The United States and many other countries are threatened by a number of new crises because of terrorist activities. Behind these new threats looms the ever-present danger of a natural disaster, such as an earthquake, fire, or hurricane, and human-made or technological disasters, such as a transportation accident or loss of an electrical grid. All of these incidents generate strong demands on the collection, analysis, coordination, distribution, and interpretation of many types of health and preparedness information. Along with the increasing risk of bioterrorism, there is a greater requirement and stronger emphasis on the use of sophisticated information-gathering tools and information technologies. These tools are necessary to manage the complex surveillance and data analysis necessary to spot trends and make early identification of outbreaks, as well as allow for rapid communication of health information, mitigation strategies, and treatment modalities to health care workers in the field.
Fortunately, many of those involved in emergency management have begun to embrace technology, and, consequently, many vendors have recognized the need to produce hardware and software to meet the needs of disaster responders. Various tools have been used to help mitigate, prepare for, and respond to disasters. One of the more difficult issues during a response to a disaster is the inability to communicate. The breakdown of communications has been a recognized effect of almost every major response to a disaster. Communications issues occur at some level in almost every disaster response, no matter how large or small. As the disaster community has experienced these failing communications systems, it has found strategies to improve the systems or replace them with methods that work. Over time, the ability to accumulate, analyze, and disseminate disaster preparedness and response information has improved. Largely, this is due to advances in information technology that have taken place during the past half century.
Historical perspective
The disaster response community got off to a slow start with embracing information technology; however, this technology is rapidly gaining momentum. Before the 1980s, computer systems were primarily used in the business, banking, and scientific communities. For the most part, anything close to emergency or disaster planning use of these systems was limited to the Department of Defense and large commercial research firms who did operation planning and simulation, or occasionally, epidemiological or sociological studies.
During the 1980s, the desktop computer, or personal computer (PC), was introduced. Data could be stored on a disk that was easily carried in a briefcase. By the mid-1980s, disaster responders could enter data into a computer so that documents could be produced, spreadsheets updated, and commodities and resources tracked, sometimes even in the field. During the late 1980s, the Internet began to gain popularity and became more in the reach of the average person. The precursors to the Internet—BITNET and ARPANET—transformed into the World Wide Web, and at that time the average citizen began getting a dial-up Internet connection via CompuServe or America Online. Online resources at major centers of learning began to accumulate databases related to disaster management and planning. People could exchange files and documents via e-mail or by way of a number of sites that acted as file repositories, called file transfer protocol (FTP) sites (FTP is the methodology of transferring binary and text files from one computer to another). Special software programs called “gophers” (short for “go for this and that”) cataloged these file repositories and allowed a person to search for them by keyword. These programs were the precursor to the big search engines such as Yahoo! and Google.
Applications such as computer-aided management of emergency operations (CAMEO) were developed in 1988 by the National Oceanic and Atmospheric Administration. CAMEO is used to assist first responders with easy access to response information. It provides a tool to enter local information and develop incident scenarios. It contains mapping, an air dispersal model, chemical databases, and other tools to help display to the emergency responder critical information in a timely fashion. Hazardous materials information and material safety data sheets (MSDS) became available on CD-ROM. Other databases also became available on CD-ROM to allow the responder access to a library of information while at the disaster site. About this time, the Centers for Disease Control and Prevention (CDC) released Epi Info ( www.cdc.gov/epiinfo ). Using this software, an epidemiologist or public health professional could develop a questionnaire or form, customize the data entry process, and enter and analyze data. Epi Info can be used to produce epidemiological statistics, tables, graphs, and maps.
Specialized computer mapping software called geospatial information systems (GIS) integrates data with map information. Because disasters are usually spatial events, GIS can assist in all phases of disaster management. It is often useful for disaster planners to see a map of the disaster to assist in plan development. A map will show the scope of the disaster, where damage is greatest or has the greatest impact, what property or lives are at risk, and what resources are available and where are they needed. Disaster managers, using GIS to graphically display critical information that is location based, can quickly map the disaster scene, establish priorities, and develop action plans.
In the 1990s, information exchange improved exponentially. List servers on the Internet allowed emergency managers, disaster responders, and medical providers the ability to discuss disaster response in an informal setting. It was not uncommon to see a post to a list server from a responder actually at the site of the disaster. Lessons learned could be immediately disseminated throughout the disaster response community. Agencies such as the Federal Emergency Management Agency, the Natural Hazards Center at the University of Colorado, and the CDC all began to publish large amounts of public information about disasters on their websites. The use of satellite telephone systems and cellular phone–based data networks allowed those with a laptop to stay connected in the field and collect and transmit a large amount of information to other responders and to their response agencies.
