The Evolving Role of GIS in Hospital and Healthcare Emergency Management

The Evolving Role of GIS in
Hospital & Healthcare
Emergency Management
The Stoneybrook Group LLC Ric Skinner, GISP

I’ve been involved with the application of GIS in hospitals and healthcare for about 20
years. During this time I’ve experienced and observed GIS being applied in epidemiology,
health sciences, health resources, clinical/medical areas, health facilities management,
market analysis, medical recruiting … and as I’ll discuss today … hospital and healthcare
emergency management and disaster preparedness. The material for this talk comes from
research I’m doing for a book that will be published by CRC Press early next year on the
evolving role of GIS in hospital and healthcare emergency management.

Successful Reponse
Starts with a Map

Improving Geospatial Support for
Disaster Management

Committee on Planning for Catastrophe:
A Blueprint for Improving Geospatial Data,
Tools, and Infrastructure

Mapping Science Committee Board
on Earth Sciences and Resources
Division on Earth and Life Studies

www.nap.edu/catalog/11793.html

Ric Skinner, GISP The Stoneybrook Group LLC URISA GIS/Public Health Conf., June5-8, 2009, Providence, RI

The National Academy of Sciences concluded in their comprehensive report “Successful
Response Begins With a Map -- Improving Geospatial Support for Disaster Management”
that geospatial data and tools should be an essential part of every stage of emergency
management, from planning through response and recovery to the mitigation of future
events. This is certainly true in the hospital and healthcare domain.

Critical Infrastructure and Key Resources
Agriculture and Food
Defense Industrial Base
Energy
Healthcare and Public Health
National Monuments and Icons
Banking and Finance
Water
Chemical
Commercial Facilities
Critical Manufacturing
Dams
Emergency Services
Nuclear Reactors, Materials
Waste
Information Technology
Communications
Postal and Shipping
Transportation Systems
Government Facilities


The Department of Homeland Security includes hospitals and healthcare facilities in the list
of Critical Infrastrucure/Key Resources. Therefore it is important that this sector be
prepared, able to respond effectively, and recover quickly from all hazards – natural,
technological, and human-caused.

DHS emphasizes the important contribution that geospatial information and technology
plays in protecting the Nation’s Critical Infrastructure/Key Resources and has published the
Homeland Security Grant Program Supplemental Resource on Geospatial Guidance.

With National Academy of Sciences and DHS as foundation, it is only logical to apply GIS to
decision making and other areas related to emergency management in the
hospital/healthcare sector.

The 80% Paradigm
80% of information needed for decision making has a
location or spatial component (Yung 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 (EMSINA, 2004)


Further justification is what I call the “80% Paradigm”

It is commonly said that 80 percent of information needed for decision making has a
location or spatial component

More than 80 percent of all healthcare transactions are believed to have significant
geographic relevancy.

As much as 80 percent of information used during emergencies is 'spatial' information


Many books and articles have been published on the application of GIS in emergency
management and disaster response. A number of these have addressed GIS as a tool in the
public health sector, and a few can be found on GIS in the hospital and healthcare facility
sector of emergency management.

The indication from these various publications is that GIS is rapidly evolving and has an
important role in hospital/healthcare facility emergency management. This is because
many of the emergency management and disaster preparedness challenges faced in
hospitals and healthcare facilities, such as resource inventory and allocation, situation
awareness, decision support and locational intelligence, are the same that other business
sectors experience.

My talk today will provide examples of how hospitals and healthcare facilities are
benefiting from the use of GIS to improve their emergency management and disaster
preparedness mandates and responsibilities. As time allows, I’ll mention a number of
examples that I’ve uncovered in my research that I think will be of interest to hospital &
healthcare emergency management professionals, health geographics practitioners,
emergency management/disaster preparedness students, Homeland Security professionals
working in the hospital/healthcare Critical Infrastructure/Key Resources sector,
professionals and practitioners working in the Emergency Support Function-6 (ESF-6 Mass
Care) and Emergency Support Function-8 (ESF-8 Health and Medical) areas. You’ll hear
similar approaches and implementations of GIS are occurring in a variety of sources.

I have a lot to cover so let’s get started.

Network GIS as a Tool for Healthcare Emergency
Preparedness in Special Situations

Petros Apotsos
Independent Civil Engineering Consultant
Greece


It is crucial for healthcare facilities to have a routing GIS in order to offer the best possible
response to emergency calls and disaster situations. Based on scale and need, these
systems can cover a city, a county or even a whole state or country.

