Analysis of Emerging Technology
As the world has globalized over the last 30 years, many people are traveling further and further away from the comforts of modern technology. Tourists and workers are exploring developing nations looking for new adventures and new opportunities. But, as they traveled many miles from their home base, these adventurous persons discovered that the safety net of emergency services and in particular emergency medical services became more and more fragmented. Now, communication technology has helped fill this gap, not only for the distant traveler in far-flung corners of the world, but for residents in developed countries that still face a fragmented infrastructure for summoning emergency medical assistance. Today, automatic call-outs for emergency medical care are being placed by a network of satellite, cellular, WI-FI, and Bluetooth connected telecommunications devices that not only tell you the time, let you make calls, and are micro-sized portable computers in the form of the widely possessed SMART watch, but monitor your vital signs and other data received from any Smart-Prosthetics you may be wearing or have had implanted within your body that will automatically contact your medical provider to record medical information about your real-time health, evaluate those results, and determine next step courses of action for basic medical treatment including summoning emergency medical attention. This network is called the Auto-ER network.
The Auto-ER network is an integration of data feeds and communications components that allow an array of medical data to be collected using currently available technology that is communicated to medical personnel. One of the latest expansions of this network is the summoning of emergency medical personnel without the intervention of the patient nor the assistance of anyone else in physical contact with the patient. The main physical component within the network is the android based SMARTwatch.
Introduced in mid-2013, this maturing technology evolved from a basic Bluetooth device that connected with a larger cellular phone or tablet device into the powerful wristwatch that has overtaken the market for these larger devices. It interacts with the human body via contact with the wearer, allowing neurological data feeds through highly accurate sensors located in the back of the device that interact with the vast array of epidermal nerve endings located just below the surface of the human skin. These sensors easily detect blood pressure, pulse rate, and other basic bio-medical indicators, but now have advanced far enough to allow for stress-level indicators, neurological activity, as well as generalized mental patterns. The SMARTwatch also leverages Bluetooth and radio signal connections with prosthetic appliances such as pacemakers, insulin monitors, and modern prosthetic limbs with internal computing and monitoring functionality that enhance the performance of the limb as well as provide feedback data for real-time understanding of patient status. The ability to go global was also rolled out with this new watch, as nanotechnology advances have allowed manufacturers to install satellite as well and the normal cellular, Wifi, and Bluetooth communications bundle within the tiny device. While the technology for satellite communications has been widely available for many years, recent developments in reduction of the size of the internal components have made the satellite communications link with the SMARTwatch back to patient records database. This link connects with the emergency medical services database that compiles all known medical services allowing a call-out to the closest emergency medical personnel to the wearer’s GPS location.
The Auto-ER network looks to be a revolutionary network impacting many stakeholders involved in the process for summoning emergency medical care from anywhere in the world. While various government agencies such as the Federal Communications Commission are involved in some of the telecommunications standards and legislation required to provide the fundamental communications infrastructure, the Department of Health and Human Services has worked indepth to help provide standards for reporting medical information both historical and real-time by which future developers will leverage. These standards negotiations helped this burgeoning industry avoid standards wars of the past, allowing an accelerated development of the electronic health record format now employed. We anticipate the cross-side effects from the standardization of the format for EHRs to allow subsequent technology releases as more application developers embark on leverage the overall communications network. Real-time electronic health data passed from individual to medical provider with feedback passed back to the individual will accelerate response times for those in distress.
Combining all of these indicators together, comparing the real-time data feed to an established baseline stored within the Auto-ER cloud database, the SMARTwatch can monitor pain levels, injury or illness type, seriousness of the injuring or illness, and overall status of the patient. The wearer can initiate the call themselves with a single push of a panic button or if medical indicators fall outside baseline guidelines, the SMARTwatch can initiate the call itself. Individuals can rest assured that even if incapacitated, they can reach out for emergency medical assistance that will contact Enhanced 911 or local emergency medical facilities from anywhere in the world.
