilities.

2. User selects on “Manage Your Account” tab
3. System displays “Manage Account page”.
4. System displays list of emergency type.
5. System displays all available Account Management options.
6. Users create, update, send password reset email and remove user
accounts.
7. System sends password reset and confirmation messages.
8. Systems saves and updates the database.

Alternative Flows: 5a Invalid email and/or password

The System displays error message if incorrect email and password

entered.

Post-condition Users profile and account has been either created or updated.

Use Case Name Send request

Actors Emergency Patient

Description Allow emergency patient to send emergency request to the nearest

Ambulance Drivers.

Precondition To send emergency request Emergency patient has to logged in with

android smartphone, turn inbuilt GPS location on and must have internet
access.

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Flow of Events 1. User selects a particular emergency type then presses the “Call
Ambulance” button to send request or notify nearest ambulance
driver.
2. System allows the user to get the current location.
3. Users get updated location periodically.
4. System allows the user to see available ambulance.

Alternative Flows: 1a if the request is not accepted

1. System display “Getting your ambulance driver location”

Message.
2. Use case resume at flow of event step 1.

1b if the request is accepted

1. System display assigned ambulance drivers location “Locking for

ambulance driver location…” Message.
2. System display “Ambulance Found: meter” message.
3. System display “Ambulance is here” message.

Use case resume at flow of event step 1.

Post-condition Emergency request will be sent to the nearest ambulance driver.

Use Case Name Accept request

Actors Ambulance Drivers

Description Enables the Ambulance Drivers to use the system to offer emergency
service on the spot.

Precondition Ambulance Drivers has to logged in and must have android smartphone
with internet access and GPS location turned on to accept emergency
request.

Flow of Events 1. Ambulance Drivers selects a particular emergency type to accept

emergency request.

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 2. Ambulance Drivers press “Ambulance available”
3. Ambulance Drivers Presses the “Accept Emergency Request”
button to accept emergency notification.
4. System displays the user current location and the emergency
patient location in the google map.

Post-condition Emergency Request has been Accepted.

Use Case Name View emergency patient information

Actors Ambulance Driver

Description Enables the Ambulance Drivers to see emergency patient user detail.

Precondition The emergency patient is logged in and needs to fill the profile form
whenever there is an emergency service.

Flow of Events 1. The emergency patient selects on “Setting” to enter his profile.
2. The system displays the form to be filled.
3. The emergency patient fills the form.
4. The emergency patient submits personal detail to the system.

Post-condition Emergency patient information can be displayed on ambulance driver map

activity.

Use Case Name View Ambulance Drivers information

Actors Emergency patient

Description Enables the emergency patient to see Ambulance Drivers user detail.

Precondition The Ambulance Drivers is logged in and needs to fill the profile form.

Flow of Events 1. The Ambulance Drivers selects on “Setting” to enter his profile.
2. The system displays the form to be filled.
3. The Ambulance Drivers fills the form.
4. The Ambulance submits personal detail to the system.

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Post-condition Ambulance Drivers information can be displayed on emergency patient
map activity.

Use Case Name Real-time tracking emergency patient

Actors Ambulance Drivers

Description The Ambulance Drivers needs to track the patient in real-time.

Precondition Emergency patient has to logged in and must have android smartphone
with internet access and GPS location turned on.

Flow of Events 1. System allows the user to get the current location.
2. Ambulance Drivers get emergency patient updated location
periodically.

Post-condition View emergency patient location

Use Case Name Real-time tracking Ambulance Drivers

Actors Emergency patient

Description The emergency patient needs to track the ambulance in real-time.

Precondition Ambulance Drivers has to logged in and must have android smartphone
with internet access and GPS location turned.

Flow of Events 1. System allows the user to get the current location.
2. Emergency patient get ambulance drivers updated location
periodically.

Post-condition View ambulance driver’s location.

