UNIT II TELEMEDICAL TECHNOLOGY 9

Principles of Multimedia - Text, Audio, Video, data, Data communications and networks, PSTN,
POTS, ANT, ISDN, Internet, Air/ wireless communications Communication infrastructure for
telemedicine – LAN and WAN technology. Satellite communication, Mobile communication.

Principles of Multimedia - Text, Audio, Video, data,

MULTIMEDIA- TEXT, AUDIO, VIDEO, DATA
 Multimedia involves multiple modalities of text, audio, images, drawings, animation, and video.
 Examples of how these modalities are put to use:
1. Tele-medicine
2. Video teleconferencing.
3. Distributed lectures for higher education.
4. Co-operative work environments.

Multimedia Telemedcine System(MTS)

 A multimedia telemedicine system (MTS) using Transfer Control Protocol and Internet Protocol
(TCP/IP) over the Internet is developed
 Real-time data, including audio, video and instant message (IM), and non-real-time data, including
vital sign signals, radiological images with DICOM 3.0, file, bio-signal, bio-data can be exchanged
on the system.

 Discrete (or Time independent) Media:

 E.g., Text, graphics and images, have no real-time demands.
 Termed discrete media.
 Continuous (or Time dependent) media:
 Information becomes available at different time intervals.
 Time intervals can be periodic or a periodic depending on the nature of the media.
 Audio and video are examples of periodic, continuous media.
 Orchestrated Multimedia:
 Capture and/or generation of information done by retrieving stored objects.
 Stored multimedia lecture presentations, on-demand servers, and other multimedia database
applications fall under this category.
 Live Multimedia:
 Information generated from devices such as video camera, microphone or keyboard.
  Multimedia teleconferencing and panel discussion applications fall under this category.
 Participants communicate among themselves by exchanging multimedia information
generated from video camera or microphone.

Multimedia Telemedicine System – Network Architecture

Discrete Media – Size per Page

Media Size
Text 9.4KB
Graphics 2.8KB
Bitmap Picture 300-900KB
A4 15-247MB
Continuous Media – Bandwidth

Media Bandwidth

Audio digital telephony 64Kb/s

Audio stereo CD quality 1.34Mb/s

Video PAL 176Mb/s

Video HDTV 936Mb/s

Types of Telemedicine Information

 Text and Data
 Audio
 Video
 Frame Rate and Bandwidth

In a face-to-face consultation, a physician might use some combination of all five senses-sight, sound, touch,
smell and taste-to assess a patient’s condition.
The first three methods are by far the most common and the sensory data are transmitted directly from the
patient to the observer. In telemedicine, however, the sensory data are first converted into electrical impulses
for transmission to the remote physician. Methods to convert smell and taste stimuli into electrical signals are
still in the experimental stage and. while the sense of touch can be translated successfully into an electrical
equivalent, the reverse process is more difficult and not well understood. Hence. A teleconsultation relies
primarily on the two senses of sight and sound. The information (useful data) derived from these senses can be
divided into four types:
 text and data;
 audio;
 still (single) images;
 video (sequential images).

Table 3 gives telemedicine examples of these types along with their typical file size in kilo- or megabytes
following digitisation. The wide range of electronic files sizes from these sources suggests the need to match
the choice and performance characteristics of the telemedicine equipment to the clinical need. Under- and
over-specification of systems can otherwise lead to disappointment and premature abandonment of a promising
project.

Table 3. Typical examples of telemedicine information

Source Type Typical file size

Patient notes Text < 10KB
Electronic stethoscope Audio 100 KB
Chest X-ray Still image 1 MB
Foetal ultrasound (30 s) Video 10 MB

Text and Data

Electronic documents such as reports, correspondence or medical records containing ASCII or Unicode text
and numerical information can be transmitted directly in digital format. The digitized file can be edited with a
word processor, database or spreadsheet program but this is seldom necessary, or even desirable, since the
transmitted information is invariably ‘read-only’.
If a document is only available in paper format then it can be digitized for transmission with either a scanner
(e.g. fax) or a document camera. Unless the text is subjected to optical character recognition it will be in
bitmapped format and cannot be edited. Frequently, textual information is needed before the teleconsultation
takes place or later, as a consequence of the process. In these cases it is more efficient to send the documents
by post or, better still, as attachments to emails .

Audio
The public switched telephone network (PSTN but sometimes known as the plain old telephone system, POTS)
can be used to transmit sound (e.g. speech) and establish a remote diagnosis. However, the quality (ease of
understanding) and bandwidth (capacity to carry information) of analogue telephony are seldom adequate for
medical applications. In contrast, digital signals can be transmitted over networks for large distances without
degradation. Digital signals can also be manipulated to improve system performance.
An analogue sound is digitised by sampling its amplitude at discrete time intervals to recreate the waveform.
The discrete nature of the digitization process introduces quantisation or amplitude round-off errors as the
digital sample value approximates the analogue signal at a given instant. The human ear detects this error as a
hissing noise and to reduce the effect the sample value should have a resolution of at least 1 in 65 536 (216),
giving a 16-bit quantisation error.

3.2.5 Video
Our perception of video is conditioned by television to the extent that a videoconference between patient or
carer and consultant is regarded as the normal practice of telemedicine. Where video is needed, for example. to
demonstrate a patient’s mobility after a hip replacement, it is usually sufficient to use a commercial
videoconferencing unit (Section 3.3.2) rather than the much more expensive broadcast television. The output
from such units approaches broadcast quality.
An important consideration for international teleconsultations is the compatibility of the analogue video
signals, and therefore the video equipment, in different countries. There are two widely used formats for
analogue video:
The National Television Standard Committee (NTSC) system adopted in North America and Japan, having
525 lines per picture and a frame rate of 30 pictures per second;
The Phase Alternating Line (PAL) system used throughout Western Europe and Australasia, having 625
lines per picture and a frame rate of 25 pictures per second.
Most modern television receivers and video recorders are able to convert signals from one standard to another.
The Common intermediate Format (CIF) is a format introduced to provide compatibility between NTSC and
PAL and offers a lower resolution of 288 lines per picture at 30 pictures per second.

Frame Rate and Bandwidth

Video frame rates of 25 discrete pictures per second and above fool the human brain into perceiving
continuous and smooth motion. However, when video compression takes place, the display frame rate may fall
due to the time needed to decompress the images. The effective frame rate may drop to 7.5. 10 or 15 frames
per second.
The ultimate solution to this problem is of course to increase the bandwidth at a cost. A no-cost, sometimes
acceptable compromise is to reduce the size of
the display window and hence the number of pixels needed to output a frame.
Naturally, the window size must be large enough to allow a valid teleconsultation to take place.

