Minimize Telemedicine

Telemedicine : Tempus Pro Applications

References

• 08 May 2020: Some €10 million is now available for proposals to use space to improve healthcare and distance learning in response to the coronavirus pandemic, thanks to the Italian national delegation to ESA. - The funding has quadrupled because of the large quantity of high-quality ideas received. 1)

- ESA first launched its call for proposals “Space in response to COVID-19 outbreak” on 31 March, in collaboration with the Italian Minister for Technological Innovation and Digitalization and with the support of the Italian Space Agency.

- More than 120 proposals were made within three weeks, almost 100 of which involved an Italian company. In total, companies from 16 countries responded to the call.

- Paola Pisano, Minister for Innovation and Digitalization in the Italian government, said: “Space technologies are drivers of economic development and innovation in a number of sectors, ranging from agri-food to healthcare, from environment to telecommunications. New connectivity means new structures and infrastructures, new ways of augmenting navigation signals and innovations in the molecular domain.

- "The space sector is a growth sector, which Italy supports with investments, thanks to the collaborations with the Italian Space Agency and ESA.”

- Magali Vaissiere, Director of Telecommunications and Integrated Applications at ESA, said: “We are delighted to support European industry to demonstrate the benefits that space can bring to respond to the current emergency.

- “The selected projects, to be started in June, will show the value that space-based applications can bring to operators in healthcare and education, as well as to European citizens. The relevance of the current initiative is testified by the involvement of renowned Italian hospitals and healthcare institutions in the pilot activities.”

- Giorgio Saccoccia, president of the Italian Space Agency, said: “I find great satisfaction with the outcome of this first phase of the call and the extraordinary response from national space and health companies.

- “Thanks to Italy’s increased ESA subscription, we were able to promptly request an increase in funding, thus helping to provide concrete help to many small and medium-sized enterprises in this time of difficulty.”

- The funds will be used to support projects in education and distance learning, social care, support for medical operations, monitoring and security, telemedicine, and epidemiology and resource planning.

- In parallel, ESA is undertaking other initiatives to support companies demonstrating the benefits of using space assets during the coronavirus pandemic.

- A Europe-wide call for proposals focussed on healthcare is due to be issued shortly. This will complement an existing call for proposals in the UK that is based on the requirements made by its National Health Service.

- The work is co-funded with the ESA contribution dependent on the size of the partner – 50% for large companies and up to 80% for small and medium-sized enterprises, universities and research centers.


• 30 April 2020: Space technology is in action in Barcelona, Spain, as emergency responders employ two ESA-supplied telemedicine devices to triage and treat urgent patients. 2)

Offering ultrasound, laryngoscopy and electrocardiogram among other features, the Tempus Pro devices allow operators to quickly check a patient’s vital parameters such as heartrate, blood pressure, respiration rate and temperature, before transmitting these to medical colleagues elsewhere. This can be done via a secure satellite link or phone network such as 4G.

In its first version, Tempus Pro was designed as a telemedicine device for commercial airlines. It has been further supported by ESA to become a dual-use, lightweight, all-in-one monitor with telemedicine capabilities for healthcare professionals.

The two Tempus devices currently on loan to Catalonia’s emergency medical service Sistema d’Emergències Mèdiques (SEM), are used by doctors at ESA’s European Astronaut Center (EAC) to assess and communicate the condition of astronauts when they return to Earth. They are already being praised for simplicity and connectivity by emergency responders in Barcelona.

Increased care through remote expertise

Spain is one of the countries hardest hit by the current COVID-19 pandemic. At the time of writing, 47,755 cases of coronavirus had been recorded in Catalonia alone, putting additional pressure on emergency teams.

ESA flight surgeon Sergi Vaquer Araujo and medical projects engineer Roger Huerta Lluch say loaning the devices to SEM for the duration of the COVID-19 response was an easy decision. After a successful training, carried out remotely from ESA’s European Astronaut Centre in Cologne, Germany, they are pleased to see Tempus Pro in action where it is needed most.

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Figure 1: Remote training for Tempus Pro. Medical projects engineer for ESA, Roger Huerta Lluch, carries out remote Tempus Pro training for emergency medical teams in Barcelona, Spain, from his station at ESA's European Astronaut Center (EAC) in Cologne, Germany. Two Tempus Pro devices have been loaned to Spain's Sistema d’Emergències Mèdiques (SEM) to help in the fight against COVID-19 (image credit: SEM, CC BY-SA 3.0 IGO)

“The two Tempus devices have been deployed in what are known as intermediate ambulances,” Sergi explains. “Each of these ambulances is staffed by a nurse and a paramedic who receive medical support from an intensive care specialist remotely. The addition of Tempus enables these teams to take care of the most severe patients and deliver a higher level of care without having to have a doctor there.”

