Advanced Engineering Informatics 54 (2022) 101766

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Advanced Engineering Informatics

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Full length article

A framework for the elderly first aid system by integrating vision-based fall
detection and BIM-based indoor rescue routing
Yuan Chen a, Yuxuan Zhang b, Bo Xiao c, *, Heng Li c
a
College of Management and Economics, Tianjin University, Tianjin 300072, China
b
Department of Civil and Environmental Engineering, University of Alberta, Edmonton T6G 2R3, Canada
c
Department of Building and Real Estate, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region

A R T I C L E I N F O A B S T R A C T

Keywords: The occurrence of falls among older adults may result in life-threatening injuries and accidental deaths due to
Building Information Model (BIM) their vulnerability. As such, an advanced first aid system is significantly necessary to accurately detect falls and
Fall detection provide prompt assistance. However, current research primarily focused on fall prevention, fall detection, and
First aid system
first aid services after falling, thus lacking studies dealing with a systematic solution. To address this issue, the
Older adult
present research proposes an integrated framework for the elderly first aid system in an indoor environment
Rescue routing
using computer vision and building information model (BIM) techniques, which consists of three primary
components: a vision-based module for fall detection, a cloud server (internet), and a BIM-based module for
rescue routing. The experimental results showed that the proposed method could achieve 94.1% precision in
identifying the fall status of older adults (i.e., falling or non-falling). Also, the proposed method enabled to
automatically generate a rescue route in consideration of the routing accessibility for first aid in a BIM envi­
ronment. The framework proposed in this study will improve the efficiency of the elderly first aid when falls
occur, with shortening the rescue time to mitigate injury severity.

1. Introduction biological, behavioural, environmental, social, and economic factors)

Population aging has become an unprecedented demographic chal­
lenge that almost all countries are confronted with [1]. As of 2019, 703
million people were aged 65 years or over worldwide, accounting for 9%
of the total population; the number of elderly people is expected to
double to 1.5 billion by 2050, which makes up 16 % of the global
population [2]. As people get older, their body form, physiological
function, and physical quality will gradually decline, and their mobility
efficiency will also be significantly reduced. As such, it is common for
elderly individuals to fall, and their risk of falling rises drastically with
age [3–4]. For instance, the likelihood of falling for people aged 65–69
years is approximately 22%, while this percentage is more than 35%
among individuals aged 80 years or over. In terms of older adults, falls
are the major cause of life-threatening injuries and accidental deaths [5]
and are a frequent causal factor for hospital and long-term care visits
[6].
Currently, numerous studies have investigated causes for falls among
older adults (e.g., environment, gait problems, and weakness) [7–8] and
risk factors that lead to having a greater potential for falling (e.g.,
[9–10]. Based on these findings, fall prevention strategies and measures
could be put forward accordingly. However, the above research studies
tend to be carried out before the occurrence of falls or after collecting
extensive incidents of falls. In fact, the amount of time that elderly
people spent lying on the floor or ground is critical after a fall occurs [8],
especially when they fail to call for help or need lots of time to get up
individually.
These problems highlight the need for an advanced first aid system
that can accurately detect falls and provide prompt assistance for the
elderly to mitigate injury severity [11]. Although the existing literature
outlines a diversity of fall detection-based first aid systems [12–13],
little attention is given to the system’s capability in indoor rescue
routing after receiving an alert, which might cause a problem of route
accessibility in real practice. Specifically, with the improvement of
living standards, an increasing number of older adults prefer to select
age-restricted communities (a type of residential apartment) since they
can live with individuals of a similar age and have better residential
satisfaction due to a high quality of life and social interaction [14]. In
this context, the rescuer may find a route on his/her own when they are

* Corresponding author.
E-mail addresses: yuanchen_2020@tju.edu.cn (Y. Chen), yuxuan.zhang@ualberta.ca (Y. Zhang), eric.xiao@polyu.edu.hk (B. Xiao), heng.li@polyu.edu.hk (H. Li).