Introduction to Data Communications:

In Data Communications, data generally are defined as information that is stored in digital
form. Data communications is the process of transferring digital information between
two or more points. Information is defined as the knowledge or intelligence. Data
communications can be summarized as the transmission, reception, and processing of
digital information. For data communications to occur, the communicating devices must be
part of a communication system made up of a combination of hardware (physical equipment)
and software (programs). The effectiveness of a data communications system depends on four
fundamental characteristics: delivery, accuracy, timeliness, and jitter.

A data communications system has five components:

1. Message: The message is the information (data) to be communicated. Popular forms of
information include text, numbers, pictures, audio, and video.
2. Sender: The sender is the device that sends the data message. It can be a computer,
workstation, telephone handset, video camera, and so on.
3. Receiver: The receiver is the device that receives the message. It can be a computer,
workstation, telephone handset, television, and so on.
4. Transmission medium: The transmission medium is the physical path by which a message
travels from sender to receiver. Some examples of transmission media include twisted-pair
wire, coaxial cable, fiber-optic cable, and radio waves.
5. Protocol: A protocol is a set of rules that govern data communications. It represents an
agreement between the communicating devices.

Data Communication Circuits

The underlying purpose of a digital communications circuit is to provide a transmission path
between locations and to transfer digital information from one station (node, where
computers or other digital equipment are located) to another using electronic circuits. Data
communications circuits utilize electronic communications equipment and facilities to
interconnect digital computer equipment. Communication facilities are physical means of
interconnecting stations and are provided to data communications users through public
telephone networks (PTN), public data networks (PDN), and a multitude of private data
communications systems.
The following figure shows a simple two-station data communications circuit. The
main components are:
Source: - This device generates the data to be transmitted; examples are mainframe
computer, personal computer, workstation etc. The source equipment provides a means for
humans to enter data into system.
Transmitter: - A transmitter transforms and encodes the information in such a way as to
produce electromagnetic signals that can be transmitted across some sort of transmission
system. For example, a modem takes a digital bit stream from an attached device such as a
personal computer and transforms that bit stream into an analog signal that can be handled
by t he telephone network.
Transmission medium: - The transmission medium carries the encoded signals from the
transmitter to the receiver. Different types of transmission media include free-space radio
transmission (i.e. all forms of wireless transmission) and physical facilities such as metallic
and optical fiber cables.
Receiver: - The receiver accepts the signal from the transmission medium and converts it
into a form that can be handled by the destination device.
Destination: - Takes the incoming data from the receiver and can be any kind of digital
equipment like the source.

Data Communication Circuit Arrangements

A data communications circuit can be described in terms of circuit configuration and
transmission mode.
Circuit Configurations
Data communications networks can be generally categorized as either two point or
multipoint.
A two-point configuration involves only two locations or stations, whereas a
multipoint configuration involves three or more stations.
A two-point circuit involves the transfer of digital information between a mainframe
computer and a personal computer, two mainframe computers or two data communications
networks.

A multi-point network is generally used to interconnect a single mainframe computer (host) to

many personal computers or to interconnect many personal computers and capacity of the
channel is either

Spatially shared: Devices can use the link simultaneously or Timeshare: Users take turns

Transmission Modes
There are three modes of transmission for data communications circuits:

In simplex mode(SX), the communication is unidirectional, as on a one-way street.

Only one of the two devices on a link can transmit; the other can only receive. Commercial
radio broadcasting is an example. Simplex lines are also called receive-only, transmit-only or
one-way-only lines.

In half-duplex(HDX) mode, each station can both transmit and receive, but not at
the same time. When one device is sending, the other can only receive, and vice versa. The
half-duplex mode is used in cases where there is no need for communication in both
directions at the same time; the entire capacity of the channel can be utilized for each
direction. Citizens band (CB) radio is an example where push to talk (PTT) is to be pressed or
depressed while sending and transmitting.

In full-duplex mode(FDX) (called duplex), both stations can transmit and receive
simultaneously. One common example of full-duplex communication is the telephone
network. The full-duplex mode is used when communication in both directions is required
all the time. The capacity of the channel must be divided between the two directions.

Network Models
Computer networks can be represented with two basic network models: peer-to-peer
client/server and dedicated client/server. The client/server method specifies the way in
which two computers can communicate with software over a network.

Peer-to-peer client/server network: Here, all the computers share their resources, such as
hard drives, printers and so on with all the other computers on the network. Individual
resources like disk drives, CD-ROM drives, and even printers are transformed into shared,
collective resources that are accessible from every PC. Unlike client-server networks, where
network information is stored on a centralized file server PC and made available to tens,
hundreds, or thousands client PCs, the information stored across peer-to-peer networks is
uniquely decentralized. Because peer-to-peer PCs have their own hard disk drives that are
accessible by all computers, each PC acts as both a client (information requestor) and a
server (information provider). The peer-to-peer network is an appropriate choice when
there are fewer than 10 users on the network, security is not an issue and all the users are
located in the same general area.

The advantages of peer-to-peer over client-server NOSs include:

No need for a network administrator
Network is fast/inexpensive to setup & maintain
Each PC can make backup copies of its data to other PCs for security.
Easiest type of network to build, peer-to-peer is perfect for both home and office use.

Dedicated client/server network: Here, one computer is designated as server and the rest
of the computers are clients. Dedicated Server Architecture can improve the efficiency of
client server systems by using one server for each application that exists within an
organization. The designated servers store all the networks shared files and applications
programs and function only as servers and are not used as a client or workstation. Client
computers can access the servers and have shared files transferred to them over the
transmission medium. In some client/server networks, client computers submit jobs to one
of the servers and once they process the jobs, the results are sent back to the client
computer.

Network Topologies
In computer networking, topology refers to the layout of connected devices, i.e. how the
computers, cables, and other components within a data communications network are
interconnected, both physically and logically. The physical topology describes how the
network is actually laid out, and the logical topology describes how the data actually flow
through the network.
Star topology: A star topology is designed with each node (file server, workstations, and
peripherals) connected directly to a central network hub, switch, or concentrator. Data on a
star network passes through the hub, switch, or concentrator before continuing to its
destination. The hub, switch, or concentrator manages and controls all functions of the
network. It also acts as a repeater for the data flow.

