|Year : 2015 | Volume
| Issue : 3 | Page : 129-135
Role of mhealth in effective response to disaster
Mohammad H Yarmohammadian1, Reza Safdari2, Nahid Tavakoli3
1 Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Health Information Management, Tehran University of Medical Sciences, Tehran, Iran
3 PhD Candidate of Health Management in Disaster, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
|Date of Web Publication||20-May-2015|
Health Management and Economics Research Center, Isfahan University of Medical Sciences, Hezar Jerib Street, Isfahan
Source of Support: None, Conflict of Interest: None
In recent years, many countries have suffered from various natural disasters. Disaster response has continued to face challenges in health care sector in all countries among which, information and communication management is a significant one. During the last decades, rapid advances in information technology have led to information management effectively and communication improvement in health care settings. Information technology is a vital solution for effective response to disasters and emergencies, so that if an efficient information and communication system is available it would be highly valuable. Of that, mobile technology represents a nearly computing technology infrastructure which is accessible, convenient, inexpensive, and easy to use. This article reviews the literature on the state of mobile health application in disaster management in some countries in 2014 by electronic search in databases such as: PubMed, Google scholar, Proquest, Science direct, etc. The findings showed that most projects have not yet reached the deployment stage, but evaluation exercises show that mHealth should allow faster processing and transport of patients, improved accuracy of triage, and better monitoring of unattended patients in a disaster scene. Since there is a high prevalence of cell phones among world population, it is expected health care providers and managers take measures for applying this technology to improve patients' safety and public health in disasters. There are challenges in the utilisation of mhealth in disasters, such as lack of structural and financial issues among countries. In the present paper, we have discussed on utilisation of mHealth technology in disaster response.
Keywords: Disaster, information technology, mobile health, mhealth, response
|How to cite this article:|
Yarmohammadian MH, Safdari R, Tavakoli N. Role of mhealth in effective response to disaster. Int J Health Syst Disaster Manage 2015;3:129-35
|How to cite this URL:|
Yarmohammadian MH, Safdari R, Tavakoli N. Role of mhealth in effective response to disaster. Int J Health Syst Disaster Manage [serial online] 2015 [cited 2021 Feb 27];3:129-35. Available from: https://www.ijhsdm.org/text.asp?2015/3/3/129/157363
| Introduction|| |
Health care is critical to life which might be modified to a great extent as a result of unexpected health conditions including disasters and events.  During the last decades, different instances of great devastating events have occurred because of different reasons ranging from human factors (terrorism and bio-terrorism) to natural disasters (e. g. earthquake in Bam, Iran, tsunami in Indonesia and famine in Africa). Such events have long-term harmful effects on human health and health care systems. In addition, they create needs for a large population in case services, infrastructure, and sources are minimally available.  When facing a large number of injured people in accidents, prioritising and detecting them has always been very challenging. Often, we have no information about the number of injured people, number of those who have been put to triage and are required to wait up for being taken after, their location, and where they need to be transferred to.  Emergency response local systems are responsible for taking care of such emergency conditions along with state resources, local communities, human support organizations, medical personnel, and volunteers of different foreign resources. Managing an effective and influential response requires mutual cooperation which is facilitated through information and communication technology. In this way, new information can be gained from the accident scene.  Automatising these responsibilities reduces responsible people's work to a great extent, increases quality and quantity of patients' cure, and sets the stage for their optimal transference to the hospital. Great developments in wireless networks, medical sensors, and interactive software would offer equipment for the improvement of emergency cares.  Moreover, prioritizing a bunch of wandering injured and patients in the accident scene, waiting up to receive medical services, and avoiding crowded emergency departments require appropriate techniques. A retrospective study showed that applying e-health technology can be led to 15% decrease of cases in which transferring injured people from the accident area to the hospital is necessary.  In an accident, the first critical step in response process is quick and correct triage. Triage information in the accident scene is transferred to different responders team, which needs to be updated repeatedly for constant response. This information help the response team request additional ambulance and personnel, inform about health care equipment, and prioritize patients for transference and cure.  When an accident has taken place, economic, social, and personal infrastructures are deeply damaged, due to which state capacities quickly saturated as result of direct and mass request for assistance. In such conditions, pertinent connection, gathering information, and adaptation are very influential for helping victims and vulnerable people.  Technologic realm of health mobile: Natural resources in every society can significantly affect that society's health. Some developed countries have different health systems whose citizens receive advanced medical cares. Low- or average-income developing countries often suffer from medical information, availability of health services, quality of care and behavioural values. Such shortages can be evident in poor area of developed countries.
