WASHINGTON STATE: An earthquake measuring magnitude 9.0 on the Richter scale rocked the Cascadia Subduction Zone. It sent 30-foot waves smashing through Puget Sound, sweeping coastal community out to sea and creating massive devastation. The main tremor knocked out power and ruptured waterlines from Bellingham to Olympia. Aftershocks, many of which were earthquakes in their own right, pummeled Washington, Oregon and British Columbia. Thousands are missing and feared dead. Thousands more may be left homeless or without power and water for indefinite periods. Hospitals and emergency services were caught unprepared.
WASHINGTON STATE: An earthquake measuring magnitude 9.0 on the Richter scale rocked the Cascadia Subduction Zone. It sent 30-foot waves smashing through Puget Sound, sweeping coastal community out to sea and creating massive devastation. The main tremor knocked out power and ruptured waterlines from Bellingham to Olympia. Aftershocks, many of which were earthquakes in their own right, pummeled Washington, Oregon and British Columbia. Thousands are missing and feared dead. Thousands more may be left homeless or without power and water for indefinite periods. Hospitals and emergency services were caught unprepared.
The above scenario is fiction, but tomorrow, it could be fact. Are we ready? The events on Sept. 11, 2001 showed the world what Americans are made of. Although thousands lost their lives, including hundreds of first responders, triage at ground zero took place and under the most extreme conditions. It is a tribute to the efforts and training of those first responders that hundreds of people survived. Could America have been better prepared?
Answering the Clarion Call“Lack of timely information-sharing and inadequate communications capabilities likely contributed to the loss of emergency responders’ lives,” said Dr. Shyam Sunder in a 2005 New York Daily News article. Sunder is deputy director of the Building and Fire Research Laboratory (BFRL) at the National Institute of Standards and Technology (NIST), and was the lead investigator during the building and fire safety investigation of the World Trade Center disaster.
Communications breakdown was the number one complaint made by the emergency personnel who responded to disasters at the World Trade Centers and Pentagon, and later Hurricane Katrina in New Orleans. During Katrina, EMS rescued hundreds of walking wounded from the waters and airlifted them to triage areas, only for them to become misplaced in the system, sometimes for days. In response, Congress subsequently released billions of dollars to help companies develop systems to improve communications and data sharing between first responders and hospitals during mass casualty events.
Companies of all sizes answered the call. One was Iomedex in Seattle, Wash., makers of MobileIRIS (Mobile Incident Response Information System), a wireless patient tracking system that enables first responders to track the movements of casualties through triage and treatment using bar codes. It also provides local healthcare organizations with a common database from which to exchange information and access patients’ electronic health records (EHR).
MobileIRIS consists of a network of ruggedized, hand-held computers built by Hand Held Products of Skaneateles Falls, N.Y., and powered by Microsoft PocketPC 2003. The handhelds feature bar-code scanning and Adaptus imaging technology for taking pictures of wounds, and connect by Wi-Fi or wireless data technology to dedicated servers distributed in secure locations throughout the country. The servers operate on Microsoft SQL Server 2000.
In a USA Today article posted April 15, 2006, Nancy Ridley, assistant commissioner for the Massachusetts Department of Public Health is noted as saying the marathon would provide a good training ground to test a patient tracking system that could be used following a disaster. A terrorist attack might be another appropriate use.
When first responders use the hand-held devices to transmit critical patient data and incident information, including photographs of the casualty’s injuries, directly into Iomedex’s database, the data is immediately accessible to multiple providers and healthcare facilities 24/7. Emergency responders perform the identification process during triage, at which time a bar code is scanned and attached to the patient’s wrist.
As the patient moves through the system, healthcare providers can access up-to-the-minute patient history—a critical advantage during life-saving procedures—and track the patient’s location simply by rescanning the bar code. The system allows ED clinicians to study a patient’s condition and secure needed resources prior to the patient’s arrival. In triage situations, where mass casualties are widely distributed, such technologies could be critical in saving hundreds of lives.
Planning for the InevitableShortly after the 9-11 attacks, CEOs from across the nation converged to discuss the topic of disaster preparedness. John Todd, M.D., CEO, Stevens Hospital, was alarmed by a lecture that covered the pitfalls experienced by the local Manhattan hospitals, and discussed a hospital’s responsibility to be prepared in times of disaster. Stevens is located in Edmonds, Wash., on Puget Sound, 15 miles north of Seattle, near the Cascadia Subduction Zone—the most extensive fault line in the Pacific Northwest—prime earthquake country. Magnitude 6.0 or greater earthquakes in this area are not uncommon.