Bus topology: Bus networks use a common backbone to connect all devices. A single
cable, (the backbone) functions as a shared communication medium that devices attach or
tap into with an interface connector. A device wanting to communicate with another device
on the network sends a broadcast message onto the wire that all other devices see, but only
the intended recipient actually accepts and processes the message. The bus topology is the
simplest and most common method of interconnecting computers. The two ends of the
transmission line never touch to form a complete loop. A bus topology is also known as
multidrop or linear bus or a horizontal bus.

Ring topology: In a ring network (sometimes called a loop), every device has exactly
two neighbours for communication purposes. All messages travel through a ring in the
same direction (either "clockwise" or "counter clockwise"). All the stations are
interconnected in tandem (series) to form a closed loop or circle. Transmissions are
unidirectional and must propagate through all the stations in the loop. Each computer acts
like a repeater and the ring topology is similar to bus or star topologies.

Mesh topology: The mesh topology incorporates a unique network design in which each
computer on the network connects to every other, creating a point-to-point connection
between every device on the network. Unlike each of the previous topologies, messages sent on
a mesh network can take any of several possible paths from source to destination

Hybrid topology: This topology (sometimes called mixed topology) is simply combining
two or more of the traditional topologies to form a larger, more complex topology. Main
aim is being able to share the advantages of different topologies.
Network Classifications
One way to categorize the different types of computer netw ork designs is by their scope or
scale. Common examples of area network types are:
LAN - Local Area Network

WLAN - Wireless Local Area Network

WAN - Wide Area Network

MAN - Metropolitan Area Network

SAN - Storage Area Network, System Area Network, Server Area Network, or sometimes Small Area
Network

CAN - Campus Area Network, Controller Area Network, or sometimes Cluster Area Network

PAN - Personal Area Network


DAN - Desk Area Network

Local area network: A local area network (LAN) is a network that connects computers
and devices in a limited geographical area such as home, school, computer laboratory, office
building, or closely positioned group of buildings. LANs use a network operating system to
provide two-way communications at bit rates in the range of 10 Mbps to 100 Mbps. In
addition to operating in a limited space, LANs are also typically owned, controlled, and
managed by a single person or organization. They also tend to use certain connectivity
technologies, primarily Ethernet and Token Ring.
Metropolitan Area Network (MAN):

A metropolitan area network, or MAN, covers a city. The best-known example of a MAN is the
cable television network available in many cities. This system grew from earlier community
antenna systems used in areas with poor over-the-air television reception. In these early systems,
a large antenna was placed on top of a nearby hill and signal was then piped to the subscribers'
houses. At first, these were locally-designed, ad hoc systems. Then companies began jumping
into the business, getting contracts from city governments to wire up an entire city. The next step
was television programming and even entire channels designed for cable only. Often these
channels were highly specialized, such as all news, all sports, all cooking, all gardening, and so
on. But from their inception until the late 1990s, they were intended for television reception only.
To a first approximation, a MAN might look something like the system shown in Fig. In this
figure both television signals and Internet are fed into the centralized head end for subsequent
distribution to people's homes. Cable television is not the only MAN. Recent developments in
high-speed wireless Internet access resulted in another MAN, which has been standardized as
IEEE 802.16.
Wide Area Network (WAN).

A wide area network, or WAN, spans a large geographical area, often a country or continent. It
contains a collection of machines intended for running user (i.e., application) programs. These
machines are called as hosts. The hosts are connected by a communication subnet, or just subnet
for short. The hosts are owned by the customers (e.g., people's personal computers), whereas the
communication subnet is typically owned and operated by a telephone company or Internet
service provider. The job of the subnet is to carry messages from host to host, just as the
telephone system carries words from speaker to listener.

Public Switched Telephone Network System

All of the above systems use digital telecommunications, often ISDN , but with better compression algorithms
it has become possible to transmit video pictures across the public switched telephone network system. Picture
quality is of course limited but connectivity is extremely high, allowing telemedicine to the home .
Irrespective of the type, a videoconferencing system consists of the same basic components:
Codec, which. as we have seen, compresses and decompresses still and video images. The codec also
manipulates the audio information and ensures synchronisation of voice and image. A further task is to control
the interface between the videoconferencing unit and the network and peripherals.

Monitor. to display video images either on a television or monitor according to the NTSC or PAL standards.

Camera: usually an auto-focus, auto-iris, single chip device with remote pan/tilt/zoom to capture information
from any part of the consultation room. The camera can be controlled locally or from the remote site.

Audio system, which needs surprising sophistication to make it an acceptable approximation to normal speech.
The system should provide automatic echo correction and allow full duplex conversation, i.e. the ability to
interrupt and be interrupted. It should also have automatic gain control so that listeners can hear no matter how
close or far a talker is from the microphone.

User interface to make the system easy to operate for all users. A mouse or some other push-button control
may be more acceptable than a keyboard.

The telephone infrastructure at that time could not support the required transmission rates and sales were poor
although the device was a clear 'proof of concept'. AT&T attempted to develop the idea in the late 1960s and
early 1970s, including some telemedicine applications that showed what might be possible if the technology
could be developed further.
The real breakthrough in mass-market terms was made in the early 1990s by Intel with its ProShare personal
videoconferencing product designed to operate over ISDN networks. The market has since expanded to include
PictureTel , VTEL and CLI, all of which offer a range of products and services to suit individual
requirements.

PSTN stands for Public Switched Telephone Network, or the traditional circuit-switched
telephone network. This is the system that has been in general use since the late 1800s.

The phones themselves are known by several names, such as PSTN, landlines, Plain Old
Telephone Service (POTS), or fixed-line telephones.

PSTN phones are widely used and generally still accepted as a standard form of communication.

PSTN Phone Lines Work

Think of a Public Switched Telephone Network (PSTN) as a combination of telephone networks

used worldwide, including telephone lines, fiber optic cables, switching centers, cellular
networks, as well as satellites and cable systems. These help telephones communicate with each
other.

Put simply, when you dial a phone number your call moves through the network to reach its
destination – and two phones get connected. To fully understand how a POTS actually works,
consider what happens when you dial a number from your own phone.
Step #1 – Your telephone set converts sound waves into electrical signals. These signals are then
transmitted to a terminal via a cable.

Step #2 – The terminal collects the electrical signals and transmits these to the central office
(CO).

