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Secure Scalable Disaster Electronic Medical Record and Tracking System
- Gerard DeMers, Christopher Kahn, Per Johansson, Colleen Buono, Octav Chipara, William Griswold, Theodore Chan
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- Journal:
- Prehospital and Disaster Medicine / Volume 28 / Issue 5 / October 2013
- Published online by Cambridge University Press:
- 26 June 2013, pp. 498-501
- Print publication:
- October 2013
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Introduction
Electronic medical records (EMRs) are considered superior in documentation of care for medical practice. Current disaster medical response involves paper tracking systems and radio communication for mass-casualty incidents (MCIs). These systems are prone to errors, may be compromised by local conditions, and are labor intensive. Communication infrastructure may be impacted, overwhelmed by call volume, or destroyed by the disaster, making self-contained and secure EMR response a critical capability.
ReportAs the prehospital disaster EMR allows for more robust content including protected health information (PHI), security measures must be instituted to safeguard these data. The Wireless Internet Information System for medicAl Response in Disasters (WIISARD) Research Group developed a handheld, linked, wireless EMR system utilizing current technology platforms. Smart phones connected to radio frequency identification (RFID) readers may be utilized to efficiently track casualties resulting from the incident. Medical information may be transmitted on an encrypted network to fellow prehospital team members, medical dispatch, and receiving medical centers. This system has been field tested in a number of exercises with excellent results, and future iterations will incorporate robust security measures.
ConclusionA secure prehospital triage EMR improves documentation quality during disaster drills.
,DeMers G ,Kahn C ,Johansson P ,Buono C ,Chipara O ,Griswold W .Chan T Secure Scalable Disaster Electronic Medical Record and Tracking System . Prehosp Disaster Med.2013 ;28 (5 ):1 -4 .
Balance model for equatorial long waves
- Ian H. Chan, Theodore G. Shepherd
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- Journal:
- Journal of Fluid Mechanics / Volume 725 / 25 June 2013
- Published online by Cambridge University Press:
- 14 May 2013, pp. 55-90
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Geophysical fluid models often support both fast and slow motions. As the dynamics are often dominated by the slow motions, it is desirable to filter out the fast motions by constructing balance models. An example is the quasi-geostrophic (QG) model, which is used widely in meteorology and oceanography for theoretical studies, in addition to practical applications such as model initialization and data assimilation. Although the QG model works quite well in the mid-latitudes, its usefulness diminishes as one approaches the equator. Thus far, attempts to derive similar balance models for the tropics have not been entirely successful as the models generally filter out Kelvin waves, which contribute significantly to tropical low-frequency variability. There is much theoretical interest in the dynamics of planetary-scale Kelvin waves, especially for atmospheric and oceanic data assimilation where observations are generally only of the mass field and thus do not constrain the wind field without some kind of diagnostic balance relation. As a result, estimates of Kelvin wave amplitudes can be poor. Our goal is to find a balance model that includes Kelvin waves for planetary-scale motions. Using asymptotic methods, we derive a balance model for the weakly nonlinear equatorial shallow-water equations. Specifically we adopt the ‘slaving’ method proposed by Warn et al. (Q. J. R. Meteorol. Soc., vol. 121, 1995, pp. 723–739), which avoids secular terms in the expansion and thus can in principle be carried out to any order. Different from previous approaches, our expansion is based on a long-wave scaling and the slow dynamics is described using the height field instead of potential vorticity. The leading-order model is equivalent to the truncated long-wave model considered previously (e.g. Heckley & Gill, Q. J. R. Meteorol. Soc., vol. 110, 1984, pp. 203–217), which retains Kelvin waves in addition to equatorial Rossby waves. Our method allows for the derivation of higher-order models which significantly improve the representation of Rossby waves in the isotropic limit. In addition, the ‘slaving’ method is applicable even when the weakly nonlinear assumption is relaxed, and the resulting nonlinear model encompasses the weakly nonlinear model. We also demonstrate that the method can be applied to more realistic stratified models, such as the Boussinesq model.
