Andrea Connor, Marcia Fawcett,
Marissa Frimpong-Mensah, Cassandra Jilek,
Alex Shulman, and Toni Visser
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There has been a rise in terrorism incidents,
and natural disasters worldwide.
Natural events range from earthquakes,
tsunamis, floods, hurricanes, typhoons, to
pandemic disease.
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Today, more than 40 countries with a
combined population of more than 1.3 billion
are faced with emergencies and humanitarian
crises.
Resulting in both planning and response
efforts.
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Not immune from this increased emphasis on
emergency preparedness.
September 11, 2001, helped put the
realization that the country was not
adequately protected from terrorism.
Anthrax outbreak stressed the public health
infrastructure to the point that bioterrorism
arose as an additional deadly threat.
With these events, the States responded to
better prepare and manage terrorist events.
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Earlier response by the informatics
community focused on contributions toward:
 Surveillance of threat detection
 Biosurveillance and bioagent detection
 Increasing the efficiency in disaster response
 Providing a telepresence for remote medical care
givers
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A challenge for emergency and disaster
response continues to be communication and
information management.
Requires:
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a moment-to-moment “situational analysis”
real-time information to assess needs and
available resources that can change suddenly
and unexpectedly
These technologies are being used and
evaluated to improve patient care and tracking,
foster greater safety for patients and providers,
enhance incident management at the scene,
coordinate response efforts, and enhance
informatics support at both the scene of the
disaster and at the community resource levels.
Technologies such as:
 Smart devices
 Wireless connectivity
 Positioning technologies
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In 2004, an earthquake and tsunami
devastated Southeast Asia.
The uncoordinated invasion of people and
organizations resulted in duplication,
competition, and failure to assist many
victims in need.
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Initiated changes called the “humanitarian
reform”
◦ Organized clusters whose principal mission was to
assist the impacted government with coordination
of all responses and with evaluation of the impact
of intervention.
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Appointed as the lead agency for health.
Includes coordination and production of
health information.
At global level, it aims at discouraging
individual and organizational response efforts
that were not part of this coordinated
response.
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Government Operations Centre (GOC)
Provides strategic-level coordination on behalf
of the Government of Canada in response to
an emerging or occurring event affecting the
national interest
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lead the coordination, development and
implementation of prevention, mitigation,
preparedness, response and recovery
strategies to maximize the safety and security
of all Ontarians.
http://www.emergencymanagementontario.c
a/stellent/groups/public/@mcscs/@www/@e
mo/documents/abstract/ec093297.pdf
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2009 H1N1 influenza pandemic provides a
recent illustration of how informatics can
contribute to an emergency response.
Believed to have major effects on global
economy, especially travel, trade, tourism,
food, consumption, and
Eventually, investment and financial markets
and could lead to widespread economic and
social disruption.
Results
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Many countries engaged in detailed pandemic
planning and prepared to adopt draconianlike measures to delay but not stop the arrival
of the virus, such as border closures and
travel restrictions.
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Characterize the severity of a pandemic.
Designed to predict the impact of a pandemic
and provide local decision makers with
standardized triggers that were matched to
the severity of illness impacting a specific
community.
Based on a case-fatality ratio to measure the
proportion of deaths among clinically ill
persons.
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Monitors influenza activity and trends and
virus characteristics through a nationwide
surveillance system.
Estimates the burden of flu illness using
statistical modeling.
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Monitoring system tracked the real-time
purchase of over-the-counter medication,
such as fever reducers and influenza
treatments, in over 29,000 retail pharmacies,
groceries, and mass merchandise stores.
Provides early detection of naturally occurring
outbreaks as well as bioterrorism.
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Is a Department of Defense (USA) tool that
fuses syndromic information from multiple
data sources that differ in their medical
specificity, spatial organization, scale, and
time-series behaviours to provide early
warning at the community level.
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Took chief complaint information from
clinical encounters hospitals and classified it
into one of seven syndrome categories using
Bayesian classifiers.
Data is stored in a relational database, used
univariate and multivariate statistical
detection
Alerted users of when algorithms identify
anomalous patterns in the syndrome count
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Now more than ever before consumers have
the opportunity to contribute to surveillance
activities.
Some cases, the participation is a conscious
decision, but in others consumers may be
unknowingly contributing to this informatics
process.
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Shorten the typical lag time to publication for
CDC’s publicly reported data which can be
from 10 to 14 days.
