Shadow Bowl is organised to demonstrate applied Distributed Medical Intelligence (DMI) in the case of a mass casualty event, and to develop a network of national DMI expertise and a surge capacity for medical response. The demonstration of advanced physiologic and environmental monitoring showed how firefighters, hazardous material clean-up crews and other first responders can send a continuous stream of real time, high-resolution, ICU-level, physiologic, and environmental data to a field command post, where it could be used to make critical life and death decisions.
The Shadow Bowl presented several civil readiness drills based on scenarios of mass medical surge, with a focus on the physical infrastructure response and use of community resources to enhance community readiness.
Medweb's Mobile Medical Communications and Triage Vehicle uses a high speed self-pointing satellite transceiver to provide Internet access, video conferencing, VOIP phone connection, a 24-line phone system, wireless LAN capabilities, as well as fax and laser printer options for the Instant Internet Field Clinic.
The IIFC is a series of wireless laptop-based stations where patients can have history and vitals taken, receive a physical exam, an x-ray, EKG, respirometry or other tests, and receive immediate advice from remote experts before receiving initial treatment. The IIFC runs on the Telemedicine Workflow Server that provides work flow, clinical protocol generation, real time epidemiological information and reach-back to medical facilities and practitioners over the satellite Internet connection.
The Telemedicine Workflow Server manages the diagnosis and treatment process at the field clinic while providing diagnostic information to remote specialists. It allows the primary caregivers to use remote specialists so they can handle larger volumes of patients simultaneously. They are able to share clinical protocols and treatment information with a large group of caregivers in real time to accelerate the delivery of effective treatment regimens. The work flow server is Web-based and can be housed in a mobile vehicle or at a remote Internet hosting facility.
Based on gold standard technology used in hospital intensive care units (ICUs) for more than 20 years, VivoMetrics' LifeShirt System collects more than 30 high-resolution physiologic parameters and is currently used in pharmaceutical trials, academic research and health care delivery. In this demonstration of a prototype system, an emergency worker is wearing the VivoMetrics' LifeShirt, a comfortable, lightweight garment, beneath a protective hazardous materials (hazmat) suit. The LifeShirt System will continuously gather the worker's cardiopulmonary and body position data and send it via wireless telemetry to a remote command station to be analysed and displayed in real time.
The first responder is also wearing Siemens' TeleTrak radiation dose and rate monitoring sensor that provides real time data on the received dose and ambient radiation dose rate in the responders' immediate environment. Siemens' TeleTrak sensors are currently used by the Air Force and the nuclear power industry to measure radiation levels.
The TeleTrak sensor and LifeShirt are worn beneath a fully enclosed hazmat protective suit. This demonstration system combines two state-of-the-art, field proven monitoring systems into one with wireless telemetry and real time analysis capabilities. Use of this system could greatly increase safety for first responders, firefighters, hazardous waste cleanup crews, and other workers who put themselves in harm's way.
Right now, the biggest risk experienced by emergency workers is heat exhaustion while wearing heavy protective clothing. Often a firefighter or hazmat worker will deplete fluids, overheat and lose decision making capabilities that may result in loss of consciousness and injury.
In addition to heat, these workers face potentially high levels of radiation or other biohazard. By continuously monitoring physiologic signs, a field commander can identify potential problems early enough to make enhanced deployment decisions that could save the life of a first responder whose cardiopulmonary and cognitive integrity has been compromised as a result of thermal stress or a toxic environment. In the near future, VivoMetrics and Siemens plan to add additional parameters such as GPS and other chemical and biological sensors to this base platform.
Other participants at the Shadow Bowl included Johns Hopkins University's Office of Critical Event Preparedness and Response (CEPAR); Denver Health and Hospitals; Virginia Commonwealth University's Medical Informatics and Technology Applications Consortium (MITAC); Alion Science and Technology; Research Triangle Institute; CRI, a Division of RSI; Global Communication Solutions; Tandberg Healthcare Services; Lightpointe, Laser Communications; Wave Three Software; and Medweb.
Medweb has been providing distributed telemedicine solutions since 1992 and holds the patent for Web-based medical image viewing. Its clinical information solutions are built upon public standards such as DICOM, HL7 and Internet technologies. Medweb's robust portfolio of reliable and secure products is designed to dramatically improve the delivery of high-quality health care, reduce provider costs, and increase profitability for medical care organisations.
The LifeShirt System is the first non-invasive, continuous ambulatory monitoring system that can collect data on cardiac and respiratory function and other physiological parameters and correlate them over time. Its sensors monitor heart function, posture and physical activity, and it features an enhanced, ambulatory version of the technology that is currently the gold standard for in-hospital, non-invasive respiratory monitoring and apnea detection. It also includes an electronic diary function to capture subjective patient experiences. More details on the LifeShirt System are available in the VMW March 2002 article Health-monitoring LifeShirt enhanced with GPS and tested by U.S. Air Force.