People in the St. Louis region may not be more immune to a disaster than those living elsewhere, but thanks to a new metropolitan emergency medical information network, they may be better prepared than most for a terrorist attack or natural disaster.

St. Louis' Web-based system, nicknamed STARRS for St. Louis Area Regional Response System, can track people transported by ambulance to area hospitals during a large-scale emergency or disaster. STARRS also enables paramedics to use handheld devices or laptop PCs to electronically send a patient's medical and logistical data to waiting doctors and nurses at area hospitals.

STARRS could transform the way emergency medical services (EMS) and hospital officials collaborate in big-time emergencies. "It really revolutionizes the way that you would handle any kind of mass casualty incident," said Brad Perry, information technology manager and a paramedic with the Des Peres, Mo., Public Safety Department. Des Peres is one of the cities participating in STARRS.

For example, EMS teams will no longer have to spend time counting injured people in large-scale disasters or phoning hospitals to find out whether they can handle an influx of patients, Perry said. The system will monitor that data, leaving EMS officials to focus on what they do best: providing medical care.

Built by IBM and EMSystem, STARRS cost about $1.5 million in federal homeland security funds.

To get the system up and running, three Illinois counties, four Missouri counties and the city of St. Louis - which uses STARRS on a daily basis - were given mass casualty incident kits for area EMS teams. Each kit includes four ruggedized Symbol Technologies handheld devices, bar code tags, one Panasonic Toughbook laptop equipped with a cellular card and wireless access points.

During an emergency, paramedics would use those tools to help manage triage operations. First, they would enter patient data - such as age, gender and, if time allows, chief complaints - via drop-down menus to limit keystrokes. Then they would print a bar code bracelet to attach to the patient. The encrypted data would be transmitted wirelessly to the destination hospital.

Automatic messaging
Hospital officials "automatically get a message over the Internet that says you have patients coming," said Terry Sofian, operations manager for STARRS. "It will tell them how many and how severe their injuries are."

Previously, "we had to use radio," Sofian said. "We had mostly gone to cell phone for a lot of this information, but it was pretty much like the old Squad 51 days," he said, referring to the 1970s hit TV show "Emergency!"

Sofian said the biggest challenge in launching STARRS was designing a system that addressed the needs of all the participating communities.

To that end, he said, EMS, hospital and public health representatives worked together from the beginning to choose common data elements and an interface design. The region had already been using another EMSystem application called EMResource, an application designed to monitor hospitals' status and resources, such as bed availability. In the end, the group decided to integrate the old and new systems.

"By mating these two [applications] together, it gives us both halves of the puzzle," said Sofian, who is also a veteran volunteer firefighter and emergency medical technician. "The patient tracking gives us the number of patients, where they're at, their condition and exactly how they're being moved through the system. The EMResource lets us look at who's got resources and where can we send these patients."

Authorized emergency officials can then see if a particular hospital is overburdened and redirect ambulance providers to other hospitals or facilities if necessary.

The system incorporates international mass casualty triage codes - red, yellow, green and black - to flag the severity of a patient's injury. It also has
a fifth code to identify non-injured people to enable rescue organizations such as the Red Cross to locate people and reunite them with their families more quickly. The system would show rescue groups only the names and/or demographic data on patients and others, but it would not reveal any private medical information.

The system complies with the Health Insurance Portability and Accountability Act, which is designed in part to ensure the security and privacy of shared medical information. Users receive rights to access a patient's demographic information and sometimes more sensitive data based on their affiliation and professional status.

To ensure constant communications, IBM officials drove across all eight counties in the region to analyze cellular coverage. Three counties use the Cingular network, and five use Sprint. Jane Harbron, an IBM Public Sector executive, said they found only two spots where it was difficult for EMS workers to get coverage. But she said the handheld devices can store and forward information automatically as soon as paramedics enter an area with cellular coverage.

"We don't lose records," she said. "We don't lose people."

The company is evaluating a satellite backup system to keep critical applications running if the cell networks are disabled or clogged, Harbron added.

Stress testing
The system has performed well under stress in several mock exercises. "We pushed 300 sets of patient data in a half-hour, and we were able to refresh the screen in less than 30 seconds," Sofian said. "We had simulated queries from over 100 simulated users to stress the system. It would have been as if every EMS service, all the regional hospitals and all the regional [emergency operations centers] were all looking at the data all at the same time, and we were still refreshing under 30 seconds for the event."

Although the system was designed to help manage mass casualties, St. Louis officials are using it on a daily basis. Thirteen ambulance units operate in the city during peak time and 11 during off-peak hours. The city's EMS units transport about 45,000 patients annually.

Monroe Yancie, chief paramedic at the St. Louis Fire Department, said the city had used a similar system in the past, but it did not work well.

"It was using a scanner at the end of a cell phone, but there were several problems," he said. "The cell phone battery was draining real quick. You could barely see the screen, it was tiny and it was too slow. This is much better: better format, larger screen, not delicate like the Palm was and definitely much faster. The maintenance and support are much better."

Yancie said the new tracking system will help ensure that hospitals get the information they need on incoming patients. When paramedics had to rely solely on cell phones to reach doctors or nurses at hospitals, they often had trouble getting through.

Perry said Des Peres officials would also like to use the tracking system on a daily basis, but it will take time to coordinate with the dozens of EMS providers across the 90 cities, towns and villages within St. Louis county.

"You're talking about joint decisions that have to be made among m