Medical Disaster Resources Network MD.RN

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Medical Disaster Resources Network (MD.RN)

• 2008 ATALACC Meeting
• Panama City, Panama

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Medical Missions for ChildrenMission Statement

• Provides medical diagnoses and treatment via
  telemedicine to children and mothers
• Facilitates medical knowledge transfer from its
  source to healthcare providers worldwide
• Delivers health related resources to underserved
  hospitals
• Supports applied medical research utilizing
  communications infrastructure

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MMC Facts

• Founded in 1999 at St. Josephs Childrens
  Hospital, MMC is a not-for-profit charity
  supported entirely by grant and donations
• MMC net worth in excess of 10 M (donated
  services, equipment, satellite time)
• gt30,000 children helped

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MMC History

• Founded by Frank and Peg Brady
• First Milestone Hospital del Nino in Panama
  City, Panama

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First Child Helped

• Yordano, 11 years old with cranial deformity
  resulting in mild retardation, only one eye, and
  difficulty swallowing
• Poster child for handicapped children for Panama
• Family of six with a healthy twin brother
• Using telemedicine to collect measurements, a
  computer model was reproduced. His skull was
  reshaped with computer imaging to correct the
  problems. Implants of titanium and harvested
  bone were created.
• First surgery took place (in this case) back at
  St. Josephs, the 10 hour phase one operation to
  change the shape of Yordanos skull and create an
  eye socket for prosthetic eye.
• In conclusion, MMCs Telemedicine and Teaching
  network was used to review the entire procedure
  with approximately 50 physicians in Panama as a
  forum for learning.

Yordano and Dr. Ephros
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Early Timeline

• 1999
• MMC founded by Frank and Peg Brady
• 2000
• United Nations (UNOPS) agrees to support MMC
  effort
• Pilot program established with Hospital del Nino
  in Panama City
• 2001
• World Bank and USAID partner
• MMC wins Polycom contest for best use of
  videoconferencing
• 2002
• Certificate of recognition from US Congress
• DOD agreement with MMC to provide telemed in
  eastern Europe
• Wins 14th Annual Federal Award
• 2003
• Intelsat, Ltd partnership formed
• US AID Grant
• 22 mentoring hospitals
• 2004
• St. Joes provides MMC headquarters, satellite
  teleport, studio digital NOC
• Internet2

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Giggles Childrens Theater

• Live performances 3 days a week
• Puppet shows, celebrity performers, magicians
• Transports patients to places such as Panama Rain
  Forest, Bronx Zoo, NASA or diving with sharks
• Archived Performances broadcast daily

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Media Production
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Telemedicine Outreach Program

• Two-way interactive video via IP
• TOP sessions are recorded and broadcast on MBC
• Consultations scheduled via MMC Help Desk
• 24 Mentoring Hospitals

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Medical Broadcasting Channel (MBC)

• US FCC license as a global satellite broadcaster
• Multi-cast streaming via Internet2
• Satellite time donated by Intelsat, Ltd.
• 9 M physicians, 14 M nurses, 89K hospitals, 16 K
  major universities, plus 110K institutions (I2)
  globally

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MBC Schedule
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MBC Content by Category
Physician Education 23
Medical Science 13
Prevention and Public Health 22
Family Health 14
Nursing Education 19
Patient Education 9
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Global Video Library of Medicine

• Electronically stores processed digital content
  to feed MBC
• Content supplied by highly credentialed tier-one
  hospitals, federal agencies, research centers,
  global organizations

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GVLM Content Partners (125)

• Alabama Dept of Public Health
• Montefiore Medical Center
• American Cancer Society
• California Distance Learning and Health Network
• Capital Media Group
• Childrens Heartlink
• Childrens Hospital Boston
• Operation Smile
• Center for Disease Control
• Childrens Hospital of Wisconsin
• Childrens Hospital of Omaha
• Deaconess Clinic
• Food and Drug Administration
• Howard Hughes Medical Institute
• Johns Hopkins Medical Center
• Kaiser Family Foundation
• Lifestar

Massachusetts Medical Society Miami Hand Center,
Badia Clinic National Library of
Medicine National Institutes of Health Partners
Healthcare SLP 3D, OR Live Southern Nevada Health
Network St. Josephs Regional Medical Center St.
Jude Cure4Kids St. Petersburg College St. Vincent
Healthcare Sutter Health System University of
Albany, School of Public Health University of
Maryland Medical Center World Health
Congress World Health Organization
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Global Video Library of Medicine

• GVLM is positioned to become the single largest
  repository of medical education video in the
  world

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MD.RN

• Medical Resources Disaster Network
• Up to date inventory of telemedicine hub networks
  used to provide care coordination and services in
  response to large scale disasters
• Long term goal develop telemedicine response
  that can increase long term surge capacity

