Chapter 35: Informatics Solutions for Emergency Planning and Response

Andrea Connor, Marcia Fawcett, Marissa Frimpong-Mensah, Cassandra Jilek,

Alex Shulman, and Toni Visser

There has been a rise in terrorism incidents, and natural disasters worldwide.

Natural events range from earthquakes, tsunamis, floods, hurricanes, typhoons, to pandemic disease.

Introduction

Today, more than 40 countries with a combined population of more than 1.3 billion are faced with emergencies and humanitarian crises.

Resulting in both planning and response efforts.

Not immune from this increased emphasis on emergency preparedness.

September 11, 2001, helped put the realization that the country was not adequately protected from terrorism.

Anthrax outbreak stressed the public health infrastructure to the point that bioterrorism arose as an additional deadly threat.

With these events, the States responded to better prepare and manage terrorist events.

The United States

Earlier response by the informatics community focused on contributions toward:

Surveillance of threat detection

Biosurveillance and bioagent detection

Increasing the efficiency in disaster response

Providing a telepresence for remote medical care givers

Early Response

A challenge for emergency and disaster response continues to be communication and information management.

Consistent Challenge

Requires:

a moment-to-moment “situational analysis”

real-time information to assess needs and available resources that can change suddenly and unexpectedly

Effective Response

These technologies are being used and evaluated to improve patient care and tracking, foster greater safety for patients and providers, enhance incident management at the scene, coordinate response efforts, and enhance informatics support at both the scene of the disaster and at the community resource levels. Technologies such as: Smart devices Wireless connectivity Positioning technologies

New Technologies

In 2004, an earthquake and tsunami devastated Southeast Asia.

The uncoordinated invasion of people and organizations resulted in duplication, competition, and failure to assist many victims in need.

Southeast Asia

Initiated changes called the “humanitarian reform”

◦ Organized clusters whose principal mission was to assist the impacted government with coordination of all responses and with evaluation of the impact of intervention.

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

Appointed as the lead agency for health.

Includes coordination and production of health information.

At global level, it aims at discouraging individual and organizational response efforts that were not part of this coordinated response.

World Health Organization (WHO)

Emergency management(Canada)

Government Operations Centre (GOC)

Provides strategic-level coordination on behalf of the Government of Canada in response to an emerging or occurring event affecting the national interest

lead the coordination, development and implementation of prevention, mitigation, preparedness, response and recovery strategies to maximize the safety and security of all Ontarians.

http://www.emergencymanagementontario.ca/stellent/groups/public/@mcscs/@www/@emo/documents/abstract/ec093297.pdf

Emergency Management Ontario (EMO) 

2009 H1N1 influenza pandemic provides a recent illustration of how informatics can contribute to an emergency response.

Believed to have major effects on global economy, especially travel, trade, tourism, food, consumption, and

Eventually, investment and financial markets and could lead to widespread economic and social disruption.

Case Study: Informatics and 2009 H1N1

Results

Many countries engaged in detailed pandemic planning and prepared to adopt draconian-like measures to delay but not stop the arrival of the virus, such as border closures and travel restrictions.

Case Study: Informatics and 2009 H1N1

Characterize the severity of a pandemic. Designed to predict the impact of a

pandemic and provide local decision makers with standardized triggers that were matched to the severity of illness impacting a specific community.

Based on a case-fatality ratio to measure the proportion of deaths among clinically ill persons.

Pandemic Severity Index (PSI)

Monitors influenza activity and trends and virus characteristics through a nationwide surveillance system.

Estimates the burden of flu illness using statistical modeling.

The Centers for Disease Control and Prevention (CDC)

Monitoring system tracked the real-time purchase of over-the-counter medication, such as fever reducers and influenza treatments, in over 29,000 retail pharmacies, groceries, and mass merchandise stores.

Provides early detection of naturally occurring outbreaks as well as bioterrorism.

National Retail Data

Is a Department of Defense (USA) tool that fuses syndromic information from multiple data sources that differ in their medical specificity, spatial organization, scale, and time-series behaviours to provide early warning at the community level.

Electronic Surveillance System for Early Notification of Community-Based Epidemics (ESSENCE)

Took chief complaint information from clinical encounters hospitals and classified it into one of seven syndrome categories using Bayesian classifiers.

Data is stored in a relational database, used univariate and multivariate statistical detection

Alerted users of when algorithms identify anomalous patterns in the syndrome count

Real-time Outbreak Disease Surveillance (RODS)

Now more than ever before consumers have the opportunity to contribute to surveillance activities.

Some cases, the participation is a conscious decision, but in others consumers may be unknowingly contributing to this informatics process.

Healthcare Consumers Contribute to Surveillance Activities

Shorten the typical lag time to publication for CDC’s publicly reported data which can be from 10 to 14 days.

