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The Evolving Role of GIS in Hospital and Healthcare Emergency Management
 

The Evolving Role of GIS in Hospital and Healthcare Emergency Management

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Ric Skinner, GISP ...

Ric Skinner, GISP
The Stoneybrook Group LLC
www.healthGISguy.com

I’ve been involved with the application of GIS in hospitals and healthcare for about 20
years. During this time I’ve experienced and observed GIS being applied in epidemiology,
health sciences, health resources, clinical/medical areas, health facilities management, market analysis, medical recruiting … and as I’ll discuss today … hospital and healthcare
emergency management and disaster preparedness. The material for this talk comes from research I’m doing for a book that will be published by CRC Press early next year on the
evolving role of GIS in hospital and healthcare emergency management.

Ric Skinner, GISP
The Stoneybrook Group LLC
www.healthGISguy.com

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    The Evolving Role of GIS in Hospital and Healthcare Emergency Management The Evolving Role of GIS in Hospital and Healthcare Emergency Management Document Transcript

    • The Evolving Role of GIS in Hospital & Healthcare Emergency Management The Stoneybrook Group LLC Ric Skinner, GISP I’ve been involved with the application of GIS in hospitals and healthcare for about 20 years. During this time I’ve experienced and observed GIS being applied in epidemiology, health sciences, health resources, clinical/medical areas, health facilities management, market analysis, medical recruiting … and as I’ll discuss today … hospital and healthcare emergency management and disaster preparedness. The material for this talk comes from research I’m doing for a book that will be published by CRC Press early next year on the evolving role of GIS in hospital and healthcare emergency management.
    • Successful Reponse Starts with a Map Improving Geospatial Support for Disaster Management Committee on Planning for Catastrophe: A Blueprint for Improving Geospatial Data, Tools, and Infrastructure Mapping Science Committee Board on Earth Sciences and Resources Division on Earth and Life Studies www.nap.edu/catalog/11793.html Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI The National Academy of Sciences concluded in their comprehensive report “Successful Response Begins With a Map -- Improving Geospatial Support for Disaster Management” that geospatial data and tools should be an essential part of every stage of emergency management, from planning through response and recovery to the mitigation of future events. This is certainly true in the hospital and healthcare domain.
    • Critical Infrastructure and Key Resources Agriculture and Food Defense Industrial Base Energy Healthcare and Public Health National Monuments and Icons Banking and Finance Water Chemical Commercial Facilities Critical Manufacturing Dams Emergency Services Nuclear Reactors, Materials Waste Information Technology Communications Postal and Shipping Transportation Systems Government Facilities Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI The Department of Homeland Security includes hospitals and healthcare facilities in the list of Critical Infrastrucure/Key Resources. Therefore it is important that this sector be prepared, able to respond effectively, and recover quickly from all hazards – natural, technological, and human-caused. DHS emphasizes the important contribution that geospatial information and technology plays in protecting the Nation’s Critical Infrastructure/Key Resources and has published the Homeland Security Grant Program Supplemental Resource on Geospatial Guidance. With National Academy of Sciences and DHS as foundation, it is only logical to apply GIS to decision making and other areas related to emergency management in the hospital/healthcare sector.
    • The 80% Paradigm 80% of information needed for decision making has a location or spatial component (Yung et. al, 2008) More than 80% of all healthcare transactions are believed to have significant geographic relevancy (Davenhall, 2003) As much as 80% of information used during emergencies is 'spatial' information (EMSINA, 2004) Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Further justification is what I call the “80% Paradigm” It is commonly said that 80 percent of information needed for decision making has a location or spatial component More than 80 percent of all healthcare transactions are believed to have significant geographic relevancy. As much as 80 percent of information used during emergencies is 'spatial' information
    • Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Many books and articles have been published on the application of GIS in emergency management and disaster response. A number of these have addressed GIS as a tool in the public health sector, and a few can be found on GIS in the hospital and healthcare facility sector of emergency management. The indication from these various publications is that GIS is rapidly evolving and has an important role in hospital/healthcare facility emergency management. This is because many of the emergency management and disaster preparedness challenges faced in hospitals and healthcare facilities, such as resource inventory and allocation, situation awareness, decision support and locational intelligence, are the same that other business sectors experience. My talk today will provide examples of how hospitals and healthcare facilities are benefiting from the use of GIS to improve their emergency management and disaster preparedness mandates and responsibilities. As time allows, I’ll mention a number of examples that I’ve uncovered in my research that I think will be of interest to hospital & healthcare emergency management professionals, health geographics practitioners, emergency management/disaster preparedness students, Homeland Security professionals working in the hospital/healthcare Critical Infrastructure/Key Resources sector, professionals and practitioners working in the Emergency Support Function-6 (ESF-6 Mass Care) and Emergency Support Function-8 (ESF-8 Health and Medical) areas. You’ll hear similar approaches and implementations of GIS are occurring in a variety of sources. I have a lot to cover so let’s get started.
