WEEK 10: Informatics Solution for Emergency Planning & Response

1. Syria

2. Typhoon Haiyan (Yolanda)

3. Central African Republic

WHO (2014) had responded to 3 Major Humanitarian Crisis:

9/11 (September 11, 2001)

After this event, US realized that they were not adequately protected against terrorism

1. H1N1 Pandemic (2009),

2. Mass shooting,

3. Hurricane Sandy,

4. Tornado,

5. Boston Marathon Bombing,

6. 2004 earthquake & tsunami in Southeast Asia

Other Disasters

Interagency Standing Committee (IASC) for United Nations Office for the Coordination of Humanitarian Affairs (UN-OCHA)

• Ensures organizations work together instead of duplicating efforts or sending resources to the same location unnecessarily

• Main Goal: coordinate humanitarian assistance during disasters, specifically international disasters

• Humanitarian Reform

Humanitarian Reform

Its mission is to assist the impacted government with coordination of all responses & evaluations of the impact of interventions.

World Health Organization (WHO)

• Lead agency for health (coordination & production of health information)

• Lead help agency during international health emergencies

• Its responsibilities include monitoring disease outbreaks, coordinating health resources between countries, and providing reliable health information

1. Improve health information and operational intelligence.

2. Provide baseline information on health risks, reduction, and emergency preparedness.

3. Build emergency preparedness knowledge & skills through guidance, research, & information services.

Three of 8 Strategic Areas of WHO 5-Year Programme:

Improve health information systems and operational intelligence

Three of 8 Strategic Areas of WHO 5-Year Programme:

• Countries must develop systems that can collect and analyze health data quickly

Provide baseline information on health risks, reduction, and emergency preparedness

Three of 8 Strategic Areas of WHO 5-Year Programme:

• Identify common health threats/risks in specific regions

Build emergency preparedness knowledge & skills through guidance, research, & information services

Three of 8 Strategic Areas of WHO 5-Year Programme:

• Healthcare workers must be trained to respond to disasters effectively

local

Federal System for Emergency Planning & Response:

Most emergencies in a country are handled at the ___ level, such as city hospitals, local health departments, and emergency responders.

1. Federal Government

2. Homeland Security Presidential Directive 5 (HSPD5)

3. National Response Framework (NRF)

4. Federal Emergency Management Agency (FEMA)

Federal System for Emergency Planning & Response:

Federal Government

Federal System for Emergency Planning & Response:

• Provides supplemental assistance when the consequences of a disaster exceed local and state capabilities.

Homeland Security Presidential Directive 5 (HSPD5)

Federal System for Emergency Planning & Response:

• Coordinates Federal actions within the United States to prepare for, respond to, and recover from terrorist attacks, major disasters, and other emergencies

• ensure that all gov’t agencies coordinate their actions during emergencies

• Goal: coordinated national response

• Is activated during terrorist attacks, major disasters, national emergencies

• So it ensures that federal agencies such as emergency management organizations, health departments, law enforcement, and disaster response teams work together.

1. A federal department/agency requested assistance from the secretary.

2. State/local resources are overwhelmed, and federal help is requested.

3. More than one Federal department/agency has become substantially involved in responding to the incident.

4. The Secretary has been directed to assume responsibility for managing the domestic incident by the president.

4 Conditions for HSD5 Coordination

National Response Framework (NRF)

Federal System for Emergency Planning & Response:

• Enacted January 2008

• Provides a comprehensive national plan corresponding to disasters and emergencies

• This establishes guidelines for cooperation among government agencies, hospitals, and private organizations. 

• The framework outlines roles and responsibilities, coordination strategies, and response principles.

Federal Emergency Management Agency (FEMA)

Federal System for Emergency Planning & Response:

• Is an agency of the US Department of Homeland Security (DHS) that coordinate the response to a disaster that has occurred in the US and that overwhelms the resources of local and state authorities.

Crowdsourcing

What does FEMA use, which means collecting disaster information directly from the public through technology such as social media, emergency reporting apps, and online apps?

Hurricane Katrina

In what hurricane was FEMA activated?

• Interactive emergency kit checklist 

• Disaster reported feature

• FEMA LinkedIn page

• US Fire Administration FB page (“a Day in a Life”)

FEMA Ways to Crowdsource Disasters

H1N1 Influenza Pandemic

What pandemic demonstrates the importance of disease surveillance systems and health info systems?