Given the specific characteristics of each area and based on integration level, scenarios can
be developed in Healthcare Management so that the routing system takes these special
situations into account. The use of a routing system for emergency units can decrease the
response time to an emegrgency call

All road networks should be modeled in the highest detail possible, so as to offer accurate routing data an

Natural disaster cutting or impairing certain segments of the network.
Evacuation or heavy traffic situations when parts of the network are gridlocked above predicted lev
Situations when traffic direction limitations are compromised resulting in other parts of the networ

Trauma Resource Allocation Model for
Ambulances and Hospitals
(TRAMAH)
Charles Branas, University of Pennsylvania
Marlen Kokaz, Cartographic Modeling Lab
& Robert Cheetham, Avencia Corp.
Philadelphia, PA


The difference between life and death for severely injured people depends upon
the amount of time it takes to get them to a trauma center hospital. The siting of
trauma center hospitals, however, is more complex than just maps of land area
coverage showing ringed bands around each hospital. The speed and location of
helicopters and ambulances, the number and location of trauma centers in a
region, and the spatial relationships between these facilities need to be considered.


To address these concerns, researchers from the University of Pennsylvania and
Johns Hopkins University have developed the Trauma Resource Allocation Model
for Ambulances and Hospitals (TRAMAH), a mathematical optimization model that
uses population and access to existing trauma centers based on geographic
relationships to ambulances and helicopters to simulate the effects of newly sited
trauma centers. TRAMAH is supported by an interactive website that uses GIS
technology to enable visitors to identify the locations of current hospitals and
trauma centers and their accessibility via ambulance or helicopter.


Roughly 600 Americans die or sustain long-term disability each day from traumatic
injuries.
Trauma is the leading cause of death in US for people under 45
~40% of deaths would be preventable with improved access to well-organized
trauma systems

This slide shows the modeled 60 minute response time by ambulance or helicopter
to trauma centers in Oregon.

Disaster Preparedness and Response for
Vulnerable Populations: Essential Role of
GIS for Emergency Medical Services during
the San Diego County 2007 Firestorm

Isabel Corcos, Holly Shipp, Alan Smith,
& Leslie Upledger-Ray,
County of San Diego, Health and Human Services Agency, Public
Health Services Agency, Emergency Medical Services
San Diego, CA

The San Diego Emergency Medical Services Departmental Operations Center coordinates
the medical response to disasters. In 2007, a massive wildfire “firestorm” destroyed nearly
400,000 acres of San Diego County, and more than 500,000 individuals were evacuated
from fire-threatened areas.

The EMS DOC coordinated the evacuation of medically fragile individuals from residential
health care facilities and 2 acute care hospitals using GIS to pre-plan the evacuation of
threatened facilities and to ensure that patients were evacuated to comparable facilities or
appropriate temporary evacuation points.


Critical to the multi-level emergency response plan was a GIS database containing
information on medical resources such as facilities, ambulance agencies and shelters. The
locations of medical facilities, the number of patients housed, medical and transportation
needs, contact information, and other information were all available. Furthermore, the GIS
database contained data about the location and needs of other vulnerable populations
including the young, the old, and those that were medically or physically disabled.

12

EMS directed 2100 medical evacuations in one day Evacuation with minimal impact on
2 acute care hospitals patients
1 psychiatric hospital Moved them only once
12 skilled nursing facilities With 3 days of medications
With their medical records
With staff from the sending
facility

During the initial response to the incident, GIS-trained epidemiologists drew perimeters
around rapidly changing fire zones, evacuation zones, and predicted fire paths in order to
locate nursing homes, group homes, care centers and other medical facilities within the
affected areas. EMS DOC staff then called each facility to assess individual evacuation
plans, determine transportation and receiving facility needs, and coordinate the
deployment of ambulances and other transportation. The EMS DOC mapping capabilities
also provided real-time updates on facility status, shelter status and road closures.

All patients evacuated from a medical facility were tracked through the DOC. Individual
patients who were evacuated and transported via the GIS-based system were tracked for
repatriation once the danger had passed and facilities were cleared to reopen. Although a
formal procedure was not in place at the time, facilities reported all patients who were
evacuated from their facility and the location to which they were evacuated.

13

Integrating GIS into
Emergency Medical Services

Peter Dworsky
MONOC
Monmouth-Ocean Hospital Service Corp.
Neptune, NJ


In the recent event involving US Airways flight 1549, over 50 BLS Ambulances, 6 paramedic
Units, 3 medevac helicopters, 10 specialized Mass Casualty Response Trucks and trailers
along with more than 200 EMS providers were dispatched to multiple staging areas
throughout the region. All of the assets were tracked at the local level and some not at all.
Technology was not leveraged and some units were lost as they were repositioned.
Hospitals typically do not have the ability to see the incident other than what is on TV.