Impact of Wireless Electronic Medical Record System on the Quality of Patient Documentation by Emergency Field Responders during a Disaster Mass-Casualty Exercise
- Theodore C. Chan, William G. Griswold, Colleen Buono, David Kirsh, Joachim Lyon, James P. Killeen, Edward M. Castillo, Leslie Lenert
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- Journal:
- Prehospital and Disaster Medicine / Volume 26 / Issue 4 / August 2011
- Published online by Cambridge University Press:
- 13 October 2011, pp. 268-275
- Print publication:
- August 2011
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Introduction: The use of wireless, electronic, medical records and communications in the prehospital and disaster field is increasing.
Objective: This study examines the role of wireless, electronic, medical records and communications technologies on the quality of patient documentation by emergency field responders during a mass-casualty exercise.
Methods: A controlled, side-to-side comparison of the quality of the field responder patient documentation between responders utilizing National Institutes of Health-funded, wireless, electronic, field, medical record system prototype (“Wireless Internet Information System for medicAl Response to Disasters” or WIISARD) versus those utilizing conventional, paper-based methods during a mass-casualty field exercise. Medical data, including basic victim identification information, acuity status, triage information using Simple Triage and Rapid Treatment (START), decontamination status, and disposition, were collected for simulated patients from all paper and electronic logs used during the exercise. The data were compared for quality of documentation and record completeness comparing WIISARD-enabled field responders and those using conventional paper methods. Statistical analysis was performed with Fisher’s Exact Testing of Proportions with differences and 95% confidence intervals reported.
Results: One hundred simulated disaster victim volunteers participated in the exercise, 50 assigned to WIISARD and 50 to the conventional pathway. Of those victims who completed the exercise and were transported to area hospitals, medical documentation of victim START components and triage acuity were significantly better for WIISARD compared to controls (overall acuity was documented for 100% vs 89.5%, respectively, difference = 10.5% [95%CI = 0.5–24.1%]). Similarly, tracking of decontamination status also was higher for the WIISARD group (decontamination status documented for 59.0% vs 0%, respectively, difference = 9.0% [95%CI = 40.9–72.0%]). Documentation of disposition and destination of victims was not different statistically (92.3% vs. 89.5%, respectively, difference = 2.8% [95%CI = -11.3–17.3%]).
Conclusions: In a simulated, mass-casualty field exercise, documentation and tracking of victim status including acuity was significantly improved when using a wireless, field electronic medical record system compared to the use of conventional paper methods.
Contributors
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- By Aakash Agarwala, Linda S. Aglio, Rae M. Allain, Paul D. Allen, Houman Amirfarzan, Yasodananda Kumar Areti, Amit Asopa, Edwin G. Avery, Patricia R. Bachiller, Angela M. Bader, Rana Badr, Sibinka Bajic, David J. Baker, Sheila R. Barnett, Rena Beckerly, Lorenzo Berra, Walter Bethune, Sascha S. Beutler, Tarun Bhalla, Edward A. Bittner, Jonathan D. Bloom, Alina V. Bodas, Lina M. Bolanos-Diaz, Ruma R. Bose, Jan Boublik, John P. Broadnax, Jason C. Brookman, Meredith R. Brooks, Roland Brusseau, Ethan O. Bryson, Linda A. Bulich, Kenji Butterfield, William R. Camann, Denise M. Chan, Theresa S. Chang, Jonathan E. Charnin, Mark Chrostowski, Fred Cobey, Adam B. Collins, Mercedes A. Concepcion, Christopher W. Connor, Bronwyn Cooper, Jeffrey B. Cooper, Martha