Advanced Communications for Disaster Response 2008 ATALACC Meeting Panama City

1. Advanced Communications for Disaster Response 2008 ATALACC Meeting Panama City August 16, 2008 David Balch, Chairman EPR SIG ATA

2. Some Challenges of Disaster Response • Local Hospitals quickly exceed Surge capacity • Specialty Medical expertise not always available at local hospitals • Need easy access to knowledge experts • Local resource management often in chaos • Need resource tracking tools for staff, supplies, and equipment • Need efficient bed tracking for nearby hospitals • Need optimal deployment of resources to maximize response • Need Pre-hospital care (field triage)‏ • Must effectively handle quarantined and isolated populations

3. Integrating TM into the Response Supporting surge capacity for all hospitals Move expert support to the point of care electronically—voice, video, data Draft off of DoD Initiatives Just in time information via cell phone Field Triage/pre hospital care using TM Store Forward consultations Incident management tools help optimize resources and coordinate patient transfers Online toxicology databases provide toxin specific clinical protocols

4. Using Existing TM Networks as part of Disaster Response Real-time access to niche expertise across the network Expert support to front-line providers Sharing of situation, threat, and patient data Rapid dissemination current clinical protocols for out of the ordinary symptoms More prudent referrals to where the resources are available (situational awareness)‏

5. Developing a Global Telemedicine Network for Disaster Medical Response Prevention and Surveillance Early Detection Crisis Response Treatment

6. Existing Telemedicine Resources Over 200 TM Networks in US alone Over 3000 TM sites Est. $2 billion infrastructure in place Over 40 clinical specialties available Clinical tools and protocols in place 4 Time Zones 24 X 7 coverage

7. MD.RN Medical Disaster Resources Network 50 disaster networks identified Covers 5 Time Zones 1700 TM sites ready to respond Geocoded data Plans to expand to International‏

8. Potential Roles for Telemedicine Reducing impact on ER’s during crisis Improving communication between patients and physicians in a crisis Environmental monitoring reduces risks to first responders Collecting, analyzing, and disseminating critical information requires advance tools and technologies

9. Hurricane Floyd • 1999-Flood waters consume Eastern North Carolina homes and businesses • Roads closed, Hospitals are cut off from shelters

10. 1999 Hurricane Relief Efforts Telemedicine Team from ECU deploys to shelter sites, carrying telemedicine equipment, food, and medical supplies using choppers provided by the National Forest Service.

11. Hurricane Floyd Relief Efforts • Low bandwidth telemedicine deployed • Links from shelters to Hospital Emergency Room • Improved surge capacity by reducing ER visits during recovery

12. WHO and NATO Training Exercise

13. Strong Angel 2001 Overlooking refugee camp from Puu Paa, located on a volcano plain on the big island of Hawaii

14. Low Cost Low Bandwidth Telemedicine Field Tested in Harsh Environment Ham Radio Satellite Coms Microwave Hybrid technologies

15. Alternative Power Sourcesin Austere Environments

16. Operation Shadowbowl 2003 Super Bowl – San Diego, CA Built Advanced Communication Response system for real Bio-Terrorism threats for large public event Established communication system Built a sensor grid Conduct Critical Infrastructure Vulnerability Analysis and Threat Assessments Track Indications and Early Warning of Threat Activities Provide real-time assessment and Threat Situation Awareness Increased surge capacity for local hospitals

19. Laser Links Installed on Qualcomm Stadium

21. RemotePathogen Sensor

22. Sensor Grid

23. Sensor Grid around Stadium

24. Communications Infrastructure

25. Robots for Search and Rescue

26. Snap-on payload SPO2 Any skin Capnography CO2 FLIR Infrared Medical Payload

27. Qualcomm Water Supply Monitoring

28. 3 Sites—SDSU Campus, Private Garage, Parking Lot Clinic

29. Command and Control Center (SDSU)‏

30. Advanced Communication Applications for Homeland Security Environmental Sensing of Toxins Bio Chem Detection and Notification Virtual front-line Patient Care Supply Chain Monitoring/Management Disease Monitoring/Management Treat long-term psychological problems Just in time training over existing networks

31. Agroterrorism and Biothreats Biological warfare targeted at animal agriculture The purpose of agro-terror is to cause economic destruction Trade-damaging diseases are very real Protecting first responders is crucial May create quarantined populations May challenge surge capacity at local clinics Telemedicine in Disaster Response

32. Improving Telemedicine Network Preparedness Build local databases Location of specific medical expertise Protocols for linking to each site IP and/or ISDN numbers for each site Specific TM capabilities at each site Schedule regular tests as part of regional and national disaster exercises Document what works and what does not work for each site Maintain a living database

38. Incident Management and Disease Tracking Software Criteria Must support- Data Fusion Must support - Data Analysis Must support - Data Visualization Must be flexible Must be always on Must support ease of communication between partners

39. Montana Bioterrorism Drills 2005~2006 To raise awareness of the resources and needs of Public Health and explore the capabilities of Telehealth in disasters

40. Overview of Technologies • Web Portals • RP-6 Robot • Geospatial mapping • Predictive Modeling • Surge and Information Management

41. Advanced Communications Tools for Disaster Response • Interactive web portal—streaming video, realtime messaging, HAN messages, resource documents and web links • AIMS – surge management • Ramsafe – predictive threat and resource modeling • ESRI/GCS – geospatial mapping • Statewide (30+ sites) videoconferencing • Robot--telepresence tool for quarantined patients

45. Communication Web Portal

46. InTouch RP-6 Robot for Treating Quarantined Patients St. Vincent’s Healthcare Physician Console

47. Robotic Telepresence

48. Format • Montana State Public Health leaders share situational awareness and their clinical resource needs. • 3 Telehealth networks respond, gather resource data (bed tracking, and provide specialty physicians as needed from their network hospitals.

50. Web Portal Management