Cambridge EMS Tracks Influenza A (H1N1) in Real Time with FirstWatch®

EMS organizations around the country are on alert, preparing for an anticipated worsening of the current Influenza A(H1N1) pandemic.
 
The Cambridge EMS system – comprised of the Cambridge Fire Department and Pro EMS, as well as the Cambridge Police, Emergency Communications, and Public Health Departments – have taken their preparations one step further: Cambridge is the only emergency medical services system in New England to incorporate a real-time surveillance technology into its daily operations.
 
With the Centers for Disease Control and Prevention (CDC) expecting an increase in the number of new H1N1 flu cases this fall, particularly as the academic year kicks into full gear, paramedics and EMTs will be increasingly called upon to respond to, treat and transport suffering individuals.
 
The ability to utilize real-time surveillance to follow the numbers of suspected H1N1 flu cases, as well as pinpoint their specific geographic locations, can give paramedics and EMTs an advantage on their calls — maximizing both their safety as well as the health of the general public. Moreover, this real time surveillance is providing data and information that can be used by all providers to improve response and provide data on public health and quality of life issues.
 
“We purchased the system to identify trends,” said Pro EMS Chief Executive Officer Bill Mergendahl. “We can track what we are seeing in the field. We can monitor how many flu cases we respond to, and where they are, so that we can have advanced warning for the future.”
 
The FirstWatch Advantage
 
Pro EMS implemented the surveillance program, called FirstWatch, about a year ago. It is currently used by only 90 agencies – primarily EMS-related organizations – nationwide
 
The software automatically detects emerging trends, patterns, and geographic clusters in real-time for a range of public health and safety concerns for emergency services, hospitals and homeland security.
 
As part of its commitment to continuous quality improvement, Pro EMS has implemented a variety of new technologies over recent years to improve the quality of care and service. FirstWatch complements and interfaces with existing technology of Pro EMS.
 
FirstWatch monitors the Pro EMS computer-aided dispatch (CAD) and electronic patient care reporting system, specifically RescueNet Tablet PCR. When keywords – previously determined by Pro EMS – indicating possible H1N1 flu symptoms surface in the CAD and run reports, FirstWatch is immediately triggered to capture data about that patient.
 
All aspects of all systems are HIPAA compliant and are maintained to protect patient confidentiality.
 
The patient’s data is sent to FirstWatch’s primary server, where it is compared to existing information and patterns about medical symptoms and geographic characteristics.
 
When a suspicious or statistically significant pattern is detected, FirstWatch immediately sends an alert to supervisory staff phones. At the same time, they also receive a detailed email with clinical information, a statistical graph, and an area map.
 
In this way, Cambridge’s emergency system can track the rapidity of spread of H1N1 flu across the city.
 
Knowing which patient populations may be severely affected and what the prevalent symptoms appear to be can assist personnel in providing the most appropriate and effective care.
 
Seeing how the trends develop can also provide valuable data to assist Cambridge EMS make administrative and logistical decisions about staffing, protocols and resource allocation.
 
Better Prepared
 
Cambridge EMS workers in the field are also better prepared to respond to potential H1N1 flu-related calls with the help of FirstWatch.
 
Suppose, for example, that EMS workers receive a call for a patient with symptoms such as fever, difficulty breathing, or persistent vomiting. The EMS workers can look at the surveillance program and see if it identifies a statistically significant cluster of flu cases in the patient’s immediate area.
 
Advanced knowledge of the situation will result in responders putting on their personal protective equipment –N95 respirators, gowns, gloves and eye goggles – before even entering the patient’s residence.
 
Implementing these mandated “scene safety” precautions – well before getting within six feet of a patient – in addition to placing a mask on the patient to contain secretions can be vital in preventing the transmission of the disease.
 
Not only will future patients the EMS personnel come into contact with and transport have a reduced chance of encountering the virus, but the precautions will help the paramedics, EMTs, and First Responders stay healthy so that they can continue their critical work during the pandemic.
 
Not Just for Influenza
 
In addition to monitoring current H1N1 flu trends with FirstWatch, Pro EMS uses the program to track substance abuse overdoses and situations involving certain hazardous materials leaks or poisonings.
 
Pro EMS shares the information gathered about opioid (such as heroin and OxyContin) overdoses with the Cambridge Prevention Coalition, which operates under the auspices of the City of Cambridge Department of Human Service Programs.
 
“FirstWatch has been an incredible resource; it helps track what’s going on in real time in the community. We’re able to put the information together to identify causal factors,” said Gisela Rots, Director of the Cambridge Prevention Coalition.
 
Her organization broadly focuses on substance abuse prevention. Currently, one of their projects involves collaborating with a number of organizations, including Pro EMS, on a state-funded opioid overdose prevention program.
 
“I haven’t heard of any other ambulance company [besides Pro EMS] in the state who provides data or comments on trends going on.”
 
She added, “Pro EMS is a great partner; they are willing to share their information to benefit our project.”
 
Rots hopes the work of the Cambridge Prevention Coalition will soon reciprocally benefit Cambridge EMS by leading to decreased numbers of opioid overdose-related 9-1-1 calls and transports.
 
Facts about H1N1 Influenza
 
The World Health Organization (WHO) declared a pandemic of Influenza A(H1N1) in June 2009 due to the rapid spread of the disease. While the future course of the virus is still unclear, WHO officials estimate that between 15 and 45% of the world’s population will eventually contract the virus.
 
H1N1 flu is spread from person to person. The virus is airborne; tiny droplets that are released into the air when infected individuals cough or sneeze can then be breathed in by others within a three- to six-foot radius. In addition, if people touch a contaminated surface or object, neglect to wash or clean their hands, and then touch their own mouth, nose or eyes, they can also become sick.
 
Currently, most infected individuals only experience mild symptoms. Symptoms of H1N1 flu may include fever, cough, sore throat, runny or stuffy nose, fatigue, body aches, diarrhea or vomiting.
 
The CDC recommends that people with suspected or confirmed H1N1 flu stay home from school or work for at least 24 hours after their fever has gone, and limit their contact with others during their illness.
 
Uninfected individuals can help keep themselves healthy by washing their hands or using alcohol-based hand cleaners frequently, as well as avoiding unnecessarily touching their eyes, nose or mouth.
 
Several H1N1 flu vaccines are currently being tested, but may not be available for distribution until October. The first recipients are expected to be people most at risk, including health care and emergency medical personnel, pregnant women, people with chronic illnesses, and children.
 

For more information:
 
FirstWatch:
www.firstwatch.net
 
Cambridge Prevention Coalition:
http://www.cambridgema.gov/dhsp2/cpc.cfm
 
Centers for Disease Control and Prevention:
http://www.cdc.gov/H1N1 fluflu/general_info.htm
 

World Health Organization: Pandemic (H1N1 FLU) 20009:A
http://www.who.int/csr/disease/H1N1flu/en/

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