Integrating Location into Hospital and Healthcare Facility Emergency Management

This is the third in a series of articles (1, 2) 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. Applying the location factor to support situation awareness and decision making is a key strength of GIS in hospital and healthcare emergency management. Summarized here are examples of GIS applications that have been implemented in this regard.

Interoperability & Communications
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. Dual-use systems are designed on the front-end with GIS requirements, rather than GIS being an add-on when systems are completed. An example of this is the Critical Data Sheets application into which all coastal county hospitals and nursing homes are required to enter their shelter in-place and evacuation plans if they want to request the ability to shelter in-place for a category III or lower hurricane. 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.

Health First in Florida is using GIS to help formulate the county's and the hospital's Hazard Vulnerability Assessment (HVA), which ultimately impacts the approved emergency management plan and drill scenarios supported by the HVA. GIS on the "regional table" facilitates joint-partnership programs and participation with Emergency Support Function #8 during disasters. GIS also supports the development of a hospital evacuation tool that has matured from a fax-based approach to an organizational Intranet based system, and ultimately to a currently used Web-based system.

Facilities Siting
The difference between life and death for severely injured people often depends upon the amount of time it takes to get them to a trauma center. The siting of trauma centers, 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 resources need to be considered. To be viable, the hospital must serve a large enough population of severely injured people to maintain the skills of its healthcare providers and offer high quality care. To address these concerns, researchers from the University of Pennsylvania and Johns Hopkins University have developed the Web-based 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.

Regional Situation Awareness & Inventory
Loma Linda University Medical Center's Advanced Emergency Geographic Information System (AEGIS) is 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. 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.

The New York City Office of Emergency Management (OEM) Hospital Mapping Project is 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. The database contains critical infrastructure information on:

Generators
Fueling sites
Oxygen delivery systems
Electrical vaults
Imaging systems
Hazardous material storage
Location of decontamination showers and corridors

There are 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.

Dispatch of Assets

Emergency Medical Center Zagreb (EMCZ) provides medical help to citizens of Zagreb, Croatia using a sophisticated computer aided dispatch system based on GIS technology. Since the implementation of the system in 2002, 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, an interactive GIS map of Zagreb with detailed information on streets, house numbers and points of interest, and Call Center integration with voice recording and CallerID positioning. Incoming calls are located on the map and a medical doctor enters relevant information and determines the level of emergency. These data are recorded into the incident database. Dispatchers retrieve these data, determine the nearest available vehicle and assign the incident to a team in the field. This allows faster response and more efficient utilization of emergency resources. Data collected during the intervention are stored in the central database and are used for analysis, such as response times, efficiency of medical teams or frequency of emergencies based on spatial conditions and administrative boundaries.

Disaster Planning

In 2008, the College of Public Health at the University of Nebraska Medical Center contracted with the State Association of City and County Health Offices (SACCHO) to advise 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. The application enables UNMC and the LHD to locate specific populations in specific locations based on pre-defined characteristics of all-hazards events that may affect the health, property or lives of those special needs individuals. The LHD-level modular application allows any or all of the 19 LHD to be merged, providing a regional or state level situation awareness and decision support capability by both the NEHHSS Dept. of Communications and the UNMC Bioterrorism Offices. In the event that communications are compromised, the individual LHD agencies can 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 the 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.

In the next and final installment in this series I'll summarize some of the case stories that provide an assessment of benefits of having implemented GIS as a core technology into the hospital and healthcare emergency management solutions.