Role-Tailored Software Systems for Coordinating Care at Disaster Sites: Enhancing the Capabilities of "Mid-Tier" Responders

In disaster settings in which field care is organized using the Incident command system (1), there are three “tiers” of providers: first tier emergency medical personnel who provide direct patient care at the Triage, Treatment and Transport areas( first tier), the supervisors who organize care within of the areas (mid-tier), and medical director, who organize care-process for the entire site (top tier). Current systems for disaster respond and field medical care rely on paper triage tags that are attached to the patients and pen, paper and clipboard to record aggregate information on patients, ambulance availability and hospital status. Radio and direct communications have been the primary way of delivering information about the disaster scene, the patients being treated, and where these patients will ultimately go for definitive care for their injuries. As part of the WIISARD project (2), we are developing role-tailored computer systems for all responders to replace radios and paper documents. Mid-tier providers play a crucial role in response. tracking where victims are at the disaster site, determining which victims need treatment and the priority for treatment, determining the best place for the victim to receive definitive care and last, determining the best means of transport. This task is made more difficult because work must be coordinated among the different area supervisors. While devices for first-tier responders have an analog in electronic medical records systems, there is comparatively little experience in informatics with software that supports management of scarce resource in real-time situations by “mid-tier” supervisors. Current work- flow for mid-tier supervisors is based on use of checklists for procedures and notes on clipboards for maintenance of data on victims. The computer replacement uses a spreadsheet model on a tablet computer, with tailoring of displayed columns based on the position of the supervisor (Triage, Treatment, Transport). The mid-tier system interface details activities in various patient care areas using aggregate list of patients on the scene. The current triage status of the patient (needs immediate treatment, delayed treatment, walking wounded, or expectant/dead), the list of hospitals available to receive patients, how many patients each hospital can take, and which transporting ambulances area available, as well as their location and estimated time of arrival are all displayed. This information is supplemented by access to maps, individual level patient data, and communications tools. Screen from a prototype of the Mid-Tier system and a picture of the rugged tablet-computing-device used by the system.