(1) H1N1; Avian Flue (H5N1)

(2) H1N1

Initially, experts believed (1)____ and ____ ____ would cause the next pandemic, but (2) ____ today is spread worldwide.

H1N1 Pandemic

• situation highlighted the need for real-time disease monitoring systems that can quickly detect outbreaks and track the spread of infections.

2015

When was the most recent influenza pandemic?

Pandemic Severity Index

• Categorizes pandemics based on their mortality rate and severity

• Helps local decision makers plan public health responses.

• these specifications help governments with either new and appropriate public health measures, such as school closures, travel restrictions, vaccination campaigns, and social distancing policies.

Category 1: Low Severity

Category 2: Moderate Severity

Category 3: Severe

Category 4: Very Severe

Category 5: Extremely Severe

Categories for Pandemic Severity Index

Category 1: Low Severity

Category for Pandemic Severity Index

• Example: Seasonal influenza

• Casualty Range: Minimal to no excess deaths above normal seasonal flu mortality.

• Example: Seasonal influenza, mortality rate < 0.1%

• General Impact: The number of deaths might not exceed normal yearly influenza-related deaths, < 10,000 in a large population.

• Intervention: Voluntary Isolation

Seasonal Influenza

Example of Category 1

<0.1%

Category 1 mortality rate

Category 2: Moderate Severity

Category for Pandemic Severity Index

• Casualty Range: Mortality rate could be around 0.1% - 0.5% of the infected population, but it could vary.

• Example: H1N1 (2009), mortality rate of 0.02% - 0.1% but spread widely.

• General Impact: Tens of thousands to low hundreds of thousands of deaths could occur.

H1N1 (2009)

Example of Category 2

0.1%-0.5%

Category 2 Casualty Range

Category 3: Severe

Category for Pandemic Severity Index

• Example: COVID-19

• Casualty Range: A mortality rate between 0.5% - 1%

• General Impact: Hundreds to thousands to millions of deaths, depending on the scale of the pandemic and population size.

COVID-19

Example of Category 3

0.5-1%

Category 3 Casualty Range

Category 4: Very Severe

Category for Pandemic Severity Index

• Casualty Range: Mortality rate of about 2.5%

• General Impact: Millions of deaths globally, potentially overwhelming healthcare systems.

~2.5%

Category 4 Casualty Range

Category 5: Extremely Severe

Category for Pandemic Severity Index

• Casualty Range: Mortality rate could be greater than 1% and possibly much higher (several percentage points).

• Example: Highly lethal and contagious viruses: Spanish Flu

• General Impact: Millions of deaths, potentially tens of millions. This would represent a pandemic of catastrophic proportions, with overwhelming global mortality rates and long-lasting societal impacts.

• Wear the appropriate PPE for standard, droplet, and airborne precaution.

>1%

Category 5 Casualty Range

1. National Retail Data Monitoring System

2. Biosense Influenza Module

3. Real-Time Outbreak Disease Surveillance (RODS)

4. Google Flu Trends

5. Flu. gov

6. “I’m a Flu Fighter!” Facebook Campaign

Alternative Tracking Methods

National Retail Data Monitoring System

Alternative Tracking Method

• tracks the sale of over-the-counter (OTC) medication such as fever or flu medicine

BioSense Influenza Module

Alternative Tracking Method

•  tracks flu with data from local & state health departments

Real-Time Outbreak Disease Surveillance (RODS)

Alternative Tracking Method

• Collect & analyze disease surveillance data in real time.

Google Flu Trends

Alternative Tracking Method

• Analyzes search engine data

• If many people search for terms like flu symptoms or fever medication, it indicates that the flu cases are increasing in that region. 

• So as mentioned, if pharmacies have increased OTC sales of fever medications, the search engine will track the location of those that searched for flu and fever tts

Flu. gov

Alternative Tracking Method

• 1st federal one-stop pandemic information site

  • See the signs and symptoms, vaccination sites

  • Flu vaccine locator (search zip code)

  • FAQS for individuals, businesses, and healthcare professionals.

• Used during COVID-19

• For those that received vaccines, it is placed when, where, brand of vaccine

“I’m a Flu Fighter!” Facebook Campaign

Alternative Tracking Method

• Launched by the HHS (U.S. Department of Health and Human Services) to spread awareness.

