**4.1 Innovative testing strategies**

Sampling patients to diagnose cases of COVID-19 is considered aerosol generating procedure by itself, thus requiring healthcare personnel (HCP) in full Personal Protective Equipment (PPE) to be recruited. In resource limited settings with scarcity of PPE, the concept of sampling booths has emerged. These are booths similar to telephone booths which are being used widely to sample patients in Delhi, Kerala and other states [6]. An innovative modification of the traditional kiosk called by the name "COVSACK" was made functional at ESI hospital in Hyderabad. The main differences from traditional kiosk being that COVSACK has the suspected patient inside the kiosk instead of the HCP. HCP is positioned outside the kiosk. Kiosk is

also equipped with self-disinfection capability. As HCP is positioned outside the kiosk and at theoretically reduced risk of aerosol exposure, the need for PPE is also reduced [7]. Few models with dual chamber booths have also been proposed and tried [8]. South Korea has devised an innovative model of "Drive Through" COVID-19 testing of patients [9].

Testing using RT-PCR has been the standard but with a drawback of prolonged downtime to obtain results especially in emergency settings. Over ten rapid antibody based kits for quick point of care testing have been devised, approved by Indian Council of Medical Research (ICMR) and validated for clinical use [10]. With easy availability this has led to increased rates of testing along with quicker results particularly in life threatening conditions.

A paper strip based COVID-19 detection test named "Feluda" has been devised by research team at the CSIR-Institute of Genomics and Integrative Biology in India and has been approved by Drug Controller General Of India (DCGI). Feluda is based on Clustered Regularly Interspaced Short Palindromic Repeats-cas 9 (CRISPR-cas 9) technology. The test has been performed on over 2000 patients reporting a sensitivity of 96% and a specificity of 98% which is very similar to the gold standard RT-PCR [11]. With quicker results feluda could help reduce number of patients waiting for over 12 hrs before interventions and definitive management procedures at emergency rooms.

#### **4.2 Innovative infection control and prevention strategies**

Care of COVID-19 patients revolves around several logistic issues such as availability of oxygen ports and ventilators in resource constraint settings. Innovative methods of oxygen splitting and ventilator splitting to benefit multiple patients using a single device have been proposed and utilized in few parts of the country with success [12, 13]. Critically ill patients mandate interventions such as intubation which is aerosol generation procedure requiring measures to ensure HCP safety. Novel aerosol containment chambers have been designed with modifications and used in India [14, 15]. These plastic or acrylic boxes have openings to allow HCP insert his hands and maneuver as per need.

Innovative negative pressure isolation tents called "Care cube" have been functional in United States to care for COVID-19 patient population [16]. These tents being low-cost models, similar designs can be adapted in resource limited settings for infection control and prevention. Overcrowded ER with lack of free space to set up new isolation areas can resort to such negative pressure tents to cater to COVID-19 positive patients.

#### **4.3 Innovative airway management strategies**

Companies like AgVa solutions, Big Band Boom Solutions, Aerobiosys, etc. are building cost-effective portable ventilators. They are also lending a helping hand in ramping up the production and supply of ventilators to the hospitals.

InnAccel Bangalore, a Stanford India Biodesign based medical devices setup, has come to the fore with SAANS Pro, a non-invasive breathing support system that was developed to serve as an alternative for ventilators in low resource settings. The device has been designed to function with limited or no oxygen supply, with an added benefit of being portable. This can be used in ambulances to transport patients and in rural tertiary care centers where ventilators are in short supply [17].

The Gradian CCV (Comprehensive Care Ventilator) supports critically-ill patients in settings with unreliable supplies of power and oxygen, including temporary field hospitals being set up to manage COVID-19 patients in many countries.

*Practice Changing Innovations for Emergency Care during the COVID-19 Pandemic in Resource… DOI: http://dx.doi.org/10.5772/intechopen.98293*

The ventilator can run for 21 hours on battery power, and its portability features enable single-ventilator use throughout critical care, including patient transport. Simulation-based training is a critical component of Gradian's model, with teams of clinicians and bio-medical technicians providing remote and on-site training to healthcare providers. Gradian has placed ventilators in Nepal, Sierra Leone, Kenya, and several other countries, conducted several remote trainings with clinicians, and is continuing to work with more health systems to build capacity for COVID response and other critical care needs [18].

RespirAID is a portable breathing support system developed by Biodesign Innovation Labs with an aim to meet the shortage of ventilators in Indian hospitals and globally. It uses a ventilation strategy called Intermittent Positive airway pressure that can moderate essential respiratory parameters. This makes it suitable for patients who are at severe risk of lung collapse [17].

#### **4.4 Telemedicine innovations to combat COVID-19**

Digital healthcare has been a boon in testing times of COVID-19 pandemic. Telemedicine has been used widely for obtaining consultations and care via virtual pathway. Many healthcare setups across the country have switched to telemedicine based patient care. From obtaining appointments before presenting at a healthcare facility thereby reducing overcrowding to obtaining consultations and treatment for minor ailments, telemedicine has facilitated patient care in a simple and user-friendly manner. Telehealth care to a certain extent has helped in maintaining the continuum of care of chronically ill patients unable to visit healthcare setups amid COVID-19 case surges and lockdowns. Telemedicine has been a virtually perfect way to deploy HCP for patient care in remote parts of the country [19, 20].

