Integrating Location into Hospital and Healthcare Facility Emergency Management - Part 4, Case Stories

By Ric Skinner

This is the fourth and final in a series of articles (1, 2, 3) based on my research for the book GIS in Hospital and Healthcare Emergency Management, which will be published by Taylor & Francis/CRC Press in spring 2010. A case story is the best way to document and demonstrate concepts and applications in which GIS has proven to be of value in hospital and healthcare emergency management. The case studies summarized here should drive the point home.

Regional Healthcare Preparedness, Planning and Response
California knows all too well what major disasters are about. The annual spate of wildfires cause death and injury and cost millions of dollars in damage and response. The County of San Diego Emergency Medical Services Departmental Operations Center (EMS DOC) coordinates the medical response to disasters in San Diego. 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 healthcare facilities and two acute care hospitals. It used GIS to pre-plan the evacuation of threatened facilities and to ensure that patients were evacuated to comparable facilities or appropriate temporary evacuation points. The system used a comprehensive spatial 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. Further, the GIS database contained data about the location and needs of other vulnerable populations including the young, the old and those who were medically or physically disabled.

More than 2,100 medically fragile individuals were evacuated by medical transport and mass transit agencies, along with ambulance strike teams from outside of the area. Two hospitals were safely evacuated during this emergency, one of which evacuated and shut down in less than eight hours, and the other in less than two hours. All patients were safely transported with their medical records and necessary prescription medications to a hospital or a skilled nursing facility depending on their needs. Individual patients who were evacuated and transported were tracked for repatriation via the GIS-based system once the danger had passed and facilities were cleared to reopen.

This operation would not have been possible without the ability to pre-plan evacuations using the GIS system and data base. The ability to anticipate the path of the fires and identify facilities in the danger zone gave ambulance agencies and receiving facilities time to address the needs of the displaced patients. Injury and death surveillance showed that far fewer people were injured or killed during the 2007 fires than in a previous firestorm in 2003, despite the fact that the 2007 fires were almost as large and destroyed nearly as much property as the 2003 fires.

Mass Casualty Incident Planning and Response
Present healthcare facility bed utilization is approaching 98% of bed capacity at a national level. The potential for a large scale mass casualty incident (MCI) places significant pressure on healthcare facilities, first responder partners and their surrounding communities. Hospitals are required to develop plans in collaboration with the community. These 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 as part of a community's ability to surge patient care 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 that could be used in the planning, response and recovery phases of any MCI.

Mapping the healthcare resources available makes a difference as part of the development of a regional approach to planning for an MCI. Regional planning should bring together individuals from different disciplines and geographical locations. Regional planners are often unfamiliar with resources or critical infrastructures that are outside their city or county boundaries, and GIS has helped to create an informed regional picture by identifying 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.

Preplanning Medical Resources
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 were asked to work with the medical, safety, facility and/or engineering personnel to identify 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

The data were captured on a project worksheet and also plotted on blank aerial maps of each hospital. OEM Health & Medical personnel worked directly with the hospitals to obtain precise data. OEM GIS personnel then took the submitted data and created maps with all floors of the hospital superimposed onto one aerial view. Critical infrastructure points were plotted with imbedded data detailing specifics about floor location and other information relating to that particular area.

This collaboration yielded multiple benefits. 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. They provided the hospitals with poster-sized maps and encouraged them to incorporate the maps 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. While the hope is to never have to use these maps, they will certainly prove invaluable to first responders as they work on-scene at an incident located at one of New York City's hospitals.

Lessons Learned from the Haiti Earthquake
There is no doubt that many lessons will be learned for many years from the response, recovery and rebuilding following the earthquake in Haiti. GIS is, and will be, playing a major role. Involved in the effort are the USGS, the University of Texas, Google and Mapaction, among many others. But lessons learned are useless if they are not lessons applied. This is where GIS will hopefully make a huge difference in how we plan, prepare for, mitigate, respond to and recover from mega-disasters, as well as the "smaller" midwest ice storms, hurricanes, landslides and all other hazards around the world.

If you are aware of specific examples of how GIS is being used in hospital and healthcare emergency management, I would be interested in hearing about them. Please contact me at .(JavaScript must be enabled to view this email address).

Published Tuesday, March 2nd, 2010

Written by Ric Skinner

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