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Secure and Fast Emergency Road Healthcare Service Based on Blockchain Technology for Smart Cities

Secure and Fast Emergency Road Healthcare Service Based on Blockchain Technology for Smart Cities

1. Introduction

According to the World Health Organization (WHO), 1.3 million people die because of car crashes annually. In Tunisia, 616 people lost their lives, and 4873 others were injured in road accidents during the first 8 months of 2022, according to data from the National Observatory of Road Safety under the Ministry of the Interior.

The United Nations General Assembly has set an ambitious target for road safety to halve the total number of road traffic deaths and injuries by 2030 (A/RES/74/299). Several factors can contribute to reducing this number. Among them are the timely arrival of ambulances at the scene of the accident and the recognition of the medical data of the injured in advance by the medical staff. However, the questions here are how to determine the nearest available emergency vehicle and how to inform the emergency services of patient information. Therefore, two strategies are possible responses to these two questions. The first is the use of connected ambulances and the second is the sending of vital signals of injured people to the appropriate service in real time. In this case, emergent technology such as the Internet of Things is seen as a prominent solution to manipulate the components mentioned above.

The Internet of Things (IoT) has invaded several areas, including connected vehicles and healthcare [1,2,3]. As a result, a new paradigm named the Internet of Medical Things (IoMT) is arising. IoMT proposes to radically transform healthcare delivery. Through machine-to-machine (M2M) interaction and real-time intervention solutions, IoMT solves accessibility and reliability issues [4,5]. In addition, increased patient engagement in decision making will drive healthcare compliance. IoMT enables faster disease diagnosis and decision making by compiling large amounts of medical data in a timely manner. IoMT increases human–machine interaction, which improves medical record keeping. We are talking about the exchange of medical data that require a prominent level of confidentiality, security, and rapid intervention.
The convergence of IoT and Intelligent transportation system (ITS) gave rise to the concept of Internet of Vehicles (IoV) [6]. Over the past decade, the concept of the smart vehicle has grown considerably. It plays an especially key role in several application areas such as smart cities, healthcare, and intelligent transportation systems, since vehicles can communicate with each other and with their surroundings. Through vehicular communication, many data are manipulated that require extremely high security, confidentiality, and availability.
Blockchain technology has recently become important in systems that handle security and privacy concerns. In its report, published in December 2018, the National Assembly’s joint information mission on the uses of BC and other register certification technologies, defined BC technology as follows [7]: “A BC is a register, a large database that has the particularity of being shared simultaneously with all its users, all of whom are also holders of this register, and all of whom also have the ability to enter data into it, according to specific rules set by a computer protocol that is very well secured thanks to cryptography”. It is indeed a connection of nodes that communicate and save transactions. So, every entity in the network records a copy to mitigate a single failure point. The record from the BC is arranged in blocks to construct a distributed ledger (DLT). Cryptographic processes guarantee the confidentiality and integrity of data. Satoshi Nakamoto introduced the idea of BC for the first time in 2008 [8]. Numerous key characteristics highlight BC technology, such as decentralization, integrity, autonomy, confidentiality, and immutability [9,10]. These characteristics increase the demand for BC in a wide range of sectors [11,12].

The fusion between IoV and IoMT gives a fantastic opportunity to reduce the number of people losing their lives due to road accidents. However, the data managed in such cases are highly sensitive. They need a dependable, decentralized, and secure system. To ensure these properties, BC technology is highly recommended. The integration of blockchain technology, l’IoV, and IoMT is a crucial solution to these issues with decentralized, efficiency, privacy, and partner trust management. In the form of a distributed and secure register that enables emergency medical personnel in addition to have admission to harmed vital signs but also to change them, blockchain technology offers just such a solution. Hence, we guarantee the compatibility of the platform used by the various actors of the proposed system using Blockchain technology. To cut maintenance costs and get rid of legacy threats from centralized systems, this approach removes the central authority (CA). The fundamental goal is to build autonomous interaction without human involvement through smart contracts, ensuring security and trust amongst the agents in the system. To guarantee the security of patient data, the following criteria must be taken into consideration: authentication and access control.

