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 Table of Contents  
REVIEW ARTICLE
Year : 2016  |  Volume : 4  |  Issue : 3  |  Page : 75-81

Health sector readiness for patient tracking in disaster: A literature review on concepts and patterns


1 Health Management in Disaster, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Health Information Management, Tehran University of Medical Sciences, Tehran, Iran
4 Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Web Publication26-Sep-2016

Correspondence Address:
Mohammad H Yarmohammadian
Health Management and Economics Research Center, Isfahan University of Medical Sciences, Hezarjerib Street, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9019.191106

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  Abstract 


Background: One of the main concerns for patient safety in disaster is continuous patient trace from disaster scene to a care center, including victims' identification, data register at the scene, records of the initial medical assessment, real-time alerts regarding patients' situation, and update location of them. This process is called patient tracking which promotes their safety and reduces number of victims and secondary problems caused by disaster. The aim of this study was to review the literature and evidence of patient tracking in disasters. Materials and Methods: This was a review study which was performed through databases, journals, and available electronic resources in the case of a contract with the Ministry of Health. Inclusion criteria included the resources regarding the concepts, considerations, and components of patient tracking and related patterns for tracking the patients who were injured in disasters. Data were collected through taking notes, were analyzed by content analysis, and were presented in two categories. Results: The review and evaluation of the results obtained were classified into two areas: The findings of the research showed that 40% of references were pertained to patient tracking concepts, considerations, and components, and the rest of them were related to the implementation of the tracking system and patterns in the exercises and rarely at disasters. Conclusions: Identification and tracking of natural disaster's victims is a vital role to collect important information and facilitate communication in a timely manner which helps to address patients' medical needs, reduce duplication activities for them. Also classification and distribution of this information among health officials and institutions is a national necessity. This important issue facilitates to do preparedness plans for disaster response and to reduce people losses in the community. This important issue facilitates to do preparedness plans for disaster response and to reduce people losses in the community.

Keywords: Concepts and patterns, disaster, healthcare preparation, literature review, patient tracking


How to cite this article:
Tavakoli N, Yarmohammadian MH, Safdari R, Keyvanara M. Health sector readiness for patient tracking in disaster: A literature review on concepts and patterns. Int J Health Syst Disaster Manage 2016;4:75-81

How to cite this URL:
Tavakoli N, Yarmohammadian MH, Safdari R, Keyvanara M. Health sector readiness for patient tracking in disaster: A literature review on concepts and patterns. Int J Health Syst Disaster Manage [serial online] 2016 [cited 2019 Mar 26];4:75-81. Available from: http://www.ijhsdm.org/text.asp?2016/4/3/75/191106




  Introduction Top


During the past 20 years, a lot of countries have been experienced a significant number of natural catastrophic disasters which have had global effects on nature and societies.[1],[2],[3] In 2014, natural disasters had devastating effects on the human society. Three hundred and twenty-four natural disasters caused the death of more than 7823 individuals, 140.7 million injured individuals, and 99.2 billion dollars financial damages. Asia has experienced the highest number of disasters (44.4%) and naturally has had the highest number of victims (69.5%).[4] During the past three decades until 2010, natural disasters in Iran annually caused the death of 3000 individuals and affecting 1.5 million individuals. In such a country enjoying such frequent natural disasters, informing, preparing, and managing disasters are significant points in the public health.[5],[6] Due to these disasters, disaster planning based on few experiences and assumptions is changing into evidence-based planning.[7] Therefore, paying attention to the issue of health management in natural disasters in Iran and organizing the information and communication situation for rescuing victims, as well as doing comprehensive research on disasters in Iran, result in preparedness and more appropriate responses in cases of occurrence of such events.[8],[9] These studies require the existence of data and documented information about public health such as number of patients who have been cured, their release states, and types of diseases and injuries which have been cured after disasters in order that different reports needed for studies of disaster management in Iran, and particularly, epidemiological studies should be provided.[10] Insufficiency in tracking casualties of Katrina Disaster in the USA was identified as a weakness in the planning of local and national preparedness for handling the event.[11] After Bam Earthquake, Rathore stated that due to the insufficiency of patients' information, their management and effective assessment of their states were difficult.[12] Marres declared that facing great disasters needs a coordinated response of different organizations, but establishing coordination among organizations and geographically dispersed locations is a complicated process. One of the biggest challenges in such conditions is patient tracking. Mostly, there are no data about the number of victims, their conditions, their places, and their transfer.[13]