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 Sequence diagram

Sequence diagrams depict the dynamic behavior of the system and interaction between the systems.
They can be used to capture the interaction between participating objects in a given use case, and they
are also helpful to identify the missing objects that are not identified in the analysis object model.

Figure 5-2:User login Sequence diagram

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Figure 5-3: User Registration Sequence diagram

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Figure 3.4 Manage User account Sequence diagram

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Figure 5-4: Send/Accept emergency request Sequence diagram

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 Class Diagram

Class diagrams are used to describe the structure of a system in terms of classes, attributes, operations
and association of objects in the class. The class diagram of Android-based EMS of GURH is
presented on Figure 5-5 below.

Figure 5-5: ABEMS class diagram

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 Design Elements

This section presents the descriptions of the activities carried out during the design phase for the
Android-based medical Emergency Service system. First, it describes the primary design goals set for
the project. Next, it describes the general system architecture and then it describes the system in terms
of subsystem decomposition and hardware/ software mapping.

Design Goals

The Design goals of the system are derived from the non-functional requirements of the system and
represent desired qualities of the system and provide a consistent set of criteria that must be considered
when making design decisions. The non-functional requirements identified in Chapter 3, are
transformed into design goals. The following are the key goals needs to be satisfied.

• Security: - The system should prevent data from unauthorized access.

• Performance: - The system should be able to serve multiple users.
• Portability: - The system should be accessible from different android smartphones.
• User Interface: - The UI should be easy to work with and no special training will be required.
• Response time: - The system should be able to short response times.

The Proposed System Architecture

As shown in Figure 5-6, Emergency patents will send the request from their smartphone to the firebase
app server then will be sent to the ambulance drivers smartphone. The sent data is consisting of GPS
location information (latitude and longitude) and user’s details such as patents name, phone number,
photo, age and blood type. The ambulance drivers will also send his/her location information and
details to the emergency patents so that the patients will know which driver will fetch them and they
know the nearest ambulance drivers will take the responsibility to bring them to the hospital as soon
as possible. The ABEMS starts when the ambulance driver receives an emergency request, following
determination of the urgency of the incident, an ambulance is dispatched. The ambulance will arrive
as soon as possible at the emergency scene to provide first aid and to transport the patient to the
hospital. Once the patient is transport to the hospital, the ABEMS process finishes. For the proposed
system, Android will be used for the development.

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Figure 5-6: Proposed System Architecture
The proposed system will be functioning as below:

• Sends emergency request to ambulance drivers’ android phone: The emergency patient can tap
call ambulance button and the notification will be sent to the ambulance driver.
• Cuts off waiting time: The emergency patients don’t have to call and check for availability of
the ambulance anymore.
• Ambulance driver will be able to track the current location of the emergency patient with built
in GPS: the request that sent by the emergency patient will provide the GPS location of the
emergency patient and also provides the pre-registered detail such as name of the patient, photo,
phone number, gender, age and blood group.
• The emergency patient also will be able to track the current location of the Ambulance driver
with built in GPS.
• Safe and reliable: Provides the patient all the information about the ambulance driver that
accepted the request such as photo, name and phone number.

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 System Decomposition

In order to simplify the solution domain and minimize its complexity, the system has been divided
into different subsystems. these are User management subsystem, Location management subsystem,
Emergency management subsystem, Authentication subsystem and Profile management subsystem.
The following figure depicts the subsystem decomposition.

Figure 5-7: Subsystem decomposition of the system

Hardware/software Mapping

This section shows the relationship among the nodes and the independent components in the system
and will have three processes, specifically, the mobile application process, App server process and the
database process. The database process, which runs on firebase NoSQL Server database engine, is
responsible for maintaining data manipulation operations and storing the user information as well as
user’s current location information. Whereas, the app server is responsible to process and manage the
user’s data and the location information that are retrieved from the mobile device. It is also responsible
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to process, analyze and find match between those data and deliver the notification to the mobile device.
In case of the user side, the mobile application of the system resides there. It requests service from the
app server and accept the processed responses.

