Hosea: Emerging Horizons of Clinical Engineering in Disaster Preparedness and Management

Received April 21, 2020, accepted June 15, 2020, date of publication June 30, 2020

and active cultivation of public health intelligence. For the professional education and certifications around the reasons that follow, clinical and biomedical engineers are world, CEs share a common mission to optimize safety, among the best-suited health professionals to assume- efficiency, cost controls, and healthcare quality through Emerging Horizons of Clinical Engineering in Disaster an expanded and more comprehensive leadership role the application of systems-oriented engineering expertise as subject matter experts in this urgently needed trans that encompasses not only devices, but processes, human Preparedness and Management: Proposal for an formation, “particularly following the recent adoption of importanceresources, procurement, in disaster circumstances. risk management, Compared and strategic to many the recommendations of the UN High-Level Commission planning. These integrative skillsets take on even greater expanded professional identity on Health Employment and Economic Growth, the WHO Global Strategy on Human Resources for Health, and the other vertically-specialized professions in healthcare, By F. Hosea establishment of national health workforce accounts.” the multi-disciplinary, intersectoral span of professional In particular, the WHO analysis and recommendations relationships in CE provides a unique foundation to Yachay Tech University, Ecuador. - in “Human Resources for Medical Devices” provide a bring a more coherent, rapid-cycle integration of science, transformational vision for Biomedical and12 Clinical En technology, standards, regulation, institutional strategy, - gineering worldwide that strongly harmonize with the planning, and execution. ABSTRACT WHYrecommendations CLINICAL and contained BIOMEDICAL in this article. ENGINEERS? As science and technology have advanced with in- - creasing velocity and scope, these life-saving engineering professions are also 16evolving and expanding to incorpo The COVID-19 pandemic of 2020 has exposed a wide range of systemic deficiencies in public health strategy, poor alignment- Traditionally, Clinical Engineers and Biomedical Engi of global health and economic institutions, insufficient budgeting, and the urgent need for real-time management of scientific rate new tools and processes into increasingly complex neers are professionally prepared to perform a very broad under disaster resources, rapid-cycle clinical innovations, competent political decision-making, and supply chain logistics under disaster condi circumstanceshealthcare systems. The successful incorporation of tions. This article proposes that a new model of multi-disciplinary professional skills is needed globally to re-engineer existing range of overlapping clinical, technical and operational existing knowledge and urgent innovations public and private healthcare systems for both normal and disaster conditions. Clinical engineers are recommended to play a- tasks – working from bench13 innovations to bedside care, requires new categories of professional growing role in future global disaster management and systemsst integration activities, owing in large part to their multifunctional including the design and assessment of medical devices and expertise and institutional alignments. Because of their expertise in technology assessment, hospital operations, and as stakeholders in healthcare innovation. Twenty-six recommen - their internal components, to the management of complex wide-ranging organizational knowledge and technical dations are presented as foundational strategies to create a 21 century model of globally aligned healthcare systems, centered hospital infrastructures and supply chains, encompassing Keywordson the growing – disaster role of clinicalpreparedness, engineers clinical as subject engineering, matter experts systems in bothengineering, normal and alternate disaster sites conditions. of care, health technology skills, CEs are uniquely prepared to become the next gen design, dual-use infrastructure. possibly hundreds of device families, models, network eration of multifunctional experts who can help cultivate interfaces and “care-anywhere” services via telehealth the systemic organizational intelligence and planning that Copyright © 2021 Creative Commons - Attribu- and telemedicine. For the purposes of this article, the tion 4.0 International - CC BY 4.0 is increasingly indispensable for modern healthcare, as . This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY): term “Clinical Engineer” (CE) will be used to encompass well as for disaster preparedness and management. . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) both biomedical and clinical engineers, because clinical PROPOSAL FOR AN EXPANDED PROFESSIONAL are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is IDENTITY permitted which does not comply with these terms. engineers (and clinical systems engineers) typically have INTRODUCTION the widest, multi-systems professional orientations and THE GROWING NEED FOR SYSTEMS EXPERTISE skillsets that are well-suited.14,15 to the often improvisational GLOBAL DISASTER UNPREPAREDNESS FOR BOTH NORMAL AND EMERGENT complexities of disaster preparedness and management CONDITIONS in healthcare systems repeated top-levels warnings by epidemiological and public Beyond individual hospital operations, CEs may also systems,The global1,2 governments, COVID-193,4 crisis of 2020 has5 thrown a6 - be involved extramurally in standards development 13 17 global spotlight on the many 7ways in which healthcare health experts, the world’s governments, markets, and signingAs innovators or improving in the diagnostic medical device devices, industry, monitoring, CEs may and technology assessment organizations, research and 18 medical industries, markets, catastrophe.healthcare systems have failed to prepare and prevent a be involved in highly specialized research aimed at de and healthcare professions have been unprepared, health disaster from exploding into a multidimensional clinical trials, innovation consortia, startups, professional 16 and designed for “preci- associations, and consultations to ministries of health under-resourced, tragically slow and uncoordinated in8 have