Medical Librarian and Disaster Preparedness

1. Medical Librarian and Disaster Preparedness Patti Reynolds, MLIS Sarasota Memorial Hospital

2. Medical Library Components • Preservation of the library collection • Delivery of medical information that is pertinent to the event – toxicology, infectious disease, etc • Provision of necessary medical guidance information for emergency preparedness within the hospital, county or region such as guidelines, literature, etc. • Ethical information

3. Preservation of the library collection • Natural disasters and emergencies • Floods, hurricanes, tornadoes, fire, cyclones,tsunamis, volcanoes • Man made disasters • Sprinkler system malfunction, arson, computer systems, terrorism, bioterrorism; cyberterrorism, nuclear accidents, chemical accidents

4. Maintain Library Operations: 5800 NN/LM Libraries of Medicine Back-Up Plans Disaster Plans Emergency Preparedness and Response Toolkit Publishers Emergency Access Plan http://nnlm.gov/ep 4

5. #2 Delivery of Medical Information • Depends on the type of emergency • H1N1 • Clear, definitive, authoritative information on vaccine and anti-virals: availability, clinical studies,etc. • Guidance for hospital on supplies, algorithms, finance, state policies, etc. • Guidance for local doctors: • Phone numbers, etc for Department of Health • Where to send specimens • Latest DOH updates – changed every other day

6. H1N1 • Policies on vaccination • Daily changing nationally • New York, HCA • Ethics information • Triage • Mandating vaccination • Duty to treat • Duty to return to work • Etc, etc

7. Education and Training • Education of staff • NIMS, HICS, local organization of emergency preparedness • Department of Health • EOC – police, fire, ems • Hospital • Security department – in charge of EOP • Clinical departments – mandatory education • Physicians and community - all separate groups. • Drills • Need for constant drills

8. Joint Commission • An independent, not-for-profit organization, • The Joint Commission accredits and certifies more than 17,000 health care organizations and programs in the United States. • Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards. • Tremendous emergency preparedness section implemented in last 3 years.

9. Lessons learned • Dramatic silos – all groups • Within the hospital - departments • Locally – city and county • Regionally • Federally • Results of silos • Defensiveness • Leads to denial of information • Ignorance • Inability to educate

10. Librarians actions and goals • Embed yourself in your close and extended world. • Listen, evaluate, research, offer • Become completely knowledgeable about topic – takes time – • become the local knowledge expert!!!

11. Library as Switzerland • Interpersonal relationships enormously important • Build distribution list to all affected groups and send updates, articles, news, etc. • Slowly build up distribution of information

12. NIH Institute • Employees ~ 1300 • Budget ~ $360 M • Free 1836 • 9 million items in collection • 1 billion searches of our databases done each year • Biomedical informatics and communications • New focus: Disaster Health Information

13. Identify key steps in preparing for & responding to disasters from an information management/ information technology perspective http://disasterinfo.nlm.nih.gov

14. Disasters • Acts of Nature • Pandemics Accidents Terrorism

15. “Accidents” On 4/26/86 major explosion power reactors at Chernobyl 92 nuclear weapons lost , U.S. lists 11 Bhopal India 40 tons methyl isocyonate An accident at a Soviet biological weapons facility in 1979 released a plume of anthrax that killed people and livestock Rapeseed oil 1982 800 deaths Unguarded Soviet Bio Grade Anthrax on Renaissance Island

16. Terrorism sarin WTC X 2 anthrax SUICIDE TERRORIST sent to the U.S. OK City UK, Spain, India

17. Disaster Information ManagementResearch Centerhttp://disasterinfo.nlm.nih.gov

18. DIMRC OBJECTIVES Organize the literature Maintain library operations Provide information &tools for responders Research & Development Surge Model / Partnerships

19. Non-Commercial • Government reports • Homeland Security Presidential Directives • National Incidence Management System • National Response Plan Framework • Conference Proceedings • State publications • Red Cross • Commentaries • NGO publications • Official Reports • Non peer reviewed publications • Community resources • Training design & technologies • Preparedness options • Response plans for different events • Sister Agency Publications • Catalogues • Non Peer Reviewed Journals • Cosco Magazine Commercial

20. Who will Identify, Organize, Preserve, Distribute this varied, diverse, Non-Commercial Literature (& Commercial)?

21. Answer: The Disaster Information Specialist • A new subspecialty of library science • Support emergency personnel with disaster information • 400 librarians EOC / TOC / DIC • Teamed with disaster planners & responders • “just- what-I-need” information “just-in-time” 21

22. The Disaster Information Specialist • Information needs • How they search • Data mining • Create tutorials 5800 22

23. CYBRARIAN LIBRARIAN 23 23

24. http://toxtown.nlm.nih.gov

25. Information & Tools for emergency preparedness & response activities TOXMAP CHEMM PTSD/TBI screener 25

26. R & D -Web 2.0 Tools

27. Virtual Worlds & Games for Training & Simulations 3-D computer simulated environments Users interact via avatars (virtual characters) Parcels of land can be bought, developed, and customized Examples: Second Life, Google Lively, Webkinz