https://doi.org/10.1016/j.aei.2022.101766
Received 15 March 2022; Received in revised form 15 August 2022; Accepted 19 September 2022
Available online 28 September 2022
1474-0346/© 2022 Elsevier Ltd. All rights reserved.
Y. Chen et al.
not familiar with the indoor environment or may be given a rough route
to arrive at the location where a fall occurred and exit the building. This
routing strategy may be suitable for the rescuer only, but when the
injured need to be transported to the exit of the building or any location
in this building with the help of some medical equipment, such as
wheelchairs or stretchers, accessibility of routes in indoor environments
should be more important to the rescuers instead of the shortest route
[15].
The objective of this study is to develop a novel framework for the
elderly first aid system that can detect falls of older adults in an indoor
environment, send first aid messages, and generate an accessible rescue
route. To fulfil the purpose of indoor rescue routing based on accessi­
bility, the design configurations of a building, such as layout and ge­
ometry of exits, need to be provided in advance to support the decision-
making for accessible rescue routes. Compared with conventional
computer-aided design (CAD) drawings, building information model
(BIM) that is defined as “a digital presentation of physical and function
characteristics of facility” [16] is usually treated as an information-
sharing platform assisting in the design, construction, operation and
maintenance as well as supporting various stakeholders to make de­
cisions during the whole lifecycle of a project [17]. In this regard, the
database of BIM is adopted in this study to support efficient and useful
information retrieval among building attributes within different envi­
ronmental situations. It is believed that the interaction between BIM-
based rescue route planning and fall detection analysis could support
a more precise and efficient decision in the first aid procedure of elderly
falling.
The structure of the remainder of this paper is as follows. First, a
literature review regarding fall detection methods and BIM-based route
planning is presented in Section 2. Section 3 introduces the framework
of the elderly first aid system, which could be illustrated through two
primary parts: fall detection for the elderly and BIM-based indoor rescue
routing. The feasibility of the developed methodology is then validated
by the experimentation in Section 4. Finally, conclusions and the di­
rection of proposed future research are summarized based on the results
of this study.
2. Literature review
2.1. Methods for fall detection
Fall detection attracts significant research attention from academia
because the timely detection of falls is the fundamental step for imme­
diate assistance to rescue people, especially elderly people. The methods
developed for automatic fall detection can be roughly categorized into
wearable-based methods and ambience-based methods according to the
type of sensor involved [13]. Wearable methods tend to utilize attach
sensors (e.g., accelerometers, gyroscopes, and pressure sensors) on
clothes or shoes for fall detection. For example, Montanini et al. [18]
adopted a footwear-based fall detection method by attaching pressure
sensors to shoes, which achieved a maximum accuracy of 97.1% in ex­
periments. Antwi-Afari and Li [19] used a wearable insole pressure
system to investigate changes in biomechanical gait stability parameters
based on foot plantar pressure patterns so that fall risks of construction
workers could be analysed. Lee and Tseng [20] put forward a
smartphone-based fall detection system that can identify crucial
thresholds of the falls and non-falls based on the features of triaxial
acceleration values derived from smartphones. Pandya et al. [21]
developed a web application for real-time fall detection by integrating
accelerometer and gyroscope sensors. Nahian et al. [22] proposed a
novel elderly fall detection system by integrating accelerometer and
time-series feature analysis. Nho et al. [23] introduced a generative
adversarial network-based fall detection method using a heart rate
sensor and an accelerometer so that caregivers could promptly receive
alert when a fall occurs. Nooruddin et al. [24] conducted a review of two
main categories of sensor-based fall detection systems (i.e., single
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Advanced Engineering Informatics 54 (2022) 101766
senior-based and multiple senior-based) and made a comprehensive
comparison of detection performance among these systems. However,
this category of methods usually requires prior installation or posi­
tioning, which makes their usage relatively inconvenient to some extent.
By contrast, ambient sensors (i.e., RGB cameras and depth cameras)
have been widely adopted for fall detection due to the rapid develop­
ment of computer vision. As such, analysing recorded videos by vision-
based methods has become an important research direction for fall
detection. Generally, vision-based methods detect person objects from
videos at each frame and then classify their activities. For instance, de
Miguel et al. [12] proposed a vision-based fall detection system by
integrating object tracking and the K-nearest neighbours classifier.
Núñez-Marcos et al. [25] adopted a vision-based fall detection method
based on VGG16 [26], which is independent of environmental features.
Harrou et al. [11] detected the elderly from videos and classified the
falling activity by the support vector machine. Lu et al. [27] developed
3-dimensional convolutional neural network (3D-CNN) and long short-
term memory networks (LSTM) to detect falling activities from video
in an end-to-end manner.
Although existing vision-based methods based on ambient sensors
have achieved comparable performance to wearable-based methods in
terms of fall detection, there still exist two limitations: (a) the perfor­
mance of vision-based methods is sensitive to the background environ­
ment in videos, which results in low generalizability; (b) the robustness
of vision-based methods needs to be improved since most methods
simply analyse the whole areas of person objects for classification, while
other information, such as person skeleton, is not taken into account. To
solve these limitations, this research will propose a novel vision-based
fall detection method integrating the recognized skeleton of person
objects.
2.2. BIM-based route planning
Although many efforts have been devoted to developing fall detec­
tion methods that are used to precisely classify the status (i.e., falling or
non-falling) of older adults and (or) alert a designated person or emer­
gency services, there is still lack of a detailed solution of decision-
making for rescue route planning after fall detection and further a
comprehensive elderly first aid system. As the buildings nowadays are
increasingly complex and interconnected, the desire of route planning in
indoor environments is becoming increasingly valued [28]. As empha­
sized in previous studies, the cost of healthcare related to elderly falls
could be greatly influenced by the response and rescue time [29]. Thus,
a timely response and appropriate rescue route planning could be crit­
ical factors for the first aid system for elderly falls. In the building in­
dustry field, BIM as a digital, reliable, three-dimensional virtual
representation of buildings that embeds with a rich body of information
regarding the building elements, has been widely used in the lifecycle of
building projects including the design decision-making, construction
planning and scheduling, maintenance, and cost estimation of projects
[30].
Among extensive BIM applications, the incorporation of BIM tech­
nology in indoor rescue planning has been attracting increasing atten­
tion over the last decades. For instance, Chen and Huang [31] began
with the investigation on the capacity and time for building evacuation
with the support of the information from BIM. Some studies further
explored its capability by integrating BIM in route planning for pedes­
trian navigation to improve the quality of route planning [31–33].
Similarly, Cheng et al. [34] integrated BIM with an agent-based model to
assess the performance of different evacuation decisions. Different from
the global shortest route planning in the BIM environment, other
research studies attempted to fully utilize BIM models in a particular
situation. For instance, Strug and Ślusarczyk [35] retrieved the infor­
mation from BIM along with the sensing technologies and natural lan­
guage processing to balance the route distance and complexity, which
was proved to provide the optimal pedestrian navigation for blind and
Y. Chen et al. Advanced Engineering Informatics 54 (2022) 101766