wide-ranging, inter-institutional experiences that or therapeutic devices that are technically complex, and the World Health Organization. As such, they can responding to the most disruptive9 medical disaster of The fragmentation of plans and competencies across multi-systems challenges of multifunctional, networked, our times. Despite numerous10 threat-analysis studies, sectors – complicated by political decision-making – sion medicine” that may disrupt traditional clinical and are directly relevant to the business practices. As managers of a clinical operations detailed pandemic scenarios, and simulations by11 state and andclearly systems-oriented demand mission-critical re-organization among the and federal agencies, despite trillions of dollars spent institutional players, with more coordinated, integrated, disaster preparedness and management. Although they infrastructure, CEs may be responsible for the 24 × 7 on post-9/11 international disaster preparedness, professional approaches worldwide, may work with different job titles and tasks different hospital requirements for maintenance and repairs, for

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systems-of-systems a. Schedule specialized DP/DM coursework, in- - maintenanceassessing new and technologies, repairs, coordinating managing installations IT integration, and panoramic, long-term view that will conditions. The world is already fortunate this day to terdisciplinary and cross-functional workshops, upgrades, project and team coordination, scheduling strengthen the organizational, technological and profes have many gifted CEs around the world who are ready for Re-write job descriptions for CEs to include DP/ conferences, credentialing and certification. - sional underpinnings of both normal operations and DP such a noble quest – highly educated, energetic, caring, DM as a required competency; set aside time for facility design consultation and new facility provisioning, that should dramatically improve the global response to creative, expert in the complex lifecycles of healthcare b. cross-functional troubleshooting with IT, end-user train future threats to public health. andsystems, human and sufferings now, tested imposed by the in thehigh-velocity 2020 pandemic. change, In ing, vendor and supply chain management, surge capacity19 logistical chaos, global uncertainty, economic disruption dedicated assignments to organizational emergency These recommendations are organized in a series of- planning, replacement planning, service-level agreements, highly concentrated topics and specific actions that can heroes rose to the occasion. preparedness teams and practice drills.36,37 Include as CE budgeting, technology assessment, risk management,20–23 be executed incrementally over time to expand the pro the coming years, let there be no doubt how these quiet readiness research, conferences, and publication hazard alerts and recalls, and emergency preparedness. in scientific and professional journals fessional competencies and institutional roles of CEs for RECOMMENDATIONS c. Arrange for CEs to be permanent delegates to Because CEs may span such vast areas of expertise DP/DM. Each topic can easily be expanded as a workshop performance evaluation criteria. Note that are essential to the quality and reliability of day-to-day or academic course to provide the necessary technical - organizational Emergency Preparedness Teams – healthcare services, they are at the same time uniquely or operational details needed for full implementation. ( : Additional information and links for many of d. Delegate CEs to serve on standards committees local, regional, and national. positioned to be recognized as systems-oriented, subject While some of the recommendations can be enacted at the following recommendations can be found in the RE management.matter experts who can help repair and re-engineer the an individual level of persons and organizations, others SOURCES section at the end of this document, grouped 1. Understand your existing local, national, and inter- and medical device design consortia to promote38 prevailing fragmentation in disaster preparedness and will require scaling up through new24 regional, national, by topic) national frameworks of DP and Management. inclusion of DP/DM performance factors in design AN ACTION PLAN FOR THE FUTURE and international collaborations. e. Contribute to the design of table-top exercises standards for medical devices and systems. throughOngoing its programsCE Division between25 WHO, the International Don’t - - Federation of Medical and Biological Engineering (IFMBE,26 re-invent the wheel. Investigate with your Ministry of This article provides a very condensed compilation of for DP/DM, with emphasis on functional inter ), the ICEHTMC27 (International Health and Emergency Preparedness agencies, public technological, organizational, and professional recommen agreements, processes, and resources. dependencies and risk/failure points that other CE and Health Technology Management Congress ), the health agencies, and local hospitals to identify existing dations that will enable CEs, clinical systems engineers, a. 3. Promotestakeholders regional might and ignore. national purchasing coop- American College of CE (ACCE),28 the Chinese Society eratives and biomedical engineers to build upon their existing- of CE, The Association for the Advancement of Medical system lifecycle expertise and assume wider institutional - United Nations, WHO, OCHA, CADRI, UN Clusters Instrumentation29 (AAMI), the European30 Alliance for to maximize cost-savings over the lifecycle roles in disaster preparedness (DP) and disaster manage and the Global CE Journal are creating new, (UNISDR, UNHCR, IFRC, IOM, FAO, WFP, UNDP, UNICEF, Medical and Biological Engineering31 & Science (EAM of devices and services, including specific disaster- ment (DM). Although the current global concerns are for - Save the Children), IFRC, ICRC, Sendai Framework, BES), GDACS, OSOCC, INSARAG (See Resources section) 4. Promoterelated terms Health and Technology conditions. Design among CEs as pandemic response, the following topics will be equally global frameworks for research, professional develop the front-end of the Device Lifecycle management relevant for all-hazards disaster conditions. as well as for c.b. Your national frameworks: National Incident