# Presentation: 163460

## WISERWireless Information System for Emergency Responderswiser.nlm.nih.gov

**Notes:**
National Library of Medicine was mandated in the mid- 1960s (in response to recommendations made in the 1966 report "Handling of Toxicological Information," prepared by the President's Science Advisory Committee) to (1) create automated toxicology data banks, and (2) provide toxicology information and data services. In the mid-1990's, the mission was expanded to include environmental health. The Toxicology and Environmental Health Program (TEHIP) which was created to support creating, organizing, and disseminating toxicology and environmental health information
In response to the directive, NLM developed a cluster of databases and information resources – some of you may have heard of TOXNET, which is one of products.

Over the years TEHIP has evolved into a web-based collection of authoritative toxicology and environmental health information, which is within the public domain and freely available to anyone.

One of our databases is called Hazardous Substances Data Bank

## Local HAZMAT Team Getting Right Information at Right Time

**Emergency Responders**
- First Responders (first on scene)
- HAZMAT Specialist Teams
- EMS Personnel
- Incident Commanders
- Law Enforcement
- Military Personnel

**Notes:**
All have slightly different immediate information needs....

The first on-scene responders need basic information and substance identification support.  
HAZMAT specialists require detailed technical information about the substance so that the response is properly coordinated.  
The Incident Commander (IC) needs situational awareness, geographic locations of response equipment and personnel, and vital substance information.  As the response progresses, the IC also needs real time environmental information and remediation status.
EMS personnel need access to basic and advanced life support procedures for patients affected by the substance, symptom information, antidotes, reactivities, and contraindications.  
At the same time, because of the fluid nature of hazardous response incidents, each person must have access to data for all profiles. 

First Responder Needs assessment results:
Lack of
 integrated data sources.  Need to reference multiple sources of data at the incident scene due to confidence and context factors.
Paper (reference volumes, manuals, etc.) 
Electronic (page-turning CDs, telephone)
decision support
Situation and diagnostic analysis support (physical and symptomatic)
workflow support
Priorities, situation management, standard operating procedures, communication
Good wireless data communication support 

## HSDB – Hazardous Substances Data Bank comprehensive peer-reviewed information on hazardous chemical substances

***Includes...***
***Human exposure symptoms***
***Physical properties***
***Emergency handling procedures***
***Environmental fate***

**Notes:**

The HSDB is a comprehensive, up-to-date, peer reviewed and integrated source of over 4500 critical hazardous chemical substance information.  It contains indepth information collected from a variety of sources, and covers information on toxicity, human exposure symptoms, physical properties, how to contain the substance, necessary protective zones, and much more.
...very comprehensive – one record could be 100 pages long.

## HSDB – Hazardous Substances Data Bank 

**DOT 2000 Emergency Response Guidebook**
**U.S. Coast Guard, CHRIS – Hazardous Chemical Data**
**NFPA Fire Protection Guide to Hazardous Materials**
**NIOSH Pocket Guide to Chemical Hazards**
**EPA Integrated Risk Information System (IRIS)**
**POISINDEX(R) Information System, Micromedex, Inc., CCIS**
**TOMES(R) Information System, Micromedex, Inc., CCIS**
**ACGIH Guidelines Select of Chem Protect Clothing **
**American Conference of Governmental Industrial Hygienists, TLVs & BEIs**
**Association of American Railroads, Emergency Handling of Hazardous Materials in Surface Transportation, Association of American Railroads, Bureau of Explosives**
**and many others....**

***Sources of information in HSDB***

**Notes:**
Source of the data comes from a variety of reliable sources, such as 
DOT Emergency Response Guidebook
NIOSH Pocket Guild to Chemical Hazards
Poisindex and Tomes from Micromedix

I mention these because all emergency responders rely on their training, experience, knowledge, and available resources to make critical initial decisions.  
Currently, there are a number of paper and electronic data sources that can provide the HAZMAT specialist with technical information; however, those information sources have limitations, including:
         Large amounts of content that is difficult to navigate
         Incomplete or out of date reference material
         Limited scope of information

## WISERWireless Information System for Emergency RespondersStrategic Objectives

- Easy navigation, intuitive
- Information tailored to the specific role of the emergency responder
- Focus on unknown substance identification capabilities
- Provide a platform that can be expanded to support other emergency response needs
- Rich, stand-alone capability with enhanced connected (wireless) capabilities
- Cross-platform, multi-device architecture

**Notes:**
Easy navigation, intuitive

Information tailored to the specific role of the emergency responder

Balances their data, workflow, and decision support needs 

Focus on unknown substance identification capabilities

Provide a platform that can be expanded to support other emergency response needs
Biological, radioactive, fire, rescue, EMS, etc.
Geographical Information System (GIS)
Information derived from sources other than HSDB 

Rich, stand-alone capability with enhanced connected (wireless) capabilities
Contains must-have information only

Cross-platform, multi-device architecture
Pocket-PC, Tablet-PC, Laptops, MDT, and others