Advantage

Is being used to track influenza in specified geographic location with the added advantage that the data is real-time in nature.

Telephone Triage Data

Assumption that there was a relationship between how many people search the internet for flu related topics and how many people have flu-like symptoms.

Comparing to CDC published data, they found that the search-based flu estimates had a consistently strong correlation.

Google Flu Trends

Nurses must be appropriately and consistently educated to provide the right response.

Competency-Based Learning and Informatics Needs

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

However, there are no accepted, standardized requirements for disaster nursing training or continuing education… yet!

Competency-based Education

Identified:

Nine objectively measurable skills for public health workers

Seven competencies for leaders Three competencies for public health

professionals, and Two competencies for public health

technical and support staff

Columbia University School of Nursing

Later renamed the Nursing Emergency Preparedness Coalition.

Generated a list of 104 competency statements for all nurses responding to disasters using domains developed by the American Association of Colleges of Nursing.

International Nursing Coalition for Mass Casualty Education

Requires:1. Continuous monitoring of a variety of data2. Standards for combining data from different

sources and coordination of such efforts3. Computer-based processing and analysis that

help detect unusual and statistical significant patterns

4. Centralized diagnostic and therapeutic tools such as computer-based algorithms and protocols for treating conditions caused by infectious agents

5. Communication technology

Detection of and Response to the Threat of Bioterrorism

Incident management systems (IMS) was first used by firefighters to control disaster scenes in a multijurisdictional and interdepartmental manner.

Calls for a hierarchical chain of command led by the incident manager or commander.

Each job assignment is consistently followed by assigned personnel who refer to a specific job action sheet.

Informatics and Incident Management

Improves communication through a common language.

Allows staff to move between management location.

Facilitates all responders to understand the established chain of commands.

Benefits

Is a physical location where the Incident Management Team convenes to:◦ Make decisions◦ Communicate◦ Coordinate the various activities in response to an

incidents Accurate, real-time data acquisition

regarding:◦ Patient needs◦ Rescue personnel◦ Resources available

Emergency Operations Center (EOC)

Technology can be used to capture and represent data for purposes of increasing situational awareness in the Emergency Operations Center (EOC) for making the most informed and efficient decisions.

(see Table 35.5, pp 520)

Technology and Informatics Contributions to Incident Management

Healthcare volunteers are a necessary components of mass casualty events but can also create challenges

Questions to think about:◦ How do you count volunteers so that they are only

entered once?◦ How do you educate them so that they can

perform effectively when needed?◦ How are liability issues dealt with?◦ Are there certain tasks that lend themselves to

volunteer efforts?

Informatics and Volunteerism

Federal government system for organizing teams that are willing to travel to other regions if the country in the event of an emergency.

When activated, members of the teams are federalized or made temporary workers of the federal government

Disaster Medical Assistance Teams

National network of community-based volunteer units that focus on improving the health, safety, and resiliency of their local communities.

Include medical and public health professionals such as:◦ Physicians◦ Nurses◦ Pharmacists◦ Dentists◦ Veterinarians◦ Epidemiologist

Medical Reserve Corps

Require education prior to responding to an event.

MRC unties have competency based education requirements.

American Red Cross has a long history of volunteerism

Regardless the group, nurses are urged to be a part of an organized group rather than just showing up to the disaster

Volunteers

Health information technology investments are a necessary foundation in healthcare reform, linking potentially valuable information such as vaccination records and subsequent use of healthcare services to provide information about adverse events as well as vaccine effectiveness.

Future Advances

Using “grids” to connect multiple computers across the country will allow data sources to share and view large amounts of health information.

Grid participants will be able to analyze data in other jurisdiction with out moving the actual data

Grids

Expanding the use of electronic health records should help both patients and their healthcare providers during times of emergencies and disasters.

Improve clinical data and sharing of clinical information for displaced patients.

Electronic Health Records

2009 H1N1outbreak reinforced the fact that estimating the number of actual flu cases is very challenging as current case counting relies on encounter information, which is prone to underreporting.

Informatics has the potential to immediately support the early identification of a communicable disease, therefore reducing loss of life and the consumption of limited resources.

Technology development will further enhance the ability to use informatics to detect first warning signs during an emergency.

Summary

1. What do you believe is the most important aspect of informatics solutions for emergency planning and response?

2. Do you think that nurses should be provided education based on emergency planning and response? Why?

Two Questions

Saba, V. K., McCormick, A. (2011). Chapter 35 Informatics Solutions for Emergency Planning and Response. Essentials of nursing informatics (5th ed). McGraw-Hill. pp 513-523

http://www.emergencymanagementontario.ca/english/home.html

http://www.publicsafety.gc.ca/prg/em/index-eng.aspx

Reference