ment, conference coordination, standards development, process to integrate best disaster practices into improving normal strategic and operational efficiencies Management and Emergency Operations Centers. credentialing, regulatory frameworks, and consultation future designs. and resilience of clinical systems, ensuring a more robust, d. YourConduct state/province interviews and and document local hospital existing and gaps public at to establish moresystemically coherent, relevantinnovative and dynamic health frameworks. a. Formalize device and system design to provide integrated infrastructure for future events. Because of the capabilities across healthcare systems. In many cases, 33 real-time networked performance feedback of device inherent complexities of normal healthcare operations,- the ability to ask questions will be any level of preparedness or response capabilities where it is necessary to work in a 3-to-5-year planning more important than the application of known, but overly window to make significant changes, it is likewise neces and discuss proposals to remediate them. Arrange specialized answers which may risk delivering obsolete data to manufacturers (as feedforward into next- to attend32–35 training and simulations, and become sary to begin planning now during the 2020 COVID-19 or disjointed solutions. The world is clearly in need of generation device/system design, with all necessary pandemic, to deliver the global systemic improvements subject matter expert in one or more areas of DP/ professional expertise that can help compress and align 2. safeguards for patient privacy and confidentiality).- that will be necessary to prevent, mitigate and better In DM.your organizations (hospital, professional underthe scientific, extraordinary technological, circumstances. and operational timelines for association, standards organizations, R&D con- Formalize consulting relations between CEs and manage future disaster challenges 5 to 10 years from now. life-critical innovations and successful implementation manufacturers to conduct regular design consulta - sortium, government agency, legislative and regu- Define, design, and enforce Universal Mini- These expanded CE competencies will fill critical gaps tions as part of the contractual relationship. latory bodies), promote Clinical and Biomedical mum Functionality for medical devices (UMF). in the ways that healthcare systems plan and manage We cannot allow these monumental challenges to de Engineers as Subject Matter Experts b. mosttheir offuture the current DP/DM responses programs, to which the COVID-19 often suffer pandemic from ter us from the necessity, now being proven worldwide, product differentiation from their competitors, lack of functional integration, staffing, and budgets. While to forge a radically different, long-term model of public for System Most medical device manufacturers emphasize are suited simultaneously Lifecycle Management, with specific applications in health stewardship and institutional capabilities that DP/DM. Develop DP/DM skillsets and experience are necessarily focused on near-term endpoint devices, to both normal and disaster and this produces highly specialized devices that therapies and protections, this article will offer a wider, through the following: may be perfect for normal circumstances, but be

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- d. Coordinate CE tightly with IT asset management and service management sub-optimal or dangerous under disaster condi create a predictable minimum of standardized - field tents, military bases, factories, and other sites. tions, when there may be a transfer of life-support device functionality globally that will increase the to develop aligned CEs should play a major role in anticipating, planning, patients to other sites of care, significant rotation safety and efficiency of clinical efforts by clinicians processes, data dictionaries, configuration man and executing on ASOC logistics, deployment, testing, disaster sites. a. of staff across locations, and staff who have to use who at times must work at remote and unfamiliar agement, and roles that will support standardized andAnticipate site readiness the certification.need to prepare 5. Include Smart Design requirements - medical devices that are different from what they service and performance analytics for primary, to work rapidly are accustomed to. The specialized differences in transitional and Alternate Sites of Care, including- for all medi andauthorities closely towith manage local, dynamic national, disaster and international conditions user interfaces, IT connectivity, consumables, and ambulance services and military locations having military, National Guard, national and local police performance characteristics may cause significant cal devices with computing capabilities so they have other network, security, and compatible consum - e. Explore secured, cloud-based product development risk to patient safety. We need to promote UMF extensive, built-in capabilities for universal time ables standards. Clarify in advance the hierarchy of decision- partnerships for device design and prototyping. and coordinate efforts to plan and deploy ASOCs. requirements for procurement of all medical de synchronization, self-monitoring, self-reporting, self- making updating, self-diagnosis, and self-healing. Real-time b. settingvices to under ensure disaster the lowest conditions, common to denominator support rapid of location, performance readiness, configuration, and decision crises.authorities, geographical jurisdictions, transportsafety, performance, and accurate and continuityuser interfaces of patient as a default care Promote interdisciplinary, intersectoral alliances, mobility of medical devices will be critical for rapid and processes. Use scenarios to anticipate potential 6. Adoptand thecollaboration ITIL framework frameworks. of service strategy and c. Evaluate facility Surge Area design, setup, device emergency deployment and redeployment conditions service management. (e.g., patient transfer to an alternate site of care, with across locations, caregivers, and device brands. a. Specify multicore device design infusion pump and ventilator). With the push of a button, the UMF functions can- The Information Technology- transferrequirements, processes, disinfection, patient patient monitoring, identification, surge