If we imagine a scenario of earthquakes, a large number of injured or dead individuals which are beyond the capacity of the emergency answering system are at scenes. Hospitals do not receive information about the number of patients whom they are to admit. Incident commanders at scenes have no appropriate information about the cases such as how many patients are transferred to different hospitals?, whether hospitals have capacity for admitting new victims?, how many vehicles of emergency medical services are at hand?, and where are their exact locations at each time? The emergency personnel has no idea of destinations of patients and the injured people who are removed from the scene. Members of families cannot call each other due to the insufficiency of telephone and mobile lines. Medical centers which admit victims are overcrowded and cannot make communications with patients' families at least in the primary hours. It may also be need to transfer patients to medical centers in other cities or countries if disasters are large enough.[14] Therefore, plans for preparedness against disasters should move toward a standard global system for labeling, identifying, and tracking victims.[15] In the recent decade, most patient tracking systems designed in different countries and reported in different articles are at different levels of development and they are not completely implemented. However, all have the common aim of positioning patients, tracking their medical conditions, returning them to the conditions before disasters, and joining them to their family members.[16] This study aimed to perform a literature review on concepts and patterns of patient tracking in disasters.


  Materials and Methods Top


This literature review study was conducted in nine databases which were available electronic resources in the case of a contract with the Ministry of Health in February 2016 using the search strategy which is showed in [Table 1].
Table 1: Search strategy details

Click here to view


All articles published between 2003 and 2015 were screened and read in full text. Relevant references were assessed to meet the study's inclusion criteria and included in the review and they were divided into two categories. From the 78 references extracted, 34 documents were excluded because they were not relevant for the aim of this study. Data were collected through taking notes. Finally, data were analyzed by content analysis.


  Results Top


The findings of the research showed that 40% of references pertained to patient tracking concepts, considerations, and components (Part A), and the rest of them (Part B) were related to the implementation of the tracking system and patterns in the exercises and rarely at disasters.

Issues of patient tracking concepts, considerations, and components

Patient tracking

In emergency medicine, the concept of tracking has different meanings. One of its meaning refers to tracking patients' physical location, and the other refers to the advancement in patients' treatment and tracking their medical needs while providing emergency services.[17] Tracking the injured people in disasters refers to identifying and registering names of the injured, recording their information and medical conditions, prioritizing schedules for evacuation of them from scenes in accordance with the color of triages, and tracking and positioning them from scenes to reaching medical centers and then up to the end of the treatment course and their discharging states.[18]

Importance of patient tracking

Accurate, accessible, and timely information about patients, their conditions and injuries, services provided for them at the scene, and their final discharging states for the success and organization of general responses to disasters are highly vital. The incident commander should access to timely information about casualties and patients' needs regarding the resources at hand such as physicians at the scene, deployment places of ambulances, and the capacity of hospitals so that he/she can develop necessary coordination. Real-time data for determining patients' appropriate destinations are vital depending on the type of their injuries and the capacity of hospitals.[19]

Objectives of patient tracking

Due to the primary effect of disaster, patients' relatives tend to know that where their family members are being cured? In most disasters, patients may be transferred to different locations. In addition, patients may themselves directly and without prehospital emergency intervention refer to medical centers and hospitals or they may be referred to hospitals by their relatives. The primary aim of patient tracking is to identify patients' identities and locations in all moments and inform their relatives and supervisors about their medical conditions at real time. The significance of this issue is no less than the process of caring patients and their drug treatment.[20]

Tracking stages in emergencies and disasters

The tracking process starts with patients' triage; at the same time, when patients are prioritized by triage officers and their assistants, they are identified with an observable label and grouped with similar patients in a geographical area. Tracking starts with registering their documents which enter healthcare systems with the emphasis on this issue that registering data can be done only to the extent that treatment conditions allow. When documentation tags were used for patients, the number previously assigned to this tag is the first identification of patients' identities. Technological development for tracking triaged victims eliminates problems of the paper system and helps track patients up to reaching final destinations. By scanning each patient's unique wristband in each place (accident scene, scene-care center, emergency room, hospital wards, operating rooms, and Intensive Care Unit), the system can track him and identify the latest location of that patient. Adding a Wi-Fi network compatible with a barcode reader device at the point of collecting patients which can be uploaded to the network provides the possibility of tracking, dispatches, and updates paths for all hospitals. This process helps hospitals guide patients' family members to the latest patients' locations.[21]

Patient tracking system

It includes the three terminologies of locating, tracking, and organizing.

