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Medicine Joins Disaster Response

August 2012
By Rita Boland, SIGNAL Magazine
E-mail About the Author

 

Medical assistants from the Yellow Triage Center tend to a Hurricane Katrina evacuee at Dobbins Air Reserve Base, Georgia. The National Emergency Preparedness and Response (NEPR) Research Center—a public/private partnership headquartered in Maryland—is improving the sharing of medical information across state and federal agencies to improve medical care during disasters such as hurricanes. The work also aims to contain disease outbreaks and improve the response to bioterrorism attacks.

A research center aims to shore up national security and control pandemics by improving the exchange of health care data.

Sharing medical information among public and private entities during emergency situations is entering a new age. A consortium of partners has laid the foundation for a national center that will develop protocols and methodology necessary to enhance current capabilities for handling crisis situations.

The National Emergency Preparedness and Response (NEPR) Research Center located on the campus of Bowie State University, Maryland, is a national medical and biosurveillance center created to assist federal and state governments meet public health, homeland security and emergency needs during catastrophic events. The national network it establishes will respond to recommendations from government and industry groups to create tools or procedures necessary to improve medical response. In addition, the center will make resources and systems available for event simulations and exercises for government and corporate clients. Its main public-sector partner is The Maryland Center, which supplies master contracting, oversight and advisory services for government users and provides support staff during disasters.

Private-sector partners Intelaform Incorporated, VisualMED Clinical Solutions Corporation and Verizon also are involved. Intelaform is providing five operating systems for medical/biosurveillance, patient triaging, accessing volunteers’ capabilities, and managing medical personnel, volunteers and medical assets by utilizing medical systems and optimizing mobile applications as appropriate. VisualMED handles the medical care and clinical support systems on mobile applications. Verizon contributes the telecommunications backbone and security architecture to guarantee patient safety, as well as capabilities to assist systems migration into the Verizon and other clouds.

According to Randy Hoggle, chairman of Intelaform, the first priority of the NEPR Research Center is to assist the government and the private sector with medical and biosurveillance capabilities for natural, manmade or pandemic events. The collection of such surveillance information is critical to determining and responding to emergency events, he explains, which is one reason why the partners immediately set up the Intelaform systems.

Personnel involved with the project are preparing to handle various types of emergencies ranging from a deliberate bioterrorism attack to yearly emergencies such as hurricanes and tornados. During a situation such as the cholera outbreak in Haiti in 2010, the center’s systems would take in information from the field, then segment and analyze elements to pinpoint immediate and longer-timeline recommendations. Though the answer might not specifically state what disease is causing the problem, it could reduce the options to only a few, and medical professionals could begin broad treatment.

Definitive analysis would be carried out in a laboratory, but that work takes more time than reporting symptoms and drawing conclusions. Gerard Dab, chairman and chief executive officer, VisualMED, says that in certain critical situations, “You can’t wait until you know every detail before you intervene.” Early identification and control could save lives as well as prevent the germs from spreading to more places. Dab explains that although doctors coming out of medical school know all about certain diseases, they are unfamiliar with others. The center’s capabilities could help identify these lesser-known ailments along with the proper response methods to them.

Such resources would help equip medical personnel to respond to many types of emergencies. Referencing medical troubles during Hurricane Katrina, Dab states that, “We felt there was a lack of preparedness.” Partners want their efforts to result in more accurate and effective reactions to similar future scenarios. During the aftermath of the 9/11 terrorist attacks, the emergency community identified a need for medical information to flow to triage centers and teams on the ground so they could provide care for immediate and chronic symptoms. The information they gather on-site will be fed into various relevant agencies including those for public health, homeland security and education to develop an overall picture of what is happening and to share back with the first responders who need to make immediate care decisions.

The center aims to form partnerships on a state-by-state basis. If a condition can be isolated at the state level, the goal is not only to control it there, but also to alert other states and federal agencies about the issues. The Maryland Center has a two-pronged initial strategy for the NEPR Research Center. The first objective is to combine information from disparate systems, then optimize and qualify the data for state use, positioning the center to be a trusted third-party adviser. Partners say federal and state government agencies have sought the establishment of an unaffiliated nonprofit institution dedicated to addressing healthcare and emergency preparedness disparities.

