Iepd analyze Requirements Use Cases for edxl situation reporting messages Draft Version 4



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EMS Response Scenario Synopsis


This scenario takes place in Bayport on a coastal island across a bridge from Fisherville on the mainland. The nearest large city is Central City which is 40 miles away and has two hospitals. The first, Faith Hospital, is a regional cardiac catheterization and care center. Central City Hospital is a level 1 trauma center and operates a medevac helicopter service called Med Flight-1. Fisherville has a small community hospital with a physician-staffed ER. Fisherville Hospital runs a health clinic in Bayport, staffed by a physician assistant. The Bayport EMS (BEMS) staff supports the physician assistant, as well as Central City and Faith Hospital physicians who have patients in Bayport, by working in the clinic.

The real-time status of EMS-involved calls and other events, EMS responders, hospitals and other resources upon which EMS and hospitals depend are maintained in databases linked in a network called the emergency medical service resource and events monitoring system (““COMMON SYSTEM OR SHARED DATABASE””). Similar database networks exist for fire, police (i.e.; National Law Enforcement Telecommunications System) and transportation responders, and many of the databases are shared among disciplines. The network is accessed via desk-top computers and mobile-base systems at dispatch centers, hospitals, 1st responder vehicles and elsewhere.

The “COMMON SYSTEM OR SHARED DATABASE” screen displays a map representing the service area of the particular ambulance, hospital helicopter or other provider monitoring the screen. Labeled icons represent resources or events such as EMS calls. By selecting an icon, one accesses drop down menus and more detailed information about the event or resource.

Scenario Participants:


  • County dispatch center / Public Safety Answering Point (PSAP)

  • Faith Hospital (regional)

  • Central city Hospital (regional, level 1 trauma center)

  • Medevac Helicopter service

  • Fisherville Hospital (community hospital)

  • Bayport Police Department

  • Bayport EMS (BEMS) / Health Clinic

  • Bayport Fire Department

  • Bayport Coroner

  • Private Ambulance Services

  • Hospital Ambulance Services

  • Private Towing & Recovery Services

Use Case Events Chronology
extracted from the “EMS Call” Scenario
“EMS Call Scenario Version 3.4.doc”


GENERAL PRECONDITIONS:

  1. Protocols and mutual aid agreements for communication are in place

  2. Interoperability communication capability is in place

  3. Asset Management capabilities are in place

NOTE 1: Specify where applicable mobile terminals / laptops used in first responder vehicles

NOTE 2: Consider communication within incident site, between incident and centers/support orgs between centers/support orgs, up the command chain and to the public. Also consider mobile terminals / laptops in 1st responder vehicles


EMS Response Scenario Time-line


Step / Seq.

Date/Time

Activity / Task / Communication

Sender(s)

Recipient(s)

Information-Sharing Requirement /

Remarks







(Initial Work Shift Tasks)















  1. NOTE: An Acknowledgment message from each recipient is required to be sent back to the sender of any message regardless of whom or what system originated the message (e.g. AACN, PSAP, dispatcher, 1st responder unit) and regardless of the type of message sent (e.g. whether the message provided alerts, notifications, situation information or updates to any information), to verify that the content of the message has been received by the recipient system.



0600

A paramedic and an emergency medical technician (EMT) partner report for their shift at BEMS. After being assigned to ambulance A-1 and receiving the day's situation updates from the crew going off-duty, they go to their ambulance and begin the daily unit check-out.



Ambulance Team

EMS Service , Direct Supervisor

Shift change information - Vehicle / vehicle type, new shift / staff names, staff credentials / EMT levels.

Depends on Region – RMCC may be in place to manage regional resources



1a







EMS Service

County Dispatch

Local and Regional Medical Communications Center (e.g. RMCC)



Ambulance shit staff status/ on duty… (same info as above)






The crew performs the daily unit check-out using RFID readers that identifies that all the medical supplies needed are onboard, all medical equipment and monitors are functioning within specification, and “Vehicle Status” is operational (Every vehicle system, fluid level, and tire inflation level)

Ambulance Team information capture Equipment (the readers)

Role e.g.: Direct Supervisor. Role: e.g. RMCC also receives Vehicle Status. Technology recipients may be ambulance crews PDA and an ambulance central server – waiting for anyone to pull the information

Verify or request Medical supplies, medical equipment and monitors diagnostics (against spec), Vehicle operation status information



0625

The A-1 crew automatically reports to the dispatcher that it is active and available for calls. The dispatcher acknowledges that A-1 is active

Ambulance Team EMS SErvice

Local dispatcher

Shift change information - Vehicle / vehicle type, new shift / staff names, staff credentials / EMT levels, Ambulance and crew active and available.