visually impaired people. Chen et al. [36] and Wang et al. [37] inte­
grated BIM with fire dynamic simulators for estimating safety egress
time and escape distance as well as resource arrangement to provide
help of route navigation for people in the fire emergency. Deng et al.
[38] proposed a BIM-based framework for emergency evacuation nav­
igation focusing on the local safety performance. In summary, enough
research has been carried out into the indoor route planning in a BIM
environment, while there was no single study that adequately addressed
the issues of the accessibility requirements of building elements in the
process of transporting the injured for the first aid system. Also, a
comprehensive solution of route planning for elder fall protection is still
expected in practice.
3. Elderly first aid system development
3.1. Overview of system architecture
An integrated framework of an elderly first aid system is proposed in

Fig. 1. A framework for the first aid system of elderly falls.

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Y. Chen et al.
this study to automatically detect fall activities of older adults in an
indoor environment, monitor the real-time status of older adults, and
further formulate the rescue route with the support of the BIM envi­
ronment. Fig. 1 presents a brief overview of the system architecture of
the proposed elderly first aid system, which is composed of three com­
ponents: a) a vision-based module for fall detection in an indoor envi­
ronment; b) a cloud server (internet) module to receive the falling alerts
and notify the staff in an emergency and rescue centre (e.g., nursing and
security personnel in an age-restricted community) for further rescuing
actions; and c) a BIM-based module for indoor rescue routing consid­
ering the accessibility requirements of building elements. Specifically,
by analysing the video clips captured by indoor cameras using computer
vision-based technologies, the emergency status (i.e., fall status) of the
older adult could be recognized by feature extractors and skeleton
classifiers. The vision-based module for fall detection (Part (a) in Fig. 1)
then connects to the cloud server module (Part (b) in Fig. 1) and sends
out the alter information. The indoor cameras have the unique serial
numbers that are linked to the location information. As such, the cloud
server maintains the record and sends it to the emergency centre for
further processing; meanwhile, the corresponding data will be shared
with the BIM-based module (Part (c) in Fig. 1). Once personnel in the
emergency centre confirming the status of the injured and selecting the
emergency transport equipment, an accessibility analysis of building
elements and transport tools will be conducted in the BIM environment
and further the most efficient rescue route can be generated by means of
the proposed algorithm.
It should be noted that the following sections will primarily give a
detailed introduction for the vision-based module and the BIM-based
route planning module, respectively, since the cloud server technology
used in Part (b) is relatively mature and there are many available
hardware and software tools to support the real-time monitor and
emergency notification service functions. For instance, Taramasco et al.
[39] used 3G networks to develop a cloud server enabling the data ex­
change between the web platform and a mobile device. Parane et al.
[40] incorporated Wi-Fi or Bluetooth techniques to forward the data to
the cloud where the data is stored for further processing or future
reference. To adopt this framework in reality, the users could select an
appropriate approach to achieve this purpose according to the available
resource and the environment context. In addition, the fall detection
method proposed in this study will target daytime scenarios because the
illumination conditions during the day are more stable and suitable for
vision-based methods.
3.2. Fall detection for the elderly
Fig. 2 shows an overview of the proposed vision-based method for
Fig. 2. Overview of the method for fall detection.
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Advanced Engineering Informatics 54 (2022) 101766
fall detection, which consists of four main steps, including object
detection, tracking, skeleton detection, and skeleton classification. First,
the object detection method is executed on all frames in the input video
to detect person objects with producing the pixel location information.
Then, the detection results across frames are associated for tracking
person objects, and a unique identification (ID) number is assigned for
each object. Next, the tracked person objects are input into the skeleton
detection step to recognize the skeleton of each person. Finally, the
skeleton areas are forwarded into a CNN for classifying the status of an
older adult into falling or non-falling.
3.2.1. Object detection and tracking
In the proposed method, object detection is the first and fundamental
step that aims to detect person objects from each frame in a video. Object
detection produces two kinds of information in terms of the presence of
person objects and their pixel locations. In this research, the Faster
