Informatics Solution for Emergency Preparedness and

Response
By: Robert P. Pedrioli

What is Emergency Preparedness

and Response?
According to the American Journal of Public Health, emergency preparedness and response is the
capability of the public health and health care systems, communities, and individuals, to prevent,
protect against, quickly respond to, and recover from health emergencies, particularly those whose
scale, timing, or unpredictability threatens to overwhelm routine capabilities. Preparedness involves
a coordinated and continuous process of planning and implementation that relies on measuring
performance and taking corrective action.
Emergency planning has become increasingly important in the United States due to changing and
often unpredictable weather patterns, new disease threats, and the rise of global terrorism.
The responsibility for the preparedness of the nations communities lies in all of us. From
governmental agencies to community residents, to local businesses, emergency preparedness and
response is a coordinated effort and requires cooperation and participation from all sectors.
http://www.region4b.org/PreparednessAndResponse.aspx

Overview
Events in the United States, such as the September 11, 2001
incident and the anthrax breakout lead the government of the
United States to respond at an unprecedented pace to better
prepare and manage terrorist events.

Informatics could contribute to increasing the efficiency in disaster

response as well as providing a telepresence for remote medical
caregivers.

What happened on September 11, 2001 ?

On September 11, 2001, 19 militants associated with the Islamic extremist group alQaeda hijacked four airliners and carried out suicide attacks against targets in the
United States.

Two of the planes were flown into the towers of the World Trade Center in New
York City, a third plane hit the Pentagon just outside Washington, D.C., and the fourth
plane crashed in a field in Pennsylvania.

Often referred to as 9/11, the attacks resulted in extensive death and destruction,
triggering major U.S. initiatives to combat terrorism and defining the presidency of
George W. Bush.

Over 3,000 people were killed during the attacks in New York City and Washington,
D.C., including more than 400 police officers and firefighters.

http://www.history.com/topics/9-11-attacks

What is the American Anthrax Breakout of

2001 ?
The anthrax outbreak in the United States which occurred during the latter part of
2001 has many of the same characteristics as a typical outbreak.

What is different, however, is that there was no transmission from infected to

susceptible persons that linked one case with another.

Instead, all of the cases were generated by a terrorist or group of terrorists who sent
letters containing anthrax spores through the postal system.

These spores -- very small in size -- typically entered the skin or lungs or victim
when the envelop was handled or opened, when coming in contact with an
environment where envelopes had previously been handled or opened, or when
passing through small holes in unopened envelops.

http://www.ph.ucla.edu/epi/bioter/detect/antdetect_intro.html

Changes in the Federal System Affecting Emergency

Preparedness and Response
A New Definition of Community
Community health is the provision of healthcare outside the hospital infrastructure. As such, the public
health departments have been viewed as the major delivery system of healthcare.
Federal funds were channeled through the Centers for Disease Control and Prevention (CDC) to the
states in order to strengthen the public health infrastructure.
At the same time, federal funds were directed to hospitals through the Health Resources and Services
Administration (HRSA).

Both funding agencies encouraged the development of systems that would intersect one another, and
for the first time a concerted effort was made to promote a collaborative system that would best meet
the needs of the nations health.

Changes in the Federal System Affecting Emergency

Preparedness and Response (1)
Even the reporting of victims during a mass casualty event created
challenges.

There was no central place for the family members of the victims to
access the information.

Healthcare members in St. Louis wanted to make certain this did not
happen to their community.

As a result, they developed a bar code system to log and track their
victims.

In addition, PDAs were used by medics to log patients and belongings as

well as notebook computers with wireless technology and networked
desktop machines in command centers.

Federal Responsibilities for

Healthcare Providers
The U.S. Department of Health and Human Services (DHHS) is responsible for the education of
healthcare professionals in preparedness for emergencies, including potential terrorism.

Three of the units focus on emergency planning and response: the Centers for Disease Control and
Prevention (CDC) , the Agency for Healthcare Research and Quality (AHRQ), and Health Resources
& Services Administration (HRSA).

Each of these agencies play a critical role in emergency planning and response.

The organization of the new Department of Homeland Security (DHS) caused some confusion about
whether education for emergency planning and response of healthcare professionals would remain
within Department of Health and Human Services (DHHS) or move to other first responder training
activities already instituted by the Federal Emergency Management Agency (FEMA).
Typically, first responders are: firemen, policemen, and emergency technicians who arrive first on the
scene of an event but now healthcare providers are included. This allows for the healthcare community
to be eligible for funding from the DHS.

New Visibility of CDC Promotes

Informatics Solutions
The CDC is recognized as the lead federal agency for protecting the
health and safety of people at home and abroad, providing credible
information to enhance health decisions and promoting health through
strong partnerships.

CDC serves as the national focus for developing and applying disease
prevention and control, environmental health, and health promotion and
education activities designed to improve the health of the people of the
United States.

CDC also compiles statistical information to guide actions and policies

to improve the health of the nation.

New Visibility of CDC Promotes

Informatics Solutions(1)

Several of the CDC initiatives require informatics support.