Figure 5-8: Deployment Diagram

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 Chapter Six

6. Implementation and Evaluation

Overview

In this Chapter, different tools and development environments used to develop the prototype of the
system will present. Furthermore, ABEMS app screen shots will be presented to demonstrate the UI
and the outputs of the system.

Development Environment

To achieve the objective of the project, several tools and technologies were used. the prototype was
developed and tested on Android smartphone. A Dell OptiPlex 780 computer with Intel Core (TM)2
Duo CPU of 3.00GHz speed, 8 GB RAM and 500 GB HDD and a Microsoft Windows 10 Pro
operating system was used as a development machine. The project was developed on Android version
4.0 using Android studio 3.0 as a development platform and Android SDK has been integrated to work
with. To be able to run the app, users will need to give Internet and GPS permissions on their Android
smartphone. The tools used to develop the system are presented in the next section.

Tools Used

A. Smartphones

When compared to a regular mobile phone, Smartphones considerably have a lot of functionality.
Smartphones are mobile computers, powerful and versatile as a result of built-in sensors, powerful
processors, network interfaces and a high amount of memory for such small devices.

B. Android

Android is the most popular and a Linux kernel based open-source mobile operating system which
was developed by Google for phones, tablets and other electronic devices. Everyone has access to the
Android source code because Android is open-source with some kind of restriction such as it cannot
be used for any financial gain or any personal profit. Open-Source Operating systems alternatives to

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Android include iOS by Apple, Windows Phone, BlackBerry, Symbian Plasma Mobile, Ubuntu
Touch, Tizen, Mobian OS, Graphene OS and a few others. We chose Android just because Android
have the largest population of the user and it is the operating system that have the most programming
experience with. The market dominance and cheap release costs of applications were also determining
factors.

C. Android Studio

Android Studio provides a unified environment where you can build apps and it is the primary or the
official Android IDE for Google's Android OS. It provides all the necessary tools to develop an
Android application for android phones, tablets, android wear (watches), android TV, Android Auto
(car) and other electronic devices to an android developer. Structured code modules allow you to
divide your project into units of functionality that you can independently build, test, and debug. More
specifically Android Studio enables auto-completion tool to write code, to debugging, running or
testing your Android applications on physical or virtual Android device and setting programming
related or visual preferences. So, before debugging, running or testing your code, you have to create
an Android virtual device by Launching Android AVD Manager or test your app on a physical device
before releasing it to users by opening the setting app on the device, select Developer options, and
then enable USB debugging. The only languages needed to build Android applications using Android
Studio are Java and XML. Android Studio does not have any alternatives worth considering. With
Eclipse, it is possible to build Android apps by using the Android Developer Tools plugin, but Google
no longer supports it.

D. Google Play Service

Google Play services gives you a comprehensive set of useful features, such as Google sign-in, cast
and Maps. The services include the Google Play services client library makes it possible to access any
feature with a user’s account and deals with different issues that may occur when using the services
and the Google Play services Android Package Kit communicates with the client library and provides
access to a specific service when necessary. when using Firebase Google Play services is must be
used. Important functionalities in Android-based Emergency medical service system, for example,
viewing on a map and obtaining a user’s location also rely on the services. In general Google Play

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services provides you the freedom to use the newest APIs for popular Google services without having
to think about device support.

As Google Play services is system app you should not uninstall. It's a package of APIs (things that
assist programmers and allow apps to easily communicate with other apps) that ensure fewer apps are
dependent upon Android OS updates to run. Google Play Services cannot be uninstalled
directly because it is inbuilt app.