Hospitals and other healthcare facilities must plan for evacuations; this is a requirement
under Joint Commission and ESF-8. Unfortunately, this is often done in a vacuum and local
EMS providers are not involved in the process and find themselves working off of a
different operations plan. By implementing a GIS program, EMS agencies would have the
ability to properly distribute the patients to the appropriate destination that most closely
matches the patient’s need, which is not necessarily that of the transferring facility, many
evacuation plans are based on business relationships and not medical care. When patients
are transferred out of state, all tracking capability is lost because the paper trail that has
been used is broken and there is no follow up. Integrating GIS into these processes benefit
the patient, the medical resources and the emergency services.


By integrating EMS into Healthcare GIS systems, hospitals will be able to make better use
of their resources and activate disaster plans based on real time data. This is a screen shot
from a dispatch console of a system showing color coded primary response zones.

Introducing GIS to Hospital Emergency
Management Decision-makers

Joseph G. Ferko III DO, MS
EMS Innovations, Inc.
Pasadena, MD


The disaster operations environment is changing for the hospital & healthcare emergency
manager and GIS is seeing an increasingly more important role.


In many Mass Casualty Incidents the hospital emergency manager no longer works in the
hospital. The hospital is now moving to the scene or surging to the outdoors.


GIS is being used for the mapping of injury and illness locations for WMD and pandemic.
Considerations include locating patients and locations for staging medical care. GIS is also
being used for the determination of staffing, pre-positioning of supplies and transportation
issues.

Natural Disasters and the
Role of GIS in Assessing Need

Omar Ha-Redeye
Univ. of Western Ontario
&
Bryan Heal
The Armichand Group


In the past 10 years, topographic maps generated by GIS have become as indispensable to
humanitarian healthcare providers as surgical kits and purified water. Under intense
pressure to act quickly, aid agencies and governments increasingly use GIS maps as a
foundation for major decisions from aid planning to where to build a field hospital. While
the benefits of rapid action in crises are clear, agencies should seek ways for GIS to
compliment sound field epidemiology principles when conducting a post disaster needs
assessment. Whether in a clinical program in rural Northeastern Aceh (Indonesia) to
institutionally backed medical support in Hulhumale (Maldives), GIS has an important role
that can be leveraged when conducting health assessments in the field.


In some countries the traditional practice of talking to people and gathering on the ground
intelligence is still important. However, GIS compliments sound field epidemiology
principles conducting a post disaster needs assessment.

21

Integrating GIS into county based
emergency management, HVA, and
disaster planning on Florida's East
Coast

James C Kendig
Health First Inc.
Rockledge, FL


GIS was used to formulate the county's and hospital based Hazard Vulnerability
Assessment (HVA) which was ultimately used to help develop the approved emergency
management plan and drill scenarios supported by the HVA.


Do you think location might be important factor, and that therefore GIS is an important
tool, in this Florida hospital’s Hazard Vulnerability Assessment?

1900-2005 Atlantic Hurricanes and
hurricanes passing within 75 miles of Cape Canaveral


GIS was used in joint-partnership programs (participation with county special
needs/enhanced care), participation with ESF8 during disasters, and the development of a
hospital evacuation tool that has matured from a fax based approach, to an organizational
Intranet based system, ultimately to a currently used web based system. Clearly, GIS can
be an important tool in regional approaches to mutual aid.

Boston Marathon Patient Tracking

Johanna Meyer
AECOM
Boston, MA
&
Dana Ohannessian
Mass DPH
Boston, MA


GIS use in emergency management for events like the Boston Marathon offers the ability
to track events and people.


From the lead runners to the injured, the events along a 26 mile route are recorded and
reviewed to allow the dispatch of assistance. ESF-8 (Health & Medical Facilities) tracks
each injury from evaluation to hospital admissions along the route at multiple locations.
This real time tracking also monitors the emergency room capacity as ambulances are
dispatched.

GIS and Regional Mass Casualty Incident
Planning: The Role of GIS in Identifying
Regional Risks and Assets

Jonathon Mohr
Philadelphia University
&
J. L. Querry
City of Philadelphia


In the wake of ongoing economic challenges, many acute healthcare facilities are closing to
reduce costs. As a result, the numbers of available hospital beds are shrinking in many
urban areas. 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.

GIS at Emergency Medical Center Zagreb

Vlatko Roland
GISDATA
Zagreb, Croatia


Emergency Medical Center Zagreb (EMCZ) provides medical help to citizens of Zagreb,
Croatia using a sophisticated computer aided dispatch system based on GIS technology.


Incoming calls are located on the map and a medical doctor enters relevant information
and determines level of emergency. This data is captured in incident database.


