Cryopreservation is a time-sensitive procedure. The more time between circulatory arrest and the onset of cryoprotection, the more cellular death occurs. However, no cryopreservation procedures can be performed before legal pronouncement. Even in cases where the worsening of the conditions clearly indicate imminent death, the standby team must wait for a specialized person to officially confirm the patient's death in writing. That’s why, for a better chance at high-quality cryopreservation, it’s important to have an efficient notification system in place. This ensures that no unnecessary time is wasted. Tomorrow Bio’s specialized standby teams are one solution to minimizing the time sensitivity issue. For more information, here’s a brief overview of how we get notified in the case of a sudden death. 

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The SST / Standby Team

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The cryopreservation process should begin as soon as possible following legal death. This increases the quality of preservation of both your brain and body. To improve the likelihood of this scenario, Tomorrow Bio is focusing on building standby teams that are highly trained and available 24/7. At the moment, we have one team based in Berlin, one in Amsterdam through a partner, and we will soon have one in Switzerland, located at EBF’s long-term storage facility. SST teams, or some colloquially called standby teams, aim to decrease the time between legal death and the onset of cryoprotection procedures. They include doctors, EMTs, and personnel specifically trained for cryopreservation procedures. 

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In best case scenarios,  the attending doctor or medical team contacts Tomorrow Bio to inform us that a member might die in a few hours or days (i.e., they’re in critical condition). This allows our team to arrive on site, so we can begin stabilization as soon as possible. As we mentioned earlier, this cannot happen until AFTER legal death has been pronounced. Once a medical professional declares the patient legally dead, the standby team initiates the process of cryoprotection. Once the patient is fully perfused and cooled down to around -20°C, most of the major biological processes are virtually paused. Following perfusion, the patient is moved to EBF, where they go into a computer-controlled cooling box to continue lowering their temperature to about -196°C (the temperature of liquid nitrogen). Once this is achieved, the patient can be transferred to a cryogenic storage dewar, which is filled with liquid nitrogen. 

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The above situation describes perfect circumstances and the “best case scenario.” Although in most cases the potential death of a member is known beforehand, death can be unexpected. Still, in sudden death scenarios, the equipped standby team is dispatched and deployed as quickly as possible after we’re notified. 

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How is Tomorrow Bio Notified in Case of Sudden Death? 

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As described, best case scenarios allow Tomorrow Bio to begin the stabilization and cryoprotection process almost immediately. However, some deaths can be sudden and unexpected. In the case of a sudden death, many people wonder about all of the “Who? What? Why? Where? When? How?” questions. 

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Who notifies Tomorrow Bio? What happens when they’re notified? Why might the notification process be challenging? Where does Tomorrow Bio go after they receive notification? When will they arrive? How do they get there? 

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The Steps of Notification 

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All of the above questions can be answered by walking through the steps of notification. This is a working model at Tomorrow Bio and we intend to continue developing it over time. However, as of now, it remains to be an effective way to respond to cases of sudden death. There are a few situations that dictate how our standby team is notified: through the Tomorrow Bio wristband, using our integrated app for smartphones, through the next of kin, or via the attending physician. 

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Notification Through Tomorrow Bio’s Wristband or Necklace

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When you become a member at Tomorrow Bio, you receive a Welcome Box. Inside will be: 

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• Your membership card
• Your Tomorrow Bio wristband (or a necklace on request)
• A few emergency cards
• A template for your last will
• A template for your patient advance directive (PAD)
• A letter from our CEO, Dr. Emil Kendziorra welcoming you to the Tomorrow Bio community. 

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The included cards will include all of the relevant information in case you have an emergency. However, for the sake of notifications, the Tomorrow Bio wristband is an important accessory. 

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In the event of a sudden death, the first person who notices the bracelet should contact Tomorrow Bio. Medical ID bracelets are normal for many conditions, so doctors, first responders, EMTs, and other medical staff might see them and respond appropriately. If, for some reason, the medical team does not contact Tomorrow Bio directly, the patient’s family should reach out as soon as possible to begin the cryopreservation process quickly following legal death. To make sure your family members and friends know how to behave in case of sudden death, give them one of the emergency cards you can find in your Welcome Box.