Cordoba-Amorocho, Stephen B. Corn, Darin J. Correll, Gregory J. Crosby, Lisa J. Crossley, Deborah J. Culley, Tomas Cvrk, Michael N. D'Ambra, Michael Decker, Daniel F. Dedrick, Mark Dershwitz, Francis X. Dillon, Pradeep Dinakar, Alimorad G. Djalali, D. John Doyle, Lambertus Drop, Ian F. Dunn, Theodore E. Dushane, Sunil Eappen, Thomas Edrich, Jesse M. Ehrenfeld, Jason M. Erlich, Lucinda L. Everett, Elliott S. Farber, Khaldoun Faris, Eddy M. Feliz, Massimo Ferrigno, Richard S. Field, Michael G. Fitzsimons, Hugh L. Flanagan Jr., Vladimir Formanek, Amanda A. Fox, John A. Fox, Gyorgy Frendl, Tanja S. Frey, Samuel M. Galvagno Jr., Edward R. Garcia, Jonathan D. Gates, Cosmin Gauran, Brian J. Gelfand, Simon Gelman, Alexander C. Gerhart, Peter Gerner, Omid Ghalambor, Christopher J. Gilligan, Christian D. Gonzalez, Noah E. Gordon, William B. Gormley, Thomas J. Graetz, Wendy L. Gross, Amit Gupta, James P. Hardy, Seetharaman Hariharan, Miriam Harnett, Philip M. Hartigan, Joaquim M. Havens, Bishr Haydar, Stephen O. Heard, James L. Helstrom, David L. Hepner, McCallum R. Hoyt, Robert N. Jamison, Karinne Jervis, Stephanie B. Jones, Swaminathan Karthik, Richard M. Kaufman, Shubjeet Kaur, Lee A. Kearse Jr., John C. Keel, Scott D. Kelley, Albert H. Kim, Amy L. Kim, Grace Y. Kim, Robert J. Klickovich, Robert M. Knapp, Bhavani S. Kodali, Rahul Koka, Alina Lazar, Laura H. Leduc, Stanley Leeson, Lisa R. Leffert, Scott A. LeGrand, Patricio Leyton, J. Lance Lichtor, John Lin, Alvaro A. Macias, Karan Madan, Sohail K. Mahboobi, Devi Mahendran, Christine Mai, Sayeed Malek, S. Rao Mallampati, Thomas J. Mancuso, Ramon Martin, Matthew C. Martinez, J. A. Jeevendra Martyn, Kai Matthes, Tommaso Mauri, Mary Ellen McCann, Shannon S. McKenna, Dennis J. McNicholl, Abdel-Kader Mehio, Thor C. Milland, Tonya L. K. Miller, John D. Mitchell, K. Annette Mizuguchi, Naila Moghul, David R. Moss, Ross J. Musumeci, Naveen Nathan, Ju-Mei Ng, Liem C. Nguyen, Ervant Nishanian, Martina Nowak, Ala Nozari, Michael Nurok, Arti Ori, Rafael A. Ortega, Amy J. Ortman, David Oxman, Arvind Palanisamy, Carlo Pancaro, Lisbeth Lopez Pappas, Benjamin Parish, Samuel Park, Deborah S. Pederson, Beverly K. Philip, James H. Philip, Silvia Pivi, Stephen D. Pratt, Douglas E. Raines, Stephen L. Ratcliff, James P. Rathmell, J. Taylor Reed, Elizabeth M. Rickerson, Selwyn O. Rogers Jr., Thomas M. Romanelli, William H. Rosenblatt, Carl E. Rosow, Edgar L. Ross, J. Victor Ryckman, Mônica M. Sá Rêgo, Nicholas Sadovnikoff, Warren S. Sandberg, Annette Y. Schure, B. Scott Segal, Navil F. Sethna, Swapneel K. Shah, Shaheen F. Shaikh, Fred E. Shapiro, Torin D. Shear, Prem S. Shekar, Stanton K. Shernan, Naomi Shimizu, Douglas C. Shook, Kamal K. Sikka, Pankaj K. Sikka, David A. Silver, Jeffrey H. Silverstein, Emily A. Singer, Ken Solt, Spiro G. Spanakis, Wolfgang Steudel, Matthias Stopfkuchen-Evans, Michael P. Storey, Gary R. Strichartz, Balachundhar Subramaniam, Wariya Sukhupragarn, John Summers, Shine Sun, Eswar Sundar, Sugantha Sundar, Neelakantan Sunder, Faraz Syed, Usha B. Tedrow, Nelson L. Thaemert, George P. Topulos, Lawrence C. Tsen, Richard D. Urman, Charles A. Vacanti, Francis X. Vacanti, Joshua C. Vacanti, Assia Valovska, Ivan T. Valovski, Mary Ann Vann, Susan Vassallo, Anasuya Vasudevan, Kamen V. Vlassakov, Gian Paolo Volpato, Essi M. Vulli, J. Matthias Walz, Jingping Wang, James F. Watkins, Maxwell Weinmann, Sharon L. Wetherall, Mallory Williams, Sarah H. Wiser, Zhiling Xiong, Warren M. Zapol, Jie Zhou
- Edited by Charles Vacanti, Scott Segal, Pankaj Sikka, Richard Urman
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- Book:
- Essential Clinical Anesthesia
- Published online:
- 05 January 2012
- Print publication:
- 11 July 2011, pp xv-xxviii
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Impact of the San Diego County Firestorm on Emergency Medical Services
