Role of Telemedicine in Disaster Management

Presenter: Dr. AijazQadir PatoliMBBS, MBA, DISM, (MSc)

Sr.MO Govt: of Sindh Pakistan

Venue: TTeC2006 Tromso Norway12th June, 2006

Sources of Data: WHO web site

PROLOGUE

2004 (Dec), tsunami of 9.0 Richter scale 183,170 lives & 43,320 – missing still.

2005 (Oct), earthquake (7.6) in South Asia > 18,000 lives & 4 million need healthcare. 20 after shocks of 5 & >. above.

PROLOGUE

1995, Great Hanshin-Awaji earthquake in Japan

5488 victims perished, 81% died in the first 7 hours.

Disasters have adversely affected 80 million or more in last 20 years

HOW TECHNOLOGY CAN HELP US IN SUCH DISASTERS?

Sources of Data: B-1; Theodore C. Chan, MD, Jim Killeen, MD, William Griswold, PhD, Leslie Lenert, MD, MS “Information Technology and Emergency Medical Care during Disasters"

B-2; Dr. Najeeb Al-Shorbaji Regional Information Officer Regional Office for the Eastern Mediterranean World Health Organization Alexandria, Egypt

DISASTER

Disaster; unexpected & extensive, catastrophe, can be natural or man made in origin, causes huge losses of lives & property & sometimes with permanent environmental changes.

Major concern is Human Life. Traditional medical care facilities are either

collapsed or inaccessible in the disaster area.

TELEMEDICINE

Telemedicine; synchronized use of ICT to deliver medical services to patients in areas where access is restricted by geography or environment.

Diagnosis, treatment, monitoring, and education of patients & other stakeholders.

Transmission modalities may be wired or wireless between 2 or more ends.

TELEMEDICINE & DISASTER MANAGEMENT

Telemedicine was first applied in disasters by NASA in 1985 earthquake in Mexico City. It provided critical voice communication support within 24 hours of the disaster.

Improved space & ground technologies provide suitable communication infrastructure for disaster management.

TELEMEDICINE IN DISASTER MANAGEMENT

Disaster Management broadly has three phases; Preparedness Relief Response Post response rehabilitation.

Telemedicine can be integrated in all phases of disaster management.

Pakistan has also learned lesson.

PREPAREDNESSPlanning & Development

Preparedness begins with planning process, risk analysis and Technology assessment: Risk Analysis & Reduction. Disaster Telemedicine integrated groups. Infrastructure Finance Technological needs & applications. R & D through Pilot Projects.

PREPAREDNESS Risk Analysis & Reduction

Classification of high risk zones on the basis of TYPE and ORIGIN.

Databases of identified set of requirements for human safety in each distinct type of disaster.

E-Surveillance; social & environmental electronic Data collection, dissemination and electronic statistical analysis from high risk areas.

Modeling of the magnitude and anticipated impacts of a potential Disaster.

Early warning system for people & stakeholders.

PREPAREDNESS Telemedicine Planning groups

National Disaster Telemedicine groups: Community : Telemedicine centers for awareness and services. Taluka : Disaster Telemedicine training centers. District level: Annual Telemedicine Planning & implementation. Provincial level: 3-year Telemedicine Strategic Planning Federal Level: 5-year Telemedicine Strategic Planning Vertical Integration

International Level: Planning groups with WHO & others Tele-education & e-Trainings of groups:

Disaster; basics, epidemiology, logistics, medical management. Injuries Types; Mechanical & environmental, biological, radiation Information & Telemedicine management strategies

PREPAREDNESSInfrastructure

Human Resource; Management & administration of the Telemedicine System Medical expertise and other health and medical activities Patients and telemedicine users E-Trainings & E-education

Medium; Wired or Wireless broadband; Contingency wireless & mobile backup.

Wares; Equipments and software

Finance; Funding, sponsorships, and investment. budgetary allocations

PREPAREDNESSTechnological needs & applications.

Databases; with off-site back ups for information of: Inventory & Human resource management Logistics & trainings material Organizations expert in disaster management Epidemiological techniques.

Artificial Intelligence, & Expert Systems; Expert Systems & Decision Support Systems on medical issues.

GIS; Databases in GIS environment useful in disaster management for: situational analysis risk assessment spatial modeling disaster mapping, and simulation It facilitates search and rescue operations.

PREPAREDNESSR & D Pilot Projects

To study & establish role of Telemedicine in Disaster Management & new systems.

Generate variety of data & information; Management information Clinical information Surveillance and epidemiological information Knowledge Personal and community information Literature

RELIEF RESPONSE

Disaster detection & Response activation. Telemedicine Resource mobilization. Mobile Field Hospitals in the disaster area. Reference Hospitals Medical Missions, in area denial scenario just

after disaster, consists of 3 steps:1. Victim Localization.

2. Life Algorithm.

3. Victim Management.

RELIEF RESPONSE

Robot assisted Medical Reach back; Access to the victim during the 4-10 hrs of extrication All functions deeper depths of 10-30 meters in rubble

Telemonitoring Critically ill patient – sensors nodes. During triage

Patient Tracking Systems; triage tagging Tech!! Bar coding and mobile wireless data acquisition to

individually identify and track victims of disasters. Bar coding has been piloted and tested in Europe.

RELIEF RESPONSE Pre-Hospital Management

Mobile Technology in Pre-Hospital Management Telediagnosis and teleconsultation, crucial signals fixed or portable, wired or wireless, TCP/IP

Miniaturization Technology; PDAs Support keyboard, pen, touch, & voice inputs Information management, portability, & connectivity e-mail, fax, graphics, digital photography, & voice

recording capabilities.

Personnel Status Monitor (PSM) Mobile ICU!!!

RELIEF RESPONSE

Telediagnostics; Teleradiology; The term covers X-rays,

computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound.

Telepathology. Teleconsultaion;

during surgery; reduce # of unneeded amputations.

Ambulatory Patients.

POST RESPONSE REHABILITATION

Telepsychiatric Interventions Telerehabilitation Clinical Decision Support system for

ambulatory patients. Public Health Issues:

Disease Early Warning System

Disaster Medicine Epidemiology

LESSONS LEARNED

Telemedicine has great potential to minimize the loss of human lives during a disaster.

October 2005 earthquake devastation; that Pakistan should go for telemedicine facilities.

Governmental policies now aim at: elimination of constraints in growth of Telemedicine. facilitate local language contents indigenous ICT research & development Official plans include HRD, joint ventures, urban networks

and rural build-out. integration and development of online applications.

STRATEGIC OPTIONS

Globalization of Disaster Telemedicine Institutionalization of Disaster Telemedicine Specialized Disaster Telemedicine courses. Disaster Intelligence System Unified code system; like WHO’s ICD-10. Unified information exchange standard; HL7. One health database language like MIQUEST. WHO-NST lead in e-Health Disaster Management NST be declared as Headquarter of e-Health

Disaster Management.

EPILOGUE

Technological advancements has imparted Telemedicine with the capability to significantly minimize human life loss during a disaster.

Disaster Telemedicine is promising & noble, and with impressive sense to save human lives.

“The feeling of creating something, simultaneously imposing, reassuring & beautiful is enough to mobilize endless amounts of human efforts.”

THANK YOU FOR YOUR ATTENTION