Step #3 – The central office routes the calls in the form of electrical signals through fiber optic
cable. The fiber optic conduit then carries these signals in the form of light pulses to their final
destination.

Step #4 – Your call is routed to a tandem office (a regional hub responsible for transmitting calls
to distant central offices) or a central office (for local calls).

Step #5 – When your call reaches the right office, the signal is converted back to an electrical
signal and is then routed to a terminal.

Step #6 – The terminal routes the call to the appropriate telephone number. Upon receiving the
call, the telephone set converts the electrical signals back to sound waves.

This may sound complicated, but the thing to remember is that it takes a few seconds for your
call to reach its destination. This process is facilitated by using fiber optic cables and a global
network of switching centers.
PSTN – Understanding The Art of Switching

Now, let’s have a look at each of the four types of switching which take place at different levels.

1. The Local Exchange

A local exchange – which may consist of one or more exchanges – hooks up subscribers to a
PSTN line. Also known as a central office or a switching exchange, a telephone exchange may
have as many as 10,000 lines. All telephones are connected to the local exchange in a specific
area. Interestingly, if you were to dial the number of your supplier located in the building next to
yours, the call won’t leave your local exchange and will be routed to the supplier as soon as it
reaches the exchange.

The exchange then identifies the number dialed so it can route the call towards the correct end
destination. This process works as follows:

The first three digits of a phone number represent the exchange (the local switch), while the last
four digits identify the individual subscriber within that exchange.

This means that when you dial a number and it reaches your local exchange, your call is
immediately linked to the subscriber without the need for any further routing.

2. The Tandem Office

Also known as a junction network, a tandem office serves a large geographical area comprising
several local exchanges while managing switches between local exchanges.

Let’s say you dialed the number of a client who lives in the same city but in another suburb. In
this case your call will be routed to a tandem office from your local exchange, and the tandem
office will route the signal on to the local exchange near your client’s location.

3. The Toll Office

This is where any national long-distance switching takes place.

A toll office is connected to all the tandem offices. For instance, if you have an office in another
city you’ll find that, whenever you dial that branch’s number, your call will be switched through
a toll office.
4. The International Gateway

International gateways manage international call switching, routing domestic calls to the
appropriate countries.

PBX

Large organizations with 40 or more employees usually go with a Private Branch Exchange
(PBX). A PBX converts your organization into a local exchange where all the phones in your
organization are connected and you get to enjoy a range of services such as call transfer, call
conferencing, auto attendant, voicemail, call hold, and more.

The PBX is connected to your local exchange. It routes external calls to a local exchange while
all internal calls are routed by your PBX.

A PBX is a combination of software and hardware, so it will cost you some serious bucks. It
comes with hubs, switches, phone adapters, routers, and several telephone sets. It is like creating
your own small exchange where your PBX handles switches internally.

Most businesses use PBX phone systems to manage calls because they are easier. However,
installing and managing a PBX is costly. The actual cost may vary depending on the number of
features you prefer to have and the complexity of the PBX. A massive, complex, and feature-rich
PBX will cost your business more than a simple PBX system with just some basic capabilities.

Plain Old Telephone Service

 POTS is an acronym for plain old telephone service, which refers to the standard low
speed, analog telephone service that is still used by most homes and many businesses.
 The term is sometimes used to distinguish that service from the newer
telecommunications services which are digital and have much larger bandwidths. These
include ADSL (asymmetric digital subscriber line), ISDN (integrated services digital
network) and FDDI (fiber distributed data interface).
 POTS is basically an analog voice transmission phone system implemented over copper
twisted pair wires. It is the phone line technology most of us grew up with at home and is
exactly what you think it is: copper wires dangling overhead, carrying your voice from
one place to another.

 POTS networks were created to facilitate voice communication over copper cables that
traversed countries and continents, and it has been the standard voice-grade telephone
system used by residences and businesses across the world since the 1880’s. But the
POTS most of us are familiar with is an upgrade over the rudimentary phone system
invented by Alexander Graham Bell.

 The newer services provide some part of their channels for POTS while using most of
their bandwidth for digital data transmission. The newer services also make possible
added features such as call waiting or call forwarding.

 POTS utilizes the lowest 4kHz of bandwidth on twisted pair wiring (i.e., conventional
low-speed copper wiring). Any service sharing a line with POTS (e.g., DSL) must either
use frequencies above POTS or convert POTS to digital signals and interleave them with
other data signals.

 POTS, is a term which describes the voice-grade telephone service that remains the basic
form of residential and small business service connection to the telephone network in
most parts of the world. The system was originally known as the Post Office Telephone
Service or Post Office Telephone System. Today the term Plain Old Telephone Service is
used, after the services were removed from the control of national post offices.
 The pair of wires from the central switch office to a subscriber’s home was called the
subscriber loop. It was typically powered by 40V(DC) and backed up by a large bank of
batteries in the central office, resulting in continuation of service during most commercial
power outages.
 This 64Kbps service is a bi-directional, or full duplex, voice path with limited frequency
range of 300 to 3400 Hz: in other words, a signal to carry the sound of the human voice
both ways at once. Today, it is also used for internet access via a dial modem, DSL, fax,
credit card terminals, etc.
 Users accessing the Internet with the same twisted pair copper wiring as is used by their
telephone are using a POTS connection. The TCP/IP (transmission control
protocol/Internet protocol) digital data from their computer or LAN (local area network)
is converted to analog format using a modem prior to transmission over the POTS.
The POTS setup has remained virtually the same for decades. There have been many upgrades to
usher components of the POTS telephone system into the digital era, but the copper wire
connection has weathered the storm.

As far as the mechanics of a POTS lines go, this phone service works by establishing a dedicated
circuit between Point A and Point B for the duration of a transmission.

Circuit Switching

Back in the old days, circuit switching was the reason you needed an operator’s assistance when
making calls.

In those days, operators would sit by one giant wooden switchboard, plugging copper wires into
a common patch panel. In the case of connections that required two exchanges, two operators
would go about simultaneously plugging the caller’s and receiver’s wires into the same inter-
exchange wire.

This wire was known as a “trunk”.

Long distance calls were unbearably costly because calling long distance was akin to renting the
use of a very long piece of copper wire each time you wanted to make a call.

