NEXES Exercise with the Turkish Emergency Services

On March 17th 2017, AAHD organised a NEXES exercise involving forty-three representatives of eighteen organisations that are relevant stakeholders within the Turkish emergency service and members of the NEXES end-users community: the Izmir Ambulance Service, the Izmir Fire Department, the Izmir Police Department, the Izmir Metro, the Emergency Medical Technicians and Paramedics Association, the Izmir North Public Hospitals Union, the Aegean Young Businessmen Association, the Turkish Radio Amateurs Association, the Urla Training and Simulation Centre, the Dokuz Eylul University Distant Learning and Practice Centre, the Prevention of Communicable Diseases Association, the TUPRAS Izmir Refinery, the Paramedic School of the Izmir Economics University, the Izmir Provincial Health Directory, the Izmir Disaster and Emergency Management Directory, the Izmir Governor Crisis Centre, the Izmir 112 Single Number Directory and the Izmir Municipality IT Department. Each representative has extensive expertise and experience in the fields of emergency preparedness, response and recovery.

Intending to highlight the differences between the existing Turkish command control centre for emergencies and the new features proposed by NEXES, the Exercise considered two different NEXES Reference Scenarios, one involving a traffic collision and another exploiting a sudden medical incident, namely a cardiac arrest. The first scenario aimed to explore accessibility features, communication difficulties and location capabilities, whereas the second scenario focused on the PSAP operators’ situational awareness and the delivery of medical instructions prior to the arrival onsite of first responders. To best capture the involved participants’ attention and feedback, the exercise combined a table-top approach and a live simulation.

After the unfolding of the exercise, participants enthusiastically shared their views and opinions on the new capabilities brought by NEXES. From the emergency service professionals’ perspective, NEXES comprises valuable new communication channels for citizens to reach emergency services and provides added features that facilitates the PSAP operator to become fully aware of the whole emergency situation and decide on the adequate assets to dispatch. The Turkish representatives were very impressed with NEXES’s video ability, enabling scene management before the arrival of First Responders, significantly improving the timing of emergency management, namely in situations of mass casualty incidents. Similarly, PSAP operators were very interested in the possibility to receive the victim’s medical history and combine it with the data retrieved from personal health apps. Through the NEXES App, it was also recognised the benefits of providing instructions to the caller on how to proceed or act, even correcting inadequate interventions by bystanders, thus allowing first aid interventions to start earlier on scene. There was a general acknowledgment of the positive impact that NEXES might exert on the increase of survival rates.

As far as the concerns expressed by the Turkish emergency professionals, the highlight is placed on the need for additional resources to handle the new information sources. The NEXES’s reliance on smartphones and new Internet-based technologies also raises concern with respect to the population’s ability to own and use these technologies. To address these concerns, it was suggested that emergency services need to review emergency procedures to accommodate the new technologies and determine the need for additional human resources in the PSAP centre. It was also suggested that public authorities and emergency services develop a large communication campaign to raising citizen’s awareness to the NEXES App, explaining how citizens should use and benefit from the App, as part of the public training for emergencies.

Concerning specific new features on the NEXES App, the emergency responders believe to be relevant the enabling of the option to easily reverse the camera’s direction, the inclusion of an icon to indicate at all times the battery situation and the level of Internet connectivity and the pre-definition of the different languages supported by the App. NEXES’s ambition to empower emergency calls from laptops, tablets and computers is also highly praised, and it is suggested to also enable the NEXES App to run on smart televisions. The Turkish emergency services professionals have volunteered to test NEXES in a mass causality incident environment.

With respect to the observations made by the citizens participating in the NEXES exercise, they mostly underline the recognition of the benefits of the NEXES’s total conversation capabilities and the improved accessibility of deaf and blind citizens to emergency services. It is also stressed the NEXES’s relevant contribution to a faster response by first responder teams, while enabling the delivery of necessary instructions to bystanders. It was also agreed that the NEXES user interface was very simple, intuitive and easy to use, therefore highly suitable for the distress and panic felt in emergency situations.

The major concerns were focused on the NEXES’s ability to deliver improved location information in multi-floor buildings and the NEXES App disconnect button, with a single pressure terminating the App. Because this may prompt accidental disconnections, it is suggested to add a message clarifying if the user wants to discontinue the NEXES App with a Yes/No option. Other propositions refer to the possibility of PSAP operators retrieving automatically the phone’s location information. Specifically on the NEXES App, the participants recommended that an enter button is included in the message feature (reassuring the message has been sent), the possibility to enlarge the text font, the addition of information notes and instructive videos to be provided by emergency services to the caller (also contributing to enhance the public emergency training).