be invoked to provide a specific menu of minimum, on separate computing cores,, whichwith a will hypervisor segregate Infrastructure Library (ITIL) is the global standard tracking, and medical record continuity, patient universally standardized functions, and user in clinical and device lifecycle operations functions for business process engineering, based on IT life terfaces. UMF device design and training would cycles, for ensuring alignment and coherence of all capacity limits. Conduct periodic drills. Establish criteria for transfers from hospital or surge areas support patients with generic functionalities that bridge. This will enable highly secure, real-time services provided within an organization and between d. Develop technology-mediated patient transfer to ASOCs. would assure higher overall population benefits- asset, service, and configuration management organizations. It is an indispensable tool to ensure protocols and process maps to ensure continuity than what would result from overly specialized to be executed without interfering with clinical- that all organizational services support healthcare - functions that could put patients at risk due to in performance. This includes device identification, activities that are safe, efficient, effective, and expertly appropriate use by untrained staff. Include supply thelocation, device configuration an active partner history, in managing component its asset,prov managed. Careful mapping of service processes and of care: patient transport, infusion pumps, medi chain guarantees and contingency plans to ensure enance, performance and service history, making toaccountabilities disaster conditions. during normal operations should be cations, belongings, device tracking, ventilators, technical support for diverse disaster locations, and used to create parallel process maps that are adapted vital signs, family contacts, data interfaces with c. Capability Maturity Roadmaps to iden- process a. training and certification for CE staff in connectivity. plan for universally standardized consumables. and service lifecycle. Architect devices to internalize electronic medical records, wireless or cellular controls e. Evaluate and acquire Early Situation Awareness Develop and support external service, security and - Obtain and services with a 5- to 10-year performance Create end-to-end service process maps for your software - tify strategic pathways for medical technologies ance, andso reporting that devices activities. themselves become active basic ITIL concepts and methods (3-day course). 39,40 players in managing routine monitoring,41 compli conditions. Leverage emerging IPv6 capabilities Envision b. , pre-load critical infrastructure loca horizon. Adjust roadmaps for different economic d. formal collaborations between IT and paths,organization and decision for normal points. and disaster conditions, tions, facilities and profiles. Update annually. This- b. working closely with all stakeholders, escalation will enable instantaneous activation of a regional biomedical forecasting institutions c. business process Promote devices as intelligent members of the extended IoMT incident tracking utility, enabling Emergency Op (Internet of Medical Things). Device components automation - erations Centers to know exact the GPS location such as Gartner- Where feasible, explore how dangerous conditions. can be independently addressed and managed via - of incidents, deployed responder vehicles, and and ECRI, professional and industry associations. can improve workflows during di f. Evaluate facility needs IPv6 addressing, to significantly improve security, Produce joint assessments of innovative technolo - saster conditions by guiding staff through auto - gies and plot on Biomed/CT/IT hype cycles and remote patient monitoring, and cloud management e. Design to Cascade mated, pre-defined checklists and options so staff for backup power, space of IoMT data which will become increasingly im circumstances. extendedmagic quadrants. use and re-use across diverse economic services. doesn’t have to improvise randomly amid stressful maintenancemanagement coordination,and repair parts, utilities, disinfection, wireless acIT portant in “care-anywhere” and behavioral health – Devices should be designed for- c. Build “developmental headroom” into device 7. Prepare Professionally for Alternate Sites of Care coordination.cess, medical gasses, waste management, security, hardware and software architecture, to extend (ASOCs) g. Arrange to serve - development zones so that UMF functions even - Disaster Resource/ . Certain disaster situations will overwhelm tually become available to LDCs (less-developed - Emergency Operations as a Centermultifunctional design Engineer countries) through redeployment, using local usable life and afford built-in capacity for new existing hospital facilities and small-scale surge prepa ing expert and consultant in refurbishing and production where possible, and functionality without burdensome replacement ration, requiring the setup of emergency hospital capa , simulations, strictly-managed donations. This will gradually costs and inefficiencies. bilities at schools, warehouses, hotels, sports arenas, response roles.

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h. Evaluate the need for additional equipment d. - and personnel, fire services, community safety military and civilian professionals can interact Crisis Response, Google Public Alerts, and - e. Review and establish trusted domain rights on e. for decontamination, generators, mobile or field associations, disabled persons, language transla without obstruction or delay. Fusion . f. operating rooms, Rapid Assembly Shelters, Con tors, time-sensitive treatments (chemotherapies, i. Perform quarterly updates of ASOC status to Solar-poweredham radio. wireless access points. tainerized Clinics. pregnancy, dialysis, etc.), livestock owners, parents DM networks; update credentials as needed for - f. - g. Failsafe communications: Bluetooth walkie talkie; representatives,and teachers, pet owners, university individuals research with partners, physical instant, uncontested sign-on in ASOCs. establish dedicated network identify any significant changes in readiness, re access and mobility needs, media contacts, tribal h. Evaluate the role of portable Emergency Elec- priorityNegotiate