1. H5N1 (Avian Flu)

2. H7N9

3. MERS-CoV

Other Emerging Viral Threats

H5N1 (Avian FLu)

Other Emerging Viral Threat

• 630 confirmed cases (2003-2013) and 375 deaths.

H7N9 (Avian Influenza A)

Other Emerging Viral Threat

• Highly fatal (~30% mortality)

MERS-CoV

Other Emerging Viral Threat

• Respiratory virus with unpredictable mutation risks.

1. CDC Surveillance Mechanisms

2. Telephone Triage

3. Physician Group Proprietary System

4. Google’s Flu Trends (2009 H1N1 Outbreak)

Programs that contribute to surveillance activities:

CDC Surveillance Mechanisms

Programs that contribute to surveillance activities

• Shorten lag time for CDC to publish data reports estimated from 10-14 days.

Telephone Triage

Programs that contribute to surveillance activities

• Tracks real-time influenza data in specified geographic location.

Physician Group Proprietary System

Programs that contribute to surveillance activities

• Healthcare providers enter data for suspected/confirmed influenza patients.

Google’s Flu Trends (2009 H1N1 Outbreak)

Programs that contribute to surveillance activities

• Showed a strong correlation between online flu-related searches and actual flu cases reported by the CDC.

Competency-Based Education

• provides an international infrastructure for nurses to learn about emergency preparedness and response.

1. CDC

2. Columbia University

3. NEPEC

4. University of Hyogo

5. International Council of Nurses

Organizations that have developed competency frameworks for public health & disaster nursing

1. Incident Management System (IMS)

2. Hospital Incident Command System (HICS)

3. Emergency Operations Centers (EOC)

Informatics & Incident Management:

Incident Management System (IMS)

Informatics & Incident Management:

• Originated from firefighting & was adapted for hospital use

• a structured system used to manage emergency situations. 

• It was originally developed for firefighting operations, but was later adapted for healthcare settings.

Hospital Incident Command System (HICS)

Informatics & Incident Management:

• IMS adapted into hospital use

• Provides workflow of what to do

• ensure that emergency responses are organized with clear leadership and defined goals. 

• During a disaster, there is usually an incident commander who oversees operations, while different teams handle logistics, communication, and patient care. 

• Without this structured system, healthcare workers might be confused about responsibilities during chaotic emergency situations

Emergency Operations Centers (EOC)

Informatics & Incident Management:

• Central command center where disaster response decisions are made

• So it collects data from multiple sources, monitors the situation, and coordinates emergency activities.

• Physical locations where the IMT convenes to make decisions, communicate, and coordinate the various activities in response to an incident.

1. Healthcare Volunteers

2. Federal Disaster Medical Assistance Teams (DMATS)

3. Medical Reserve Corps (MRC)

4. Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)

Informatics & Volunteerism:

Healthcare Volunteers

Informatics & Volunteerism:

• Necessary components of mass casualty events but also create challenges.

Federal Disaster Medical Assistance Teams (DMATS)

Informatics & Volunteerism:

• willing to travel to other regions of the country in the event of an emergency.

• these teams consist of healthcare professionals who can travel to disaster areas to provide medical care

Medical Reserve Corps (MRC)

Informatics & Volunteerism:

• Represent initiatives of DHHS to improve the nation’s ability to prepare for and respond to public health emergencies

• For instance, this program was active during the COVID-19 pandemic.

• recruits volunteers such as nurses, physicians, and community members to assist during public health emergencies. 

• So they would work together when there are disasters or emergencies.

• Usually together with with EOC

Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)

Informatics & Volunteerism:

• Verifies the credentials of healthcare volunteers before they are deployed. 

• Of course, before deploying personnel to disaster or emergency sites, they need to know what they are doing and are trained on what to do during disasters.

• Ensures qualified professionals can quickly assist communities affected by disasters

1. Katrinahealth. org

2. Joplin, Missouri Tornado (2011)

3. WIISARD (Wireless Internet Information System for Medical Response in Disaster)

Disaster Electronic Medical Records & Tracing:

Katrinahealth. org

Disaster Electronic Medical Records & Tracing:

• Provided medication records for Hurricane Katrina evacuees.

Joplin, Missouri Tornado (2011)

Disaster Electronic Medical Records & Tracing:

• Demonstrated the importance of EHR backups in disaster recovery.

