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"To put it simply, this is a powerful tool that can help save lives."
- Dr. Jeff Grange, Emergency Medical Services Director, Loma Linda University Medical Center
The Organization
Loma Linda University Medical Center (LLUMC) is strategically located in the center of Southern California, serving a vast area with a population of over 3.3 million. This geographically diverse region spans some of the largest urban, rural, and wilderness areas in the country, including the highest and lowest points (Mt. Whitney and Death Valley) in the continental U.S. LLUMC is the only level one regional trauma center for Inyo, Mono, Riverside, and San Bernardino counties.
ESRI is the world leader in geographic information system (GIS) technology. ESRI software is used by more than 300,000 organizations worldwide including most U.S. federal agencies and national mapping agencies, 45 of the top 50 petroleum companies, all 50 U.S. state health departments, most forestry companies, more than 24,000 state and local governments, and many others in dozens of industries.
Air-Trak, Inc. provides location, tracking and communications systems that combine GPS data with wireless and Internet technologies for real-time, historical, and exception-based reporting. Operating over cellular and satellite networks, the Air-Trak system is designed to facilitate the development of custom applications and integration of real-time tracking data into enterprise applications.
The Challenge: Gathering information for rapid emergency response
It may be a cliché, but it can't be overstated. In emergency response - especially medical situations - every second counts. Often, the most critical time factor is the availability of basic information: Where is the patient (or event) located? Where are the nearest and most appropriate emergency resources (ambulances, helicopters, hospitals, firefighters, police officers, etc.)? How quickly can they get there?
Collecting all of this information can waste valuable time. As Emergency Medical Services Director for LLUMC, Dr. Jeff Grange has often witnessed the problem firsthand.
"In addition to working at Loma Linda, I fly with the San Bernardino County Sheriff's Air Rescue Team and work as their Medical Director. I was on the helicopter one day when we had just dropped off a patient. As we were flying back, a little 6-year-old girl got run over by a car and we were only about 30 seconds away. But the County Communications Center didn't know we were right there, so they dispatched a helicopter from Anaheim that was more like 30 minutes away. It became clear that we weren't getting the right information to the right people to make the right decisions in a timely manner."
He recalls a similar situation during a large Southern California wildfire. "I was sitting out there with a number of helicopter pilots and they were going nuts because they could see these houses burning, but they weren't allowed to just freelance. They can't dump water on the fire unless they're ordered to by the EOC (Emergency Operations Center). I went over to the EOC and it was clear that they were really just trying to get information - making phone calls, radio calls, just trying to figure out what they had, and where.
"Those were some of the motivations behind thinking, 'Gosh, we've got the technology. Why can't we fix this?'" That's also why Dr. Grange became the driving force behind the AEGIS concept.
The Solution: Real-time situational awareness for faster, better decisions
Recognizing that the challenge was fundamentally geospatial in nature, Grange and his LLUMC colleagues contacted ESRI, the world leader in GIS technology, to discuss some general concepts.
ESRI then developed a web-based system (The Advanced Emergency GIS, or "AEGIS") that monitors and maps the location and status of emergency resources such as hospitals, air ambulances, and rescue helicopters. The real-time vehicle location and tracking data is provided through Air-Trak.
The AEGIS server receives continuous data feeds and photos that show where air ambulances have been dispatched and which freeways are congested. At the medical center, a Mobile Intensive Care Nurse can see the information displayed on a digital map on a 40-inch LCD monitor. The map layers also include roads, schools, and malls.
By glancing at the screen or clicking a button marked with symbols, the nurse can see an instant snapshot of:
"Those features and others on the AEGIS system help emergency personnel, whether they're at a hospital or in a communications center, route patients faster and to a hospital that specializes in the care they need," says Grange.
"In the past, emergency vehicles have occasionally run into traffic jams. By consulting the freeway camera feeds and traffic incident reports on the computerized map, emergency personnel can plan alternate routes to the hospital."
