IHS practices for pandemic

Mass flu vaccination tests Indian Health Service's common environment for communication, information sharing

"The most important aspect is that it creates a common operating picture, which provides an atmosphere where senior leadership can make decisions in an informed manner." Dean Ross, Indian Health Services Deputy Director of Emergency Services

In one day last November, the Indian Health Service vaccinated 24,000 members of the Navajo tribe against flu. It was the largest mass vaccination in the United States, agency officials said, and it was perhaps the closest simulation yet of an inoculation for a pandemic outbreak.


The mass vaccination at 15 sites proved how ready IHS is to respond to a regional public health emergency, said Tommy Atha, the agency's emergency management director and physical coordinator with the Navajo area in Arizona.


The exercise tested the agency's ability to manage communications and response resources using alert and incident response management services.


Through the online Incident Management System from Send Word Now Communications Inc. of New York, officials had a platform that acted like a command center to centralize the communication flow among the locations, keeping key first responders in touch, said Dean Ross, IHS deputy director of emergency services. It also lets senior officials assign, manage and track tasks, and store reference material related to the emergency.


'The most important aspect is that it creates a common operating picture, which provides an atmosphere where senior leadership can make decisions in an informed manner,' he said.


The system also created a permanent record of actions taken, actions proposed, goals and objectives.


'You can't do that by e-mail. You'll most likely leave out an important party in the decision-making process. This provides a common platform for the exchange of information,' Ross said.


The system provided bi-directional voice and text messaging communications, and automated alerts. It also could include mapping and current weather conditions.


Participants in the vaccination, which included partners in Arizona and New Mexico, three counties, federal organizations and the Navajo Nation Division of Health, found the Incident Management System relatively easy to use and log into, since it is totally online, Atha said.


Atha said that, because of the system's flexibility, he would like to see it used for responding to wildland fires, 11 of which his office dealt with last year.
'Had we had something like this, it would have made the jobs of the emergency operations center and incident command level teams out in the field a lot easier,' he said.


During the vaccination event, radio and telephone communications at times were backed up, so the Incident Management System became the primary mode of communication for the 138 users at command posts and vaccine dispensing sites, Atha said.


System users sent in reports hourly about the number of persons vaccinated, adverse reactions and any other safety incidents. The unified command tracked the number of people vaccinated, how many were left to do, how many vaccine doses were available and where.


'Through the Incident Management System, we also could develop an Excel spreadsheet and watch the flow and identify where we needed to reallocate vaccines,' Atha said.


At the same time, the system helped them respond to a local emergency separate from the vaccination event. A hostage situation in Apache County, Ariz., meant law enforcement and some emergency resources were diverted. The Incident Management System handled the logistics and operations so IHS could obtain other equipment.


'The biggest difference using the Incident Management System was that at the unified command level, we're able to look specifically at what logistics, planning and operations is doing, so the command can make decisions based on what is happening in the field. Instead of sending 10 to 15 people to make all these phone calls, we're able to see it in a Web-based format that gives us immediate information,' Atha said.


The Health and Human Services Department, IHS' parent agency, wants IHS to run a nationwide exercise later this year in several tribal areas.


Messages and alerts can go to and from Send Word Now call centers, smart phones, wired and wireless phones, and e-mail. Communications also can move from text to voice. There are BlackBerry- and Treo-based parts of the service. Send Word Now can communicate through group pin blasts, even when BlackBerry servers go down, said Mitchell Orlowsky, president and CEO of Send Word Now.


It sends it via the BlackBerry network directly to the device through its unique ID instead of going through the telephone number, IHS' Ross said.


The system has 128-bit Secure Sockets Layer encryption, he said. There are three sites nationwide for the data repository and there is connectivity.


Send Word Now's network, which is powered by 100 Dell rack-mounted servers with Cisco providing the networking gear, has triple redundancy to assure reliability, Orlowsky said. On the front end, applications can provide content-triggered alerts, crisis communications and mobilizing of field forces. Customers also can integrate their applications with Send Word Now services using standards-based Web services. These application programming interfaces let users manage their contact information, initiate alerts, get responses to alerts, and see the status and history of their alerts.


The software applications are connected to the various communication modes, including a two-way priority short message service or text messaging. It has a priority above, for example, text messages responding to American Idol, he said.


The Incident Management System and Smart Alert services are subscription based, with Send Word Now as an application service provider. The user needs only an IP connection and browser.


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