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What We Know

• No nationally coordinated telemedicine network in
  place to respond to large-scale disasters
• With the very real threat of biological outbreaks
  or terrorist attacks, there is a need for a
  coordinated national response network
• Existing telemedicine infrastructure is well
  positioned to provide essential links between
  local, regional and national resources in a mass
  disaster
• Utilization of telemedicine resources requires
  access to a documented network of willing
  telemedicine providers

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Infectious Disease ScenarioWhat Can 80 Sick
People On A Plane Cause

• If an infectious agent such as smallpox they can
  reach 64,079 people in 9 days.
• Of which 4673 will be hospitalized within 15 days
  not counting the 5766 worried well that will show
  up at the hospital
• Requiring on a bad day- 8,000,000 gloves,
  3,000,000 HEPA masks and 16,000 extra doctors and
  nurses.
• Source CDC

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Infectious Disease Scenario Or if the 80 Simply
Touch 800

• Assuming a pneumonic plague and early
  containment, providers will still need 20,000
  sets of gloves, 9,000 HEPA masks (per day), 67
  nurses, 49 doctors and 1298 volunteers (without
  Telemedicine)?

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Driving Factors

• Improved Containment Measures
• Resource Coordination
• Biological, Radiological, Pandemic Disasters
• Just in time training, education, treatment
  protocols
• Access to highly specialized clinical expertise
• Cant always move the patient to the doc or the
  doc to the patient

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Questions to Think About

• When is the movement of information more
  valuable than the movement of people?
• What role can telehealth play in disaster
  response?
• How do we integrate telehealth into existing
  disaster plans?

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Existing Telemedicine Database

• 200 Networks identified
• 3000 Telemedicine sites
• Not filtered for disaster preparedness
• Not tested for connectivity
• Currently includes
• Hub Networks
• Medical Call centers
• Home Telehealth
• Remote Monitoring
• Outsourced Clinical Services

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ATA EPR SIG TDRN Goals

• Define essential fields for the Database
• Create the inventory/direct and determine
  collection methodology
• Create specialized collaborative web based tools
  to share information and promote dialogue on
  emerging health threats and infectious disease
  outbreaks
• Identify target users (medical, EMS, federal, and
  state agencies, public health, NGOs, military
  and private sector entities)?
• Develop dialogue and opportunities to educate
  target users
• Create appropriate use policieswho gets what
  data
• Define activation protocolsdo exercises, add
  technical details to database
• Qualify technical and clinical capabilities of
  disaster TM sites

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TDRN Volunteer Coordinators
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TDRN Participation Form

• Network or Program Name
• of Sites
• Program URL
• 24/7 Point of Contact
• Title, Organization, Address, City,
• State, Zip, Phone, Cell, Pager, Email
• Clinical Resources (Yes or No)
• Infectious Disease Tropical Medicine
• Pulmonary Medicine
• Nuclear Medicine
• Pediatric Burn
• Notes
• Alternative POC
• Specialized resources

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New TDRN Telemedicine Database

• 55 disaster networks identified
• 5 Time Zones
• 1700 TM sites ready to respond
• Infectious Disease (21)?
• Pulmonary (23)?
• Nuclear (17)?
• Peds Burn (18)?

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Next Steps for MD.RN Work

• Qualify technical and clinical capabilities of
  MD.RN listings
• Test and exercise the MD.RN sites to refine
  activation protocols
• Identify sites that are most useful for specific
  disaster situations
• Make information on volunteer network providers
  useful and available to federal, state, and local
  response agencies, while respecting permissions
  for such use
• Integrate telemedicine networks into local and
  state emergency communications systems
• Use MD.RN to complement and build upon other
  existing efforts related to public health,
  emergency response and threat detection, such as
  CDCs Health Alert Network and Emergency Medical
  Operation Centers (EMOCs)?
• Dialogue with FEMA regarding reimbursement for
  network costs in disasters
• Dialogue with ASPR regarding a virtual DMAT type
  team or an NDMS adjunct resource
• Dialogue with state Medicaid programs about
  reimbursement in disasters
• Seek funding to support these activities

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Acknowledgements

• American Telemedicine Association (ATA) and the
  Emergency Preparedness Response Special
  Interest Group (EPR SIG
• Volunteer Coordinators
• Participating Programs
• Medical Mission for Children
• 24/7 POCs

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For additional MD.RN information
Lori Balch lbalch_at_mmissions.org 252.917.1520
David Balch, EPR SIG Chair dbalch_at_mmissions.org 25
2.917.4412
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Thank you.
Restoring Hope through Technology