Evaluation of a Cell Phone-Based Mobile Medical Documentation System During Operation Black Swan

Abstract

Operation Black Swan, an Offshore Mass Rescue Operation exercise with the US Coast Guard (USCG), the cruise ship industry, the Bahamas, and numerous other stakeholders, was conducted on April 1- 5, 2013. Black Swan is a series of USCG exercises designed to prepare for a catastrophic incident at sea. The objective of this study was to test and evaluate a cell phone mobile medical documentation and tracking application as simulated patients were triaged, treated, and evacuated during Operation Black Swan. A cell phone based documentation and tracking system called the Pathfinder Rapid Assessment System (PRAS) was modified to store and transmit medical data. This mobile technology enables field observers to take pictures and add field notes on a cell phone, which are geocoded and time-date stamped into a command map for Emergency Operations Center (EOC) personnel to analyze as an incident unfolds. Simulated patients were evacuated from the Royal Caribbean “Monarch of the Seas” cruise ship via ship lifeboats to Freeport, Bahamas, where they were triaged on shore and transported to Rand Memorial Hospital in Freeport as medically indicated. Patients identified as needing evacuation to a higher level of care were aeromedically evacuated by the Florida Advanced Surgical and Transport Team (FAST) to Miami FL. An emergency physician accompanied simulated patients while abandoning ship in lifeboats and during on-shore triage, hospital treatment, and air evacuation by the FAST via a USCG C-130 aircraft. Assisted by a non-medical scribe, the physician provided information to the scribe for entry into the PRAS cell phone triage and abbreviated medical forms. Participants included the USCG, the Coast Guard Auxiliary, the cruise ship industry, Rand Memorial Hospital, the Bahamas National Emergency Management Agency, the Pathfinder Task Force, the FAST, and other stakeholders. The emergency physician assisted by a scribe utilized a cell phone-based triage form and triaged 56 patients in 42 minutes as documented by the software, transmitting initial triage criteria (respirations, pulse, mental status), triage tag status, 2 pictures of each victim with geotag and time/date stamp data. A more detailed cell phone-based medical form was utilized at the FAST team aeromedical staging site to create and transmit an abbreviated disaster patient movement record, which included patient name, vital signs, aeromedical evacuation movement precedence, critical care transport medical requirements, treatment, and equipment requirements. This exercise demonstrated the feasibility of using mobile medical documentation to provide real time information to an EOC or other agencies monitoring patient treatment, status, and location. The simplicity of this system and ability to store and transmit data allows for use in a 100% disconnected environment, can improve communication from responders, and can provide valuable real-time situational awareness for healthcare facilities, and EOCs. This technology can be utilized for rapid data collection during disasters, and can provide patient and responder rosters for subsequent surveillance or disaster research. The PRAS application should be further evaluated and tested in disaster exercises and during real-world disaster response and mass gathering events.