Dispatchers retrieve this data, determine the nearest available vehicle and assign the
incident to the team in the field. This allows faster response and more efficient utilization
of emergency resources. Data collected during the intervention is stored in the central
database and is used for analyzing response times, efficiency of medical teams or
frequency of emergencies based on spatial conditions and administrative boundaries.


Since 2002., when the system was implemented, more than a million interventions have
been recorded in the database. The project was funded by the World Bank and includes
vehicle tracking using Tetra network for transmission of GPS positions, address geocoding
of incidents, interactive GIS map of Zagreb with detailed information for streets, house
numbers and points of interest and Call Center integration with voice recording and
CallerID positioning.

The Emergency Response System
Agent 9-1-1™

Sabatni Monatesti, Jack Murphy, Jeff Sherer, Stephen Beller,
Paul D. Cacciamani & David G. Smith

ES Enterprises Inc., JJM Associates, Instaknow Inc.,
NHDS Inc., Synergist Technology Group, Inc.


When dealing with a disaster in a disparate data world, the 1st responder and the Trauma
unit are faced with many difficulties. In a major disaster it is often apparent that we’re
unprepared to deal with event management issues, such as dynamic triage relocation,
effective apparatus dispatch, decision processing, situational awareness, victim search &
rescue, and real time victim identification. In addition, we lack an effective way to assist
emergency room staff in rendering treatment in a way that manages critical resources
(e.g., personnel, beds, medications, and supplies) and supports clinical decisions.

33


This system is designed to leverage GIS technology in a unique way using a patented,
interoperable technology which ensures that hospitals and healthcare facilities benefit
from bringing disparate databases together for improvements to situation awareness,
resource inventory & allocation, and decision support.

34

Michael Shambaugh-Miller & Nicole VanOsdel,

Department of Health Services Research and Administration
College of Public Health
University of Nebraska Medical Center
Omaha, NE


In 2008 the College of Public Health at UNMC contracted with the State Association of City
and County Health Offices (SACCHO) to advise on and construct an at-risk populations
pandemic flu contact system using desktop GIS as the primary operations system.

In cooperation with the 19 local health departments (LHD) in Nebraska the UNMC team
established a set of system parameters based upon both CDC and Nebraska Dept. of Health
and Human Services (NEHHSS) definitions of at-risk groups. These parameters allowed
UNMC and the LHD to collect information general to the entire state and unique to
individual offices.

The information was used to construct LHD level GIS systems which allow the agencies to
locate specific populations in specific locations based upon the specific characteristics of
any natural or man-made event that may endanger the health, property, or lives of those
members of the population that are most at risk due to issues involving their own health,
communications abilities, or financial status.

The system is designed to be modular so all 19 systems can be merged at the state level
for statewide response by both the NEHHSS Dept of Emergency Communications, but also
by UNMC Bioterrorism Offices and in case of comprised communications systems,
individual LHD agencies so that they may cover multiple regions in addition to their own.

The system is also designed to work in concert with a statewide individual at-risk persons
web based registry which allows local and state agencies to registry their clients who may
also require assistance in event of a natural or man-made disaster. Both systems allow
real-time communication with field EMS personnel so as to increase the speed and efficacy
with which emergency response is received by those groups and persons most in need in
the early stages of a local or statewide emergency.

Hospital Preparedness Integrated at the State
Level

Jared Shoultz, Doug Calvert, Guang Zhao, Max Learner

Department of Health and Environmental Control (DHEC),
Public Health Statistics and Information Services (PHSIS),
Division of Public Health Informatics
South Carolina


At the South Carolina Department of Health and Environmental Control GIS plays a critical
role in all emergency response, preparedness, planning, and routine public health
activities. An example of this would be the existing Critical Data Sheets application which
all hospitals and nursing homes in the coastal county are required to enter their shelter in-
place and evacuation plans into if they want to request the ability to shelter in-place for a
category III or less hurricane.

Large agencies with multiple program areas, mandates, funding sources, and computer systems
need systems integration to generate business intelligence. GIS is well suited to integrate data
from across the enterprise based on the one common aspect of all data, GEOGRAPHY.


Every hospital and nursing home in the coastal counties has an automatically created
account when they are licensed by the state. When they log into this system they instantly
have access to a map with the location of all state evacuation zones, hurricane surge
zones, facility location information, evacuation routes, and other pertinent information in
relation to their facility.

NEDSS GIS Viewer Emergency Operations & Facility Facilities Mapping
notifications

Advanced AVR tools for Public Health Data Field Data Collection


Other GIS-based emergency response and planning systems and concepts are Emergency
Hurricane Shelters, Hospital Preparedness Planning, Infectious Disease Outbreak
monitoring, emergency notifications, and field data collection for vulnerability and rapid
needs assessments.

