Information-sharing in out-of-hospital disaster response: the future role of information technology

Advancing the scientific study of prehospital mass casualty response through a Translational Science process: the T1 scoping literature review stage

PURPOSE

The European Union Horizon 2020 research and innovation funding program awarded the NIGHTINGALE grant to develop a toolkit to support first responders engaged in prehospital (PH) mass casualty incident (MCI) response. To reach the projects' objectives, the NIGHTINGALE consortium used a Translational Science (TS) process. The present work is the first TS stage (T1) aimed to extract data relevant for the subsequent modified Delphi study (T2) statements.

METHODS

The authors were divided into three work groups (WGs) MCI Triage, PH Life Support and Damage Control (PHLSDC), and PH Processes (PHP). Each WG conducted simultaneous literature searches following the PRISMA extension for scoping reviews. Relevant data were extracted from the included articles and indexed using pre-identified PH MCI response themes and subthemes.

RESULTS

The initial search yielded 925 total references to be considered for title and abstract review (MCI Triage 311, PHLSDC 329, PHP 285), then 483 articles for full reference review (MCI Triage 111, PHLSDC 216, PHP 156), and finally 152 articles for the database extraction process (MCI Triage 27, PHLSDC 37, PHP 88). Most frequent subthemes and novel concepts have been identified as a basis for the elaboration of draft statements for the T2 modified Delphi study.

CONCLUSION

The three simultaneous scoping reviews allowed the extraction of relevant PH MCI subthemes and novel concepts that will enable the NIGHTINGALE consortium to create scientifically anchored statements in the T2 modified Delphi study.

Method and application of information sharing throughout the emergency rescue process based on 5G and AR wearable devices

The 2022 Winter Olympics were held in the three competition zones of Beijing, Yanqing and Zhangjiakou, China. The venues of this Winter Olympics were scattered and the terrain was complex. Moreover, the medical resources of Hebei and Beijing were relatively unbalanced. In the medical security of major events, the connection between first aid and in-hospital processes is of the utmost importance to rescue quality. 5th generation mobile network (5G) applications in medical scenarios are on the rise. It would be of great relevance to fully use 5G's low-latency and high-speed features to share the process information of patients, ambulance personnel, and the destination hospital's rescue team at emergency scenes and in transportation, improving rescue efficiency. This paper proposes a system scheme of cross-institutional emergency health information sharing based on 5G and augmented reality wearable devices. It also integrates the construction method of monitoring and other sign data sharing, in addition to testing the proposed scheme's service quality in 5G environments. In the deployment area of the 5G emergency medical rescue information sharing scheme for the Beijing Winter Olympic Games, we selected two designated medical support institutions for testing. The test adopted a combination of fixed-point and driving tests to experiment on the service data, voice service, and streaming media indicators. The 5G signal's coverage rate was close to 100%, the standalone connection's success rate was 100%, and the drop rate was 0. The average downlink rate of multiple scenarios was 620mbps, and the average uplink rate of 5G was over 71.8mbps, which is higher than the average 5G level in China. The downlink rate was more than 20 times larger than the 4th generation mobile network (4G) rate. This study's proposed scheme demonstrates the importance of 5G applications in emergency response and support, in addition to providing a suitable scheme for the integration of 5G networks in the medical scene.

High-Level Design and Rapid Implementation of a Clinical and Non-clinical Blockchain-Based Data Sharing Platform for COVID-19 Containment

As the world has moved toward rigorous containment measures due to the spread of a novel coronavirus, it is crucial to push the boundaries of clinical data obtaining methods using real-time capturing facilities. During this time of crisis, data-centric technologies that could provide authenticity and immediate access to patient data are essential. A blockchain-based digital health protocol for access to real-time data with user-centric data protection measures can achieve these aims. Immediate and secure access to biomedical data can provide credible insights and also help in discovering intelligence to expediate the development of effective therapeutics. It also aids in altering policies for restrictions by extracting key insights required for modeling studies. This paper delivers a high-level design of a blockchain-based clinical research data collection and health service intervention platform, where the users can exercise control of data. This application also provides a platform to deliver technology-based interventions which would assist in streamlining aid for vulnerable users to prevent the NHS from being overwhelmed. Further steps are also recommended to achieve a data compliant solution for rapid deployment, based on available resources, allowing a collaborative effort, which is extremely necessary at times of such crisis.