Based on smart contracts, we propose a system for the treatment of road accidents. This system is composed of two subsystems. The first one includes an IoV part that takes care of the search for the nearest available ambulance and the nearest emergency service. On the other side, the second sub-system deals with the transfer of the vital signs of injured people to the appropriate emergency service staff.

The following are the most significant contributions of this manuscript:


Designing a system for road safety emergencies.


Proposing a subsystem to search for available rescue vehicles and the nearest emergency service, using IoV.


Suggesting a sub-system to transfer the patient’s health data to the appropriate service.


To ensure the security and confidentiality of the exchanged information, smart contracts are provided in each part of the total system.

The rest of this manuscript is structured as follows. The second section covers the fundamental concepts of BC technology, IoMT, and IoV. Section 3 shows how BC technology is being used in healthcare data management and connected vehicles. Section 4 describes in detail the proposed system architecture. Finally, Section 5 wraps up this paper and offers some suggestions for future research. Table 1 summarizes a list of abbreviations and acronyms used in this paper.

4. Proposed Framework

The proposed system is composed of three main stakeholders: connected vehicles, emergency vehicles and hospital emergency services.

The idea, as illustrated in Figure 3, is to broadcast the information in case of a road accident to the neighboring vehicles to give way or change the traffic voice. In a second step, emergency vehicles are sought in the surroundings and the exact location of the accident is transmitted. After arriving at the indicated location, these vehicles collect information about the injured person through sensors that measure vital signals to the emergency service. These services in turn process the data in advance. The prompt treatment of the data and the timely arrival of the emergency service increase the likelihood of saving the life of a human being. To reach our goal, we divide our system into three sub-systems that will be detailed in the next section. Based on BC technology, we process all data automatically via smart contracts.

4.1. V2V Communication Sub-System

In the case of vehicular communication, each smart vehicle can transfer information either to neighboring vehicles or to the nearest emergency services. The distributed information must be decentralized. Indeed, the list of services and the vehicles are registered on the BC. In case of an accident, a request is automatically launched to search for a nearby medical center, which in turn informs the ambulance to travel to the scene of the accident. As a result of these requests, data about the parties involved are automatically recorded via a smart contract.

In such a case, priority on the road is given to the emergency vehicles. Figure 4 illustrates the communication process between the vehicles. After receiving an accident alert, the emergency vehicles proceed as follows:
  • Automatically generate an itinerary by indicating its position and destination.

  • Use GPS to locate the other vehicles on the route.

  • Send a message to the located vehicles to give way.

The Blockchain network allows the management of communication between cars. Vehicles access a public blockchain network to send the data collected on the location of an accident. This whole process runs automatically via smart contracts. The smart contract has two main roles: sending messages or publishing a new message on the blockchain network, and reading messages, which allows the device connected to the blockchain network to read the existing data.

4.2. Emergency Vehicles and Healthcare Communication Sub-System

This sub-system allows communication between the emergency vehicles and the emergency service center (Figure 5). Each injured person in an emergency vehicle must be equipped with sensors to measure vital signals such as temperature, respiration rate, oxygen level, etc. The collected information is transmitted to the appropriate emergency service to be processed in advance by medical staff. In this case a smart contract is established between the sources of the medical data and the existing system in the hospitals. So, in this way, an EMR containing the medical data of the person in question is handled in a decentralized and secure way.

4.3. Remote Healthcare Sub-System

This part consists of tracking the patient by different stakeholders, namely the doctor, the analysis laboratory and the pharmacist. For the management of EMR of the patient, each stakeholder must authenticate with his identifier and his role. The manipulated information is gathered and saved on the BC. A smart contract is responsible for their update.

4.4. System Requirements

The data manipulated in our system are sensitive and requires confidentiality and security during transmission. So, we need two types of BC: public and consortium.