The Evolution of the Auto-ER network, 1993-2013
In 1993, the three fundamental technologies that make the SMARTwatch and the Auto-ER grid work, the epidermal neural sensor contact, satellite communications nano-technology, and the artificial intelligence driven Auto-ER, did not exist. The ability to connect individuals to an EMS support matrix accurately and globally was in its infancy stages. Historical medical information about individual patients was not readily available electronically via an integrated network. Finally, neural sensory devices were in a primitive state not advanced enough to determine more than cursory electrical signals emanating directly from the epidermis. Much of the data available from specific nerve contact points was unknown at that time.
In 1993, the state of the support matrix involved in summoning medical help was fragmented and localized. In a position statement from the National Association of EMS Professionals, commenting upon this fragmented nature of the EMS response system, it was determined that “Quality patient care will depend upon total commitment to the development and operation of an integrated and comprehensive EMS system.” Since 1968, one of the developing methods for contacting emergency medical personnel in the U.S. has been the 9-1-1 system. However, this system was not standardized within the U.S. until the Wireless Communications Act of 1999, also known as the 911 Act, which “mandated that 9-1-1 would be the digits to be dialed within the United States for "reporting an emergency to appropriate authorities and requesting assistance". As the 9-1-1 system became standardized for analog networks, the digital cellular network system appeared in commercial use for the first time in 1993. While this new technology expanded the use of cellular phones, it also complicated the ability of end-users to access the 9-1-1 system as well the ability for EMS responders to locate, contact, and treat patients. The digital system had many short-comings with regard to end-users not being in a fixed point as landlines of the past gave. Therefore, Enhanced 9-1-1 evolved to fill in these short-comings. Enhanced 9-1-1 provides caller identification and location information to the Public Safety Answering Point. In 2005, FCC mandates required all U.S. telecommunications carriers to have 95% of their network location compliant for E911. By February of 2010, the Enhanced 9-1-1 mandates developed in the U.S. were adopted in Canada. However, as of 2013, the emergency response system was still highly fragmented throughout the globe and in search of a service or product that could standardize how end-users could contact and request emergency medical assistance and take accessing emergency medical services to a global level.
Another area of significant fragmentation within the support matrix occurred with communicating of patient medical information both historical and real-time information to emergency medical personnel. At this time, tracking medical information was based on historical information usually kept in local files either on one’s personal doctor computer systems or paper files stored on sight at an office or hospital. Access to an individual’s medical information was extremely limited and took days or even weeks to share between medical providers. In 2004, then President George W. Bush proposed the formation of electronic health records. In his 2004 State of the Union address, he stated that standardized, on-line electronic health records would “avoid dangerous medical mistakes, reduce costs, and improve care.” In March of 2010, then President Barack Obama signed into law the Patient Protection & Affordable Care Act with provisions designed to enhance electronic health records through the HITECH Act. “Physicians and hospitals need to prove that they have met 25 different functional objectives with their use of an EHR product to be considered “meaningful users”. These objectives include computerized physician order entry (CPOE), the use of clinical decision alerts, incorporation of lab results into their EHR as discrete data, ePrescribing and electronic information distribution to patients.” While the provisions did standardize medical information and its accessibility in later years for the U.S., it did not provide for real-time medical information nor did this create standards globally. As of 2013, medical providers around the globe still continued to struggle communicating historical and real-time medical information for any single patient to any medical provider around the globe.
