EMS Data by Flare

⅔ of the world lacks access to emergency response. In places with no functional 911/112-like services, people are 10 times more likely to die from an emergency (approx. 8.6 million preventable deaths every year). Many more cases - that do not lead to death - result in temporary or permanent disability or life-altering economic and emotional distress.  

The issue disproportionately affects Low to Middle-Income Countries (LMICs), where more people die from injuries every year than HIV/AIDS, TB and Malaria combined. Even the top 2 leading causes of death (cardiac & stroke emergencies) can be significantly reduced by access to urgent rescue services.The WHO estimates that ½ of all deaths, and tens of millions of disabilities, can be prevented with improved emergency response and pre-hospital services. 

Approximately 5.8 Billion people live in places where in an emergency, there is no central hotline to call. In such places, unless you happen to be near an A&E department that you know (that has the services your illness/injury requires), your hope for a good samaritan (who has the skills and means to help you) is often your only hope. When every minute saved can increase chances of survival by 5% (Sempalis, 1999), and the “golden hour” defines the ideal time to get admitted for definitive care in critical emergencies, rescue services go far beyond the millions of lives that can be saved annually: they provide essential peace of mind for people, families, and communities.  

According to the World Health Organization, Emergency medical dispatch and communication systems are a fundamental component of emergency medical services (in turn, a fundamental component to Universal Healthcare/UHC and ensuring Health & Wellbeing SDG Goal 3), with approximately one ambulance required for every 50,000 people. In Kenya, where response times were nearly 3 hours before Flare, we found that there were more than enough ambulances and responders to satisfy these criteria. However - as is the case throughout most of the African continent - these responders were distributed between various healthcare clinics & hospitals and were not networked together to facilitate access to their services. 

Flare is a cloud-native mobile & IoT solution that quickly networks available responders to assemble a nationwide response network and unlock EMS collaboration. It has a proven track record in Kenya, where we’ve achieved world-class response times (often beating the global gold standard of 8 minutes). Designed for ⅔ of the world without access to 911/112, it was built to work on and offline - so that it scales seamlessly to even the most remote locations. 

Unlike traditional 911/112 services (built for places in the world with advanced hospital networks and abundant emergency facilities), the Flare platform works to bridge the gaps in hospital referral networks where many hospitals lack most essential trauma, cardiac, and advanced A&E facilities. It uses integrated hospital & medical service data to route patients to the most appropriate facility (one that has the available services/equipment/specialists to provide definitive care), unlocking access to primary healthcare within the network to a much larger number of people.

Flare was founded on the vision that everybody should have access to urgent care, in minutes, and from the realization that with the right team and today’s technologies, this world-scale problem can be solved in a way that both (1) empowers the responders on the ground, and (2) brings lifesaving services & peace of mind to families and communities around the world. 

Through tech-enabling and networking responders on the ground with hospitals and clinics, and making all their services available to users at the press of a button (or one phone call), Flare addresses many of the systemic problems that have historically prevented access to rapid response & urgent care. During an emergency dispatch, the information collected by EMS caregivers in patient care reports is extremely valuable to governments in policy-making, public health officials,  and health care providers. We are efficiently positioned to collect hundreds of data points for every emergency case and are able to gather and share information on the new care pathways for trauma, maternity and newborn care, acute and chronic care, the location of where additional critical care facilities, personnel, blood transfusion sites are, and where additional resources are needed due to the patterns and volumes of transfer.

⅔ of the world living without any access to 911/112 (95% of the African continent) are most affected by the problem. This equates to 5.8 Billion people globally and 1.2B people on the African continent. 

While anybody, anywhere can experience an emergency at any time - the lack of 911/112 infrastructure disproportionately affects Low and Middle-Income Countries (LMICs). People in such places are 10 times more likely to die in an emergency than if they lived in the United States, for example, where 911 is widely available. 

Vulnerable populations, people living with chronic diseases, women of reproductive age, babies and young people of working age tend to be most affected. Women in sub-Saharan Africa have nearly 50x higher rates of maternity-related death and their babies are 10x more likely to die (both usually preventable by access to urgent care; WHO 2019). Three out of the five top causes of death for people between the ages of 15 and 29 are injury-related causes often preventable with urgent care, with road traffic accidents as the leading cause of death. 