WIISARD (Wireless Internet Information System for Medical Response in Disaster)

Disaster Electronic Medical Records & Tracing:

• A wireless electronic medical record system used in disasters

• A handheld, linked, wireless EMR system utilizing current technology platforms.

• Merges data with the receiving hospital EMR using HIPAA-compliant methods.

• Used an ad hoc field network (like LAN)

1. Tracking of Patient Victims

2. Situational Awareness

3. Victim Tracking & Tracing System (VITTS)

4. Mobile Health (mHealth) Technology

Disaster Electronic Medical Records & Tracking:

Tracking of Patient Victims

Disaster Electronic Medical Records & Tracking:

• Needed during disaster and emergency events for lesser death rates or mortality rates

Situational Awareness

Disaster Electronic Medical Records & Tracking:

• Ability to make timely and effective decisions during rapidly evolving events.

Victim Tracking & Tracing System (VITTS)

Disaster Electronic Medical Records & Tracking:

• This system design allowed for early, unique registration of victims close to the impact site that was able to later connect to the receiving systems.

Mobile Health (mHealth) Technology

Disaster Electronic Medical Records & Tracking:

• Aids victim tracking, triage, patient care, facility management and theatre-wide decision making

iChart

An mHealth Technology that improved provider handoffs & continuity of care, and standardized the information into one language.

1. Disaster scene management

2. Remote monitoring of casualties

3. Medical Image Transmission (like X-rays)

4. Decision Support Applications

5. Field Hospital Information Technology Systems

5 Classifications of Applications that could help in disaster medicine

1. Data for Incident Command System

2. Communications

3. Patient Tracking

4. Provider Safety

5. Ambulance Tracking

6. Patient Data Acquisition and Monitoring

Technology & Informatics Contributions to Incident Management:

Data for Incident Command System (Incident Command Center)

Technology & Informatics Contributions to Incident Management:

• Detects patterns and trends in data.

• Predict resource needs and safety zones.

• Record and process decisions for legal/financial purposes.

• Standardize data collection and vocabulary.

• Smart White Board

• Electronic Dashboards

• Resource Modeling

• Internet Access

• Online Disaster Manual

Technologies providing Data for Incident Command System (Incident Command Center)

Communications

Technology & Informatics Contributions to Incident Management:

• Prioritize and determine accuracy of data transmission.

• Send real-time data from the field to the Emergency Operations Center (EOC).

• Improve situational awareness.

• Landlines

• Radio Communications

• Cell Phones

• Satellite Phones

• Email

• Social Media

Technology providing communications

Patient Tracking

Technology & Informatics Contributions to Incident Management:

• Process triage and transport data

• Determine disaster magnitude

• GPS

• Barcode Tracking

• Radio Frequency Identification (RFID)

Technology for Patient Tracking

Provider Safety

Technology & Informatics Contributions to Incident Management:

• Monitor hazards like Radiation levels

• Use cellular triangulation for location tracking

• Radiation Monitors

• GPS

• Cell Phones

• Radio Communications

Technology providing Provider Safety

Ambulance Tracking

Technology & Informatics Contributions to Incident Management:

• Monitor triage and admission status

• tracks patient transport

• GPS

• Cell Phones

• Radio Communications

Technology for Ambulance Tracking

Patient Data Acquisition & Monitoring

Technology & Informatics Contributions to Incident Management:

• Collects patient data through electronic health records

• Collect and analyze data across geographic areas.

• Identify trends in patient status and resource needs.

• Electronic Records

• ED Status System

• Wireless Monitoring

• Pharmacy Electronic Records

Technology for Patient Data Acquisition & Monitoring

1. Informatics

2. CDC; WHO

Future Advances:

1. _____ will enhance emergency preparedness by integrating vaccination records, healthcare service use, and adverse event monitoring.

2. ____ and ____ collaboration is improving database interoperability for global emergency response.

1. Social Media for Crowdsourcing

2. Grid Computing

3. ONC Goal for HIT

Future Advances:

Social Media for Crowdsourcing

Future Advances:

• Will remain an important contribution to disaster care.

Grid Computing

Future Advances:

• Will facilitate secure data sharing across jurisdictions while protecting privacy,

ONC Goal for HIT

Future Advances:

• Having interoperable patient data and mobile access will improve disaster care by providing real-time clinical information