Finally, while developments in telecommunications and medical data were being formalized through legislative standardization in the U.S., the technology needed to collect vital medical information, identifying the medical situation a patient was involved in, and compare that information to a baseline to help remotely activate emergency medical responses was almost non-existent in 1993. The challenges centered on being able to accurately access this vital medical information through a non-intrusive device that could be worn as an aesthetically pleasing device such as a wrist watch. Nanotechnology or microelectronics had not developed to the point to allow such a device. Also, the technology to gather more than skin temperature and blood pressure from a patient was not capable. The concept of accessing epidermal dermal level neural electrical signals that contains information from the limbic, endocrine, and nervous system as whole was not possible in 1993. In 1998, US patent 5715821was filed by Biofeld, Corp for a neural network method and apparatus for disease, injury, and bodily condition screening or sensing. The concept of the patent was to use a multitude of sensors in a matrix connected to several points on the body to detect information from the epidermis level without intrusive modes for sensing. In 2001, Dr. John Wood and his colleagues Simon Beggs, and Liam Drew described human sensory receptors connected the spinal cord that are channels for detecting tissue damage and pain. In 2013, the Rehabilitative Institute of Chicago begin producing bionic prosthetics that patient could control with electrical signals from the brain received through epidermis sensors. Later in 2013, Dell computer processor manufacturer sent to market a processor that accomplished perceptual computing. The purpose of the processor was to combine several sources of data inputs from the human body, including eye movement, facial gestures, and voice patterns to sense human emotion and detect biometric data that would give a more comprehensive and human like understanding of an individual. This technological step allowed developers of biometric systems to come closer to real-time collection and synthesization of human medical information that had not been available before. At the end of 2013, the only step left was connecting the human sensory receptors to the perceptual computing capability all within the small package of a wrist watch.
Importance of the Last Decade (2013-2023) in Auto ER-Network Development
Infrastructure
Since 2013, the world has continued to benefit from the network originally created for the mobile phone turned smartphone market. This large network provided on demand connectivity for millions of phones around the world. In 2016, over 1 Billon mobile devices were added to the network which far exceeded estimates and was well above the annual average of 500M additions for the previous 5 years. The rapid expansion can be attributed to factors – In the developed work, the Internet of Things increased demand for mobile devices and in the developing world, growing middle class was seeking the worldwide access the devices offered. This expansion created a truly world-wide network that reduced the barriers of entry as well as travel concerns many mobile users experience as they leave their home countries. This development was essential in the development of the Auto-ER Network as it virtually eliminated the concerns users had with respect to global coverage. The large telecom providers continued to invest in improving speed and coverage worldwide with the full implementation of the 5G network with more than doubled LTE data rates.
In addition, many urban areas, high-speed Wi-Fi become widely available at very reasonable cost (or free), often included in the user’s home internet package such at Comcast’s now ubiquitous Xfinity Wi-Fi package. This brought higher speed wireless connectivity to a broader audience without the constant worry of data consumption of traditional mobile networks. When available, smartphones and other connected devices are able to seamlessly transfer both voice calls and data transfers to the more robust Wi-Fi network. This network allows the user to remain connected even when in urban centers that are dominated by large, steel-framed buildings that often restrict traditional cellular data signals. Of significant concern for the Auto-ER Network was the ability to contact individuals who may be located in a building where traditional cellular coverage is diminished, but broad access to Wi-Fi remains. This connection allows the SMARTwatch device to communicate its location relative to the access point and thus pinpoint the location of the wearer.
Finally, an improving global economy in the latter part of the decade provided new business opportunities. One such opportunity was the successful launch of a communications satellite network by SpaceX, the company founded by Elon Musk in 2002. The company has been able to provide a reliable globally network at a reasonable cost which has sparked a wide variety of products that leverage affordable satellite coverage. The Auto-ER Network’s access to this array of satellites has increased the appeal of the product to younger customers who expect the benefits of always connected device regardless of location.
Adoption
With the failure of the implantable RFID tag, developers of the Auto-ER Network knew that a device designed to keep people connected must be worn outside the body. To further support the environment for Auto-ER Network the introduction and mass adoption of wearable technology. The introduction of Google Glass in 2014, and first commercialization of the SMARTwatch by Samsung a year earlier brought an introduction of wearable technology to the consumer. The SMARTwatch continued to progress through the decade and gradually gained more of the functions traditionally isolated to the smartphone. As this happened improvements in OLED technology allowed the displays to increase in flexibility which improved overall comfort for the end-user.