  • Public BC: Everyone with Internet connectivity can connect to a BC platform to become an authorized node, making the public BC open and unconstrained. This person has access to both recent and old data, and they can also do mining operations—complex calculations necessary to confirm transactions and add them to the ledger. On the network, no valid entries or transactions can be altered. This kind of BC is used to hold information about vehicles and other emergency services.

  • A consortium BC: this type of BC operates in a restrictive environment as a closed network. The members of this network collaborate on a decentralized network. However, access is limited to a particular group. The controlling organization defines permission levels, security, permissions, and accessibility. We need to identify all the medical staff so that it can manage the data of the injured person in full confidentiality and security, so we resort to the use of this type of BC.

For the transmission of vital signs of an injured person, sensors are needed to collect the information and transmit it in real time to the appropriate service. These devices are integrated into computer networks via the web. This process takes place as illustrated in Figure 6.

In this article, we are just interested in the simulation of the part of the proposed system that involves the processing of data manipulated via BC technology. The study of sensors used as well as the communication protocols in IoMT network architecture are the subject of another paper.

5. System Implementation and Results

In our system, several actors share a large amount of information. The crucial aspect of the manipulated information requires a fast transfer in a secure way and in real time. Therefore, these requirements must be considered. To ensure this, smart contracts are used to automate the distribution of data. Authentication and access control ensure confidentiality. Table 4 describes the concepts used.

5.1. Fundamental Framework and Software Required

All simulations are executed on an Intel Core i5, CPU 2.60 GHz, 8 GB RAM, and Windows 10 to verify our framework. Ethereum BC is based on BC technology. It aims to create a platform based on smart contracts. This technology is also distributed via a P2P network. The smart contracts in Ethereum are written by the programming language Solidity; via this language, one manipulates transactions. An Ethereum transaction consists of several elements, such as the sender and the receiver as well as a fee that the sender must pay. Both the sender and the receiver have an account or an Ethereum address which consists of twenty bytes. We utilize the web3.js framework to access this account over an HTTP connection in JSON RPC style. To compile and move smart contracts to the neighborhood BC Ganache, one must use the Truffle development environment.

Table 4.
Used concepts.

Concept Description
Smart contract Because they perform basic functions, smart contracts are among the most critical features of any BC schema. The implementation of various smart contracts, whether for the system, interested parties’ enrolment, or for access control to manipulate and monitor exchanged data, is the first step in designing our conceptual model.
Access control A method of restricting user access to resources. It specifies the actions that each user must take and prevents unauthorized access to information. The access control model is built on authentication, identification, and authorization. Based on role-based access control (RBAC) and attribute-based access control (ABAC), each user is assigned a role that defines their access to a resource.
Authentication User authentication mostly through Ethereum addresses is required for each agent’s entry into the system. Following authentication, medical personnel can consult and communicate with one another.

5.2. Smart Contracts Deployment

We use a personal blockchain, Ganache, to implement our smart contracts. It enables the deployment of smart contracts, the development of Dapp, and the execution of tests. Ganache offers ten Ethereum accounts, each with a balance of 100 ether, as well as a graphical interface for examining everything that happens on this network. The creation and transfer of smart contracts to the blockchain Ganache are shown in Figure 7 and Figure 8.
Several smart contracts have been developed to meet the requirement of our system. Among them we find a Registration contract (Figure 9) which allows us to assign to each user a predefined role linked to his Ethereum account. The hospital contract, as shown in Figure 10, allows us to add information related to each emergency service. Figure 11 illustrates the basic functions of the doctor contract. These functions include the consultation of the patient’s vital signs as well as the addition of prescriptions or treatments to be performed for a patient.

5.3. Smart Contracts Cost

The Ethereum BC assesses presented systems according to the costs incurred by smart contracts. These are the fundamental units for the execution of transactions and smart contract operations. Alternatively, both the transaction and execution costs would be incurred. The price of migrating the smart contract script to the Ethereum BC is referred to as the transaction cost. The size of the smart contract is a constraint. The underlying transactions that a smart contract performs determine its size. The data needed to store global variables and smart contract approach calls is their execution cost. The arithmetic activities performed during execution also have an impact on it.