Research and Evaluations of the Health Aspects of Disasters, Part IX: Risk-Reduction Framework

A disaster is a failure of resilience to an event. Mitigating the risks that a hazard will progress into a destructive event, or increasing the resilience of a society-at-risk, requires careful analysis, planning, and execution. The Disaster Logic Model (DLM) is used to define the value (effects, costs, and outcome(s)), impacts, and benefits of interventions directed at risk reduction. A Risk-Reduction Framework, based on the DLM, details the processes involved in hazard mitigation and/or capacity-building interventions to augment the resilience of a community or to decrease the risk that a secondary event will develop. This Framework provides the structure to systematically undertake and evaluate risk-reduction interventions. It applies to all interventions aimed at hazard mitigation and/or increasing the absorbing, buffering, or response capacities of a community-at-risk for a primary or secondary event that could result in a disaster. The Framework utilizes the structure provided by the DLM and consists of 14 steps: (1) hazards and risks identification; (2) historical perspectives and predictions; (3) selection of hazard(s) to address; (4) selection of appropriate indicators; (5) identification of current resilience standards and benchmarks; (6) assessment of the current resilience status; (7) identification of resilience needs; (8) strategic planning; (9) selection of an appropriate intervention; (10) operational planning; (11) implementation; (12) assessments of outputs; (13) synthesis; and (14) feedback. Each of these steps is a transformation process that is described in detail. Emphasis is placed on the role of Coordination and Control during planning, implementation of risk-reduction/capacity building interventions, and evaluation.

BirnbaumML,DailyEK,O’RourkeAP,LorettiA.Research and evaluations of the health aspects of disasters, part IX: Risk-Reduction Framework.Prehosp Disaster Med.2016;31(3):309–325.

Research and Evaluations of the Health Aspects of Disasters, Part III: Framework for the Temporal Phases of Disasters

Each of the elements described in the Conceptual Framework for disasters has a temporal designation; each has a beginning and end time. The Temporal Framework defines these elements as phases that are based on characteristics rather than on absolute times. The six temporal phases include the: (1) Pre-event; (2) Event; (3) Structural Damage; (4) Functional Damage (changes in levels of functions of the Societal Systems); (5) Relief; and (6) Recovery phases. Development is not a phase of a disaster. The use of the Temporal Framework in studying and reporting disasters allows comparisons to be made between similar phases of different disasters, regardless of the hazard involved and/or the community impacted. For research and evaluation purposes, assessments, plans, and interventions must be described in relation to the appropriate temporal phase.

16. Information

Effective disaster management requires systems for data acquisition and information management that enable responders to rapidly collect, process, interpret, distribute, and access the data and information required for disaster management. Effective information sharing depends on the types of users, the type of damage, alterations of the functional status of the affected society, and how the information is structured. Those in need of information should be provided with the information necessary for their tasks and not be overloaded with unnecessary information that could serve as a distraction. Such information systems must be designed and exercised. To disseminate and share data with the relevant users, all disaster responses must include effective and reliable information systems. This information includes that acquired from repeated assessments in terms of available and needed human and material resources, which resources no longer are needed, and the status of the relief and recovery workers. It is through this information system that vital decisions are made that are congruent with the overall picture as perceived by the most relevant coordination and control centre. It is essential that information systems be designed and tested regularly as part of preparedness. Such systems must have the capacity to acquire, classify, and present information in an organised and useful manner.

Recommended Modifications and Applications of the Hospital Emergency Incident Command System for Hospital Emergency Management

The Hospital Emergency Incident Command System (Hospital Emergency Incident Command System), nowin its third edition, has emerged asa popular incident command system model for hospital emergency response in the United States and other countries. Since the inception of the Hospital Emergency Incident Command System in 1991, several events have transformed the requirements of hospital emergency management, including the 1995 Tokyo Subway sarin attack, the 2001 US anthrax letter attacks, and the 2003 Severe Acute Respiratory Syndrome (Severe Acute Respiratory Syndrome) outbreaks in eastern Asia and Toronto, Canada.