In addition, older population demographics worldwide, especially those who wanted to continue to live independently created a large pool of potential users for the Auto-ER network. Interestingly, this group of the population was very comfortable with wearing a wristwatch as they had traditionally worn a watch throughout their lives, not having the smartphone to rely on for timekeeping. This demographic, and their offspring demanded a solution that would be simple, even seamless, to use and monitor. Emphasis was placed on creating a solution that would benefit not only the user, but all who are involved with the user’s care. Improvements such as health monitoring through the SMARTwatch allowed the user to remain at home when previously that information would only have been available with an in person visit to the doctor’s office. While not a primary function, this did increase the interest among the large elderly population and offers a good complement to the traditional ER notification of the network.
On the other side of demographic spectrum, active, younger consumers hungry for adventure had one concern, privacy. These individuals wanted the benefits of the Auto-ER Network without the fear of being continually tracked as they went about their daily lives. To help assuage these fears, Auto-ER network shipped units with the embedded tracking feature disabled. In this mode, the user’s location and personal data is only transmitted in an emergency scenario. This toggle switch, similar to the one found on internet browsers, made users feel much more comfortable with the device, driving strong sales within the active community. In the middle of the decade, to activate network effects, the company gave away the devices to competitors in extreme trekking as well as more traditional sports from skiing to sailing. This provided the most demanding users the product to test, use, and provided feedback which was incorporated in future releases throughout the decade. An interesting benefit were the success stories that began to arise from these elite athletes who eventually became spokesmen for the Auto-ER Network feeling that the incredible product had the potential to save lives. This ultimately put the product in the hands of weekend warriors as they aspired to higher levels of athletic achievement.
The Auto-ER network looks to be a revolutionary network impacting many stakeholders involved in the process for summoning emergency medical care from anywhere in the world. While various government agencies such as the Federal Communications Commission are involved in some of the telecommunications standards and legislation required to provide the fundamental communications infrastructure, the Department of Health and Human Services has worked indepth to help provide standards for reporting medical information both historical and real-time by which future developers will leverage. These standards negotiations helped this burgeoning industry avoid standards wars of the past, allowing an accelerated development of the electronic health record format now employed. We anticipate the cross-side effects from the standardization of the format for EHRs to allow subsequent technology releases as more application developers embark on leverage the overall communications network. Real-time electronic health data passed from individual to medical provider with feedback passed back to the individual will accelerate response times for those in distress.

Stakeholders:
Four major stakeholders were affected by the rise of the Auto-ER Network (ARN): Device manufacturers, telephone companies, governments, and emergency responders.
1. Manufacturers
The market leading manufacturers of the SMARTwatch were Samsung and Apple (1 and 2 respectively). However, as the Auto-ER Network spread to developing nations, Nokia and Blackberry quickly experienced a surge in demand for its version of the device. In fact, Blackberry leapfrogged both Apple and Samsung to become worlds the largest mobile device manufacturer with over 50% market share worldwide.
SMART-limb (aka SMART-prosthetics) manufacturers standardized their devices to operate on the Auto-ER Network. Hanger (http://www.hanger.com/) became the market leader in SMART-limb devices by cornering the market via contracts with world government organizations (WGO’s). However Liberating Technologies (http://www.liberatingtech.com/) has quickly become the innovation leader in the industry by pushing the limits of the status quo by developing “SMART” accesories like fashionable fingernails, earrings, & wigs for cancer patients. Liberating Technologies is also currently running trials on SMART makeup. Companies like IBM and Oracle have partnered with WGO’s to provide analytics software to help manage and monitor the Auto-ER Network. TIBCO Software (www.tibco.com) has gained notoriety for its work in providing WGO’s with predictive capabilities via complex event processing. This enables the Auto-ER Network to predict and respond to epidemics before they have a chance to do any significant harm by using advanced statistical models on the networks data stream.
