Trinity College Dublin Colaiste na Trionoide, Baile Atha Cliath University of Dublin What is the optimal design of a Mountain Rescue Patient Assessment Smartphone Application? Rita Darcy A dissertation submitted to Trinity College Dublin, in partial fulfilment of the requirements for the degree of Master of Science in Health Informatics 2016 Declaration I declare that the work described in this dissertation is, except where otherwise stated, entirely my own work, and has not been submitted as an exercise for a degree at this or any other university. I further declare that this research has been carried out in full compliance with the ethical research requirements of the School of Computer Science and Statistics, Trinity College Dublin. Signed: ___________________ Rita Darcy 24th June 2016 ii Permission to lend and/or copy I agree that the School of Computer Science and Statistics, Trinity College Dublin, may lend or copy this dissertation upon request. Signed: ___________________ Rita Darcy 24th June 2016 iii Abstract The purpose of this study is to explore what is the optimal design of a patient assessment Smartphone application that will be used by Mountain Rescue team members. It is proposed that a suitably designed application could assist Mountain Rescue team members in conducting and recording a patient assessment during a callout. A review was conducted of existing First Aid and Mountain Rescue apps. A Smartphone app was discovered that assists with patient assessments in remote emergency care situations, called the NOLS (National Outdoor Learning School) SOAP (Subjective, Objective, Assessment and Plan) Note Smartphone application. This application could potentially be used in Mountain Rescue. Three research studies were conducted. The first was a questionnaire that focused on the current functionality of the NOLS SOAP Note app to identify required functionality of a patient assessment app. The second study involved interviewing selected Dublin & Wicklow Mountain Rescue Team members who have both Mountain Rescue and healthcare experience, to ascertain the data that should be recorded during a patient assessment, and the information that should be transferred during a handover. The author used the feedback from the studies to develop a prototype app. The final study was an evaluation of the prototype app. The feedback received from the first two studies was used in the design of a prototype app. The prototype app was deemed by the research participants to have a high level of usability and scored closely to the NOLS SOAP Note app usability score. The design of the prototype app was an iterative process. The screen mock-ups used to define the screen layouts, were created using a tool called Ninja Mock. The prototype app was developed using the Xamarin development environment using the C# language. The prototype app was deployed using Dropbox. It is recommended that the IMIST-AMBO handover protocol is used by Mountain Rescue team members when handing over a patient to paramedics. It is also recommended to involve stakeholders in the design process. The resulting prototype app is functional, but further development is required to optimally design a patient assessment app for Mountain Rescue. iv Acknowledgements I would like to sincerely thank my supervisor Mary Sharp for providing advice and support throughout the year. I would like to thank the members of the Dublin & Wicklow Mountain Rescue Team for participating in my research studies, for sharing their invaluable insight and knowledge with me, and for supporting my ideas. All the team members give up a considerable amount of their time to support Mountain Rescue, so I really appreciate the additional time that they gave to this project. Many thanks are due to my friend Maebh Ni Fhalluin who assisted by proof reading this document and providing valuable suggestions. Finally, thanks to my classmates who have provided encouragement and support over the last two years. v Table of Contents Chapter 1 Introduction .......................................................................................................................... 1 1.1 Introduction ................................................................................................................................. 1 1.2 Background .................................................................................................................................. 1 1.3 First Aid Standards ....................................................................................................................... 5 1.4 Problems in Patient Assessment in Mountain Rescue ................................................................ 7 1.5 Research Question and Study Aims ............................................................................................. 7 1.6 Overview of the Research .......................................................................................................... 10 1.7 Overview of the Dissertation ..................................................................................................... 11 Chapter 2 State of the Art .................................................................................................................... 12 2.1 Introduction ............................................................................................................................... 12 2.2 Search Strategy .......................................................................................................................... 12 2.3 Mobile Technology..................................................................................................................... 13 2.4 Software as a Medical Device .................................................................................................... 14 2.5 Pre-hospital care ........................................................................................................................ 16 2.6 First Aid Apps ............................................................................................................................. 19 2.7 Apps used in Mountain Rescue .................................................................................................. 23 2.8 Handover Protocols ................................................................................................................... 24 2.9 Conclusion .................................................................................................................................. 25 Chapter 3 Research Methodology ....................................................................................................... 26 3.1 Introduction ............................................................................................................................... 26 3.2 Study Group ............................................................................................................................... 27 3.3 Questionnaire Method .............................................................................................................. 27 3.4 Interview Method ...................................................................................................................... 31 3.5 App Evaluation Method ............................................................................................................. 33 vi 3.6 Ethical Considerations ................................................................................................................ 33 3.7 Conclusion .................................................................................................................................. 33 Chapter 4 Analysis of Results ............................................................................................................... 34 4.1 Introduction ............................................................................................................................... 34 4.2 NOLS SOAP Note app Email Results ........................................................................................... 34 4.3 NOLS SOAP Note app Questionnaire Results ............................................................................ 36 4.4 Interview Results ........................................................................................................................ 47 4.5 Review of Feedback ................................................................................................................... 53 4.6 Prototype Evaluation ................................................................................................................. 56 4.7 Conclusion .................................................................................................................................. 57 Chapter 5 App Design .......................................................................................................................... 58 5.1 Introduction ............................................................................................................................... 58 5.2 Design ......................................................................................................................................... 58 5.3 Development .............................................................................................................................. 66 5.4 Deployment................................................................................................................................ 70 5.5