Montana Regional Readiness Project

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Montana Regional Readiness Project
St. Vincents Healthcare Foundation, Billings,
MT Doris Barta and David Balch
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Montana ProjectsPurpose

• To explore and optimize the capabilities of
  advanced communication systems in disasters and
  to raise awareness of these resources as they fit
  the needs of Public Health in Disaster
  situations.

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HRSA Project Activities

• A series of disaster response exercises in the
  Northwest
• A series of educational seminars using VTC and
  webinar formats
• A Statewide Infectious Disease Networkwww.MT-ID.o
  rg

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Telemedicine in Natural Disasters

• In 1999 NC experienced 4 Hurricanes in 10 days
• ECU team set up TM in shelters
• TM has a role to play in Disaster Response
• Advanced Communications can Improve Surge
  Capacity and response management and help
  streamline patient movement in a Disaster
• HEICS is very relevant (unified command/control)

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Broadening the Application of Telemedicine

• Enhancing Command and Control using Advanced
  Communication Technologies
• Real-time data display
• Wireless for field data
• Situational awareness (environmental sensors) as
  part of medical response
• Telemedicine networks provide redundant
  communication systems

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Enhanced Command and Control Center
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Communications Matrix
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Sensor Grid as a Bio-Shield
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Mobile Telemedicine

• Snap-on payload
• SPO2
• Any skin
• Capnography
• CO2
• FLIR
• Infrared

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Advanced Communications for Mass Casualty
Disasters

• Managing and Containing Infectious Diseases
• Caring for Quarantined Patients
• Higher skills for infectious disease
• Lower skill providers for the walking wounded
• Pathology and Radiology Image transfers
• Environmental Sensors/Surveillance
• On-the-fly education to remote hospitals
• HEPA filters
• PPE suits
• Decontamination processes

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Whats New in Disasters?Pandemics vs Natural
Disasters

• Medical Responses to Pandemic (or biological)
  Outbreaks need to be very different than disaster
  response in the past.
• Mass casualty events used to bebus wrecks, train
  wrecks and domestic disasters could always be
  handled by simply triage and transport to nearest
  or largest local hospital
• ERs could put minor injuries in the hallways, no
  need for isolation.
• Serious injuries were moved to surgery or icu or
  treatment rooms

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Ultimate Risk Impact of Pandemic Influenza

• Ultra scenario - worse than the 1918 Flu
• 142.2 million death
• GDP loss of US 4.4 Trillion
• Mild scenario - similar to 1968-1969 Hong Kong
  Flu
• 1.4 million deaths
• GDP loss of 0.8 (US 330 Billion)

Source Lowy Institute for International Policy
(Feb 2006)
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Risk Factors

• Nature of diseaseaffects diff age group
• Infection ratehigher
• Mortality and Morbidity--higher
• Human risk factors including socio-econ,
  geography, employment, health history
• Countermeasuresclose schools, businesses, reduce
  social clusters

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Learning from the past 1918

• Very different epidemic patterns seen in
  different US cities in fall 1918.
• Timing and nature of public health interventions
  varied between US cities.
• Can public health interventions provide a
  plausible quantitative explanation of the
  variation between US cities?
• What if? measures hadnt been imposed, or were
  imposed earlier

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Predicting Spread

• Effectiveness of global quarantine
• Effectiveness of vaccine and antivirals
• Effectiveness of social interaction/intervention
• Effectiveness of employer preparedness
• Effectiveness of regional collaboration
• Appropriate Technologies in the Loop

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Challenges in Readiness Planning

• Likely no other infrastructure is downall
  appears normal to the General Public
• Huge Staff absences are to be expected at Health
  Care Institutions
• There is no regular communication sharing
  sessions between/among states
• Capturing data from multiple disparate sources is
  more than a technical issue
• Low incidence events with high impact outcomes
  are very difficult to train for

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The Challenge of Capturing Data From Multiple
Sources to Share With Multiple Stakeholders

• GoalTo marry historical and emerging event data
  to craft an effective response to the crisis.
• Solution Explore strategies prior to a crisis
  and link with real-time data sources for use
  during the event
• Disease Surveillance Systems to capture and share
  data on emerging pandemic threats
• Deterministic simulation of human behavior
  institutional processes across time and space
• Evolutionary simulation for non-deterministic
  adaptive behavior
• Integrated Incident Management Systems to manage
  crises
• Service Oriented Architectures (SOA) to tie them
  all together

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HRSA Project Activities in Montana

• A series of disaster response exercises in the
  Northwest
• A series of educational seminars using VTC and
  webinar formats
• An Infectious Disease Networkwww.MT-ID.org

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Research Questions

• When is the movement of information more valuable
  than the movement of people?
• What role can telehealth play in disaster
  response?
• What other tools and communication technologies
  could we use.

