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- About KHI
June 27, 2011
TOPEKA Michael McNulty was getting ready to eat dinner when he got news of the tornado in Joplin, Mo.
It was immediately clear to the Kansas director of Public Health Preparedness that the town just seven miles east of the Kansas border was devastated, with the destruction including a Level II regional hospital.
Within hours on that May 22 evening, busloads of injured victims would begin arriving at hospitals in southeast Kansas. (The disaster, it was later learned, was the seventh deadliest tornado in U.S. history.)
With medical demand soon to surge at 10 southeast Kansas hospitals, a relatively new piece of technology proved critical in quickly deploying limited resources — EMResource.
The Web-based portal is used to aggregate real-time information about available resources at every hospital in the state. Missouri uses the same system, as do Oklahoma and Colorado. While the different state systems generally operate independently, they can quickly link up when needed.
From his home that Sunday evening, McNulty was able to quickly alert all southeast Kansas hospitals to ready themselves for an influx of patients. Soon after the tornado hit, he issued Mass Casualty Incident alerts via EMResource.
Screens in every hospital emergency department — sometimes on a wall-mounted big screen video display, sometimes on a dedicated computer screen at the main desk — flashed a red warning banner at the top and displayed critical needs.
Hospitals then posted what needs they could fill according to the triage color code — for example, a hospital in nearby Pittsburg could post that it could admit four "reds" (life-threatening injury), 10 yellows (serious) and 25 greens (walking wounded).
Constant situational awareness
Dispatchers for ambulances, police, firefighters, and other emergency responders also had access to the system, which allowed them to quickly determine the medical facility best equipped for a given patient — or a bus full of patients.
With EMResource, officials can see at a glance information such as how many beds a hospital has open, how many beds are projected to be open within 24 hours, which medical specialists are available or not.
"The nice thing about the Web-based application is that we can use it from anywhere," and on any device that has Internet access, McNulty said. "I can use it from any remote location and still be in contact with my partners in the Emergency Management Response community, coordinating resources and helping out the locals."
Just five years ago, McNulty and his five-person staff would have had to make a series of phone calls back and forth between medical providers, emergency responders and coordinators at the State Emergency Operation Center in order to coordinate the same resources.
Now, individual hospitals can provide continual status updates, posting to EMResource at least twice daily.
"Before this system, it was a lot more difficult — it was a lot of phone calls," McNulty said.
With EMResource, "we can get the information without having to actively seek the information. So in a passive way we can maintain situational awareness for the agency and the government at large — sharing appropriate information with EMS partners, highway patrol, the Governor's Office, etcetera."
Tracking the victims
Kansas hospitals are just now beginning to assess the effectiveness of their response to the Joplin disaster, said Dan Leong, the Kansas Hospital Association's emergency preparedness director.
"Some of the initial comments we've received (were that) having the alerts and being able to track the statuses of our hospitals was very beneficial as the Joplin situation occurred," Leong said.
Association spokesperson Cindy Samuelson said EMResource also was critical for locating hundreds of missing persons in the aftermath of the tornado. Each hospital used a "comments" field in its status indicator to list Joplin patients by name.
She said the system helped hospitals to quickly notify state officials of the, "names of individuals they had so that could be confidentially tracked and help folks reunite."
Funding future uncertain
EMResource is currently available to hospitals and responders through Kan-ed, a state-subsidized digital network that connects hospitals, schools and libraries. The annual licensing fee for all hospitals, emergency responders and government officials to use EMResource was $112,750 last year. Kan-ed pays that fee — plus $67,250 in administrative costs — through the hospital association. Samuelson said neighboring states pay for EMResource with federal grant dollars.
Leong, armed with knowledge of the benefits of EMResource, said he watched with apprehension as the Kansas House this year voted to eliminate Kan-ed funding for the fiscal year that starts July 1 and to terminate the program entirely in 2012.
"We're trying to do all we can to at least continue some funding (for EMResource) through Kan-ed, but we know there's going to be some challenges with what is bound to transpire over the next year or so," Leong said.
The Bureau of Public Health Preparedness is housed within the Kansas Department of Health and Environment, but is funded solely by federal grants from the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services. McNulty said he could not speculate about what options KDHE might have to pay for EMResource absent Kan-ed funding.
Samuelson said the hospital association is waiting to see how Kan-ed adjusts it budget.
"We want to continue (EMResource) — it's a very important service for Kansans,” Samuelson said. If Kan-ed cuts its funding, “there are a number of scenarios we could look at — from other funding sources (to) trying to get some funding from our membership. Until we know what that dollar amount is, we're waiting to see"
"As we've just seen in Joplin, when a crisis happens it's important that everyday hospitals are using this tool. So we would hate to turn it off," she said.
More recently, McNulty said much of his attention has been focused on northeast Kansas counties bordered by the cresting Missouri River, particularly Doniphan, Leavenworth, Wyandotte and Atchinson counties.
Bureau workers are helping coordinate contingency plans for hospitals and emergency responders should one or more of the river levees be breached. The river has just recently begun to crest and the high water is not expected to abate until August.
"Incident management teams have been sent to towns along the river to help officials develop emergency management plans specific to their current situations," McNulty said.
"With the possible inundation maps that we've been given by the Corps of Engineers, it doesn't look like there are any hospitals that are in the inundation areas at this time. But we're constantly getting new data and reevaluating. Never a dull moment around here.
"You want to be constantly educating people about preparedness plans," he said. "You don't reach up to find the fire plan when you see smoke. You write the fire plan beforehand and educate people so they know immediately what to do when the alarm goes off," he said.