Patient Monitor

Evaluating Disaster ResponseThe Wiisard Project

David KirshDept of Cognitive Science, Cal(IT)2 UCSD

What is WIISARD?Wireless Internet Information System for Medical Response to Disasters

Disaster responders operate under a standardized Incident Command System.

Old Artifacts: all record keeping is done by hand using pencil and papers, and communication channels are radio and runners in addition to sound, sight and touch.

New artifacts introduced by WIISARD:

• Provider Device: a hand-held device that records START triage, patient details, interventions, vital signs, barcode scanner for patient identification.

• Intelligent Triage Tag (iTAG): for rapid triage and registering of patient into the system via wireless.

• Individual Patient Monitors: for wireless transmission of pulse oximetry and telemetry data.

• Mid-Tier: tablet pc with applications specific to the roles of Triage, Treatment, Transport and Staging.

Conceptualization of disasters• To understand how response units conceptualize the physical space of a

disaster and their organized response in order to develop an ontology for geospatial and context-aware technology.

Justification Perimeter defined

Perimeter marked

Perimeter moves

Center marked

Duration Shape Nested spaces?

Zones Factual: degree of safety

Yes Yes Yes No Event 3D Yes

Areas Long-term requirements of activity

Often Sometimes

Sometimes Yes Event 2D Yes

Ad hoc regions

Short-term requirements specific to one activity

No Sometimes

No (expires)

No Phase of activity

2D/1D Other ad hoc

Table 1. Geolocation attributes of space types: the conceptual map of first responders is far more complex than a geographical map.

• Cost-benefit structure of a Disaster Response System (DRS) along many dimensions.

Variance

Time

1

0

Variance of Routines

AcceptableVariance

AcceptableTime

Acceptable

V2V1 V3 V4

ProbabilityofError

Time

1

0

Better

Speed Accuracy of Routine

No RemoteRemote

Expertise

Time to learn

Great design

Good design

Average design

• Complexity of routines: Ri is better than Rj if Ri tasks:

- are more complex

- can be performed in acceptable time and error rate

Triage: PDA vs. paper - can do more complex routines in acceptable time

Transport: Mid Tier vs. paper- can do more complex routines in acceptable time

• Recovery time of Routines: time to recover previous level of routine performance after interruption, disruption, switch of activity.

Design Challenge:

•redesign the environment to lower recovery time

•redesign to facilitate vigilance and error detection

Quantitative Objectives• Victim Flow Rate per node

Evaluate information diffusion through computer simulations Information diffusion: how quickly and accurately information is propagated through a communication network

When does increased information diffusion compensate for the time responders lose to communicating rather than responding?

Assumptions: nature of links, responder locations, number of agents

Static world

Changing World Good Connectivity

Changing World Bad Connectivity

In a world where things change very slowly Wiisard provides a large initial advantage in information diffusion. However regular channels do catch up and slightly exceed Wiisard.

In a dynamic world where victims change state a communication channels which Wiisard provide will dominate, although there remain potential dangers of local inconsistency.

In a dynamic world where Wiisard network has frequent problems users are no better off with it than without it.

Ultimate Goals of Wiisard• Improve the efficiency of response

–Increase victim flow through key areas

–Reduce bottlenecks

–Reduce cost of errors• Improve the efficacy of response

–Reduce numbers of errors• Improve situation awareness

Data Collection• Interviews

– on site– off site with hand simulation

• Shadowing key responders taking photos and notes

• Counting victim flows at key nodes• Logs• Usability

– on site with responders– on site, with responders after activity– in lab

• Video, ethnographic study

Provider Device

Intelligent Triage Tag

Mid-Tier

Information diffusion: Wiisard vs. standard system