To remove such impediments, there is an obvious need to technology. To get a better access to health through a constant and reasonable way, countries need to utilize ideas and technologies that employ ready and available resources. Abundance of mobile technology in developing countries provides such opportunity. These technologies cannot take drugs, doctors, and equipment to different locations, but they can process and transfer information in different vocal, auditory, and visual forms. Main technologies which are in charge of transference of information in mobile equipment are: General Packet Radio Service (GPRS), Global System for Mobile Communications (GSM), third and fourth generation of mobile phones, Wimax, Wi-Fi, computer-centered technologies, and Bluethooth which is used for short-distance connections.  Generally speaking, technologies used in electronic health are divided into three categories: Portable equipment of medical imaging, personal digital assistants/intelligent telephones, and wireless communication infrastructures. 
In recent years, mHealth has been known as an important subpart of electronic health. In spite of diversity, these terms can be defined as follows:
Ehealth is using information and communication technologies such as computers, mobile phones, and satellite communication to offer health information and services.
Mhealth is using communication devices such as digital personal assistant, mobile phones to gather and transfer health services information.
Ehealth and mHealth have an indivisible connection; both of them are used to improve health results and include same technologies. Formal investigation about the initial evaluation in developed and developing countries show that mobile technology improves health care efficiency and eventually makes it more influential. Advantages of mHealth programmes in prevention and cure include patent's improved health and health system improved results.
Masiluleke's project is being carried out in South Africa to capture the power of mobile technology as a gadget with high influence and low price which can be used to deal with AIDS. Every day, one million SMSs are sent in colloquial language to encourage people to test and cure AIDS. 
- Warning and making first call: Mobile phones offer major concepts for making a first call to seek help and collect information through which people in the accident can seek help from friends and relatives. This is the most important and beneficial service mobile gadgets can offer in difficult conditions
- Receiving vital information when other media such as television, radio, and computer are not available. Here, mobile phone is the only information resource for taking evacuating measures, taking injured people to havens and providing other services and facilities. Also, raising awareness about climate conditions and other suggestions related to survival can be beneficial to injured population and rescuers
- Spreading data and information for assistance and supportive agencies: During an earthquake, storm, flood and epidemics. 
A study was carried out aiming at evaluating mobile-centered documentation system during Black Swan maneuver in America, and its findings showed that this system enables path finders (seekers) to take photos, add scene notes to the mobile, code them, set date and time for them, and enlist them in the leader's map, so that emergency sector personnel could analyse the disaster. It also indicated that the possibility of using mobile documentation provides timely information for emergency sector or other agencies which monitor patients' cure locations and conditions. Simplicity and capability to save and transfer data has made it possible to be used in environments with no connection. Also, it can improve communication for the rescuers and offer valuable and timely information about victims' location to health care centers, and information executive chief. This technology can be used in quick data collection during the disasters and create lists of rescuers and patients for crisis-related researches. 
As WHO reports, 51 mHealth projects have been carried out (or in progress) in Tanzania, Indonesia, Georgia, and India, aiming at creating more effective heath cares which would have a positive considerable effect on clinical findings such as fetus death, more lifetime, and reduction of diseases. Besides, nowadays millions of people use mobile phones as a means of daily communication, and data transference, 64% of who live in developed countries. This progress in the use of mobile is an important element in viewing mHealth technology. In developing countries, people have plentiful access to mobile phones, though other technologies might be out of reach. This mobile phone explosion would precede a potential for the improvement of health services in vast numbers. 
After Haiti's earthquake in 2010, International Red Crescent sent more than 45 million SMSs to Viole mobile phone users; 95% of the receiver announced they had gained useful information out of these SMSs while 90% announced they had made themselves prepared. 