Transistors
The transistor heralded the electronic exchange era, which slowly paved the way for the digital
network. Current phone lines have been upgraded to carry digital signals in the form of
“packets.” Packet-based technology does not dominate the transmission channel by demanding a
continuously open and dedicated circuit, unlike its analog counterpart. Rather, it uses the
underlying network to transmit voice (and data) messages independently through the switches. A
copper line is a bi-directional 64Kbps service capable of carrying human voice both ways at the
same time

Modems

This is a device that was designed to exploit the digital nature of the public switched telephone
network without overhauling your entire phone system. This should come as good news for
small business owners who are not planning to upgrade their analog communications systems
any time soon, especially considering the wealth of options available on the market.

Integrated Services Digital Network (ISDN)

Integrated Services Digital Network (ISDN) ISDN is a dial-up (not dedicated but used on a call-
by call basis) digital connection to the telecommunication carrier. An ISDN line can carry
information at nearly five times the fastest rate achievable using analog modems over POTS
(plain old telephone service).

1980: ISDN Integrated access to all services

Digital end-to-end (Digital subscriber loop)
 One set of interfaces for all services at multiple speeds
 Supports both circuit switching and packet switching
 Out-of-band signaling. Sophisticated network management and maintenance using
Signaling System 7 (SS7)
 Layered protocol architecture
ISDN Channels
B: 64 kbps for data or voice
D: 16 or 64 kbps for signaling or packet switched data
H: 384 kbps (H0), 1536 kbps (H11), 1920 kbps (H12)

ISDN Access Interfaces

Basic Rate Interface (BRI): 2B + D = 2 × 64 + 16 = 144 kbps (192 kbps total)

Primary Rate Interface (PRI): For LANs or PBX

23 B + D = 23 × 64 + 64 = 1.536 Mbps » T1
30 B+ D = 30 × 64 + 64 = 1.984 Mbps = 5H0+D = E1- 64 kbps Framing+mgmt
Functional Groupings
 Terminal Equipment 1 (TE1): ISDN terminal
 Terminal Equipment 2 (TE2): Non-ISDN terminal, e.g., POT
 Terminal Adapter (TA): Allows non-ISDN devices on ISDN
 Network Termination 1 (NT1): Physical layer device. Separates user premises from phone
company. Owned by user in USA. Owned by PTT in many countries.
 Network Termination 2 (NT2): OSI layers 2-3, e.g., PBX, LAN
 Network Termination 1,2 (NT12): NT1 + NT2

NT1:
 Physical and electrical terminal of ISDN at user
 Isolates the user from the transmission technology of the subscriber loop
 Line maintenance functions such as loop back testing and monitoring
 Bit multiplexes various B and D channels m Supports multi-drop lines
 Telephone, personal computer, and alarm on one NT1
NT2:
 Digital PBX, LAN, Terminal controller Switching and concentration

ISDN Reference Points

 Rate (R): Between Non-ISDN and Terminal Adapter. Uses X or V series recommendations.
 System (S): Between ISDN equipment and NT2. Separates user equipment from switching
equipment. Terminal (T): Between NT2 and NT1. Separates network from user.
 User (U): U interface not defined by ITU. Defined in North America since NT owned by user.
ISDN Services Six types of services
 Circuit switched calls over a B or H channel
 Semi-permanent connections over a B or H channel
 Packet switched calls over a B or H channel
 Packet switched calls over a D channel
 Frame relay calls over a B or H channel
 Frame relay calls over a D channel

It is a new set of integrated systems that can integrate many different communication services into a
single digital network capability called the Integrated Services Digital Network. ISDN is specially designed
for transmission of digital data and is about twice as fast as conventional telephone lines. It categorized
into two generations:

Narrow-band ISDN, it uses 64 kb/s and has circuit switching orientation.

Broad-band ISDN, it uses very high data rates and has packet-switching orientation. ISDN is a digital
networking that is necessary to Telemedicine applications. Digitalization and integration of services are
the benefits of ISDN.

ISDN provide greater flexibility. The fundamental objectives of ISDN is that it be based on the telephony
network and gives much better audio quality and much faster data transfer. Future versions of ISDN-
Based Telemedicine system will include facilities for on-line interaction between practitioner and
specialist with simultaneous speech.

Internet technology
Internet technology created in 1969 at UCLA by US Department of Defense (4 computers) expanded
to include 50 research sites by 1972 interconnected with other private and public networks during
1970s and 1980s currently a privately run system.

Internet technology World-Wide Web (WWW) –invented by Swiss physicists in 1989 –access
improved through development of browsers (Mosaic, Netscape, Internet Explorer) –usefulness
improved through development of search engines (Yahoo, Infoseek, Alta Vista) –growing in
popularity (53.5 million US adults) .

Taking advantage of technology for medical care medical informatics –computerized patient records
(history, insurance claim processing) –integrated information management systems –expert systems
for advice or warnings –on-line journals and research reports .

Internet Patient Console Referral Hospital

Step 1. Upload Information
step2. Download Information
Step 3. Post Suggestions Telemedicine Server
Step 4. Receive Suggestion Telemedicine over web