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Is being used to track influenza in specified
geographic location with the added
advantage that the data is real-time in
nature.
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Assumption that there was a relationship
between how many people search the internet
for flu related topics and how many people
have flu-like symptoms.
Comparing to CDC published data, they
found that the search-based flu estimates
had a consistently strong correlation.
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Nurses must be appropriately and
consistently educated to provide the right
response.
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Provides an international infrastructure for
nurses to learn about emergency
preparedness and response.
However, there are no accepted, standardized
requirements for disaster nursing training or
continuing education… yet!
Identified:
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Nine objectively measurable skills for public
health workers
Seven competencies for leaders
Three competencies for public health
professionals, and
Two competencies for public health technical
and support staff
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Later renamed the Nursing Emergency
Preparedness Coalition.
Generated a list of 104 competency
statements for all nurses responding to
disasters using domains developed by the
American Association of Colleges of Nursing.
Requires:
1. Continuous monitoring of a variety of data
2. Standards for combining data from different
sources and coordination of such efforts
3. Computer-based processing and analysis that
help detect unusual and statistical significant
patterns
4. Centralized diagnostic and therapeutic tools
such as computer-based algorithms and
protocols for treating conditions caused by
infectious agents
5. Communication technology
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Incident management systems (IMS) was first
used by firefighters to control disaster scenes
in a multijurisdictional and interdepartmental
manner.
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.
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Improves communication through a common
language.
Allows staff to move between management
location.
Facilitates all responders to understand the
established chain of commands.
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Is a physical location where the Incident
Management Team convenes to:
◦ Make decisions
◦ Communicate
◦ Coordinate the various activities in response to an
incidents
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Accurate, real-time data acquisition
regarding:
◦ Patient needs
◦ Rescue personnel
◦ Resources available
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Technology can be used to capture and
represent data for purposes of increasing
situational awareness in the Emergency
Operations Center (EOC) for making the most
informed and efficient decisions.
(see Table 35.5, pp 520)
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Healthcare volunteers are a necessary
components of mass casualty events but can
also create challenges
Questions to think about:
◦ How do you count volunteers so that they are only
entered once?
◦ How do you educate them so that they can perform
effectively when needed?
◦ How are liability issues dealt with?
◦ Are there certain tasks that lend themselves to
volunteer efforts?
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Federal government system for organizing
teams that are willing to travel to other
regions if the country in the event of an
emergency.
When activated, members of the teams are
federalized or made temporary workers of the
federal government
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National network of community-based
volunteer units that focus on improving the
health, safety, and resiliency of their local
communities.
Include medical and public health
professionals such as:
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Physicians
Nurses
Pharmacists
Dentists
Veterinarians
Epidemiologist
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Require education prior to responding to an
event.
MRC unties have competency based
education requirements.
American Red Cross has a long history of
volunteerism
Regardless the group, nurses are urged to be
a part of an organized group rather than just
showing up to the disaster
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Health information technology investments
are a necessary foundation in healthcare
reform, linking potentially valuable
information such as vaccination records and
subsequent use of healthcare services to
provide information about adverse events as
well as vaccine effectiveness.
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Using “grids” to connect multiple computers
across the country will allow data sources to
share and view large amounts of health
information.
Grid participants will be able to analyze data
in other jurisdiction with out moving the
actual data
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Expanding the use of electronic health
records should help both patients and their
healthcare providers during times of
emergencies and disasters.
Improve clinical data and sharing of clinical
information for displaced patients.
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2009 H1N1outbreak reinforced the fact that
estimating the number of actual flu cases is very
challenging as current case counting relies on
encounter information, which is prone to
underreporting.
Informatics has the potential to immediately
support the early identification of a
communicable disease, therefore reducing loss of
life and the consumption of limited resources.
Technology development will further enhance the
ability to use informatics to detect first warning
signs during an emergency.
1. What do you believe is the most important
aspect of informatics solutions for emergency
planning and response?
2. Do you think that nurses should be provided
education based on emergency planning and
response? Why?
Saba, V. K., McCormick, A. (2011). Chapter 35
Informatics Solutions for Emergency Planning
and Response. Essentials of nursing
informatics (5th ed). McGraw-Hill. pp 513-523
http://www.emergencymanagementontario.ca/
english/home.html
http://www.publicsafety.gc.ca/prg/em/indexeng.aspx