bandwidth with government during disasterand commercial conditions, net SMS messaging. sources, staffing, plans. providingwork providers top Quality to of Service 12. tronic Medical Records volunteer coordinators. PlanMobile for Standard refrigerated Tests morgueand Point-of-Care trailers. Diagnostics j. - system users and devices, and research partners. and mobile connectivity n. Consultpact of cultural, with anthropologists, ethnic, religious, ethologists, and linguistic social for all medical g. Require universal wireless location of medical a. to medical devices for vital signs, medications, differencespsychologists and historians to evaluate the im to supplement or replace centralized laboratory use Review Supply Chain Management practices to devices administered COVID-19 tests. infusions, treatment plans, etc. Evaluate rapid turnaround, automated, and self- that will significantly affect patient k. use this andfunction high-value, to support mobile patient capital andequipment device - treatment and possible interactions with families, address specific disaster conditions. by using built-in radio-frequency identification; b. Evaluate conformal electronic vital signs monitors practices.relatives, loved ones, ambulance services, forensic, i. Use multi-professional scenarios to iden and wireless links to nursing station monitors or morgue and funeral services, burial, and grieving transfer to ASOCs and timely return of outgoing c. maytify probable impede rapid stress ramping points, gaps,up of failures,disaster 8. Establish Dual-Use Infrastructure telemedicine monitoring stations. devices; formalize control of network credentials, and decision-making bottlenecks that - Assess telemedicine/telehealth and automated 9. Ensurelogin, Cross-border and device recovery credentialing processes. database exists - - The dual-use monitoring technologies annually to determine the response actions: vendor contracts, pre- concept in traditional military usage refers to civil best combination of onsite clinicians, offsite moni orders, 3-D printing, open-source online- ianDual-Use-Infrastructure materials or processes that can also be used or to enable rapid verification of professional skills for tors, and automated alerts to manage patients who altered for terrorist purposes. But in our case, the a. design specifications, delivery, receiving, ASOCs. d. may be treated at home, in ambulance, in hospital, storage, distribution, security, configura conceptmaximum requires compatthat all- countries may arrive to assist in disaster response at ASOCs, or post-discharge. medical equipment that may be used under disaster activities,Volunteers and and it retirees is important from other to verify regions/states/ in advance - tion for ASOCs. ibility between civilian and military services, and Evaluate: conditions shall be designed for - ii. Anticipate the need to coordinate with i. Bluetooth proximity monitoring technolo national military logistics agencies and shall include a least-common-denominator of clini their identities, relevant skills, and credentials, gies on smartphones as early detection ensure that minimum compatibility cal functionality, data standards and user interfaces and issue necessary identification badges, vests, and contact tracking tools. standards for devices and consumables that enable instant usability by trained clinical staff or wristbands to enable rapid access to different ii. Smartphone diagnostic attachments: a. Build on military alliances 10. Research and compose Mutual Aid Agreements at are applied in the procurement process. anywhere, regardless of brand. areas of disaster control microassays, flow cytometry. iii. Identify critical trigger points in early for large/complex iii. Miniaturized mass spectrometry. disaster awareness that will prepare disasters; identify and establish formal liaisons all levels and ensure clear jurisdictional authorities iv. Lab on a Chip. manufacturers to shift from just-in-time a. 42 and production standards. and schedule periodic meetings to keep current at eachO level. production to large-scale emergency identify relevant medical v. Electrochemical detection. Pre-define equipment lists, of developments. devices needed for each risk category, - existingbtain Master agreements. Service Agreement templates vi. Saliva test. b. For all-hazard risks, - confer with local public health agencies to identify vii. Antibody test. l. multiple-hazard rapid disasters supply and chain re- includ strategies, and ASOC requirements to manage the viii. Antigen test. ing multiple disaster situations (e.g., simultane b. Meet with actual and potential partners to review possibility of ix. Molecular/PCR test. ous earthquake, tsunami, radiation), and ensure 11. ResearchMSAs and and adjust Incorporate as needed. Rapid Deployment m. sulting health threats (e.g., simultaneous pandemic cross-compatibility between military and civilian Identify multiple constituencies/stakeholders c. Align military and civilian procurement processes, Technologies x. ELISA, IFA tests. and earthquake victims). - applications. a. 13. Identifyxi. CRISPR.emerging Treatment Modalities for DM who need to be involved in normal and ASOC ca - and track inventory synchronization, and decision-making Hastily formed networks. a. pability planning: Building science professionals for disaster procurement, especially for national (COVID-19 examples) (air quality, negative pressure, decontamination, d. Ensure interoperability b.c. USHAHIDI (an online tool for aggregating informa providers, disaster survivors, emergency managers stockpiles. Blood purification, apheresis, and adsorption. medical gasses), contractors and vendors, childcare tion from the public for use in crisis response). of electronic identity Sahana (open-source DM software). b. Convalescent plasma transfusion. management applications and processes so that

