Calit2 WIISARD Researchers Demonstrate That They Are 'Rough and Ready'

Rough & Ready DMAT tents
DMAT triage area
[Photos by Barbara Haynor]
Rough & Ready inside hangar
Inside hangar, DMAT triage area is located just outside  bottom left corner of photo.

Moffet Field, NASA AMES, CA, May 20, 2006 -- Researchers from Calit2's WIISARD project (Wireless Internet Information System for Medical Response in Disasters) successfully demonstrated their mass-casualty patient tracking system during the California EMS Authority's annual Rough and Ready on May 7, which was held at NASA AMES Moffet Field, in Santa Clara County. WIISARD's participation in the largest state-wide emergency preparedness exercise also brought a couple of 'firsts' for the research group.

WIISARD researchers have participated in many drills and exercises over the past several years. However, this was the first time that the team traveled outside of the San Diego area for a drill and it was the first time that they have worked with Disaster Medical Assistance Teams (DMAT) in an exercise. "We already had close relationships with the San Diego DMAT team. This exercise gave us the opportunity to test our equipment and determine if our system can work well with their mission," explained Leslie Lenert, associate director of the UCSD Division of Calit2 and a professor of medicine at UCSD's School of Medicine.

The results were very successful. The research group's participation was originally intended to be a shadow exercise. However, as the day-long drill progressed, WIISARD's mass-casualty tracking, triage and medical information management system became integrated into the exercise. The system enables the creation of real-time electronic medical records of victims/patients triaged at disaster scenes. This information, both aggregated and individually, is available to medical personnel throughout a deployed WIISARD system: supervisors at the scene, the command center and at the receiving hospital. Medical and transport group supervisors can match the conditions and needs of patients with real-time data on available resources such as ambulance availability and location and hospital status.

(More information on the system and set-up is available in the related article, click on title: Tech Specs: Specifics on WIISARD System Set-up .)

Lenert, Jacoby, Lippin
Calit2's Leslie Lenert (WIISARD PI), Irving 'Jake' Jacoby (Commander, DMAT San Diego CA-4) and David Lipin (Commander of the Bay Area DMAT CA-6 and Incident Commander for the Rough and Ready exercise)

"WIISARD's patient tags worked well. I was impressed," noted Ted Chan, medical director, department of emergency medicine, UCSD Healthcare. "This system is useful both immediately after a disaster occurs and in the hours-to-days afterwards, where you are still tracking patients in the field. Patient tracking is a real challenge for any disaster situation where you have lots of victims."

The simulated scenario for the day was that an earthquake had taken place in the area and the focus of the exercise was on large scale transferring of patients. The overall goal of the Rough and Ready was to practice patient tracking. Another participant in the drill, Colleen Buono, an emergency medical services fellow with UCSD Healthcare, reflected on the importance of good patient tracking, "it is a safety issue and a family issue, for which there is no good answer currently." Buono and Chan are also members of the San Diego DMAT team.

Ted Chan triage
Volunteers from the local community play the part of the victims (left), seen here receiving both kinds of patient tracking tags. On the right, Ted Chan (DMAT, WIISARD) holds electronic tag in left hand. Next patient (middle) is being handed paper patient tracking materials (white paper on manila envelope).
inside C-130
Patients were loaded into the C-130; it took five minutes to load each one. The plane took off, circled a few times then landed. Patient were taken off and a second wave of patients were triaged.

The exercise took place inside a gigantic hangar, built in the 1920s and designed to house two zeppelins. Approximately 150 - 200 people participated in all, a dozen were WIISARD researchers and 42 were members of DMAT San Diego. The inside of the hangar was like a wind tunnel, very chilly with winds to 40 mph. A paper being held in hand rattled so bad that it was difficult to read.

A C-130 aircraft (4-engine cargo plane with a rear ramp) located just outside the hangar, was used to simulate transporting the evacuees. It was loaded with 'patients' (community volunteers), took off and circled several times before relanding and reloading. DMAT set up operations in the hangar close to where the patients were to be loaded and unloaded.

As patients were triaged, each was given two tags, a traditional paper one and one of WIISARD's electronic 'smart' tags. The 'smart' tags have LED lights on them corresponding to the patient's status. After the first responder triages the patient, the light indicating their status flashes. "The clinicians loved the lights and being able to see status without having to look through papers," stated Chan, who is also a professor of clinical medicine at UCSD's School of Medicine. He continued: "They really thought the system was very useful for them." Doug Palmer, WIISARD's Tag Design project leader, was surprised to see that "on the receiving side, they waited for the tag to come up. Even though we were shadowing, they relied on the tags."

UCSD's Buono was also impressed, "by the power of the system's usefulness, accuracy and reliability." Chan felt that the tags really shined, "particularly at reassociating, when we turned them off and then back on." In addition to the very positive reactions of the first responders, comparison of results between the paper and WIISARD's electronic systems were also strong (~99% WIISARD to ~70% paper). For the WIISARD system, all but one of the patient records was maintained completely and accurately. The paper system, on the other hand, had problems: four patient's records were lost completely and others were incomplete. The wind was a significant factor.  

"The software worked well, they were actually using it," said a pleased Steve Brown, WIISARD's Software and Systems Architect for the patient monitoring system. "There are trade-offs. Obviously you have additional difficulties with an electronic system that you do not have with paper, but many of the issues with paper records are resolved," he explained. "I want to make sure that it is not a system that will completely take over and replace paper. I want it to augment the standard way of treating people using a paper system."

WIISARD's Palmer, also a Calit2 development engineer, was equally impressed with the performance of the first responders. "In the DMAT tents there was this huge seething amount of activity, very focused and professional. And if you pared it down carefully to see what it was, it was all information transfer - yelling data and data entry - so much record keeping. It was amazing to watch it happen." It struck him that there is much that WIISARD can do to help manage this. DMAT member Buono summed it up, "There is a lot of potential for future collaborations. It may solve tracking problems in the future."

Rough & Ready Fang Highberg Huang
Inside a triage tent: (l-r) Fang Liu with WIISARD electronic tag, Sandra Highberg (DMAT CA-1) and Ricky Huang with WIISARD Mid Tier device.

The primary organizer of the 'Rough and Ready' drill was the California EMS Authority. WIISARD participated in just one day of the overall exercise. Nine DMAT teams, seven from California and one each from Arizona and Nevada, participated in a week long exercise involving many aspects of their activities. DMATs provide medical care and services in disaster areas and associated transfer points and reception sites. Although they are locally organized volunteer medical teams, they are deployed throughout the U.S. as needed. DMAT San Diego CA-4 is sponsored in part by UCSD.  

Another factor raising the level of this exercise was the participation of the California Air National Guard, as they have not engaged in one for several years. Other participants included personnel from: CNG C/297th SPEARR, CANG 146th, the California Department of Health Services, Santa Clara County, City of Fremont, Stanford University, Valley Medical Center, Salvation Army, NASA, and many others from the surrounding communities.

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