Review Article

A Systematic Review on Recent Advances in mHealth Systems: Deployment Architecture for Emergency Response

Table 1

Summary of the recent architectures for m-Health in emergency situations.

Ref.Emergency contextTarget loc.1st tier2nd tier3rd tierEnergy opt.Infras. connec.Type of dev.
SensorsCom. tech.Mobile unitCom. tech.Local serv.Rem. serv.

[8]Direct transmission of ECG through mobile network where the nearest medical center can be contacted, and by GPS, the patient can be found and saved.OutdoorsECG
EEG
Bluetooth or ZigbeeSmartphone with GPSGSM or EDGE/Bluetooth or Wi-FiBase stationNetworked PC

Internet
→ healthcare station
TraditionalAlgorithm evaluation

[9]A personal emergency response system with an automatic detection on falls to send an alarm to the caregivers.Indoors/outdoorsACCBluetoothSmartphone with internal ACC, GPS, and GUICan be reduce the transmission 1st-2nd tiers. 1st detects falls instead of 2nd.TraditionalSystem reliability

[10]Abnormal medical parameters are sent immediately to medical facilities by reserving priority slots to report them in real time.Indoors/outdoorsPhys.
Environ.
PAN coord
Bluetooth or ZigbeeSmarthpone or tablet with GPS and GUIGSM, 3G, or 4G

Ambulance

VANET
Hospital serverLAN, WLAN

Remote database or Doctor’s PDA
Power management mechanism. Efficient MAC protocol to control sensor’s activityVANETModel proposal and algorithm evaluation

[11]Multiple videos and medical data are multiplexed and transmitted in real time to the hospital. Medical staff can coordinate, visualize, and prearrange treatment.Indoors/outdoorsAmbient videosAmbulance with cameras, GPS, USG, and vital signsLTEHospital centerTraditionalAlgorithm evaluation

[12]Emergency medical information is transmitted directly through a cellular network without multihop communications. It is critical to allocate a dedicated channel to the base station.Indoors/outdoorsEEG
ACC
ECG
Temp.
BP
EMG
Glucose
BluetoothSmartphoneCellular network or Wi-FiBase stationAP

Internet

Doctor’s PDA
Determine dynamically the number of channels to efficiently utilize the resources of the networkTraditionalEnergy scheme evaluation

[13]Patient’s vital signs are transmitted simultaneously during a disaster to the medical center for fast analysis and diagnosis.Indoors/outdoorsHR
RR
BP
SpO2
ZigbeeSmartphoneLTE or Wi-FiBase stationAP

Internet

Emergency center
NDN reduce upstream traffic to efficiently utilize the resources of the networkCloud servicesProtocol network evaluation

[14]In the hospital emergency room, the BAN patient data is displayed in real time to the medical coordinator. Patient may be transferred to further treatment.Indoors/outdoorsEEG
Positioning
ACC
SpO2
EMG
Glucose
BP
Hearing
MAC IEEE 802.15.4BAN coordinatorInternetDatabase serverEmergency ambulance device provider systemEnergy-aware peering routing protocolCentralized and distributed servicesRouting protocol implement.

[15]Wearable light device (WLD) detects an abnormal event. Mobile phone reports an alarm signal to caretaker without user interaction. The caretaker could request further measurements.Indoors/outdoorsECG
SpO2
PPG
Temp.
ACC
WLD coord.
Videoconf.
GPS
BluetoothSmartphoneCaretaker siteOnly transmits alarms to reduce data transmissionTraditionalSystem dev.

[16]In a web portal to real-time monitoring of health status of elderly, their families or clinicians can visualize a person’s location and status of alarm of abnormal physiological parameters.Indoors/outdoorsECG
Temp.
ACC
Glucose
EMG
SpO2
Arduino coord
BluetoothSmartphone with GPS and RFID tagWi-Fi or LTEWeb services

Healthcare management system
Fuzzy logic to decide events and minimize communication resourcesInternet-of-thingsSystem implement.

[17]Heart rate signals are available through PSI network. Alarm is generated and a nearby hospital is notified. The system provides access to EHR.Indoors/outdoorsECG
Arduino coord
Zigbee or Bluetooth or Wi-FiSmartphonePSIStorage and visual. deviceDistributed servicesConceptual and prototype implement.

[18]If the m-Carer system detects a critical situation, it sends a message to the location server and to the emergency service to inform the location of the patient.OutdoorsSmartphone with GPSWi-Fi or 3GEmergency serviceLocation and preference servers

Internet

Doctors, relatives
TraditionalSystem dev.

[19]If an abnormal condition is detected such as critical cardiac event, patients are referred to the emergency department.Indoors/outdoorsECGBluetoothSmartphone3G or Wi-FiClinical decision supportNetworked PC

Internet

Doctor’s PDA
BATCH transmission to improve battery duration versus greedy transmission nodeTraditionalSystem dev.

[20]CARA system reasoning is capable to predict possibly risky situations by correlating different sensor readings over time and to notify the emergency.Indoors/outdoorsECG
RR
HR
BP
ACC
Environ.
BluetoothSmartphoneWeb services

Internet

Emergency services, caregivers
Cloud servicesSystem implement.