Internet Patient Console Referral Hospital Step 1. Upload Information step2. Download Information Step
3. Post Suggestions Telemedicine Server Step 4. Receive Suggestion Telemedicine over web
e biosignal sensors are responsible for
acquiring the
physiological data (patient’s vital signs)
and transmitting
it to the signal processing unit. Several
studies are made
focusing only on designing these sensors
to be tiny in
size [], maintain patient mobility [],
and consume low
operating power to reduce battery size
which can last for
longer durations []. A collection of
wearable medical sensors
could communicate using personal area
network or body
network [], which can be even
integrated into user’s clothes
[]. At the next stage, sensor layer of
every remote monitoring
system is typically connected to the
processing device fo
e biosignal sensors are responsible for
acquiring the
physiological data (patient’s vital signs)
and transmitting
it to the signal processing unit. Several
studies are made
focusing only on designing these sensors
to be tiny in
size [], maintain patient mobility [],
and consume low
operating power to reduce battery size
which can last for
longer durations []. A collection of
wearable medical sensors
could communicate using personal area
network or body
network [], which can be even
integrated into user’s clothes
[]. At the next stage, sensor layer of
every remote monitoring
system is typically connected to the
processing device fo
e biosignal sensors are responsible for
acquiring the
physiological data (patient’s vital signs)
and transmitting
it to the signal processing unit. Several
studies are made
focusing only on designing these sensors
to be tiny in
size [], maintain patient mobility [],
and consume low
operating power to reduce battery size
which can last for
longer durations []. A collection of
wearable medical sensors
could communicate using personal area
network or body
network [], which can be even
integrated into user’s clothes
[]. At the next stage, sensor layer of
every remote monitoring
system is typically connected to the
processing device fo
e biosignal sensors are responsible for
acquiring the
physiological data (patient’s vital signs)
and transmitting
it to the signal processing unit. Several
studies are made
focusing only on designing these sensors
to be tiny in
size [], maintain patient mobility [],
and consume low
operating power to reduce battery size
which can last for
longer durations []. A collection of
wearable medical sensors
could communicate using personal area
network or body
network [], which can be even
integrated into user’s clothes
[]. At the next stage, sensor layer of
every remote monitoring
system is typically connected to the
processing device fo
The biosignal sensors are responsible for acquiring the physiological data (patient’s vital signs) and
transmitting it to the signal processing unit. Several studies are made focusing only on designing these
sensors to be tiny in size , maintain patient mobility , and consume low operating power to reduce
battery size which can last for longer durations . A collection of wearable medical sensors could
communicate using personal area network or body network [8], which can be even integrated into
user’s clothes . At the next stage, sensor layer of every remote monitoring system is typically connected
to the processing device for signal acquisition, processing, analysis, and formatting data to be sent to the
communication layer. The processing unit may evaluate patient status and trends in patient’s medical
condition. Processing unit can be PC , mobile phone , or embedded system (microcontroller, DSP
processor, and FPGA) . Many medical algorithms were developed in recent telemedicine studies to help
in patient diagnosis and early detection of cardiovascular diseases .

Health Care and the Internet

• Patients canAccess health care information
Join chat groups
Purchase drugs and other medical items
Consult a health care practitioner online
Informatics describes the development and use of information technology
Assign groups of students the task of finding examples of the Internet services mentioned.

Uses of telehealth the Internet

Patient monitoring (e.g., electrocardiogram, lung capacity)
Patient consultation by videoconference
Transmission of images for diagnosis
Robotic surgery (telesurgery).

Wireless Technology

e biosignal sensors are responsible for

acquiring the
physiological data (patient’s vital signs)
and transmitting
it to the signal processing unit. Several
studies are made
focusing only on designing these sensors
to be tiny in
size [], maintain patient mobility [],
and consume low
operating power to reduce battery size
which can last for
longer durations []. A collection of
wearable medical sensors
could communicate using personal area
network or body
network [], which can be even
integrated into user’s clothes
[]. At the next stage, sensor layer of
every remote monitoring
system is typically connected to the
processing device fo
e biosignal sensors are responsible for
acquiring the
physiological data (patient’s vital signs)
and transmitting
it to the signal processing unit. Several
studies are made
focusing only on designing these sensors
to be tiny in
size [], maintain patient mobility [],
and consume low
operating power to reduce battery size
which can last for
longer durations []. A collection of
wearable medical sensors
could communicate
Wireless Communication Infrastructure-Telehealth

Online Module
Telehealth – Wireless Communication -Multipath Propagation
• Signal can take many different paths between sender and receiver due to reflection, diffraction
and scattering

• Time dispersion: signal is dispersed over time

• è interference with “neighbor” symbols, Inter Symbol Interference (ISI) – Equalizers
compensate ISI
• The signal reaches a receiver directly and phase shifted
• è distorted signal depending on the phases of the different parts

e biosignal sensors are responsible for

acquiring the
physiological data (patient’s vital signs)
and transmitting
it to the signal processing unit. Several
studies are made
focusing only on designing these sensors
to be tiny in
size [], maintain patient mobility [],
and consume low
operating power to reduce battery size
which can last for
longer durations []. A collection of
wearable medical sensors
could communicate using personal area
network or body
network [], which can be even
integrated into user’s clothes
[]. At the next stage, sensor layer of
every remote monitoring
system is typically connected to the
processing device fo
Telehealth -Signal Propagation
• Propagation in free space is always like light (straight line).
• Receiving power proportional to 1/d² in vacuum – much more in real environments (d = distance
between sender and receiver)
• Receiving power additionally influenced by
– fading (frequency dependent)
– Shadowing (blocking)
– reflection at large obstacles
– refraction depending on the density of a medium
 – scattering at small obstacles
– diffraction at edges

Wireless Network Stakeholders

1. Regulatory Authorities
2. The operator or the Service Provider
3. The user or the subscriber
4. Equipment Vendors (network equipment and user device)
5. Research Organizations

1G Wireless Systems
 The geographical area divided into cells
 Each with own antenna
 Each with own range of frequencies
 Served by base station - Transmitter, receiver, control unit to carry out actual radio
communications with the device
 Adjacent cells on different frequencies to avoid crosstalk
 Mobile Switching Center Controls all calls attached to this device, Maintains billing information
&Switches calls
 PSTN Public Switched Telephone Network

2G Wireless Systems – Characteristics

 Deployed in mid 1990s
 Fully Digital network elements
 TDMA/CDMA for spectrum sharing; Circuit switching
 Operates at 900-1800 MHz frequency band
 3-times increase in overall system capacity.
 supported voice-centric services and limited data-service, like short messages(SMS), FAX, etc.
 <9.6 kbps data rates
3G Wireless Systems
 Simultanous voice and data transmission
 Faster Internet access -Interactive web sessions
 Video calling
 Multimedia Content - voice, data & video
 Universal global roaming

4G Wireless systems
 Highly integrated
 High bandwidth / high-speed wireless
 Highly compatible with wired network infrastructures
 provides mobile ultra-broadband Internet access
 Integration of multi-networks using IP technology
 applications include mobile web access, IP telephony, gaming services, high-definition mobile
TV, video conferencing and 3D television.

Telehealth - Radio-Air Medium model

Telehealth – Layer Functionalities
• Application
– new applications and adaptations
– service location, multimedia
• Transport
– congestion and flow control
– quality of service
• Network
– addressing and routing
– device location, hand-over
• Link
– media access and security
• Physical
– transmission errors and interference

NETWORKS( LAN & WAN)

 A network is two or more computers that are connected so that data and resources can be
shared.
 Most computers are connected to some kind of network.
 Connection can be through a copper wire, fiber optics, microwaves, infrared or satellite.

