 When the first bomb
went off, Megan Miller was knocked flat. She came to, at the doors
of the ground floor elevator, surrounded by about 10 other badly
injured victims. Her stomach felt wet, and when she looked down
she saw a 10-inch gash from jagged shrapnel. She was confused and
disoriented, but when she heard the wails of the fire truck sirens
drawing closer she knew that help was on the way.
The first crew of firemen was setting up a command post in the
parking lot when BAM! a second bomb exploded at the building’s loading
dock. This one contained an ounce of highly radioactive cesium-137,
making it a “dirty bomb.” Now the original command post
was suddenly contaminated. This meant that some of the first responders
were also casualties, and the most severely injured found themselves
inside a hot zone of radiation. How could rescuers stay safe, while finding out who needed immediate
attention and evacuation to a hospital? How could they transport
Megan Miller and the other critically injured out of the chaos before
they succumbed?
These are the main questions this disaster drill, Operation Moonlight,
was trying to answer. But there was another, larger question being
tested by researchers, students, and staff from UCSD’s California
Institute for Telecommunications and Information Technology (Cal-(IT)2),
where Miller, ’05, and several of the drill’s other “victims” work.
In a world where terrorism can suddenly create 500 or 1,000 casualties,
and existing emergency medical response relies on aging technologies,
can advanced wireless networks be adapted to help save more lives?
Leslie Lenert, MD, certainly believes so. Lenert, 44, is the principal
investigator on the UCSD School of Medicine’s joint project
with the VA San Diego Medical Research Foundation and Cal-(IT)2 called
WIISARD (Wireless Internet Information System for Medical Response
in Disasters). A three-year, $4.1 million project funded by a Homeland
Security contract through the National Institutes of Health, WIISARD
constitutes a major effort to transfer UCSD’s engineering expertise
into the public health sphere.
Lenert was appointed as an associate director at Cal-(IT)2 last June
to help oversee Homeland Security projects that capitalize on UCSD’s
expertise in wireless network engineering. “Essentially, what
I can do is hear the problems that one group of people has, and then
hear the solutions that another group has, and imagine how they can
be knit together,” he explains. With that in mind, Lenert was present at the disaster drill in
the vacant Farmers Insurance building in Carlsbad, last May.
The drill
was organized by the San Diego Metropolitan Strike Team (MMST), whose
medical director, Theodore Chan, is an associate professor in the
emergency department of the UCSD Medical School. “In our drills,
problems have arisen that WIISARD can address,” says Chan.
The strike team, made up of about 100 first responders, including
SWAT teams, paramedics, firefighters and hazardous materials crews, “needs
something that tracks people to within a few feet,” Chan continues. “The
test showed that the system works, but we have a lot of refining
to do.” The drill was the first big test of WIISARD’s “emergency
room in a box,” which first responders would use in a disaster
such as a gas attack at the convention center or
a truck bomb at a Chargers game. Two other drills, one slated for
April and another for late 2006, will refine the system.
During the first drill, Lenert, Chan and other researchers were
in a mock “command center”—actually a UCSD shuttle
bus outfitted for wireless communication—looking at two display
screens. One screen showed the location of a dozen or so volunteer
victims, and the other showed their heart rates and the levels
of oxygen being absorbed into their blood.
The boxed emergency room is envisioned as a cache of equipment
carried on a fire truck. This includes wireless transmission devices
called “bread crumbs,” which are positioned throughout
a disaster scene. To test this concept, the first paramedics to
arrive at the site in Carlsbad dropped suitcase-sized transponders
throughout the building to establish a wireless “mesh” network.
This system created an “always best connected” wireless
link to the command center, switching the communications pathway
among the ethernet, internet or cellular connections whenever the
signal was momentarily broken. “We understand that what happened
on 9/11 was there were no communications. This was the biggest
single failure,” Lenert says. “So you have to bring
your own network.” At the disaster site, a radiation perimeter was established outside
the vacant building and paramedics had to don full anti-radiation
suits and masks before they could venture in to treat Megan Miller
and the others. When they found Miller they checked her injuries,
tried to stop her bleeding with direct pressure on the wound, then
entered her vital signs into a Personal Digital Assistant (PDA),
which they hung around her neck. Other victims had pulse oximeters
clipped to their fingers and attached to the PDAs. These sent a
constant reading of heart rate and oxygen uptake to the mock command
center in the shuttle bus. The PDAs also had a device, sending
information on the patient’s location. When WIISARD becomes
fully functional next year, emergency medical specialists in the
command center will be able to monitor each patient’s vital
signs and dispatch the nearest paramedic when these become critical. In the next drill, scheduled for April, the PDAs will be replaced
with bulky wristbands, called “tags,” which will include
a bar code as well as both a locator feature and a pulse oximeter.
The emergency room in a box will carry dozens of these battery-powered
tags, each about the size of a cigarette pack, and medics will
strap them onto the wrists of patients. The wristband tags are being developed with the help of students
in the Jacobs School of Engineering as part of their Electronic
and Computer Engineering (ECE)191 and 291 classes, in which they
work on a real project with local companies through Cal-(IT)2.