region-based convolutional neural network (R-CNN) [41] is integrated
for person detection. The Faster R-CNN method is one of the most ac­
curate object detection methods in the computer vision community,
achieving a mean average recall (mAP) of 41.6% and 75.9% on the
common objects in context (COCO) dataset [42] and pascal visual object
classes dataset [43], respectively.
As illustrated in Fig. 3, Faster R-CNN is composed of a feature
extraction network (FEN), a region proposal network (RPN), and a
classifier network (CLS). When an image is inputted to Faster R-CNN, the
FEN adopts ResNet50 networks [44] to generate feature maps that
represent the original image. In the RPN, multiple spatial windows are
proposed to slide over the feature maps produced by FEN. Then, 12
regions of interest (ROIs) are initialized for each sliding window, and all
ROIs are processed by a three-layer CNN, a box classification network,
and a box regression network. The top 300 ROIs are fed into the CLS to
compute the possibility of each ROI being the person object and the pixel
location of the person object. By applying non-maximum suppression on
the outputs of CLS, the detection results can be produced to indicate the
presence of person objects and their corresponding location on the
image. Notably, this study adopts Faster R-CNN pretrained on the COCO
dataset, which can detect 90 classes of objects, including persons. The
detection results are filtered by only keeping the person category since
this research focuses on the fall detection of a person.
The object tracking aims to associate the detection results across
frames to assign a unique ID for each object in the video. In the proposed
method, the simple online real-time tracking (SORT) [45] method has
been selected for object tracking due to its high processing speed (260
Hz) and stable tracking performance (33.4% on multiple object tracking
accuracy). In SORT, Kalman filtering first predicts the tracking boxes in
the current frame. Then, the detection boxes are associated with the
Y. Chen et al.
Fig. 3. Overview of the Faster R-CNN.
tracking boxes at each frame by using the intersection-overunion (IoU)
similarity, and a matrix is built in the association process. Finally, the
tracking problem is converted into a linear assignment problem, which
is solved by the Hungarian algorithm [46]. The results of the object
tracking are fed into the skeleton detection step.
3.2.2. Skeleton detection
The tracked areas of the person objects at each frame are fed into the
skeleton detection to estimate their skeleton. The retrieved skeleton
contains the pose information of the person, which can be used for fall
detection. In this research, the OpenPose method [47] for human pose
estimation aiming at single or multiple objects will be employed for
skeleton detection because of its high accuracy and inference speed. As
reported, the OpenPose method achieved a mAP of 75.6% on the MPII
multi-person dataset [48] with an inference time of 36 ms in a GPU
environment.
Fig. 4 shows an overview of the OpenPose method. First, a tracked
person area is processed by a multistage CNN producing two kinds of
information: a) a set of confidence maps of body part locations and b) a
set of 2D vector fields of part affinity fields (PAFs), which contains the
degree of association between parts. Then, the confidence maps and the
PAFs are forwarded into the part match step to generate the 2D key
points of the person object by using greedy inference. Finally, the key
Fig. 4. Overview of the OpenPose method.
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Advanced Engineering Informatics 54 (2022) 101766
points are assembled to produce the skeleton detection result, where the
detection skeleton contains 17 key points or joints of the body. Notably,
the OpenPose method has already been trained on the COCO and MPII
datasets for recognizing person skeletons, and no further fine tuning is
required in the skeleton detection step. For each tracked person object,
the OpenPose method will produce a skeleton image, which comprises
the black background and colourful skeleton.
3.2.3. Skeleton classification
The main purpose of skeleton classification is to classify the skeleton
images produced in the previous step into the following status: falling or
non-falling. The classified status of all tracked person objects is formed
as the output of the proposed fall detection method. In the present
research, the ResNet101 classifier [44] has been integrated for skeleton
classification. ResNet101 is a state-of-the-art deep learning classifier
with implementing the residual block, which achieved the top 1 accu­
racy of 77.37% and the top 5 accuracy of 93.56% on the ImageNet
dataset [49]. The concept of the residual block is to add the convolu­
tional output weights to the input weights as the final output weights of
the block, which can be used for solving the gradient vanishing problem
in deep neural networks.
The detailed architecture of ResNet101 is illustrated in Table 1. First,
the skeleton image is resized to 224 × 224 and processed by a 7 × 7
Y. Chen et al. Advanced Engineering Informatics 54 (2022) 101766

