Podcast – GoodSam App Update with Mark Wilson at LTC

Welcome to the St Emlyn’s podcast. I’m Iain Beardsell

and I’m Natalie May

And we are at the London Trauma Conference as it happens 10 years from the last time, we were here with an interviewee who we interviewed 10 years ago.

Mark, why don’t you introduce yourself and we can talk a little bit about the advances the over the last decade.

 My name is Mark Wilson. I’m a neurosurgeon at Imperial Hospitals NHS Trust, which is based in Charing Cross in London. I’m an Air Ambulance Doctor with Kent Surrey Sussex.

So, you are a unique personality. I’m not sure there’s many neurosurgeons who are doing pre hospital emergency medicine, but one of the main things we talked about 10 years ago was the GoodSam app, which I’m utterly delighted to say is still going, thriving, but you could give us all a bit of an update about that journey.

So, when we were first talking, I think it was quite a beginning of the idea. There was this idea about impact brain apnoeic. We have a podcast with Gareth Davis from 10 years ago, talking about the idea that was an important thing. And the sooner we get to people, I think that was one of the main reasons GoodSam came about was identifying people with head injury who then had this apnoeic process, but it seems worldwide now. Can you give us a, a sort of brief idea about the last decade and what’s happening with it now? Cause I think it’s a truly, life changing for many, application and something that’s unique probably.

Yeah, so it really has evolved, hugely and you quite rightly say that it emanated from the world of trauma from impact brain apnoeic and wanting us to, basically us wanting to alert off duty people to go and hold an airway open to minimize hypoxic brain injury.

 But it has evolved hugely since then and it goes off in so many different directions. I’m sorry, it’s going to take me a few, a minute or so to go over them. Obviously the cardiac arrest world is one where it has an obvious functionality and that’s across most of the U. K., large parts of Australia, New Zealand, and actually U. S. and Canada and other places are now using it, to alert off duty people to go and start CPR. And that saves many hundreds of lives. We see a real good impact from that. And one of the things, staying on that subject for a moment, where it’s, really evolved recently is Police services that are on board as well.

We’ll come to police in a minute. But police services are on board as well Have a really big impact if you take Cambridgeshire over the last year and a half, they’ve got a hundred ROSCs, just from the police arriving before the ambulance service arrived. So that’s a fairly big deal and we’re trying to get that rolled out across other police services as well.

So just a quick reminder because I’m sure most people have heard of it.

We’ve mentioned GoodSAM already. Give us the idea of what it is. This is an app on your phone that you can sign up as a provider, a responder. But tell us a bit more about what it actually means for people who perhaps maybe haven’t heard about it.

Yes, so the GoodSAM system started off as a tool to alert those who are trained in CPR to, to go and respond to people in cardiac arrest.

So, it geolocates those in need and those who can help and marries the two up. The idea being that the faster you get CPR, the faster you get defibrillation, better chance of survival. And we know that from, so if you’re looking at airports, 80% chance of survival in Heathrow airport, 10% chance of survival on the streets, and that’s about time to CPR and AED use.

So, we were wanting to use technology to try and improve that outcome figure, And as I say, it’s evolved rapidly as more and more people have come on board. We’ve teamed up with the resuscitation council here in the UK to, to provide an online training system, which is called Lifesaver.

So, if people go to life-saver.org.uk, complete the 40 minutes of a very highly interactive video, that leaves a little cookie on your computer basically says you’ve done the training and then you can come on GoodSAM. So, there’s no barriers now for people who have done some basic level of training to be on the system and then be deployed or alerted by the ambulance services to their next-door neighbor who might be on cardiac arrest.

Basically, we’re trying to nudge the system towards what you get in an airport, which is someone on your chest within a couple of minutes. That’s what we’re wanting to achieve with that.

So a 999 call goes in, a call operator takes it, identifies there’s a cardiac arrest, and now, which I think is different to 10 years ago, that may then activate a GoodSAM alert to people nearby who can then respond whilst waiting for that pre hospital service to get to the patient.

Yeah, so if they, for every minute supposedly 10% better survival, so someone gets there three or four or five minutes earlier, that’s a pretty big chance increasing survival odds.

And we certainly hear of many survivors as a result of that.

