Using Geographic Information To Aid Patient Care
A prehospital crew working on a shooting victim radios the control facility for an available trauma center. Looking at a map of available centers, the mobile intensive care nurse at the control facility sees the crew is only a few miles from the nearest one. But what if they can't get there?
ESRI, a Redlands, CA, company that develops mapping software applications, is working with Loma Linda University Medical Center to develop the Advanced Emergency Geographic Information System (AEGIS). Lea Lynch, MD, an attending physician in the LLUMC emergency department, says the system is already being used in the ED.
"If there is a collision in between you and the closest hospital," says Lynch, "it may make more sense for you to go to the next-closest hospital." With AEGIS, she explains, an ambulance can be rerouted based on live traffic information, saving valuable time. "AEGIS shows specialties and up-to-date diversion status information for each hospital," Lynch says.
It also shows weather and traffic information. The California Highway Patrol and California Department of Transportation (Caltrans) provide data feeds to the public via the Internet. CHP offers accident information, and Caltrans provides video from cameras monitoring freeway traffic. "What we do is harvest those feeds," says Anak Agung, a senior consultant with ESRI.
Agung says AEGIS takes feeds showing ambulance and helicopter availability, traffic, and weather and hospital status, and portrays that data graphically using icons on a map. When a user needs to check highway traffic or look at hospital resources, he or she simply clicks on its icon. Users can pick which icons to display on the map, like adding layers over a base picture.
Currently, AEGIS only works with a map viewer developed by ESRI. Eventually, says Agung, it will be usable on many common viewers. "The system will be a subscription service," he explains. "Users will have very little software to install." Information will be sent over the Internet to clients through GeoRSS, an emerging standard for encoding location as part of an RSS feed, disseminating it out to users for viewing on whatever map they like.
Most viewers, says Agung, process geographical information in similar ways. GeoRSS feeds can be laid directly onto any map. The next generation of AEGIS, he explains, will be able to run on laptops and tablet PCs. Eventually, even mobile phones will be able to communicate with AEGIS.
According to Lynch, the system has been well received. "We have all that information coming in," she says. "The daily use is to make the best patient care decisions based on available information." But, she says, the applications for AEGIS are just beginning. "This second phase we envision as not only an EMS tool but a disaster tool."
"Interoperability has been a key process we've tried to build into this," says Ron Holk, operations coordinator for Loma Linda's Center for Prehospital Care, Education and Research. "We wanted to develop a good, workable situational awareness piece that an incident commander can use in the field during a disaster. If an IC wants to know what's happening at the far edge of an incident, he has to know the cell phone number of the person he's calling. With AEGIS, he can click the white truck on the map and send that person a text message. The IC doesn't even have to know who's in the white truck."
The future of projects like AEGIS touches on ideas that seemed science fiction just a few years ago. "You in the field won't have to tell us a whole lot, because we can see it," says Lynch. "All the info you would tell us from the scene could be plotted on the map—number of patients, resources, etc."
A single database like AEGIS can be used to manage electronic health records or flag concerns. "We'll be implementing some stuff for biosurveillance so we can see things develop in real time," adds Lynch.
It stands to reason that even with such futuristic applications of AEGIS, those working with the system will find new and innovative ways to use it.
Rod Brouhard is a paramedic for American Medical Response in Modesto, CA, and former director of the EMS program at Modesto Junior College.