Table 1 3.3. BIM-based indoor rescue routing

The architecture of ResNet101.
Layer name Output size Architecture (kernel size, depth) 3.3.1. Decision-making process for indoor rescue routing
When the fall of the elderly is detected, the corresponding indoor
conv1 112 × 112 7 × 7, 64; stride 2
conv2_x 56 × 56 3 × 3 max pool; stride 2 rescue routing is expected to be generated based on the principle of the
⎡
1 × 1, 64
⎤
shortest path and the context of building attributes. In the proposed
⎣ 3 × 3, 64 ⎦ × 3 framework, the decision-making into indoor rescue routing is greatly
1 × 1, 256
⎡ ⎤ influenced by different accessibility requirements during the round
conv3_x 28 × 28 1 × 1, 128
⎣ 3 × 3, 128 ⎦ × 4 trips. Technically, the rescue route is determined by the shortest path
⎡
1 × 1, 512
⎤
algorithm, but the rescuer should also measure the accessibility per­
conv4_x 14 × 14 1 × 1, 256 formance of route options in real practice. For instance, whether there is
⎣ 3 × 3, 256 ⎦ × 23
1 × 1, 1024
an element on the route that can make it harder or even impossible for
conv5_x 7× 7
⎡
1 × 1, 512
⎤ the rescuers to pass; or whether there are different accessibility re­
⎣ 3 × 3, 512 ⎦ × 3 quirements (e.g., dimension requirement) during the rescuing trips.
1 × 1, 2048
Considering this, the measurement of accessibility along the route path
1×1 Average pool, 1000-d fc, softmax
is introduced for rescue routing decision in the proposed elderly first aid
Note: [] refers to a residual block. system. The accessibility is measured by checking whether the edge
building elements along the rescue routes satisfy the dimension
convolutional layer with a stride of 2 and a 3 × 3 max pooling layer with requirement under different scenarios, which includes the building el­
a stride of 2. Then, four stacks of residual blows named from conv2_x to ements of exit doors, hallways, stairways, and elevators.
conv5_x are adopted. Finally, the outputs of conv5_x are processed by an Accordingly, a decision-making process for indoor rescue routing is
average pooling layer, a fully connected layer, and a SoftMax layer to presented in Fig. 5. It should be noted that the indoor rescue routing for
predict the possibilities of the skeleton image falling and non-falling a multiple story building in this study is simplified to search the route
status. The classified status indicates whether the tracked person ob­ between the location of the injured and the exit (e.g., elevator or stair­
ject is falling at a certain frame. Considering that the status of a person case) on the same floor since it is rarely to observe that the rescuer
changes slowly in the real-life scenario, the major voting is applied to the changes to another vertical traffic facilities once one transport method
classification results in every 10 frames to ensure that a certain person selected during the rescuing process.
object has the same status in every 10 consecutive frames. This post­
processing will occasionally reduce errors resulting from skeleton clas­ 3.3.2. Algorithm for indoor rescue routing
sification, and the processed status is the output of the proposed fall The decision-making process for indoor rescue routing is imple­
detection method. mented in a BIM environment using Revit’s API (Application Program
Interface) to facilitate the information access and inference making. The
3.2.4. Detection performance evaluation algorithm for indoor rescue routing is illustrated in the pseudo code of
By following the previous study [50], four metrics (see Eqs. (1)-(4)) Fig. 6.
are employed to evaluate the performance of the proposed fall detection As illustrated here, to determine a rescue route for transporting the
method, including precision, recall, F1-score, and accuracy. Of them, injured with first aid and emergency equipment (e.g., wheels chairs or
precision indicates the ability of the proposed method to identify only stretchers), all exit elements on the same floor (i.e., elevators and
the relevant activities at each frame in a video sequence; recall repre­ staircases) are exhaustively extracted from BIM models along with their
sents the ability to identify all relevant activities; F1-score is a combi­ dimensional property and locations (i.e., space coordinates). Then, each
nation metric of precision and recall; and accuracy reflects the similarity exit is scanned to see whether its dimension could fulfil the requirement
between the predicted results and the ground truth. Notably, this study of accessibility (areq) when using a specific type of first aid and emer­
wil calculate the precision and recall for each activity (i.e., falling, and gency transport tool, since each tool might have its unique space
non-falling) in each video, respectively, and then adopt their weighted requirement in transportation. In combination with design guidelines
mean as the final precision and recall of this video. The evaluation and building standards, such as the Accessibility for the Disabled Manual
process will be achieved by using the scikit-learn library [51]. [52] and the Americans with Disabilities Act standards [53], an example
of accessibility requirements of some primary building elements,
TP
Precision = (1) including stairway and elevator car, is summarized in Table 2, which
TP + FP
will lay a foundation for outputting the indoor rescue route in support of
TP BIM models.
Recall = (2) Following the requirement listed in Table 2, the selection of a rescue
TP + FN
path considering accessibility can comply with the principle in Eq. (5).
Precision × Recall ∑
F1 = 2 × (3) { 1, if requirementik = Ni
Precision + Recall
Ai = k (5)
TP + TN 0, otherwise.
Accuracy = (4)
TP + FP + FN + TN
where Ai represents the accessibility measure on edge building element i
where TP (true positive) is the number of correctly recognized activities; (i.e., stairway, or elevator car in this case), while requirementik is the
FP (false positive) is the number of negative activities that are incor­ accessibility requirement of building element i for first aid transport tool
rectly identified as positive activities; FN (false negative) is the number k; and Ni is the total number of accessibility requirements of building
of positive activities that are identified as negative ones; TN (true element i.
negative) is the number of negative activities that are identified as For instance, the accessibility of elevator car in a building when
negative ones. using wheelchair is equal to 1 if two accessibility requirements (i.e., the
area and the width) are both satisfied; otherwise, the value is equal to 0.
It should be noted that the accessibility measure could also be expanded
to other edge building elements, such as hallways and ramps, and the

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Y. Chen et al. Advanced Engineering Informatics 54 (2022) 101766

Fig. 5. Decision-making process for indoor rescue routing.

Fig. 6. Pseudo code of the algorithm for indoor rescue routing.

system could accumulate these accessibility measures to represent the
overall accessibility performance of a specific route. The interested
reader could refer to the study of Hashemi and Karimi [15] for detailed
discussion.
The exits fulfilling the accessibility requirement are marked acces­
sibility exits (avblexit). Subsequently, the algorithm for searching a
single sourced shortest path is executed for each available exit and the
closest exit is then determined. To achieve this goal, A* algorithm on the
grid-based approach is used in this study to determine the shortest path
(see Eq. (6)). Compared with another well-known path finding
algorithm (Dijsktra), A* algorithm incorporates a heuristic function h(n)
that gives priorities to nodes with a potential of better performance,
while Dijsktra algorithm only explores all possible paths [54]. When the
decision into BIM-based indoor rescue routing is determined, the system
would generate a view with the selected path in a form of image that
could be immediately shared with the rescuer. To perform A* algorithm,
the plan view (fp) is divided by 0.2-meter grids and each grid cell is
assigned as the value associated with the distance from the end point of
the path (i.e., the injured and the selected exit). It should be noted that
the cell would be removed from the candidate cells if it contains