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c. 18. Negotiate Trigger Criteria and Rapid Execution d. Interferon. Timelines and Industry Workplans - Antivirals. as call-center staff for telemedicine screening; b. Compile improvised and emerging good practices e. - . Negotiate spe CEs may be re-deployed to set up field hospitals for ongoing evaluation and validation, using a f. Monoclonal antibodies. cific terms under which Early Disaster conditions or other ASOCs and work closely with IT staff to standardized ontology for technologies, pharma will be officially declared which will trigger initial integrate ASOC devices into IT networks. Identify ceuticals, clinical trials, prototyping, dilemmas, 14. Refine Triage and Fatality Management resources and industry partners, to prepare for ramping up corrective and preventive maintenance services. Hydroxychloroquine. 25. Establish Inter-professional Innovation Partnership and processes work plans of academic, professional, government, the rescheduling and re-prioritization criteria for and other relevant topics of concern. 22. Form Strategic Health Intelligence Alliances - Networks a. of pre-defined research activities and production of 19. essential equipmentNegotiate and supplies.Manufacturing Alliances industry partners. be team formation,to coordinate standards brainstorming, promotion, process prototyping, engi- Isolation tents with diagnostic and sterilization tools. tween academic, government, provider, and medical troubleshooting, problem-solving, resource-sharing, for DP/DM a. b. Wireless patient identification and vital signs Evaluate and c. ecosystems a. dedicated DP/DM monitoring, location monitoring. to establish contractual agreements Develop comprehensive models of healthcare neering, best-practice identification, and dissemination. Backup plans for wireless infrastructure during that obligate manufacturers to prioritize emergency to complement the increasing clinical Form a team to sustain multi- disasters that can include cell towers and Hastily 20. Promoteproduction an requirements organizational specific culture to the of disasterInformation type. specializations and technical granularity that often year innovation efforts and report results in all d. sponsor Formed Networks. Sharing and Tactical Flexibility lack proper integration or rational cost controls. relevant professional journals and associations. Inter-professional Design Forums and scenarios 15. TestRefrigerated DP morgue trailer. a. b. Coordinate 5-year outlook analyses to identify, b. Use virtual meetings and conferences to for DP/DM assess, and prioritize candidate technologies to routinely to point of failure, to identify weak c. a. Promote professional and organizational norms of provide new efficiencies and DM capabilities. to ensure – in advance of disasters – the alignment links in plans and performance. device and system performance data and discuss informational openness to ensure that decisions are Establish routine evaluation sessions to review criteria.of cross-functional activities, data exchange, device Large-scale stress testing. made based on evidence, not rumor or guesswork. device/system design. interoperability, status updates, and prioritization 16. b.Include Intersectoral Failsafe simulations. and High-Reliability Communica- b. Promote professional and organizational norms 26. Media Liaisons d. any strategic implications for next-generation tions that optimize the ability to be tactically flexible- - Work with to help elevate social and adaptable to changing circumstances and Explore academic and professional channels for to ensure basic communication capabilities if information. Build in specific secondary role as andexpectations incorporate that preparedness DP is a social recommendations priority and thatinto commercial wireless or Internet services fail or are joint degree and certificate programs with medi political leadership will be expected to understand a. signments and responsibilities (role-shifting) in job cal and nursing schools, to build stronger career overloaded. 21. Definedescriptions need for forRole all CEs Shifting and disaster-related staff. 23. Establish Data Fusion and Monitoring a. relationships between CEs and other clinicians. public policy and budgets. Ham radio. - - . During early and Centers 17. b.Acquire Dedicated Early medical Situation Wi-Fi Awareness spectrum. - or link to - and other clinical professionals to CE mid-disaster conditions, routine clinical roles and to monitor emergent, multi-hazard condi and DM conferences, simulation exercises, and dis Centers.43 platform ca responsibilities and reporting relationships may need tions that may require rapid changes in disaster re seminate proceedings of events to media outlets, pabilities and integrate into Emergency Operations to change significantly to enable proper execution of sponse – flooding, landslides, biohazard dispersion, including social media. a. CONCLUSION disaster protocols. Doctors, nurses, CEs, facility, and disruption of transport or supply chain plans, power administrative staff may be shifted to other tasks that Evaluate software options; acquire and install the a. monitoringoutages, gas centers.leaks, tsunamis, firestorms, etc. Establish over-ride normal job descriptions. formal membership for CE liaisons with fusion and - application in Emergency Operations Center and- a. - Taken together, these aspirational recommendations Identify most likely disaster scenarios for your dedicated cellphones. dents, discuss options, and coordinate decisions. offer a comprehensive, but not yet exhaustive set of ac location or region, including the possibility of 2 - c.b. Pre-load regional database with critical infrastruc Establish hourly conference calls to review inci tions that can improve outcomes and alter the historical simultaneous disasters. 24. an ture sites, profiles, contacts. Establish International CE Rapid-Response trajectory of the CE profession and DM capabilities world b. Based on projected needs for equipment, staffing, for rapid-response information sharing in Establish criteria for distributed use of cellular Network wide. Certainly, other topics and recommendations can and ASOC, estimate which types of activity will be reporting application by responsible staff and and must be added to the agenda, but this list does offer d. de-prioritized (such as elective surgery, non-critical civilians to ensure data reliability. a plausible foundation of starting points with sufficient preventive maintenance, training), and which the early stages of any disaster. Convene daily online Conduct training and simulations. c. a. activities will become mission-critical. consultation meetings. andbreadth in teams and detail and toassociations, begin the transformational the daunting magnitude work with a collective framework of efforts. Working individually Identify secondary roles for each job family to be Establish a dedicated website and teamwork tools invoked under disaster conditions and obtain cross- to compile findings, promote problem-solving, . circumstances. of the challenge can be mastered over time, building on training as needed. Specialists may be re-deployed and maintain, professional focus under difficult the global presence and growing leadership of CEs as hospitalists. Hospitalists may be re-deployed