For example, in LMICs where most hospitals do not have all necessary A&E equipment and Drs/specialists on staff 24/7, where (which hospital) the patient is taken has a huge impact on the treatment they will receive (and if they will receive treatment at all). Flare’s focus on “the entire route to care” includes our hospital and clinics data integrations that let our dispatchers coordinate the patient’s journey all the way to admission for definitive care - meaning we make sure each patient is taken to the right hospital and is admitted quickly to receive the care they need. 

Our various financing options have provided access to over 1M users, and our first government contract has further unlocked access for 200K mothers and babies. By deploying our service with more governments, as well as in new geographies on the continent, we seek to provide peace of mind as well as rescue/pre-hospital care services to 1B+ people on the African continent.

We are uniquely qualified to solve this problem because we have assembled a team of leaders in logistics technology, medical response, operations, and finance - the key components to building our proven and scalable 911 solution. Our team has a unique drive and dedication to our vision - that no matter where you are, or who you are, access to urgent medical help should be available to you in minutes. Our key team members have a background in the health sector across the continent giving them the experience and first-hand knowledge of the effects of the lack of coordination in emergency response.  

The company was co-founded by Caitlin Dolkart and Maria Rabinovich who met as friends in Kenya, and both identified the massive gap and opportunity to build and operate 911 systems in Africa and across the globe. 

Caitlin leads business development and operations - building client relationships and growth strategy. Before co-founding Flare, she led healthcare implementation programs in Africa & US, was the former Director of Malaria Programs at the Clinton Foundation, and a Healthcare Management Consultant at Huron. Caitlin has more than 10+ years of working in healthcare across African countries and brings a ton of experience and learnings from previous projects in Kenya and Ghana in addition to strong management skills. 

Maria leads products and technology - with 10+ years of experience in engineering, development & product strategy for corporate, startup, and NGO software platforms in New York and Los Angeles, before pivoting to Emergency Response Technologies in 2016. Her strength is in technology development, design, and marketing.  

In leadership, Dr. Sheila Maina, Medical Partnerships & Provider Director; licensed Kenyan and Hungarian physician. Formerly led the operations and clinicians at a large Kenyan government Accident & Emergency. From the hospital and doctor side, Dr Sheila Katungwa Maina (project lead) has first-hand experience. She was previously a doctor in a county hospital emergency/A&E department. Like all doctors in Kenya, she was tasked with coordinating patient rescues as well as medical transfers of patients between facilities, using hundreds of potential ambulance phone numbers, personal connections, and well-honed coordination skills. As is the case for all doctors who can’t rely on any rescue & transfer coordination service, Dr Sheila had to manage that process (a process that can easily take up to 24 hours in remote regions) all while handling too many critical patients, with too little time. Massive delays, when not a complete lack of transport options for her patients, led to many tragic consequences and a lot of frustration for her and her team.  

Also in leadership, Peris Asenji, Kenyan, Country Dispatch Director, ICU trained nurse with 10+ years working at public and private hospitals and ambulance services in Nairobi including Aga Khan and MSF. She has training and experience in nursing and Monitoring and Evaluation in the public health field in both Kenya and Tanzania. Her 10+ years of experience include roles ranging from research, family planning (Marie Stopes International), and inpatient care including patients in critical condition. She has also worked as a paramedic with MSF, a role that sparked her enthusiasm for working in prehospital/emergency projects.

Beyond these core leadership team members, we have experts in software development, design, marketing, operations, finance, and dispatching. The diversity of skills, experience, and horizontal organizational structure means that every employee is directly working toward the objectives of the company.

Operating the Flare platform, through the aggregation of medical emergency responders including ambulances and the hospital referral system, gives us access to frontline data on the numbers, frequencies, severity of medical cases, and capabilities in the referral system, which can open up useful data points for various users of the healthcare system. Our interaction with all health workers allows them to be able to shape the primary healthcare information that is accessible. This means that we passively collect hundreds of data points for every emergency case vis-a-vis actively collecting as part of the research study, therefore, as we grow, we continue to amass more insights into the healthcare system

For example, through our data we were previously able to inform the following: i) new care pathways for trauma and maternity and newborn care; ii) the location of where additional operating theatres, labs, and blood transfusion sites are, and where additional is needed due to the volume of transfers. This information has been used to impact millions of lives of underserved populations. 

