Medical Librarian and Medical Librarian and Disaster PreparednessDisaster Preparedness

Patti Reynolds, MLISPatti Reynolds, MLIS

Sarasota Memorial HospitalSarasota Memorial Hospital

Medical Library ComponentsMedical Library Components

Preservation of the library collectionPreservation of the library collection Delivery of medical information that is Delivery of medical information that is

pertinent to the event – toxicology, pertinent to the event – toxicology, infectious disease, etcinfectious disease, etc

Provision of necessary medical guidance Provision of necessary medical guidance information for emergency preparedness information for emergency preparedness within the hospital, county or region within the hospital, county or region such as guidelines, literature, etc.such as guidelines, literature, etc.

Ethical information Ethical information

Preservation of the library Preservation of the library collectioncollection

Natural disasters and emergenciesNatural disasters and emergencies Floods, hurricanes, tornadoes, fire, Floods, hurricanes, tornadoes, fire,

cyclones,tsunamis, volcanoes cyclones,tsunamis, volcanoes Man made disastersMan made disasters

Sprinkler system malfunction, arson, Sprinkler system malfunction, arson, computer systems, terrorism, computer systems, terrorism, bioterrorism; cyberterrorism, nuclear bioterrorism; cyberterrorism, nuclear accidents, chemical accidentsaccidents, chemical accidents

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Maintain Library Operations: 5800Maintain Library Operations: 5800NN/LM Libraries of MedicineNN/LM Libraries of Medicine

Back-Up Plans

Disaster Plans

Emergency Preparedness and Response Toolkit

Publishers Emergency Access Plan

http://nnlm.gov/ep

#2 Delivery of Medical #2 Delivery of Medical Information Information

Depends on the type of emergencyDepends on the type of emergency H1N1H1N1

Clear, definitive, authoritative information on Clear, definitive, authoritative information on vaccine and anti-virals: availability, clinical vaccine and anti-virals: availability, clinical studies,etc.studies,etc.

Guidance for hospital on supplies, algorithms, Guidance for hospital on supplies, algorithms, finance, state policies, etc.finance, state policies, etc.

Guidance for local doctors:Guidance for local doctors: Phone numbers, etc for Department of HealthPhone numbers, etc for Department of Health Where to send specimensWhere to send specimens Latest DOH updates – changed every other dayLatest DOH updates – changed every other day

H1N1H1N1

Policies on vaccinationPolicies on vaccination Daily changing nationallyDaily changing nationally New York, HCANew York, HCA

Ethics informationEthics information TriageTriage Mandating vaccinationMandating vaccination Duty to treatDuty to treat Duty to return to workDuty to return to work Etc, etcEtc, etc

Education and TrainingEducation and Training

Education of staffEducation of staff NIMS, HICS, local organization of emergency NIMS, HICS, local organization of emergency

preparednesspreparedness Department of HealthDepartment of Health EOC – police, fire, emsEOC – police, fire, ems Hospital Hospital

Security department – in charge of EOPSecurity department – in charge of EOP Clinical departments – mandatory educationClinical departments – mandatory education Physicians and community - all separate groups.Physicians and community - all separate groups.

DrillsDrills Need for constant drillsNeed for constant drills

Joint CommissionJoint Commission

An independent, not-for-profit organization, An independent, not-for-profit organization, The Joint Commission accredits and certifies The Joint Commission accredits and certifies

more than 17,000 health care organizations more than 17,000 health care organizations and programs in the United States. and programs in the United States.

Joint Commission accreditation and Joint Commission accreditation and certification is recognized nationwide as a certification is recognized nationwide as a symbol of quality that reflects an symbol of quality that reflects an organization’s commitment to meeting certain organization’s commitment to meeting certain performance standards.performance standards.

Tremendous emergency preparedness section Tremendous emergency preparedness section implemented in last 3 years.implemented in last 3 years.

Lessons learnedLessons learned Dramatic silos – all groupsDramatic silos – all groups

Within the hospital - departmentsWithin the hospital - departments Locally – city and countyLocally – city and county RegionallyRegionally FederallyFederally

Results of silosResults of silos Defensiveness Defensiveness

Leads to denial of informationLeads to denial of information IgnoranceIgnorance

Inability to educateInability to educate

Librarians actions and goalsLibrarians actions and goals

Embed yourself in your close and Embed yourself in your close and extended world. extended world. Listen, evaluate, research, offerListen, evaluate, research, offer Become completely knowledgeable Become completely knowledgeable

about topic – takes time – about topic – takes time – become the local knowledge expert!!!become the local knowledge expert!!!

Library as SwitzerlandLibrary as Switzerland

Interpersonal relationships Interpersonal relationships enormously importantenormously important

Build distribution list to all affected Build distribution list to all affected groups and send updates, articles, groups and send updates, articles, news, etc.news, etc.