Hospital Preparedness Planning for
Evacuation and Sheltering with GIS

Jared Shoultz, Doug Calvert, Guang Zhao & Max
Learner,
DHEC Division of Public Health Informatics & Office of
Public Health Preparedness
South Carolina


Another example from the South Carolina Department of Health and Environmental
Control is a system that is accessed by coastal hospitals for emergency preparedness and
planning.

Critical Data Sheets System
• Designed for Hospitals, Nursing Homes, and
Hospice Facilities along the SC Coast.
•If facilities have any intentions of “sheltering-in-
place” for a Category III or less hurricane they
must have all information completed so it can be
reviewed for approval by DHEC before
evacuation.

Non-spatial Benefits
•Linked to license database to pull data
•Accessible from any PC with web access and data
stored offsite from facility
•Standardized for reporting on vehicles requested,
sheltering agreements, transport vendor
arrangements
•All info needed to evaluate sheltering requests
(communications plans, emergency contacts,
emergency generator, wind loads, supplies, etc..)


The Critical Data Sheets System is an online ArcIMS application that integrates licensing
data from the state with critical emergency response GIS layers such as shelters, flood
zones, surge zones, evacuation routes, transportation infrastructure, and evacuation zones
to provide hospitals without GIS capabilities the ability to enter and evaluate their Shelter
in-place plans against these crucial layers. All hospital entered plans are instantly tied to
GPS coordinates collected in the field by DHEC staff and accessible via a secured interactive
map service.

Spatial Benefits

• Spatial Tools for facilities with no “in-house” GIS
• Advanced Analysis, Visualization and Reporting
•Predefined overlays with surge zones,
evacuation zones and evacuation routes
•“Real-time” overlay capabilities with weather and
hurricane track data


This gives the hospitals the ability to access these plans from anywhere at any time and
provide updates to DHEC in real-time while allowing DHEC to more fully comply with the
NIMS architecture and have the ability to do full reporting and spatial queries from any
location on the plans currently in place for each facility. DHEC uses these plans and the
associated spatial data to determine if a request to shelter in-place for a Category III or less
hurricane will be approved.

GIS in Preparedness Preplanning
Using Hospital Operational Condition
Modeling

Nathanial Szejniuk
HICS Educational & Training Center


Disaster preparedness and response is multi-dimensional. Factors that need to be
considered include hazard event, location, distance, time, and staffing functions, among
others. A concept that is gaining ground in health care is the Healthcare Operational
Conditions or HOPCON readiness model. This application addresses the application of GIS
in healthcare preplanning, as well as, post event recovery issues.

Nate Szejniuk, Healthcare Preparedness Consultant 2/17/2008
©

A t th is p o in t W ilm a w a s tak in g a m oa more e rly a p p ra oapproach
At this point Wilma was taking re n o rth northerly ch th a t
cthatgchanged 6 h o u rs 6 hoursre na rthe a s te rly tra ve l o u t to se a .
h a n e d w ith in within to a m o to o more northeasterly travel

out to sea.

http://www.hurrevac.com/


GIS is an important tool that should be integrated with the Hazard Vulnerability Assessment (HVA) which all
healthcare facilities should conduct at least annually or as other situations may dictate. HVA can use tools like the
NOAA Hurricane evacuation system to track and do advanced planning response.
Having the capability for early recognition of a hurricane’s path and status is critical in responding with appropriate
actions.

EcoLEAP2 Consulting, Inc. 44

6/4/2009

1

2

3

4


Another example of GIS is to support concept of operations and situation awareness planning. This is a view of a
hospital that is relatively close to a main railroad line. Maps such as this can reveal the importance of understanding
hazards outside the healthcare facility, such as transportation incidents, hazardous materials storage, crime, flooding,
etc.

CHCER - Szejniuk 45

Nate Szejniuk, Healthcare Preparedness Consultant 2/17/2008
©


Another consideration is staffing issues during disaster planning and response. Where
do essential staff live and what route might they use to get to work? Preplanning can
provide assurance that the hospital will have adequate staff of the necessary specialties.
Similarly analysis can be done to support supply and re-supply issues.

EcoLEAP2 Consulting, Inc. 46

Interagency Logistical Support during
Emergencies

Jerry D. VanVactor
US Army Medical Service Corps
Afghanistan


No health care community or organization is immune from emergencies whether natural
or man-made. Disaster takes many forms and can come at any time. Preparedness, one
aspect of the national emergency planning elements, involves leaders within multifaceted
healthcare practices to conduct business processes in a state of readiness to respond to a
disaster, crisis, or any other type of emergency situation.

Only recently have healthcare organizations begun to develop “partnerships among
disciplines, across sectors, or with private sector and media in relation to disaster
preparedness”.