The Implementation: Integrating data from multiple sources
After exploring some general concepts with ESRI, Dr. Grange and others obtained federal funding and began to build the AEGIS system.
Full integration for total situational awareness
Part of the challenge in developing AEGIS was the fact that emergency services are so fragmented, with numerous fire departments, police departments, ambulance companies, hospitals and other resources involved. LLUMC wanted to build one system that could become a community resource for all of these EMS organizations, enabling them to be fully coordinated, with each one having situational awareness of what the others were doing.
"I think the unique aspect here is the number of sources of information we've brought together in one user-friendly system," Grange explains. "We integrated the hospital diversion statuses and the locations of all the fire departments, schools and law enforcement officers. We integrated real-time traffic and weather conditions and all these other things that affect the decisions we make. I don't know of anyone else who's integrated all of those into one system."
Real-time vehicle location and tracking with cellular and satcom coverage
Of course, real-time vehicle location and tracking information is also a central component, says Grange.
"We looked all over the country for somebody that had current, off-the-shelf technology that could be integrated with the ESRI system … but also something that would be flexible. Air-Trak stood out because they really have it all. You have the options of using a basic cell phone or an in-vehicle unit with a cellular antenna or even satellite communications, so we literally have coverage everywhere. Most of the other companies we looked at were either cell-based or satellite-based, but not the full spectrum.
"Air-Trak also had a relationship with ESRI and a history of working with ESRI software, which certainly helped. Integrating the Air-Trak service was very smooth, and it happened very quickly."
Flexibility for implementation by EMS agencies anywhere
The ESRI application, a customization of the new version of ESRI's ArcGIS technology, can also be replicated elsewhere, according to Bill Davenhall, Health and Human Services Solutions manager for ESRI. "This unique system has been developed for LLUMC, but the solution can be implemented for any hospital or EMS organization in the world.
"It enhances the day-to-day decision-making of the nurses and physicians in the emergency department. And in case of a major emergency, it provides a single view for emergency personnel across the region. This is the first time that a hospital emergency department has had the tools to achieve situational awareness from multiple sources in one view."
Dr. Grange agrees that much of the system's power lies in its flexibility. "If you're an EMS organization and you want to add - whatever - where are your hazmat teams or your caches of antibiotics or anything else, you can add those as additional layers."
How can other organizations benefit from this solution? "We've already built the software and now we'd like to see it be a community resource not just here, but regionally and nationwide, says Grange. "This is basically current, off-the-shelf technology, so someone can take this system today and start using it anywhere in the country. We'd love to collaborate with other organizations."
The results: Instantaneous information that helps save lives
From hospitals to dispatch centers to field personnel, the AEGIS system fills a critical need for EMS users everywhere.
In the past, says Grange, an ambulance might have been directed through bad traffic, or even through another accident scene. Now, with AEGIS, the base hospital can see everything in real time. When someone makes a 911 call on their cell phone, it shows up on the map, and the team can respond accordingly.
"If you have a battalion chief who's out at a big trauma or an accident and trying to decide, 'Should we take this patient by ground or go by air? Which hospitals are open, which ones are on diversion?' Each one of those things would have taken a radio call or a telephone call. But now, because it's all web-based, he can take a glance and immediately see where his ambulances and helicopters are, and make better decisions.
"Just the other night when I was working in the ER we had a patient up in the Cajon Pass area, in the mountains north of Loma Linda University. It was a significant trauma and it was in the afternoon when the traffic's typically really bad.
"We didn't know whether they should call a helicopter or go by ground ambulance to the hospital or what. But we were able to look on the AEGIS system and immediately see that traffic was moving well and that there were no helicopters in that area. So we told them to go by ground instead of air. That allowed us to make a much better decision. Before, we really would have been functioning in a black hole without any real-time information.
"To put it simply, this is a powerful tool that can help save lives."