Slowly build up distribution of Slowly build up distribution of information information

•9 million items in collection • 1 billion searches of our databases done each year• Biomedical informatics and communications

•New focus: Disaster Health Information

• NIH Institute

• Employees ~ 1300

• Budget ~ $360 M

• Free

1836

http://disasterinfo.nlm.nih.gov

Identify key steps in preparing for & responding to disasters from an information management/ information technology perspective

Disasters

PandemicsAccidents

Terrorism

Bhopal India 40 tons methyl isocyonate

Rapeseed oil1982 800 deaths

“Accidents” 92 nuclear weapons lost , U.S. lists 11

Unguarded Soviet Bio Grade Anthrax onRenaissance Island

An accident at a Soviet biological weapons facility in 1979 released a plume of anthraxthat killed people and livestock

On 4/26/86 major explosionpower reactors at Chernobyl

anthrax

sarin WTC X 2

OK City

UK, Spain, India

Terrorism

SUICIDE TERRORISTSUICIDE TERRORISTsent to the U.S.sent to the U.S.

Disaster Information ManagementDisaster Information ManagementResearch CenterResearch Center

http://disasterinfo.nlm.nih.gov

DIMRC OBJECTIVESDIMRC OBJECTIVES Organize the literatureOrganize the literature Maintain library operationsMaintain library operations Provide information &tools for Provide information &tools for

respondersresponders Research & DevelopmentResearch & Development Surge Model / PartnershipsSurge Model / Partnerships

Non-Commercial•Government reports•Homeland Security Presidential Directives•National Incidence Management System •National Response Plan Framework•Conference Proceedings•State publications•Red Cross•Commentaries •NGO publications•Official Reports•Non peer reviewed publications•Community resources •Training design & technologies•Preparedness options •Response plans for different events •Sister Agency Publications•Catalogues•Non Peer Reviewed Journals•Cosco Magazine

Commercial

The Public Health System

MCOs

Home Health

Parks

Economic Development

Mass Transit

Employers

Nursing Homes

Mental HealthDrug Treatment

Civic GroupsCHCs

Laboratory Facilities

Hospitals

EMS Community Centers

Doctors

Health Department

Churches

Philanthropist

Elected Officials

Tribal Health

Schools

Police

Fire

Corrections

Environmental Health

Who will Identify, Organize, Preserve, Distribute this varied, diverse, Non-Commercial Literature (& Commercial)?

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Support emergency personnel with disaster information

400 librarians EOC / TOC / DIC

Teamed with disaster planners & responders

“just- what-I-need” information “just-in-time”

Answer: The Disaster Information SpecialistA new subspecialty of library science

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The Disaster Information Specialist

•Information needs•How they search•Data mining•Create tutorials5800

2323

LIBRARIAN CYBRARIAN

http://toxtown.nlm.nih.gov

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Information & Tools for emergency preparedness & response activities

TOXMAP

PTSD/TBI screener

CHEMM

R & D -Web 2.0 R & D -Web 2.0 Tools Tools

Virtual Worlds & Games for Virtual Worlds & Games for Training & SimulationsTraining & Simulations

3-D computer 3-D computer simulated simulated environments environments Users interact Users interact via avatars via avatars (virtual (virtual characters)characters)Parcels of Parcels of land can be land can be bought, bought, developed, developed, and and customizedcustomizedExamples: Examples: Second Life, Second Life, Google Lively, Google Lively, WebkinzWebkinz

We are Not !

Bellevue Hospital Bellevue Hospital 90 patients presented in 5 hours; 194 triaged/treated in 24 90 patients presented in 5 hours; 194 triaged/treated in 24

hourshours Hospital lost track of patients, ran out of supplies and Hospital lost track of patients, ran out of supplies and

struggled with MD staffingstruggled with MD staffing

NYU Downtown HospitalNYU Downtown Hospital Typically treats 5-10 patients per hour; on Sept 11 treated 175 Typically treats 5-10 patients per hour; on Sept 11 treated 175

per hour (over 1,500 total)per hour (over 1,500 total) Lost electricity, steam, gas, phone and computer services, and Lost electricity, steam, gas, phone and computer services, and

had dangerously reduced water pressurehad dangerously reduced water pressure

St. Vincent’s HospitalSt. Vincent’s Hospital Treated nearly 800 patientsTreated nearly 800 patients Shared water lines and telecommunications lines with WTC, Shared water lines and telecommunications lines with WTC,

systems were disruptedsystems were disrupted

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Hospital Surge Response: Hospital Surge Response: September 11, 2001September 11, 2001

200 injured, 100 killed200 injured, 100 killed Kent County Hospital received 40 patients Kent County Hospital received 40 patients

in first hour; 25 were intubatedin first hour; 25 were intubated Ran out of critical supplies and ventilatorsRan out of critical supplies and ventilators Struggled to support family membersStruggled to support family members Communications problems from disaster Communications problems from disaster

scenescene Ultimately, 16 New England hospitals Ultimately, 16 New England hospitals

received 196 burn victims including a received 196 burn victims including a pediatric hospital that received 16 adultspediatric hospital that received 16 adults

(Dacey, MJ. (2003). NEJM, 1990-2)(Dacey, MJ. (2003). NEJM, 1990-2)

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Hospital Disaster Experience: Hospital Disaster Experience: RI Nightclub Fire (2003)RI Nightclub Fire (2003)

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ARE WE READY ?