Today, it is hard to find someone in the disaster response field that has not used e-mail or some type of computer resource to do his or her job. It appears that the use of information technology is reducing operational costs and increasing productivity, although this is difficult to quantify because information technology is still growing so rapidly. Portable computers have now decreased in size. The cellular phone and personal data assistant (PDA) have merged into a smartphone. Tablet PCs and the iPad have allowed desktop computing power to become highly portable. Although still falling behind that of the corporate sector, information technology training for disaster response and management personnel is beginning to be a job requirement. Electronic commerce is allowing disaster responders to achieve real-time procurement and payment for relief supplies. Broadband and wireless networks can be set up rapidly and cheaply to allow for access to vast informational resources. The public has become far better educated, and they seek information on their own health care; manage their finances online; and now are able to research, mitigate, and prepare for disasters using the many publicly available resources on the Internet.
What does the future hold for informatics in disaster management? It is hard to tell because information technology in general continues to develop so quickly. It is likely that the disaster responder will one day use a wearable computer with a small flexible screen. It is also probable that voice and data technologies will continue to merge so that interaction with digital devices can be accomplished by voice command. Storage devices will continue to become smaller so that victims of a disaster may have their entire financial records, health records, and other personal information archived on a chip they carry in their pocket, which will allow them to save this important personal information from being destroyed by a disaster. Real-time monitoring and surveillance will assist the disaster responder to become aware of an impending disaster sooner. The ability to monitor patient flow, track resources, and perform real-time mapping and visualization of the disaster scene will allow planners and managers to “roll with the punches” during a disaster and modify the response effectively. It is likely that information technology will continue to be a stronger and stronger tool for disaster response personnel.
Current practice
Various tools and elements of informatics and telecommunications are being used currently by disaster managers and responders. Some of these tools are used in the preparation and mitigation stage, and some are used during the response phase. Some tools can be used in all phases of the disaster cycle.
Computer Devices
The computer has revolutionized many aspects of modern life. Some people are so dependent on e-mail for doing their daily work that when the corporate e-mail system goes down, they find it hard to conduct business. The same is true for researchers using the Internet to access the vast amount of knowledge on the Web to do their research: when it is inaccessible, they almost feel withdrawal symptoms. There are many types of computing devices available to a disaster manager or responder, everything from corporate mainframes to wearable PCs.
The Laptop
Probably the most commonly used device other than the smartphone is the laptop. As technology improves, the speed and power of laptops have become equivalent to a desktop computer. Because memory and storage are cheap, the average laptop has a larger hard drive than it did just a few years ago. Most of the applications written for the desktop are also used on the laptop, so many laptops have memory equivalent to that of the desktop. New chipsets and microprocessors use lower power and run cooler, allowing for longer running time on batteries. Some laptops are even fanless with solid state hard drives, greatly improving battery life. Laptops are getting thinner, and many of them are bundled with all the accoutrements, such as wide theater-like screens, DVD players, CD burners, and high-speed connections, such as a High Definition Multimedia Interface (HDMI) and Universal Serial Bus (USB) connectors, for peripheral devices. Most new laptops also include wireless access technologies, such as Bluetooth and Wi-Fi. With a docking station and external keyboard, mouse, and monitor, many people are finding that they can use their laptop docked at their desk and then pop it out and take it when they travel. This takes the place of a desktop computer and provides the user all the amenities of the office or home while out in the field. See Box 25-1 for tips on traveling with a laptop.
- •
Update the antivirus and spyware protection software to the latest virus definitions, because one cannot be sure that a network used on the road is fully protected.
- •
Use a program that creates an image of the laptop’s hard drive, so that if the hard drive crashes, it can be recovered from the image.
- •
Check the batteries and, if time permits, cycle them all the way down and back to full charge again. If possible, take an extra battery that is charged to extend your PC time if you are isolated without power. Consider alternative power sources, such as solar panel chargers, disposable battery replacements and power cells, and a 12-volt adapter for converting power from a car battery to use your laptop.
- •
Place the computer in a hard-shell padded case. It also helps to have an assortment of plugs and adapters and an extra network cable, just in case. Do not forget a power/recharge cable.
- •
Put everything in plastic baggies, even when the equipment is in its case. If you can find a large enough baggie for your laptop, you can protect it from moisture should your case be exposed to the elements and leak. Temperature changes can cause condensation, so if you do pack your equipment in baggies, throw a couple of silica gel desiccator packs into the baggie, too.
- •
Take a surge protector to prevent power spikes from damaging your devices, particularly if you know you will be in an area operating on generator power.
- •
Avoid, at all costs, having your laptop or computer device go through a baggage check. Make sure it can be stowed as a carry-on. Try to keep it away from metal detectors because they might erase magnetic media.
