Ambulance Data Connectivity Test in Kainuu, Finland

Kainuu Health District organized a system testing for Ambulance Data Connectivity in Kainuu region (Central-Eastern Finland) during the summer 2013. This is a free to use summary of the actual tests, results and summary with suggestions. The significance of a special vehicle router system is underlined.

Test Kit

Router

• Installed in the vehicle. Goodmill w24e-RR router with external magnet antennas.
• The router used total of three networks (WAN links). Two 3G networks - Sonera and Elisa, as well as one 450CDMA network
• The connection via the router to the computer is enabled through a WIFI Access Point connection.

Computer

• Computers used in this test were 2 laptops. 
• The first tests were carried out on the Windows XP operating system and the router plus an internal 3G modem (Mokkula)
• Second tests used Effica Health Care application by Tieto on the Laptops.
• This testing was carried out on the Windows 7 operating system with 3G USB modem and the router. Both 3G modems used DNA's network.

Tested applications

Effica

• Effica testing was carried out using a test environment which had the same IT requirements as the proper usage environment Effica would have.
• The programme requires a non-stop wireless network connection and does not allow any interruptions in the Wifi connection while the registration is being carried out.

Citrix

• Citrix remote desktop enables using Effica with a suboptimal internet connection.
• Effica runs on the server and there is a desktop view on the computer of the programme. With CITRIX, Effica does not sign the user out if the internet connection is interrupted for a short period of time.

Birdstep Technology Oy, Safemove

• Safemove software is needed for creating a password secure connection and changing connection without interruption. 
• When the connection is directed from the 3G modem to the router it causes the IP address to change - which would result in losing the Effica network connection. 
• A mobile IP address is created by the Safemove software, allowing the IP address to stay the same, ensuring the internet connection does not get interrupted.

Safemove software has vehicle router installed in as a priority connection to enable connectivity inside and close to the vehicle. When the WiFi connection to the vehicle is cut, the computer automatically starts using the 3G modem.

Test set up in Kainuu

Testing Methods Stage 1

In the first stage only the connection speed and the reliability was tested for Effica. At this stage only a router and a computer with a Windows XP operating system was used.

Road Test

The road test was mainly done using a moving vehicle. When the connection was poor the vehicle was brought to a halt.

The reliability of the connection was tested simply by running continuous ping-tests. Ping is a TCP/IP protocol tool which tests the reachability of a certain specified device. Ping sends an ICMP echo request package to the device, which the remote computer responds to with its own echo reply package. Ping tests were sent to the Google server address 8.8.8.8 using the Windows command line.

The upload/download connection tests were carried out using http://speedtest.net.

Apartment Test 

The testing methods were the same as in the road test. In each test situation the vehicle was parked about 10-20 metres outside the entrance.

The test locations were:

• A second floor of Kainuu First Aid’s building
• The Central Hospital Patient Tower; a concrete block of flats in Kajaani City Centre 
• A wood-insulated detached house in Kajaani's Pärsänsuo
• A tiled detached house in Vuolijoki.

Testing Methods Stage 2

During the second stage the suitability of Effica for First Responders was tested.

Stage 1 Test Results

Road test with router

The reliability of the internet connection was very good. The connection was not offline for more than ten seconds at a time even in the most remote areas. When the connection was poor the car was stopped which brought the connection speed up again. The minimum connection speed was 1Mbit which is high enough for Effica to function well.

The connection speed was also periodically tested using a single 3G modem without the router. This showed that connection speed was very low outside suburban areas. Effica would not work in these areas.

First Aid Building connectivity

The WiFi connectivity was tested from laptop to the vehicle. The connection to the vehicle router was not interrupted during the whole test period. The vehicle was parked ~10 metres from the main entrance.

Connection speed from the laptop near the building inside the car:

• Download  7,68 Mbit/s 
• Upload  2,01 Mbit/s
• Ping 74 ms

Connection speed inside the apartment:

• Download  2.84 Mbit/s
• Upload  1,53 Mbit/s 
• Ping 75 ms 

These both connection speeds are sufficient for Effica.

Patient Tower building connectivity

The vehicle was parked right by the patient tower, the distance to the car was ~20 metres. The WiFi connection from laptop to the router was cut almost instantly when entering the building.

Stone-built Block of Flats in Kajaani City Center

The vehicle was parked ~10 meters from the main entrance. The connection was lost when entering the building, ~10 meters from the building’s entrance.

Detached house, wood-paneling inside

Vehicle was parked ~10 meters from the main door. The connection was lost in the bathroom as this was farthest from the car. This was likely due to the concrete bathroom wall. The connection was also tested using a single 3G modem.

Connection speeds using a router:

• Download variable: 2.5-0.3 Mbit/s
• Upload variable: 1.5-0.1 Mbit/s
• Ping variable: 80-100 ms

Connection speeds using a 3G modem:

• Download Variable: 4.5-0.3 Mbit/s 

The connection speeds were better using a 3G modem in the laptop inside the flat.

Tiled detached house in Vuolijoki 

The vehicle was parked circa 10 meters from the main door. The laptop WiFi connection remained uninterrupted. Not much variation on the connection speed.

• Download 3.0 Mbit/s 
• Upload 2.0 MBit/s
• Ping 88 ms 

Stage 1 Test Summary

The connection cannot be guaranteed in all locations, but when in the near vicinity of the vehicle the CDMA450 connection is very comprehensive nationwide and therefore the connection is fairly reliable.

A router fixed inside the vehicle is needed when using Effica. This enables a reliable and comprehensive network. An additional laptop 3G modem connection is needed when using Effica in tall buildings and far away from the vehicle when in suburban areas.

Stage 2 Test Results

Road Test 

The Effica test environment stayed active and recordable throughout the route. The WiFi connection was active and operational the whole time. Downloading and uploading information went smoothly and without any major interruptions or twitching. The same Effica session was used throughout the road test. At one test point along the Lahnasjärven Road Effica was working even at ~100 metres from the car. For test reasons there was an inbuilt WiFi antenna in the car which probably shortened the range. A normal setup would be an outside antenna.

Stage two road test route

When tested outside the WiFi range, the laptop used Effica using 3G modem although connection was in this case very slow. A speed test for the 3G modem resulted in ping 875 ms and download 0,02 Mbit/s, whereas the router received ping was 85 ms and download 1.08 Mbit/s.

Kainuu road test data

A Detached House with a wood-paneling inside

The car was parked in the same spot as in the speed tests, ~10 metres from the main door. When entering the room that was furthest from the car, the connection automatically switched over to the 3G connection. There was virtually no difference in the recording once this happened. 

Patient tower (Kaks potilastorni)

The connection automatically switched to the 3G modem and recordability remained the same. The testing continued in the stairwell up to the 4th floor and recording of Effica was also working inside the lift going down.

Test 2 Summary

Effica works faultlessly using this setup. Switching between connections is unnoticeable to the user and it is likely to be sufficient for Effica over the whole Kainuu region. The connection to Citrix was lost a couple of times but this was due to the user. The same session was still open after logging back into Citrix. So even though the connection was lost in the middle of recording, the data was not lost.

End Result and Summary

It is possible to get the Effica patient database working reliably in ambulances. The router reliability and connection speeds are sufficient in and around Kainuu region. On top of the router, a 3G modem connection is needed because the WiFi connection does not work through thick walls or at distances greater than 100-300 meters from the vehicle.

The Safemove software from Birdstep Technologies Oy is also needed, as this enables the switching of the router and 3G modem connection to ensure that the Citrix connection is not lost.

You can read more about Kainuun sote, the organisation conducting the by clicking the link:

Modified from Finnish report by Juhani Lehtonen