The feedback gathered from the NEXES Exercise with the Turkish Emergency Services is instrumental to continue the innovative development work in the project concerning the NEXES App for citizens and of the next generation PSAP systems.

Two videos presented below were produced by AAHD.

  • The video below demonstrates how NEXES can improve emergency response in case of a citizen suffering from speech impairment.

  • The video below demonstrates how NEXES can improve emergency response in case of a citizen suffering from a cardiac arrest.

NEXES Exercise with the Swedish Emergency Services

On September 20th 2016, Omnitor organised a NEXES walkthrough exercise involving six representatives of the Swedish national emergency service operator (SOS Alarm, a member of the NEXES EUAB) and of the Agency for Participation (MDF), with extensive expertise in the 112 service (112 service coordination, 112 system development and architecture, head of development for the112 medical service, 112 operators and 112 service trainers) and accessibility in communications (accessibility issues at the federal level).

The Exercise addressed three of the NEXES Reference Scenarios – A Deaf Arab Citizen Witnessing an Accident; a Fire and Explosion At A Power Plant; and A French Tourist Lost In The Mountains With Hypoglycaemia -, and aimed to better understand the routines and capabilities in the present Swedish 112 service, its limitations and needs, as well as to collect knowledge and feedback from the SOS Alarm professionals on the NEXES system and the NEXES Citizen App, particularly considering the information exchange and interaction between citizens and emergency services.

Based on the hypothetical emergency situations in the scenarios, SOS Alarm representatives explained the capabilities and limitations of the current 112 service handled by 14 PSAP operators, such as the need to pre-register in order to use the Swedish 112SMS service (requires knowing the Swedish language), the lack of capability to call a number that did not initiated an emergency call, the system’s restrictions on location and use of In Case of Emergency contacts, the ability to relay public alerts incoming from the federal level, the inability to send geographically-targeted messages, the absence of a social media channel, the lack of effective daily collaboration/contact between different national emergency services.

Specifically created for the deaf and hard-of-hearing community, the Swedish 112SMS service receives about 300 calls per year, half of which are either hoax calls or citizens checking to see if the service is available. One specific downside of this service is that an actual emergency may require more than 30 SMS exchanges before assistance is dispatched. It is a time-consuming resource that would largely benefit from real-time texting or even video connection. SOS Alarm has agreements in place with interpreter/translator services for voice calls in several languages but to set-up these calls may take more than 15 minutes, too long for emergency cases.

In addition, SOS Alarm declared that their current system hinders the 112 operators’ capability to retrieve location information from calling deaf citizens calling the service. The system only provides location information on registered voice calls and there is no function enabling 112 operators to call back deaf citizens. Consequently, the opportunity to have enhanced location information, associated with emergency calls, namely those initiated by deaf citizens, is considered of high interest. SOS Alarm will be fitted with Advanced Mobile Location (AML) technologies in 2017, but already a shortcoming has been identified: SMS are sent to the user’s home country if the user is abroad since the AML specification does not consider the roaming issue.

Concerning NEXES, the Exercise participants highlighted the interest of emergency services in receiving medical and health data, in having pre-defined emergency messages, in being able to communicate using real-time text, real-time public early warnings and notifications, the identification of emergency SMSs as emergency calls, use of icons and body images to clarify the emergency, defining the injury/pain area, the integration of a social media channel and a direct point of contact with emergency services across Europe.

SOS Alarm representatives consider the opportunity to receive medical data is important to identify situations when the citizen is talking incoherently or making indistinct sounds. Providing information on a possible stroke victim, or a speech problem, a temporary disability, or a medical condition such as diabetes or epilepsy could be of great assistance to prepare adequate and timely emergency response. The capability to include speech-to-text transcription in the system would be desirable. In cases where the caller is not the victim but a bystander, it is important that the medical data retrieved is not from the wrong citizen. The interview techniques should also be adapted to Yes/No questions and also the use of symbols and pre-defined messages should be limited with a clear objective to provide basic information: type of assistance needed (medical, law enforcement, fire-fighting), area of body affected (head, heart, arms, legs), victim status (awake, breathing, unconscious). In this case, if the victim is wearing health devices that transmit data to emergency services, it would be excellent, in SOS Alarm’s perspective.

SOS Alarm also conveyed their expectation that next generation emergency services would improve the cooperation amongst different PSAP services across Europe. As an example, they shared an experience involving a Swedish citizen that was in Spain and suffered an accident. The relatives in Sweden were alerted and contacted the Swedish PSAP to reach their Spanish counterpart and provide assistance. However, it was not possible for the Swedish PSAP to reach the Spanish emergency services and the Swedish citizen in Spain died, without assistance.

