Mapping System Gets Patients to the Right ED

Mapping system gets patient to the right ED

Web program shows ED locations, diversions, etc.

A new web-based mapping system in Loma Linda, CA, provides EDs and emergency service organizations in a wide geographical area with real-time information that helps ensure that accident and disaster victims will get to the closest available ED in the shortest possible time. Called AEGIS (Advanced Emergency Geographic Information Systems), it was developed by the Redlands, CA-based Environmental Systems Research Institute (ESRI) for the Center for Prehospital Care, Education, and Research at Loma Linda University Medical Center.

The system, funded by a federal grant for projects that adopt innovative uses of technology related to pre-hospital care, was requested by Jeff T. Grange, MD, FACEP, emergency medical services director, associate professor of emergency medicine, and an attending physician in the ED at Loma Linda University and Medical Center. It was installed last September.

Grange, who also is a pilot and the medical director for the San Bernardino Sheriff's rescue team, realized several years ago that such a system was badly needed. "I was flying back to the hangar when a six-year-old girl was run over," he recalls. "I did not know it, but we were immediately over the scene and had all we needed to take care of her, but instead they dispatched a helicopter from half an hour away." In other words, he notes, the system was not able get the right patient into the right facility in a timely manner.

System uses 'smart maps'

AEGIS, which uses "smart maps," is a situational awareness application, says Edward Carubis, a senior consultant with ESRI. It uses a map interface to bring together information from different sources to help make decisions about patient transport and managing medical surge capacity. "It covers an area from Las Vegas to Bakersfield, to San Diego and the [Mexican] border," he notes. That area encompasses almost 25% of the land mass of California for which Loma Linda is the only level I trauma center, adds Grange.

It also shows hospital locations, and allows the user — by looking at the map — to quickly determine diversion status, adds Carubis. The system, which is refreshed on a real-time basis, requires a log-on access in the ED, the fire department, and so forth. At the medical center, for example, a mobile intensive care nurse working on a computer can see the information displayed on a digital map on a 40-inch LCD monitor.

By glancing at the screen or clicking a button marked with symbols, such as an "H" for a hospital or a helicopter for an air ambulance, the nurse — who directs ambulances regarding hospital destination — will receive an instant snapshot of which hospital emergency departments in San Bernardino and Riverside counties can, at that time, accept more ambulances. A green "H" symbol on the map indicates that people can be transported there, while a yellow "H" means the emergency department is busy and a request is being made to divert ambulance patients to another hospital.

The system also serves as a resource utilization tool, says Grange. "Under the old system, a team in the high desert might have given us an ETA of 15 minutes, and we might have activated the trauma team and waited for 40 minutes, instead of being able to see two or three more patients here," he notes. Real-time traffic and weather conditions are available via the system, he explains, and care providers in the ED are able to see the location of the helicopter flying the patient to the trauma center, so they can tell how much longer they have before the trauma patient arrives.

In addition, he points out, Loma Linda, as a base hospital, provides medical direction to all ambulance companies and fire department EMTs in the region.

"If they need to go beyond their written protocols they have to contact us," Grange explains.