it & health care disaster management: training + delivery = progress

4th International Conference on Transforming Healthcare with IT 6th – 7th Sep. 2013 Hyderabad, India

IT & Health Care Disaster Management: Training + Delivery = Progress

Russell J. AndrewsAmes Associate, Smart Systems & Nanotechnology

NASA Ames Research Ctr, Moffett Field (Silicon Valley), CA, [email protected]


JAMA(J Am MedAssn)7 Aug 2013


First Young Neurosurgeons Forum quarterly online symposium 29th January 2011

Muhammad Raji Mahmud, MD, FWACS, Chair, Young Neurosurgeons Forum of the World Federation of Neurosurgical Societies (WFNS)

Neurosurgical Service for Disasters: Telemedicine/Telesurgery & the Mobile

Emergency/Neurosurgical Unit (MEU/MNU)

Leónidas Quintana (WFNS 2nd Vice President) Russell J. Andrews (NASA Ames)


Disasters destroy medical facilities – NO HOSPITALS, NO ORs

Disasters destroy local infrastructure – NO ELECTRICITY, NO WATER, NO FOOD, NO HEAT, NO LIGHT, NO STERILIZATION

Disasters destroy local supply lines – NO ROADS, NO AIRPORTS, NO REPLACEMENT EQUIPMENT, NO RESTOCKING SUPPLIES

Disasters may destroy personnel – LOCAL MEDICAL PERSONNEL ARE NOT IMMUNE FROM INJURY or DEATH

Disaster Management: The Problem


Disasters destroy medical facilities – SELF-CONTAINED PORTABLE O.R., WARD, CLINIC

Disasters destroy local infrastructure – “IMPORTED” FOOD, ELECTRICITY, HOUSING

Disasters destroy supply lines – ALL RESOURCES MUST BE “IMPORTED” BY HELICOPTER

Disasters may destroy personnel – NEUROSURGEON IS USELESS w/o ANESTHESIOLOGIST, NURSES, SUPPORT STAFF (and TRAUMA SURGEONS, etc)

TELESURGERY is essential to provide personnel for immediate full-service Neurosurgery Disaster Relief

Disaster Management: The Requirements


A Combat Support Hospital (CSH ) is a mobile hospital delivered in standard military-owned Demountable Containers (MILVAN) cargo containers and assembled by the staff into a tent hospital to treat wounded soldiers. The hospital is typically between 16 and 256 operational hospital beds.

The great operational advantage of the DEPMEDS facility is the use of single or double expanding milvans to create hard sided, air conditioned, sterile operating rooms and intensive care facilities, which can produce surgical outcomes similar to that seen in fixed facility hospitals, and do so in an austere environment.

Wikipedia

Mobile Emergency Unit (MEU)US Military Combat Support Hospital Model


Chinook Helicopter: Payload 12,000 kg; Range 1,100 km


CereTom® Portable CT Scanner


• CT Angio, Contrast & Xenon Perfusion• Mobile – On Rollers• Can be powered by a car battery with an inverter!


CARS Berlin 2011


Ceiling mounted remote robotic camera (OR): Remotely located assistant “master surgeon” Neurosurgery education Guide Emergency Physician in Remote Clinic

Portable (“briefcase”) remote robotic camera: Held by EMT at trauma scene – “remote exam” Attach to mounting – helicopter, ambulance

Constant remote pt monitoring (visual, auditory, vital signs) from injury site to hospital neurosurgeon –anywhere there is internet access!

Vigilent Telesystems: Quebec, Canada


Medical Design Briefs, May 2010


Tech Review 2010 &MDDI 2013

MedicalDesignBriefs2011

Sometimes a disaster…

Can become an opportunity!(Bring together people for a humanitarian response)


To facilitate the personal association of neurological surgeons throughout the world. To aid in the exchange and dissemination of knowledge and ideas in the field of neurological surgery. To encourage research in neurological surgery and allied sciences. To address issues of neurosurgical demography. To address issues of Public Health. To implement, improve and promote the standards of neurosurgical care and training worldwide.

World Federation of Neurosurgical Societies (WFNS) Mission Statement


Portable OR w/ full infrastructure supportComplete medical/surgical & support staffMobilization by helicopter to disaster site < 24 hrsContinuously operating MEU will be ready for deployment at any timeIT for remote communication & surgery supportIdeally 4 (or more) sites: Latin America, Africa, Central Asia, Southeast Asia

Mobile Emergency Unit (MEU)


Competitive application - similar to site selection for WFNS educational courses & meetingsIn conjunction with local neurosurgical/trauma unitLocated where the ongoing service need is great (underserved region)Located where tertiary backup available (e.g. by air transport)Two years support in a given location/country

MEU Site Selection


Combination of ‘host country’ and ‘developed country’ staff, residents, and support (e.g. nursing)One month to one year term for all visiting staffStandardized training – curriculum developed by international organizations (e.g. WFNS)Integrated training of both ‘host country’ and ‘developed country’ residentsResident experience with IT + remote monitoring & surgery under challenging conditions by host country

MEU Staffing & Educational Benefits


An ‘apolitical’ way the WFNS can foster universal neurosurgical standards for training and certificationExtended day-to-day association of staff from developed and developing countries – camaraderie Junior host country neurosurgeons will gain appreciation & respect for the WFNS missionResearch platform for trauma, remotely-guided surgery & disaster management ITImprove Public Health & neurosurgery worldwide

MEU Additional Site Benefits


Or will IT be misinterpreted or misused by future generations??


San Jose (Calif) Mercury News 14 Aug 2013


San Jose (Calif) Mercury News 13 July 2013

“Every breath you take, every move you make – Euclid Analytics will be watching you!”

With apologies to Sting…


Proteus Digital Health IEM

MDDI Nov 2012

“Because nothing is more reassuring to a schizophrenic than a corporation inserting sensors into your body that beam information to all those people watching your every move.”

The Colbert Report

Not entirely a joke…

Ingestible Event Marker wonFDA approval July 2012.


Med Design Tech 2013


BioOpticsWorld &Lab Chip 2013

Smartphone cradle + $200 optics

=$50,000 lab-basedspectrophotometer


Conducting polymer-coated CNF arraysgreatly enhance

biosensitivity for a “Lab On A Chip”


Using cell phones to track malaria…Tech Review Mar 2013


Tech ReviewMarch 2013


“You must be the changeyou wish to see in the world.”

IT & Health Care Disaster Management: Progress is Possible if We Think & Act

Creatively & Responsibly!

Mahatma Gandhi


ThankYOU!!

Foreign AffairsSep/Oct 2013

PS: Let us not forget the“fruit walas”…

it & health care disaster management: training + delivery = progress

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