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Broadening the Application of Telemedicine for a
Regional Readiness Plan

• Web Portals
• Existing TM Networks
• Streaming video over the Web
• VTC over TM nets
• RP-6 Robot
• Geospatial mapping
• Predictive Modeling
• Surge and Information Management

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Advanced Communications Tools for Disaster
Response

• Interactive web portalstreaming video, realtime
  messaging, HAN messages, all forms, resource
  documents and web links
• AIMS surge management
• Ramsafe predictive threat and resource modeling
• ESRI/GCS geospatial mapping
• Statewide (30 sites) videoconferencing
• Robot--telepresence tool for quarantined patients
• Ilinc software for web conf

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Disease Surveillance SystemsCapturing data from
hospitals and other sources that can be analyzed
to determine the emergence of infectious diseases
including pandemics
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Incident Management SystemsExecute effective
response operations in events of Public
Emergencies/Mass Casualties through enhanced
coordination among public safety agencies.
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SimulationPost Alert View
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Future Foresight and Right Action
Information
Business Intelligence and Disease Surveillance
Systems - ESSENCE - MedMined
Simulation Science and Evolutionary
Computation - SimLib GeoLib - AutoCore
AnyLogic
Incident Management Systems - AIMS - Cicero


Public Health
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Disease Tracking Software Criteria

• Must support- Data Fusion
• Must support - Data Analysis
• Must support - Data Visualization
• Must be flexible
• Must be always on
• Must support ease of communication between
  partners

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Telemedicine Networks can Help Bridge Information
Silos

• Data captured from disease surveillance and
  incident management can be shared via
• a. Web based tools such as AIMS
• b. Desktop shared tools such as Ilinc
• c. VTC and Telemedicine Networks
• d. Secure FTP sites or Intranet

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Web Portal w/ Streaming Video
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InTouch RP-6 Robot
St. Vincents Healthcare
Physician Console
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Format of Public Health Exercises

• Public Health announces an outbreak situation and
  describes their needs for medical response.
• Telehealth community observes and is given a
  chance to respond and provide surge information
  and key staff to VTC from their hospital.

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2006 Norovirus Outbreak

• Affected 15 assisted living and nursing home
  facilities in Yellowstone County
• Focused on containing outbreaks at individual
  facilities
• Communication with border state public health
  departments not important

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March 2007 Outbreak(Dance Competition)

• 781 individual case reports
• 580 sick persons
• 447 sick persons at Event
• 116 sick persons NOT at Event
• Attendees from 5 border states
• Communication with border states Public Health
  Very Important

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Idaho Department Of Public Health And
Welfare Boise, ID
PHTN Bridge Billings
Wyoming Department of Health Cheyenne, WY
METNET Helena, MT
University Of S. Alabama Mobile, AL
North Dakota Department of Health Bismarck, ND
Interstate Communications For Disaster
Response June 22, 2005 Bioterrorism Exercise
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Montana Infectious Disease Nework

• 10 Infectious Disease Physicians in the state of
  Montana
• Large Geographic area, poor distribution of
  clinical resources
• Most had never met
• Soutions
• Web Portal
• Filtered literature review
• Regular meetings on the web using ilinc
• Regular sharing of cases and clinical issues
• Document sharing center
• Occasional VTC
• Quarterly In-person meeting

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MT-ID A Road Ahead
State and County Health Departments
MT-ID Network
Hospitals and Other Providers and Leading
Researchers
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Region Response Seminars

• Lessons Learned from Natural Disasters, Gary
  Muller, West Jefferson Medical Center
• Thinking Beyond Your Disaster Plan, Carl
  Taylor, University of South Alabama
• Role of the Military in a Pandemic Flu, Bob
  Armstrong, National Defense University
• Bio Economics of Pandemic Flu, Steve Aldrich,
  Bio Economic Research Associates
• Role of CDC in Pandemic Planning, David Kim,
  Center of Disease Control
• Pandemic FluCurrent Issues, Tim Stephens,
  President, Rescobie Associates
• Managing the Psychological Consequences of All
  Hazards Disasters and Terrorism Events, Col
  Elspeth Ritchie, Office of Army Surgeon General
• Managing Psychological Consequences of
  DisastersToward and Integrated Model, Dean
  Schreiber, UCLA School of Public Health
• Interstate Communications in Managing Infectious
  Disease OutbreaksDoug Moore, MD, Yellowstone Co.
  Health Dept.
• Interoperable Information Infrastructure
  (Syndromic Surveillance)Mohlenbrock, MD

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Recommendations

• Specific telehealth demonstrations should be
  built into future Public Health Disaster response
  exercises.
• TM Disaster Response Exercises should have
  limited pre scheduling and notification of
  telehealth network sites.
• Integrate telehealth representatives into
  specific ICS rolesoperations, planning,
  logistics and public information at state Public
  Health and local hospitals.

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Recommendations to Telehealth Community

• Telehealth community must broaden their view of
  TM and their knowledge of available tools to
  support medical response in disasters
• Telehealth community needs to learn about ICS and
  plug into local plans
• Use Statewide Telehealth Networks to support
  training, planning, and information sharing with
  Public Health Community
• ATA and TRCs should build and maintain inventory
  of TM resource for DR

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When to Move Bits Instead of Atoms (TM in
disasters)

• In a mass casualty event
• In a chemical or biological disaster
• In an Infectious Disease outbreak
• During a shortage of specific medical expertise
• For critical just-in-time information/education
• To alleviate distance and travel time

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Key Steps in Forming a Readiness Plan for
Pandemic Outbreaks

• Build inventory of TM networks in your state
• Build inventory of TM networks in border states
• Conduct regular meetings and connectivity tests
  between these sites
• Involve Public Health officials in these meetings
• Engage hospitals ICS teams in cross borders
  meetings over TM network
• Explore patient tracking systems being used in
  your region
• Use TM network to build relationships between
  these teams and the information silos

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Conclusions

• What we know is that we dont know enough about
  emerging infectious diseases to be adequately
  prepared without interstate communication
• What we seek is common knowledge sharing to
  promote effective early detection and response
• Properly deployed communication systems like TM
  will help bridge information silos and play a
  vital role in Regional Readiness Plans

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Contact Information
David Balch davidbalch_at_yahoo.com 252-830-0510