## WISER Development Approach

- User Needs

- Mock-up
- Prototype
- Development

- Field Testing
- Baltimore Fire Department
- Fairfax Fire Department

*Feedback*

*New Release*

**Add sound bytes**

**Notes:**
Worked with Baltimore County Fire Chief (Capt Brooks) and Fairfax County HAZMAT team to develop a prototype

Prove the concept on Palm Pilot using ATSDR Medical Management Guidelines (MMG) list of chemicals from HSDB

Focus on data search and display capabilities

Get first responder design feedback
International Hazardous Materials Response Teams Conference – workshop and exhibit, June 2003
Fire-Rescue International – over 16,000 fire and emergency service professionals – exhibit in collaboration with the xxxx RML – focus on WISER and had a questionnaire for them to fill out

Have 125 registered prototype users (as of Mar 2004)

[think Big, start Small, scale Fast]

Operational version scheduled for Spring 2004

## Data Review Process

**HSDB**

**SearchFormIndices.h**

**Index.PDB, Element.PDB**

**HSDB **
**Migrator**

*TBD *
*Migrator*

**Palm **
**Generator**

**Pocket PC**

**Generator**

*TBD *
*Generator*

***Other Sources ***
***(Future)***

**Substance List**

**External**

**Review**

- Review

- Update

**Migrators**

**Target Data**

**Generators**

**Data**

**Sources**

**WISER DB**

**WISER **
**DB**

- Export

- Import Updates

**Pocket PC DB**

- TBD

**Data Review **
**Excel Workbooks**

**Notes:**
The key area of interest above involves the migration of data from the HSDB to the WISER database. This is an automated process which transfers the data of interest for each substance, while performing any necessary formatting and data extraction to support WISER functionality such as searching for unknown substances. Certain aspects of this migration require human review to verify accuracy and to add additional information. To support this, Microsoft Excel workbooks are automatically generated from the migrated data, one per substance. Reviewers can verify the data in the workbooks, make any necessary changes and additions, and provide comments, all of which is incorporated back into the WISER database, from which it is deployed to the WISER platforms.
The typical data review process will be structured as follows:
For the substances targeted for WISER, data is automatically migrated from the HSDB source to the WISER database.
For each newly migrated substance, a Microsoft Excel workbook is automatically generated that contains the portions of the data requiring review.
NLM distributes the workbooks to the data reviewers.
Data reviewers verify the data in the workbooks, making any necessary changes.
NLM reviews the updates that were made to the workbooks.
The workbooks are automatically imported into the WISER database, such that the database is updated with any changes that were made in the workbooks.
This process will be repeated each time a new set of substances is defined for inclusion in WISER, or when updates occur in the HSDB which affect previously reviewed data.

## WISER Application

## Scenario - Highway cargo tank overturned

- HAZMAT  Specialist is 1st on scene...
- _Substance:_ Colorless liquid, smells like alcohol
- _Workers’ symptoms:_
- headache, dizziness, eyes irritated, nausea feeling

**Notes:**
Huge chemical spill shuts down part of Interstate 30 in Hopkins County, East Texas
18 wheeler carrling 5,500 gallons of isoprophl alcohol (which is isopropanol)

17 people had to be treated for injures due to breathing the toxic chemical and a local school was evacuted.

Shutdown both sides of the interstate for majority of day

Liquid, colorless, alcolhol-like odor – fruity, floral, sweet
Eyes – irritated, dizziness, headache, nausea, skin burning feeling

## Wiser Application (2)

## WISER Application (3)

## WISER Application (4)

## WISER- Future Directions

- Other devices in addition to Palm
- Action oriented  - workflow (SOPs)
- Integrate with other incident factors (e.g., weather conditions, type of incident, terrain)
- Substance category (vs. named) data
- Biological & radiological agent data
- Wireless interaction and dynamic data transfer
- Companion web-based training ‘game’
- Integrated patient care and reporting

**Notes:**
Other Devices in addition to Palm
PocketPC
Laptop/Tablet PC
Mobile Data Terminal (Vehicle equipment)
Smart Phones & RIM Blackberry
Web Based
Action Oriented  - Workflow (SOPs)
Substance Category (vs. Named) Data
Biological Agent Data – 20 of these
Radiological Agent Data
Wireless Interaction and Dynamic Data Transfer
Integrated Patient Care and Reporting
Integration with DHS Initiatives
Global Harmonization System Support

## WISER Availability

- Prototype Release – available now with 44 chemical substances
- Operational Version Deployment
- Version 1 (Spring 2004) – 400 chemical substances
- Focus Groups/Feedback – Spring/Summer
- Enhanced Version 2 (Fall 2004)
- Enhancement Phases and Staged Release
- Cross platform – Pocket PC version, Windows OS
- New functionality
- Wireless capability
- Additional data sources

## WISER is available for downloading http://wiser.nlm.nih.gov 

- Application and databases
- User’s guide
- Survey form