(Response to Car Crash)












0839

County dispatch receives a call from an Advanced Automatic Crash Notification (AACN) (e.g. GM On-star or Mercedes Benz TeleAid) call center about an airbag deployment on Rte. 1-A, 12 miles southwest of Bayport. The AACN operator is unable to establish voice contact with the occupants. The AACN data feed indicates a 50 MPH head-on collision and roll-over. The AACN indicates three occupants, with two occupants still in the vehicle and one ejection. There is a belted driver who remained in the front seat and a passenger now in the back seat. The AACN center advises that there is an “urgency” alert derived from the onboard sensors for one severely injured patient, while the other occupant is likely less injured.

(NOTE: SEE GENERAL REQUIREMENTS SECTION BELOW - “Open Issues” #1 and scope statements)



AACN / service provider monitoring / call center checks validity and relevance before sending

PSAP

** For initial analysis, the team will focus this use case / standard on interoperability FROM PSAP / 911 centers out to others…
NOTE 1: the future requirement is for the AACN data feed to go directly to the telematic service provider, who will screen the call and then electronically provide the information to Dispatch / 911 centers (PSAP) (today it’s a phone call). A more forward-thinking and aggressive requirement is for real-time automated receipt of vetted AACN data by PSAP’s and any others who are “registered” to receive this information per a defined protocol (e.g. an alert).

NOTE 2: Although this is clearly “Situation Reporting” data, this is a scope issue under discussion (NASEMSO, HITSP, others) to determine the appropriate process and forum to define standard message(s) from these devices


5a




Based upon this information, Bayport police, Fire first responders and Bayport ambulance A-1 is dispatched

NOTE: Contact could be made directly from PSAP to 1st responders, or from PSAP to local dispatch to 1st responders. Paid responders normally are directly called while volunteers are contacted through a local dispatcher.



PSAP

Local dispatcher


Message 1 = Incoming 911 call information reporting the crash (info from the AACN service provider call center - to the PSAP - which is then provided to local dispatch)


5b







Dispatcher

EMS Service

Message 2 = (Same info as 5a)

5c







Dispatcher

1st responders

Message 3 (or combined with message 2) = Resource Request / local responders needed at crash site. (EDXL-RM “Request Resource” message? Define info here, in order to match with RM and confirm?)

6a

0840

The 911 center also begins to receive cell phone calls reporting the car crash, but providing more information about a third victim outside the car.

(NOTE: SEE GENERAL REQUIREMENTS SECTION BELOW - “Open Issues” #1 and scope statements)



Citizens / 911 callers

911 call center

Voice call from citizen.

Similar issue to Step 2. Assume for now that information coming into the PSAP is out of scope.



6b







PSAP

Local dispatcher

Message 1 = Incoming 911 call information reporting the crash (same / similar information as in step 5a, but additional situation information – the third victim outside the car.)

6c







Dispatcher

1st responders

Message 2 = Additional information about the third victim outside the car

Message 3 = Resource Request / local responders needed (additional?) at crash site. (EDXL-RM “Request Resource” message? Define info here, in order to match with RM and confirm?)

NOTE: Different information may need to go to different responder organizations (Fire, LE, EMS etc.) Where applicable, break out to define each set and then determine gap / overlap


7a

0841

Bayport police are the first to arrive on the scene and verify a single vehicle crash involving three victims; two of which are entrapped in the vehicle and a third which has been ejected and decapitated.

Police on-scene

Dispatch / Responders

Message: Status update – now on scene - time of arrival etc.

Message: Confirmation / revision of situation report information



7b







On scene police

County Coroner

Message: Notification of decapitated individual

8a




Bayport police indicate patients meet trauma triage criteria, and request a second Bayport ambulance, A-3, as well as fire department extrication and manpower

Police on-scene

Dispatch

Message: Notification that trauma criteria are met…

8b







Police on-scene

Dispatch

Message: Resource Request - additional resources

(EDXL RM?)

NOTE: In an alternative scenario branch, Fire Department extrication resources may have already received AACN info and dispatched immediately


9a




Area Hospital status and availability information is requested

2 steps – 1 requestig status and another where hospitals provide that status.



dispatch

Area Hospitals

RMCCs


EDXL-HAVE (Hospital Availability Exchange) standard?

Verify whether HAVE incorporates a request; otherwise where / how a HAVE request is defined?



9b




Area Hospital status and availability information is provided

Area Hospitals

RMCCs


Dispatch


EDXL-HAVE (Hospital Availability Exchange) standard

10




The PSAP tone alerts Med Flight-1, which prepares for departure but awaits dispatch. It also triggers notification of the Trauma Team (Central City Hospital). This information is entered automatically into the “COMMON SYSTEM OR SHARED DATABASE” (a regional medical database)

PSAP

Central City (others too?) hospital directly?. “COMMON SYSTEM OR SHARED DATABASE” system? Other hospitals notified through “COMMON SYSTEM OR SHARED DATABASE”?

