Role of Telemedicine in Disaster Management

1. Role of Telemedicine in Disaster Management Presenter: Dr. AijazQadir Patoli MBBS, MBA, DISM, (MSc) Sr.MO Govt: of Sindh Pakistan Venue: TTeC2006 Tromso Norway 12th June, 2006

2. 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. Sources of Data: WHO web site

3. 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

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. PREPAREDNESSTelemedicine 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

11. 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

12. 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 inGIS environment useful in disaster management for: • situational analysis • risk assessment • spatial modeling • disaster mapping, and simulation • It facilitates search and rescue operations.

13. PREPAREDNESSR & DPilot 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

14. 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: • Victim Localization. • Life Algorithm. • Victim Management.

15. 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.

16. RELIEF RESPONSEPre-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!!!

17. 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.

18. POST RESPONSE REHABILITATION • Telepsychiatric Interventions • Telerehabilitation • Clinical Decision Support system for ambulatory patients. • Public Health Issues: • Disease Early Warning System • Disaster Medicine • Epidemiology

19. 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.

20. 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.

21. 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