Integrating Location into Hospital and Healthcare Facility Emergency Management

This is the second in a series of articles based on my research for the book GIS in Hospital and Healthcare Emergency Management, which will be published by Taylor & Francis/CRC Press in the spring of 2010. As in all areas in which GIS is applied,"location" is a principal consideration in deciding whether or not to implement geospatial technologies. This applies to hospital and healthcare emergency management when answering questions such as:

What's the best route for ambulances from the site of the mass casualty incident to hospitals, and which hospitals?
How has the flood water elevation changed in the area of this hospital over the past six hours and what can be expected in the next six hours?
What burn centers within 100 miles are still accepting burn patients?

Professionals involved in hospital and healthcare emergency management are increasingly applying spatial thinking in their approach to emergency planning, preparedness, mitigation, response and recovery. This article discusses some of the conceptual ideas discovered in my research for the book that could form the basis for GIS implementations and case stories.

Routing and Logistics
Whether consciously thinking spatially or not, healthcare emergency management professionals know it is crucial to be able to identify and communicate the best possible emergency routing in a disaster situation for transport of victims or evacuation of patients. Preplanned primary routes may be developed in the planning phase, however ad hoc disaster impacts such as road closures, traffic jams, earthquake fissures, chemical plumes, etc. may demand that dispatchers and emergency managers react in real-time to identify alternatives based on current situation awareness. GIS is essential in this capacity.

Another consideration is staffing issues during disaster planning and response. Where do essential staff live and what routes might they use to get to work? Preplanning can provide assurance that the hospital will have adequate staff with the necessary specialties, but having the ability to alert staff to route changes due to impeding hazard events (e.g., flooding, chemical plume, civil disturbance) is a good justification for GIS.

Similar analyses can be done to support supply and re-supply issues. No healthcare community or organization is immune to emergencies, whether natural or man-made. Disaster takes on many forms and can come at any time. Preparedness, one aspect of national emergency planning, requires leaders within multifaceted healthcare organizations and agencies to conduct business processes in a state of readiness to respond to a disaster, crisis or any other type of emergency situation. Healthcare organizations have recently begun to develop disaster preparedness partnerships internally and externally among their various disciplines, across types of organiztions and responsibility areas, and with private sector partners. Crises extend beyond the first responders in the field. Once a crisis is identified, a concerted effort must begin, often behind the scenes, to ensure that a continued provision of material, goods, and services takes place throughout the four phases (preparedness, response, mitigation, and recovery) of crisis management and mitigation.

Inventory and Tracking Assets
In the recent event involving US Airways flight 1549, numerous resources (ambulances, paramedic units, helicopters, mass casualty response vehicles and trailers) from many agencies and hospitals, including more than 200 EMS first responders, were dispatched to multiple staging areas throughout the region. Assets were tracked at the local level and some were not tracked at all. Without a regional GIS in place it was impossible to track and efficiently use all the available assets. Some units even disappeared from the tracking system as they were repositioned.

Planning for any type of crisis cannot be done in isolation; healthcare organizations must embrace external agencies to create and write more detailed and thorough emergency response plans in order to yield the most good for the affected population. Many organizations have transitioned to more streamlined approaches to logistics management by reducing inventory to stockless and just-in-time processes. The hypothesis here is that logistics needs and 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. A baseline decision making model is helpful when establishing criteria for logistical support prior to the occurrence of an event. During the initial response effort for an event there will be little time for deciding among events and it will be a period of extremely rapid supply consumption that will likely taper as the length of an event extends. Any function that supports the delivery of essential services must be considered an element of the logistics chain. Much like preparation, mitigation involves the identification of common characteristics of hazards most likely to affect operations in supply chain management.

Remote Healthcare Incident Command
As regional collaborative planning and response are becoming better developed, the disaster operations environment is changing for the hospital and healthcare emergency manager. GIS can have an increasingly important role, for example, in mass casualty incidents where the hospital emergency manager no longer works in the hospital but is positioned at the scene in a mobile operations center. From there, decisions can be enhanced by using GIS to visualize a common operational picture of healthcare assets, resources, requests, allocations, tracking and inventory. The ability to have real-time information and multi-organization/agency interoperability (Skinner 2008) is essential for effective response.

Regional Disaster Response Planning and Facility Siting
The economic situation faced by many hospitals and healthcare systems has caused facilities to close and available hospital beds to diminish. This presents both a challenge and an opportunity for planners. The use of GIS can provide timely analysis of the region's shuttered facilities with the potential for reactivation and utilization during a mass casualty incident. Moreover, 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.

Global Healthcare and Surveillance
Low probability, high consequence infectious disease events pose a challenge to the hospital infection control professional. A returning traveler may have, unbeknownst to his physician, traveled through a foreign area reporting an unusual disease outbreak with serious infection control implications. These geographic and temporally contextualized events require infrequent notification to local hospital personnel. Emerging capabilities in global infectious disease events, including crisis and disaster early warning, and proactively disseminating information to the local hospital for risk mitigation, are facilitated with GIS.

Another approach suggested by Jim Wilson (Veratech Corp.) is based on Aaron Koblin's spatio-temporal modeling of commercial aircraft flight patterns over time. This could help us visualize and understand the globalization and spread of infectious diseases such as H1N1 flu.

Workplace Violence and Worker/Patient/Visitor Safety
GIS can be used to understand and prepare for the most likely dangers to healthcare professionals. Workplace violence in the healthcare sector has become a very hot topic internationally, and there is a need for defensive training for healthcare professionals. GIS can be used to help ensure that staff education and administrative procedures are in line with the real threats and dangers. Whether the risk is criminal activity (e.g., gang violence, hostage situation) that can find its way into a facility, or socio-economic conditions which can influence the actions of patients, family members and guests, GIS can be an important tool in the overall crisis management and emergency response arena. It is critical that a facility is able to maintain a safe environment, as well as reduce stress, minimize employee turnover due to the lack of a properly prepared workplace violence plan, and avoid costly legal damages due to perceived negligence and liability.

Planning for Efficient Use of Medical Assets
Simulation models and geospatial reasoning engines are used to conduct emergency contingency planning, focusing on nursing workload and scenario-driven physical space architecture. One area gaining recognition is agent based modeling to assess and plan for emergency (surge) patient load on a hospital medical surgical unit and its effect on the nursing team. These models used RFID (radio frequency identification device) and advanced agent based modeling to represent nurse behavior and performance. Such a tool could be useful to assess staffing, processes and unit layout to accommodate the surge patient load. The analysis would be used to develop contingency plans for the emergency condition.

GIS and models can be integrated to provide a more seamless planning capability. Consequence management for missile defense planning GIS and service oriented architecture (SOA) can be combined in a real-time decision support application. This application demonstrates the integration of multiple and disparate real-time and strategic computer programs, including bed-boards, admission planning tools and electronic health records.

Research by Professor Mei-Po Kwan at Ohio State University presents some interesting ideas that could be used for mapping movement of medical and disaster management professionals and emergency response equipment. Her gallery shows a sample of the 3D GIS scenes rendered using a variety of data, including activity-travel diary data, and GIS databases of land parcels and transportation networks. This could easily be replaced by hospital floor plans and disaster scene situational awareness maps. Her examples are organized into three types of scenes: (a) space-time paths; (b) urban scenes; and (c) density surfaces.

In the next installment in this article series I'll discuss some of the applications that have been developed to support hospital/healthcare emergency management initiatives.