[21]After detection of a fall or cardiac anomaly, alert enabler system automatically contact patient’s family or emergency services.OutdoorsBiomedicalBluetoothSmartphone with GPS3G or Wi-FiLocal databaseRemote databaseTraditionalApp dev.

[22]The system monitors continuously the patient’s health condition, and if an emergency situation is detected, a request for ambulance is sent.OutdoorsECG
EEG
BluetoothTablet3G, 4G or Wi-FiWeb services

Internet

Doctor’s device
Energy and resource-aware monitoringCloud servicesModel evaluation and implement.

[23]A system allowing real-time analysis of sensors’ data, providing guidance and feedback to the user. This approach generates warnings based on the user’s state, level of activity, and environmental conditions related to patients.Indoors/outdoorsBP
HR
ECG
EKG
Temp.
Video
Audio
GPS
M2M
Area network
Mobile devices,
M2M gateway
M2M
Communication technology (Internet)
Database serverDoctor’s PDA, insurance companies.Optimization scheme for movement coordination technique and data routing within the monitored area.M2MMovement tracking algorithm evaluation

[24]Sports environment monitoring system. An alarm is sent if any hazardous condition appears or any of the defined user upper or lower thresholds are surpassed.OutdoorsHR
RR
ACC
Temp
Environ.
BluetoothSmartwatch or smartphoneInternet (technology not specified)Emergency servicesDistributed servicesWireless sensor network app develop.

[25]A system is developed through a program running on a smartphone integrated with Bluetooth. The smartphone is able to receive data from sensors in order to detect fall and issue alarm.Indoors/outdoorsACC
Gyroscope
GPS
BluetoothSmartphone3G/GSMFamily and Healthcare providersEfficient learning algorithm with the highest accuracy running on a cell phoneTraditionalSystem develop.

[26]A context-aware smart solution able to track and determine disabled user’s location. If the user is having a critical health issue, a message will be sent to a caregiver.Indoors/outdoorsRFID tags (for user’s movements)
GCS
BS
Video
Hearing
RFID/Wi-FiAPs
Smartphone
Wi-FiDatabase serverCaregiver’s PDA/smartphoneUse of RFID technologyTraditionalSystem develop.

[27]A pervasive health system enabling self-management of chronic patients during their everyday activities.Indoors/outdoorsHR
SpO2
BP
Weight
BluetoothSmartphone (mobile base unit)3G/4G
HTTP
Medical center
Web-based microblogging services (Twitter)
SOASystem develop.

[28]Abnormal detection while a heart attack, the smartphone sends the data along with the patient’s location to the remote cloud. A decision support system notifies entrusted emergency centers.Indoors/outdoorsEEGBluetoothSmartphone with microphone and GPSUWB, RSSI on WLAN, LBS, Wi-Fi, 4G, and/or RFIDWeb services

Emergency services, doctors
Cloud servicesSystem evaluation

[29]A patient suffering from CHF is continuously monitored. The cloud services generate alarms to ER services when abnormalities are detected.Indoors/outdoorsGlucometer
CO2 level
SpO2
ECG
BluetoothTablet or smartphone with GPSWi-Fi, LTEWeb services

MC, doctors, ambulance
A fuzzy-based data fusion technique to remove redundant dataIoT and cloud servicesSystem evaluation

[30]In a smart fall detection system, the patient monitored for mobility and fall events are reported as alarms.Indoors/outdoorsACCBluetoothSmartphoneCellular networkWeb servicesIoT and cloud servicesAlgorithm evaluation

[31]Emergency is detected and notified by appropriate ringtone or vibration patterns in the smartphone. Also, alerts are sent to the rescuers.Indoors/outdoorsPPGBluetoothSmartphoneWi-Fi, 2G, 3G, 4GWeb services

Doctors, users
Efficient Bluetooth low energy protocol stackIoT and cloud servicesPrototype implement.

[32]Different levels of attention but the patient is monitored continuously, and in mobility, it can respond to emergency situations.Indoors/outdoorsBlood pressure
ECG
ACC
Temperature
Wi-Fi with P2P architectureSmartphoneWi-Fi with P2P architectureBase stationHospital, doctor’s PCA dispersed cross-layer optimization algorithm to optimize resources in the networkM2MModel evaluation and implement.

Note. Ref. = reference; Loc. = location; Com. = communication; Tech. = technology; Serv. = Server; Opt. = optimization; Infras. = infrastructure; Connec. = connectivity; Dev. = development; ECG = electrocardiography; GPS = global positioning system; EEG = electroencephalography; PC = personal computer; ACC = accelerometer; GUI = graphic user interface; PR = pulse rate; Temp = temperature; SpO2 = oxygen saturation; BP = blood pressure; Phys. = Physiological; Environ. = environmental; NDN = named data networking; PAN = personal area network; coord = coordinator; PDA = personal digital assistant; VANET = vehicular ad hoc network; USG = ultrasonography; EMG = electromyography; AP = access point; BAN = body area network; HR = heart rate; RR = respiratory rate; implement. = implementation; PPG = photoplethysmography; Videoconf = videoconference; perform. = performance; EHR = electronic health record; M2M = machine to machine; GCS = gesture control sensor; BS = behavior sensors; UWB = ultrawideband; RSSI = received signal strength indication; LBS = location-based services; CHF = congestive heart failure; MC = monitoring center; P2P = peer-to-peer; SOA = service-oriented architecture.