    • Network GIS as a Tool for Healthcare Emergency Preparedness in Special Situations Petros Apotsos Independent Civil Engineering Consultant Greece Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI It is crucial for healthcare facilities to have a routing GIS in order to offer the best possible response to emergency calls and disaster situations. Based on scale and need, these systems can cover a city, a county or even a whole state or country. Given the specific characteristics of each area and based on integration level, scenarios can be developed in Healthcare Management so that the routing system takes these special situations into account. The use of a routing system for emergency units can decrease the response time to an emegrgency call
    • All road networks should be modeled in the highest detail possible, so as to offer accurate routing data an Natural disaster cutting or impairing certain segments of the network. Evacuation or heavy traffic situations when parts of the network are gridlocked above predicted lev Situations when traffic direction limitations are compromised resulting in other parts of the networ
    • Trauma Resource Allocation Model for Ambulances and Hospitals (TRAMAH) Charles Branas, University of Pennsylvania Marlen Kokaz, Cartographic Modeling Lab & Robert Cheetham, Avencia Corp. Philadelphia, PA Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI The difference between life and death for severely injured people depends upon the amount of time it takes to get them to a trauma center hospital. The siting of trauma center hospitals, however, is more complex than just maps of land area coverage showing ringed bands around each hospital. The speed and location of helicopters and ambulances, the number and location of trauma centers in a region, and the spatial relationships between these facilities need to be considered.
    • Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI To address these concerns, researchers from the University of Pennsylvania and Johns Hopkins University have developed the Trauma Resource Allocation Model for Ambulances and Hospitals (TRAMAH), a mathematical optimization model that uses population and access to existing trauma centers based on geographic relationships to ambulances and helicopters to simulate the effects of newly sited trauma centers. TRAMAH is supported by an interactive website that uses GIS technology to enable visitors to identify the locations of current hospitals and trauma centers and their accessibility via ambulance or helicopter.
    • Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Roughly 600 Americans die or sustain long-term disability each day from traumatic injuries. Trauma is the leading cause of death in US for people under 45 ~40% of deaths would be preventable with improved access to well-organized trauma systems This slide shows the modeled 60 minute response time by ambulance or helicopter to trauma centers in Oregon.
    • Disaster Preparedness and Response for Vulnerable Populations: Essential Role of GIS for Emergency Medical Services during the San Diego County 2007 Firestorm Isabel Corcos, Holly Shipp, Alan Smith, & Leslie Upledger-Ray, County of San Diego, Health and Human Services Agency, Public Health Services Agency, Emergency Medical Services San Diego, CA The San Diego Emergency Medical Services Departmental Operations Center coordinates the medical response to disasters. In 2007, a massive wildfire “firestorm” destroyed nearly 400,000 acres of San Diego County, and more than 500,000 individuals were evacuated from fire-threatened areas. The EMS DOC coordinated the evacuation of medically fragile individuals from residential health care facilities and 2 acute care hospitals using GIS to pre-plan the evacuation of threatened facilities and to ensure that patients were evacuated to comparable facilities or appropriate temporary evacuation points.
    • Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Critical to the multi-level emergency response plan was a GIS database containing information on medical resources such as facilities, ambulance agencies and shelters. The locations of medical facilities, the number of patients housed, medical and transportation needs, contact information, and other information were all available. Furthermore, the GIS database contained data about the location and needs of other vulnerable populations including the young, the old, and those that were medically or physically disabled. 12
    • EMS directed 2100 medical evacuations in one day Evacuation with minimal impact on 2 acute care hospitals patients 1 psychiatric hospital Moved them only once 12 skilled nursing facilities With 3 days of medications With their medical records With staff from the sending facility Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI During the initial response to the incident, GIS-trained epidemiologists drew perimeters around rapidly changing fire zones, evacuation zones, and predicted fire paths in order to locate nursing homes, group homes, care centers and other medical facilities within the affected areas. EMS DOC staff then called each facility to assess individual evacuation plans, determine transportation and receiving facility needs, and coordinate the deployment of ambulances and other transportation. The EMS DOC mapping capabilities also provided real-time updates on facility status, shelter status and road closures. All patients evacuated from a medical facility were tracked through the DOC. Individual patients who were evacuated and transported via the GIS-based system were tracked for repatriation once the danger had passed and facilities were cleared to reopen. Although a formal procedure was not in place at the time, facilities reported all patients who were evacuated from their facility and the location to which they were evacuated. 13
    • Integrating GIS into Emergency Medical Services Peter Dworsky MONOC Monmouth-Ocean Hospital Service Corp. Neptune, NJ Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI In the recent event involving US Airways flight 1549, over 50 BLS Ambulances, 6 paramedic Units, 3 medevac helicopters, 10 specialized Mass Casualty Response Trucks and trailers along with more than 200 EMS providers were dispatched to multiple staging areas throughout the region. All of the assets were tracked at the local level and some not at all. Technology was not leveraged and some units were lost as they were repositioned. Hospitals typically do not have the ability to see the incident other than what is on TV.
    • Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Hospitals and other healthcare facilities must plan for evacuations; this is a requirement under Joint Commission and ESF-8. Unfortunately, this is often done in a vacuum and local EMS providers are not involved in the process and find themselves working off of a different operations plan. By implementing a GIS program, EMS agencies would have the ability to properly distribute the patients to the appropriate destination that most closely matches the patient’s need, which is not necessarily that of the transferring facility, many evacuation plans are based on business relationships and not medical care. When patients are transferred out of state, all tracking capability is lost because the paper trail that has been used is broken and there is no follow up. Integrating GIS into these processes benefit the patient, the medical resources and the emergency services.
    • Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI By integrating EMS into Healthcare GIS systems, hospitals will be able to make better use of their resources and activate disaster plans based on real time data. This is a screen shot from a dispatch console of a system showing color coded primary response zones.
    • Introducing GIS to Hospital Emergency Management Decision-makers Joseph G. Ferko III DO, MS EMS Innovations, Inc. Pasadena, MD Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI The disaster operations environment is changing for the hospital & healthcare emergency manager and GIS is seeing an increasingly more important role.
    • Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI In many Mass Casualty Incidents the hospital emergency manager no longer works in the hospital. The hospital is now moving to the scene or surging to the outdoors.
    • Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI GIS is being used for the mapping of injury and illness locations for WMD and pandemic. Considerations include locating patients and locations for staging medical care. GIS is also being used for the determination of staffing, pre-positioning of supplies and transportation issues.
    • Natural Disasters and the Role of GIS in Assessing Need Omar Ha-Redeye Univ. of Western Ontario & Bryan Heal The Armichand Group Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI In the past 10 years, topographic maps generated by GIS have become as indispensable to humanitarian healthcare providers as surgical kits and purified water. Under intense pressure to act quickly, aid agencies and governments increasingly use GIS maps as a foundation for major decisions from aid planning to where to build a field hospital. While the benefits of rapid action in crises are clear, agencies should seek ways for GIS to compliment sound field epidemiology principles when conducting a post disaster needs assessment. Whether in a clinical program in rural Northeastern Aceh (Indonesia) to institutionally backed medical support in Hulhumale (Maldives), GIS has an important role that can be leveraged when conducting health assessments in the field.
    • Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI In some countries the traditional practice of talking to people and gathering on the ground intelligence is still important. However, GIS compliments sound field epidemiology principles conducting a post disaster needs assessment. 21
    • Integrating GIS into county based emergency management, HVA, and disaster planning on Florida's East Coast James C Kendig Health First Inc. Rockledge, FL Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI GIS was used to formulate the county's and hospital based Hazard Vulnerability Assessment (HVA) which was ultimately used to help develop the approved emergency management plan and drill scenarios supported by the HVA.
    • Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Do you think location might be important factor, and that therefore GIS is an important tool, in this Florida hospital’s Hazard Vulnerability Assessment?
    • 1900-2005 Atlantic Hurricanes and hurricanes passing within 75 miles of Cape Canaveral Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI GIS was used in joint-partnership programs (participation with county special needs/enhanced care), participation with ESF8 during disasters, and the development of a hospital evacuation tool that has matured from a fax based approach, to an organizational Intranet based system, ultimately to a currently used web based system. Clearly, GIS can be an important tool in regional approaches to mutual aid.
    • Boston Marathon Patient Tracking Johanna Meyer AECOM Boston, MA & Dana Ohannessian Mass DPH Boston, MA Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI GIS use in emergency management for events like the Boston Marathon offers the ability to track events and people.
    • Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI From the lead runners to the injured, the events along a 26 mile route are recorded and reviewed to allow the dispatch of assistance. ESF-8 (Health & Medical Facilities) tracks each injury from evaluation to hospital admissions along the route at multiple locations. This real time tracking also monitors the emergency room capacity as ambulances are dispatched.
    • GIS and Regional Mass Casualty Incident Planning: The Role of GIS in Identifying Regional Risks and Assets Jonathon Mohr Philadelphia University & J. L. Querry City of Philadelphia Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI In the wake of ongoing economic challenges, many acute healthcare facilities are closing to reduce costs. As a result, the numbers of available hospital beds are shrinking in many urban areas. This presents both a challenge and an opportunity for planners.
    • Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI The use of GIS can provide timely analysis of the region’s shuttered facilities with the potential for reactivation and utilization during a mass casualty incident. Moreover, the use of GIS can help identify at-risk primary and secondary sites through Hazard Vulnerability Analyses and assist with enhanced logistical planning of evacuation routes. The integration of GIS in regional planning could ultimately lead to a more accurate identification of the best facilities in the region for the sheltering of evacuated patients and long-term patient care during and after a mass casualty incident.
