Integrating Location into Hospital and Healthcare Facility Emergency Management

By Ric Skinner

"Location" is an exceedingly important attribute that is too often under-recognized and therefore under-utilized in critical decision making when it comes to hospital and healthcare emergency management. Fortunately, location is slowly gaining appreciation in this arena supported by increasing implementations of GIS technologies. Healthcare facility emergency managers are beginning to realize that by thinking spatially, deciding visually and acting wisely they will be more satisfied they've done the best they can with the information provided. The purpose of this article, and the more detailed examples in subsequent articles, is to provide an overview of how GIS is being used to support emergency management in hospitals and healthcare.

Questions like these are finding better answers because GIS is becoming part of the decision maker's tool set:
  • What's the fastest way to get from the mass casualty incident (MCI), such as might result from a transportation accident, building collapse, terrorist bombing, etc., to the emergency room (ER)?
  • Will the high water affect access to our alternate care site?
  • Which skilled nursing facilities (SNF) are at risk due to the wildfire?
  • Will I have to evacuate my facility because of the chemical tank rupture upwind?
  • Can my off-duty medical staff safely get to the hospital through the civil disturbance?
  • Where are the hospitals in my region with available burn beds right now?
  • Which homebound patients on electrically powered oxygen equipment need portable generators during the power outage?
  • Is my hospital at a greater hazard risk due to dam inundation than my health clinic one mile away?
  • Which of my healthcare facilities have greater exposure to workplace violence because of their location near high crime neighborhoods?
  • Where can I most effectively and safely establish points of distribution for H1N1 vaccine?
  • How can I more effectively manage the emergency medical services (EMS) in my region?
The National Academy of Sciences (NAS) concluded, among other things, in its comprehensive report, "Successful Response Begins With a Map - Improving Geospatial Support for Disaster Management" (NAS 2007) that geospatial data and tools (i.e., GIS and GPS) should be an essential part of every stage of emergency management, from planning through response and recovery to the mitigation of future events.

There is a widely used "80% axiom" in the healthcare industry which holds that 80% of healthcare and emergency management information has a geographic relevance:
  • A full 80% of information needed for decision making has a location or spatial component (Folger 2009, City of Boston 2009, Yong 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 (Emergency Management Spatial Information Network of Australia 2004).
The Department of Homeland Security's (DHS) inclusion of hospitals and healthcare in its list of Critical Infrastructure/Key Resources (CI/KR; DHS 2008a) emphasizes that it is essential that hospitals and healthcare be prepared, able to respond effectively and recover quickly from all hazards - natural, technological and human-caused. It is clear from its "Supplemental Resource: Geospatial Guidance" for the Homeland Security Grant Program (DHS 2008b) that DHS recognizes the importance that geospatial information and technology play in protecting the nation's CI/KR. GIS technologies improve the overall capability of information technology applications and systems to enhance public security and emergency preparedness and efficient response to all-hazards. Therefore, it only seems logical to apply GIS technologies to support emergency management and disaster preparedness in the hospital and healthcare sector.

Many books and articles have been published on the application of GIS in emergency management and disaster response (Kataoka 2007, Maantay et al. 2006, Greene 2002). A number of these have addressed GIS as a tool in public health (Briggs et al. 2002, Cromley and McLafferty 2002) and a few have touched on isolated stories about GIS in the hospital and healthcare sector (Khan and Skinner 2002). The synthesis of GIS, hospitals and healthcare, and emergency management has been addressed sporadically in occasional journal articles. However, the topic has not been given the visibility it deserves until now. This author has just completed the first book on the topic: GIS in Hospital and Healthcare Emergency Management, which will be published by Taylor & Francis/CRC Press in spring 2010.

Healthcare facility emergency managers are using GIS to: enable better location-based hazard vulnerability assessments, which are required by healthcare accrediting organizations such as The Joint Commission (2008); understand spatial factors in workplace violence; track nosocomial (i.e., acquired in the hospital) infections; and in logistics planning for healthcare supplies and resources. GIS-based applications have been developed to improve: trauma center siting, mass casualty incident planning, evacuation and sheltering, patient tracking, prehospital and disaster response. Case stories attest to the value of GIS in flu preparedness, identifying and caring for vulnerable populations, determining needs during natural disasters, and regionalized incident planning and integration of emergency management services (EMS) and hospital response. An added benefit of GIS implementations, when developed with open source technologies such as the Common Alerting Protocol, is that disparate entities - such as hospitals, EMS, public health, emergency management agencies - and support functions have an interoperability platform to provide the critical common operating picture to support multifaceted situational awareness, decision making, identification and allocation of resources, and more effective use of resources for response and recovery.

Follow-up articles will highlight in more detail some of the GIS concepts and implementations from hospital and healthcare emergency management.


Briggs, D.J., P. Forer, L. Järup and R. Stern. 2002. GIS for Emergency Preparedness and Health Risk Reduction. Proceedings of the NATO Advanced Research Workshop, Budapest, Hungary, 22-25 April 2001. NATO Science Series: IV: Earth and Environmental Sciences, Vol. 11.

City of Boston. 2009. What is GIS? Official Website of the City of Boston (MA).

Cromley, E. and S. McLafferty. 2002. GIS and Public Health. The Guilford Press, New York.

Davenhall, W. F. 2003. Redefining quality of patient care and patient safety using GIS. Directions Magazine, Aug. 20, 2003.

Department of Homeland Security. 2008a. National Infrastructure Protection Plan Healthcare and Public Health Sector

Department of Homeland Security. 2008b. Homeland Security Grant Program: Supplemental Resource, Geospatial Guidance (pdf).

Emergency Management Spatial Information Network of Australia. 2004. EMSINA Web page.

Folger, P. 2009. Geospatial Information and Geographic Information Systems (GIS): Current Issues and Future Challenges. Congressional Research Service (pdf).

Greene, R. W. (Ed). 2002. Confronting Catastrophe. ESRI Press. Redlands, CA.

Kataoka, M. (Ed). 2007. GIS for Homeland Security. ESRI Press. Redlands, CA.

Khan, O. and R. Skinner. 2002. Geographic Information Systems and Health Applications. Idea Group Publishing, Hershey, PA.

Maantay, J., J. Ziegler and J. Pickles. 2006. GIS for the Urban Environment. Ingram Publisher Service, LaVergne, TN.

National Academy of Sciences. 2007. Successful Response Begins With a Map - Improving Geospatial Support for Disaster Management. National Academies Press, Washington, DC.

The Joint Commission. 2008. Emergency Management (pdf).

Yong, N. S., C. V. How, L. M. Khai and A. Mukherjee. 2008. Land Information Network: Transforming land information sharing to support an integrated government vision. In: Proceedings of the 28th Annual ESRI Users Conference, San Diego, CA, August 4-8, 2008.

Published Tuesday, December 8th, 2009

Written by Ric Skinner

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