This is supported by ESA instrumentation engineer Arnaud Runge who supervised the development of Tempus Pro by UK-based Remote Diagnostic Technologies (RDT) under ESA’s Business Applications program.

“RDT has reported an increase of orders throughout the COVID-19 crisis with many citing the ability to deliver senior expertise remotely, without doctors being limited to one vehicle or directly exposed to the COVID-19 environment, as instrumental in their response. Space is proving again its importance in our daily life” he adds.

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Figure 2: A blood pressure cuff used by emergency medical teams in Barcelona, Spain, where two ESA-provided Tempus Pro devices have been deployed to help in the fight against COVID-19 (image credit: SEM, CC BY-SA 3.0 IGO)

Tempus Pro in action

Registered nurse specializing in emergency and critical care Borja Violant Gomez is part of the SEM team now working with Tempus in Barcelona. For him, its benefits are threefold: simplicity, operability and connectivity.

“We always say that in emergencies, the small details can make the biggest difference,” Borja says. “Performing a tracheal intubation in a surgery room is very different to carrying out the same procedure in a crashed car with a trapped victim, for example. Any simplification and reduction in the weight in size of essential medical equipment allows for better care in hostile environments.”

Borja also commends the device’s intuitive interface, as easy to learn and operate: “our daily work often involves buying time until we can get a diagnosis and treatment. Due to the critical nature of our patients, any time we can save increases a patient’s chance of survival. In the case of a heart attack, an early and clear electrocardiogram is essential to providing the best care and Tempus allows us to do this.”

A truly European effort

The Tempus Pro devices are on loan to SEM for an initial three-month period, during which time they will be evaluated by the emergency medical service’s professional team.

Though the current need was not deemed as urgent as in Spain, ESA is also exploring the potential for Tempus Pro devices to be used in Cologne, Germany – home to the European Astronaut Center.

It is an action supported by the city’s vice mayor Ralf Heinen who says, “In these difficult times, any support through medical equipment is valuable. I am therefore pleased that the EAC was able to help our twin city Barcelona, which was particularly hard hit by the Corona pandemic. This is the very best of European solidarity in action."


• 30 January 2020: ESA is working with Argentina to test the telemedicine device ”Tempus Pro” in the harsh conditions of Antarctica as Europe prepares for its next phase of human exploration in space. 3)

The development of these devices was supported by ESA and it is thought they could be used by astronauts and medical teams during future exploration missions. The testing and validation of Tempus Pro in Argentinian Antarctic bases marks a new era of cooperation between ESA and Argentina – a nation that is already a long-standing partner of ESA in Latin America.

ESA telemedicine monitors have been deployed for testing at two of Argentina’s Antarctic bases – Belgrano II and Carlini.

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Figure 3: Belgrano base crew and Tempus team. ESA senior scientific advisor Dr Victor Demaria-Pesce, Dr Daniel Vigo from the Catholic University of Argentina and Dr Juan Manuel Cuiuli pictured with the crew of Argentinia's Belgrano II Antarctic base onboard the icebreaker vessel ARA Alte Irizar. The trio travelled to Antarctica to support the deployment and testing of two Tempus Pro telemedicine devices as ESA prepares to take its next steps into space (photo credit: ESA)

Belgrano II is located less than 1 300 km from the South Pole, with temperatures that can drop below –35ºC over the summer. Isolated, and built on rocky outcrops, it is seen as a good analogue for missions to the Moon and Mars.

The Carlini base is located at South Coast Potter Cove, on King George Island. Being less isolated than Belgrano II, it will allow teams to compare two different, but extreme, environments.

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Figure 4: A view of Argentina's Belgrano II Antarctic base and its landscape where ESA's Tempus Pro telemedicine devices are being put to the ultimate test.(photo credit: ESA)


Tempus Pro in action

Tempus Pro telemedicine devices have been used by ESA medical teams to record and transmit the vital signs of ESA astronauts after landing since the return of Thomas Pesquet from his Proxima mission in May 2017. The technology will be used again in February when ESA astronaut Luca Parmitano returns from his second six-month mission to the International Space Station, known as ‘Beyond’.

The device also allows geolocation and voice communications between rescue teams and receivers and is regularly used by civilians and military personnel around the world to measure and transmit life parameters such as a patient’s heartrate, blood pressure, respiration rate and temperature to medical doctors.

The harsh environment of Antarctica will provide the ultimate viability test.