We’ve been using it in New South Wales with integration with our ambulance service and we can sit on our pre hospital base and see the triple zero, in Australia, calls coming through and you’ll see in every computer aided dispatch line, there’s a line that says an exclusion phrase was found and GoodSam has not been activated for someone who’s fallen over with a sore leg or whatever it is. So, it’s really taken that kind of human element of having to alert people to the patient out of the equation to make things run more smoothly, which is a great innovation.

So, a decade ago, this was about individuals knowing about it, signing up. And we tried to do our little bit to make people sign up, but it sounds like now that has exploded. So, who’ve you got using GoodSam? How many alerts might you get a day? And have you got any idea about the impact?

So, it’s really got bigger, largely because of good people.

So, really good leadership where, you know, especially in Australia and in the UK with really good Medical Directors and CEOs of ambulance services who have taken this on and, I seen that it’s the right thing to do and deployed it in a way that they can do culture change. Some places struggle with culture change.

And we’ve really enjoyed working with, those, leaders who have done that. And, where it’s done correctly and then we get really good numbers in terms of additional survivors. I couldn’t tell you how many alerts there are a day. There are literally hundreds, if not thousands of alerts now going across, as I say, UK, Australia, New Zealand, US and Canada now using it quite extensively as well.

And there’s many organizations, all the big ambulance services in those places are using it.

And this was just an idea that you and others had a while ago. What’s the infrastructure behind that now? So, to keep an app running to keep all this thing happening, how’s that working and how’s it funded?

It’s got a lot bigger than that now.

So, the cardiac respite was one piece of it. We’ve got very heavily involved with, NHS, volunteers during COVID. So, this was a system that then got adapted by NHS England to alert people who needed support during COVID, by the community. So, we had about 800,000 people who joined during COVID who delivered food to their next-door neighbors, delivered pharmacy to check in and chat, these people are lonely during COVID. Isolation was a big deal. So, they’d ring up people and make sure they were okay. and that sort of spawned off another area of this micro volunteering process. So, traditionally we always thought of volunteering as being I would give up next Tuesday to go and work down the hospital library, whatever, but micro volunteering is doing little tasks for people in your neighborhood.

So, collecting some milk for Doris on the way home from work. And it’s really spawned that micro volunteering element as well. And post COVID that’s continued now, in other areas. And we’re now really trying to build up, community response to fallers, elderly falls or vulnerable people who fall, and supporting local dementia services as well.

So, give us a bit of an idea about what it takes to run this, because this is not a small thing and you’re a full-time consultant, and there are others involved who are doing other jobs. There must be other people who are doing this as their role.

Yeah. So, we have a team ourselves, but actually we work with lots of services that embed it within their service.

So, if you take New South Wales, for example, they’ve got people within the ambulance service who look after the GoodSAM elements of it, the, the responders and those components of it. But really, it’s grown at a rate that people have been able to adapt to that culture change.

So, as I say, if we work with people who can do that locally, then it’s great, we work with them. But it really has expanded even beyond that now, and everything we’ve talked about so far has required an app. So that’s people who are responding, have geolocates them, but the flip side of it, and probably the bigger side of it now, is the non-app-based element.

This is the ability to open up any 999 or triple zero or 911 caller’s mobile phone cameras. Someone dials in now maybe they’re trying to describe a situation, or they might not know where they are. then they get sent a text, they click link on the text and that opens their cameras and locates them immediately.

So that saved many people’s lives. People have just been lost out in the bush in Australia. People have been lost out at sea. People who have been abducted, all kinds of people being trapped in lorries, come across from the continent. That’s the kind of thing that, that location element helps.

And then the visual element, really started in the world of triage. It’s what we always thought it would be, this ability to say, actually, this person looks very sick. They’re going to need a greater resource. So, like an air ambulance or something like that. And we always thought it would be a triage phenomenon.

And it is, it makes a difference in about a third of all 999 calls, basically downgrading about 20%, upgrading about 10%. So, it does have effect on triage, but where we’re really noticing is in the world of treatment. So, if you’ve got really good people who answer the phone andlook at the video, they can guide the bystander through stuff. So do you remember at the start, we said this was about alerting people to go and start CPR. Actually, if you can guide the person who’s dialed the 999 calls through CPR and see what they’re doing, you can guide them really well. Not just for CPR, but for, stopping bleeding, for lots of other things as well. So, we can When I say we, the prehospital care community can effectively be on scene immediately, through other people’s hands. And what I find the most enjoyable thing about all this is seeing really good paramedics who are experienced clinical, good paramedics, actually working immediately through other people’s hands.