E. Android Google Map API

The Android Google Maps API is a service which is part of the Google Play services library. To add
maps and to access the Google Maps servers automatically through the Maps API we have to add
Android Google Maps API credential key to android Smartphone application. We are going to start
working on our maps because the main activity is going to a map in which the user the emergency
patient can call ambulance and see the location where the ambulance is and his current location and
for the ambulance driver the map will serve as a way to see where the emergency patient location will
be and his current location. So, to do this we first need to use the Google API because the google map
is an API and we are going to use it. we must register our application first with the google service,
then what we are going to do is, go to google cloud platform console and enable the google map API,
once enabled you can generate an API key and use that API key and you get probably an empty one
because we already have some app registered with but you can create your project and a page similar
to will open.

Figure 6-1: Google Cloud Platform window screen shoot

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you can go ahead APIs manager dashboard to enable APIs and you have a bunch of APIs that google
offers but what we are going to use is the google map android API, create credentials and then your
API key will appear. The API key will tell google that your app is being used. The Google
Maps Platform offers a free $200 monthly credit for Maps and can work with other application that
calls the Maps API, and it supports several users. Map API also allows to add markers, polygons, and
basic map overlays, and to transition the user's context of a specific map area.

F. Google Direction API

The Google Directions API is a service that enables to search for directions in several modes of
transportation driving, cycling and walking. Directions API using an HTTP request to calculate
distance between locations and to access driving, cycling, walking and public transportation routing.

G. Backend as a Service

BaaS is a platform that automat backend side development takes care of clouds infrastructure, this
allows you to manage and scale cloud infrastructure automatically, sped up the backend development.
If you use a backend as a service you can focus on the front-end development. It provides really to use
a number of server-side capability features like authentication, cloud storage, database management
and push notifications. Most mobile apps need backend service for things that can’t be done solely on
device, like sharing and processing data from multiple users or storing large files. We have shown a
lot of backend services but the different about building BaaS for mobile app is similar to building a
web service, but there are some additional requirement’s, first it is important to limit on devices data
storage, storage on mobile devises is limited. Users need to be able to use their storage spaces the way
that they want to. BaaS is a model for providing mobile app developers with the way to link their
application to the backend cloud storage it is also provide features such as user management, push
notification, integration with social networking services and many more. These services are providing
through the use of custom SDKs and APIs, there are many solutions are available and the most popular
one is listed as follow: -

✓ Firebase
✓ AWS Amplify
✓ Microsoft Azure
✓ IBM mobile first

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 H. Firebase

Firebase is a fully managed platform for building iOS, Android and web applications. It provides
automatic data synchronization, authenticating service, messaging, file storage and more. So, starting
with firebase seems to be an efficient way to build a prototype. With firebase you can develop your
app quickly because firebase client SDK simplify getting backend service up and running. But firebase
products are designed to scale, so you can use them seamlessly from prototype to production to top
apps. Firebase is a great solution especially for mobile applications, firebase address a lot of the unique
needs of mobile apps, its great at limiting on-device space usage when you manage key value data in
cloud fire store and file in cloud storage for firebase. It makes sending notifications and data messages
a snap with firebase cloud messaging (FCM), it offers automated real-time data synchronization across
multiple devices and offers authentication of users through a verity of identity providers such as
facebook, google, tweeter and more.

I. GeoFences

GeoFences are virtual fences or perimeters around the physical locations. GeoFences detect when
someone comes in or leaves the given region, when this happens, it is possible to trigger events and
actions, such as sending a notification to the users mobile app. We use GeoFences to notice emergency
patient when ambulance driver arrives to the area.

J. GeoFire

GeoFire allows us to save our current location to the database, this will be really important primarily
to the ambulance driver. so, whenever the ambulance driver changes the location or the location is
updated you will be saving the latitude and longitude of the ambulance drivers to the database, to do
that we use a geolocation library which is called GeoFire and you can find it online. We use GeoFire
Android/Java because it allows us to make real-time location queries with firebase. This will greatly
help us in making things really easy for us, when emergency patients are trying to find which
ambulance is closest to them. In general, GeoFire Android/Java simply to store and retrieve locations
(Latitude and longitude) with string keys and display it on map.