The challenge we face is less on how we collect the data, but more on understanding its application: 1. The specific questions that we want to address with this data because we have amassed troves of it, and therefore, the focus is key;  2. The data is constantly growing and evolving and how we use these insights to adjust our operational processes - e.g., one week the radiology department might be down or not operational at a major hospital, but then the next week, everything has been fixed and is now operational (same thing for an operating theatre) - how we leverage this data to adjust quickly our processes and standard operating systems internally and how we continue to feed this into the government(s) policy and planning to build an overall efficient PHC system is key.

Our solution is powered by Flare, a digital platform that creates software infrastructure and operational support for emergency response teams for a tiny fraction (less than 1%) of the cost of a traditional 911 infrastructure - meaning Flare makes 911/112 services accessible to countries that have historically lacked the technology, sustained budgets or operational capacity to set up traditional emergency response infrastructures. Critically, Flare works by unifying, harmonizing, and uplifting emergency responders throughout the country, generating utility and revenues for their businesses to unlock engagement and sustainable continuous improvement of the sector. Flare also networks public and private responders across the country and allows emergency medical service (EMS) collaboration  Our solution will address many of the systemic problems that have historically prevented access to rapid response & urgent care through:

1. Passive data collection - we need this data to operate and therefore initially collect it through on-the-ground meetings and surveys with ambulances and hospitals.  We are able to maintain and grow this data through passive means and our core operations of dispatch

2. Holistic information about the healthcare system (not verticalized approach - EMS data tells you everything about all types of incidents from infectious disease, cardiac, neuro, trauma, maternity, newborn, etc.

The average age of an emergency patient in Kenya is 28, and the average lifespan is 66. The average time to medical attention without Flare is 162 minutes; with Flare it is 22 minutes. That differential in speed translates to a 50% reduction in mortality [WHO]. Based on our calculations, the base rate of mortality in an emergency situation is 5.5%. So with Flare-speed response times, and collected data, we have reduced this to 2.7%. This will save 4,012 lives and 152,000 Disability Adjusted Life Years DALYs by September 2025. This does not include jobs/income saved due to the prevention and reduction of disability, benefits to the Kenyan economy, and jobs created at Flare. Being the leading resource of EMS data in locations where non exists, we will be the leading provider of this data that is critical to policymakers, health care providers, public health officials, and anyone else seeking solutions to the public health problem and thus:

1. Become the preferred pan-African provider of EMS services as we scale into our 2nd, 3rd, 4th and 5th markets

2. Reach 10M individuals and provide them access to lifesaving services

We will understand and track our progress in terms of an input, output, outcome, and impact framework. Here’s how we will track and collect data.

INPUTS 

• Supply: Members including Covered dependents (1.14m and growing), ambulances (628)
• Capital: Current human capital of EMTs and first responders, quality of medical capital, financial capital
• Technology: Flare dispatch system
• Tracking our members and ambulances in-network is straightforward. We add members to our database as they receive membership through their employer or subscribe directly to our service. We track the ambulances in our system as well as their location. 

OUTPUTS

• New emergency response standards
• Denser coverage in rural and peri-urban areas
• Better trained EMTs & first responders and a higher degree of attention
• Faster response times are measured on three margins: time-to-arrival, time-to-hospital, and time-to-admission

OUTCOMES

• Faster response times (sub-30 minutes, associated with a 50% reduction in mortality)
• Membership (total members, number of business partners, types of subscribers, government contracts); usage rates
• We track our membership and government Contracts over time to see that Flare is recognized as providing best-in-class emergency service. 
• Our usage rates, which have trended upwards, speak particularly to the trust our members have in Flare. We calculate them by looking at the percentage of members to which we dispatched ambulances over a given month. Over a long time horizon, increasing rates suggest Flare members value the service and see it as their best option during an emergency. 

IMPACT 

• Reduced emergency-related mortality; Saved emergency-related DALYs
• We will track the health of Flare members compared to a control group. We expect to see lower mortality and DALYs for those with Flare.

THEORY OF CHANGE

Coordinated medical emergency response can halve fatalities from emergencies. [WHO, 2017] Our innovative emergency response system coordinates already-existing medical resources to be much more efficient. This leads to a virtuous cycle: 

More productive ambulances and hospitals ==> encouraging further investment from partner networks ==> leading to faster response times, increased number of ambulances, lower mortality, and healthier members. 

Improved coordination happens on every level. Below we show how our theory translates into results.