That’s a really good skill. That’s amazing skill set, not only to be able to diagnose sick, but also to then be able to clearly articulate what someone’s gotta do and have that immediate impact within a few seconds of the 999 calls,

This all feels revolutionary but seems to come from the idea of a few people who’ve worked really hard to make it happen. But there must be funding involved.

We fund it all as ethically as we can, which is, which is the services, pay for the use of it, pay of the server costs and things like that. And we also work with organizations now that like Vodafone, SpecSavers and others as well, that also utilize it, more commercially.

The big area that was really started to, increases our work with security and policing services. The ability to open up people’s cameras very quickly has a big impact in certain areas of policing. Obviously, you’ll be able to see crime, be able to record those crimes. And in one area in particular, that’s having a big impact is domestic violence.

Quite a lot of services, we’re in, I think 40 out of 43 police services in the UK now use the system. Largely for domestic violence. people can open up someone’s camera relatively quickly after an instant whilst the room is still in a bad state, or the person has been coerced into not pressing charges, for example.

And there’s lots of other advantages, subtle advantages. for example, there’s not a police car on the driveway, which is beneficial for the victims of the, not the whole neighborhood knows. But this whole process of being able to do that video element of it very quickly after an instant has resulted in a tripling of arrest rates for domestic violence where it’s used.

So, it’s having a big impact way beyond cardiac now. As I say, this is where it started from but it’s all about looking after the public in different ways.

So, Mark, I had no idea quite what you’ve just told me about. I thought we were gonna hear a little bit about yes, we’re getting people a bit sooner to do some CPR. And yes, we’ve identified some defibrillators, but this is extraordinary stuff. So, this is about a whole public health intervention, or at least a way of looking at things that are happening in real time.

And I guess gathering evidence. Would the video then be recorded and you can use that in court? Or is it something that’s used at the

time? No, the police can utilize that in court. I guess it opened my eyes to a world that I wasn’t really familiar with. I always thought the medical world as a triage was the thing that I thought would make a difference in what we’re going to deploy. But then the treatment element affects the course of that disease, as in like you can get in earlier and treat it quicker. We’re seeing diseases at a time which you’d never normally be able to see, impact brain amnia for one, for example, would never be there quick enough to see it.

But I do think in the world of policing, it’s going to have a different effect, which is not only can you make better decisions about what you’re going to deploy, but also it might affect the evolvement of that crime that’s ongoing. If people know that it’s being filmed and if they know that’s going to be used in evidence in court, then whatever crime that might be, might terminate quicker, than it otherwise would do.

So, it’s quite interesting how, the use of technology can affect the progress of disease or crime or any of those things.

So just to sum up where I think you’ve said we’re at now. Started off with this impact brain apnoeic idea, which probably comes from your background as a prehospital physician neurosurgeon. It’s then gone into CPR and people in cardiac arrest and helping people do those things quicker.

Then it’s into identifying fallers and other people with, medical needs and triaging them to the help they need. Then in COVID, you’ve managed to direct people and do those micro volunteering things to help people at home and maybe offer those little bits of assistance and help with loneliness in COVID.

And now you’re helping fight crime. It feels like you should be in line for some sort of knighthood.

no. Firstly, this is not me. This is, there’s a team, there’s, Ali Ghorbangholi, who’s the co-founder, co-founder and a fantastic coder. Chris Postwell who runs the police side of stuff. So, it’s not just me. I’m taking a lot of credit here for stuff that’s not me. But the, I guess what we’ve done is we’ve moved with the areas of need. So, we’ve got technology that is that we’re not technology.

And then where can we plug it in? It’s evolved with amazing leaders. And I can name fantastic people who absolutely should be up for all kinds of honors, who have an ability to affect culture change within their institutions. So, let’s take New South Wales Police, for example, they’ve been fantastic, revolutionizing how they can deliver some of this element of it. I think make very good, not just efficiency savings, but also provide better care for the public.

