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Lesson 2: Disaster Response and Preparedness for Emergency Medical Services
Communication and Equipment Standards
Communication Technology Standards
Communication technology standards are technical specifications that enable technological components from different suppliers to work together within a given communication system. Some standards refer to the physical interfaces between network and terminal equipment. Others refer to logical elements expressed in algorithms and embodied in software.
- Mesh Networks
- WiMAX
- Voice over IP (VoIP)
- Software Defined Radio (SDR)
- Supply Management System (SUMA)
- Internet
- Security/HIPAA and Wireless Peer Networks
- Wireless Technology Overview
Mesh Networks
Mesh networks offer higher bandwidth, improved reliability and greater coverage than Wi-Fi, and could allow first responders to create interoperable networks on the spot (McKay, 2005). Standard point-to-point or point-to-multipoint technologies, such as 802.11, are short range, wireless networks where bandwidth decreases as additional users join the network, but mesh networks are stronger with more users. The multiple nodes in a mesh network provide reliability because if one node fails, many more are available. Mesh networks can also be used for areas where Wi-Fi would not work, such as in concrete buildings. Functionality begins to decline when a large-scale network is needed, such as a statewide system.
WiMAX
WiMAX is an extension of Wi-Fi, which can deliver high-speed wireless connectivity but at a far greater distance, as far as 30 miles, and this ability to blanket a large area is of benefit to public safety operations. WiMAX may have the potential to provide an open standard nationwide that will allow for true interoperability between agencies in different areas and could revolutionize wireless public safety systems. It offers flexible radio performance in both licensed and unlicensed radio spectrum.
Fixed wireless, or “pre-WiMAX” networks are already being deployed for police, hospitals, and ambulances to transmit data and images in real time. More WiMAX wireless products that support mobility are expected to become available.
A challenge to overcome is the matter of interference, which is likely in unlicensed spectrum. The FCC has freed spectrum in the 800 MHz band for public safety so interference can be avoided (McKay, 2005).
VoIP
VoIP refers to the transmission of voice over a data network. VoIP digitizes voice audio, sends it in the form of data packets over an IP network, then converts the data back to an audible voice. This would be valuable where efficient or enhanced voice communications, advanced calling, or messaging features are needed, such as those in emergency operations centers during simultaneous multiple communications (Amber Alerts, tornado warnings).
Challenges still exist in securing the system, but the technology is showing promise—the Commerce Department turned to a VoIP network after the agency’s emergency system failed after the September 11th attacks (McKay, 2005).
Software Defined Radio (SDR)
SDR is a major breakthrough in interoperability, especially for major incident response where many public safety agencies are mobilized on little or no notice and have incompatible radio systems. SDR allows the different agencies to plug into a base station and download software that connects with everyone. Since response for a disaster can result in many teams from different areas of the country converging, this technology solves a major communications block. Costly, not well understood, and lacking stardards or guidance, this technology thus far has not been widely adopted (McKay, 2005).
Supply Management System (SUMA)
One of the best-known applications of IT during the emergency phase of disaster is the Supply Management System (SUMA), a computerized information management tool created by the Pan-American Health Organization. SUMA helps national authorities track donated supplies in disasters until they are effectively distributed to the affected population. Another example is the use of commercial software packages (e.g., EIS or Softrisk) by emergency operations centers in support of emergency management functions, such as incident or resource tracking or mapping, or real-time communication (Arnold, 2004).
Internet and Social Media
If accessible, the Internet can be a valuable tool for information sharing and news gathering during the emergency phase of a disaster. Social media allows for another channel of broadcasting messages to the public, but also allows for two way communication between emergency managers and major stakeholder groups. Recent emergencies have shown that the public is turning to social media technologies to obtain up to date information during emergencies and to share data about the disaster in the form of geo data, text, pictures, video, or a combination of these media. Social media also can allow for greater situational awareness for emergency responders. While social media allows for many opportunities to engage in an effective conversation with stakeholders, it also holds many challenges for emergency managers.
FEMA utilizes numerous social media accounts as part of their mission to provide information to the public before, during, and after a disaster. This includes YouTube, Facebook, Twitter and IdeaScale, and for a list of their official social media accounts see http://www.fema.gov/social-media
Security/HIPAA and Wireless Peer Networks
In areas of total devastation, OOH responders may need to bring their own communication infrastructure. This type of communications may be too sparse to cover the entire geographic area affected. One way to overcome this is wireless peer networks. These are created by mobile devices brought to the scene by emergency responders, where each device produces, receives, and relays information. Two key innovations are ad hoc wireless routing networks and peer-to-peer (P2P) architectures (Arnold, 2004).
Ad hoc wireless routing networks make use of the ad hoc location of mobile peers and discover the shortest route between arbitrary peers when other peers are used as intermediaries. Two peers out of radio range are enabled to communicate via an intermediary peer who is within communication range of both. This allows network routing independent of pre-existing network infrastructure, fixed peer locations, or network partitions (Arnold, 2004). No single device or peer is crucial, allowing all information to be widely available and is redundant in distribution. This makes P2P architecture resistant to disruption. As more peers enter the network, the P2P architecture becomes more robust.
Immediately after a disaster event, once-secure networks may no longer exist, so care must be taken when transmitting data that could be used adversely. Policy must be defined for information sharing and a risk assessment performed. Security requirements include ensuring the following:
- All communications between emergency response personnel are authenticated;
- Only authorized users are able to access information;
- Information always is available to all authorized users who require it;
- The integrity of all information being shared or collected must be maintained;
- The confidentiality of all records being shared or collected must be maintained.