- •
Take a cable lock so that you can secure your laptop somewhat. Although it will not prevent a thief who really wants it, it may deter someone walking by from snatching it while you have your back turned.
The Tablet PC
Similar to a laptop is a specialized portable computer called a tablet PC. These are finding rapid popularity. These devices use primarily a stylus or finger for the input and for data entry. Tablet PCs are finding a niche in vertical markets such as health care and on the warehouse floor. They can be extremely useful for filling out forms such as a medical record or a field survey at a disaster site that can be plugged into a GIS for mapping. Tablet PCs usually have equivalent performance to that of a laptop, with the added convenience of usually a longer battery life, a slightly smaller form, and the stylus- or finger-based input.
When selecting a laptop or tablet PC to take to the field, one will be deluged with thousands of choices. In selecting a device, it is important to consider the conditions under which the device will be used. There are many “hardened” devices, specifically designed to military standards for shock and vibration resistance, water resistance, and dust impingement. These hardened devices can be twice the price of the regular off-the-shelf laptop or tablet. If a hardened device is affordable, one can rest assured that it will more than likely survive being taken into the field and be able to keep data safe. An alternative, however, is to purchase an off-the-shelf laptop from a local computer or electronics store and an insurance policy for it. Oftentimes, a $50-per-year policy with a deductible of only a few hundred dollars is available. This would easily cover a catastrophic loss of the device (e.g., major drop, crush, or immersion), but it probably would not cover minor damage such as the disk drive door breaking off. When buying a hardened device, ask the vendor specific questions about drop and immersion tests and whether the device meets military standards ( Box 25-2 ).
MIL-STD is a series of specifications set by the U.S. Department of Defense. When purchasing a hardened device for field use, look for vendor affirmation that their device meets military standards to ensure that it will survive use in a postdisaster field environment.
If at all possible, test a device in various types of weather, from direct sun to nighttime. Make sure the screen is readable in direct sunlight, can be dimmed for use during night operations, and is ergonomic when held and does not cause undue strain due to weight or bulkiness. Try the doors, accessory ports, and plugs to make sure that, by simply plugging a peripheral into the device, it is not rendered immobile or unwieldy or that its water resistance or another hardened standard is not rendered ineffective.
The Smartphone
Another handheld device that is usually smaller than the tablet PC is the smartphone. The smartphone has become the peripheral brain for many in the health care setting. Rather than wear or carry a laboratory coat full of plastic cards with scores and scales, quick guide books, and other reference texts, a health care provider can store all of this information in a smartphone. The information can be indexed and referenced quickly. Smartphones utilize a number of operating systems, such as iOS for Apple devices, Android, and Microsoft Windows Mobile. Most of the major vendors are authoring software for all three platforms. Software is often downloaded from a marketplace, and most titles are very affordable, with many being free and public domain. A smartphone can be an invaluable resource for the disaster responder. Often in the field, the disaster responder does not have the luxury of ducking into the emergency department library to look up something in the Physicians’ Desk Reference or other medical text. With a smartphone, however, one can “take” those texts to the field ( Box 25-3 ). In many cases, searches can be done with a keyword to rapidly find the needed information. You can even do a quick consultation with another provider outside the disaster scene via e-mail, text message, or video chat.
- •
Epocrates ( www.epocrates.com ): Epocrates is an enhanced drug and formulary reference with integrated ID treatment guides and tools.
- •
WISER ( http://wiser.nlm.nih.gov.easyaccess1.lib.cuhk.edu.hk/ ): WISER provides a wide range of information on hazardous substances, including substance identification support, physical characteristics, human health information, and containment and suppression advice.
- •
Skyscape Books ( http://www.skyscape.com ): This is a portfolio of medical references for use on handheld devices.
- •
PEPID ( http://www.pepid.com/ ): PEPID is a physician, critical care, and nursing reference suite.
- •
Sites that have tablet or smartphone disaster or medical software:
- •
http://www.fema.gov/smartphone-app
- •
http://sis.nlm.nih.gov.easyaccess1.lib.cuhk.edu.hk/dimrc/disasterapps.html
- •
http://www.grabpak.com/the-ultimate-smartphone-disaster-preparedness-app-list/
- •
http://lifehacker.com/how-to-use-your-smartphone-as-an-essential-part-of-your-1442683676
- •
- •
Related posts:
Role of Emergency Medical Services in Disaster Management and Preparedness
Psychological Impact of Disaster on Displaced Populations and Refugees of Multiple Traumas
Nongovernmental Organizations in Disaster Medicine
Occupational Medicine: An Asset in Time of Crisis
Needs Assessment
Operations and Logistics
Full access? Get Clinical Tree