    • GIS at Emergency Medical Center Zagreb Vlatko Roland GISDATA Zagreb, Croatia Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Emergency Medical Center Zagreb (EMCZ) provides medical help to citizens of Zagreb, Croatia using a sophisticated computer aided dispatch system based on GIS technology.
    • Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Incoming calls are located on the map and a medical doctor enters relevant information and determines level of emergency. This data is captured in incident database.
    • Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Dispatchers retrieve this data, determine the nearest available vehicle and assign the incident to the team in the field. This allows faster response and more efficient utilization of emergency resources. Data collected during the intervention is stored in the central database and is used for analyzing response times, efficiency of medical teams or frequency of emergencies based on spatial conditions and administrative boundaries.
    • Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Since 2002., when the system was implemented, more than a million interventions have been recorded in the database. The project was funded by the World Bank and includes vehicle tracking using Tetra network for transmission of GPS positions, address geocoding of incidents, interactive GIS map of Zagreb with detailed information for streets, house numbers and points of interest and Call Center integration with voice recording and CallerID positioning.
    • The Emergency Response System Agent 9-1-1™ Sabatni Monatesti, Jack Murphy, Jeff Sherer, Stephen Beller, Paul D. Cacciamani & David G. Smith ES Enterprises Inc., JJM Associates, Instaknow Inc., NHDS Inc., Synergist Technology Group, Inc. Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI When dealing with a disaster in a disparate data world, the 1st responder and the Trauma unit are faced with many difficulties. In a major disaster it is often apparent that we’re unprepared to deal with event management issues, such as dynamic triage relocation, effective apparatus dispatch, decision processing, situational awareness, victim search & rescue, and real time victim identification. In addition, we lack an effective way to assist emergency room staff in rendering treatment in a way that manages critical resources (e.g., personnel, beds, medications, and supplies) and supports clinical decisions. 33
    • Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI This system is designed to leverage GIS technology in a unique way using a patented, interoperable technology which ensures that hospitals and healthcare facilities benefit from bringing disparate databases together for improvements to situation awareness, resource inventory & allocation, and decision support. 34
    • Michael Shambaugh-Miller & Nicole VanOsdel, Department of Health Services Research and Administration College of Public Health University of Nebraska Medical Center Omaha, NE Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI In 2008 the College of Public Health at UNMC contracted with the State Association of City and County Health Offices (SACCHO) to advise on and construct an at-risk populations pandemic flu contact system using desktop GIS as the primary operations system. In cooperation with the 19 local health departments (LHD) in Nebraska the UNMC team established a set of system parameters based upon both CDC and Nebraska Dept. of Health and Human Services (NEHHSS) definitions of at-risk groups. These parameters allowed UNMC and the LHD to collect information general to the entire state and unique to individual offices. The information was used to construct LHD level GIS systems which allow the agencies to locate specific populations in specific locations based upon the specific characteristics of any natural or man-made event that may endanger the health, property, or lives of those members of the population that are most at risk due to issues involving their own health, communications abilities, or financial status.
    • The system is designed to be modular so all 19 systems can be merged at the state level for statewide response by both the NEHHSS Dept of Emergency Communications, but also by UNMC Bioterrorism Offices and in case of comprised communications systems, individual LHD agencies so that they may cover multiple regions in addition to their own. The system is also designed to work in concert with a statewide individual at-risk persons web based registry which allows local and state agencies to registry their clients who may also require assistance in event of a natural or man-made disaster. Both systems allow real-time communication with field EMS personnel so as to increase the speed and efficacy with which emergency response is received by those groups and persons most in need in the early stages of a local or statewide emergency.
    • Hospital Preparedness Integrated at the State Level Jared Shoultz, Doug Calvert, Guang Zhao, Max Learner Department of Health and Environmental Control (DHEC), Public Health Statistics and Information Services (PHSIS), Division of Public Health Informatics South Carolina Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI At the South Carolina Department of Health and Environmental Control GIS plays a critical role in all emergency response, preparedness, planning, and routine public health activities. An example of this would be the existing Critical Data Sheets application which all hospitals and nursing homes in the coastal county are required to enter their shelter in- place and evacuation plans into if they want to request the ability to shelter in-place for a category III or less hurricane.
    • Large agencies with multiple program areas, mandates, funding sources, and computer systems need systems integration to generate business intelligence. GIS is well suited to integrate data from across the enterprise based on the one common aspect of all data, GEOGRAPHY. Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Every hospital and nursing home in the coastal counties has an automatically created account when they are licensed by the state. When they log into this system they instantly have access to a map with the location of all state evacuation zones, hurricane surge zones, facility location information, evacuation routes, and other pertinent information in relation to their facility.
    • NEDSS GIS Viewer Emergency Operations & Facility Facilities Mapping notifications Advanced AVR tools for Public Health Data Field Data Collection Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Other GIS-based emergency response and planning systems and concepts are Emergency Hurricane Shelters, Hospital Preparedness Planning, Infectious Disease Outbreak monitoring, emergency notifications, and field data collection for vulnerability and rapid needs assessments.