Several modifications of the Hospital Emergency Incident Command System are suggested to match the needs of hospital emergency management today, including: (1) an Incident Consultant in the Administrative Section of the Hospital Emergency Incident Command System to provide expert advice directly to the Incident Commander in chemical, biological, radiological, nuclear (CBRN) emergencies as needed, as well as consultation on mental health needs; (2) new unit leaders in the Operations Section to coordinate the management of contaminated or infectious patients in chemical, biological, radiological, nuclear emergencies; (3) new unit leaders in theOperations Section to coordinate mental health support for patients, guests, healthcare workers, volunteers, anddependents in terrorismrelated emergencies or events that produce significant mental health needs; (4) a new Decedent/Expectant Unit Leader in the Operations Section to coordinate the management of both types ofpatients together; and (5) a new Information Technology Unit Leader in the Logistics Section to coordinate the management of information technology and systems.

New uses of the Hospital Emergency Incident Command System in hospital emergency management also are recommended, including: (1) the adoption of the Hospital Emergency Incident Command System as the conceptual framework for organizing all phases of hospital emergency management, including mitigation, preparedness, response, and recovery; and (2) the application of the Hospital Emergency Incident Command System not only to healthcare facilities, but also to healthcare systems.

Finally, three levels of healthcare worker competencies in the Hospital Emergency Incident Command Systemare suggested: (1) basic understanding of the Hospital Emergency Incident Command System for all hospital healthcare workers; (2) advanced understanding and proficiency in the Hospital Emergency Incident Command Systemfor hospital healthcare workers likely to assume leadership roles in hospital emergency response; and (3) special proficiency in constituting the Hospital Emergency Incident Command System ad hoc from existing healthcare workers in resource-deficient settings. The Hospital Emergency Incident Command System should be viewed asa work in progress that will mature as additional challenges arise and ashospitals gain further experience with its use.

Logistic support provided to Australian disaster medical assistance teams: results of a national survey of team members

BACKGROUND

It is likely that calls for disaster medical assistance teams (DMATs) continue in response to international disasters. As part of a national survey, the present study was designed to evaluate the Australian DMAT experience and the need for logistic support.

METHODS

Data were collected via an anonymous mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 Asian Tsunami disaster.

RESULTS

The response rate for this survey was 50% (59/118). Most of the personnel had deployed to the South East Asian Tsunami affected areas. The DMAT members had significant clinical and international experience. There was unanimous support for dedicated logistic support with 80% (47/59) strongly agreeing. Only one respondent (2%) disagreed with teams being self sufficient for a minimum of 72 hours. Most felt that transport around the site was not a problem (59%; 35/59), however, 34% (20/59) felt that transport to the site itself was problematic. Only 37% (22/59) felt that pre-deployment information was accurate. Communication with local health providers and other agencies was felt to be adequate by 53% (31/59) and 47% (28/59) respectively, while only 28% (17/59) felt that documentation methods were easy to use and reliable. Less than half (47%; 28/59) felt that equipment could be moved easily between areas by team members and 37% (22/59) that packaging enabled materials to be found easily. The maximum safe container weight was felt to be between 20 and 40 kg by 58% (34/59).

CONCLUSIONS

This study emphasises the importance of dedicated logistic support for DMAT and the need for teams to be self sufficient for a minimum period of 72 hours. There is a need for accurate pre deployment information to guide resource prioritisation with clearly labelled pre packaging to assist access on site. Container weights should be restricted to between 20 and 40 kg, which would assist transport around the site, while transport to the site was seen as problematic. There was also support for training of all team members in use of basic equipment such as communications equipment, tents and shelters and water purification systems.

Future Connectivity for Disaster and Emergency Point of Care

OBJECTIVE: The goal of this paper is to identify strategies for connectivity that will optimize point-of-care testing (POCT) organized as small-world networks in disaster settings. METHODS: We evaluated connectivity failures during the 2010 Haiti Earthquake, applied small-world network concepts, and reviewed literature for point-of-care (POC) connectivity systems. RESULTS: Medical teams responding to the Haiti Earthquake faced connectivity failures that affected patient outcomes. Deploying robust wireless connectivity systems can enhance the efficiency of the disaster response by improving health care delivery, medical documentation, logistics, response coordination, communication, and telemedicine. Virtual POC connectivity education and training programs can enhance readiness of disaster responders. CONCLUSIONS: The admirable humanitarian efforts of more than 4000 organizations substantially impacted the lives of earthquake victims in Haiti. However, the lack of connectivity and small-world network strategies, combined with communication failures, during early stages of the relief effort must be addressed for future disaster preparedness.