What’s the info? Trauma center needed / alert…? Decision that hospital air transport is needed?

NOTE: For our purpose, I would like to assume the messaging provides all notifications and information updates in order to identify all requirements; rather than rely on “COMMON SYSTEM OR SHARED DATABASE” to provide info.



11

0842

As the ambulance A-1 approaches traffic lights along the route, the onboard signaling system changes the lights to the ambulance's favor







A message or signal is sent to the light system commanding the light to turn to “green”. Likely out of scope of this standard.

12




Fire and Ambulance A-1 arrive directly after Bayport police.

EMS on-scene

Dispatch

Message: Status update – now on scene - time of arrival etc.

13a




Based upon AACN information, EMS observation / verification and trauma protocols, County Dispatch requests Med Flight-1 be dispatched to scene.

EMS on scene

Dispatch

Message: Resource Request – additional resources

(EDXL RM?)



13b







Dispatch

Med Flight-1

Message: Resource Request - additional resources (same / similar message relayed)

(EDXL RM?)



14a




Fisherville Hospital ER is the closest to the crash site and is Bayport's local medical direction facility. EMS notifies Fisherville ER to prepare / be on alert

EMS on scene

Dispatch

Message: Notification of incoming patients

NOTE: This step was questioned as redundant – that the facilities were alerted by the AACN. Above does not specifically call this out, but the alternative flow for more automated regions does assume receipt of alerts by registered entities.

So, keep this step to ensure no information exchance requirements are missed.


14b







Dispatch

Fisherville Hospital ER & Central city Hospital

Message: Notification of incoming patients



















16a




Bayport police begin traffic diversion around the crash scene.

Police

Dispatch

Message: Notification of traffic diversion

Message: Resource Request (Sign boards…)



16b







Dispatch

DOT / Traffic administration / Media

Message: Notification of traffic diversion

Message: Resource Request (Sign boards…)



17a




The paramedic identifies a helicopter landing site which is a mile from the crash scene.

EMS on-scene

Dispatcher then to Med flight

Location of landing site

17b







Dispatcher

Med flight-1

Location of landing site

18.




All units provide their response status, which is automatically received by County Dispatch and by other responding units.

Responding units / resources

Dispatch

Many to many exchange?

What info is passed to provide “response status”?








Additional status updates from County Dispatch are automatically received by responding units

Dispatch

Responding units / resources and support orgs

Many to many exchange?

What info is passed to provide “response status”?








The Central City Hospital Trauma Center, the Med Flight-1 crew and the lead trauma nurse check their “COMMON SYSTEM OR SHARED DATABASE” screen on the computer/communications device that is beeping an alert tone

At the same time, the triage nurse at Fisherville Hospital checks “COMMON SYSTEM OR SHARED DATABASE” in response to an audible alarm on the desktop computer/communications device from the PSAP alert. She notes that one ambulance (A-1) arrived on scene at (time), and one ambulance is responding,10 minutes from the scene. She sees that the Trauma Center has been put on alert for this crash and that Med Flight-1 has been requested to dispatch and is currently launching to the Bayport scene



Potential many to many exchange (need to identify senders)

Potential many to many exchange (need to identify recipients)

NOTE: May be a bit futuristic

Message: Response / resources status update. (One ambulance on-scene (tim), one ambulance is responding with 10 minutes from the scene. Trauma Center has been put on alert for this crash.

Med Flight-1 has been requested to dispatch and is currently launching to the Bayport scene

(EDXL “Report Resource Deployment Status” message?)






0900

A-3 arrives on scene simultaneously with a paramedic and EMT

EMS on-scene

dispatch

Message: Status update – now on scene - time of arrival etc.






The paramedic examines the patients and verifies a single vehicle crash into a tree with roll-over. There are three victims; two of which are seriously injured, including a male (the driver) and female, both approximately 50 years old and a deceased male, approximately 20 years old. The 50 year old male victim is semi-coherently responding to voice, has no visible injuries, and is complaining of chest and shoulder pain. The paramedic determines that there is no tenderness to touch in the chest area and suspects cardiac pain. The female patient is trapped in the back seat with doors pinned by a collapsed roof, is unresponsive but breathing, and appears to have an open head injury with possible skull fracture

EMS on-scene




Message1: Initial assessment - Observations, diagnostics, treatments of patients / victims on scene (e.g. I have triage patients, 2 reds and a black…?)