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 Prototype

In this section, we will look into the details of the implementation of the ABEMS prototype of GURH.
The designed ABEMS system consists of:

• Emergency patient: An android application for emergency patient that runs on an android
mobile phone.
• Ambulance Driver: An android application for emergency responders that runs on an android
mobile phone.
• Firebase: as Server Back end, Real time Database, Cloud Storage and Auth.

Emergency Patient Part

Emergency patient ABEMS is developed in java using Android Studio. This app is developed for
android operating system having a minimum API level 21, and target API level 28. The application is
implemented on the Android smartphone, the main activity page is the starting page of the emergency
patient ABEMS app with I’M EMEREGENCY PATIENT button.

Login and Registration

When the emergency patient opens the ABEMS app, a window to login and registration is displayed
so that ones the emergency patient registered enters email and password to access the application. If
the email and password entered is valid, the emergency patient gets map window of the application as
shown Figure 6-2below.

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Figure 6-2: Login and Registration
Figure 6-2 shows log in and registration screen of ABEMS, users can use email and password that
they used to register, to log in to the system. After users successfully logs in to the system, they can
use all system features.

Emergency patient map view

Whenever an emergency occurs, the emergency patient selects their emergency type and presses the
call ambulance button. When call ambulance button is pressed request to nearest ambulance driver
will be sent, then a map window containing his current location marker, the list of available
ambulances and the assigned ambulance driver profile is displayed as shown in the Figure 6-3.

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Figure 6-3: Map view of the application

Figure 6-4: Map view of the application

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Figure 6-4 shows call ambulance feature of ABEMS, users can select the type of emergency service
they want and press “CALL AMBULANCE” button to send an emergency request to nearest
ambulance driver and the user can also abort sending request by pressing the same button to call
ambulance.

Figure 6-5: Emergency patient Map view of the application

Figure 6-5 shows, an emergency request sent by emergency patient is accepted by ambulance driver,
and ABEMS display details about that ambulance driver to the emergency patient.

Manage Profile

Before sending emergency request to ambulance driver, emergency patients are expected to manage
their profile that help first aiders or EMTs to simplify emergency reporting.

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Figure 6-6: Manage Profile
Figure 6-6 shows manage profile screen, users have to provide details such as name, phone blood
group and photo in order to send their user detail to the assigned ambulance driver. After entering all
the user information users has to press confirm button that will be saved at Firebase database

Manage Account

In case the emergency patient forgot his password, forgot password activity is devoted to reset the
password. The emergency patient has to insert his email address, and click the “RESET PASSWORD”
button then firebase sends an email with a link to reset the password to registered email address. And
it is possible to manage their account such as remove their account, change email and password and
totally remove his user account.

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Figure 6-7: Manage account screenshot
Ambulance Driver Part

Ambulance driver ABEMS is developed in Java programming language using Android Studio. This
app is developed for android operating system having a minimum API level 21, and target API level
28. The application is implemented on the Android smartphone and the main activity page is the
starting page of the ambulance driver ABEMS app with I’M AMBULANCE DRIVER button.

Ambulance driver Login and Registration

When the Ambulance driver opens the ABEMS app and press I’M AMBULANCE DRIVER button,
a window to login and registration is displayed, so that ones the ambulance driver registered, he must
enter his email and password to access the application. If the email and password entered is valid, the
ambulance driver gets map window of the application as shown in Figure 6-10 below. if not, error
massage will be displayed as shown in Figure 6-9 .

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Figure 6-8: Ambulance driver Login and Registration
Figure 6-8 shows log in and registration screen of ABEMS, to log in to the system users can use email
and password that they used to register. After successfully logs in to the system, they can use all system
features.

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 Figure 6-9: Error Handling

Users can access the app using their email and password. Login and registration activity manage
different errors the user could make during the registration and the login phase. If the user enters short
password less than six characters, miss the email and password field and enters bad formatted email
which means there is no user with that email, usually due to a user error, the registration or login fails
and an error message is shown as a toast at bottom of the page after the registration or Login button is
pressed.