  • Locating: It is a system which provides allowed users the ability to determine the current and update location of patients and their medical conditions
  • Tracking: It is a system which provides allowed users the determination of the current and previous locations as well as medical conditions of patients
  • Organizing: It refers to a process in which efforts are exerted to ensure that patients or evacuated individuals have been transferred by appropriate vehicles to a place having human forces, equipment, and other facilities for curing them.[16]


Dimensions of the patient tracking system

Patient tracking system can be explained in three dimensions: Functional, data, and technological.

The functional domain includes functions expected to be fulfilled in the system. In this domain, important questions about the function of the patient tracking system are presented. Some of these questions are as follows:

  • Who should enter the tracking system?
  • Where data should be entered?
  • Who is responsible for recording data?


The content domain includes main elements of data and their other elements. In this domain, two important parts are referred to:

  • Main elements of data which should be completed as far as possible
  • Other elements of data which are better to be completed; however, due to particular conditions of events, it is not mandatory and they can be added to the database later.


The technological domain includes different types of information technology (IT) required in the system.

In spite of the lack of standardization, there are some common cases for the patient tracking system with facilitated technological platforms. Planners should consider four domains related to technology:



  1. Patient identification technologies
  2. Information and communication technologies (ICTs) for collecting and recording data
  3. Main application.


This application includes three sections: Database, number of observable and web-based user interfaces in different locations, and Internet network for making connections among those who revise data.[7],[22]

A patient tracking system should have the following capabilities:

  • Tracking patients from their entrance to the healthcare system up to their discharges
  • Identifying users of the system who have appropriate permissions to access the electronic system
  • Accessing patient tracking mass data from the prehospital emergency and hospitals
  • Observing rules and regulations concerning patient confidentiality
  • Integrating by the national patient tracking system.[23]


Requirements for developing the patient tracking system

Extensive discussions with incident management personnel have caused that it is felt that functional requirements needed for improving situational awareness can be classified into five groups:

  • Performance: The system should ensure that vital information collected at the scene is transferred rapidly and accurately to the personnel who receive patients
  • Registration and documentation: The system should ensure that all patients and rescuers have been registered and identified
  • Accountability: The system should ensure that patients, personnel, and equipment are continuously counted
  • Integration: The system should integrate all information related to the situational and decision-making management into a unit plan
  • Support: The system should have contingency capabilities in cases of occurring deficits in the system or in the network.[24]


The data set required for the patient tracking system

At the same time, when victims are transferred from hot zones to triage and treatment units, information started to be produced. This information includes triage, physical evaluation, and conducted treatment provided at the scene.[25] The minimum elements of primary data include patients' unique numbers, names, gender, dates of birth, health conditions, location identifier, identifiers of arriving or leaving locations, and dates of arriving or leaving locations. In addition, more elements of data such as transportation, specific medical needs, decontamination states, particular security needs, IDs for joining members of a family to each other, attached files such as medical files and images, particular communication needs, and disposition from the healthcare system are required.[16]

The patient tracking systems and patterns implemented in the exercises and disasters

Electronic triage

Zhao conducted a study with the aim of assessing a portable tool for the use of rescuers in documenting victims' triages in high loss incidents. This tool provides the rescuers this possibility to collect patients' vital signs, injuries, and triage states immediately and appropriately and then send wirelessly the patients' vital signs for continuing their treatment. Architectural infrastructures for this manual tool are called triage and casualty informatics technology and can facilitate triage measures, transportation, and treatment in a mass casualty incident (MCI). This system was developed and executed by integrating handle equipment such as wireless networks, global positioning system (GPS), digital cameras, and bar code scanners with software localized triage. This system was confirmed in two trial tests at the scene and the results indicated that it had realized software, battery life, accuracy of data, wireless transfer of data, and needs of the emergency response system. Furthermore, the performance power, reduction in the triage period, and improvement in the accuracy of data collection were indicated using this system.[26]

Gao conducted a study entitled, “A next generation electronic triage to aid mass casualty emergency medical response,” in which the integrated computer system of triage can be used in emergency services in such a way that it can easily facilitate tracking victims by making patients' triage documentations electronic and supporting triage assessment by decision support systems. This study was conducted with the cooperation of three prehospital emergency groups in the Washington metropolitan area where the triage system of the next generation was developed for improving the efficiency of emergency responses.[27]

