Have cell phones improved survival rates in life-threatening emergencies?

May 11, 2023
Since the beginning of the cell phone era, we are always available and in touch, regardless of the location or time. This means we can get help quickly when we witness an accident or emergency. Be it a heart attack, a stroke, a severe injury, a car accident, etc. We only need a few seconds to reach the emergency number. Within a few minutes, an ambulance usually arrives, and an emergency team can help us. In the 1990s, when cell phones started to gain popularity, calling for help required a phone location, so the time between the emergency and the arrival of an emergency medical team was significantly longer. The cell phone revolution began in 1996 when Motorola launched the first flip phone (StarTAC model). Since then, small wireless phones have become cheaper and widely available. According to Statista, in 2021, there were already 15 billion cell phones, and this number is growing. Forecasts predict 18.2 billion devices by 2025. However, the penetration of mobile communications differs between countries: in Hong Kong, there are 3 phones per resident, statistically, and 2 in the United Arab Emirates. The last ones on the list are Sudan (0.36 phones per resident), Kiribati and Mozambique (0.42).

A correlation which is difficult to prove

Specifying the effect of mobile communications on the death rate in emergencies is not so easy. There are two reasons. First, it is impossible to carry out a randomized controlled trial, i.e., a study in which one group would call for help using a landline phone, and another group using a cell phone. Those calls must refer to the same case to eliminate other factors. We could compare countries with greater and smaller mobile phone penetrations, but then we would have to consider other variables. For example, countries with greater mobile communications penetration are usually well-developed countries. And it means – they also have better healthcare infrastructure etc. So comparing them to less developed countries make no sense—however, some studies compared reports made using cell phones and landline phones, which we will discuss further below. What’s more, there are many other factors affecting the death rate over the years. Let’s take an example of stroke, where the response time determines the chances of survival. The “golden hour” is a door-to-treatment time of 60 minutes or less in which a patient should be diagnosed, and thrombolytic treatment should be introduced, aiming at dissolving a thrombus blocking a cerebral artery. In the “Factors Influencing the Decline in Stroke Mortality” study published by the American Heart Association, the researchers indicated a significant decrease in the death rate within the last few decades. This mainly results from a reduced stroke frequency, which we owe to the introduction of arterial hypertension monitoring in the 1970s. Other factors that contribute to higher survival rates are diabetes and dyslipidemia monitoring programs and the decreasing smoking rates combined with hypertension treatment. Looking at the chart showing the death rate over the last 70-80 years, we can indeed see the death rate due to cardiovascular diseases has dropped more than three times. Surprisingly, no big bumps in the decreasing trend have been observed since the 1990s, when cell phones became popular. However, this does not mean a lack of correlation.

Small-scale studies provide more insights

Many studies confirm the positive effect of mobile communications on the survival rate in emergencies. One example is a study carried out at Kanazawa University in Japan. The researchers analyzed 3000 out-of-hospital cardiac arrest (OHCA) cases in Ishikawa Prefecture between 2012 and 2014. The conclusion was that the survival rate was higher in the case of emergency communication via a cell phone as compared to a landline phone. More specifically, the one-month survival, in the case of OHCA with communication using a cell phone, was significantly higher (9.1%) in comparison to a landline phone (4.3%). Aside from the response time, cell phone communication has one significant asset: the caller can approach the patient. This means that medical dispatchers can obtain more detailed and precise information on the patient’s condition and that other people can provide first aid, following real-time instructions. Returning to the first aid response time, we should also consider another technology – the ability of paramedics to locate cell phones. This kind of technology does not always work. In Europe, 112 does not allow the people making emergency calls to be located. To make it possible, an emergency communications center must implement AML technology, while the caller’s telephone must also be equipped with AML technology. It is available for smartphones with Android and iPhones with iOS 11.3 or later. Otherwise, the caller must inform the paramedic about their location. In December 2018, the European Commission adapted new requirements - smartphones sold in the EU starting from March 2022 must be equipped with the GNSS function. This allows them to locate the person calling the emergency services.

The effect is not significant

Interesting results come from the “Mobile Phone Use for Contacting Emergency Services in Life-threatening Circumstances” study, which analyzed 354,199 cases of ambulances dispatched to emergencies. Here the conclusion is similar: reporting an emergency using a cell phone, as compared to a landline phone, significantly reduced the risk of death in the location of the accident. However, this did not affect the number of fatalities following transportation to an emergency department. The relationship between using cell phones to call emergency services in emergencies and the improvement of the treatment results in patients is a fact. However, the popularization of cell phones did not have a revolutionary effect on the decrease in the death rate that one might expect. The death rates in emergencies, such as a heart attack, a stroke, or a car accident, continue to drop. This trend is supported by several other factors, including lifestyle, healthcare infrastructure, prevention, new treatment technologies, etc.