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Figure 5: The ESA and Argentinian flags stand side-by-side at the Carlini base in Antarctica where teams are testing the Tempus Pro telemedicine device (photo credit: ESA)

Connecting in harsh conditions

Members of ESA’s space medicine team at EAC (ESA Astronaut Center) in Cologne, Germany prepared the Tempus Pro devices for testing in Earth’s southernmost continent in late 2019. Dr Victor Demaria-Pesce, senior scientific advisor at EAC, and Dr Daniel Vigo from the Catholic University of Argentina then travelled to Antarctica with the devices to support their deployment and the testing that is currently underway.

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Figure 6: The Tempus Pro telemedicine device, and antenna to connect to the Iridium satellite network that orbits Earth, on display in ESA's astronaut center in Cologne, Germany before being shipped to Argentina for transfer to Argentinian Antarctic bases. Tempus Pro is being tested in the harsh conditions of two Antarctic bases as Europe prepares for the future of human space exploration to the Moon and Mars (photo credit: ESA)

Victor and Daniel believe the strength of Tempus Pro lies in the way the device combines all medical techniques needed to carry out an initial medical assessment in a single, robust unit, as well as its flexibility to transmit information via a range of voice and data networks. Non-medical users can also operate the units thanks to detailed instructions on screen.

In Antarctica, there are few reliable options for data transmission. In addition to their own base transmission systems, operators will use an antenna to connect Tempus Pro to the Iridium satellite network that orbits Earth. These satellites will then retransmit the medical data to a receiver in a different location.

Made up of 66 cross-linked satellites in Low-Earth Orbit, the Iridium network enables global coverage even when traditional systems are unavailable and will allow users in Antarctica to communicate, by voice in addition to sending data, with the medical team at EAC as well as Dr Juan Manuel Cuiuli and colleagues from the Joint Antarctic Command in Buenos Aires, Argentina.

Spotlight on simulation

Six simulations, similar to what astronauts may encounter during future missions to the Moon and Mars, are planned for the two Tempus Pro devices during their time in Antarctica. These simulations include nominal and off-nominal scenarios such as emergencies where the medical officer is incapacitated, medical emergencies in an outdoor environment and situations where communication is limited.

The devices will be used by researchers as well as by the medical officer of the bases for everyday medical purposes while the technology is evaluated for potential use during space missions.

“The fact that ESA’s medical operations team already use this commercially-successful technology for their operations as well space exploration preparatory activities closes the loop nicely,” says Arnaud Runge, medical engineer who supervised the technical development of the Tempus Pro. “It demonstrates ESA’s ability to support industry in many different areas”.

Their journey to Antarctica marks the first step in a recent agreement between ESA, the Argentine Antarctic Directorate (DNA) and CONAE (National Commission of Space Activities). This growing scientific cooperation will include other institutions such as the Catholic University of Argentina, National University of Quilmes and CONICET. It will allow further development of scientific and operational projects in the extreme environment of the Antarctic continent as ESA prepares for further exploration of our solar system.

First results of the experiments should be available in the coming weeks and demonstrate how Tempus Pro can be used to medically support a crew of explorers in a situation and environment that most closely resembles what future astronauts will encounter on Mars.




Device development

The Tempus Pro devices were developed by RTK (Remote Diagnostic Technology) in the UK with funding and support from the Business Applications part of ESA’s ARTES (Advanced Research in Telecommunications Systems) program. 4)

The unit combines the diagnostic facilities found in standard hospital vital signs monitors with extensive two-way communications, packaged in a compact, robust, highly portable unit that can be tailored to user needs with the use of external devices.

It has GSM (3G), GPS, wi-fi, bluetooth and ethernet connectivity, and can use available VSAT facilities to exchange voice, video, medical data and GPS positioning.

It is a robust portable device for monitoring vital signs and providing communications for medics developed with the support of ESA offers a lifeline even in the remotest areas on Earth via satcom.

Various external devices can be connected such as a digital stethoscope, video laryngoscope, contact temperature sensors and electrocardiogram leads and USB ultrasound probe.

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Figure 7: Ultrasound patient monitoring using Tempus Pro (photo credit: ESA) 5)

Portable telemedicine device for medics

Can satellite-based telemedicine offer real benefits to medical practitioners working in remote locations? With the support of the European Space Agency, a recent ARTES project set out to try to answer that question. The goal was to see whether portable satcom technology could be successfully deployed for the transmission of key medical data from remote locations to doctors and healthcare technicians who provide medical support at a long distance in emergencies. 6)

Tempus Pro provides all the integrated features and capabilities expected in a market-leading vital signs monitor with extensive two-way communications, packaged in a compact, robust, highly portable unit designed to meet users immediate and evolving needs and budgets, with the ability to add advanced capabilities post-purchase.

