Between 9am and 2pm today, UCSD scientists will participate in a large-scale drill on campus conducted by the county's Metropolitan Medical Strike Team, which brings together fire, police, hazmat, SWAT and other first reponder units, including the campus's own emergency-medical response units. The drill will test out more than a dozen new technologies developed over the past year to help first responders and improve the response to mass-casualty events. This year's drill, code named Operation College Freedom, will test a scenario involving terrorists and a chemical release, and it will take place in and around Atkinson Hall, the home of the California Institute for Telecommunications and Information Technology (Calit2), which developed the technologies. Operation College Freedom will test of how San Diego emergency and law-enforcement agencies respond to a simulated terrorist attack. “This full-scale exercise is the culmination of a three-year, $4 million research project carried out by the California Institute for Telecommunications and Information Technology,” said Calit2 associate director Leslie Lenert, M.D., a professor of medicine at UCSD and Director of Health Services Research for the VA San Diego Healthcare System. “What I am most proud of is the unprecedented degree of collaboration we've achieved among UCSD academics, administrators and public safety officers, as well as regional law enforcement, fire and paramedic, and HazMat leadership.” Lenert has overseen the development of new technologies for medical first responders as principal investigator on the Wireless Internet Information System for Medical Response in Disasters (WIISARD) project, funded by the National Institutes of Health’s National Library of Medicine. WIISARD is a joint project between Calit2 and UCSD’s School of Medicine.Calit2 has also been developing first-response technologies in two other projects: Responding to Crises and Unexpected Events (RESCUE), and ResponSphere (both funded by the National Science Foundation). “All of these projects have required extremely close collaboration between the engineers who are creating the technologies and the expected users of those same technologies,” said Calit2 division director Ramesh Rao, a principal investigator or co-principal investigator on all three projects. “From the very beginning it was clear that we couldn’t design new systems in a vacuum—that we needed constant feedback from our colleagues in emergency medicine, law enforcement and the entire first-response community. I’m not aware of anywhere else in the nation where this type of partnership has flourished so effectively.” San Diego’s Metropolitan Medical Strike Team (MMST), which coordinates the city and county’s medical response to a disaster, has staged a series of drills based on real-world disaster scenarios. During the 2005 drill, it was a car bomb detonated at Del Mar Fairgrounds. This year, the scenario involves a terrorist attack and chemical spill at Atkinson Hall, Calit2’s headquarters on the UCSD campus. Some 200 city and county officials and first responders will take part in the exercise, along with emergency-room physicians, nurses and technicians from the UCSD Medical Center. The UCSD campus will participate both in the field and via activation of their Emergency Operations Center. Campus first responders (including UCSD police and HazMat) will link with San Diego City and County to form a unified command presence at the Incident Command Post. In addition, approximately 100 volunteers will play victims in the drill. “Half of them will be processed and treated using the new technologies developed by WIISARD and RESCUE,” said MMST medical director Theodore Chan, a professor of clinical medicine at UCSD. “The other half will be the control group, using traditional methods currently in use. We will look at patient outcomes and other metrics to assess the value of these new technologies, and if they prove effective, they will no doubt lay a foundation for improving the care and management of patients in mass casualty disasters.” A system for tracking of mass casualties, triage, and managing all medical information, WIISARD combines state-of-the-art networking, data collection, display devices and database services to produce a consistent, real-time view of the disaster scene. The innovative technologies developed at UCSD and Calit2 include: - CalMesh: Wireless access is critical to disaster communications, especially in locations where existing infrastructure has been destroyed. CalMesh is an ad-hoc network of small, lightweight and easily deployable access point boxes which create a Wi-Fi ‘bubble’ at the scene. Nearly all the other new technologies to be demonstrated at the drill depend on this reliable and robust wireless mesh network to communicate data and information both locally and via the Internet. - iTag: The patient's medical status is keyed into this electronic tag by triage personnel and is beamed continuously to the command center. Bright flashing colored lights (associated with the severity of each patient's condition) can be seen from a distance by personnel at the scene. The iTags carry the treatment record of the patient at the scene and go with the patient to the hospital. - Medical Record PDAs: Medical first responders carry these modified PDAs to enter data from physical exams and treatments in the field. Multiple patients are recorded on each device. The PDA includes a barcode scanner to identify medications and accurately link patients (via their iTags) with given doses of medications. The information is transmitted to the command center and available for supervisory personnel. - Mid-Tier Tablet: This modified Tablet PC assists medical supervisors in the field (i.e., responders in the middle 'tier' who interface between command-center officials and front-line responders). They have access to all patients and medical records involved and can filter the information as they desire. The software allows them to manage care and resources in specific areas, and a barcode scanner is attached to the unit for ease of data collection. - WIISARD Command Center: Custom software on a laptop computer puts all key medical resources and geographic information on a single interface, including an overview of the affected area, summaries of casualties, locations of victims and first responders, etc. The interface will be available on large displays at the MMST Incident Command Post (ICP) as well as UCSD’s Emergency Operations Center. - Non-Uniform Tile System OptIPortal (NUTSO): Field command-and-control display wall of eight tiled standard size laptop monitors and one large television display for the ICP. They are linked together, and each monitor can be used independently or in concert with any number of the others. It is designed to be set up quickly, is robust enough for field deployment and the monitors have bright displays -- even in daylight. - Antenna Caddy: A mast structure for elevating antennas at a disaster scene; it can accommodate multiple types of antennas (Wi-Fi, microwave, etc.). Antennas and CalMesh boxes can be deployed up to 30-ft high. This is important to the reliability and robustness of the communications network because emergency vehicles, such as fire trucks, can interfere with wireless communications. - Synchronized Audio-Video: Arrays of cameras and microphones provide a panoramic representation of interactions in a command-and-control environment; this will be deployed in the UCSD Emergency Operations Center. Later analysis of this data will be used to develop tools to improve situational awareness. - Location Tracking: CalMesh boxes have GPS units on them. That information can then be used to estimate locations of personnel or equipment using their relative signal strengths from the CalMesh boxes. - RealityFlythrough: Combination helmet-cam and wireless tablet PC allows a first responder to send real-time video and still images to a central server where the images are mapped to a diagram of the scene and stitched together into a 360-degree, interactive visualization of the site for incident commanders. - Call-2-Collaborate: Announcements can be recorded and broadcast simultaneously to the cell phones of selected groups of responders, to alert them quickly of an incident or where their help is needed. - Patient Flow/Tracking: Ground mats that detect an ID sensor attached to each victim's arm or shoe will be strategically placed to provide an independent measurement of the flow of victims at the mock disaster scene. This data will be one of the metrics used to compare the control and WIISARD system groups. This same ground mat and ID technology is used for lengthy and wide-ranging sporting events, such as marathons and bicycle races. Apart from the technologies, Operation College Freedom will also showcase the interdisciplinarity of this type of research. WIISARD alone involves students, faculty and staff from the School of Medicine, VA, Electrical and Computer Engineering, Computer Science and Engineering, and Cognitive Science departments. The long-range value of technology innovation to deal with mass-casualty situations is particularly apparent in some of the WIISARD technologies being demonstrated. “The iTag, PDA, midtier and WIISARD Command Center have their data collected and distributed by the replicated WIISARD server using remote objects shared by publish/subscribe,” explained UCSD computer-science professor William Griswold. “This supports an information-rich workflow without burdening providers with the task of explicit communication. Typically these communications are done with paper and radio, resulting in infrequent and sometimes out-of-date status updates. Those drawbacks can lead to delayed decision making that puts lives at risk—a risk that the WIISARD system is designed to minimize.”