Mission status Information needs relating to Mission status (Table 3) varied depending on the scenario. The typical information needs were both the number and skill level of EMS units assigned to the mission, and information on whether the assigned resources were sufficient. Paramedic field supervisors also needed other information, such as whether an EMS doctor was already assigned to the mission, when the EMS units could be released, and the estimated action time. They delivered information, such as their own status (on the way/estimated time of arrival at the scene, on scene, not available), the sufficiency of the EMS units (enough, need more, can be released), the estimated action time, and confirmation of a completed mission.
Area status Typical information needs for Area status (Table 4) were the number, type, and location of free EMS units, the status and location of the occupied units, the availability of an EMS doctor, and the possibility of getting more units (created ad hoc or from the neighbouring town). The youth scenario had the highest Area status value. Paramedic field supervisors delivered information relating to Area status mainly to Emergency Medical Dispatch (EMD). It was about giving instructions on how to manage urgent and non-urgent incidents and their current status to identify the possibility to free some EMS units if needed, and the PFS availability.
Safety at work In the Safety at work category (Table 5), paramedic field supervisors had a generic information need in all scenarios, this was a request to the police or rescue services on whether there were any safety risk factors. The rest of the needs related to the shooting scenario; which were the location of the safe zone and permission to enter the scene. Universally the paramedic field supervisors only accepted this information from the police in charge of the operation. After receiving the required information in the shooting scenario, the PFS cascaded the safety action plan to all EMS units and the EMS doctor. Tactical information (Table 6) needs in the shooting scenario were received mainly from the police. In the road traffic accident and youth scenarios, the information needs related to operative leadership. This information came from the EMS doctor and the EMS unit currently in charge of the incident. After analysing the information received, paramedic field supervisors made the tactical action plan and passed it on to the units, doctor and the police.
Information sources and targets There were differences relating to information sources and targets, i.e., the social network, of the EMS (Table 7). Paramedic field supervisors mainly received information from the EMD and, depending on the case, from the police, EMS unit, and fire rescue. When looking at all the data, it seems that paramedic field supervisors both receive and deliver information to the EMS in equal measures. Paramedic field supervisors receive more information from the EMD and the police than they deliver back to those groups; however they mainly disseminate information to the EMS doctor, hospital, and fire rescue teams than receive information back.
Methods to receive and deliver information As shown in Table 8, the paramedic field supervisors used three different methods to receive and deliver information. The use of communication equipment (TETRA, mobile phone) was the most common. However, there were differences in their use. Information was mainly received using TETRA, but when delivering information, TETRA and the mobile phone were used equally. Paramedic field supervisors used two information systems: the field command system and the electronic patient record. In this study, the field command system was only used to receive information. It is noteworthy that one quarter of the information was delivered face to face.
Himss15 Paramedic Disaster Data
Disaster Data Challenges: Don't let data
become part of the disaster
April 14, 2015
Nick Nudell, MS, NRP
The Paramedic Foundation, Inc - Chief Data Officer
PrioriHealth Partners, LLP – Partner
National Association of State EMS Officials – EMS Compass Initiative Project Manager
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
• Be able to describe key data needs during disasters
• Learn what issues and challenges were faced during previous disasters
• Learn considerations and solutions for common disaster day challenges
Biggest Killer Natural
Disasters – 1915-2015
• 1920 a 8.2M earthquake killed 200,000
in Gansu Province
• 1927 an earthquake in Qinghai (Xining)
Province killed 200,000
• 1931 Yellow River flooding killed 1M and
flooded more than 40,000 sq/mi
• 1948 a 7.3M earthquake in Ashgabat,
Turkmenistan killed 176,000
• 1970 the 150mph Cyclone Bhola hit
Ganges Delta killing 300-500,000 in
• 1971 the Red River in Vietnam flooded
• 1976 Tangshan 8.2M earthquake killed
655,000 & injured 779,000
• 1991 Cyclone 2B killed 145,000 in
Bangladesh and destroyed 1.5M homes
• 2004 a 9.4 Indian Ocean earthquake and
Asian Tsunami killed 230,000 and
displaced 1.79M across 15 countries
• 2005 a 7.5M Kashmir earthquake killed
76,400 and displaced 3M
• 2008 120mph Cyclone Nargis killed
138,000 and displaced 54,000 in
• 2010 Haiti 7.0M earthquake killed
160,000 & displaced 895,000
• 2011 a 8.9M earthquake in Japan caused
a Tsunami killing 28,700
Disasters – 2000-2014
• 2003 a 6.6M earthquake in Bam (Iran)
killed 26,271 and 80% of the area’s
buildings were damaged or destroyed
• 2005 Cat 5 Hurricane Katrina cost
over $100B in damages and killed
• 2007 California wildfires burned 1M
acres in SoCal, 1,500 homes
destroyed, killing 14 and injuring 160
of which 124 were firefighters.