Ambulance driver map view of the application

When the Ambulance driver successfully login to the system, a map window is displayed, and before
turning the ambulance availability status on, ambulance drivers must select the type of emergency they
provide and update their user information by pressing the setting button as shown in Figure 6-10.

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Figure 6-10 Ambulance availability status
To make the app a bit better and user friendly, from the moment a driver logs in to the system he is
not automatically displayed available in our database until he switches the ambulance available status
on, this helps him to get out of the map activity and the app still send updates to the database ones the
ambulance available statues turned on.

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Figure 6-11 Ambulance driver Map view of the application
In Figure 6-11 ABEMS shows, an emergency request sent by emergency patient is accepted by
Ambulance driver, ABEMS will show real time location of emergency patients’ marker on a Google
map to the ambulance driver and user information about emergency patient such as name, phone,
gender and blood group.

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 Manage Profile

Figure 6-12 shows the manage profile page of ABEMS ambulance driver, ambulance drivers or
emergency responders can view and update their information such as name, photo, phone number,
massage to the emergency patient and select the type of emergency services they provide, e.g.,
Pregnant, Accident, COVID-19, Chemical burn, Animal Bite, Fainting, Choking, Bleeding, Coughing,
Birthing Problem, Heart attack and Stroke.

Figure 6-12 Ambulance driver Manage profile

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 Firebase Backend

ABEMS application database is made of three principal branches:

• Users
• Ambulance Available
• Emergency Request

Figure 6-13 ABEMS app Database Structure

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 Evaluation of ABEMS

In this section we present a user study aimed at analyzing different aspects of the ABEMS app such
as the usability of the proposed system, the level of acceptance of the app and the usefulness of the
proposed system during an emergency situation

Usability Test

Usability testing is a method used to assess a usability of the product’s by testing the product directly
with the end users. This is used to test user experiences with the product to detect possible defects in
user experience.

A survey was performed to determine the usability of this app. There were 30 participants between
the ages of 19 to 48 and they are familiar with smartphones in order to avoid problem during the review
related to the use of mobile technologies. To perform usability test, we used a survey method. Surveys
method are employed to know participants opinions or to understand their preferences about proposed
system through the use of questionnaires. In this way, we had the opportunity to gather useful
comments about the user acceptance of the application.

Tasks

In general, we decided to start the usability test with no initial training on the app. During the beginning
of the study, participants received a short demonstration about how the proposed system. Then, after
introduced to ABEMS app there is list of tasks that must be done, to make precise testing and had to
fill out the questionnaire. As the system is a mobile-based, we need to have a GPS and GPRS enabled
android smart phone and the app is installed on it to test the system and the following are the activities
to be carried out in order to get the right input from the participants:

• First, participants should have a deep view of the app.

• Participants call ambulance drivers to get medical emergency service.
• Participants accept emergency requests and needs to remind patients with a notification that
help is on the way to them.

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 Evaluation and results

As was discussed previously, the method we have used is survey method. We have evaluated the
ABEMS app according to the following criteria using the questionnaire. Questionnaire has been
prepared to test user perceptions about the usability of the Android-based Emergency medicals Service
system (see Appendix a:).

After participants have seen all the capabilities of the app, we distributed questionnaires to them. It
has 21 items and consisted of specific questions, then they were told to fill out the questionnaires to
give us their opinion about the proposed system which is used to identify users’ degree of satisfaction.
The questionnaires formed based on five level Likert scale strongly agree, agree, neutral, disagree and
strongly disagree are equivalent to 5, 4, 3, 2, 1 respectively is used for the responses of the questions.
The response of participants category is stated below in Error! Reference source not found..

