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. Andrews
Ames Associate, Smart Systems & Nanotechnology
NASAAmes Research Ctr, Moffett Field (Silicon Valley), CA, USA
rja@russelljandrews.org

JAMA
(J Am Med
Assn)
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
Medical
Design
Briefs
2011

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 support
Complete medical/surgical & support staff
Mobilization by helicopter to disaster site < 24 hrs
Continuously operating MEU will be ready for
deployment at any time
IT for remote communication & surgery support
Ideally 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 & meetings
In conjunction with local neurosurgical/trauma unit
Located 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 staff
Standardized training – curriculum developed by
international organizations (e.g. WFNS)
Integrated training of both ‘host country’ and
‘developed country’ residents
Resident 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 certification
Extended day-to-day association of staff from
developed and developing countries – camaraderie
Junior host country neurosurgeons will gain
appreciation & respect for the WFNS mission
Research platform for trauma, remotely-guided
surgery & disaster management IT
Improve 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 won
FDA approval July 2012.

Med Design Tech 2013

BioOpticsWorld &
Lab Chip 2013
Smartphone cradle
+ $200 optics
=
$50,000 lab-based
spectrophotometer

Conducting polymer-
coated CNF arrays
greatly enhance
biosensitivity for a
“Lab On A Chip”

Using cell phones to track malaria…Tech Review Mar 2013

Tech Review
March 2013

“You must be the change
you wish to see in the world.”
IT & Health Care Disaster Management:
Progress is Possible if We Think & Act
Creatively & Responsibly!
Mahatma Gandhi

Thank
YOU!!
Foreign Affairs
Sep/Oct 2013
PS: Let us not forget the
“fruit walas”…

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

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