the evolving role of gis in hospital and healthcare emergency management

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.

Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI

Committee on Planning for Catastrophe:A Blueprint for Improving Geospatial Data,

Tools, and Infrastructure

Mapping Science Committee Board on Earth Sciences and ResourcesDivision on Earth and Life Studies

www.nap.edu/catalog/11793.html

Successful ReponseStarts with a Map

Improving Geospatial Support for Disaster Management

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 HealthNational Monuments and Icons Banking and Finance Water Chemical Commercial Facilities Critical Manufacturing Dams Emergency Services Nuclear Reactors, MaterialsWaste

Information Technology Communications Postal and Shipping Transportation SystemsGovernment Facilities

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.


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)

The 80% Paradigm

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


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

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 and minimal response ti

Natural disaster cutting or impairing certain segments of the network.

Evacuation or heavy traffic situations when parts of the network are gridlocked above predicted levels.

Situations when traffic direction limitations are compromised resulting in other parts of the network faster or more accessible.


Trauma Resource Allocation Model for Ambulances and Hospitals

(TRAMAH)

Charles Branas, University of PennsylvaniaMarlen Kokaz, Cartographic Modeling Lab

& Robert Cheetham, Avencia Corp.Philadelphia, PA

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.


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.


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.

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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.

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EMS directed 2100 medical evacuations in one day2 acute care hospitals1 psychiatric hospital

12 skilled nursing facilities

Evacuation with minimal impact on patientsMoved them only once

With 3 days of medicationsWith their medical recordsWith staff from the sending facility

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.


Integrating GIS into

Emergency Medical Services

Peter Dworsky

MONOC

Monmouth-Ocean Hospital Service Corp.

Neptune, NJ

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.


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.


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

The disaster operations environment is changing for the hospital & healthcare emergency

manager and GIS is seeing an increasingly more important role.


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.


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

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.

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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.


Integrating GIS into county based

emergency management, HVA, and

disaster planning on Florida's East

Coast

James C Kendig

Health First Inc.

Rockledge, FL

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.


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

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

GIS use in emergency management for events like the Boston Marathon offers the ability

to track events and people.


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

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.


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

Emergency Medical Center Zagreb (EMCZ) provides medical help to citizens of Zagreb,

Croatia using a sophisticated computer aided dispatch system based on GIS technology.


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.


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.


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.

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.

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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.

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Michael Shambaugh-Miller & Nicole VanOsdel,

Department of Health Services Research and Administration

College of Public Health

University of Nebraska Medical Center

Omaha, NE

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

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.

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

notifications

Facilities Mapping

Advanced AVR tools for Public Health Data Field Data Collection

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

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..)

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

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

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.


At th is point W ilm a was tak ing a m ore northerly appraoch that

changed with in 6 hours to a m ore northeasterly travel out to sea.At this point Wilma was taking a more northerly approach that changed within 6 hours to a more northeasterly travel out to sea.

http://www.hurrevac.com/

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.

Nate Szejniuk, Healthcare Preparedness Consultant

©

2/17/2008

EcoLEAP2 Consulting, Inc. 44


1

2

3

4

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.

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6/4/2009

CHCER - Szejniuk


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.

Nate Szejniuk, Healthcare Preparedness Consultant

©

2/17/2008

EcoLEAP2 Consulting, Inc. 46


Interagency Logistical Support during

Emergencies

Jerry D. VanVactor

US Army Medical Service Corps

Afghanistan

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.

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.

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Emergency Response

Plan

Critical Item

Inventory List

Periodic review of

items on-hand

Supports contingency

requirements

Audit

Identify resources

available

Identify and

prioritize

deficiencies in

supplies, resources,

and equipment

Further evaluation

Further

need

Continue supportEliminate from the

list

New items added to

list

Adjust prior to a

trigger event

Yes No

Yes No

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.

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MedicalCenter

SupplyNode

Supply

Node SupplyNode

SupplyNode

SupplyNode

Disaster

Impact

Area

Downwind

direction

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.

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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

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 bedistributed 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 NameHospital Name

••StatusStatus

••TimeTime

••Updated every minuteUpdated every minute

••Air PhotosAir Photos

••Fire StationsFire Stations

••Police StationsPolice Stations

••Sheriffs StationsSheriffs Stations

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.


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 IncidentsCA Highway Patrol IncidentsCA Highway Patrol Incidents

•Location

•Type

•Time

•Updated every minute

••LocationLocation

••TypeType

••TimeTime

••Updated every minuteUpdated every minute

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 WeatherMeterologix Weather

•Precipitation

•Current Weather

•Forecasts

•Updated every 15 minutes

••PrecipitationPrecipitation

••Current WeatherCurrent Weather

••ForecastsForecasts

••Updated every 15 Updated every 15

minutesminutes

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

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

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.


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

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

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

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

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

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

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.

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

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, [email protected]

www.healthGISguy.com

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