• 2008 a 7.9M earthquake in Sichuan
(China) killed 68,712 people were
confirmed dead (with another 17,921
missing but presumed dead)
• 2011 1-mile wide EF5 tornado hit Joplin,
MO killing 158, injuring 1,150, and
causing $2.8B in damages
• 2012 Superstorm Sandy killed 233 and
caused $68B in damages
• 2014 Ebola outbreak
• 2014 20 wildfires in San Diego County
burned 30,000 acres killing one over 17
Disaster Data Needs
• Am I in danger?
• What is going on?
• Where are my friends/family?
• What should I do?
• Where should I go?
• How long will it last?
• Do I need to evacuate?
• Are my pets safe?
• Can I volunteer?
• What if I need help?
• Am I in danger?
• Is my family safe?
• What hospitals are open?
• Is there traffic blocking access?
• How long will I be at work?
• What kind of supplies do I need?
• Where will my meals come from?
• Is the incident scaling up?
• Who is in charge?
• How do I use the volunteers?
• How do I communicate with others?
August 29, 2005
• Most destructive natural disaster in
• Large and powerful hurricane as well
as a catastrophic flood
• Impacted nearly 93,000 square miles
across 138 parishes and counties
• Crippled thirty-eight 911 call centers
• Knocked out 3+ million customer
phone lines in Louisiana, Mississippi,
• 50 percent of area radio stations and
44 percent of area television stations
went off the air
• 770,000 people were displaced
• 500+ ambulances plus thousands
of paramedics provided mutual aid
• The inability to rapidly share data is the #1 problem
• Critical data lives in disparate systems on a day to day basis
• Damaged infrastructure complicates sharing across distance, languages, cultures,
geographic barriers, & borders
• Automating manual records – a reality
• Communication systems may work
• Staff and their families need linkage
• Coordinating out of state resources
Pre Disaster Data
• Build in situational awareness
technologies to stay ahead of the
• Real-time & redundant tools for
communication, data management &
• To be effective technologies must be
used every day, not just disaster day
• Support mobile technologies and web
• Scalable from 1:N
• Information assurance = success
• Empower someone to rapidly adapt
changes to policies & procedures as
needed for effective response
Disaster Day Situational Awareness
“Disasters are sites of human innovation” – Leysia Palen
Situational Awareness = information and its interpretation – right type, at the right time,
in the right amount
1) Incident data - Detailed scene information about patients (status, number, triage,
2) Mission status - Units assigned, resources available, location of responders,
hospital capability, police units assigned, distance to hospitals, etc
3) Area status – Available units (number, type, location), EMS doctor, status of
missions in area, number of non-urgent missions, mutual aid availability, possibility
to assemble ad hoc units, etc
4) Safety status – Risk factors, location of safe zone, permission to go to scene
5) Information Sources & Targets – EMS units, doctors, dispatch, fire/rescue, police,
6) Information Sharing – EMS radio, cell phone, ePCR, incident management
software, face to face
Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2015, 23:4
• Patient & Pet
• Mortuary services
• Medical records
• Fleet tracking records
• Human resources data &
follow-up for exposures
• Resupply for redeployment
• Resuming normal operations
• Communication systems
returning to ‘normal’
• Reimbursement forms &
• Debrief & Lessons Learned
Don’t Forget The Pets!
To Do: To Avoid:
• Plan for interoperability on a big scale
• Test for disaster scenarios while
building for daily use
• Develop resiliency plans with
contingencies for data system
• Establish regional data sharing
councils & agreements
• Work out how you will:
– Manage thousands of ad hoc
– Integrate disaster assistance
teams from across country
– Move data systems to the cloud
– Train (OJT) for new systems
– Coordinate with NGO & federal
• Don’t wait for FEMA – that is too late
• Hope PH or someone else has the
• Skip testing and drilling with partner
agencies and/or competitors
• Buying off the shelf solutions without
• Fail to engage “boots on the ground”
• Purchasing solutions that tie your hands
– Data ownership
– Change management
– Transitional periods
– Sandbox development