The Advanced Health and Disaster Aid Network has developed electronic triage strips which identify patients' geographical locations automatically everywhere both indoors and outdoors. When patients are marked with electronic triage strips, they are tracked automatically without any need for other entries on the part of medical personnel involved in servicing via the software tracking system. These strips which are founded on smart hardware grounds are small, lightweight, easy to use, and cost-effective, and their application is easy in high loss events. After each MCI, emergency response services require that all patients be registered. In this system, registering all patients at the scene is conducted electronically and automatically. The emergency personnel, accordingly, instead to waiting for the subsidence of incidents, can track real time all patients.[28]

Online and wireless tracking system

an online victim tracking and tracing system (VITTS) can be designed and executed based on a wireless network with routers in ambulances and online and direct guidance of registering victims and their triage data via barcode cards. The system was tested for its feasibility and applicability during an incident maneuver. The results indicated that the establishment of a local radio network from mobile canons and routers and the connection based on the general packet radio service with a central database work appropriately. The VITTS provides correct storage of data, timely access to data and investigation of the number of victims, their injury severity, and accommodation. The results of the study indicated that this system provides the grounds for registering victims near the incident scene. Using different online and wireless connections by a diverse range of chains in releasing events increases interaction capabilities and makes patient tracking possible.[29] Gao conducted a study on monitoring vital signs and patient tracking via wireless networks. Patients at the scene can enjoy technologies which constantly monitor their vital signs and track their locations until their admission in hospitals. A system was developed for real-time patient monitoring which can provide the integration of vital signs sensors, location sensors, electronic patient records, and web gateway technology. This system facilitates the relationship between service providers at the disaster scene, medical specialists in hospitals, and specialist at hand for getting consultations from remote institutes. In large events, when medical teams quickly triage a large number of victims, they do not have time for responding alerts until all patients are discharged from the triage scene. This system can prioritize those patients who have been triaged and are waiting for ambulances. This system was performed in Suburban Hospital and the Johns Hopkins Pediatric Trauma Center.[30]

Patient tracking system

Dobson conducted a research on the tracking systems in the pediatric emergency department with the aim of enhancing the understanding of how to use electronic tracking technologies in clinical systems and their effects on the consequence of patients' care and safety in a systematic way. The research resulted in the extraction of five tracking systems: Infant monitoring/prevention of abduction, tracking using barcodes, radio frequency identification (RFID)-centered tracking, infrared (IR)-centered tracking, and mixed IR- and RFID-centered tracking. Key findings of the study emphasized the application of barcodes, RFID, and IR in the pediatric emergency department for documenting patient flow, improvement in safety, and increase in the temporal effectiveness in this department.[2]

In 2006, a study was conducted on the traumatic patient tracking system using the infrastructure of wireless monitoring for emergency response. In this study, the traumatic patient tracking system reports constantly victims' locations by tagging them by the first respondents and at the same time using a wireless device. This system not only contributes to prioritizing traumatic patients but also registers the time of providing healthcare services for patients. In this system, to track patients' locations inside and outside incident scenes, GPS and RFID are used. Each patient tag uses the Wi-Fi network (the IEEE 802.11 standard) for communicating with the central server using each main Wi-Fi base. A key part of increasing the tolerance of errors in the terrestrial position and timing system as a main mobile base which applies different internet connections for ensuring sending information to the central server by tags even when local infrastructures is not able to respond. This template system can be integrated with equipment for measuring pulse rate and blood pressure as well as with electrocardiographs. The stability of this system was tested in a stimulated situation of trauma in an urban environment on four patients.[31]

The medical evacuation support system for documentation and the flow of optimal information are in the field of a study conducted by Walderhaug for showing the use of new technologies for obtaining and sharing information in case of connection among ambulances. Accordingly, the Evac Sys was used during a military maneuver at the north of Norway in 2008 and it was assessed in comparison with the paper system. In this system, emergency technicians use personal digital assistants for reading personal information and use soldiers' electronic tags also called MedTag for medical conditions of soldiers. This tag has a piece of electronic memory connected with a personal digital assistant via an adaptor and can store data as 4 gigabytes. During the time, when victims are transferred to a healthcare center, tracking their locations and medical information is possible via this electronic tag connected to the personal digital assistant. The architecture of this system is flexible and can be configured for realizing needs of different operational structures. The study's results indicated that there was no technical problem in performing of the system, and users believed that feasibility and applicability of the system had vital significance as compared to the paper system for obtaining accurate and timely data at the scene.[16]