• Logistics readiness is a factor in each phase
of emergency management
• Preparation
• Mitigation
• Response
• Recovery
• Health care logistics does not begin and end
with the first responder; in some cases, the
institution can assume multifaceted roles
before, during, and after a trigger event
occurs.


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 a continued provision of material,
goods, and services takes place throughout the four phases (preparedness, response,
mitigation, and recovery) of crisis management and mitigation.

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 to yield the most good for an 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/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.

48

Emergency Response Critical Item
Plan Inventory List

Periodic review of
items on-hand

Supports contingency
requirements

Yes No

Audit
Further evaluation
New items added to
list
Identify resources
Further available
need

Identify and
Yes No prioritize
Adjust prior to a
deficiencies in
trigger event
supplies, resources,
and equipment
Eliminate from the
Continue support
list

A baseline decision-making model becomes helpful when establishing criteria for logistical
support prior to an event occurring. During the initial response effort for an event there
will be little time for deciding among events and 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.

49

Supply
Node Supply
Disaster Node
Impact
Area

Downwind
direction
Medical
Center
Supply
Supply
Node
Node

Supply
Node


This example depicts how the integration of multiple GIS can provide insight during a
disaster for a healthcare logistics manager. Note that the hospital and one supply node is in
the affected/impact area. Another supply node is affected by being down wind of the
affected/impact area and is also inaccessible for re-supply operations. Another primary
supply node cannot access the hospital through the disaster area.

Planning that incorporates this kind of spatial analysis can provide the healthcare
logistician with in-transit visibility and real time shipping data related to incoming supplies
so that the medical center can maintain a continued access to supplies.

50

Improving Prehospital and Disaster
Response Using a Geographic
Information Interface

Elizabeth Walters, MD, Stephen W. Corbett, MD, PhD,
& Jeff Grange, MD,
Loma Linda University Hospital
Loma Linda, CA


The Advanced Emergency Geographic Information System (AEGIS) AEGIS is reportedly the first integrated emergency system to provide
the user access to a suite of tools necessary to manage resources and respond effectively and efficiently during prehospital and disaster
incidents.

Interoperable communications among a variety of devices is facilitated by AEGIS via text messaging to an individual or group
participating through the system. Personnel in critical locations can be identified and given specific instructions, and personnel or assets
in other locations can be redeployed to more strategic positions.

This interface can be used universally at the response or command level, and across political and jurisdictional boundaries. It allows
users to consider a diversity of pertinent information, interpret and analyze trends and threats, share information, and communicate
with other responders. It is especially suited for operations where a great amount of information from multiple sources must be
distributed and analyzed quickly for appropriate decision-making. It is designed to be agency independent and can be used for daily
operations as well as for incident response. The system is designed to provide secure access to information sources, and to expand and
contract to include only the information that is necessary for the level of response needed and operational success.

•Hospital Name
•Status
•Time
•Updated every minute

•Air Photos
•Fire Stations
•Police Stations
•Sheriffs Stations


AEGIS incorporates both static and dynamic information into a single user-friendly
interactive map. Static information includes a variety of typical maps with the location and
attributes of key facilities and resources. Dynamic information includes hospital diversion
status, real time traffic information, weather conditions, and updated major incident
information. AEGIS also visualizes ground and airborne emergency assets in real time.


AEGIS creates a unique level of situational awareness that has not been available
before. The spatial representation of the incident, the wealth of information for
decision support contained in the data layers, visualization of adjacent critical
structures, and the understanding of resources available with current asset
allocations, all allow managers to make well informed decisions in real time.
Predictive tools that are currently available for wildfire activities, toxic plume
behavior, hazardous materiel incidents, flooding, and earthquakes, can be
incorporated into AEGIS for immediate use by Emergency Managers.

CA Highway Patrol Incidents
CA Highway Patrol Incidents

•Location
•Location
•Type
•Type
•Time
•Time


Information from CHP’s CAD system is relayed to the system. This, along with
traffic and hospital information, allows the hospital to make better decisions in
routing ambulances traffic. AVLs show where rescue and air evac helicopters are
currently located, even shows direction and airspeed.

Meterologix Weather
Meterologix Weather

•Precipitation
•Precipitation
•Current Weather
•Current Weather
•Forecasts
•Forecasts
•Updated every 15
•Updated every 15
minutes
minutes


Weather information can be important in planning for air transport of patients.
Also useful in HazMat incidents. Although this does not show ‘plume models’, that
kind of information could also be fed into the map.