28. We are Not ! Studies 2001-2009 • Institute of Medicine • American Hospital Association • Lay Media • 2008 House Committee On Oversight & Gov’t Reform reported Emergency Care Capacity Survey in 7 major cities • No ER capacity for a surge • Few ICU a surge • Few regular beds for a surge

29. Hospital Surge Response: September 11, 2001 • Bellevue Hospital • 90 patients presented in 5 hours; 194 triaged/treated in 24 hours • Hospital lost track of patients, ran out of supplies and struggled with MD staffing • NYU Downtown Hospital • Typically treats 5-10 patients per hour; on Sept 11 treated 175 per hour (over 1,500 total) • Lost electricity, steam, gas, phone and computer services, and had dangerously reduced water pressure • St. Vincent’s Hospital • Treated nearly 800 patients • Shared water lines and telecommunications lines with WTC, systems were disrupted 29

30. Hospital Disaster Experience: RI Nightclub Fire (2003) 200 injured, 100 killed Kent County Hospital received 40 patients in first hour; 25 were intubated Ran out of critical supplies and ventilators Struggled to support family members Communications problems from disaster scene Ultimately, 16 New England hospitals received 196 burn victims including a pediatric hospital that received 16 adults (Dacey, MJ. (2003). NEJM, 1990-2) 30

31. ARE WE READY ? We Can Be ! 31

32. The Bethesda Hospitals’ Emergency Preparedness Partnership (BHEPP) 2004 Congress earmarked $ 12.9 million to develop a partnership to respond to an extreme patient surge need in event of major DC disaster Leverage combined resources of 3 adjacent hospitals Conduct research to improve the response Develop an exportable model for surge needs National Naval Medical Center NIH Clinical Center Suburban Hospital NLM 32

33. BHEPP VIDEO http://www.suburbanhospital.org/Emergency/EmergPreparedness.aspx 33

34. BHEPP NLM Role: 11 Disaster R & D Projects Patient Information Management Communications Information Access Responder Training • Laser Back-up • Dark Fiber Back-up • MARS Radio Back-up • Wireless Voice Bridge • Virtual World Disaster Training • Prescription Drug access in Disaster • Disaster Information Specialist • Lost Person Finder • Digital Pen • Patient Data Exchange • Patient RFID Tracking

35. 35

36. Digital Pen&"Electronic" Paper

37. Digital Pen Work Flow A disaster generates mass casualties Digital pens capture patient triage data Digital pen transmits triage data to system Triage data is available through BHEPP network Data reports are available for emergency personnel 37

38. 2009 – View Triage Data 38

39. 2009 – View Summary Reports 39

40. Lister Hill National Center for Biomedical Communications Lost Person Finder Purpose: To address a surge of lost persons in a local disaster, by developing a system to enter, search for,&display their descriptions&pictures. Disaster occurs with mass casualties Injured are triaged Staff/volunteerscapture text & photos of victims – initial & updates LPF Database (MySQL), Web server, Image file storage, Email interface Notification and status by wall displays, email, web, etc. Includes statistics for disaster management/awareness Public search & entry of photos & descriptions via LPF web site, mobile email

41. NLMResources to Support the Response to the Earthquakes in Haiti

45. Lister Hill National Center for Biomedical Communications Lost Person Finder Purpose: To address a surge of lost persons in a local disaster, by developing a system to enter, search for,&display their descriptions&pictures. Disaster occurs with mass casualties Injured are triaged Staff/volunteerscapture text & photos of victims – initial & updates LPF Database (MySQL), Web server, Image file storage, Email interface Notification and status by wall displays, email, web, etc. Includes statistics for disaster management/awareness Public search & entry of photos & descriptions via LPF web site, mobile email

46. Haiti Earthquake Person Locator (HEPL) http://hepl.nlm.nih.gov Found in Haiti iPhone App Interactive Notification Wall disaster@mail.nih.gov PFIF Data Exchange 46 Smartphone Person Finder: Haiti Earthquake

47. The successful response to Disasters requires the coordination of multiple elements based in federal, state or local authority, or in the private sector • patients, who may require rescue or medical evacuation • treatment facility-an existing hospital, portable field hospital • competent health care workforce • appropriate medical equipment and non-perishable medical supplies • appropriate drugs, vaccines, tests and other perishable medical supplies • a system of medical records • a health care financing mechanism. 47

48. Conclusion 48 48 Use Informaticstechnologies to provide tools, communications literature, perform research to enhance the Public Health GOAL To Deliver “Just What I Need” Information, “Just in Time”