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Medical Disaster

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K7OPA
K7OPA's picture
Medical Disaster
All,
I am looking for an example, presentation, or other detail of setting up or testing a MESH to support a medical disaster.  I have searched the forums and the net but not found anything.  We want to approach 2 regional hospitals with the idea to link them via a mesh network and provide emergency services in an emcomm situation.  Would like to show them an example of how it would work, what services could be provided, etc. Would be great to show if some other group has already set up a similar function.
Thanks in advance for any help,
Ron K7OPA
WU2S
WU2S's picture
Medical Reserve Corps
The Medical Reserve Corps may be able to help you. See their website for a group near you.
K7OPA
K7OPA's picture
Thanks
Thanks but there does not seem to be any MESH tie-in there.
KG6JEI
A key item to keep in mind
A key item to keep in mind the mesh often doesn't need specifically designed systems.

The mesh is a wide area network. The mesh is an in independent internet like network that behaves a lot like the internet across the mesh, and a LAN when your plugged into the local ports of the mesh node.

Many tools exist already that work on a routed IP network. Many of these can easily be made accessible over a mesh.  How that is done will depend on each served agency and how they need/want to interact with the system.  I can think of something like a medical information exchange that displays number of beds available which could be on an internal website that could be exposed over the mesh.

Other local groups use Winlink for data on packet, mesh provides a massive speed (and file size) increase on these existing tools.

Working with local groups (if they exist) to understand what is already done will help you tailor it to how the mesh can improve the existing infrastructure and ultimately expand the system. Using existing tools means you only have to design the integration not the tools.
KE2N
KE2N's picture
services

I am not sure we should be providing any services other than the communications link. It's important to understand what they already have in place.  In this area there is quite an elaborate system for things like beds available (and much more). 
http://www.novaha.org/nvha/assets/File/9.11.01%20to%209.11.11.pdf
They can still use the last-gasp broadband link that hams would provide as a backup to their backup. Exactly what they use it for is up to them IMHO.
We are in the early stages of setting up nodes on two of the hospitals in the list so I am interested in this topic.

K7OPA
K7OPA's picture
medical
I guess I did not realize so little had been done in this area.  I expected someone had a presentation of how they provided a mesh network to one or more hospitals and ran an exercise to show it worked.  OK we be breaking ground here,

We already have interest here locally for high speed data exchange above and beyond UHF Winlink capabilities,  We don't want to show up with a network and a bunch of toys and tell people what 'they need'.  We are trying to get a feel for what would be required when all other comms fail, in a medical environment.
From my side it would seem logical that providing voice and high speed data (email, remote printing, efax, etc.) would be of interest for a hospital that had been cut off from the world for whatever reason, BUT we want them to tell us what they need before we rush into anything.  As is usually the case they don't always know what they don't know - thus we wanted to provide them with examples of how others are using the capability.
I was just hoping someone had already had this conversation.
Thanks again for the thoughts.
K6AH
K6AH's picture
No longer a novelty

The AREDN Project was only launched in February, 2015.   Prior to 16 months ago connecting hospitals was inconceivable.  Many still have the misconception this is a WRT56G-based ham novelty.

Andre, K6AH
 

k1ky
k1ky's picture
Hospital support - the continuing saga...
In the Nashville area and throughout our major cities, Amateur Radio has provided support for decades to our hospital community.  Back in the mid 70's it was done with Packet Radio for delivery of "sensitive" patient information (before HIPPA) - we started with Airport Disaster drills, communicating from the disaster site back to the major trauma hospitals.  Today, we have a MESH network that ties together several major hospitals throughout a multi-county area. We have two 5Ghz sectors and a 2.4 Ghz sector installed on the Regional Medical Communications Center (RMCC) atop Vanderbilt Medical Center. It is tied into an AREDN based MESH network system that spans over 6 counties in their coverage area.  This system is rapidly expanding thanks to the great work of the AREDN development team and our dedicated EMCOMM volunteers.  We have IP Phone capability to communicate among the area hospitals as well as both a 1200 Baud and 9600 Baud WINLINK RMS station on UHF and VHF also installed at the hospital as well as a WINLINK Post Office server also hosted on a computer located at the RMCC.  This is a result of good working relationships built over 41 years in the community. We utilize our state-wide UHF repeater system (MTEARS) to exercise on a monthly basis with a dedicated "Hospital Net" that includes not only hospitals but our Tennessee Department of Health, Emergency Management Agencies, TN Poison Control and any other related response agencies.  This net is held at Noon on a designated weekday.  Relaxation of the FCC rules allows licensed HAM employees at the hospitals and agencies to participate in the drill without running afoul of the FCC regulations. 

I am aware of a MESH intiative in Anchorage Alaska that has already installed two 3.4 Ghz sectors on their major hospital.  These are all published on the AREDN map.


How's that for starters?

Tom - K1KY MTEARS/Southmesh Operations Coordinator

 
K6AH
K6AH's picture
Great stuff, Tom!
Great stuff, Tom!  A great example of the role Ham Radio should be performing.