    • Hospital Preparedness Planning for Evacuation and Sheltering with GIS Jared Shoultz, Doug Calvert, Guang Zhao & Max Learner, DHEC Division of Public Health Informatics & Office of Public Health Preparedness South Carolina Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Another example from the South Carolina Department of Health and Environmental Control is a system that is accessed by coastal hospitals for emergency preparedness and planning.
    • Critical Data Sheets System • Designed for Hospitals, Nursing Homes, and Hospice Facilities along the SC Coast. •If facilities have any intentions of “sheltering-in- place” for a Category III or less hurricane they must have all information completed so it can be reviewed for approval by DHEC before evacuation. Non-spatial Benefits •Linked to license database to pull data •Accessible from any PC with web access and data stored offsite from facility •Standardized for reporting on vehicles requested, sheltering agreements, transport vendor arrangements •All info needed to evaluate sheltering requests (communications plans, emergency contacts, emergency generator, wind loads, supplies, etc..) Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI The Critical Data Sheets System is an online ArcIMS application that integrates licensing data from the state with critical emergency response GIS layers such as shelters, flood zones, surge zones, evacuation routes, transportation infrastructure, and evacuation zones to provide hospitals without GIS capabilities the ability to enter and evaluate their Shelter in-place plans against these crucial layers. All hospital entered plans are instantly tied to GPS coordinates collected in the field by DHEC staff and accessible via a secured interactive map service.
    • Spatial Benefits • Spatial Tools for facilities with no “in-house” GIS • Advanced Analysis, Visualization and Reporting •Predefined overlays with surge zones, evacuation zones and evacuation routes •“Real-time” overlay capabilities with weather and hurricane track data Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI This gives the hospitals the ability to access these plans from anywhere at any time and provide updates to DHEC in real-time while allowing DHEC to more fully comply with the NIMS architecture and have the ability to do full reporting and spatial queries from any location on the plans currently in place for each facility. DHEC uses these plans and the associated spatial data to determine if a request to shelter in-place for a Category III or less hurricane will be approved.
    • GIS in Preparedness Preplanning Using Hospital Operational Condition Modeling Nathanial Szejniuk HICS Educational & Training Center Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Disaster preparedness and response is multi-dimensional. Factors that need to be considered include hazard event, location, distance, time, and staffing functions, among others. A concept that is gaining ground in health care is the Healthcare Operational Conditions or HOPCON readiness model. This application addresses the application of GIS in healthcare preplanning, as well as, post event recovery issues.
    • Nate Szejniuk, Healthcare Preparedness Consultant 2/17/2008 © A t th is p o in t W ilm a w a s tak in g a m oa more e rly a p p ra oapproach At this point Wilma was taking re n o rth northerly ch th a t cthatgchanged 6 h o u rs 6 hoursre na rthe a s te rly tra ve l o u t to se a . h a n e d w ith in within to a m o to o more northeasterly travel out to sea. http://www.hurrevac.com/ Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI GIS is an important tool that should be integrated with the Hazard Vulnerability Assessment (HVA) which all healthcare facilities should conduct at least annually or as other situations may dictate. HVA can use tools like the NOAA Hurricane evacuation system to track and do advanced planning response. Having the capability for early recognition of a hurricane’s path and status is critical in responding with appropriate actions. EcoLEAP2 Consulting, Inc. 44
    • 6/4/2009 1 2 3 4 Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Another example of GIS is to support concept of operations and situation awareness planning. This is a view of a hospital that is relatively close to a main railroad line. Maps such as this can reveal the importance of understanding hazards outside the healthcare facility, such as transportation incidents, hazardous materials storage, crime, flooding, etc. CHCER - Szejniuk 45
    • Nate Szejniuk, Healthcare Preparedness Consultant 2/17/2008 © Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Another consideration is staffing issues during disaster planning and response. Where do essential staff live and what route might they use to get to work? Preplanning can provide assurance that the hospital will have adequate staff of the necessary specialties. Similarly analysis can be done to support supply and re-supply issues. EcoLEAP2 Consulting, Inc. 46
    • Interagency Logistical Support during Emergencies Jerry D. VanVactor US Army Medical Service Corps Afghanistan Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI No health care community or organization is immune from emergencies whether natural or man-made. Disaster takes many forms and can come at any time. Preparedness, one aspect of the national emergency planning elements, involves leaders within multifaceted healthcare practices to conduct business processes in a state of readiness to respond to a disaster, crisis, or any other type of emergency situation. Only recently have healthcare organizations begun to develop “partnerships among disciplines, across sectors, or with private sector and media in relation to disaster preparedness”.