Schwartz et al., noted that remaking a pre-hospital emergency system was so vital to the optimal management of health care needs of those injured in tsunami and also to the reduction of patients in second-hand medical centres. In his study, Huffer reiterated the possibility and precision of diagnosing satellite portable transference systems in evaluation of heart emergencies. Balch proposed that high speed health networks can improve communication to respond to an accident and coordination between local and foreign organisations; further, they can be informed of what happens in the accident scene. These networks can either be pre-designed or temporary infrastructures or and include high speed satellites, local wireless networks, and mobile technologies for environmental and clinical monitoring. 
In a study entitled qualitative analysis of patients' experiences in emergency section aiming at sending SMSs to improve the management of diabetes, 23 patients were chosen. Findings showed that men and women had different information resources and self-effectiveness in nutrition management. These differences might influence the impact of mHealth interventions for the improvement of diabetes. When designing interventions in order to reach the utmost influence, people's gender and culture need to be taken into account. 
Koh's study under the title of 'medicine students' conceptualisation about the effect of mobile applications on their clinical performance' revealed that 88% of the students reported they had personal intelligent gadget and 87.5% of them had installed medicine applications on the mobile phones. Further, most of them reported a positive attitude toward using such software and their positive influence. However, they had little awareness about violating patients' confidentiality. 
| Materials and Methods|| |
In the present study, papers on mobile technology and health were searched and investigated in Google Scholar, Pubmed, Elseview, Pro-quest, etc., databases, using key words such as health technology, disaster response preparedness, and patient tracking. Furthermore, different papers were studies from related journals including Annals of Emergency Medicine and Journal of Mobile Technology in Medicine.
| Discussion|| |
MHealth gadgets are often applicable in providing care in unstable conditions such as military fights and unexpected events. Raw data in the events are often inaccurate, vague, and contradictable; they rarely provide sufficient foundation for decision making about whether to take or not to take a certain measure. Also mHealth can be categorised as a subpart of Ehealth. Quick advances in information and communication technology, especially wireless and mobile communication, have led to the advent of a new information infrastructure which potentially supports the polish of advanced services for health care. Employing effective mHealth in the country requires an identification of opportunities and limitations, setting principled and proper programming according to social and economic factors, besides providing technologic, communication and transmittal, legal, and executing infrastructures. Among different ICT gadgets, wireless and mobile phone technologies offer opportunities for reducing the expenses and increasing availability so as to improve the efficiency and effectiveness of health care. 
Social goals of investment in mHealth
- Improvement of availability and quality of health care
- Pertinent information gathering and use
- Disease prevention and public health promotion. 
One of the challenges in responding to emergency conditions is information and communication management, because pertinent and effective response in the emergency section requires continuous analysis of the situation and information so that we could evaluate available needs and resources that might change unexpectedly.  Medical care in accidents and disasters needs patients' quick triage and evaluation, harsh observation and evacuating people from where there are a bunch of people and time and resources are limited. Current systems are based on paper triage by which medical team decide patients' conditions and can record limited information about damages and cures imposed in the accident scene. Moreover, when patient's condition exacerbates, information on these tags might not be updated; they are not resistant to climate changes and would fade easily. Tags exemplify static and bondless containers, but they are needed for the management of information in real times.  In disaster scenes, rescuers (first responders) start triage through tagging paper tags or colored strips to show patients' intelligibility level which would be subsequently inform the number of patients to triage personnel. Triage personnel take information from the rescuers and categorise them on a Clipboard. Patients' triage conditions, vital symptoms, and settings constantly change and must be continuously tracked. Unfortunately, in recent response processes use is made of paper tags which are not able to guarantee triage, constant monitoring, setting patients in mass death occurrences, and efficiency, and also report homogeneous information for the disaster leaders. Leaders calculate number of patients, request for ambulance and then let nearby hospitals know about them. ,
Paper tags do not have limitations for monitoring of patients, including sufficient space for manual recording of important information such as vital symptoms and patient's major complaint during the cure. Additionally, since patient's information is recorded in tense condition in a limited time, tags are often illegible and difficult to read. Valuable times are wasted from when a patient is under triage and when verbal information is reported to the administrators. In addition to this, paper tags limit visual reflection and provide no help for patient's accommodation among many others tagged patients. When a large number of patents are counted by the leader, manual counting of each triage would encounter human mistakes.  In such a situation, new technologies such as internet, minute computers, and intelligent equipment potentially facilitate responding. 