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Table 2 are different in the dimensions of width, riser, and tread for experi­
Accessibility requirements of building elements for indoor rescue routing. mental purposes. The location of the injured where the fall detection was
Building element Accessibility requirement expected to be observed was set in Room 02.
features The experimental verification for the proposed framework was
General Wheelchair Ambulance gurney
conducted in two stages: (a) assess the accuracy of fall detection by the
Stairway Width >915 mm >1200 mm >915 mm computer vision-based method and (b) investigate the sensitivity of the
Riser 100–180 less than175 –
mm mm
decision-analytic results of indoor rescue routing regarding different
Tread >280 mm >225 mm – accessibility requirements. The details will be explained in the following
Elevator Area >2.28 m2 >1524 × A minimum distance between sections.
car 1295 mm walls or between walls and
Width >1354 1295 mm door excluding return panels
mm not less than 2032 × 1372
mm. 4.2. Experimental results of fall detection
A minimum distance from
wall to return panel not less 4.2.1. Implementations
than 1295 mm with a 1067 First, the proposed fall detection method was implemented in the
mm side door.
Python language. The Opencv library was adopted for video input/
output. The Faster R-CNN detector and the ResNet101 classifier were
obstacles such as walls or fixtures. implemented on the PyTorch library. In the SORT tracking method,
Kalman filtering was achieved by using the filterpy library, and the
F(n) = g(n) + h(n) (6) Hungarian algorithm was integrated by the scikit-learn library. The
OpenPose method was implemented by the Caffe library and integrated
where the function F(n) represents the distance of the most efficient path
into the proposed method by a Python wrapper. The method developed
estimated towards the goal; g(n) calculates the distance between the
in this study was tested in an Ubuntu 18.04 operating system on a
start node (the injured) and the current node; and h(n) represents the
computer with two NVIDIA GTA 1080Ti GPUs, two 32 GB memory
expected distance from the current node to the goal node (the selected
cards, and an Intel Core i9-7920X@2.90HZ CPU. For model training,
exit).
Faster R-CNN and OpenPose were pretrained on public datasets that
include the person object, and no further training was needed.
4. Experiment and results
ResNet101 for skeleton classification was the only neural network that
needed to be trained.
4.1. Overview of experimental validation
A classification dataset was developed based on the UR fall detection
dataset [55]. The UR fall detection dataset contains 30 falling and 40
In this section, the proposed framework is tested with an experi­
non-falling video clips that have durations between 1 and 13 s. The 500
mental case to verify its feasibility and effectiveness. A virtual 3-story
falling images and 500 non-falling images were manually selected from
seniors’ residence is used as the experimental environment, where the
the UR fall detection dataset. Then, the areas of the person objects in
floor plans are generally the same in terms of the area and the shape of
these images were manually retrieved and further processed with
envelope (see Fig. 7(a)). The building was modelled in the Autodesk
OpenPose. Finally, the 1,000 skeleton images of falling and non-falling
Revit 2020 environment. Fig. 7(b) demonstrates the floor plan of the
were employed as the training dataset. Fig. 8 shows some example im­
third floor of the building with 18 rooms and two exits. These two exits
ages of the developed classification dataset. Notably, only conv5_x and

Fig. 7. BIM environment of the senior residence and the floor plan.

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Y. Chen et al. Advanced Engineering Informatics 54 (2022) 101766

Fig. 8. Example images of the developed training dataset for skeleton classification.

fc layers were finetuned during training ResNet101, while other layers proposed method on videos of junior adults can also be used for fall
adopted the weights pretrained on ImageNet and frozen in the training detection of older adults.
process. In addition, for each detected fall activity, a record would be
sent to a cloud server (such as inserting values into the SQL Server 4.2.3. Result analysis and discussion
database) once a fall activity detected, which specifies the status of fall Table 4 illustrates the experimental results in terms of precision,
detection (Yes or No), the room ID where the fall was detected (i.e., recall, and F1-score. The proposed fall detection method achieved an
Room 02), and the time of fall detected. average precision of 94.1%, recall of 87.7%, F1-score of 90.6%, and
accuracy of 87.7% on nine testing videos, which proves that this method
4.2.2. Experimental setup has sufficient ability to recognize falling activities from videos in an
To evaluate the performance of the proposed fall detection method, indoor environment. In testing, Video 4, Video 8, and Video 9 do not
nine videos that contain movements of persons in an indoor environ­ contain falling activities, while the other six videos contain the falling
ment were collected for testing, where each video only has a single activities of persons. The proposed method achieved an average preci­
person object. Meanwhile, six testing videos contain the falling activ­ sion of 91.0%, a recall of 90.0%, and an F1-score of 90.8% on six falling
ities, and the other three videos describe the person who is walking or videos. The person objects who were sitting on the chair/sofa in three
sitting on the chair/sofa. Table 3 summarizes the information of the non-falling videos were easily miscategorized into falling, but the
testing videos in terms of duration, framerate, number of frames, reso­ method proposed in this study still achieved an average precision of
lution, and whether the falling activity appeared in the video. 100%, recall of 82.1%, and F1-score of 90.2%. The above results show
Furthermore, all testing videos were manually annotated to indicate the capability of the proposed method to distinguish falling and non-
the activities of the person object at each frame as the ground truth. To falling activities in an indoor environment.
be noted, all participants in the experiment are junior adults instead of Fig. 9 illustrates some example results of fall detection on Video 5,
the elderly for two reasons: a) simulating falling activities are dangerous Video 6, and Video 9. The person object was walking in the bedroom
for elderly people, which may result in injuries. And most previous from frame #1 and then suddenly fell on the ground from frames #55 to
studies [21,56–57] involved junior adults to conduct falling activities in #85 in Video 5. The proposed method successfully recognized the falling
the lab environment for testing; and b) for vision-based methods, the activity from frames #55 to #85 by tracking a person, recognizing a
algorithms detect falls based on visual features and the visual features skeleton, and classifying a skeleton. Similarly, in Video 6, the person
between junior and senior adults are similar. Therefore, testing the object was falling on the ground from frames #56 to #106, and this
method was able to recognize the falling activity robustly. Video 9 de­
scribes a person object sitting on the chair in the dining room, where the
Table 3
sitting activity is easily confused with falling. The method can precisely
Information of testing videos for fall detection.
Video Duration Framerate Number of Resolution Fall
name (s) (fps) frames included Table 4
Video1 5 30 145 1280 × Yes The experimental results of the proposed fall detection method.
720
Video name Precision Recall F1-score Accuracy
Video2 7 30 196 1280 × Yes
720 Video1 89.8 % 89.6 % 89.7 % 89.7 %
Video3 5 30 136 1280 × Yes Video2 93.3 % 92.3 % 92.8 % 92.3 %
720 Video3 89.0 % 88.9 % 89.0 % 89.0 %
Video4 5 30 156 1280 × No Video4 100 % 84.0 % 91.3 % 84.0 %
720 Video5 88.8 % 88.3 % 88.5 % 88.3 %
Video5 5 25 128 544 × 960 Yes Video6 92.0 % 89.6 % 90.8 % 89.6 %
Video6 6 25 144 544 × 960 Yes Video7 93.9 % 93.9 % 93.9 % 93.9 %
Video7 7 25 163 544 × 960 Yes Video8 100 % 81.3 % 89.7 % 81.3 %
Video8 7 25 167 544 × 960 No Video9 100 % 81.1 % 89.6 % 81.1 %
Video9 7 25 164 544 × 960 No Average 94.1 % 87.7 % 90.6 % 87.7 %

