Making the Most of the Golden Hour

ESRI launches the AEGIS for mobile medical response teams

Ed Carubis from ESRI Professional Services was feeling the heat, quite literally. In late October, when the Esperanza fire spread through the mountainous regions of Palm Springs, California, Loma Linda authorities dispatched a mobile healthcare vehicle -- a miniature emergency room on wheels -- to the disaster site. In addition to the necessary medical equipment, the vehicle’s onboard setup includes the AEGIS (Advanced Emergency Geographic Information System) -- a state-of-the-art, Web-based system for accessing and monitoring rescue aircraft locations, highway traffic and other critical emergency resources nearby. Carubis, former CIO of the New York City Department of Health and Mental Hygiene and now a senior consultant to ESRI, is heavily involved in the development of the AEGIS, so he rode along to see if the system could stand up to the wildfire's menace.

The Esperanza fire's perimeters are displayed within the AEGIS, overlaid on topographic and street map data.

AEGIS was conceived at the Center for Prehospital Care, Education and Research at LLUMC ( Loma Linda University Medical Center). Jeff Grange, the Center's Emergency Medical Services director, was the visionary responsible for the idea of putting an emergency room inside an all-purpose, all-terrain vehicle.

According to Bill Davenhall, manager of the Health Solutions Group at ESRI, "[LLUMC] wants to look into the future to see what the emergency room of the future would need. Dr. Grange's vision is to have as much telemetry as possible in the vehicle so the satellite medical staff can beam things like X-rays back to the 'mother ship' -- the hospital."

Grange observed, "[The digital map] will give [medical personnel] the big picture. It gets the right information to the right people so they can make the right decisions." And that information can make the difference between life and death for patients in the care of a mobile medical vehicle.

"Ever heard of the term 'The Golden Hour'?" Davenhall asked. "In a real trauma, there's about an hour's window to get the patient to one of the suitable places nearby. A lot of the time, this Golden Hour is hampered by highway traffic, air traffic and other unpredictable factors. So [LLUMC] wants to put on board the vehicle a system with a complete, dynamic view of the medical resources in the region."

The outcome is the AEGIS, which provides a comprehensive view of road and weather conditions, air rescue fleet locations, ground unit status, treatment center availability and much more, all consolidated on a dynamic digital map.

This AEGIS map of the wildfire zone compiles data on road closures, homes and power lines threatened by the fire, the fire perimeter (pink) and vegetation mortality percentages (shades of brown).

Data Sources

Using ESRI's geospatial data as the foundation, the AEGIS streams relevant information from a variety of public, private and commercial sources:

• status of the hospitals in the area by ReddiNet, which caters to Emergency Medical Services agencies;
• traffic information from TrafficCast, which supplies dynamic inter- and intracity traffic information;
• up-to-date accident reports from the Highway Patrol;
• weather information from DTN/Meteorlogix, a commercial weather service provider;
• rescue aircraft locations from Mercy Air Service, a division of the airborne healthcare service provider Air Methods;
• additional information from local sheriffs' offices; and more.

The system also incorporates satellite-based mobile asset-tracking technologies from Outerlink and mobile tracking solutions from Air-Trak.

The data is tied to Arc Web Services, hosted by ESRI. "All the information is streamed into the application, so there's no gigantic database sitting inside the vehicle's onboard computer," explained Davenhall.

Carubis, who witnessed firsthand the deployment of the AEGIS in the fight against the Esperanza fire, remarked, "Not only were we able to aggregate all the emergency response data, but we were able to bring into the interface additional data relevant to the incident itself. For example, we were able to bring in, on the fly, the data that shows the perimeter of the fire." The information was supplied by air units observing the fire from above and satellite-based thermal imagery from NASA's MODIS (Moderate Resolution Imaging Spectroradiometer) project.

In this image, the AEGIS has overlaid the fire perimeter (red line) on satellite imagery of the region.

Observing the ground operations at the site, Carubis learned what the end users ultimately need. "First responders can't be spending a lot of time developing a map. Some of what we didn't think were core abilities turned out to be far more important -- for example, the ability for someone who's not at the central command to be able to use the interface to quickly develop composite views or multiple composite views of the disaster region and serve those out," he said.

Deployment

According to Carubis, users will encounter few or no technical hurdles when deploying the AEGIS. "The limitations are not on the technology side," he said. "It relies on ESRI's Arc Web Services to deliver information from the third-party data suppliers." So the IT infrastructure needs are minimal, but the bulk of the work lies in coordinating with the data providers and negotiating data use agreements.

"In addition to [ESRI's] Web services, we're incorporating Web services from California Department of Transportation, California Highway Patrol, Hospital Association of Southern California and the sheriffs' offices, so the challenge is in building collaborative partnerships," said Carubis.

If the providers involved don't use the same georeferencing system, the underlying ESRI technology can reconcile the latitudes and longitudes, different state-plane coordination systems, and aerial photographs and project them in a single interface, Carubis explained. The real battle is getting the different agencies involved to share their data with one another.