Prior to the pandemic, the growth of telemedicine has been very slow. The apprehension among the medical practitioners regarding the legality of providing virtual healthcare has been a major contributory factor for the lack of exponential growth of telemedicine. All it required was a little help from the virus, to take telemedicine from sidelines to the centre stage.

With hospital beds and isolation centers stretched more than ever, healthcare organizations are helping patients better manage their care at home when it's deemed safe to discharge them. It can prevent costly and life-threatening readmissions by catching problems before they arise. Patients with mild symptoms receive a telehealth kit that includes a laptop with preloaded apps through which they can monitor their signs and communicate twice daily with a nurse by phone or virtual visit.

#### **4.5 Technological innovations to combat COVID-19**

#### *4.5.1 Online COVID-19 screening tools*

Artificial Intelligence (AI) Highway provides pre-screening and triage tools that are based on risk-assessment scores for Covid-19, linked to symptoms, contact history and more.

#### *4.5.2 Robots on duty*

With pandemic continuing, many countries have come up with the idea of using robots to help the medical staff which limits the risk to their lives. The major duties of these robots are autonomous delivery of food, medicine and other consumables

inside the isolation wards. They also disinfect the used items and allow patients to communicate with physicians and relatives [21].

#### *4.5.3 3D-printed medical equipment*

With the increasing number of COVID cases, the nation is scrambling to address the shortage of Ventilators, Personal Protective Equipment (PPE) and other medical devices. Amid this crisis, Indian research institutions and companies have started hinging on 3D-printing techniques as a quick fix. Medical equipment such as ventilators, face shields, oxygen masks, parts of virus test kits and other protective gear to deal with the pandemic are produced in large numbers with the help of this modern technology to address the shortage. 3D-printed ear guards for hospital staff to help alleviate the pain caused by wearing face masks for too long [22] and 3D-printed ventilator valves for dealing with COVID-19 [23].

#### *4.5.4 Artificial intelligence*

The use of AI in healthcare is not a new concept and has been around for long. Researchers and data scientists around the world are looking to use Artificial Intelligence as a way of addressing the challenges posed by the coronavirus. Several hospitals have started using AI software- which learns from experience- to help with diagnosis and assessments. Recently, a group of scientists made use of Artificial Intelligence to identify an underlying genomic signature for 29 different DNA sequences of the novel coronavirus, providing an important tool for vaccine and drug developers.

Indian based Internet of Things (IoT) startup called HELYXON uses AI-enabled devices for better management of the pandemic by constantly monitoring the vital parameters of patients or suspects. 98.6 Fever Watch is another innovation which is useful particularly for unwell children in whom continuous monitoring of temperature is a vital parameter in disease management. It connects to hospitals systems or personal systems and keeps transferring patient information to a central dashboard.

Qure.ai has deployed new solutions that automatically read and interpret chest X-Ray scans for COVID-19 in seconds. This tool quantifies how much of the patient's lungs have been affected, enabling the clinicians to monitor disease progression more effectively.

Bengaluru start-up Predible Health is using AI-based radiology solutions to pre-screen COVID-19 patients with the help of a tool LungIQ, which can measure percentage of lung damage in patients through CT scans & help doctors understand how badly a patient is affected and if he needs a ventilator or not.

Aggressive contact tracing:

Using mobile apps, security camera footage, facial recognition technology, bank card records, and global positioning system (GPS) data from vehicles and mobile phones to provide real-time data and detailed timelines of people's travel. Acrylosorban instrument to collect body fluids and to dispose of it safely, an isolation pod that restricts COVID-19 patients from having contact with others.

#### *4.5.5 Contact tracing apps*

Contact tracing applications enable users who have come in contact with COVID-19 positive patients to be notified, traced and suitably supported. The Aarogya Setu was initially conceived as a sophisticated tracking tool to map out epidemic hotspots. But along with that it is capable of exchanging short-distance Bluetooth signals when individuals are in proximity to each other. The application *Practice Changing Innovations for Emergency Care during the COVID-19 Pandemic in Resource… DOI: http://dx.doi.org/10.5772/intechopen.98293*

records these encounters and stores them in their respective mobile phones. If an individual is diagnosed with COVID-19, government accesses the data to identify contacts of the infected person. South Korea implemented tools for aggressive contact tracing, using security camera footage, facial recognition technology, bank card records, and global positioning system (GPS) data from vehicles and mobile phones to provide real-time data and detailed timelines of people's travel. By identifying and isolating infections early, South Korea maintained among the lowest per-capita mortality rates in the world [24].

Through "Corona Watch" application, the location of corona affected patients can be tracked and their movement history of last 14 days can be recorded. A containment watch app has also been developed to undertake survey in containment zones and ensure the provision of essential services.

#### *4.5.6 Drone technology*

Drones are being used for delivery of blood, medicines, PPE and other essential medical supplies in many countries [25].