    • • Logistics readiness is a factor in each phase of emergency management • Preparation • Mitigation • Response • Recovery • Health care logistics does not begin and end with the first responder; in some cases, the institution can assume multifaceted roles before, during, and after a trigger event occurs. Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Crises extend beyond the first responders in the field. Once a crisis is identified a concerted effort must begin, often behind the scenes, to ensure a continued provision of material, goods, and services takes place throughout the four phases (preparedness, response, mitigation, and recovery) of crisis management and mitigation. Planning for any type of crisis cannot be done in isolation; healthcare organizations must embrace external agencies to create and write more detailed and thorough emergency response plans to yield the most good for an affected population. Many organizations have transitioned to more streamlined approaches to logistics management by reducing inventory to stockless and just-in-time processes. The hypothesis here is that logistics needs/demands extend beyond first responders and the emergency department during various phases of crisis intervention. GIS can aid in this aspect of emergency management. Technological developments are always evolving to allow organizations to manage inventory, track shipments, analyze cost and purchasing information, and develop trend analyses. 48
    • Emergency Response Critical Item Plan Inventory List Periodic review of items on-hand Supports contingency requirements Yes No Audit Further evaluation New items added to list Identify resources Further available need Identify and Yes No prioritize Adjust prior to a deficiencies in trigger event supplies, resources, and equipment Eliminate from the Continue support list Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI A baseline decision-making model becomes helpful when establishing criteria for logistical support prior to an event occurring. During the initial response effort for an event there will be little time for deciding among events and will be a period of extremely rapid supply consumption that will likely taper as the length of an event extends. Any function that supports the delivery of essential services must be considered an element of the logistics chain. Much like preparation, mitigation involves the identification of common characteristics of hazards most likely to affect operations in supply chain management. 49
    • Supply Node Supply Disaster Node Impact Area Downwind direction Medical Center Supply Supply Node Node Supply Node Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI This example depicts how the integration of multiple GIS can provide insight during a disaster for a healthcare logistics manager. Note that the hospital and one supply node is in the affected/impact area. Another supply node is affected by being down wind of the affected/impact area and is also inaccessible for re-supply operations. Another primary supply node cannot access the hospital through the disaster area. Planning that incorporates this kind of spatial analysis can provide the healthcare logistician with in-transit visibility and real time shipping data related to incoming supplies so that the medical center can maintain a continued access to supplies. 50
    • Improving Prehospital and Disaster Response Using a Geographic Information Interface Elizabeth Walters, MD, Stephen W. Corbett, MD, PhD, & Jeff Grange, MD, Loma Linda University Hospital Loma Linda, CA Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI The Advanced Emergency Geographic Information System (AEGIS) AEGIS is reportedly the first integrated emergency system to provide the user access to a suite of tools necessary to manage resources and respond effectively and efficiently during prehospital and disaster incidents. Interoperable communications among a variety of devices is facilitated by AEGIS via text messaging to an individual or group participating through the system. Personnel in critical locations can be identified and given specific instructions, and personnel or assets in other locations can be redeployed to more strategic positions. This interface can be used universally at the response or command level, and across political and jurisdictional boundaries. It allows users to consider a diversity of pertinent information, interpret and analyze trends and threats, share information, and communicate with other responders. It is especially suited for operations where a great amount of information from multiple sources must be distributed and analyzed quickly for appropriate decision-making. It is designed to be agency independent and can be used for daily operations as well as for incident response. The system is designed to provide secure access to information sources, and to expand and contract to include only the information that is necessary for the level of response needed and operational success.
    • •Hospital Name •Status •Time •Updated every minute •Air Photos •Fire Stations •Police Stations •Sheriffs Stations Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI AEGIS incorporates both static and dynamic information into a single user-friendly interactive map. Static information includes a variety of typical maps with the location and attributes of key facilities and resources. Dynamic information includes hospital diversion status, real time traffic information, weather conditions, and updated major incident information. AEGIS also visualizes ground and airborne emergency assets in real time.
    • Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI AEGIS creates a unique level of situational awareness that has not been available before. The spatial representation of the incident, the wealth of information for decision support contained in the data layers, visualization of adjacent critical structures, and the understanding of resources available with current asset allocations, all allow managers to make well informed decisions in real time. Predictive tools that are currently available for wildfire activities, toxic plume behavior, hazardous materiel incidents, flooding, and earthquakes, can be incorporated into AEGIS for immediate use by Emergency Managers.
    • CA Highway Patrol Incidents CA Highway Patrol Incidents •Location •Location •Type •Type •Time •Time •Updated every minute •Updated every minute Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Information from CHP’s CAD system is relayed to the system. This, along with traffic and hospital information, allows the hospital to make better decisions in routing ambulances traffic. AVLs show where rescue and air evac helicopters are currently located, even shows direction and airspeed.
    • Meterologix Weather Meterologix Weather •Precipitation •Precipitation •Current Weather •Current Weather •Forecasts •Forecasts •Updated every 15 •Updated every 15 minutes minutes Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Weather information can be important in planning for air transport of patients. Also useful in HazMat incidents. Although this does not show ‘plume models’, that kind of information could also be fed into the map.
