Gates Foundation Grand Challenges Submission · 2026

Triage that travels with the patient.

The IMCO 4T Device enables community health workers to perform accurate, multi-disease triage for TB, malaria, and neonatal sepsis — then monitor continuously through transport, so your clinical team knows what's coming before it arrives.

Live telemetry · Patient in transit
91%
SpO2
Fitzpatrick V corrected
108
bpm
Heart rate
38.9°C
Temp
IR tympanic
118/76
mmHg
Blood pressure
22
brpm
Resp. rate
NSR
ECG
Single-lead
Yellow alert active — SpO2 below threshold. Receiving team notified.
$0.40
Per patient assessment at scale
<30s
Single-action sensor placement
72 hr
Continuous battery life
6
Vital parameters, one wearable
The Technology

Two modules. Zero infrastructure dependencies.

Designed from the ground up for community health workers in resource-limited settings — offline-first, solar-chargeable, and operable after 4 hours of training.

📋
Pre-Triage Screening Module
Ruggedized Android tablet with WHO IMAI algorithms delivering 5-level acuity scores, multilingual voice guidance in 5 languages, and pictogram-based interfaces for low-literacy users.
Offline-first · MIL-STD-810G
📡
Telemetry Triage Module
Wearable slip-on band (<85g) attached in under 30 seconds. Streams 6 parameters continuously via BLE 5.0 — from first CHW contact through patient transport to facility arrival.
72-hr battery · IP54 ruggedized
🚑
Pre-Hospital Transport Monitoring
Once attached, the device operates autonomously through transport. Receiving clinical teams monitor vital sign trends and alert status before the patient reaches the door.
Pre-arrival streaming · Live alerts
🧠
AI Decision Support
Three-layer AI: rule-based clinical floor, MIMIC-IV gradient-boosted triage model, and disease-specific classifiers for TB, malaria, and neonatal SIRS. Human-in-the-loop mandatory.
Intervention-driven WHO IMCI prompts
🔗
Full Interoperability
HL7 FHIR R4 export to OpenMRS and DHIS2. Every encounter becomes a timestamped, geotagged digital record for national syndromic surveillance. AES-256-GCM encrypted.
FHIR R4 · OpenMRS · DHIS2
🌡
Zero Consumables
No reagents, test strips, or biological inputs. Solar-assisted charging. Operating range 0–50°C, storage –20–60°C. Eliminates the supply chain dependencies that render most LMIC tools unsustainable.
Zero cold-chain · Solar charging
Health Equity by Design

SpO2 accuracy for every skin tone.

Not an equity add-on — a patient safety requirement for Nigerian clinical settings.

3–4×
Higher occult hypoxemia misread rate in Fitzpatrick V–VI patients
Standard pulse oximeters using single-wavelength PPG systematically overestimate SpO2 in darker-skinned patients — producing false-normal readings that mask life-threatening hypoxemia. The 4T Device uses multi-wavelength reflectance PPG (green 530nm / red 660nm / IR 940nm) paired with a Fitzpatrick-stratified correction algorithm to address this directly. In Nigeria, where patients predominantly present with Fitzpatrick V–VI skin tones, deploying uncorrected oximetry is not a gap in equity — it is a clinical error.
Sjoding et al., New England Journal of Medicine (2020) · FDA Pulse Oximetry Guidance (2022)
Clinical Workflow

From community to clinic — continuous.

The 4T Device closes the data gap at every step of the patient journey.

01
CHW Intake
Voice-guided symptom screening in 5 languages. Sensor band attached in under 30 seconds.
02
AI Triage
ESI acuity score + disease pathway flags for TB, malaria, and neonatal SIRS generated instantly.
03
Transport Monitoring
Vitals stream continuously. Yellow/Red alerts notify receiving facility before patient arrives.
04
Facility Receipt
Clinical team has full vital sign trend for entire transport. FHIR record auto-exported to EMR.
05
Surveillance
Encounter data syncs to OpenMRS and DHIS2 for national syndromic surveillance integration.

Run a complete patient encounter.

This is a functional simulation of the 4T Device CHW workflow — from patient intake through vital sign capture, AI assessment, telemetry monitoring, and FHIR record export. Click through each step.