Table 6-1 Questionnaire results

Principles average In percent (%)

Usefulness: 4.69 93.8%

Ease of use: 4.57 91.1%

Satisfaction: 4.75 95%

Overall usability 93.3%

As you can see from the table above, the response is above 90% which shows the app fulfills the
participants requirement, also it is easy to use and is good enough to be used. In addition, user
satisfaction is measured by the comments made by each participant. Moreover, user satisfaction is
measured based on the feedback we received from users, the comments on the questionnaire show that
users are satisfied with the system.

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 Chapter Seven

7. Conclusion and Future Work

Conclusion

In this study, ABEMS app is designed to help the emergency patients to determine the nearest
ambulance and to show the assigned ambulance driver location. this allows emergency patients to feel
safe that ambulance driver has been assigned and rescue team is on the way to help them. The
ambulance driver and emergency patients address are determined by built in smartphone GPS because
the smartphone built-in GPS sensor will use to gather the user’s location information, therefore, to
perform this task user’s permission are required and the distance to ambulance driver is displayed for
the emergency patients with the help of Google Map and direction API. As a smartphone is having
built-in GPRS and GPS, whenever the GPS receives a new location information, it is updated in the
firebase real-time database at the same time we are able to see the location on the Google map with
pinpoint markers. This application is very useful and the best way to rescue people in cases of different
medical emergency as well as for the non-resident of the Gondar city. Moreover, the app has a Call
Ambulance button, which will trigger the activity of sending emergency request to the nearest
ambulance driver. With the help of ABEMS we can track ambulance drivers with list of common
emergency situation using android smartphone, common emergency situation includes (e.g., Pregnant,
Accident, COVID-19, Chemical burn, Animal Bite, Fainting, Choking, Bleeding, Coughing, Birthing
Problem, Heart attack and Stroke), in other words the system provides emergency patients simply
select their emergency and fill their profile form for example name, phone blood group, photo and
gender without wasting time explaining the situation to EMT. In general, the combination of the GPRS
and GPS provides real time tracking and the app has facilities such as storing user’s information as
well as user’s current location information. It is aim to improv the EMS or ambulance transportation
service when emergency request is made by patients without having to check the availability of
ambulance and or waiting for a long time.

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 Future Work

For better functionality of the system, future research would be conducted without redesigning the
entire app to re-solve many issues that are observed through this research, the following are some of
the possible future works to the continuation of ABEMS.

• Incorporate multimedia features such as text massage to emergency contact, video and audio
communications, this could be essential for locating the patient as well as gathering useful
information about the patient’s history.
• Integrate google place API and google direction API to solve routing problems and to search
a specific location and tap the destination on the map.
• Implement multiple language support and ambulance driver rating system to broaden the use
of the system.

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 Federal TVET Institute
Post Graduate Studies

Department of Information and Communication Technology Management

APPENDIX A: Questionnaire To be Filled by ED staffs

Dear Respondent,

I am Alazar Mengstab a postgraduate student. Currently, I am studying Master of Science in

Information Communication Technology Management at Federal TVET Institute, Ethiopia. I am
currently undertaking a research project concerning minimizing response time in Emergency Medical
Service and adopting location-based emergency application. This project is a part of my thesis to make
my qualification completed.

The research aims to explore emergency service providers and emergency patient’s perspective in
using the proposed android application, Location Based Service (LBS) in Focus. Therefore, this is to
kindly invite you to participate in the survey that needs data from you to assure the functionality of
the proposed Android Based Emergency Medical Service and assess the issues in relation to the
challenges of the current emergency system and the acceptancy or rejection of the proposed
application.

Your participation in this survey is anonymous and entirely voluntary. No one will associate your
responses with your identity including the researcher. If you feel uncomfortable with the survey you
may choose not to take the questionnaire, to stop responding at any time or to skip any question that
you do not want to answer. All the collected data are confidential and your response is respected,
extremely important and valuable for the purpose of the research project only.

Therefore, I appreciate you taking few minutes from your valuable time to fill your opinion in the
questionnaire.