LAN: LOCAL AREA NETWORK

 A Local Area Network (LAN) covers a small distance and a small number of computers.
 A LAN often connects the machines in a single room or building
 Data transferred in High speed which ranges from 100 Mbps to gigabit for system development
and have a low implementation cost.
 Upper limit: 10 km ; Lower limit: 1 km
 Twisted pair cable or Co-axial cable connects the plug in cards to form a network.
 USAGE OF LAN

A work to internet connections would most likely require broadcast network (LAN) with a connection to
the internet (packet switched network).

MERITS

• Cost reductions through sharing of information and databases, resources and network
services.

• Increased information exchange between different departments in an organization, or

between individuals.

• The trend to automate communication and manufacturing process.

DEMERITS

Special security measures are needed to stop users from using programs and data that they
should not have access to;
• Networks are difficult to set up and need to be maintained by skilled technicians.
• If the file server develops a serious fault, all the users are affected, rather than just one user
in the case of a stand-alone machine.
  There are three topologies of LAN Network

WAN: WIDE AREA NETWORK

A Wide Area Network (WAN) connects two or more LANs, often over long distance.

A WAN often connects different groups in different countries.

Range: Beyond 100 km.

ADVANTAGES OF WAN

• Covers a large geographical area so long distance businesses can connect on the one network.

• Shares software and resources with connecting workstations.

• Messages can be sent very quickly to anyone else on the network. These messages can have
pictures, sounds, or data included with them.

• Expensive things can be shared by all the computers on the network without having to buy a
different peripheral for each computer.

• Everyone on the network can use the same data.

DISADVANTAGES OF WAN

• Need a good firewall to restrict outsiders from entering and disrupting the network

• Setting up a network can be an expensive, slow and complicated.

• Once set up, maintaining a network is a full-time job which requires network supervisors and
technicians to be employed.

• Security is a real issue when many different people have the ability to use information from
other computers. Protection against hackers and viruses adds more complexity and expense.
 Technologies Involved
• Medical Instrumentation
Sensing Bio-medical Signals,
Medical Imaging, Measurement of Physical Parameters e.g. Body Temperature, Pressure etc.
• Telecommunication Technology
Trans-receiver on different communication channels and network such as, on wired network,
wireless medium etc.
• Information Technology
Information representation, storage, retrieval, processing, and presentation.

Satellite Communication In Telemedicine

Satellite communication in telemedicine is an application of satellites in medicine that resolves the issue of the
lack of professional healthcare in locations where it cannot be originally accessed . A patient can very well be
diagnosed regardless of long distances using telecommunication equipment that enables the health care specialist,
wherever they may be, to interact with the patient and local healthcare giver, thereby, providing almost accurate
diagnosis and treatment to an individual. Satellite communications transmits digital signals at a very high data rate
with low bit error rate . Satellite communication is the transmission of signals from one earth station to a satellite
in space orbiting in the galaxy which will in turn transmit the signals to another earth station .

The frequency bands are the L-Band, S-Band, C-Band, X-Band, Ka-Band and the Ku-Band [1]. For the purpose of
this research, the brief focus will lie on all with the exception of the S and X-BANDS.
Satellite communication has been adopted to allow telemedicine function globally. Telemedicine requires a high
bandwidth transmission for clear and quality digital signals for proper diagnosis and treatments. Satellite
communication has the ability to transmit at high frequencies and long distances, making it better than any other
communication technology that can be used in telemedicine.

VSAT IN TELEMEDICINE
VSAT (Very Small Aperture Terminals) is satellite communication system. As shown in Fig. 1, it comprises of a HUB
station that acts as an earth station for a group of VSATs in a network for transmitting signals to the satellite’s
transponder which will retransmit back to the earth station. VSATs are capable of providing high capacity links to
users providing 35- 45 Mbps internet backbone connectivity [3], [2]. The VSATs in a network are all connected to
each other via the HUB in a star topology network [3]. VSAT provides all the necessary connectivity including
videoconferencing, media streaming, real time video, IP multicast, where it does not necessarily mean that only a
single specialist from a location can interact with an emergency patient but, different health professionals from
different locations can interact with that patient at the same time. It also allows for immediate access to
information via the internet for medical research needed in the communication between doctors and patients in
remote area to the specialists in distant locations.

The concept of VSAT in telemedicine by ISRO (Indian Space Research Organization) consists of an integration of
medical software and computer hardware, medical equipment for cardiology, pathology, imaging and video
conferencing. At each hospital, the VSAT is installed, making it a VSAT network. Detailed information containing
medical history of patients are sent to the medical specialists, then diagnosis, and treatments can be given by
specialists via videoconferencing to the health care professional to carry out on the patient at the other hospital.

Operation of VSAT in Telemedicine

VSAT comprises of two units; Outdoor and Indoor unit .

At the outdoor unit, the (Radio Frequency Transceiver) is attached to the feed horn on the frame of the antenna,
where the size of the antenna determines the power of the signal and the received power of the antenna remains
constant given a higher amplitude of the antenna .
The RFT reduces the noise in the signal before passing it to the decoder. The feed horn, which is fixed on the focal
point of the antenna, directs power to and from the transponder to the VSAT antenna. They operate mostly in the
Ku-Band or sometimes, the C-Band with antenna size less than 3.4m in diameter and low power of 1-2 W. The
antenna gain is constant for a fixed area coverage.
At the VSAT indoor unit, the carrier signals are modulated with the user traffic signals by a set of modulators and
then transmitted to the RFT which amplifies and transmits it to the transponder. The received signals are divided
into the original traffic signal and carriers signal by the demodulators at the

VSAT network implementation in telemedicine

VSAT network implementation in telemedicine

Benefits of VSAT in Telemedicine

VSATs provide real time transmission media as required in telemedicine and are portable because of the very small
terminals. The cost of implementation is independent of the distance and volume of data and can provide 99.5-
99.9% availability in relation to the requirements [5]. VSAT option is much better than terrestrial communication in
terms of cost of wiring, availability of the network and installation. It is cheaper and easy to implement in rural
areas.
VSAT is capable of multiplexing video, voice and data on one connection [1].

VSAT is unaffected by natural disasters, geographical barriers and can be located anywhere, even in the middle of
the desert where satellite network is the only option.

VSAT does not provides a customized bandwidth depending on the requirement of the user.
Installation of VSAT takes less than a week and is cheaper in terms of time [1]. It is a scalable network, adding new
sites and reconfiguring existing ones takes only a few days.

The wide coverage and high availability of the network makes telemedicine an efficient way of medical access
which means if there are occurrences when telemedicine cannot be of aid to patients who require immediate
medical attention, it will be 0.1-0.5% of the time.