Previous studies on the importance of Emergency Medical Services are summarized here. In particular, see the Montreal Study where mortality from severe trauma decreased from 52% to 18% over 6 years (p < 0.0001) mean prehospital time decreased significantly, from 62 to 44 minutes (p < 0.001)

This was due to the Integration of the medical system, which is what Flare does.

INPUTS

• We aggregate emergency calls with one, a central number that every member has access to. We also have digital integrations so users can access Flare via an app. 
• We improve the skills and equipment of the ambulance teams, usually staffed by nurses, EMTs and operators. We train them through drills and online, gamified lessons. 
• We influence the equipment, medical supplies and drugs that ambulances stock as we see what works best and is most needed across cases. We do this by paying higher reimbursement for better-equipped ambulances and requiring minimum standards to be in our network.  
• We add our own Flare device to ambulances which helps us coordinate our fleet and assist the team in the ambulance during each evacuation.
• Live data feeds include information like optimal routes to get to the patient and hospital, etc.

OUTPUTS

• Flare’s coordinated and centralized approach has already led to faster time-to-scene response times: 22 minutes, on average, over thousands of dispatches, compared to the previous estimation of 164 minutes. 
• We’re also able to brief hospitals on incoming patients to accelerate their admission times. On average, our patients are admitted to a hospital within 102 minutes from the moment they call us. 
• We have dispatched 11,2116,289 ambulances to emergency patients. 

OUTCOMES

• More people are calling Flare during their emergencies. Monthly usage rates have trended upwards, from 70 members (0.3%) in January 2019 calling for assistance, to 484 (0.69%) in March 2021. Note that with the recent large influx of new members this trend has not continued.
• Our membership is growing exponentially, from 23,385 in January 2019 to 1.14m in May 2022

IMPACT

• Once a patient arrives at a hospital they need to pay a deposit to receive medical attention. This step can mean patients die in the waiting room. Flare negotiates on our patients’ behalf to make sure the deposit is paid or removed altogether to facilitate rapid care. 
• Some hospitals require referrals to avoid high patient volumes. Flare referral guarantees admission for patients.

All of this suggests that coordination is highly effective at accelerating arrival times which lowers mortality and disability. Our foremost KPI outcome, response times (in time-to-scene terms), have shown a massive improvement already. In 2020, 39% of ambulance responses arrived within 15 minutes, times on par with developed countries [Impact Summary]. 

We suspect that findings from impact research in this project may trigger a wider re-evaluation of the impact and viability of developing 911 and emergency response systems. The importance of these systems is still underappreciated, and implementing them could prove a highly effective health intervention, comparable with vaccines as far as cost per DALY averted goes.

Flare is a cloud-native mobile & IoT solution that quickly networks available responders to assemble a nationwide response network and unlock EMS collaboration.

Before we built Flare, average response times in Nairobi (even for critical cases like road accidents or emergency obstetrics) were nearly three hours. This means many people did not receive the care they needed, or received very delayed care. Our platform has reduced average response times throughout Kenya to just 15 minutes - and we’re increasingly responding as fast as 2, 3, and 4 minutes for critical cases in Nairobi - beating the global gold standard of emergency response of 8 minutes. Flare does this for a tiny fraction (less than 1%) of the cost of a traditional 911 infrastructure - meaning Flare makes 911/112 services accessible to countries that have historically lacked the technology, sustained budgets or operational capacity to set up traditional emergency response infrastructures. Critically, Flare works by unifying, harmonizing and uplifting emergency responders throughout the country, generating utility and revenues for their businesses to unlock engagement and sustainable continuous improvement of the sector. 

Where emergencies previously required calling hundreds of numbers to coordinate care - and then waiting without any information in hopes that somebody will arrive - our API allows clients to build bespoke SOS buttons into their platforms/applications to make all of Flare’s aggregated services available to their users at the press of one button or through a single phone call. It provides real-time transparency to doctors, dispatchers, and people in an emergency - with real-time data about the incident, responder arrival time, available care or equipment onboard the ambulance, and available nearby hospital/A&E services that can handle the case. Over 1M people in Kenya have access to our services through such integrations - meaning they have access to emergency rescue & urgent care services for the first time.

