A Force Multiplier

— June 01, 2006

Dr. Robert J. Mitchell is a retired physician and a bio-terror response coordinator for Stevens Healthcare, a hospital in Snohomish County, Washington. "Part of disaster planning is being able to track patients, so we've implemented a patient tracking system that involves handhelds in the field with EMS providers," says Mitchell. "Those handhelds are used to enter patient data, such as their photo, vital signs, medical acuity information, any treatment that occurs, etc., and that information is then sent in real time over cellular connectivity to the hospital ER, where it pops up on the flatscreen monitor."

Traditionally EMS workers conveyed the facts of a situation to the ER via cell phone, where a message was taken by hand passed by mouth. Now that the data is sent directly to the flatscreen, human error is reduced and more people can be alerted simultaneously.

"You can imagine the potentially chaotic environment of a multiple-vehicle accident," says Mitchell, "and a typical day in the emergency room is a chaotic, over-burdened emergency room staff. So you have a cell phone conversation coming from a potentially chaotic scenario in the field to a potentially chaotic receiver at the other end. That person in the emergency room frantically takes down notes about what is coming in, and then those notes are then transmitted verbally from a nurse to a physician or to another nurse. So obviously, the amount of data that's moved from mouth to mouth to mouth is limited, and there's potential for the data to be incorrect at some point.

So imagine a data path that accompanies that phone call," Mitchell continues. "What we're trying to do--and this is not in its completed state, this is an ongoing scenario we're fine-tuning--is run the data path alongside of cellular conversation. So that in addition to the cell phone conversation that the paramedic makes with the emergency room, there's now also the data path. So a photo of the patient, a photo of the accident. Potentially if there's an accident you might take a picture of the vehicle itself, you could take a photo of the wound--a photo really of any information that could be helpful at the other end, from the emergency room standpoint."

The solution at Stevens Healthcare, which involves Hand Held Products' Dolphin 9500 mobile computers deployed with IRIS (Incident Response Information System) from Iomedex, is part of a pilot being tested by 20 fire and EMS agencies and four hospitals in Snohomish County and focuses expressly on: patient tracking, credentialing and asset management for disaster scenarios. Mitchell says his dream is to see similar implementations rolled out throughout the country.

"If all hospitals in a mass-casualty event were looking at the same data and trying to distribute patients, this would hugely augment the current systems that are in place. So right now, it helps an individual hospital based on accuracy of information; there are more people exposed to the information, and a hospital is able to target its resources. For an individual hospital that's huge. Now, if you put that same technology in all of the hospitals, and you then have a mass-casualty event, there would be the ability for every hospital to view every patient and see where every patient is going, and then the hospital that's designated in charge can distribute those patients along with state or county emergency operations center. Being able to visualize all of those patients and all of their conditions, and being able to distribute them to the hospitals effectively is huge, as opposed to having them all just going to the nearest hospital, which is what would happen naturally."

The result of this, says Mitchell, is "better care and better distribution of patients, so that these patients are all being exposed to the most assets--as opposed to going to one hospital with 100 patients, and having the last 90 patients not getting optimal care. If you can distribute those patients out to other hospitals, then you're going to improve care to those patients."

The second aspect, credentialing, "becomes a huge issue in the event that you have to lockdown your hospital," says Mitchell. "So hospitals are very interested in having a method to figure out who belongs there, in the event that they have to lock their doors. So let's take pandemic flu, for instance. If we had to quarantine a hospital and have only certain people come and go, we need to be able to identify them at entry sites. And they may not be people you're familiar with. So to have a handheld that can store data of your staff so that you can photograph an individual, badge them on the spot if you need to, or you can simply consult your handheld and compare that photo to who you're looking at. It's much more powerful than any kind of badge that can be forged. And you have people unlawfully entering your area, which was an issue at the World Trade Center and continues to be an issue in any disaster area, because you have these volunteers that want to help but aren't qualified. You've got to be able to know who's there.

"You also need to be able to credential people that you don't know, that aren't part of your staff--physicians from other hospitals, firefighters from other jurisdictions. Again, in my own hospital having my own staff in the database is very powerful. But to be able to have all hospitals with a database that I can access? Wouldn't it be great if a neurosurgeon from a different hospital shows up and says, "I'm a neurosurgeon and I'm here to help,' and I could just pull out my handheld and access a database and see sure enough, here's this guy's picture, here's his privileging, here's his skill set. To be able to bring him in and put him to work--that's a huge issue of liability, as far as hospitals are concerned. To be able to do due diligence on the spot, and be able to put someone to work is very important. And again this is talking about mass casualty events--this is not day-to-day operations.

"Take the Katrina event. For Katrina, there was a call out for physicians to come to the area. There were 33,000 physicians that responded, but only very few of them could actually be utilized. Why? Because they didn't have a credentialing system in place to verify who was who. That's stupid. There needs to be a system in place, with a database, that you can access, quickly, easily and on the spot--and in the field. So your handheld gives you the opportunity to leave your office with an instrument that can go into the field and identify those people."

Lastly, there's the asset management aspect. Mitchell explains, "We have a significant cache of disaster response equipment, from ventilators to decontamination equipment, generators, lights--it's a list that just goes on and on, and all of which is bar coded, and all of which has been photographed by these handheld devices and entered into the database."

A mobile solution shared across the country is key, says Mitchell, because standardization and interoperability are the best ways to mobilize limited assets. "No single agency has the ability to respond to a disaster by itself. It's going to have to be a joint effort. If everyone's using the same tools, and using the same language, and looking at the same data, the response becomes magnified. That's called a force multiplier--that's what the military refers to it as."

Mitchell offers one last story he says he often tells, apologizing half-heartedly for it in advance. "The first time we saw this in the U.S. was at Valley Forge. Prior to Valley Forge, George Washington lost every battle in the Revolutionary War. America was losing badly. What happened at Valley Forge turned the tide ... and what happened was, Washington got this logistician, von Stuben was his name, from Prussia. And the reason he was so important is that Washington was dealing with 13 colonies, each of which sent militias. They did things 13 different ways, they used 13 different languages in terms of how they marched, what weaponry they used, what kinds of supplies they took with them. The problem was organizational.

"So von Stuben, who speaks no English, comes in and does the first "train the trainer.' He gets 100 representatives from these 13 militias and he teaches them one way to do things. One type of weapon to use, one way to march, one set of orders. He standardized the way the whole army responded. Why was that important? It was important because that organization multiplied the effectiveness, dramatically, of this assemblage of militias to respond to the most powerful army in the world--Great Britain. So what happens at Valley Forge? They win their very first battle, in June, and the tide is turned in the Revolutionary War and the first Army manual is written.

"It's all about standardization and interoperability," Mitchell concludes. "If we can get everybody to use the same kinds of technology--and it doesn't have to be the same [brand], but it has to be the same kinds of technology--so that we can all look at the same data at the same time, then we can make educated decisions, move things around, find things that we need, find people that we need, find the patients and the victims that are out there in the field and reunite them with their families, and go about the recovery piece of a disaster."

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