VSAT technology is also implemented in aircrafts and marine vessels, fulfilling the goals of telemedicine. Whereas,
it is almost impossible for terrestrial cabling to provide telemedicine service on sea and in air .

THE BENEFITS OF SATELLITE COMMUNICATION IN TELEMEDICINE

Satellite communication is the fastest wireless transmission considering the long distances that signals travel from
earth stations to space with little attenuation and can provide instant internet connection and high definition quality
video streaming in even the most remote locations eradicating the problems of unavailability to medical attention .
Patients in rural areas are more likely to seek medical care if they know it is cheap, safe and reliable . It allows for
telemedicine to be possible in local areas in a cost effective manner since the cost to implement satellite equipment
tools are decreasing constantly.

Data transmission rate is very important in telemedicine and can determine the survival of a sick patient especially
in emergency cases, to which satellite communication can provide it with the speed it needs in its functionality. This
saves a lot of time and money if the specialist needed to come and treat the patient personally because of a poor
speed internet access.

The availability of the satellite transmission is about 99.95% making it possible to for patients to receive medical
health care almost every time and any time of the year .
Satellites transmitting in the C-Band are very reliable and cannot be affected by rainfall, snow, or extremely terrible
conditions. Although, the case of mutual interference exists from terrestrial microwave users . There are now
solutions that converge the Ku-Band and the C-Band frequency bands . With this, telemedicine using the satellite
does not have to be dependent on weather condition.

Aircrafts also have the access to telemedicine via satellite communication. Telephone lines and other means of
communication are not as reliable as the high broadband transmission speed providing video and data services
associated to satellite transmission. It is a much more reliable, faster and safer way of saving lives by giving
instructions to doctors on board to carry out on patients .
Telemedicine on sea is only possible with satellite connectivity by attaching telemedicine devices to satellite feeds
for communication between doctor on ship and the healthcare specialist away . This is a much safer way of travel
since travels on water can take months before arriving the destination. If a crew or passenger were to fall ill during
those months, immediate treatments would be impossible, and the ship might have to make a stop at a closer port for
the patient to get access to healthcare. This is time wasting and can cause the shipping corporations to lose millions
of money in the long run .
Satellite communication is a frequency spectrum efficient method of broadcasting and can cover about 5.2-6.7% of
the total land area in the world with a single range of frequency and 100 W transponder in the BSS (Business
Satellite Services) and FSS (Frequency Satellite Services) band. Implementing a satellite network in telemedicine
with an efficient spectrum which can cover wide areas optimizes the network and saves cost.

Satellite transmissions can provide bandwidth greater than the needs of telemedicine unlike regular telephone lines,
or digital subscriber lines .
Satellite technology e.g. VSAT technology is not only important in the rural areas but, also important on sea and in
air where only the satellite connectivity is possible. Oceans, mountains, deserts are not obstructions in satellite and
transmission.
Mobile Telemedicine Unit
The telecommunication equipment for MTU allows transmitting results of medical examinations to
hospitals and receives corresponding conclusions, recommendations and instructions, plus providing
national medical centers and MTU with videoconference services. The telecommunication equipment
for MTU can be used for training purposes to teach local population about healthy life style, methods of
caring for sick persons, various social and other issues.

The MTU is equipped with a fast deploying ground satellite station (GSS) intended for transfer and
receipt of digital information through the allocated communication networks using channels of the
geostationary satellite. The station provides for delivery of information from any location within the area
serviced by the satellite, to central or intermediary stations-nodes of the communication network.

The wagon is equipped with the following equipment:

• system for fixation of wagon position (turning to horizontal position);
• system for illuminating the wagon;
• system for heating the wagon (heater);
• system for wagon ventilation and air conditioning (air conditioner);
• system for air disinfection in the wagon (UF-radiators);
• system for autonomous energy supply;
• water supply system;
• sanitary arrangements (bio WC, shower);
• system for storing medicines, reagents, preparations and consumables;
• remote working places (collapsible tents, folding tables and chairs).

The Mobile Telemedicine Unit

Basically the Mobile Telemedicine Unit consist of three blocks i.e. the medical devices that performs
measurement and acquisition of medical data/information including a set of video camera equipment;
the communication block , and a processing data unit.

•
 • Figure 1: Mobile Telemedicine Unit

Medical devices block

Medical devices which are equipped in the unit may vary, according to the urgent medical services that
mostly demanded by the community within the area of interest. Each of medical devices is connected to
a Telemedicine Arbiter that functions as an interface between the equipments and the local PC.
Moreover, the telemedicine arbiter is also applied as a control unit for communication transaction to
local PC and the communication manager.

The Hospital Unit :

As shown in Figure 2, the Hospital Unit consists of a dedicated PC and a Communication Manager. The
PC is used for monitoring signals and data coming from the Telemedicine Unit. Incoming signals are
biosignals measured by medical devices within the Telemedicine Unit. Data may be in a various format,
and the data transaction is controlled by the Communication Manager.

Figure 2: Hospital / Doctor Unit

Medical equipment of MTU

The medical equipment of MTU allows conducting examinations necessary for effective
screening of population, including chest X-ray with the lowest possible exposure to x-ray
radiation, biochemical examinations and functional diagnostic.

The medical equipment includes:

• digital low-radiation fluorograph for examination of chest organs in a vertical position of a

patient;
• optical medical microscope for conducting parasitic, bactericidal, cytological and histological
analysis with digital module for input/output and image registration;
• functional diagnostic facilities (digital electrocardiograph);
• set of laboratory equipment for making preparations.
If separately agreed with the Customer, the medical equipment of MTU can be completed with
a wide range of optional medical equipment including remote equipment that has wireless
communication with the MTU.
Mobile telemedicine station of emergency assistance

This is equipped with registration, data acquisition and imaging devices. There are autonomous tools of
satellite communications, autonomous power supply systems and “life-support system” providing
comfortable working conditions for personal in any climate. The station provides collection and
exchange of ES information and the delivery of the decisions and commands directly to liquidators of ES
consequences.

Small mobile telemedicine unit

This unit is equipped with transportable telemedicine terminal provided with the wireless
communications to the unit. It has autonomous tools of satellite communications and power supply
systems. This unite can be delivered by any transport mean to regional medical centers dedicated for
evacuation of injured. It provides efficient support to medical treatment and collection of data on the
state of patient.