URISA GIS/Health Conf. -- "The Evolving Role of GIS in Hospital/Healthcare Emergency Managment" (short) -- Ric Skinner

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 report 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 and emphasizes the important contribution that
geospatial technology plays in protecting these assets in the Homeland Security Grant
Program Supplemental Resource on Geospatial Guidance.

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. A number of these have addressed GIS as a tool in the public health sector,
and some articles can be found on GIS in hospital/healthcare emergency management.

GIS is rapidly evolving and clearly has an important role in this area. This is because many
of the emergency management challenges faced in hospitals and healthcare, 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 some examples of how hospitals and healthcare facilities are
benefiting from the use of GIS to improve their emergency management mandates and
responsibilities. There won’t be time to cover all the examples I have found, however they
will be included in the full length presentation that will be available in the conference
proceedings.

You’ll hear similar approaches and implementations of GIS are occurring from a variety of
sources.

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

First you’ll see a title slide referencing the source of the example and then one or more
illustrating slides. The slides and description are based on material provided by the source
authors.

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 siting of trauma center hospitals 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.


The Trauma Resource Allocation Model for Ambulances and Hospitals (TRAMAH) is
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.


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

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 San Diego Department Operations Center 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.

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

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. All patients evacuated
from a medical facility were tracked through the DOC.

13

Integrating GIS into
Emergency Medical Services

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


In the recent ditching of US Airways flight 1549 in the Hudson River, 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.


By integrating EMS into Healthcare GIS systems, EM agencies and 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.


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.

20

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 for this Florida hospital?

And do your therefore think that GIS might be an important tool in the hospital’s Hazard
Vulnerability Assessment?

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


GIS is used in joint-partnership programs participation with ESF8 (health & medical
facilities) during disasters, and the development of a hospital evacuation tool that has
matured from a fax based approach to a 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 a region’s shuttered facilities with the
potential for reactivation and utilization during a mass casualty incident. 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.
The project was funded by the World Bank.


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.


Since 2002., when the system was implemented, more than a million interventions have
been recorded in the database.

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.


The 1st responder and the Trauma unit are faced with many difficulties in a disaster
including dynamic triage relocation, effective apparatus dispatch, decision processing,
situational awareness, victim search & rescue, and real time victim identification.

32


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.

33

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


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. It has developed 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 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.

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.

6/4/2009

1

2

3

4


An example of GIS is to support concept of operations and situation awareness planning is illustrated here. 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 38

Interagency Logistical Support during
Emergencies

Jerry D. VanVactor
US Army Medical Service Corps
Afghanistan


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.


Preparedness, one of the 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.

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.

40

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.

41

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 creating a unique level of situation awareness.

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.

CA Highway Patrol Incidents
CA Highway Patrol Incidents

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


Information from CHP’s CAD system, 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.

???

These are just handful of the applications on how GIS is an evolving technology being
widely utilized by hospitals and healthcare facilities as they enhance and improve
emergency management and disaster preparedness and response.

I want to thank all the contributors to this presentation. I’ve only included here what time
will allow. An extended version of this presentation that includes all my contributors will be
posted by URISA in the conference proceedings.

And now, I can take few questions.

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


URISA GIS/Health Conf. -- "The Evolving Role of GIS in Hospital/Healthcare Emergency Managment" (short) -- Ric Skinner

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