Event logging and subsequent forensic investigations may require that records created by workers are nonrepudiable (Arnold, 2004).
Authentication of the user can be achieved in a variety of ways, with the most common being a password. Most secure wireless devices can support a 128-bit encryption password or more to help protect patient confidentiality. Protecting such confidentiality is federal law, according to the U.S. Health Insurance Portability and Accountability Act of 1996 (HIPAA), and an organization must make reasonable efforts to comply.
Wireless Technology Overview
IT communications infrastructures are wireless or tethered (wired). Wireless infrastructures include satellites, cell towers, Wi-Fi (IEEE 802.11), or Bluetooth. Tethered communications infrastructures include ethernet over coax cables or optical fibers. Most disasters require wireless communications with tethered communications being a less reliable necessity (Arnold et al., 2004). After a disaster, replacing a cell tower that only needs a cleared footprint with its own generator is much easier than running new fiberoptic cable requiring debris removal over a much larger area with extensive excavation. Alternate sites for wireless relay devices include the tops of traffic light fixtures, rooftops, or other existing fixed sites, so equipment that can withstand extremes of weather is paramount.
Unidirectional wireless systems support the transmission of data from out-of-hospital emergency responders to hospitals in a number of communities. One example is the use of a fax “notepad” linked to cell phones, which can then transmit information (e.g., a heart rhythm analysis, electrocardiogram, etc.) by fax to hospitals (Arnold et al., 2004).
Current wireless technology designs suffer from three main limitations related to their dependence on centralized architectures (e.g., cell towers) during disaster response:
- Wireless communication infrastructures must be pre-existing (already built).
- Wireless communication infrastructures must be available (e.g., not jammed with people trying to make cell phone calls in disaster-stricken areas).
- Wireless communication infrastructures (and power infrastructures) must remain intact in spite of the disaster event.
Communication Technology Applications
Assessment Databases
Wireless peer networks, which can be distributed over a wide area to responders already on-scene or en route, can enable scene assessment databases to be updated continuously as events unfold or as triage is performed. Such updating acts as a real-time briefing mechanism and can enable incident commanders to re-route incoming responders and/or equipment. Wireless peer networks may also support continuous input and tabulation of data from victim assessments to provide such real-time information as the number of victims triaged to a specific category or need (e.g., decontamination). This information can be coupled with GPS to map the locations of victims and rescue personnel and their vehicles in the affected area. In addition, radio frequency identification (RFID) systems can be utilized. RF tags (small computer circuits with identifying information) may be attached to victims during triage, to responding personnel, to vehicles, or to supplies (Arnold, 2004). In 2010 three key factors drove a significant increase in RFID usage: decreased cost of equipment and tags, increased performance to a reliability of 99.9% and a stable international standard around UHF passive RFID.
Radio-frequency tagged persons or objects do not depend on line-of-sight contact between receiver and tag. Some RF systems enable data stored on RF tags to be updated or expanded. Also, RF-tagged victims or resources may be located via GIS to produce a real-time map of the affected area.
Automated logging of key on-scene events, such as a decontamination, may alert those Incident Commanders (IC) in charge of response efforts and help plan for developing problems. Also, RFIDs can "turn on or off" as personnel or vehicles arrive or leave a scene that triggers an automated logging. This data can be kept in a database for on-going review of events and help to identify problem areas much quicker. In the case of a decontamination event, such data would notify the IC to provide or replace proper protective equipment.
Incident Command System Support
Probably the most important application of wireless peer networks in emergencies and disasters is in support of the Incident Command Systems (ICS) functions (Arnold, 2004). Effective coordination and control of emergency response depends on the effective coordination and control of information sharing.
Applications of wireless peer networks, which may facilitate incident management functions, include the following:
- Baseline and updated scene assessments, including hazard assessments and the locations of hazards;
- Baseline and updated needs assessments, including numbers, types, and triage status of victims;
- Baseline and updated capacity assessments, through tracking of on-scene and off-site personnel, vehicles, and other emergency response resources;
- Emergency response resource locations (i.e., personnel, vehicles) through GPS-linked devices;
- Pre-selected and pre-loaded operations information, including clinical algorithms, maps, and contact information;
- Automated personnel assignments to pre-selected ICS positions through ICS-linked responder registries based on pre-determined criteria;
- Customized event logs relevant to each ICS position to update newly assigned ICS unit leaders;
- System alters as scene hazards are discovered or change;
- Customized alerts relevant to each ICS position, including changes in personnel within each chain of command.
(Arnold, 2004)
Communication Technology Challenges
Numerous critical challenges exist for the effective use of Information Technology (IT) in an OOH disaster response. Among those, two key areas are human challenges and application challenges.
Human Challenges
On the human level, challenges lie in planning joint powers agreements and procedures and in deciding how to use wireless technology in different situations, which can be overwhelming to non-IT experts. Any IT being considered must meet the following criteria to mitigate the human challenges:
- User friendly
- Accepted by the personnel using the technology
- Compatible with existing communication links
- Easily taught and learned
- Cost-effective
- Flexible
- Deployable via technology already in possession of those who will be using it or via inexpensive off-the-shelf hardware
Application Challenges
Application challenges that are further exacerbated during a disaster include:
- Database access
- Text/audio/photo/video message routing
- Information retrieval systems
- Automated needs assessment systems
- Localization and directional systems
- Automated logging systems
Factors enabling the application of wireless technology to OOH disaster response include the following (Adams et al., 2004):
- Increased bandwidth for radio transmission
- Increased mobility
- Miniaturization and durability of devices
- Improvements in batteries
- Decreased costs