By Center for Prehospital Care, Education and Research staff
Loma Linda University Medical Center
One glance at the old photos on the wall of most departments or a quick look at a station scrapbook and many would ask how they ever did their jobs with the equipment used. It is readily apparent, the response apparatus and the gear that was used was archaic, whether it be for fire suppression or medical aid incidents. Since that time, service areas have increased, populations have grown, patients are older and the complexity of the job, whatever it is, has gotten significantly more difficult. Today, we respond in greater numbers with larger and more efficient equipment and navigate through a maze of roads ,often around uncertain obstacles and other traffic. Our bags are full of just about every tool we need to make our jobs easier and safer to perform, but is that the reality?
After-Action reports following a rash of recent wildland fires, hospital evacuations, school bus crashes, campus shootings, and a never-ending string of natural and manmade disasters indicate that there is more that can be done to improve our response, provide the tools to keep us safe and manage resources for the best overall outcomes. Although we have come a long way with providing up-to-the moment information to assist command staff and event responders to make informed decisions, performing their jobs successfully is one of the many challenges we are facing today. One tool, currently under development at Loma Linda University Center for Prehospital Care, promises to provide that higher level of understanding necessary to answer this challenge–a project managed under a Federal grant by the Telemedicine & Advanced Technology Research Center (TATRC) (Photo 1)
Advanced Emergency Graphical Information System
Advanced Emergency Graphical Informational System (AEGIS) is a collaborative effort between the CPCER, developers from ESRI of Redlands, California–a private business, and a host of Fire, EMS, and Law Enforcement agencies throughout California and beyond. This unique, user-friendly geographical information system (GIS) collectively combines numerous spatial and temporal elements into layers that can be accessed together or separately. AEGIS allows users to view a variety of pertinent information in one location, identify and interpret trends and threats, and analyze the information presented (Photo 2). It allows the user to make more informed decisions and has applications for law enforcement, fire and EMS response, hospitals, public health, dispatch, and emergency and disaster planners from all disciplines.
AEGIS is a unique kind of database that displays emergency information geographically or in a map view. In its present form, AEGIS provides the user with spatial awareness of the location of resources using tracking technologies, local weather and road conditions, hospital status and capabilities, and the locations of schools, hospitals, and airports. It can track the movement of fire apparatus, air transport helicopters, and other support vehicles. (Photo 3) AEGIS can also be used to support further analysis of trends such as pandemic disease, the proximity of fires to structures, and threats to infrastructure. (Photo 4) Additionally, AEGIS can be customized to include any geospatial information that is needed by a particular agency or jurisdiction.
Field Flexibility and Access
One particular advantage of AEGIS is that it can be accessed by any authorized user using an Internet-connected device such as a Windows-enabled computer or cell phone. Furthermore, the application is optimized depending on the device, minimizing down time, and allowing personnel to spend more of their time providing a service rather than referencing their computer.
The user’s sign-in profile provides security and a connection to relevant information for their level of response. It is envisioned that this access would be determined by each agency and be specific to the type of agency, the nature of the event, the intended use of the information, and the user’s job requirements. For example, health care workers would have access to patient data located on AEGIS, but not specific law enforcement or incident command information unnecessary to perform their duties. This profile-driven capability would allow the user to access only pertinent information, avoiding possible information overload and delays in making appropriate decisions.
An interactive layer is currently being developed. This will enable field personnel to identify incident locations, evacuation centers, casualty collection points, helipads, and fire camps. Responders will also be able to interact with others using geo-coded messages, photographs, and video showing images and notes directly from the scene. Other information such as three-dimensional building plans, locations of underground pipes, or hazards can be added to complement the scene by ancillary staff or participants in other locations. Everything is immediately disseminated to all authorized responders, thereby providing a higher level of understanding in seconds rather than in the usual minutes or hours it would take to transmit, catalogue, and store information using more traditional means.
More than CAD
AEGIS differs from more common Computer-aided design (CAD) interfaces by providing information from sources and resources outside the agency CAD system. In this way, a more complete picture of an event including other outside agency assets and response apparatus can be viewed.
Resources at hospitals are becoming increasingly impacted by the number of patients, their acuity and staffing. This means longer bed delays and hospital diversion. Hospital status, providing up-to-the moment capability, capacity, and diversion status is available to field responders, eliminating the delays in patient transport waiting for hospital response and direction in major incidents. Getting the patient to the right hospital the first time is a challenge, and tools that display hospital status and capability, bed delays, and availability of extended services will help medical leaders make informed decisions. (Photo 5)
Provisions are available within AEGIS that could provide transport and patient information directly to the receiving hospital. This would help to redirect the impact of lengthy reporting of less critical patients by reducing on air time and allowing for the medical management of more critical patients. The receiving hospital would also have more time to prepare for patients while they are en route and ensure that resources are available when they arrive.
In the future, public health could view regular EMS call data and the movement of patients in major incidents. This will be particularly helpful in reuniting families during and following major events or evacuations. Regular call analysis can help in providing syndromic surveillance, and the analysis tools built into AEGIS will help public health personnel identify potential pandemics and bio-hazards before they reach epidemic proportions.
During disasters and large emergency incidents, responders can input information from the scene directly into the AEGIS system. Initial estimates of patient numbers and acuities, and other incident specific information can be relayed immediately to command staff for planning and resource management. More specific patient information, obtained during triage and care via handheld patient tracking/triage devices, can be ported directly into AEGIS providing up-to-date patient care and triage information. Hospitals, using the AEGIS system, could then preview the information allowing them to prepare for the numbers and types of patients they would be receiving. Casualty collection points can be marked on the map and immediately communicated to field personnel for public dissemination. Overall, these activities would allow improved patient assessment and treatment in the field and during transport in times of emergency.