The total smart contracts cost of the proposed system is approximately 0.02723253 Eth. The cost of each sub-system is detailed in Table 5. It can be noticed that the highest cost is occupied by the sub-system of monitoring vital signs of injured persons, followed by the sub-system of exchanging them between the emergency services. The large amount and types of data exchanged are the cause of this prohibitive cost.
Figure 12 depicts the execution costs of some smart contracts in our system. The results obtained are in Ether. The execution cost for the VitalSigns_contract is 0.0088114 Eth while the cost for the registration contract is 0.00823677 Eth; 0.0083497 is the cost of V2E_contract and, for the V2V_contract, it is 0.0082886 Eth. Since VitalSigns_contract oversees the data of injured people by several intervening or different medical staff, it occupies the highest energy amount. It also holds access control to the managed information. The registration contract consumes less energy. The V2V_contract contract deals with communication between vehicles by exchanging information about an accident. Finally, the V2E_contract allows sending vital signs of the patient to the emergency centers.

It should be taken into consideration that these energy values are only test values as we use the test Ethereum network and PoW consensus. For a real system, there are consensuses that consume much less computing power, such as PoS or DPoS.

5.4. Comparative Analysis of the Proposed System and Related Work

In Table 6, we compare our work with some studies previously summarized in Section 3. BC technology, IoV, IoMT, access control and security are particularly important criteria on which we focus our comparison. All references satisfied the first criterion. In [25,26,27], the authors took into consideration the second Cr citerion. The authors in [28,30,31] satisfied Cr 3 criterion. Moreover, the access control-based criterion is satisfied in [26,28,30]. On the other hand, criterion 5 is found in the work of Halima et al., Jabbar et al. and Faisal et al. [26,27,28]. Finally, based on this analysis, it is clear that only our research considered all these evaluation criteria.

In the proposed system, very important and sensitive data are handled. For this, our system satisfies security requirements that include data security and communication security.

  • Confidentiality: The remote healthcare sub-system contains patient vital signs. To ensure the confidentiality of these data, unauthorized manipulation by third parties must be avoided. The use of smart contracts, by rejecting access to the system by any untrusted third party, ensures patient privacy, trust, and accuracy. The information saved in the system is immutable and cannot be modified by third parties thanks to the use of blockchain technology. This guarantees the confidentiality of the data handled.

  • Integrity is a further basic feature of systems that exchange sensitive data among users. As a result, the data integrity property of the proposed software solution must be evaluated. Data integrity is the accuracy and dependability of data throughout their entire life cycle. It is crucially related to the concept of data security and remains constant in its entirety. It is critical for data security to maintain consistency throughout its life cycle. In our system, Merkle Trees and cryptographic Hashing are responsible for maintaining the data integrity on public and private Blockchains.

  • Security: The security of our suggested framework is guaranteed by the usage of the RBAC and ABAC techniques. Hence, no outsider is permitted to use the system. Do not forget that protocols and methods are used to secure the blockchain. As a result, agent data can be handled securely and privately. This information is only accessible to reliable individuals. Any untrusted outsider trying to access the system is denied access by the system.

  • Availability means that a system is online and ready to be accessed at any time. The availability is ensured by the decentralized notion of the blockchain which fights against different attacks as well as the single point of failure.

6. Conclusions

This paper proposes a BC-based system allowing emergency vehicles to arrive as soon as possible at the scene of an accident. They first receive the location of the injured person. Then, with vehicular communication, they obtain road priority. In a second step and through the IoMT concept, our system allows us to collect the vital signs of the patient and transmit it to the emergency center, that, in turn prepares their treatment in advance. To achieve our goal, several smart contracts are deployed in Ethereum BC. To ensure safety, security, and trust surrounding the manipulated data, two types of access control were used, namely RBAC and ABAC.

BC technology, IoV and IoMT help to speed up the intervention in emergency cases. However, in such cases a large amount of data is manipulated. Since the data are stored in blocks, there is a problem of data storage. We will evaluate this attempt to promote the mixed hosting of blocks in the cloud and through distributed storage systems as future studies.

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