    • Use of Global Early Warning for Infectious Disease Events, Crises, and Disasters in the Hospital Setting James Wilson Veratect Corporation Kirkland, WA Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Low probability, high consequence infectious disease events pose a challenge to the hospitalist seeing a returned traveler who may, unbeknownst to the physician, have traveled through a foreign area reporting an unusual disease outbreak with serious infection control implications. These geographic and temporally contextualized events require infrequent notification to local hospital personnel. Emerging capabilities in global infectious disease events, crisis and disaster early warning and how this information is intelligently and proactively disseminated to the local hospital environment for risk mitigation is facilitated with GIS.
    • Image credit: Aaron Koblin Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI The top image shows a 'global radar' system used to track infectious disease events, crises, and disasters. The lower image is a screenshot of Aaron Koblin's fantastic visualization of air traffic connections to / from the US (which brings the threats home), and an example (not real) report of an alert that a hospital might see. Think of this Global Early Warning System as a National Weather Service for Infectious disease.
    • Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Here’s a larger view of Koblin’s composited FAA data for 24 hours of Air Traffic over the United States creating a beautiful, strange and thought provoking graphic.
    • Some additional applications of GIS in hospital/healthcare emergency management Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI The following briefly mentions work being carried out by others on this topic and are presented without examples. In many cases they’ve been distracted by the real world emergency “H1N1” Swine Flu and were not able to get slides to me.
    • Integrating GIS to Improve Medical Disaster Reponse John Dorling Community Preparedness Consulting Services Sarasota, FL Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Local and regional disasters can take on many forms and impact a large number people, institutions and resources. A successful response to such events requires the integration of resources from local, State and Federal responders as well as a variety of commercial, volunteer and private organizations. In order to effectively identify needs and maximize response efforts a variety of technologies are available to assist in the management of an integrated response system. The implementation of GIS technology in a disaster medical response provides incident and emergency operation managers the information they need in a concise and graphical format to monitor and track patient movement from the scene, resource and logistical movement, make routing decisions based on environmental changes, determine alternate routes due to unexpected barriers and provide valuable information for decision modeling. By integrating available GIS systems from other emergency response organizations, layering of incident information and resources can provide local decision makers with more timely information that other text based information systems.
    • GIS Application and a Regionalized Approach for Mass Casualty Incident Planning Deborah Kim, Wiliam Proger, Kent Simons, & Christopher Hiles IEM, Inc. South Jordan, UT & BelAir, MD Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI The potential of a large scale mass casualty incident (MCI) places significant pressure on healthcare facilities where bed capacity is approaching 100% on a “good” day, first responder partners find themselves working under diminishing funding, and their surrounding communities faced with hard economic decisions. Hospitals plans should realistically address the management of existing patient populations, as well as the anticipated casualty surge from an MCI. Potential transfer of existing patients to other facilities requires identification of transportation assets, personnel, and transportation routes. Effective and coordinated regional emergency planning requires a thorough knowledge of the locations of critical facilities and impacted populations through all phases of the emergency. In addition, regional planning requires careful evaluation of resources which could be utilized in the planning, response, and recovery phases of any MCI. Mapping the healthcare resources has been clearly shown to make a difference as part of the development of a regional approach to planning for a MCI. Regional planning brings together individuals from different disciplines and geographical locations. Regional planners may be unfamiliar with resources or critical infrastructures that are outside their city or county boundaries. GIS technology identified not only resources, transportation routes, evacuation routes, locations of critical infrastructure, and other elements essential in the development of a regional plan. GIS allows for the development of a common operating picture and facilitates the community planning partners ability to identify the spatial relationship of the elements essential to the planning, response, and recovery phase of an incident.
    • The Chemical Stockpile Emergency Preparedness Program: Application of GIS Technology and the Development of Healthcare and Community Based Planning Deborah Kim, William Proger Kent Simons & Donald Cobb IEM, Inc. South Jordan, UT Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI United States military chemical weapons storage areas (e.g., Army depots) were purposefully located in relatively remote areas of the country. As part of the treaty requirements for destruction of the aging chemical weapons stockpile, disposal facilities were constructed near these storage depots. Over the past sixty years, community development close to storage and destruction sites has become a reality, requiring intensive population protection planning efforts by affected nearby jurisdictions. Since 1988, FEMA and the U.S. Army have assisted communities surrounding the seven chemical stockpile sites to enhance their abilities to respond in the unlikely event of a chemical agent emergency. Continued success of Chemical Stockpile Emergency Preparedness Program (CSEPP) initiatives depends on the productive working partnerships enjoyed by federal, state, and local jurisdictions involved in the program. A unique emergency preparedness effort involving ten states in eight locales that would be affected by a potential off-site release of chemical agent, CSEPP has applied the information developed by the use of GIS in multiple arenas including evacuation, plume direction, identification of hospitals and the need for shelter in- place activities. GIS has been used to identify healthcare resources, evacuation routes, locations of critical infrastructure, and other elements essential in the development of each community’s CSEPP plan . The prompt provision of medical care in the community to potential chemically contaminated individuals involves multiple levels of participation in all phases of the emergency management planning process. GIS allows for the development of a common operating picture and facilitates the community planning partners ability to identify the spatial relationship of the elements essential to the planning, response, and recovery phase of an incident.