A strategy for real time improvement (RTI) in communication during the H1N1 emergency response

OBJECTIVE

To develop and implement a strategy that would enable the Emergency Operations Centre (EOC) to assess the effectiveness of communication strategies and guide real time improvements within the life cycle of the emergency.

DESIGN, SETTING AND PARTICIPANTS

An anonymous internet-based questionnaire featuring multiple choice and open text questions was administered to stakeholders of the EOC of a regional tertiary hospital.

MAIN OUTCOME MEASURES

The outcomes were perceptions of sufficiency and relative usefulness of various sources of information on Pandemic (H1N1) 2009, including differences between local, state-wide and authoritative worldwide information sources.

RESULTS

A total of 328 responses were received over two rounds of questionnaires. Email communication from the Health Incident Controller (HIC) was the most useful source of information (74% found it very useful, compared with authoritative international websites at 21% (Centers of Disease Control) and 29% (World Health Organization)). A total of 94% felt this strategy contributed to improvements. Free text responses also helped the EOC and HIC to tailor communication methods, style, content and tone during the response.

CONCLUSIONS

Real time improvement is a useful strategy for implementing change to practice during the life cycle of the current emergency and has broader applicability than Pandemic (H1N1) 2009. Local stakeholders demand local content for their information feed and messages from a trusted local leader are the most superior forms of communication.

Recurrent medical response problems during five recent disasters in the Netherlands

OBJECTIVES

The aim of this qualitative, retrospective review is to identify and analyze the occurrence of recurrent problems in 20 processes that cover all relevant aspects of disaster health during the response phase. Consequently, an attempt is made to determine if there are generic themes of coherences in these problems.

METHODS

Eight after-action reports of five consecutive disasters in the Netherlands, between 1996 and 2005, were integrally analyzed in a structured manner. The analysis was confined to processes from the start of the event up to and including the initial stages of hospital admission.

RESULTS

Problems during all five disasters arose with eight processes: (1) submission of information to the ambulance dispatch center (ADC); (2) provision of information by the ADC to disaster response personnel; (3) scaling-up of prehospital response; (4) communication; (5) logistics; (6) registration; (7) multidisciplinary cooperation; and (8) preparation. Three generic themes of coherence were identified: (1) processes in which exchange of information among medical personal plays a major role are more likely to be affected by problems than processes in which this is less relevant; (2) processes in which disaster circumstances differ from day-to-day health care, or do not figure in day-to-day health care, are more likely to give rise to problems than processes that remain essentially similar; and (3) the existence of a protocol or disaster plan governing a process does not prevent problems.

CONCLUSIONS

The method used enables a systematic analysis of the problems in health-related processes following five consecutive disasters. The analysis confirms that the majority of problems are repeated. The identified themes of coherences are in agreement with case reports and expert opinions. They are now supported with a higher level of evidence.

A national system for disseminating information on victims during mass casualty incidents

Immediate provision of information to the public is vital during mass casualty incidents (MCIs). Failure to implement rapidly a communication response system may result in the public overwhelming hospitals. This paper shares Israel's experience in developing and maintaining a national system for supplying information on the location and identification of casualties. ADAM interfaces online with hospitals' patient registration systems, and allows for immediate electronic transfer of designated data. The system permits information centres to access information on which hospital has admitted identified and unidentified casualties. The latter are photographed at the entrance to the hospital and the picture is stored in ADAM. The system enables hospitals and municipalities to ensure immediate availability and accessibility of information and thus (in our belief) mitigate the concerns of family and friends. Use of such an interface system is recommended as an integral element of emergency preparedness.

Bethesda hospitals' emergency preparedness partnership: a model for transinstitutional collaboration of emergency responses

The events of September 11, 2001 identified a need for health care institutions to develop flexible, creative, and adaptive response mechanisms in the event of a local, regional, or national disaster. The 3 major health care institutions in Bethesda, MD-the National Naval Medical Center (NNMC), the Suburban Hospital Healthcare System (SHHS), and the National Institutes of Health Clinical Center (NIHCC)-have created a preparedness partnership that outstrips what any of the institutions could provide independently by pooling complementary resources. The creation of the partnership initially was driven by geographic proximity and by remarkably complementary resources. This article describes the creation of the partnership, the drivers and obstacles to creation, and the functioning and initial accomplishments of the partnership. The article argues that similar proximity and resource relationships exist among institutions at academic centers throughout the United States and suggests that this partnership may serve as a template for other similarly situated institutions.