Unlike traditional emergency response systems (built for places in the world with formal/advanced hospital & emergency/A&E distribution), the Flare platform is designed for places where the vast majority of hospitals do not have many of the services or staff available for many types of trauma, illness, and advanced disease management. Flare uses its integrated hospital & medical services data to coordinate the patient’s ‘entire route to definitive care’. After the successful rescue or pickup of the patient for transfer, dispatchers use Flare’s health facility and services data to plan the patient’s fastest route to the most appropriate facility - one that has the appropriate medical services and specialists/doctors available to treat them, and one that can admit them right away. This reduces the number of patients left untreated in inadequate facilities, reduces hospital admission time, reduces stress on misused A&E facilities and the hospital referral network, and prioritizes the patient’s medical needs to facilitate appropriate urgent care delivery.

1. Flare Provider Team - They vet, inspect, and geo-locate ambulances across the region using the Flare provider app with a target to map all ambulances and ems teams and create countrywide networks
2. Flare Dispatch Team  - Using Flare Dispatch and a suite of software, they collect data during each case, receive patient care reports from EMS caregivers, and help revalidate the data from the provider and research team 
3. Flare Research Team - initial mapping of ambulances and hospitals and service capabilities

We are a global team spread across 6 countries, with diverse backgrounds and experiences and this diversity brings valuable outlooks to our work. We employ an incredibly diverse team and strive for a gender balance of at least 50% women and in particular with at least 50% of women in leadership positions. All employees are equally valued contributors and this inclusion ensures their contributions make for richer more innovative and high-impact solutions. 

Our company culture cultivates respect and opportunity for all our employees creating a space where you can bring your whole self to work. Diversity, equity, and inclusion are built into our organizational vision and mission that not only values each employee’s unique identities and experiences, but also those of the individuals that we impact.

Several of our projects focus on providing health equity to the underserved populations by providing an emergency toll-free number and funded ambulance and taxi transfers, giving access to primary healthcare to target populations irrespective of their backgrounds. 

The design of our solution targets high-burden locations that are highly affected by the problem and aim to create a solution that responds to the community.  In addition, data collected from all available sources (from community health volunteers, call centers, teleconsultations, activations at clinics, and dispatches) are grouped into dimensions to highlight and understand the situations of populations who are facing additional barriers due to socioeconomic factors such as age, education, income level, geographic area, ethnic background, social support among others. Our collaborations are therefore bespoke and designed to ensure that everyone in the target population is reached, adequate information on the population is collected, and solutions provided are varied and fit for the population thus advancing health equity.

We provide emergency insurance B2B, B2C, and B2G. Some members buy from us directly, some receive coverage through their employer and some receive coverage through their county, like in Kakamega County in Kenya. For less than $2 per month, businesses, consumers, and governments can obtain ambulance insurance coverage. We now have 1.14m members. 

Membership Revenue - through our product rescue.co, which is an annually renewing subscription billed per person that covers all rescues, roadside responders, patient transfers, and pre-hospital care services. 

Service Contracts – retainer based on the fee for service agreements that include API integrations (bespoke SOS buttons in client apps). This includes B2G contracts like the one we have with Kakamega County, API integrated partners like Jubilee, Bolt, etc.

We plan to break even by early 2023. Primarily, Flare will be privately funded by employers and County Governments, with some revenue from private insurance plans, NGOs, and individuals buying a membership.

To date, we’ve grossed $1m in revenue from memberships, and case fees. In 2022, we are on track to reach $1m in Annual Recurring Revenue (ARR) and have scaled substantially. Today, 25% of our revenue is from service contracts to governments and sustained donations and grants and the remaining 75% is from selling memberships, and service fees.  

At a unit economics level and gross profit level, we are currently profitable. We continue to expand and build out our services, and aim to be profitable at a company level by 2024.

We are growing sustainably through our membership product, Rescue.co, and service contracts with County governments. Our current revenue is fromB2B, and from Government Contracts like with Kakamega County in Kenya. Revenue covers our OpEx and then some. We have also received $6.7M in funding from Impact Funds, angel investors, donors, and accelerators including Johnson & Johnson, AAIC, SUNU, Kepple, VC, 4di, Grey Elephant, Blue Haven, Push Ventures, Sorenson, Foundation, Tekton Venture, DEG, Merck Health Accelerator (2016), and Google for Start-ups (2020), Kofi Annan Foundation, Austrian Development Agency, ITU, Ashoka, and Boehringer Ingelheim.