IMCO 4T Device
Safe Hands · Nigeria
Workflow
New patient
CHW: Amara Osei
Patient intake
Offline · 4T v1.0
Select language
Patient demographics
Patient type
Age
Sex
Chief complaint
Voice guidance active
All prompts available in selected language.
WHO IMAI protocol active
Select all symptoms present
Duration & history
Duration
Prior TB/malaria
Telemetry module · BLE connected
Sensor kit paired · Streaming live data · 72-hr battery: 98%
91%
SpO2
Fitzpatrick V corrected
108
bpm
Heart rate
38.9°C
Temp
IR tympanic
118/76
mmHg
Blood pressure
22
brpm
Resp. rate
NSR
ECG
Single-lead
SpO2 correction applied
Raw 88% → corrected 91%. Deploying without correction would give false-normal reading.
AI recommendation · clinician confirmation required
ESI 2
acuity
High acuity — urgent evaluation
Rule-based clinical floor: fever + tachycardia + SpO2 depression. Multi-disease pattern across vital sign stream.
Disease pathway flags
Malaria
82%High
TB syndromic
71%Moderate
Pneumonia
44%Low
Recommended actions
1. Rapid malaria RDT · 2. Sputum if TB suspected · 3. Continue telemetry · 4. Physician review within 30 min
Live telemetry · streaming to facility
Yellow alert
SpO2 (corrected)
91%
Target >95%
Heart rate
108 bpm
Normal: 60–100
Temperature
38.9°C
Fever >38.0°C
Resp. rate
22 brpm
Normal: 12–20
Yellow — receiving facility notified
Vital sign trend streaming. Clinical team sees this data before patient arrives.
Encounter recorded · FHIR R4 export ready
Syncing to OpenMRS and DHIS2.
Encounter summary
Triage levelESI 2 — Urgent
Primary flagsMalaria 82% · TB syndromic 71%
SpO2 (corrected)91% · Fitzpatrick V correction applied
Transport monitoringActive · facility notified
Cost per encounter$2.84 (pilot scale)
All AI recommendations pending physician confirmation

This simulation demonstrates the complete 4T Device CHW workflow including pre-hospital transport monitoring. Development prototype — Nigerian primary care CHW workflow.

Clinical Partnership

Phase 3 Validation Partner

We are seeking a Nigerian primary care or trauma facility as our Phase 3 clinical validation partner for a 500-patient study comparing 4T Device triage accuracy against physician gold-standard assessment.

🏥
What we are looking for
Active patient volume across trauma, TB, malaria, or maternal/neonatal presentations. Existing CHW or nursing workforce. Interest in digital health integration and Nigerian IRB capability.
🤝
What the partnership provides
Full device deployment at no cost. Dedicated technical support and CHW training. Sub-grant funding from the Gates Foundation award for site operations, IRB fees, and physician time.
📊
What the study generates
Validated triage accuracy data published open-source. Full FHIR integration with your existing EMR. The clinical evidence base for national-scale deployment across Nigeria and West Africa.

Let's talk about your patients.

We are not asking for a commitment. We are asking for 30 minutes to demonstrate the device, hear about your clinical context, and explore whether this technology could serve your team.

Reg Redmond · Founder & Executive Director · IMCO-NFP · Chicago, Illinois
IMAGEMEDIUM Consultants & Ombuds NFP · AISOTRAC Nigeria


Official Nomenclature · Component Reference

IMCO 4T Device —
Naming Architecture

Official terminology reference for clinical communications, regulatory submissions, and partner documentation.

Primary Brand & Platform Identity
IMCO 4T Device
Modular Clinical Screening Platform

Using IMCO 4T Device as the brand name while designating the overarching system a Modular Clinical Screening Platform positions it not just as a device, but as a scalable health infrastructure solution — ready for clinical deployment at population scale.