The National Electronic Disease Surveillance System (NEDSS) is an initiative that promotes the use of
data and information system standards to advance the development of efficient, integrated, and
interoperable surveillance systems at federal, state and local levels. It is a major component of
the Public Health Information Network (PHIN).
The purposes of the NEDSS include: to detect outbreaks rapidly and to monitor the health of the
nation; facilitate the electronic transfer of appropriate information for clinical information systems
in the healthcare system to public health departments; reduce provider burden in the provision of
information; and enhance both the timeliness and quality of information provided.
The Health Alert Network (HAN) was funded to develop capacity at the state and local levels for
continuous, high-speed access to public health information, and to broadcast information in support
of emergency communications.

New Visibility of CDC Promotes

Informatics Solutions(2)
The CDC established the Laboratory and Response Network (LRN) which outlined national
antiterrorism policies and assigned specific missions to federal departments and agencies.

Its objective was to ensure an effective laboratory response to bioterrorism by helping to improve
the nations public health laboratory infrastructure, which had limited ability to respond to
bioterrorism.

Today, it is charged with the task of maintaining an intergrated network of the state and local public
health, federal, military and international laboratories that can respond to both bioterrorism and
chemical terrorism.

Division of Public Health Surveillance and Informatics is an informatics component of the CDC.
Its purpose is to provide and improve access to and use of public health information.

Roles of Agency for Healthcare Research and Quality

(AHRQ) in Stimulating New Informatics Solutions
AHRQS involvement in bioterrorism comes for the
recognition that clinicians, hospitals, and healthcare
systems have essential roles in public health
infrastructure.

DECISION SUPPORT SYSTEMS

AHRQs Intergrated Delivery System Research Network (IDSRN) is to develop a computer

simulation model for citywide response planning for mass prophylaxis and vaccination during
bioterrorist attacks and other public health emergencies.
Researchers at the Childrens Hospital of Boston are building decision support models for
information systems of linked healthcare data, which would speed up reporting and enhance
rapid dissemination of relevant information.
Boston Childrens Hospital and Harvard University seeks to develop a prototype database and
Web site to facilitate clinician reporting of trends that will be used to diagnose possible
bioterrorist attacks.

SYNDROMIC SURVEILLANCE
It is a detection of a disease outbreak before the actual
disease or mechanism of transmission is identified.

Real-time outbreak and disease Surveillance (RODS)

system is a system that provides early warning of
possible infectious disease outbreaks caused by
bioterrorism or other public health emergencies.

HELPING CLINICIANS RESPOND

Provider training and education are also critical elements of a comprehensive plan for bioterrorism
and public health preparedness in general.

Researcher at the University of Alabama at Birmingham have developed continuing medical

education training modules to each healthcare professionals to identify various biologic agents, as
many pathogens and conditions (such as smallpox) are rarely seen in the United States, which limits
clinicians from being familiar with related infection.
The 6 biologic agents covered on the Website are anthraz, smallpox, botulinum toxin, tularemia,
viral hemorrhagic fever, and the plague.

There are specialized modules specifically for emergency room practitioners, radiologists,
pathologists and infection control specialists.

Roles of Health Resource & Services Administration

(HRSA) in Promoting Informatics Educational Solutions
The Hospital Bioterrorism Preparedness Program and the Bioterrorism Training
and Curriculum Development Program (BTCD) are 2 grant management programs
that exist under the management of the HRSA.

The purpose of the National Bioterrorism Hospital Preparedness Program is to aid

state, territory, and care system, including hospitals, emergency departments,
outpatient facilities, emergency medical services systems, and poison control
centers, to respond to incidents requiring mass immunization, isolation,
decontamination, diagnosis, and treatment, in the aftermath of terrorism or other
public health emergencies.

Roles of Health Resource & Services Administration (HRSA) in

Promoting Informatics Educational Solutions (1)
The BTCD program provides practicing healthcare providers
and current students.

The developed materials are designed to equip a healthcare

workforce to recognize indications of a terrorist event or other
public health emergency, meet the acute care needs of
patients, including pediatrics and other vulnerable populations
in a safe and appropriate manner rapidly.

Effectively alert the public health system of such an event at

the community, state, and national level, and participate in a
coordinated, multidisciplinary response to terrorist events.

Other Changes Affecting

Emergency Preparedness and
Response
Competency Based Learning and Informatics Needs

The American College of Emergency Physicians (ACEP) formed a

nuclear, biologic, and chemical task force to evaluate the status
of bioterrorism training in the United States, identify barriers to
this training, and offer recommendations for effective education.
Specific methods were used to adequately describe the targeted
audiences including group interactions, interviews, review of
materials, and agreement by task force. The content was
organized into three proficiency categories awareness,
performance, and planning.

Informatics and the Emergency

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

The IMS 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.

The IMS has been adapted for hospital use and is called
the Hospital Emergency Incident Command System
(HEICS.

Links
http://www.region4b.org/PreparednessAndResponse.aspx

http://www.history.com/topics/9-11-attacks

http://www.ph.ucla.edu/epi/bioter/detect/antdetect_intro.html

http://mol-mol.weebly.com/chapter-25--informatics-solutions-for-emergency-preparedness-and-response.html