Use of Global Early Warning for Infectious
Disease Events, Crises, and Disasters in the
Hospital Setting

James Wilson
Veratect Corporation
Kirkland, WA


Low probability, high consequence infectious disease events pose a challenge to the
hospitalist seeing a returned traveler who may, unbeknownst to the physician, have
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, crisis and disaster early warning and how this information is
intelligently and proactively disseminated to the local hospital environment for risk
mitigation is facilitated with GIS.

Image credit: Aaron Koblin


The top image shows a 'global radar' system used to track infectious disease events, crises,
and disasters.

The lower image is a screenshot of Aaron Koblin's fantastic visualization of air traffic
connections to / from the US (which brings the threats home), and an example (not real)
report of an alert that a hospital might see.

Think of this Global Early Warning System as a National Weather Service for Infectious
disease.


Here’s a larger view of Koblin’s composited FAA data for 24 hours of Air Traffic over the
United States creating a beautiful, strange and thought provoking graphic.

Some additional applications of GIS in
hospital/healthcare emergency management


The following briefly mentions work being carried out by others on this topic and are
presented without examples. In many cases they’ve been distracted by the real world
emergency “H1N1” Swine Flu and were not able to get slides to me.

Integrating GIS to Improve
Medical Disaster Reponse

John Dorling
Community Preparedness Consulting Services
Sarasota, FL


Local and regional disasters can take on many forms and impact a large number people,
institutions and resources. A successful response to such events requires the integration of
resources from local, State and Federal responders as well as a variety of commercial,
volunteer and private organizations. In order to effectively identify needs and maximize
response efforts a variety of technologies are available to assist in the management of an
integrated response system.

The implementation of GIS technology in a disaster medical response provides incident and
emergency operation managers the information they need in a concise and graphical
format to monitor and track patient movement from the scene, resource and logistical
movement, make routing decisions based on environmental changes, determine alternate
routes due to unexpected barriers and provide valuable information for decision modeling.
By integrating available GIS systems from other emergency response organizations,
layering of incident information and resources can provide local decision makers with more
timely information that other text based information systems.

GIS Application and a
Regionalized Approach for
Mass Casualty Incident Planning

Deborah Kim, Wiliam Proger,
Kent Simons, & Christopher Hiles
IEM, Inc.
South Jordan, UT & BelAir, MD


The potential of a large scale mass casualty incident (MCI) places significant pressure on
healthcare facilities where bed capacity is approaching 100% on a “good” day, first
responder partners find themselves working under diminishing funding, and their
surrounding communities faced with hard economic decisions. Hospitals plans should
realistically address the management of existing patient populations, as well as the
anticipated casualty surge from an MCI. Potential transfer of existing patients to other
facilities requires identification of transportation assets, personnel, and transportation
routes. Effective and coordinated regional emergency planning requires a thorough
knowledge of the locations of critical facilities and impacted populations through all phases
of the emergency. In addition, regional planning requires careful evaluation of resources
which could be utilized in the planning, response, and recovery phases of any MCI.

Mapping the healthcare resources has been clearly shown to make a difference as part of
the development of a regional approach to planning for a MCI. Regional planning brings
together individuals from different disciplines and geographical locations. Regional
planners may be unfamiliar with resources or critical infrastructures that are outside their
city or county boundaries. GIS technology identified not only resources, transportation
routes, evacuation routes, locations of critical infrastructure, and other elements essential
in the development of a regional plan. GIS allows for the development of a common
operating picture and facilitates the community planning partners ability to identify the
spatial relationship of the elements essential to the planning, response, and recovery
phase of an incident.

The Chemical Stockpile Emergency
Preparedness Program: Application of GIS
Technology and the Development of
Healthcare and Community Based Planning

Deborah Kim, William Proger Kent Simons & Donald Cobb
IEM, Inc.
South Jordan, UT


United States military chemical weapons storage areas (e.g., Army depots) were purposefully located in
relatively remote areas of the country. As part of the treaty requirements for destruction of the aging
chemical weapons stockpile, disposal facilities were constructed near these storage depots. Over the past
sixty years, community development close to storage and destruction sites has become a reality, requiring
intensive population protection planning efforts by affected nearby jurisdictions.

Since 1988, FEMA and the U.S. Army have assisted communities surrounding the seven chemical stockpile
sites to enhance their abilities to respond in the unlikely event of a chemical agent emergency.
Continued success of Chemical Stockpile Emergency Preparedness Program (CSEPP) initiatives depends on
the productive working partnerships enjoyed by federal, state, and local jurisdictions involved in the program.

A unique emergency preparedness effort involving ten states in eight locales that would be affected by a
potential off-site release of chemical agent, CSEPP has applied the information developed by the use of GIS in
multiple arenas including evacuation, plume direction, identification of hospitals and the need for shelter in-
place activities.