- Gary M. Vilke, Alan M. Smith, Barbara M. Stepanski, Leslie Upledger Ray, Patricia A. Murrin, Theodore C. Chan
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- Journal:
- Prehospital and Disaster Medicine / Volume 21 / Issue 5 / October 2006
- Published online by Cambridge University Press:
- 28 June 2012, pp. 353-358
- Print publication:
- October 2006
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Background:
In October 2003, San Diego County, California, USA, experienced the worst firestormin recent history. During the firestorm, public health leaders implemented multiple initiatives to reduce its impact on community health using health updates and news briefings. This study assessed the impact of patients with fire-related complaints on the emergency medical services (EMS) system during and after the firestorm.
Methods:A retrospective review of a prehospital database was performed for all patients who were evaluated by advanced life support (ALS) ambulance personnel after calling the 9-1-1 emergency phone system for direct, fire related complaints from 19 October 2003 through 30 November 2003 in San Diego County. The study location has an urban, suburban, rural, and remote resident population of approximately three million and covers 4,300 square miles (2,050 km2). The prehospital patient database was searched for all patients with a complaint that was related directly to the fires. Charts were abstracted for data, including demographics, medical issues, treatments, and disposition status.
Results:During the firestorm, fire consumed >380,000 acres (>938,980 hectares), including 2,454 residences and 785 outbuildings, and resulted in a total of 16 fatalities. Advanced life support providers evaluated 138 patients for fire related complaints. The majority of calls were for acute respiratory complaints. Other complaints included burns, trauma associated with evacuation or firefighting, eye injuries, and dehydration. A total of 78% of the injuries were mild. Twenty percent of the victims were firefighters, most with respiratory complaints, eye injuries, or injuries related to trauma. A total of 76% of the patients were transported to the hospital, while 10% signed out against medical advice.
Conclusion:Although the firestorm had the potential to significantly impact EMS, pre-emptive actions resulted in minimal impact to emergency departments and the prehospital system. However, during the event, therewere a number of lessons learned that can be used in future events.
MBE Grown AlN Films on SiC for Piezoelectric MEMS Sensors
- Dharanipal Doppalapudi, Richard Mlcak, Jeffrey Chan, Harry Tuller, Anirban Bhattacharya, Theodore Moustakas
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- Journal:
- MRS Online Proceedings Library Archive / Volume 798 / 2003
- Published online by Cambridge University Press:
- 01 February 2011, Y10.61
- Print publication:
- 2003
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Miniaturized piezoelectric sensors based on Microelectromechanical Systems (MEMS) offer the advantages of reduced size, reduced power consumption, increased sensitivity coupled with the ability to form compact multi-sensor arrays. Fabrication of such sensors from single crystal materials further insure more highly reproducible and stable devices with improved performance. In this paper, we describe the integration of MBE grown AlN films onto photoelectrochemically machined SiC microcantilevers and membranes. AlN exhibits excellent piezoelectric properties, including an electromechanical coupling coefficient of 0.088 and a high in-plane acoustic velocity (∼5700m/sec) as well as excellent thermal-mechanical compatibility with SiC. The fabrication of AlN-SiC-based microresonators and flexural plate wave devices, and their application to chemical, biological and fluid sensing, are reported.