The second objective is to use data for research purposes to develop tools to aid in simulations and exercises. Center personnel are running test data now for potential clients. They also are testing state data from multiple agencies to authenticate, validate and qualify data for states before providing data feeds to federal government agencies. Melvin Forbes, chief strategy officer of The Maryland Center, explains that the personnel involved are creating a model for the nation that others can replicate in various states or even in foreign countries.

Driving the capabilities of the center is the mobile revolution that enables the fast transfer of data between analysts and the field. As mobile devices increase in number, more people will have immediate access to information they require. Experts can push out findings through various communications channels already in use, and the technology firms involved, especially Verizon, could find additional ways to facilitate sharing. “The key to this is the importance of getting information that is fast, accurate and can be analyzed so you can make a quick decision,” Forbes says. Over time, more groups such as the Defense Department can be incorporated into the systems, and capabilities will evolve.

 

Members of the Pentagon Force Protection Agency aid victims of an anthrax attack during an exercise. The NEPR Research Center is combining government and private-sector resources to improve the response to mass medical emergencies such as the release of a bioterrorism weapon.

Creating such a center would have been much harder a decade ago before the advent of current technology devices and the level of connectivity enjoyed today. VisualMED’s offerings now can enable first responders or other medical personnel to move large amounts of information via tablets and smartphones. Dab says the work is about planning information flow by bringing segmented applications that can be integrated more easily than in the past. However, Louis Lombardo, a board member of VisualMED, clarifies that although processes may be simpler, more flexible and more robust now, the technology in the systems is complex and exceedingly difficult to duplicate.

The data handled by internal systems and mobile applications act as support tools to protect workers in the field and to make correct triage decisions. So, for example, if medics go into a house and discover the residents are unconscious from gas exposure, they could exit, put on respirators and then re-enter to provide help for the victims. Along the way, their data starts to feed county systems to make stakeholders aware of potential dangers. If the collectors also provide it to the NEPR Research Center, personnel there could distribute it to their partners. Ideally, the information sharing would help minimize and control exposure to the gas or any other substances that might represent health risks.

The center’s activities also could help prevent problems before they emerge. Agencies that receive early data about health conditions could put out warnings sooner whether the threat is a pathogen or something more mundane such as extremely hot weather. These notifications especially could benefit at-risk population segments including the ill or elderly. Beyond the health factor, early indicators could promote economic and social well-being. Containing problems means fewer people miss work or school, and early notification would allow organizations to put alternate procedures in place to continue operations without jeopardizing health.

As the groups involved move forward with the project, they aim to avoid pitfalls created by stovepipes and lack of interoperability. “One thing you never want to have when you have something of this magnitude is a single point of failure,” Forbes states. He adds that as technology has evolved to cloud computing, personnel are able to take advantage of portals not available before. The model will be centralized, modernized and nationalized much in the way that airlines work with different hubs and airports served. All the included technologies can be moved, expanded and integrated so developers never have to start from scratch. Many of the systems connected with the center were deployed in other places years ago, but they continue to develop as threats and health care change.

Though the work done by the NEPR Research Center has applicability to many situations, the partners have a special interest in improving national security. With the government low on money, The Maryland Center reached out to show the private sector and academia that putting medical information capabilities in place serves their best interest. Sometimes, bureaucracy is too slow.  Thomas Wilson, the director of business development at The Maryland Center, explains that, “We can’t afford to wait right now.” Current partners are eager to engage with other companies or government agencies that want to join in the effort.

Dab agrees, even though he lives in Canada. VisualMED is based in and does business exclusively in the United States, but Dab explains that the major medical schools in his country tie in closely with Ivy League universities. No plans are on the table to expand operations into Canada because, he shares, that country does not have the same emergency response concerns.

The partners believe now is the right time to have the relationships and strategies in place to deal with serious health issues. Forbes says that it is imperative for many types of organizations to pull together to find the best traditional and nontraditional methods “to make sure we protect this country.”

WEB RESOURCES
The Maryland Center: www.themarylandcenter.org
Intelaform: http://intelaform.com
VisualMED: http://definiteimage.com/visualmednew/index.php