We Can Be !

32National Naval Medical Center NIH Clinical Center Suburban Hospital NLM

The Bethesda Hospitals’ The Bethesda Hospitals’ Emergency Preparedness Emergency Preparedness

Partnership (BHEPP)Partnership (BHEPP) 2004 Congress earmarked $ 12.9 million to 2004 Congress earmarked $ 12.9 million to

develop a partnership to respond to an extreme develop a partnership to respond to an extreme patient surge need in event of major DC disaster patient surge need in event of major DC disaster

Leverage combined resources of 3 adjacent hospitalsLeverage combined resources of 3 adjacent hospitals Conduct research to improve the responseConduct research to improve the response Develop an exportable model for surge needsDevelop an exportable model for surge needs

BHEPP VIDEOBHEPP VIDEO

http://www.suburbanhospital.org/Emergency/EmergPreparedness.aspx

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• Digital Pen

• Patient Data Exchange

• Patient RFID Tracking

• Digital Pen

• Patient Data Exchange

• Patient RFID Tracking

PatientInformation

Management

•Virtual World Disaster Training•Virtual World Disaster Training

Responder Training

• Prescription Drug access in Disaster

• Disaster Information Specialist

• Lost Person Finder

• Prescription Drug access in Disaster

• Disaster Information Specialist

• Lost Person Finder

Information Access

•Laser Back-up

• Dark Fiber Back-up

• MARS Radio Back-up

• Wireless Voice Bridge

•Laser Back-up

• Dark Fiber Back-up

• MARS Radio Back-up

• Wireless Voice Bridge

Communications

BHEPPNLM Role: 11 Disaster R & D Projects

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Digital Pen&"Electronic" Paper

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A disaster generates mass

casualties

Digital Pen Work Flow

Digital pens capture patient

triage data

Triage data is available through BHEPP network

Digital pen transmits triage data to system

Data reports are available for

emergency personnel

2009 – View Triage Data2009 – View Triage Data

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2009 – View Summary 2009 – View Summary ReportsReports

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Lister Hill National Center for Biomedical Communications

Disaster occurs with mass casualties

Injured are

triaged

Staff/volunteerscapture text & photos of victims –

initial & updates

Purpose: To address a surge of lost persons in a local disaster, by developing a system to enter, search for,&display their descriptions&pictures.

Public search & entry of photos & descriptions via

LPF web site, mobile email

LPF Database (MySQL),Web server,

Image file storage,Email interface

Notification and status by wall displays, email,

web, etc. Includes statistics for disaster

management/awareness

Lost Person Finder

NLMResources to Support NLMResources to Support the Response to the the Response to the Earthquakes in HaitiEarthquakes in Haiti

Lister Hill National Center for Biomedical Communications

Disaster occurs with mass casualties

Injured are

triaged

Staff/volunteerscapture text & photos of victims –

initial & updates

Purpose: To address a surge of lost persons in a local disaster, by developing a system to enter, search for,&display their descriptions&pictures.

Public search & entry of photos & descriptions via

LPF web site, mobile email

LPF Database (MySQL),Web server,

Image file storage,Email interface

Notification and status by wall displays, email,

web, etc. Includes statistics for disaster

management/awareness

Lost Person Finder

46Person Finder: Haiti Earthquake

PFIF Data Exchange

Found in HaitiiPhone App

Smartphone

Interactive Notification Wall

disaster@mail.nih.gov

Haiti Earthquake Person Locator (HEPL)

http://hepl.nlm.nih.gov

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The successful response to Disasters requires the coordination of multiple elements based in federal, state or local authority, or in

the private sector

• patients, who may require rescue or medical evacuation

• treatment facility-an existing hospital, portable field hospital

• competent health care workforce

• appropriate medical equipment and non-perishable medical supplies

• appropriate drugs, vaccines, tests and other perishable medical supplies

• a system of medical records

• a health care financing mechanism.

ConclusionConclusion

GOALTo Deliver

“Just What I Need” Information, “Just in Time”

Use Informatics technologies to provide tools, communications literature, perform research to enhance

the Public Health