Evidence has shown that in case conditions have altered for a patient, value of paper tags are not quickly altered. Also, patients prioritized with certain colors would be done one by one; otherwise it would be impossible. After completing the initial triage, patients are transferred into a waiting place where they wait until it would be ok to send them to a hospital. This waiting would exacerbate their conditions. Second triage would facilitate patients' deep reevaluation. In this part, rescuers record demographic information (e. g. age and sex), allergies, drugs, main complaints, and injury conditions. This information are needed for the cure and transference of the patient to a hospital which is capable of taking after them. In case patient's transference is postponed, they need to be reevaluated every 5-15 minutes. In disasters with mass victims, constant reevaluation is burdensome, because it is difficult for the rescuers to focus on most injured people and gather useful information. In such a chaos, emergency sector administrators are often provided with insufficient information for responding to the needs. Moreover, patients might encounter secondary injuries such as hypoxemia, hypotension, and heart problems. To diagnose such problems, the current responding protocol in the emergency sector needs to have technicians who continuously take care of patients' triage. With the help of responding and preparation center and protocol training center MCI, disease control center has announced that patients need to be reevaluated and put under triage based on a certain pattern, because patients' conditions might exacerbate gradually and more serious injuries be imposed to them. 
Employing and executing a tracking and monitoring system for patients in emergency sector leads to improvement of medical team's workflow and work trends. Besides, in line with adding patients' information into the system which starts from triage and lasts until evacuation, entering the hospital, and up to the end of cure period, documentation and pertinent availability of patients' information would lead to proper and timely connection to the cure team, right and timely decision making, and finally promotion of patients' security. Effective management of communication and information in emergency conditions is essential to providing timely and high quality health care.  A key factor in effective management is designing communication and information technologies which support influential and indirect coordination of pre-hospital and hospital emergency sectors. Although, measures have been recently taken to support rescue team and emergency personnel, systems need to be expanded which bridge the gap between pre-hospital and hospital emergency sectors. Current technologies focus on internal connection more and do not lend support to team connections and unlimited flow of information. We need to expand information systems that support such coordination. 
MCI is a devastating event which causes a need of vast transport of medical equipment. In MCI, emergency sector must be prepared to provide service to care for a large number of patients in a short time. Information systems have a crucial role in mass victim disasters; they facilitate to-the-point, timely, and correct intelligence awareness, the management of patients' cure, department resources, and clear connections. Emergency information systems are applicable to management of data and support of workflow including tracking patient's location, recording clinical documents, entering orders, receiving results, and release management. 
Designing, expanding, and employing equipment such as wireless is useful for first responders in a mass victim disaster. Its components include a digital personal assistant having the ability equal to a wireless transaction 802.11, microprocessors, stabilized memory, peculiar software of medical electronic profile. 
In Washington, three medical service emergency groups have expanded a triage system for the improvement of response effect which includes: (1) Electronic triage tags, (2) wearable sensors of vital symptoms, (3) main stations laptops for monitoring and managing the patients, (4) overall tracking software for patients' locations in all steps of response to disaster process, (5) personal digital assistants for the support of documentation and connections. 
Internet-centered barcode tracking communication system has been designed to reduce chaos in the disaster scene, which is used to manage MCI injured people in emergency vehicles and hospitals. When a disaster takes place, this system is activated by 911, an emergency system which warns danger. Disaster is warned by a system which has been previously set in a safe web environment. Place of disaster is specified on the map. In the scene, rescuers make use of a numbered badge for each victim. These badges are coded in advance and would be attached to each injured person according to his/her condition. After evaluating the victim's condition and attaching the badge, rescuers scan personal data and then transfer the injured persons' information to his/her tracking system. Subsequently, tracking injured people would be probable in following steps of the process. 
A preliminary purpose of disaster management response is gaining control over the disaster scene at the minimum possible time. Evidence shows that coordination and communication between the responding teams are essential to ruling this control, though this was not sufficient in previous disaster and caused various problems. Not only, teams involved in responding to a disaster maintain their own expertise, responsibility, and hierarchical stance, they also follow different procedures in the scene. Therefore, a system is needed to be designed that, besides maintaining missionary process of the scene, would adapt with hospital information system and that takes care of patients' tracking from when they are registered up to when they are released.  Emergency responding routinely employs communication and information technologies. Crisis management makes use of many technologies to execute a vast set of responsibilities. Despite decades of experience in employing technology in emergencies, few papers have been published in this regard.  In a disaster, there are a large number of injured people and, due to this, the ability to gather correct information from those injured at the right time is vital to success in health care. Electronic tags used in triage and e-health communication facilities such as mobile phones, personal digital assistants have lend support to this success to a great extent.