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Once Tomorrow Bio is notified, our standby team is dispatched immediately. If the patient is local, we will take either the Tomorrow Bio equipped ambulance or one of our fast response vehicles. If the patient can not be reached quickly by land transport, our standby team utilizes either commercial or private air travel, whichever is faster—cost is also factored into this decision. In these cases, the team will use our portable equipment for in loco cryoprotection. To make sure this process goes smoothly, always confirm the receipt of your welcome package once it arrives at your home. 

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Notification Through the Tomorrow Bio App

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Another option for notification is through the Tomorrow Bio app. This helps decrease time constraints and is especially helpful when paired with a smartwatch. We recommend wearing the Tomorrow Bio wristband and downloading our personalized app on your smartphone to cover all your bases (new app version available soon).  

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After you download the app, there are two ways that notifications happen. If you have a smartwatch, the app can be paired with the watch and will constantly monitor your heart rate and other vitals. If it senses that something is wrong—i.e., lost, low, or an unusual heart rate—it will send you a notification. You can disable this by pressing the button in the app. 

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If you don’t respond to this notification after three minutes, further action is prompted. First, a text message will be sent to your phone to check on you. If you do not reply to this within a few minutes, an alarm will play on your phone and display the statement, “EMERGENCY DETECTED” if you don't react, the emergency cascade continues on.

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If no one responds to this, your emergency contacts (friends and family) are notified. The app will also send Tomorrow Bio your patient directive, last will, cryopreservation contract, and any other essential documents. This can reduce the chances of legal issues when the standby team arrives. 

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Members that don’t have a smartwatch can activate timers for wellness checks based on personal preferences. You can preset intervals for wellness checks that need to be manually disabled on your phone. These intervals include an option to turn the function off between 10:00pm and 8:00am so you can get a good night’s rest. 

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The final option for notification through the Tomorrow Bio app is an SOS system. In the case of an emergency, you can open the app and simply press the SOS button. A warning will be sent to your phone and, if not disable, Tomorrow Bio is notified directly and immediately. This bypasses any other emergency contact notifications and allows for prompt contact with our standby team. All of these options drastically reduce the risk of notification failure.

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Notification Through Next of Kin 

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In the case of a sudden death, another way Tomorrow Bio can be notified is through next of kin. Patients who have communicated their plans to be cryopreserved may have shared how to respond in the case of death with their emergency contacts. To make sure they have our emergency number within reach in case of need, give them one of the emergency cards you find in your Welcome Box. This can decrease the window between legal death and the time our standby team is dispatched. 

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Notification Through the Attending Physician 

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Tomorrow Bio can also be notified by the attending physician. This process can be expedited with a patient advance directive, as it informs your doctor of who to contact regarding medical decisions if you’re incapacitated. When you create your patient advance directive, it’s important to name Tomorrow Bio on the document. You will find a template in your Welcome Box to help you write your own PAD. This will prompt your doctor to contact us in the case of a medical emergency. Once Tomorrow Bio is contacted through the attending physician and told a member is in critical condition, a standby team is dispatched to their location. 

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How to Improve Circumstances for Sudden Death

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The best way to improve your circumstances in case of a sudden death situation is to be prepared. Make sure you sign up for cryopreservation with Tomorrow Bio, receive your Welcome Box, and put on your medical ID wristband. You should also download the Tomorrow Bio app so it’s easily accessible and synced with your smartwatch (if you have one). Additionally, inform people close to you about your decision and what actions they have to take in case of need.

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It’s also important for you to create a patient advance directive that states what actions you want taken for your health if you’re no longer able to communicate them. A personal belief statement can also be useful, as it makes it more difficult for outside parties to try and say you didn’t want to be cryopreserved. The fewer legal problems that occur after legal death, the sooner cryopreservation can begin. 

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Conclusion

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Emergency notification in case of sudden death can be challenging. At Tomorrow Bio, we have arranged several methods to alert our standby teams as fast as possible to help solve these challenges. Depending on the case, we will be notified by one or more of these methods.

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At the moment, we have our own standby team in Berlin and one through our partner organization in Amsterdam, both on call 24/7. We’re currently in the process of developing another standby team in Switzerland, that will work from our long-term facility in Rafz. Our goal is to continue building standby teams throughout European countries to optimize coverage and decrease the time between legal death and the onset of cryopreservation. 

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To learn more about our initiatives, schedule a call with one of our team members today. If you’re ready to join our community and prepare yourself for your future, sign up today!