On the topic of public alert, Swedish public alerts can either convey warnings or information and SOS Alarm is only the relay entity, since the responsibility rests at the federal level. The channels used are radio and overlay subtitles on television. It is also possible to use SMS and voice call channels but, due to regulatory restrictions associated with privacy concerns, SOS Alarm is not allowed to send SMS messages based on geographic location. The ambition of SOS Alarm is to be authorised and able to define the geographic sector for the distribution of public alerts, including accessing information on citizens entering or leaving the affected area. Also it is highlighted the importance to maintain open communication with citizens, providing updates of the public alert situation. A relevant option is also the possibility to distinguish public alert SMSs from regular SMSs. The opportunity to benefit from social media channels is also welcome to the SOS Alarm representatives, aiming to early detect a potential large-scale emergency situation.

The feedback provided by the SOS Alarm professionals during the Exercise was extremely valuable for the work being conducted on the development of the NEXES App for citizens and of the next generation PSAP systems.

NEXES Exercise on Accessibility

On May 19th 2016, during the NEXES Workshop on Accessibility, the NEXES RIA began its Campaign of Demonstrations, hosting its first Exercise, dedicated to the Accessibility in emergency services in general and the Accessibility features in NEXES, in particular.

The presence of a large audience of members of the deaf and hard-of-hearing community presented an excellent opportunity to engage directly with members of the deaf community and to secure valuable feedback on their experience dealing with emergency services and on the enhancements considered by NEXES.

Organised by EUD, the exercise took the form of a ‘walkthrough’ of an emergency response scenario involving a terrorist attack on a mass transit system (NEXES Reference Scenario 3), delivered in sign-language by representatives from EUD and OMN, with designated intervals for facilitated group discussion. The method used for the table top exercise presented no logistical constraints to the scale of the scenario. Being large-scale and complex, this scenario also gave the opportunity to explore the widest possible range of NEXES functionality and end-user requirements. The following images helped to set the ambiance for the exercise.

The NEXES Exercise on Accessibility counted with 38 participants from across Europe, each presenting deafness or hard-of-hearing impairment. The statistics on the participants show:

Discussion topics focused therefore on currently available communications options and any associated impediments to communication, as well as the proposed alternatives considered by NEXES, and their advantages and/or limitations. Topics were not overly proscriptive however, and free and creative discussion was encouraged, and enthusiastically engaged in. The exercise scenarios were written from a variety of perspectives (e.g. victim, bystander, concerned citizen), which provided a fruitful means of encouraging participants to think about the topics in the context of the broadest possible range of situations.

Organised by EUD, the exercise took the form of a ‘walkthrough’ of an emergency response scenario involving a terrorist attack on a mass transit system (NEXES Reference Scenario 3), delivered in sign-language by representatives from EUD and OMN, with designated intervals for facilitated group discussion. The method used for the table top exercise presented no logistical constraints to the scale of the scenario. Being large-scale and complex, this scenario also gave the opportunity to explore the widest possible range of NEXES functionality and end-user requirements. The following images helped to set the ambiance for the exercise.

Participants’ feedback to the NEXES Exercise on Accessibility, and in consideration of the proposed NEXES capabilities, brought about considerations that may not be readily apparent to non-deaf individuals. For example, the fact that deaf people rely on visual communication, regardless of whether they have sign language as their first language or whether they primarily lip-read. The feedback on ensuring a highly visual intuitive user interface to the NEXES App is also relevant to communicate with tourists and early migrants who cannot speak the native language. It also highlighted that accessibility is not simply a matter of developing solutions targeted at specific user groups, but rather needs the promotion of universal accessibility by employing technologies and processes which facilitate access for the greatest range of users.

Participants also emphasised the need for the NEXES App to provide accurate information sent by emergency services, the ability to verify the information’s provenance and its update capability, as well as made relevant suggestions for simple NEXES App functions, such as the utility of a ‘one touch’ system, accessible when a device’s screen is locked, the value of tutorials on emergency preparedness and first aid, the relevance of clear mapping highlighting areas of danger/safety and the opportunity to include a signal/beacon to alert the deaf of the emergency services’ presence. In addition, concerning the deaf community, participants reinforced that the challenges of communicating with emergency services persist after initial contact, throughout subsequent interactions with First Responders, since it is obvious the lack of training among emergency services personnel on how to communicate with the deaf population.

All the findings and conclusions retrieved from the NEXES exercise participants’ feedback are an integrated part of the overall NEXES user requirements and are being duly considered in the development of the NEXES App for citizens.