Brand Name
IMCO 4T
Official device identifier · all external use
Hardware Modules
2 Core
Pre-Triage & Telemetry Triage
Platform Class
Modular
Scalable clinical screening infrastructure
📱
Module 1 · Input Layer
Pre-Triage Module

The offline-first, ruggedized Android tablet providing the voice-guided interface and WHO IMAI clinical logic. Designed for frontline community health workers in low-connectivity environments, it delivers structured clinical decision support at the point of first contact — producing a 5-level ESI acuity score and disease pathway flags across TB, malaria, and neonatal SIRS from symptom input alone.

Offline-First Voice-Guided WHO IMAI Logic ESI Acuity Scoring Android Platform Ruggedized · MIL-STD-810G 5 Languages
📡
Module 2 · Sensing Layer
Telemetry Triage Module

The wearable sensor kit designed for single-action placement (<30 seconds). Streams six continuous vital sign parameters via BLE 5.0 to the Pre-Triage Module and — through mobile connectivity — to receiving clinical facilities during patient transport, enabling pre-arrival monitoring. Six parameters: SpO2 (with Fitzpatrick V–VI skin-tone correction), Heart Rate, Blood Pressure, Temperature, Respiratory Rate, and single-lead ECG. <85g · IP54 · 72-hour battery · zero consumables · zero cold-chain dependency.

Single-Action Placement SpO2 · HR · BP · Temp · RR · ECG Health Equity by Design Transport Monitoring BLE 5.0 · Real-Time 72-hr Battery · IP54 Zero Consumables
Complete Terminology Reference
Term Type Official Name Description & Context
Brand Name IMCO 4T Device
Primary commercial and clinical identifier for the system. Used in all external communications, regulatory submissions (FDA De Novo, NAFDAC Nigeria), labeling, and partner documentation.
4T Acronym Trauma · Telemetry · Triage · Treatment
Each letter maps to a clinical function: Trauma (point-of-contact assessment), Telemetry (continuous vital sign acquisition), Triage (AI-assisted acuity scoring), Treatment (WHO IMCI intervention-driven action prompts).
Platform Title Modular Clinical Screening Platform
Descriptive proposal and regulatory title positioning the system as scalable health infrastructure rather than a single-point device solution. Used in Gates Foundation Grand Challenges submission.
Module 1 Pre-Triage Module
Offline-first, ruggedized Android tablet with voice-guided WHO IMAI interface. Input/cognitive layer of the platform. Target unit cost: $50–75 at 500+ units.
Module 2 Telemetry Triage Module
Wearable sensor kit for single-action placement. Six-parameter continuous acquisition: SpO2 (with Health Equity by Design Fitzpatrick V–VI correction), Heart Rate, Blood Pressure, Temperature, Respiratory Rate, single-lead ECG. Sensing layer of the platform. Target unit cost: $75 at 500+ units.
Design Principle Health Equity by Design
The multi-wavelength PPG SpO2 correction system (green 530nm / red 660nm / IR 940nm + Fitzpatrick-stratified algorithm) addressing the 3–4× higher occult hypoxemia misread rate in Fitzpatrick V–VI patients. Documented by Sjoding et al., NEJM 2020. In Nigeria, a patient safety requirement — not an equity add-on.
Clinical Feature Pre-Hospital Transport Monitoring
The Telemetry Triage Module operates autonomously after CHW attachment — streaming vital sign data continuously through patient transport to facility arrival. Receiving clinical teams see vital sign trends and alert status before the patient reaches the door.
AI Architecture Three-Layer AI Decision Support
(1) Deterministic WHO/ESI rule-based clinical floor; (2) MIMIC-IV gradient-boosted triage model (~60,000 encounters); (3) disease-specific classifiers for TB, malaria, and neonatal SIRS. Human-in-the-loop mandatory — all outputs require clinician confirmation.
📋  Strategic Rationale

Using IMCO 4T Device as the brand name while calling the overarching system a Modular Clinical Screening Platform positions it not just as a device, but as a scalable health infrastructure solution. The two-module architecture — a cognitive input layer (Pre-Triage Module) and a physiological sensing layer (Telemetry Triage Module) — enables independent upgrade paths, targeted procurement, and deployment flexibility across diverse clinical settings. The six-parameter telemetry suite, pre-hospital transport monitoring capability, and Health Equity by Design SpO2 correction are core architectural commitments that distinguish the 4T Device from every existing LMIC triage system at this price point.