Andre, K6AH
k1ky
k1ky's picture
oh yeah... let's not forget backup Internet capability
This could be "huge" if something major catastrophic happened.  Although somewhat improbable that a facility would "lose" internet service, it is highly likely and often happens.... network failure (internal) at a facility that prevents a dispatch center from functioning.  Some of the systems that can and do fail are their internal "Paging Systems" that are internet based.  We can deliver alternative solutions to alleviate such situations..  This can be a MAJOR selling point.  Those fancy hospital bed and hospital status systems are internet based - failure of one critical component in the chain and they are useless!  We can provide alternate solutions - matter of fact, our last EMCOMM exercise demonstrated just that with a systematic message format that can be easily transmitted and deciphered on the receiving end - all without giving up sensitive information. 
 
w2rwj
Might not be the best fit...

I'm going to play devils advocate for a moment:

  • If you are pre-positioning amateur equipment, why can't the hospital deploy commercial Ubiquiti equipment to provide a backup IP connection the public internet via other hospitals/NGO
  • Most hospitals have redundant internet feeds.  My employer has 4, each to a separate wire center, with path and entrance diversity.
  • No network engineer in their right mind is going to allow interconnection of foreign IP equipment to their internal network that they don't have complete and absolute control over.  Hint: 10 net is already used by most large institutions.
  • Our paging system is stand-alone, with local terminals / controllers for both the VHF and 900 MHZ systems.  Worst case I can plug a laptop directly into either system to key the transmitter

That being said, a model similar to what HDSCS (Hospital Disaster Support Communications Systemhttp://www.hdscs.org/ might be in order.   Maybe pre-mounting the radio / antenna, and having the hospital provide fiber to the EOC where the amateur would set up a stand-alone PC for ARDEN/MESH.

73 Martin

K6AH
K6AH's picture
When All Else Fails...

What follows is my personal opinion...

The Amateur Radio role in disaster communications is when all else fails.  EOCs and Trauma Centers/Hospitals have a primary comm plan which generally uses Internet, telephone, cell, etc.  They also have a Business Continuity Plan (BCP) which defines their fallback modes of operation when those primary means fail.  RF-based IP networks are commonplace examples of these modes.  But even these modes are failure-prone which can come in a variety of forms... some involving their own IT infrastructure.

I used to think integrating with their IT network was the answer, but it's not for several reasons.  

  • Restoring their infrastructure is their responsibility under their BCP, not ours.   There are a multitude of commercially available technologies that they can fallback on for their BCP.  We shouldn't allow them to use Ham Radio to fill a gap well served commercially.  Our spectrum is a valuable resource, as are our skills, and I'm sure they are tempted to save money and get the BCP backup for free.  You hear of hospitals employing hams, or encouraging employees to become hams, so they can utilize their Part 97 licenses for this purpose... the FCC has made a narrow exception for this, but it is and should continued to be discouraged in my opinion.
  • We are not an ISP and I believe we shouldn't position ourselves as one.  You will never build a network robust enough to satisfy their business bandwidth requirements.
  • Medical workers are well aware of HIPAA requirements and their institutions have operating procedures to ensure they follow them.  Providing a network solution which is transparent from a user perspective exposes the medical worker and the institution to inadvertently disclosing protected personal health information.  Only certified HIPAA service providers are able to transport these data under a service agreement with the hospital.  Your ham radio organization will never be able to certify under the HIPAA rules.  

Where we shine is when that infrastructure and their BCP needs to be abandoned because it is no longer working... and as those of us who have supported disasters know, it happens frequently enough.

So I encourage you to think in terms of building services which are valuable under *those* circumstances: chat, email, VoIP (even BYO cell phone VoIP)  utilizing IP-dial or network-based PBX solutions.  I also believe agency-specific tools should be developed to "minimalistically" deliver what they consider critical... at least to start.  What those are, we won't know until we have more time with this technology.  Afterall, this stuff has only really been available to hams for the last year and a half.

I'm eager to see what we all can do with it in the years to come!

Andre, K6AH
 

k1ky
k1ky's picture
Right On Andre!
Absolutely dead on point Andre.  One of the "variables" is that no two hospitals operate the same and their infrastructure varies greatly from highly advanced to almost "cup-and-string" communications technology.  Tennessee has 95 counties and the structure of their EMA departments varies greatly as well, and even to this day some of them aren't communicating well with each other or their State coordinating agency...  But we are making progress!     It all boils down to the almighty $$ and who has and who hasn't.  We hardly regularly get involved with the well-funded operations, except in some rare cases but there is still a place  for us to assist when needed.   It's the underfunded and understaffed operations that need us the most where we can "make a difference" during crunch time. It's all about the "Relationships" that we build.. or have built over time that is of most importance.  Without that... you're just a fly on the wall. 
AE6XE
AE6XE's picture
+1 "it boils down to the
+1 "it boils down to the almighty $$".    10 levels of backup capability are available commercially and from this perspective, there'd virtually never be a reason to need an 11th backup ability under the provisions of Amateur radio in our professionalized world today.  It seems like to build a relationship, create an MOU, train and sustain a capability,  is to somehow smell and taste like a commercial professional entity to enable being on someone's BCP plan as ideally a 2nd level or maybe even a 1st level failover.   Who are we to say if an entity could legitimately fund or not the services we strive to provide and if we are 1st, 2nd, or whatever level?   
 