Hamilton, after investing in the emergency response system in the USA, Missouri, cooperating with two great web designing companies, designed a barcode internet-based tracking system for reducing confusion at the accident scene called the emergency patient tracking system (EPTS). The EPTS is a commutation system used for managing MCI victims, medical emergency service vehicles, and hospitals. When a disaster occurs, this system activates by the 911 call center of the emergency system announcing disasters. The disaster news is sent via a system established in a safe environment. The disaster location is identified on the map. At the disaster scene, rescuers use a barcoded armband for each victim. These armbands are identified with labels previously colored coded, and based on patients' states, they are attached to them. After assessing victims' states and attaching armbands, rescuers scan them by their personal data assistants and then transfer victims' information to the patient tracking system. This system was assessed in 2002 in a maneuver for participating five hospitals and the prehospital emergency. The problem which appeared after this maneuver was that using armbands and scanners was disturbing for prehospital emergency personnel and the burden of these devices prevented them for providing appropriate services for patients.[32]


  Discussion Top


Investigation on the past studies indicates that valid and updated information of patients at the time of occurrences of natural disasters has a vital role in effective response to disasters and enhancement of patients' safety quality. In addition, this information is vital not only for incident scenes but also for institutes and centers which are far from scenes and ready to admit patients because hospitals admitting patients are required to be aware of the number and medical states of patients who are to be transferred there for more preparedness and effective responses.[2],[17],[19],[26] Another important issue to which most studies have been referred and are very important in the dimension of humanitarian actions is the necessity of appropriately informing families for finding their family members after disasters. They have right to know whether their relatives are dead or alive, where they are, how they can join their relatives, etc., A few studies conducted in Iran have investigated the role of ICT in crisis management and the role of technology in patient identification using radio waves.[33],[34],[35],[36],[37] However, regarding infrastructures required for developing a patient tracking system in disasters, no study has been conducted in Iran and in the countries of the Middle East.[6],[9],[10],[35],[36] Other studies indicate that in a few countries such as the USA, some activities have been conducted in designing the national model of patient tracking with the emphasis on data infrastructures. In government reports, challenges and opportunities of this model have been referred to.[16],[18] In addition, a lot of studies published and presented in conferences and journals have validated different tracking systems mostly in terms of technology of data development and in maneuvers. Generally, some studies investigated information and management dimensions and other dimensions such as equipment, facilities, and IT infrastructures in patient tracking system.[19], 20, [26],[27],[28],[29],[30],[31],[32],[33] Hence, regarding the fact that in studies conducted in Iran, there was no literature indicating the existence of a national system for patient tracking in disasters; some scientific and key measures seem necessary for designing and implementing a coordinated model in terminology of patient tracking in high loss disasters in Iran so that it can provide the registration of data at a disaster scene and the possibility of registering primary medical assessment, alert the emergency team about patients' states, register treatment states, and make connection between prehospitals' emergency, incident headquarters, and hospitals for patient identification with a unique ID employing technologies such as barcodes or patient identification via radio waves. This system should have the ability to register and monitor vital signs and locate patients, track the location of ambulances and their final destination, register treatment states, track and locate patients from incident scenes up to reaching to medical centers and then up to the end of the treatment period as well as their discharge states, and regularly document and update all patients' information. It also should provide the possibility of sharing vital information among different agencies, should make possible the state of patients' discharge, the state of transferring among treatment centers and even among cities, and can collect and report information need by government officials. In addition, the system should provide the possibility of registering data in different locations (incident scenes, hospitals, etc.) and update different data in different locations about the same patients.[7],[18],[21],[38],[39],[40]


  Conclusions Top


Identification and tracking of natural disaster's victims is a vital role to collect important information and facilitate communication in a timely manner which helps to address patients' medical needs, reduce duplication activities for them. Also classification and distribution of this information among health officials and institutions is a national necessity. This important issue facilitates to do preparedness plans for disaster response and to reduce people losses in the community. This important issue facilitates to do preparedness plans for disaster response and to reduce people losses in the community. Hence, it should provide grounds for software and physical model of the patient tracking system to be used in natural disasters in Iran for locating, tracking, and organizing patients in such incidents and for enhancing the safety level and reducing casualties and secondary problems caused by disasters.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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