Digitally networked for emergencies

Whether there has been a stroke, heart attack or car accident, every second counts for those affected. Lives can be saved when paramedics and clinicians can act without delay. Fast treatment requires data that is immediately available to everyone. For this reason, experts at CRS medical GmbH, based in Asslar, central Hessen, have established Medgate, a portal for this purpose – and they are also developing a wearable coupled with artificial intelligence.

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Anyone who has an accident is typically shocked; everything seems to happen in slow motion. For emergency services, on the other hand, a race against the clock begins as soon as they’re alerted. Before they arrive, it may be unclear how the patient is doing and how quickly any type of treatment is needed. Only when the first responders arrive can they get an accurate idea of the patient’s health. “One key device in emergency care is the defibrillator,” explains Dr. Patrick Uhr, Director Data & Products at CRS medical GmbH in Asslar, Germany. “Most of us know the so-called ‘defi’ for resuscitation measures in the event of cardiac arrest. But this device is also used for diagnostics, such as recording ECGs. Modern devices can also measure oxygen saturation, blood pressure and other vital signs,” Uhr adds. All of this is important initial data that the paramedics collect directly on the scene – and which later provides important clues for choosing the patient’s treatment. But the sooner this information reaches the hospital and the doctors treating the patient, the better it is for patient prognosis.
This is precisely where the CRS medical team comes into play. Together, with the subsidiary Avetana GmbH, they’ve developed Medgate, an electronic patient database, since the ECG data measured is initially stored only on the defibrillator and can’t be viewed by the doctors in the hospital. “However, if the defibrillator is linked to Medgate, hospital physicians have direct access to this important initial information,” explains Uhr. Using this data, emergency physicians in the hospital can better prepare because they can assess the patient’s condition before arrival.

Improving the interaction between rescue teams and hospitals

Optimal coordination between paramedics and doctors is particularly important for the treatment of a patient with severe symptoms, a situation where saving time often means saving the patient. For example, if paramedics try to ensure that hospital capacity is created to receive imaging procedures, Medgate can help. “The doctors at the attending hospital login to our central Medgate server and see the patient’s ECG data. This means the hospital doesn’t need its own server, but holds licenses from CRS medical,” Uhr explains. “We also offer the option of installing Medgate on a server locally.” In this case, the hospital itself ensures the IT infrastructure. If the central Medgate server is used, CRS medical guarantees security and service.
CRS medical’s electronic patient database was developed more than a decade ago and is constantly being refined. CRS medical takes care of sales and service for Medgate. The Scandinavian countries of Norway, Denmark and Sweden in particular are already using the portal. This is also related to national requirements. “There, every ECG recorded is transmitted to the corresponding clinic because it is mandatory in these countries,” Uhr explains. With a degree in business informatics and a doctorate in engineering, Uhr has been working at CRS medical for six years and knows that “rescue is not the same everywhere. Even in Germany, there are differences and deviations from a uniform scheme between the federal states and their rescue services.” 

The doctors at the attending hospital login to our central Medgate server and see the patient's ECG data. This means the hospital doesn't need its own server, but holds licenses from CRS medical.
Dr. Patrick Uhr
Director Data & Products at CRS medical GmbH in Asslar, Germany


Digitalize – and share – deployment protocols

While Medgate is already an established system in several countries, the company continues to optimize its offerings to overcome challenges. In the last two years, for example, this included reorganizing the centrally hosted system. “When updates were due, we detected instabilities due to the significantly increased size,” Uhr says. “We rebuilt the system with an appropriate backup solution. This had to be planned elaborately, but it was absolutely worth it,” says Uhr. “We were able to significantly increase reliability and availability.” Currently, Uhr and his team are working with well-known medical device manufacturers to link deployment protocols to Medgate after they have been digitized. Up to now, the rescue services have often recorded this information on paper – which has all too familiar disadvantages for medical professionals: Among them, the analog data is not so easy to share with clinicians. In digital format, this data can be easily transmitted to the emergency room at the hospital, helping doctors to prepare optimally for critical patients. 

The wearable rescue assistant

Data transmission between a rescue service, patient and hospital plays a role in another project by Uhr and his team: KIRETT. This acronym stands for (in English) “Artificial Intelligence in Rescue Operations to Improve First Aid”. In this project, CRS medical “wants to work with partners to develop a wearable for rescue workers, a portable device that serves as a data hub the size of a wristwatch,” Uhr explains. During an emergency response, there can be a variety of measuring devices recording the patient’s ECG, blood pressure, oxygen saturation and other vital data. “The wearable should be able to collect all of this information, recognize the emergency situation at hand with computer support from artificial intelligence (AI) and then provide the rescue team with recommendations for on-the-spot action,” says Uhr. “Our core skill is developing interfaces, similar to Medgate, based on years of experience in telemetry software solutions.” This real-time, wireless data transmission to the wearable works via Bluetooth or WLAN. The project has been funded by the German Federal Ministry of Education and Research under the KMU-innovativ: Forschung für die zivile Sicherheit (Small and Medium-Sized Business Enterprise Initiative: Research for Civil Security) guideline since July 2021, and is scheduled to run for three years. CRS medical is the consortium leader for this project. 

Making the right decisions faster in emergencies

“We are conducting research on the wearable together with university partners. In this case, it’s the University of Siegen, which is contributing its expertise in terms of AI and machine learning, as well as component-based system architectures and algorithms for situation recognition,” Uhr explains. Over the years, a large volume of data has already been collected, which is now being used to train algorithms. Another consortium partner is mbeder GmbH, which is developing an energy-efficient, reliable and real-time AI platform for situation recognition and recommended actions in the wearable. “The platform will then suggest the right treatment to paramedics based on measured vital signs, thus increasing the likelihood of patient survival,” Uhr explains. It has been particularly motivating to have the participation of paramedics and medical personnel from the Siegen district as users of the wearable, and who are advising on the device’s development. “We notice that this team achieves a lot – also because it is very practical. We get very good input, and everyone involved is enormously committed,” Uhr says. The research results are to be used to create the basis for a new product family. Certification as a medical product with a high-grade classification would also be an achievement for CRS medicla. Overall, the learning potential is pointing steeply upward. “We have the chance to build up something new in the long term without sales pressure, so the project also offers growth opportunities for our company,” Uhr adds, looking to the future with confidence.

The spread of Medgate in Europe.


Juliane Frey
Director Digitalisation & Communication