So, it really has been a community that’s worked together. The other thing I should say is that it’s always looking at ways of innovating. So, whilst I’ve said things like about utilizing video, what you can do beyond that is really quite clever. So, you can forward video. If someone’s taking a 999 call, for example, from an ambulance service of a stabbing, that video can be forwarded to the armed response unit.

So, you can see what’s going on in real time inside the building or an active shooter type scenario, if you’re in the U S or those kinds of things. So, it’s not just using what’s there, but actually I think, how can we make things even better and constantly evolving, that, and that’s pretty much by working with partners who are who have who are really interested in this space.

So, you’ve hinted a bit about what the next 10 years might hold. We’ve covered a bit of what seemed to be an extraordinary last decade. What is next for this technology and where does it stop? It feels like this could have real benefits on such a wide range of environments.

 So, there’s two main things, obviously the world of AI. Everyone talks about AI, and I’m very wary of AI saying, actually let’s just use real intelligence before we talk about artificial intelligence, because as you got a whole bunch of extremely experienced paramedics who are currently just using audio, the majority of them, when actually they could be seeing what’s going on.

So, actually we can use our real intelligence before we step forward to artificial intelligence. But we are doing artificial in terms of work. Obviously, we measure pulse and respiratory rate through the video. We do language translation, a hundred languages real time, bidirectionally. And we do, we’re just releasing a whole lot of that.

We’ll take a conversation like the conversation we’re having now, put it as a transcript, and then it’ll summarize it as well. And that can be automatically summarized into, for example. A witness statement for the police just makes that all very quick and easy for them to make their things more efficient.

So, there’s a technical kind of innovation, but there’s also community innovation as well. Actually, we had a conference here at the Royal Geographical Society a year ago, and we ended that by saying, what’s the next 10 years going to look like? And the next thing is undoubtedly the big thing is climate change and all the healthcare and environmental impacts of that are going to occur.

So, we’ve got lots of volunteers on the system. They can do much more than do CPR. And many maybe we don’t want to do CPR, want to do other things. So, for example, putting sandbags out, or alerting their neighbors to a fire and things like that. So that’s where we see this moving into next, which is much more communitysupport during major incident environmental, disaster kind of work. So that’s that’s a that’s a probably the next iteration of what’s going to happen in the next few years.

And to finish off, Mark, where can people get involved? So, in the old days, you signed up to an app and you proved you have GMC registration or NMC registration or whatever it might be.

It sounds like that’s much broader now. It’s not just limited to healthcare professionals because there’s lots, we can all offer to our communities. For somebody to whom they’d never heard a GoodSam before this podcast, where do they go and how can they find out more information to get involved?

 You can look at the website, which is goodsamapp.org, or instant. help, both of those domain’s work. And if you’re trained in CPR, brilliant, just, download the app and it depends on where you are in the world. So, if you’re in Australia, they’re very happy with a, put your hand up, I can do CPR model, but you still have to prove who you are.

So, you have to have your driving license or your passport, and then you’re on the system. If you’re in the UK currently, most services still want people to demonstrate that they are trained in CPR. So, it’s a first aid certificate or do the RCUK training, which is that life-saver.org.uk. But if you’ve got an NHS email, just someone’s listening to this and speak.

I’m trained as part of my statutory training, then that’s great. You just literally click on GoodSAM, on the GoodSAM app and click on NHS Login and it opens up your normal NHS login. You just fill in your normal NHS username and password and you’re on. So, it’s as simple as that. So, there’s nothing for anyone to do if you’re in the NHS, other than login.

And if we did that, I, just getting lots more NHS people on, I think would have an even bigger impact, than what it’s already having. But there’s lots of ways of getting involved or getting in touch with us directly. If you’ve got an organization that wants to be involved with it, then yeah, let us know and we’ll happily collaborate and work as partners.

Mark, I have to say it’s an absolute joy to hear just how much has gone on over the last 10 years and full respect to you and the whole team. It is a team effort, I know, but teams do need leaders and talking to you is inspirational. Makes me wonder what on earth I’ve been doing my life for the last 10 years.

I need to go and do something a bit more worthwhile and most certainly need to think about micro volunteering, but it’s great to have you on the podcast and thank you again for joining us. Thank you.