Some of the students found the work so valuable that they stayed
on to help with WIISARD after completing the class. Ramesh Rao,
the UCSD division director at Cal-(IT)2 who oversees Homeland Security
projects, was delighted by this level of dedication. “Students
want to be able to talk about this project when they graduate,” Rao
observes. “It demonstrates their ability to work on open-ended
projects, to work against a deadline, and make design choices and
trade-offs.” The students are helping integrate the pulse oximetry sensors into
the wristband, as well as working on the battery configuration,
wireless code development and the parts required for location tracking.
Rick Pan, ’04, oversaw research on batteries, power consumption
and related part ordering, and came away with a deeper appreciation
of group endeavors. “Working in a team to do research is
challenging, but it’s effective,” says Pan. “We
all have our unique strengths. Everyone contributes his knowledge
and, at the same time, we learn from each other. No matter how
good an engineer I am, I know I have weaknesses. Working with different
people is the best way to improve my productivity and the overall
productivity of the group.” Lenert believes that the interdisciplinary nature of the WIISARD
project will have a lasting influence at UCSD. “I’d
like nothing more than to make this kind of problem my main focus
over the next 10 years,” says Lenert, who relinquished about
half his work as chief of the Laboratory for the Study of Patients’ Preferences
at the VA in order to oversee WIISARD. “It’s a redirection
of what I’ve done. It means I can’t do certain things
I would have otherwise, like help doctors and patients talk about
difficult decisions. But in view of the urgencies that we faced,
that just wasn’t as important.”
Lenert became acutely sensitive to the current medical urgencies
shortly after 9/11. A friend at Science Applications International
Corporation (SAIC) took him to a conference about the national
response to terrorism that included officials from the “black
ops” side of the National Security Administration. “What
I heard was that another attack on the United States is expected,” he
says. “I felt I needed to be involved in this because when
our country faces a dilemma or a problem like terrorism, we cannot
go about our business as usual and expect to survive. We have to
adapt what we’re doing and find a way to move forward.” After the drill in May, the WIISARD team learned that in order
to move forward they had to adapt to the fluid decision-making
that occurs at a disaster scene. Before the drill, they thought
there would only be one collection point where all the victims
would be taken before being loaded into ambulances for transport
to a hospital. But Miller, who was designated as badly wounded,
found herself wheeled on a gurney (through radiation detectors
and a watery scrub-down) to one of two transfer stations. “The
commanders on the scene set up a station for people with minor
injuries, and one for more seriously ill people,” says Lenert. “It
just made sense to them at the time. So we learned that we can’t
impose a structure on the first responders. We found that our work
is about being sufficiently adaptive to them.” The other main lesson is the importance of a live video feed from
inside the disaster. One of the Hazmat team members was supplied
with a video camera on his helmet, allowing the first responders
in the command center to see what hazards emergency crews would
have to face. “So there were two main lessons,” says
Lenert. “The engineering lesson, being able to track patients
to multiple transfer points, and the system requirement for having
video.” At the next disaster drill in April, in addition to enhanced video
capability, Lenert expects to have a couple of dozen wristband
tags, most of these are being developed by engineers and students
at Cal-(IT)2, but a few from a company called Awarepoint, whose
chief engineer, Derek Smith, is a ’98 Jacobs School alumnus
in electrical engineering. In a recent meeting between Lenert and the principals of Awarepoint,
Lenert explained that various design options for the wristband
tags were still on the WIISARD table. “I don’t want
to be stuck in one channel at this point,” Lenert told Smith
and his two colleagues. “There’s no way, short of building
this thing and trying it out, to decide whether this is going to
work.” So Lenert wants to try a few of Awarepoint’s wristband tracking
devices, which do not have a pulse oximeter, to see how they perform
next to the ones being developed by Cal-(IT)2. Part of his motivation
is the encouragement of a company that might be interested in manufacturing
parts of the WIISARD system, once it has been proven to work.
Whether there will be a market for a wireless emergency room in
a box depends on the tragic prospect of more man-made disasters.
But Lenert is confident that frontline technology can be integrated
into emergency medicine. Referring to the October 2002 takeover
of a Moscow theater by Chechen separatists, Lenert says: “When
rescuers went in with knockout gas, there were many deaths because
of the lack of coordination of the medical team.” While Russian
security forces freed 650 hostages when they stormed the theater,
116 died. Most of these died as they waited for antidote injections
to counteract the gas. “The emergency care wasn’t managed
so that commanders knew which patients needed immediate help,” Lenert
explains. “With WIISARD, we can probably save hundreds of
lives if there’s a serious event, and if we can effectively
marshal the resources that are available now.” Lenert often reflects on the lessons of the Moscow theater attack,
and the September 2004 massacre at the school in Beslan in Southern
Russia, where 331 hostages were killed, most of them children.
This is one way he keeps the technicians, students, engineers and
scientists who are involved in WIISARD focused on their true goal. “We’re
not running
a company to design this stuff and sell it,” he says. “What
we’re trying to do is figure out what components would be
useful, and how they should work, and what people should build
in the future.” He pauses, breaks into a smile, then adds, “This
has certainly been the most interesting, challenging and positive
experience I’ve been through.”
Neal Matthews is a San Diego-based writer specializing in
science and technology.
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