GIS has been used to identify healthcare resources, evacuation routes, locations of critical infrastructure, and
other elements essential in the development of each community’s CSEPP plan . The prompt provision of
medical care in the community to potential chemically contaminated individuals involves multiple levels of
participation in all phases of the emergency management planning process. GIS allows for the development
of a common operating picture and facilitates the community planning partners ability to identify the spatial
relationship of the elements essential to the planning, response, and recovery phase of an incident.

GIS Based Medical Response Management
System for Pandemic Diseases
Ajay Krishnapillai
BartiNet.com
Orlando, FL

Bindu Ravi
DTS
Orlando, FL


The Severe Acute Respiratory Syndrome (SARS) disease was a serious disease in the
Southeast Asian region. The incident resulted in 8096 known infected cases and 774
deaths. The ASEAN countries were at the forefront of the impact and response. The pace
and spread of the SARS pandemic challenged the community, medical, and healthcare
resources in that region.

A GIS based medical response management system for pandemic diseases was developed using GIS
Web Server
implementation, web based incident case data collection, map based SARS incident
reporting, real-time medical staff notification, disease spread parameters based GIS
analysis, incident location and time-distance based impact zone forecasts, and deployment
of resources

In a similar application for bird flu the incident source, incident location, patient health, the
pace of spread, treatment of affected patients and surrounding population count, etc.
were input. The information on time-lag between incidences, follow-on incidents, the
medical diagnosis and treatment process were critical. The medical treatment operations
and other bird culling at source farms were equally important during the period.

A web GIS portal allowed online mapping of bird flu incidents, medical facility, medical
staff, bird culling stations. The information was captured by public health staff in the field,
medical offices and emergency response centers. As the incident information came in,
based on distance algorithms and nature of incident, the nearest medical and public health
response teams are alerted. The operational follow-ups and responses are also captured
into the same database through the web portal.

Using GIS to Improve Workplace and
Worker Safety Crisis Management

Jeffrey M. Miller
Warrior Concepts International, Inc.
Sunbury, PA


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 insure that staff education and administrative procedures are in line
with the real threats and dangers.

Whether the risk is criminal activity (i.e. gang violence) that can find its way into a facility,
or socio-economic conditions which can be a factor in 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.

Enhanced Hospital Situational Understanding
by Integrating GIS and Simulations
Modeling

Susan O’Hara, Mark Sullivan, James Walsh & Ignacio
Hidalgo, O’Hara Consulting, SPARTA, Inc.


Simulation models and geospatial reasoning engines are used to conduct emergency
contingency planning focusing on effects on nursing workload and scenario driven physical
space architecture. One application 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 and advanced agent based modeling to represent
nurse behavior and performance. The tool demonstrates uses to assess staffing, processes
and unit layout to accommodate the surge patient load. The analysis is used to develop
contingency plans for the emergency condition.

GIS and models can be integrated to provide a more seamless planning capability. Drawing
from consequence management for missile defense planning GIS and Service Oriented
Architecture is combined in a real time decision support application demonstrating the
integration of multiple and disparate real-time and strategic computer programs including
bedboards, admission planning tools, electronic health records.

New York City Hospital Mapping Project

Joe Paz & Al Villacara
Office of Emergency Management
New York City, NY


The New York City Office of Emergency Management (OEM) Hospital Mapping Project was a 2008 initiative to
build a limited-access database of maps that capture the critical infrastructure of New York City’s 65 acute
care hospitals. OEM’s Health & Medical (Planning & Preparedness Unit) and GIS Divisions worked together to
co-lead this important endeavor.

Hospital emergency managers worked with the medical, safety, facility, and/or engineering personnel and
identified critical infrastructure areas of their facility. These vital areas included but were not limited to:
Generators
Fueling sites
Oxygen delivery systems
Electrical vaults
Imaging systems
Hazardous material storage
Location of Decontamination showers and corridors

Data inputs were organized and maps created with all floors of the hospital superimposed into one aerial
view. Critical infrastructure points were plotted with imbedded data detailing specifics about floor location
and other information relating to that particular area.

There were multiple benefits of this collaboration. NYC OEM established a database that enabled the Health
& Medical section of the Emergency Operations Center to immediately access information about NYC
hospitals during an emergency. The hospitals were provided with poster-sized maps and were encouraged to
incorporate them into their planning efforts. By the end of the 2008 calendar year the project had yielded a
database of 50 sets of maps for hospitals across the city which will be important tools should they ever be
needed to by first responders as they work on-scene at an incident located at one of New York City’s
hospitals.

Ric Skinner, GISP
The Stoneybrook Group LLC
Sturbridge, MA
ric.skinner@gmail.com
www.healthGISguy.com


The Evolving Role of GIS in Hospital and Healthcare Emergency Management

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