Joe AE6XE

 
AE6XE
AE6XE's picture
K1KY,   For the Hospitals
K1KY,   For the Hospitals that you are supporting, what is defined in the Hospitals BCP?  Does it define the services and relationship you have built and are providing under part 97?      

In my other post, "in our professionalized world today", I was eluding that  "when all else fails" is being commercialized and formalized by organization structure and processes like ICS.    I suspect, since and evolving out of Katrina, if we, Amateur Radio part 97, are not on a serving entity's 'plan' directly or daisy chained,  we aren't going to be considered as resources to utilize in a disaster, particularly for ICS centric entities.

Andre,  I bump into the Orange County Hospital Amateur radio folks here and there, but never dug into what is occurring.   FM voice services doesn't strike me as a 1st or even 2nd level BCP plan for the operation of a hospital today given the dependency on data communications including VOIP.    By the time they have reached the need to do FM voice services, wouldn't this mean that everything necessary to operate the hospital has already failed?  That their 'data' centric BCP plan and all else has already failed--they are back to the stone age and this era part 97 voice service is within the purpose?   

Joe AE6XE
K6AH
K6AH's picture
HDSCS considers a telephone

HDSCS considers a telephone system outage at an Orange County hospital a crisis.  Check out their website: http://www.hdscs.org/  The outage throws them back into the stone age because they have made no other provision for this event.  Phone outages are predictable, and in my opinion, a hospital owes it to the community they serve to have a BCP that restores that functionally without involving hams taking time off of work to man their "crisis".  

If it were an earthquake that damaged their phone system it would be a completely justifiable call-out of hams... the hospital can't do anything to stop the earthquake.  They can do something to mitigate the impact of the predictable phone outage... they've just elected to use the free services of hams instead.

Again... my opinion.

Andre

AE6XE
AE6XE's picture
Interesting,   In a quick
Interesting,   In a quick review of HDSCS recorded activations on the website, there are 10 recorded in just over the last 3 years.  Only 2 incidents resulting in 'opportunity' to handle traffic for a total of ~4hr 45min on the job.   I would be interested to know what traffic was handled during this time.   Predominately, the root cause is power failure and backup systems worked or were quickly restored before HDSCS could provide service.     I agree with you, this is all routine and predictable and it's a management and cost issue to allow such outages to occur.    

I also see from visiting my local Hospital in Orange County that voice doesn't seem to be the mechanism in use to perform the primary services, rather computers on carts that roll around.   I'm sure the phone system and voice was a critical system and a 'crisis' when it was not functioning in the past.  I wonder if that is still true today.   

Joe AE6XE


 
K6AH
K6AH's picture
Don't mean to disparage HDSCS...
Anyway, I don't mean to disparage them.... they do provide what I consider real emcomm services as well.  They are a committed group and April has done a lot with them.  Other ARES groups would be proud to have that level of commitment within their ranks.

Andre
AE6XE
AE6XE's picture
Response times of the
Response times of the recorded events also demonstrate the dedication and ability to sustain an emcomm capability over a wide area for when the big one hits.  This is good.  (Maybe these events should be called surprise drills...)    
k1ky
k1ky's picture
BCP Services
Joe,

I wasn't ignoring your question. Very interesting question and got me thinking.  I haven't thought of digging that far into "their" internal planning documents.  We do have "some" written MOU's with "some" of our hospitals, but not all of them.  We do have training requirements and ID badges issued by the hospitals for those qualified and authorized to support them.  We also "exercise" with our State Emergency Management and State Health agency twice a year with scenarios that involve hospital communications.  Our last exercise included a specific component that involved our field units in each county that has a trauma hospital to report the ER and bed availability status.  This specific scenario exercises the possible failure of a statewide reporting system for such data.  Our big concern in Tennessee is preparing for "The Big One" when the New Madrid Fault divides us into two countries!
K6AH
K6AH's picture
I'm quite familiar with April

I'm quite familiar with April, WA6OPS, and what HDSCS does in Orange County.  When the hospital telephone PBX fails they call in hams to shadow important people throughout the hospital.

While I understand why hams think this is a worthy and noble cause, I personally disagree with that approach because it utilizes Ham Radio as a part of the hospital's Business Continuity Plan and that plan should use commercially available services, not Part 97.  HDSCS is giving the hospital a free ride.  They should purchase their own radios for these important people and commercial license to operate them.

Again... only my opinion here.

Andre
 

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