The unit, which was developed by UK-based Remote Diagnostic Technologies (RDT), has GSM (3G), GPS, WiFi, Bluetooth and Ethernet connectivity, and can use VSAT to exchange voice, video, medical data and GPS positioning. Various external devices can be connected such as contact temperature sensors, electrocardiogram leads and a USB ultrasound probe.

The ability to share all vital signs and patient care record data including graphical and tabular trends, twelve-lead ECG recordings and images from the integral camera in real time increases situational awareness and allows for better-informed treatment and transport decisions to be made.

Teaming up with the French firm International SOS, RDT deployed the device in real-life situations, under rugged conditions, over a six-week period in Algeria and Nigeria. International SOS provides medical and security services for businesses and large organizations through an extensive network of offices across 35 countries, staffed with clinical personnel. They provide direct medical care, supported by a network of assistance centers staffed by doctors, nurses and specialist call handlers.

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Figure 8: Injury locations are entered via a touchscreen interface (photo credit: ESA)

“Initially, participants were slightly skeptical of the idea of telemedicine,” observed Dr Arnaud Derossi of International SoS. “However, they were quickly won over by the Tempus Pro. By the end of the six-week period, they were extremely positive about the possibilities it offers. “The key to the unit’s success is that it is a fully functional, hospital-grade vital signs monitor. On top of that, it offers very useful communications facilities.”

International SoS is active typically in locations served by poor roads with security challenges, and medical evacuations by air can be costly and problematic to arrange. “Often it is simply a matter of a medical practitioner in the field wanting to get a second opinion from a colleague. At times, a remote consult can even save an unnecessary medical evacuation,” added Derossi.

The RDT team has observed that it takes less than an hour for an experienced medical professional to learn the basic functions.

For non-medical users, RDT offers the Tempus IC, which was developed during an earlier ARTES project that ran from 2006 to 2008. “The Tempus IC has been a very successful product for RDT in the non-medical user markets,” says RDT’s Integration and Applications Manager, Mark Williams.

Tempus IC is regularly used by non-medical experts, such as pilots, crew and key staff to transmit the medical data routinely collected in an ER – such as blood pressure, cardiac condition, pulse and respiration – to 24/7 ground-based doctors from aircraft, yachts and remote locations. According to Williams, there is great interest in the new unit Tempus Pro, which is designed expressly for medical professionals, both in the civilian and in the military world.

“What made the Amazon project remarkable,” says ESA Technical Officer Arnaud Runge, “was that it didn’t concern just the development of a prototype – the Tempus Pro is a fully-certified medical device which has been validated with an end-to-end operational service.”

“ESA is highly active in health and life sciences, supporting some such 160 projects during the past 10 years, easily half of which have been telemedicine applications.”



1) ”Funds increase for space in response to COVID-19,” ESA / Applications / Telecommunications & Integrated Applications, 08 May 2020, URL: http://www.esa.int/Applications
/Telecommunications_Integrated_Applications/Funds_increase_for_space_in_response_to_COVID-19

2) ”Telemedicine on the frontline in Spain,” ESA / Science & Exploration / Human and Robotic Exploration, 30 April 2020, URL: http://www.esa.int/Science_Exploration
/Human_and_Robotic_Exploration/Telemedicine_on_the_frontline_in_Spain

3) ”From Antarctica to space: telemedicine at the limit,” ESA / Science & Exploration / Human and Robotic Exploration, 30 January 2020, URL: http://www.esa.int/Science_Exploration
/Human_and_Robotic_Exploration/From_Antarctica_to_space_telemedicine_at_the_limit

4) ”Tempus Pro telemedicine device,” ESA Applications, 9 January 2014, URL: https://www.esa.int/ESA_Multimedia/Images/2014/01/Tempus_Pro_telemedicine_device

5) https://www.esa.int/ESA_Multimedia/Images/2014/01/Ultrasound_patient_monitoring_using_Tempus_Pro

6) ”Portable telemedicine device for medics,” ESA, 10 January 2014, URL: https://artes.esa.int
/news/portable-telemedicine-device-medics



The information compiled and edited in this article was provided by Herbert J. Kramer from his documentation of: ”Observation of the Earth and Its Environment: Survey of Missions and Sensors” (Springer Verlag) as well as many other sources after the publication of the 4th edition in 2002. - Comments and corrections to this article are always welcome for further updates (herb.kramer@gmx.net).

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