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- 43. - TOPIC DETAIL URL Wireless Communications & Mobile. Computing Con Danial SN, Smith J, Khan F. Situation awareness model- https://www.undrr.org/publication/ ference (IWCMC), Limassol, 2018, pp. 1333-1338, doi: ing for emergency management on offshore platforms. Sendai Framework The Sendai Framework sendai-framework-disaster-risk- 42. reduction-2015-2030 10.1109/IWCMC.2018.8450268. s13673-019-0199-0Human-centric Comput Informat Sci 2019;(9):37. Avail GDACS Global Disaster Alerting Coordination System https://www.gdacs.org/ Cambridge Public Health. Mutual Aid Agreement among able at: https://link.springer.com/article/10.1186/ OSOCC On-Site Operations Coordination Center https://www.gdacs.org/ org/services/emergency-preparedness/products/Public Health Agencies in Emergency Preparedness. Available at: https://www.cambridgepublichealth. INSARAG International Search and Rescue Advisory Group https://www.insarag.org/ https://www.fema.gov/ FEMA Emergency Planning Exercises Mutual_Aid_Template.pdf emergency-planning-exercises RESOURCES Crisis Standards of Care: A Systems Framework for https://www.ncbi.nlm.nih.gov/ Institute of Medicine - Catastrophic Disaster Response pubmed/24830057 https://www.ifrc.org/en/what-we-do/ NOTE: All commercial mentions are for illustrative purposes only and do not imply a recommendation or endorse disaster-management/preparing-for- TOPIC DETAIL URL IFRC Training in Disaster Management ment. Links are active as of April 2020. disaster/disaster-preparedness-tools/ Clinical Engineering Division of the International Federation IFMBE/CED https://ced.ifmbe.org/ training-for-response/ of Medical and Biological Engineering https://www.gsa.gov/buying- United Nations The United Nations https://www.un.org/en/ selling/purchasing-programs/ US General Services AdministrationState and Local Disaster WHO World Health Organization https://www.who.int/ Purchasing cooperatives gsa-schedules/schedule-buyers/ Purchasing OCHA UN Office for the Coordination of Humanitarian Affairs https://www.unocha.org/ state-and-local-governments/ state-and-local-disaster-purchasing Capacity for Disaster Reduction Initiative: global partnership https://www.embedded.com/processors- Multicore Processors meet medical device design challenges of FAO, IOM, UNDP, UNICEF and UNFPA (executive meet-medical-device-design-challenges/ CADRI partners), GNDR, IFRC, OCHA, UNESCO, UNOPS, WFP, https://www.cadri.net/ WHO, WMO (technical partners) and GFDRR, OECD, ODI, https://publications.europa.eu/ The Impact of the Introduction of Multicore Technologies on resource/cellar/d2eeb993-5e7c- RedR , UNDRR, UN WOMEN Multicore the Computing Market and Opportunities for Europe 403d-b0bc-fda57388d211.0001.01/ UNISDR, UNHCR, IFRC, IOM, FAO, WFT, UNDP, UNICEF, https://www.who.int/health-cluster/about/ UN Clusters DOC_1 Save the Children cluster-system/en/ https://www.techdesignforums.com/ UNDRR (formerly Enabling embedded multicore systems with multiple OSes practice/technique/enabling-embedded- UN Office for Disaster Risk Reduction https://www.undrr.org/about-undrr Multicore UNISDR) and critical goals multicore-systems-with-multiple-oses-and- UNHCR UN High Commission for Refugees https://www.unhcr.org/ critical-goals/ International Federation of Red Cross and Red Crescent https://www.cdc.gov/coronavirus/2019- IFRC https://www.ifrc.org/en/--/ Societies ncov/hcp/alternative-care-sites.html?CDC_ Infection Prevention and Control Considerations for AA_refVal=https%3A%2F%2Fwww. Alternate Sites of Care IOM International Organization for Migration https://www.iom.int/ Alternate Care Sites cdc.gov%2Fcoronavirus%2F2019- FAO Food and Agriculture Organization of the UN http://www.fao.org/home/en/ ncov%2Fhealthcare- WFP UN World Food Program https://www.wfp.org/ facilities%2Falternative-care-sites.html https://www.undp.org/content/undp/en/ Alternate Sites of Care Global Base Camp Support Services https://www.basecampservices.com/ UNDP UN Development Programme home.html Standards and Guidelines for Healthcare Surge During http://www.cidrap.umn.edu/sites/default/ Alternate Sites of Care UNICEF UN International Children’s Emergency Fund https://www.unicef.org// Emergencies files/public/php/258/258_acstools.pdf https://asprtracie.hhs.gov/technical- Save the Children Save the Children https://www.savethechildren.org/ Medical Surge and the Role of Health Clinics; Public Health Alternate Sites of Care resources/48/alternate-care-sites-including- Emergency Preparedness, and other articles IFRC International Federation of the Red Cross https://www.ifrc.org/en/--/ shelter-medical-care/47 Pan American Health Organization/Organizacion https://www.paho.org/en/ PAHO/OPS Panamericana de Salud health-emergencies/disaster-risk-reduction

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TOPIC DETAIL URL TOPIC DETAIL URL https://emilms.fema.gov/IS706/assets/ Mobile clinics, hospitals, prefabricated hospitals, hyperbaric Mutual Aid Agreement Mutual Aid Template draft text for customizing to user needs Mobile Hospital Solutions http://oxycare.com.tr/ WyomingTemplate.pdf oxygen chambers https://scholarspace.manoa.hawaii.edu/ Mobile medical, dental, mammography, blood mobiles, Rapid Deployment Blockchain Technology for Emergency Response Mobile Hospital Solutions https://lifelinemobile.com/ bitstream/10125/63814/0061.pdf laboratories The Evolution of Hastily Formed Networks for Disaster https://www.researchgate.net/ Modular disaster response solar-powered clinics in a mobile Rapid Deployment Response publication/221567937_ Mobile Hospital Solutions container; morgue unit; laboratory; radiology suite; maternal/ http://www.clinicinacan.org/#about The Ushahidi Platform allows anyone to gather distributed infant clinic; primary care exam data via SMS, email or web and visualize it on a map or https://www.dynamism.com/healthcare. USHAHIDI