Todd assessed the risk of an unprepared Stevens Hospital being at the epicenter of a major casualty disaster, such as an earthquake, or a terrorist strike on Puget Sound’s ports or one of the area’s nuclear power plants. He focused on ensuring the hospital’s readiness as a safe haven, a vaccination point or a decontamination center. Then in 2002, following a similar federal mandate, Washington State’s Department of Health released an “All Hazards Preparation” mandate, which required the healthcare community to make all necessary preparations for a chemical, biological or environmental disaster.
Dr. Robert Mitchell, a retired obstetrician and gynecologist who is now Stevens Hospital’s bioterrorism response coordinator, had embarked on his own disaster preparedness journey. The vulnerability of Washington’s ports, military installations, nuclear power plants and borders were Mitchell’s greatest concerns. For a year following 9-11, he attended state and local government planning meetings, and late in 2002, he visited Stevens Hospital and met with Todd. Then, in 2003, Mitchell attended high-level military/uniformed first responders meetings. “It was firemen, police, EMS, the Coast and National Guards and me—the retired gynecologist,” he says.
Wanted: Specific Data Management Capability
For two more years, Mitchell traveled the country, participating in biological, chemical and radiological response training. He even spent a week at the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) in Fort Detrick, Md. studying biological defense, while they prepared to depart for Iraq.
Mitchell discovered a common need wherever he visited first responders. “They all wanted a data management system that looked at four things,” he says. “Credentialing responders, tracking casualties, tracking expenses, and resource location and availability.”
When Mitchell returned to Stevens Hospital with his findings, Todd put him in touch with Iomedex CTO and Board Chairman Peter Simpson. Stevens Hospital had been a beta-test site during MobileIRIS’s development and had purchased the system one year earlier to address issues that arose post 9-11.
“I knew nothing about computers at that time,” says Mitchell. “I could barely do e-mail.” However, he recognized the significance of a sophisticated data management system that would interface with a hospital’s existing legacy systems, install without negatively affecting budget, and be up and running on a moment’s notice in the event of an emergency.
Standardized EMS on a Regional Scale
Stevens and Iomedex are at the heart of a regional effort to standardize EMS using the MobileIRIS system. Participants include The American Red Cross, a CERFP (chemical, biological, radiological, nuclear, or high-yield explosive enhanced response force package) unit of the Washington State National Guard, Seattle’s Public Schools District, and seven hospitals, seven fire/EMS departments, three county police departments, and Snohomish and Pierce County Departments of Health and Emergency Management.
In 2005, the White House released the report “National Strategy for Pandemic Influenza,” in which President Bush states, “A new strain of influenza virus has been found in birds in Asia, and has shown that it can infect humans. If this virus undergoes further change, it could very well result in the next human pandemic.” The report further states, “It is essential that the U.S. private sector be engaged in all preparedness and response activities for a pandemic.”
Since 9-11, many companies have taken up the disaster preparedness gauntlet, some with their own wireless communications solutions. However, Mitchell believes that limited on-the-job training and experience will hinder any system that is designed to be deployed only during emergencies. To be truly effective, he says, a disaster management solution must be integrated into all EMS and hospital ED daily activities in an entire region. That way, all of the staffs are similarly trained and highly familiar with the same technology, and can operate in unison during an emergency.
“These kinds of systems are very useful on an individual basis, but they become powerful when they become regionalized,” he says. “No individual entity is capable of responding to a disaster by itself. Unless [EMS] can enlist the help of surrounding services, it will be a disaster within a disaster in terms of response.”
Mitchell strongly supports interoperability and standardization and claims they are the two most powerful terms in the EMS industry. “That’s the concept,” he says. “To put like tools [in the hands] of people with the same training, who are using the same system, looking at the same data. That’s a force multiplier.”
Organizations such as Stevens Hospital and Iomedex are preparing for the unthinkable: disasters of such magnitude that existing EMS systems may be inadequate. Regional health institutions throughout the nation might be well advised to examine similar disaster preparedness models. What’s good for the goose may well be good for the gander.
For more information on Iomedex’s MobileIRIS, www.rsleads.com/607ht-204
