URISA GIS/Health Conf. -- "The Evolving Role of GIS in Hospital/Healthcare Emergency Managment"...

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 report 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 and emphasizes the important contribution that

geospatial technology plays in protecting these assets in the Homeland Security Grant

Program Supplemental Resource on Geospatial Guidance.


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. A number of these have addressed GIS as a tool in the public health sector,

and some articles can be found on GIS in hospital/healthcare emergency management.

GIS is rapidly evolving and clearly has an important role in this area. This is because many

of the emergency management challenges faced in hospitals and healthcare, 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 some examples of how hospitals and healthcare facilities are

benefiting from the use of GIS to improve their emergency management mandates and

responsibilities. There won’t be time to cover all the examples I have found, however they

will be included in the full length presentation that will be available in the conference

proceedings.

You’ll hear similar approaches and implementations of GIS are occurring from a variety of

sources.

I have a lot to cover so let’s get started.

First you’ll see a title slide referencing the source of the example and then one or more

illustrating slides. The slides and description are based on material provided by the source

authors.


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 siting of trauma center hospitals 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.


The Trauma Resource Allocation Model for Ambulances and Hospitals (TRAMAH) is

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.


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

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.

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The San Diego Department Operations Center 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.

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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

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. All patients evacuated

from a medical facility were tracked through the DOC.


Integrating GIS into

Emergency Medical Services

Peter Dworsky

MONOC

Monmouth-Ocean Hospital Service Corp.

Neptune, NJ

In the recent ditching of US Airways flight 1549 in the Hudson River, 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.


By integrating EMS into Healthcare GIS systems, EM agencies and 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.

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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 for this Florida hospital?

And do your therefore think that GIS might be an important tool in the hospital’s Hazard

Vulnerability Assessment?


1900-2005 Atlantic Hurricanes and

hurricanes passing within 75 miles of Cape Canaveral

GIS is used in joint-partnership programs participation with ESF8 (health & medical

facilities) during disasters, and the development of a hospital evacuation tool that has

matured from a fax based approach to a 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 a region’s shuttered facilities with the

potential for reactivation and utilization during a mass casualty incident. 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.

The project was funded by the World Bank.


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.


Since 2002., when the system was implemented, more than a million interventions have

been recorded in the database.


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.

The 1st responder and the Trauma unit are faced with many difficulties in a disaster

including dynamic triage relocation, effective apparatus dispatch, decision processing,

situational awareness, victim search & rescue, and real time victim identification.

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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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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

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. It has developed 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 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.


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.


1

2

3

4

An example of GIS is to support concept of operations and situation awareness planning is illustrated here. 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


Interagency Logistical Support during

Emergencies

Jerry D. VanVactor

US Army Medical Service Corps

Afghanistan

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.

Preparedness, one of the 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.

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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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 creating a unique level of situation awareness.

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.


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, 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.


???

These are just handful of the applications on how GIS is an evolving technology being

widely utilized by hospitals and healthcare facilities as they enhance and improve

emergency management and disaster preparedness and response.

I want to thank all the contributors to this presentation. I’ve only included here what time

will allow. An extended version of this presentation that includes all my contributors will be

posted by URISA in the conference proceedings.

And now, I can take few questions.


Ric Skinner, GISP

The Stoneybrook Group LLC

Sturbridge, [email protected]

www.healthGISguy.com

URISA GIS/Health Conf. -- "The Evolving Role of GIS in Hospital/Healthcare Emergency Managment"...

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Transcript of URISA GIS/Health Conf. -- "The Evolving Role of GIS in Hospital/Healthcare Emergency Managment"...