Effective disaster preparedness needs real time collection of medical data and statistical analysis and it helps to create needs assessments during disasters.  Using mobile technology in heath has set the stage for the organization of medical resources and promotion of patient's care in emergencies which would be done through quick triage, patient's tracking, and maintenance of documents.  In addition to mass injuries, common characteristics of such disasters include imposing harm to infrastructure, difficulty in reaching goods, need to great amounts of medical and emergency services, and constant separation of those injured. In such situations, using mobile phones can be vital; especially when communication infrastructure is disjointed after the disaster. But, there still exist challenges that affect more powerful abilities mobile phones can offer as preventing means to following disasters and other emergencies. Capabilities: Two mobile phones have been considered here: Cell phones and smart phones. In terms of voice calls and sending messages, cell phones have features such as digital camera ad radio receivers; they are cheaper, more energy independent, and are still used by many people, especially vulnerable people like elderlies in developing countries. So, they must be taken into account for preparation purposes and planning. Other communication gadgets such as tablets, computers, and ground connections have such features, but cell phone peculiarity has always made it a source of help in unexpected and chaotic conditions.  MHealth is a part of Ehealth. So far, no standardised definition has been proposed for m-health. E-health observatory defines m-health as general and medical health function which is supported by equipment such as mobile phones, patient monitoring equipment, personal digital assistants, and other wireless sets. MHealth includes using and employing main voice call and message properties of a mobile phone, GPRS, third and fourth generations of mobile distant communication, GPS, and Bluetooth. Data security and users' privacy are realms which required legal considerations and strategies to ensure that e-health users have been protected well enough.  Medical experts have been meticulous in accepting communication and information technologies, since, no definite curriculums and standards have so far been set for Ehealth specialists, disaster management, and emergency medicine.  Therefore, to operationalise Ehealth program, we need to take critical steps in human health, personal information and support, crisis management for certain conditions, emergent measures, and emergency sector. 
In recent years, mobile network and cell phone expansion has been among important technologies in offering health care all over the world. MHealth allows specialists to have access to patients' data and available resources which help diagnosis and cure significantly. In comparison to traditional methods, mobile communication technology has provided a new way of information transference among many people, through which people can make use of this technology to get access to general services in places with limited infrastructure.  Meanwhile, focus has been out on technologies with wider expansion among people, especially those in suburbs. 
Mobile technology has been increasingly popular in workplaces. Popularity of intelligent phones, tablets, and other personal digital assistants has created opportunities for those specialists who are after finding ways to promote benefits . First generation of intelligent phones were introduced to the world in 1994, after which number of users has been increasing. Medical software which are downloadable by operating systems such as Android is very common among doctors. More than 13000 medical software are available for online downloading services. These applications are common among students of medicine, but their influence on clinical function is rarely recognized.  Mobile phone is a personal gadget which is always on, connected, and able of positioning. Its availability provide important opportunities for personal communication.  As Global Bank (2012) reports, three quarters of world people have access to mobile technology, majority of which live in developing countries. People are regularly in mutual interaction with expert partners, family, and other services and number of information resources has raised. 
| Conclusion|| |
Using mobile applications in health care is a new dynamic field which aims at improving welfare in the world. MHealth reduces the expenditures, promotes medical and health services, and guides behaviours towards prevention and reinforcement of whatever can improve health.
In an emergency, mobile phones are the most important means of information transference and one of the most crucial ways that people can protect themselves. Timely sending of messages in emergencies is vital. Sending SMSs can be helpful in raising people's awareness about different types of emergencies which can affect them, effective ways of responding to them, and warning them about different disasters. Creating changes in health system, mobile technology can lead to improvement of health cares and reduction of death. Popularity of this technology adds to its significance in terms of promoting welfare. Along with applying this technology, in addition to considerations on the part of the universities, researchers, and health care policy makers, optimal link is required to be made between the government and other organs such as Technology and Communication Ministry, Health Ministry, and responsible financial organizations, so that this would lead to its maintenance and employment.
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