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Y. Chen et al.
Fig. 9. Example results of fall detection on testing videos.
categorize the sitting activity into non-falling from frames #90 to #155.
Overall, the method developed in this study has shown reliable perfor­
mance in detecting falling activities in an indoor environment.
The proposed method adopted the skeleton detection for vision-
based fall detection of elderly people, which is one of the major nov­
elties of this research. Compared with the raw image areas, the skeleton
can better indicate the falling information of human objects because it
removes the noisy background information (e.g., sofa and chair), which
further improves the accuracy of fall detection from videos. To be noted,
the proposed method can also be adopted to detect the fall status of
multiple elderly people since the SORT was designed for multiple-object
tracking.
To verify the effectiveness of the proposed method, a performance
comparison was conducted with prior methods for the elderly fall
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Advanced Engineering Informatics 54 (2022) 101766
detection by cameras, RGB-D cameras, and wearable sensors. The
comparative results are summarized in Table 5. It can be seen that the
proposed method achieved a higher performance on precision than
other state-of-the-art method, while the robustness of the proposed
method is acceptable. To be noted, most state-of-the-art studies only
focused on detection of falls, but the proposed method integrated fall
detection, alerting, and rescue routing for health care of elderly citizens,
which could be regarded as an advantage of the proposed method.
4.3. Experimental results of indoor rescue routing
4.3.1. Implementations
The second part of verification aimed to assess the results of indoor
rescue routing based on the decision-making algorithm for path
Y. Chen et al. Advanced Engineering Informatics 54 (2022) 101766

Table 5
Performance comparison between the proposed method and existing methods.
Reference Sensors for fall Method description Alert after falling Precision Accuracy
detection

[58] RGB-D camera Centroid velocity for pose recognition; support vector machine (SVM) for fall N/A 93.07 % N/A
detection
[59] RGB-D camera Feature-based object segmentation; SVM for fall detection N/A N/A 79.6 %
[60] Wristband sensor Acquiring acceleration data by wristband; fall detection by k-nearest N/A N/A 91.73 %
neighbour (KNN)
[61] Wristband sensor Threshold for data pre-processing; ensemble decision tree for fall detection Yes, cloud-based computing 88 % N/A
and alerts
[62] Camera Auto-encoder-decoder for fall detection from videos N/A 92.3 % 96.2 %
Proposed Camera Faster R-CNN for object detection; OpenPose for skeleton recognition; Yes, BIM-based rescue routing 94.1 % 87.7 %
method ResNet101 for fall classification