https://www.ushahidi.com/ 3D Printing 3D printing solutions for healthcare timeline. Its goal is to create the simplest way of aggregating shtml information from the public for use in crisis response. Medical devices produced by 3D printing include orthopedic https://www.fda.gov/medical-devices/ Sahana Open-source disaster management software https://sahanafoundation.org/ 3D Printing and cranial implants, surgical instruments, dental restorations products-and-medical-procedures/3d- Google.org supports nonprofits working alongside such as crowns, and external prosthetics printing-medical-devices affected communities from the immediate aftermath of a https://www.cdc.gov/cpr/ crisis through long-tail recovery. This includes providing Supply chain management readiness/healthcare/ https://crisisresponse.google/ Prepared by US Center for Disease Control and Prevention nonprofits with funding and connecting them to the right in disasters SupplyChainDisasterPreparednessManual. Google volunteers—whether they’re a data scientist, a htm communications expert, or an engineer. Sample guidelines for Credentialing for volunteer physicians https://studylib.net/doc/7359857/ Provides global map with data on floods, earthquakes, fires and allied health practitioners; need for credentialing of Google Public Alerts https://google.org/publicalerts Disaster credentialing guidelines-for-credentialing-and-granting- and other disaster conditions professionals, call-center staff, and volunteers from other disaster-privil... https://robotechvision.com/ states, countries Solar-powered Wi-Fi Solar-powered wireless access points solar-access-point/ Online mapping software that combines pre-loaded data Backup radio communication technology in case normal https://www.youtube.com/ about critical infrastructure elements with real-time, location Ham Radio Common Operating specific (GPS) data about disaster incidents and conditions telephone and cell services fail watch?v=lLqC8cvH_Aw http://comopview.org/sfc/ Picture that are submitted via cellphone app. Helps track deployment Geospatial Science and Point-of-Care Testing: Creating https://www.ncbi.nlm.nih.gov/pmc/articles/ of first responders and visualization of regional response Point-of-care testing Solutions for Population Access, Emergencies, Outbreaks, and PMC6988819/ activities in real time. Disasters https://www.phe.gov/Preparedness/ Pandemic Planning US Dept. of Health and Human Services checklist for https://www.path.org/programs/ COVID19/Documents/COVID-19%20 Point-of-care testing PATH diagnostics for low-income settings Checklist pandemic planning diagnostics/ Healthcare%20Planning%20Checklist.pdf Innovations in Point-Of-Care Testing for Enhanced United https://www.wmpllc.org/ojs/index.php/ Capability Maturity PAHO Information Systems for Health Maturity Assessment https://www.paho.org/ish/images/docs/ Point-of-care testing States Disaster Caches – American Journal of Disaster ajdm/article/view/2135 Roadmapping Tool about-IS4H-mm.pdf?ua=1 Medicine https://www.semanticscholar.org/paper/ https://www.sciencedirect. The-Use-of-Maturity%2FCapability- Capability Maturity The Use of Maturity/Capability Frameworks for Healthcare Point-of-care testing Smartphone based medical Diagnostics com/book/9780128170441/ Frameworks-for-and-S%C3%B6ylemez-Ta Roadmapping Process Assessment and Improvement smartphone-based-medical-diagnostics rhan/30b0cdbcdb75b8f6a0105b59627d8d5 https://www.azolifesciences.com/article/ f2c015284 Point-of-care testing Lab on a chip Health-Applications-of-Lab-on-a-Chip.aspx The WHO R&D Blueprint is a global strategy and Advanced Diagnostic Lab https://pubs.acs.org/doi/10.1021/ Research Coordination preparedness plan that allows the rapid activation of R&D https://www.who.int/blueprint/en/ Mass spectroscopy Technology acsomega.9b03764# activities during epidemics. Enables the government to commandeer national production https://www.dropbox.com/ https://www.fema.gov/ A proposal to IFMBE/CED to document best practices, Defense Production Act capabilities in order to meet defense and national emergency Action Research on s/9zgq5absdlno9fu/Draft%20proposal%20 defense-production-act-program problems and recommendations about management of the needs. Disaster Response for%20Disaster%20Mgt%20Research%20 COVID-19 pandemic, led by Clinical Engineers. program%20Rev3.pdf?dl=0 https://www.mopec.com/ Mobile Morgue Trailer Refrigerated body storage mortuary-response-solutions/

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AUTHOR BIOGRAPHY

Tech University. He worked for 17 years with Kaiser Permanente, the largest non-profit hospital system in- cessthe US, re-engineering, responsible for asset annual management clinical technology and IT service plans for Northern California, implementing a national pro

management systems, and most recently was Director of Research and Innovation in Clinical Technology. He has published articles on disaster management and the future of biomedical and clinical engineering professions. He edited Human Resources for Medical Devices in 2017- Fred Hosea, PhD, has worked in different areas of for the World Health Organization to promote biomedical health care and psychosocial development for over 30 and clinical engineering as essential professions for mod years, conducting research on professional development ern healthcare systems worldwide. He lives in Cotacachi,- in philanthropy, conducting FBI research on convicted- Ecuador and is active in a variety of projects to strengthen sex offenders, and working as a mental health worker in indigenous Kichwa culture, improve local health ser adolescent psychiatric wards, community-based residen vices, and promote sustainable models of development. tial care for adolescents, school-based counseling, and in Fred is currently a collaborating member of the Clinical a maximum security treatment center for the criminally Engineering Division of the International Federation of insane. He has taught graduate-level courses in business Medical and Biological Engineering, and has presented on and professional ethics, and has taught undergraduate the future of CE at international conferences in Beijing, courses in “The Art and Science of Innovation” at Yachay Shenzhen, Visakhapatnam, Bangkok, Rome, Geneva, Sao Paulo, and Zagreb.

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