2. Telephone Companies
Telecommunications companies worldwide began to provide a hybrid service for emergency calls that integrated the established emergency with the new Auto-ER Network. This eventually led to a significant increase in load on the emergency system. There was an initial spike in the cost of mobile service plans that was eventually mitigated by the WGO’s committing to help with the necessary expansion of infrastructure. The emergency dispatcher role was quickly marginalized and subsequently eliminated within the first 2 years of ARN becoming functional.
3. Governments In order to meet the drastic increase in demand placed on the infrastructure of telco providers, WGO’s decide to transfer some of the significant savings realized by ARN into the construction and development of additional infrastructure, including satellites and wireless access points.
4. Responders
Fire fighters are able to detect carbon monoxide and other flammable compounds not readily identifiable by perceived human senses by analyzing the data feed from ARN. High speed police chases have been eliminated thanks to the ability to pinpoint suspects via access to the ARN. The need for paramedics has significantly declined thanks to the network’s predictive nature.
Resistance: Equal access, privacy, security, and the speed of adoption have been and may continue to be ethical hurdles.

Access Due to the connected nature of ARN, its efficacy is dependent upon the ability of responders to access some of the most remote and economically challenged areas of the world. Thankfully, the numerous positive externalities of a worldwide emergency system served as the impetus for cooperation between nations of all socioeconomic statuses. Organizations such as NATO, United Nations, World Bank, and others committed to the goal of 100 percent coverage for ARN and chartered the ARN Act of 2020. The ARN Act also provided developing countries with communications infrastructure that would never have been possible independently.
Privacy
In the early days of ARN, WGO’s quickly realized the espionage advantages afforded to member countries with access to ARN’s data stream. There were a number of high profile cases involving the United States. In particular, North Korea was the target of routine spying that became known in 2018 thanks to a whistleblower with Oracle’s analytics division. The US was able to target specific nuclear sites in Pyongyang and effectively end North Korea’s entire nuclear program overnight. This was successfully carried out with the use of contact lenses (worn by operatives and developed by Liberating Technologies) that provided visual data via the network. As a result, the anti-spying clause was added in order to make the ARN Act possible. In the United States, access to ARN data by legal entities for use in criminal investigations and proceedings led to large scale protests after the ARN Act. Law enforcement began to successfully prosecute criminals using the heart-rate and brain pattern data transmitted during suspected criminal activities. The ACLU is actively seeking the repeal of the ARN Act altogether due to what it calls an “egregious invasion of privacy”.
The Supreme Court is also currently hearing the arguments of insurance companies over the believed necessity of access to ARN in order to comply with the onerous requirements of Affordable Care Act. They believe that having an active ARN profile on every patient or potential patient will give them the ability to properly assess the overall risk profile of the population.
Security
In 2022, there was an incident where a couple of SMART device implants suffered from what came to be known as “burn-out”. Most patients experienced severe pain from the sudden failure of electrical components with a few experiences permanent nerve damage.
In early 2021, the ARN Act had to be modified to include security standards after several worldwide cyber-security attacks led to high profile ARN data being auctioned off on the black market. Then Prime Minister of Canada, Charles Trudeau, was assassinated by a rebel group that located him using data hacked from ARN.
In addition to “burn-out” and hacking, there have been limited instances of accidental feedback or reverse-transmission of ARN’s data stream where SMARTwatch and SMART-limb users have mistakenly received remote commands to their devices from an unknown source.
Speed of Adoption New techniques in genetic engineering coupled with advances in ARN receiver technology led to significant advances over a short period of time that haven’t been addressed with current legislation. Companies are now developing receptor genes that make every human being traceable on ARN without the need for an intermediary receiving device.
In a move to expedite the cost savings realized by ARN adoption, many WGO’s have adopted mandatory implant policies similar to vaccination requirements. In order to have access to government benefits and programs, citizens are required to “tether” themselves to ARN.