planning. The algorithm was coded into a plugin (program) with Revit
APIs using the C# language so that the data of the BIM model could be
easily accessed. To perform the decision-making, the accessibility re­
quirements of staircases for different first aid transport tools were rep­
resented in the form of If-then statements. Two example first aid and
emergency transport tools, i.e., wheeled stretcher and stokes basket,
were selected as the tool options in this experimental study. For
instance, if the wheeled stretcher was selected as the transport tool to
move the injured person, then the staircase with a width less than 1200
mm would be deemed unqualified exits and excluded from the list of
available exits. Meanwhile, once obtaining the room ID where the falling
activities were detected, the plugin retrieved the coordinates of the room
through the GetElement (elementID) method. Then, for each available
exit, the shortest distance between the exit to the room (Room 02) was
identified following the A* algorithm, and the exit with the shortest
travel distance was selected along with its corresponding routing path.
Accordingly, a simplified user interface (see Fig. 10) of a BIM-based first
aid system with fall detection was developed in the Revit environment to
simulate the basic procedure of the rescuing work.
Specifically, the system keeps monitoring the fall activities by
constantly checking data updates of the cloud database (S1 in Fig. 10).
When the fall activity is detected, the information receiver should
determine the first aid transport tool to be used, based on which the
system then generates the routing result (S2 in Fig. 10). It should be
noted that the routing decisions when selecting the wheeled stretcher
and stokes basket were both compared and analysed during the
experiment.
4.3.2. Result analysis and discussion
Fig. 11 reveals the routing results for cases when selecting the
wheeled stretcher and stokes basket. In both cases, the available rescue
routes were automatically identified and marked with a green line in the
floor plan. Although the nearest exit for Room 02 is expected to be
Staircase 01 in the floor plan, the width of Staircase 01 (900 mm) does
not fulfil the accessibility requirement, e.g., the staircase is expected to
be larger than 1200 mm when using wheeled stretcher. Thus, Staircase
01 was excluded from the list of available exits during the decision-
making process. When the accessibility requirement can be fulfilled by
both staircases in the case of using a stokes basket, the nearest exit
(Staircase 01) was selected for further path planning. The routes in
Fig. 11(c) also show the difference in the routing decisions while using
the wheeled stretcher and the stokes basket. From a sensitivity analysis
point of view, it could be inferred that the different accessibility re­
quirements could impact the decision-making into rescue route

Fig. 10. Protocol of BIM-based first aid system.

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Y. Chen et al. Advanced Engineering Informatics 54 (2022) 101766

Fig. 11. Difference in rescue routing between the wheeled stretcher and stokes basket cases.

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Y. Chen et al.
selection.
In addition, Table 6 illustrates a comparison of route distances
derived from the nearest exit method (or intuitive method) and the
accessibility-based rescue routing method proposed in this study under
various transport equipment scenarios. In case of using wheeled
stretcher, the route distance might be increased by approximately 44.2%
if route accessibility is not considered during the planning phase. This is
because the nearest exit on the floor where an older adult had a fall may
not satisfy the accessibility requirement for a given transport tool and
thus the rescuer needs to walk more distance to return to another
appropriate exit. Therefore, the proposed method can assess the acces­
sibility performance of each route option and deliver rescue routing
decisions with higher quality. Overall, the method developed in this
study could perform the route planning task for a first aid system in
consideration of the accessibility requirement of emergency transport
equipment.
5. Conclusions
The serious risk of falling among the aging population has motivated
many efforts to investigate fall prevention. However, a systematic so­
lution of the first aid system for fall protection that can automatically
monitor the status of elderly individuals and support efficient rescue
plans is still expected in current practice. This paper thus puts forward a
framework for the elderly first aid system to accurately identify fall
activities and provide immediate assistance by improving indoor route
planning and shortening the rescue time to mitigate injury severity. In
summary, the contributions of this study are three-folds: a) proposing a
systematic methodology for automatic fall detection, first aid massage
transmission, and indoor rescue route generation from an integral
perspective, thus achieving theoretical innovation in fall-based first aid
research, especially for older people; b) developing a novel vision-based
method for fall detection integrating Faster R-CNN, SORT, and Open­
Pose, which can recognize the skeleton of persons objects when classi­
fying fall status and largely enhance the tracking robustness and
precision; and c) introducing an indoor routing foundation in a BIM
environment that includes a method for automatically extracting the
characteristic information of building elements, a technique for acces­
sibility index calculation, and a routing algorithm to find the most
accessible recue route for transporting the injured.
The experiment results showed a high accuracy result in detecting
the fall activities (i.e., achieving a 94.1% precision) and the proposed
method can evaluate the accessibility requirements of different exits
given the selection of various first aid transport equipment. By propos­
ing a holistic framework for the elderly first aid system, this paper also
demonstrated how computer vision implementation and BIM techniques
could be adopted to tackle the problem of falls among the elderly, spe­
cifically in a nursing home environment. It can promote multidisci­
plinary in age-friendly building research by incorporating it into a real-
life scenario with tangible benefits. Moreover, this research could be
considered as a potential methodology for health monitoring and
accessibility engineering implementation for age-friendly design,
focusing on eliminating the potential hazards of falling for older adults.
Incorporating computer vision and BIM technologies for health moni­
toring is also a step toward smart buildings.
Although this study has successfully demonstrated the positive im­
pacts of the proposed framework, future investigation and experimen­
tation into an integrated system validation in real building scenarios are
recommended. Due to the limited annotation resources, the proposed
fall detection algorithm has only been tested on nine testing videos.
More efforts will be put on conducting more experiments in different
scenarios in future. Furthermore, vision-based methods and sensor-
based methods could be integrated for fall detection of the elderly
during the night-time and to distinguish special status (e.g., regular
sleep) from falls in future. Future research is also expected to explore the
semantic, geometric, and topological features of BIM to generate a more
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Advanced Engineering Informatics 54 (2022) 101766
Table 6
Comparison of route distances using different rescue routing methods.
Emergency transport Distance with the nearest Distance with the
equipment exit method (m) accessibility-based method
(m)
Stokes basket 27.04 27.04
Wheeled stretcher 58.13 40.30
informative navigation graph for the rescuer in the context of opera­
tional accessibility.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
Data availability
Data will be made available on request.
Acknowledgement
This research is funded by the National Natural Science Foundation
of China (Grant Number: 72002152).
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