For any information, assistance or clarification, please contact me: Mobile +251912289068 or Email:
2mengstab@gmail.com

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Thank you for your time and willingness to be a part of this study.

Term definitions

Emergency medical services (EMS), also known as ambulance services or paramedic services,
are emergency services that provide urgent pre-hospital treatment and stabilization for serious illness
and injuries and transport to definitive care.

Android is a mobile operating system based on a modified version of the Linux Kernel and other open
source software, designed primarily for touchscreen mobile devices such as smartphones and tablets.
Android is developed by a consortium of developers known as the Open Handset Alliance and
commercially sponsored by google. It was unveiled in 2007, with the first commercial Android device
launched in September 2008.

A Location-based service (LBS) is a general term denoting software services which utilize
geographical data and information to provide services or information to users. LBS can be used in a
variety of context, such as health, indoor object search, entertainment, work and personal life.

Response time in ambulance service are measured by the time it takes from receiving an emergency
phone call to a vehicle arriving at the patient’s location.

Instruction: Please fill the blanks and put” ” sign to the box related to your answer

I. General questions to the respondent

a. Job Title: _________________________________
b. Age: _____________
c. Gender: Male Female
d. Qualification:

Diploma first Degree Master’s PhD

e. Work experience
1-5 years 5-10 years 10-15 years above 15 years v

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 Questions Agree Neutral Disagree

1 Ambulance Service

Is ICT, CAD and GPS enabled device involved in the

ambulance service?

Is details about the emergency patient recorded from the

conversation?

Is it possible to track the emergency patient’s location

according to the telephone line used to call the emergency
line?

Are you satisfied with the current ambulance system?

Were emergency patient told, how long they would have to

wait for someone from the ambulance service to arrive?

Did you have trust and confidence in the current EMS?

2 Response Time

Has there been a delay in the arrival of ambulance?

Did the delay worsen the condition of the emergency patient?

Did the ambulance control room operator pass a call on to a

telephone advisor to assess emergency patient situation?

3 Emergency Patient Communication Assessment

Did emergency patient explain their situation in a way you

could understand?

Is emergency patient give an exact location information to be

able to track and reach on time.

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 Is emergency patient provide correct information about the
situation?

Do you feel the ambulance service staff listened carefully to

what emergency patients had to say?

Did you feel emergency patient were given enough advice on

the telephone about what to do?

4 Usage of Android-based emergency medical service

Would you like an EMS application that would enable

emergency patients to contact the ambulance driver directly
with a one-push button?

Do you think such application will be able to save lives and

time?

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 System Usability Test Questionnaire

Federal TVET Institute

Post Graduate Studies

Department of Information and Communication Technology Management

Appendix B: Evaluation System Usability Test Questionnaire

INSTRUCTIONS:

First take a look, and use the system deeply and read each question carefully and fill it by ticking on
your choice and select of rating from 1-5 (Strongly Disagree =1, Disagree =2, Neutral =3, Agree =4,
Strongly Agree =5).

Usability specific questions (answers scale from strongly disagree to strongly agree):

Android based Emergency Medical Service questionnaire 5 4 3 2 1

1 Usefulness:

It helps me call an ambulance.

it is useful.

It saves me time.

It meets my needs

2 Ease of use:

Is the app easy to navigate?

Is the app appearing clear?

Is it user friendly?

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 Is it requiring the fewest steps possible to call ambulance?

Is the color contrast appropriate?

Using it is effortless?

Can you use it without written instructions successfully?

Is the language used easy to understand?

Is it easy to learn to use it?

Is it easy to remember how to use it?

3 Satisfaction:

Are you satisfied with the app?

It works the way I want it to work?

Will you share/ recommend this app among your family and friends?

Is the loading time of the app appropriate?

Do you think that the app will help you to simplify the process to request an
ambulance compare to the current emergency call system?

Is the file size appropriate?

Is it easy to install?

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