Evolution of a collaborative model between nursing and computer science faculty and a community service organization to develop an information system

Nursing and computer science students and faculty worked with the American Red Cross to investigate the potential for information technology to provide Red Cross disaster services nurses with improved access to accurate community resources in times of disaster. Funded by a national 3-year grant, this interdisciplinary partnership led to field testing of an information system to support local community disaster preparedness at seven Red Cross chapters across the United States. The field test results demonstrate the benefits of the technology and the value of interdisciplinary research. The work also created a sustainable learning and research model for the future. This article describes the collaborative model used in this interdisciplinary research and exemplifies the benefits to faculty and students of well-timed interdisciplinary and community collaboration.

Enhancing community-based disaster preparedness with information technology

A critical component of community-based disaster preparedness (CBDP) is a local resource database of suppliers providing physical, information and human resources for use in disaster response. Maintenance of such a database can become a collaborative responsibility among community-based non-governmental organisations (NGOs) and public and private community organisations. In addition to mobilising resources, this process raises awareness within the community and aids in assessing local knowledge and resources. This paper presents the results of a pilot study on implementing a community-based resource database through collaboration with local American Red Cross chapters and public and private community organisations. The design of the resource database is described. The resource database is accessible via the internet and offline using laptops and handheld Personal Digital Assistants. The study concludes that CBDP is strengthened through a combination of appropriate information technology and collaborative relationships between NGOs and community-based organisations.

Identifying and tracking disaster victims: state-of-the-art technology review

The failure of our nation to adequately track victims of Hurricane Katrina has been identified as a major weakness of national and local disaster preparedness plans. This weakness has prompted government and private industries to acknowledge that existing paper-based tracking systems are incapable of managing information during a large-scale disaster. In response to this need, efforts are under way to develop new technologies that allow instant access to identity and location information during emergency situations. The purpose of this article is to provide a review of state-of-the-art technologies, with implications and limitations for use during mass casualty incidents.

Answering questions at the point of care: do residents practice EBM or manage information sources?

PURPOSE

To determine the types of information sources that evidence-based medicine (EBM)-trained, family medicine residents use to answer clinical questions at the point of care, to assess whether the sources are evidence-based, and to provide suggestions for more effective information-management strategies in residency training.

METHOD

In 2005, trained medical students directly observed (for two half-days per physician) how 25 third-year family medicine residents retrieved information to answer clinical questions arising at the point of care and documented the type and name of each source, the retrieval location, and the estimated time spent consulting the source. An end-of-study questionnaire asked 37 full-time faculty and the participating residents about the best information sources available, subscriptions owned, why they use a personal digital assistant (PDA) to practice medicine, and their experience in preventing medical errors using a PDA.

RESULTS

Forty-four percent of questions were answered by attending physicians, 23% by consulting PDAs, and 20% from books. Seventy-two percent of questions were answered within two minutes. Residents rated UptoDate as the best source for evidence-based information, but they used this source only five times. PDAs were used because of ease of use, time factors, and accessibility. All examples of medical errors discovered or prevented with PDA programs were medication related. None of the participants' residencies required the use of a specific medical information resource.

CONCLUSIONS

The results support the Agency for Health Care Research and Quality's call for medical system improvements at the point of care. Additionally, it may be necessary to teach residents better information-management skills in addition to EBM skills.

Research priorities for surge capacity

The 2006 Academic Emergency Medicine Consensus Conference discussed key concepts within the field of surge capacity. Within the breakout session on research priorities, experts in disaster medicine and other related fields used a structured nominal-group process to delineate five critical areas of research. Of the 14 potential areas of discovery identified by the group, the top five were the following: 1) defining criteria and methods for decision making regarding allocation of scarce resources, 2) determining effective triage protocols, 3) determining key decision makers for surge-capacity planning and means to evaluate response efficacy (e.g., incident command), 4) developing effective communication and information-sharing strategies (situational awareness) for public-health decision support, and 5) developing methods and evaluations for meeting workforce needs. Five working groups were formed to consider the above areas and to devise sample research questions that were refined further by the entire group of participants.