    • GIS Based Medical Response Management System for Pandemic Diseases Ajay Krishnapillai BartiNet.com Orlando, FL Bindu Ravi DTS Orlando, FL Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI The Severe Acute Respiratory Syndrome (SARS) disease was a serious disease in the Southeast Asian region. The incident resulted in 8096 known infected cases and 774 deaths. The ASEAN countries were at the forefront of the impact and response. The pace and spread of the SARS pandemic challenged the community, medical, and healthcare resources in that region. A GIS based medical response management system for pandemic diseases was developed using GIS Web Server implementation, web based incident case data collection, map based SARS incident reporting, real-time medical staff notification, disease spread parameters based GIS analysis, incident location and time-distance based impact zone forecasts, and deployment of resources In a similar application for bird flu the incident source, incident location, patient health, the pace of spread, treatment of affected patients and surrounding population count, etc. were input. The information on time-lag between incidences, follow-on incidents, the medical diagnosis and treatment process were critical. The medical treatment operations and other bird culling at source farms were equally important during the period. A web GIS portal allowed online mapping of bird flu incidents, medical facility, medical staff, bird culling stations. The information was captured by public health staff in the field, medical offices and emergency response centers. As the incident information came in, based on distance algorithms and nature of incident, the nearest medical and public health response teams are alerted. The operational follow-ups and responses are also captured into the same database through the web portal.
    • Using GIS to Improve Workplace and Worker Safety Crisis Management Jeffrey M. Miller Warrior Concepts International, Inc. Sunbury, PA Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI GIS can be used to understand, and prepare for, the most likely dangers to healthcare professionals. Workplace violence in the healthcare sector has become a very hot topic internationally, and there is a need for defensive training for healthcare professionals. GIS can be used to help insure that staff education and administrative procedures are in line with the real threats and dangers. Whether the risk is criminal activity (i.e. gang violence) that can find its way into a facility, or socio-economic conditions which can be a factor in the actions of patients, family members, and guests, GIS can be an important tool in the overall crisis management and emergency response arena. It is critical that a facility is able to maintain a safe environment, as well as reduce stress, minimize employee turnover due to the lack of a properly prepared workplace violence plan, and avoid costly legal damages due to perceived negligence and liability.
    • Enhanced Hospital Situational Understanding by Integrating GIS and Simulations Modeling Susan O’Hara, Mark Sullivan, James Walsh & Ignacio Hidalgo, O’Hara Consulting, SPARTA, Inc. Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI Simulation models and geospatial reasoning engines are used to conduct emergency contingency planning focusing on effects on nursing workload and scenario driven physical space architecture. One application is agent based modeling to assess and plan for emergency (surge) patient load on a hospital medical surgical unit and its effect on the nursing team. These models used RFID and advanced agent based modeling to represent nurse behavior and performance. The tool demonstrates uses to assess staffing, processes and unit layout to accommodate the surge patient load. The analysis is used to develop contingency plans for the emergency condition. GIS and models can be integrated to provide a more seamless planning capability. Drawing from consequence management for missile defense planning GIS and Service Oriented Architecture is combined in a real time decision support application demonstrating the integration of multiple and disparate real-time and strategic computer programs including bedboards, admission planning tools, electronic health records.
    • New York City Hospital Mapping Project Joe Paz & Al Villacara Office of Emergency Management New York City, NY Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI The New York City Office of Emergency Management (OEM) Hospital Mapping Project was a 2008 initiative to build a limited-access database of maps that capture the critical infrastructure of New York City’s 65 acute care hospitals. OEM’s Health & Medical (Planning & Preparedness Unit) and GIS Divisions worked together to co-lead this important endeavor. Hospital emergency managers worked with the medical, safety, facility, and/or engineering personnel and identified critical infrastructure areas of their facility. These vital areas included but were not limited to: Generators Fueling sites Oxygen delivery systems Electrical vaults Imaging systems Hazardous material storage Location of Decontamination showers and corridors Data inputs were organized and maps created with all floors of the hospital superimposed into one aerial view. Critical infrastructure points were plotted with imbedded data detailing specifics about floor location and other information relating to that particular area. There were multiple benefits of this collaboration. NYC OEM established a database that enabled the Health & Medical section of the Emergency Operations Center to immediately access information about NYC hospitals during an emergency. The hospitals were provided with poster-sized maps and were encouraged to incorporate them into their planning efforts. By the end of the 2008 calendar year the project had yielded a database of 50 sets of maps for hospitals across the city which will be important tools should they ever be needed to by first responders as they work on-scene at an incident located at one of New York City’s hospitals.
    • Ric Skinner, GISP The Stoneybrook Group LLC Sturbridge, MA ric.skinner@gmail.com www.healthGISguy.com Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI