The lessons of recent natural disasters around the globe are not likely to be forgotten soon, and people need to be reassured that in the event of any large-scale natural or man-made disaster, adequate medical resources and a well-coordinated cadre of personnel will be on scene rapidly. In part due to difficulties in the wake of some of these disasters, there is a growing recognition of the importance of satellite technology in supporting any surge medical response component.

The U.S. Department of Health and Human Services Preparedness and Emergency Operations Office is the medical response arm of the federal government, although its relies on other agencies for the primary response, says Dr. Kevin Yeskey, the office’s acting director. U.S. Northern Command and National Guard civil support teams on scene and all federal government mass casualty medical response teams have access to any mobile and portable or modular satellite assets under the control of local agencies, their own satellite communications equipment and those operated by the U.S. Federal Emergency Management Agency (FEMA), such as the Mobile Emergency Response Support and Mobile Air Transportable Telecommunications System. The Emergency Operations Office also has satellite phones that can be deployed for use by senior officials and incident response coordination teams.

The Emergency Operations Office operates under the Health and Human Services Office of the Assistant Secretary for Preparedness and Response (ASPR), which was created when Congress passed the Pandemic and All-Hazards Preparedness Act in December. Congress approved more than $800 million to fund public health preparedness, emergency medical response and other programs. ASPR also includes the National Disaster Medical System and the National Hospital Bioterrorism Preparedness Program.

FEMA also sustains a large supply of communications equipment, known as the National Cache, for tactical communications support during a disaster, says a FEMA spokeswoman, The equipment, also available to state and local entities, includes 400 Iridium and 260 Inmarsat M-4 satellite phones as well as with 300 Inmarsat Broadband Global Area Network terminals in addition to a large quantity of Motorola UHF handheld radios and several portable QualComm cellular systems.

In addition, at the U.S. Department of Defense, the Office of Force Health Protection and Readiness, the U.S. Army Medical Command and the Army Telemedicine and Advanced Technology Research Center are looking to enhance the role of satellite in everything from collecting patient data to managing and communicating medical information and performing robotic surgery. Satellite links support the Telemedicine and Advanced Technology Research Center’s Special Medical Augmentation Response Team Medical Command Control Communications-Telemedicine kit, for example, and enable other forms of remote battlefield telemedicine including a wireless PDA known as the Battlefield Medical Information System Tactical. During the Strong Angel 3 disaster relief exercise conducted in summer 2006 in California, the satellite-equipped Loma Linda University Medical Center Mobile Telemedicine Vehicle supported the Battlefield Medical Information System Tactical.

The U.S. Army also has funded the Disaster Relief and Emergency Medical Services, which is aimed at enhancing communications on board ambulances and LifeFlight helicopters via satellite-based digital emergency medical services systems. These allow paramedics and other medical personnel in the field to establish share telemetry data and video to emergency room physicians miles away.

Satellite imagery and geographic information system (GIS) data is growing in importance. It enables medical personnel to see quickly where medical resources are located in relation to disaster sites. “Disasters and emergency events, regardless of scale, are fundamentally a challenge in getting the right information to the right people at the right time and in the right format. Events have revealed the critical importance of integrity, compatibility, interoperability, and redundancy of information systems intercommunications,” says Ric Skinner, senior GIS coordinator at the Baystate Health Geographics Program at Baystate Medical Center in Springfield, Mass.

Timely, accurate and dependable communications, within, between and among hospitals and other private, commercial and public health care resources is critical, according to Skinner. “Projects like HavBed (a system designed to track the availability of hospital beds statewide and regionally) and CommCare Alliance’s Integrated Patient Tracking System recognize the criticality of good communications, including satellite technology,” he says. “Satellite technology should be an important component of every disaster/emergency communications infrastructure so that incident commanders have the information they need for situational awareness, decision support and asset tracking including victims, families, pets and resource allocation.”

Planning, mitigation, preparedness, response and recovery depend on accurate and reliable GIS data which often originates with GPS data. “Satellite data communications can ensure that this critical data gets from those who collect it to those who need it. The location of the event, the routing of victims to healthcare facilities, routing of response resources, tracking of assets and enabling timely recovery all require geographic intelligence,” says Skinner. “The ability of different entities to communicate with each other on demand and in real time — interoperability — is a critical success factor in assuring how well hospital surge capacity can be planned for and provided for. The needs for alternative and redundant communications to provide the requisite information systems integrity must be designed into any communications system.”

Need Ka-Band On Demand

Despite the progress made in bringing satellite communications gear in particular into the first wave of any large scale response effort, more needs to be done. “There is no doubt that satellites have an important role to play in emergency response and are a critical part of the interoperability solution,” says Steven Jones, executive director of the Washington, D.C.-based First Responder Coalition.

 “Truly effective emergency response planning will, before a disaster occurs, incorporate the use of satellite technology. Any plan that does not take into account the critical backup role of satellite communications during a disaster is a plan that puts the lives of first responders at risk.”

According to Larry Flournoy, associate director at Texas A&M University’s Academy for Advanced Telecommunications and Distance Learning, the only truly long term solution in emergency medicine is Ka-band satellite bandwidth on demand. “We feel this way because we have been focusing on collecting trauma data with our field ambulances and designing helicopter-based (satellite-enable communications) equipment,” says Flournoy. “When we will actually get electronically steerable antennae and low earth Orbit satellites is a different question. [Ka-band satellite bandwidth on demand] is the only solution that can be scaled and is economical for the mom-and-pop ambulance services as well as the city and county-based services. I cannot imagine that this would be any different for other first responders and emergency service personnel. While there are Ku-band services or buying clubs which help mitigate the economic and sustainability issues with Ku-band, satellite communications is still the most difficult of the communications solutions to sell to boards and cost-conscious administrators,” Flournoy and the team at Texas A&M which has been developing Disaster Relief and Emergency Medical Services see ordinary ambulance runs every day in rural Texas which would immediately benefit from a satellite connection for medical data and emergency personnel support from the trauma center.

Flournoy reports a growing interest in the emergency medical and mass trauma support dimension of satellite technology spanning organizations of all sizes, ranging from local and county emergency service groups in Texas to Army Telemedicine and Advanced Technology Research Center at Fort Gordon.

States Better Prepared

What stands out is the fact that the states like Texas are better prepared for man-made and natural disasters. Many have invested lots of time and money in upgrading their emergency communications networks and more often than not, satellite is present.
The Pennsylvania Emergency Management Agency (PEMA) is under a legislative mandate to provide an integrated communications capability designed to provide statewide warning and weather advisories, river forecasts, and direction and control of all emergency preparedness functions within the commonwealth. “Satellite-based systems are the ideal solution to fill our legislative requirement. We are progressive and moving ahead with the latest technology to protect and provide the best solution possible in our efforts to protect the citizens of the Commonwealth,” says a PEMA spokeswoman.

The agency is in the process of replacing its existing Ku-band terminals with Hughes model DW-7700 Ku-band systems. Hughes Network Systems Ku-band systems. The DW-7700 platforms will be used for voice and data communications in all 67 counties and at the state’s emergency operations center, three satellite uplink trucks, and PEMA Area Offices — a total of 108 sites statewide. All county emergency operations centers and 911 centers have the systems well. This satellite network forms the backbone for Pennsylvania’s Integrated Flood Observing and Warning System which is comprised of about 240 rain and stream gauges in 38 counties. PEMA’s satellite uplink trucks which respond to disasters with onboard Internet protocol (IP)-based phone services, networking, and Internet are also an integral part of PEMA continuity of government and continuity of operations planning.

Chicago Ready To Roll

Chicago’s Office of Emergency Management & Communications new satellite-equipped command vehicle is designed to extend core command, control, and communications functions to any location within the continental United States via satellite. This is accomplished by IP-based networking and a large Ku-band satellite hub terminal located in downtown Chicago. Together, these form the nucleus of Chicago’s Unified Command System.

“We have connections to our GIS spacial database engine. The Chicago area is mapped with all GIS intelligence including building layers and underground infrastructure,” says James Argiropoulos, managing deputy of information services at Chicago’s Office of Emergency Management & Communications. “The vehicle also has our 911 public safety computer aided dispatch on board. This greatly assists us in command and control situations relating to police, fire and EMS resources. All [fire department] resources are monitored by GPS. Therefore we can watch resources on our mapping system live throughout the city.”

Inside the truck are two fully-equipped dispatch positions for police and fire dispatchers, along with three technical work stations. A fully-automated 1.5-meter VSAT antenna and 80-watt solid state power amplifier allow the satellite link between the truck and the hub to operate nominally at about 4 Megabits per second (Mbps). If needed, the satellite system can operate at duplex satellite data rates of up to 45 Mbps. The Ku-band satellite hub terminal, located at the separate site from the Office of Emergency Management & Communications, is linked via an Ethernet line that can provide speeds of up to 100 Mbps. A slower Ku-band iDirect solution on the vehicle serves as the backup link in the event of a primary system failure.

“The vehicle allows us to access our servers, applications, networks, cellular and radio infrastructure from anywhere in the field as if we were in our own facility,” says Argiropoulos. “This truck brings us the hardcore technical discipline required to manage a large scale incident remotely. With the power of satellite we can now bring all of our technical tools to the key decision makers in the field.” In addition to a pair of DirecTV direct broadcast satellite receivers, the primary and back-up Ku-band satellite antennas also are able to receive private, standards-based video broadcasts via satellite using a separate receiver.

The truck is equipped with an onboard video switching and routing system to distribute video from various sources to any video monitor or broadcast element. The truck also is equipped with a complete production-quality video uplink capable of transmitting video via satellite in a number of formats including MPEG-2 and MPEG-4 over digital video broadcast and over IP. A commercial IP-based video conferencing system compatible with similar systems already has been deployed within the city’s network. The truck can also serve as a video relay platform for video originated onboard helicopters.

Because voice is so critical to the success of the city’s Unified Command System, 23 central office voice channels provided to the truck over the dedicated Ku-band satellite link are connected to a Cisco router at the satellite hub, and 92 Centrex voice channels also are provided to the truck over the dedicated Ku-band satellite. Among other things, these 92 lines are configured to forward 911 calls to the truck with a revectoring command issued in the event that the emergency operations center is inoperative in the wake of a catastrophe.

This is relevant because Chicago has 500 miles of fiber and 850 miles of copper which connects all police, fire and strategic government locations to the Office of Emergency Management & Communications, according to Argiropoulos. “We have millions of dollars invested in applications and telephony that are used during large scale events. Until September we only enjoyed our myriad of applications within the confines of our building or through commercial wireless carriers,” he says. “In an effort to step up our service delivery to the citizens of Chicago we took our technology concepts to the next level through the implementation of satellite technology. We constructed a very large Earth station in an undisclosed location and piped our fiber to the Ku satellite dish. We now have full access to our networks in the field.

“Perhaps most significantly, this vehicle’s combination of technology and mobility allows our top emergency response officials to be on an emergency scene and still able to make use of all of the applications we have generated,” he adds.