NOTE: See “General Requirements” section

Message2: “Initial assessment” (Non-EMS responders are also on-scene making observations and assessments – define this information set also)


23




The paramedic designates that this (female) patient will go to the Trauma Center via the helicopter, and provides his observations, diagnostics and treatments directly to the trauma center (Central City)


EMS on-scene

To Trauma center

Message: Initial assessment (updated / additional information) - Observations, diagnostics, treatments of patients / victims on scene

This is updated/additional info on decisions made based on initial assessment – info on where folks are being transported.

(2 red patients (names etc.) en-route to “X” and the black (name etc.) en-route to “x”…


24




On-scene EMS (or EMS in transit during a later step?) confirm that hospital resources are still available

NOTE: Status could change as time passes. Must reconfirm before designating where patients go, or can happen en route.









EMS re-checking again to confirm hospital status and availability - HAVE?

ETA and other information also passed etc.



  1. a




Bayport police dispatch Bayport Coroner to the crash scene to confirm death of male crash victim and removal of the body from the crash scene

Figure out steps here and add (JEFF SEXTON check this)



Police

Dispatch

Alert Coroner

Dispatch of coroner

Provide Info from previous exchanges / updates


31b







Dispatch

Coroner

Alert Coroner

Dispatch of coroner

Provide Info from previous


  1. a




To assist with the identification of crash victims and expedite next-of-kin notification and family member reunification, Bayport police utilize their in-vehicle mobile data system to run a National Law Enforcement Telecommunications System (Nlets) query on the crash vehicle Registration Plate and Vehicle Identification Number (VIN#) to return vehicle owner data and associated ‘emergency contact information’.

Bayport Police

Nlets system

Query on the crash vehicle Registration Plate and Vehicle Identification Number (VIN#)

33b







Nlets system

Bayport Police

Vehicle owner data and associated ‘emergency contact information’.

  1. a




For those crash victims that Bayport police has confirmed identity, a patient ID security token is sent to EMS personnel enabling EMS to query for an electronic Personal Heath Record (PHR).

Police

EMS personnel

Message: Patient ID security token and related information

NOTE 1:


Police need to be able to pass some ID (identity of the person) to EMT’s, so they can query a personal health record. This is a future concept providing info about past care (captured and stored somewhere) and a master ID provides access. Need to know who the person is before any of this could be done.


25




Coroner arrvies and determines need for scene evaluation

coroner

ECC/RMCC and State coroner

Confirms death and cause

26




Police begin to notify next of kin

Police

Next of Kin System (or organization / contact?)









The helicopter continues and the Trauma Team sets up the trauma bay in the OR and notifies the OR of potential need for neurosurgery in particular.







No exchange for this step

28a

0905

the paramedic’s assessment clearly indicate that the male patient has suffered a heart attack and alerts the Faith Hospital cardiologist who issues an immediate alert to the cardiac catheterization lab at Fisherville.

EMS on-scene

Dispatch

Message: Male patient assessment update & redirecting of patient to Fisherville

28b







Dispatch

Faith Hospital & Fisherville









To confirm the absence of any severe injuries (for the second patient – female - targeted for transport by Med Flight-1) the paramedic to performs a head to toe trauma assessment and notifies the Trauma Center of the absence of major traumatic injury.















Based on consultation among the paramedic, the Fisherville Hospital ED physician, the Faith Hospital cardiologist, and the Trauma Center surgeon, to bypass Fisherville Hospital, and transport the patient by ground to the Faith Hospital for cardiac catheterization















Med Flight-1 nearing landing zone. Landing site needs to be secured and ensure the safety of the landing site for the crew and the public

Dispatch

DOT, Police, On-scene responders

Med Flight-1 ETA, request / confirmation that landing zone is secured and cleared for landing

34b







EMS personnel

PHR system

Query for electronic Personal Health Record PHR)

34c







PHR system

EMS personnel

Message: Person specific HEALTH information including past care info…

34d







EMS personnel

PHR system

Provide update to the PHR system record

35a

0910

A fire department heavy rescue vehicle arrives. The “COMMON SYSTEM OR SHARED DATABASE” indicates that the helicopter is on the ground at the landing site. The car’s doorposts are cut and the roof is removed.

On-scene Fire

Dispatch

Message: Status update – now on scene - time of arrival etc.

Message: Status update – landed at designated site - time of arrival etc.




35b







Dispatch

All 1st responder units, hospitals, etc.

(same)

  1. 336

0920

A-1 heads to Faith Hospital, 40 miles away. The paramedic performs a 12 lead EKGs to monitor progression of the heart attack and treatment being administered. This on-board information is sent to the hospital (which does in fact happen today). Medications administered en route seem to have improved the patient’s condition.

Ambulance system

Faith Hospital, others?

Message: Patient condition and care information, medications / treatments administered

37




The female patient is collared, boarded and removed from the car to unit A-3. EMT-Intermediate accompanies the patient and EMT crew to the helicopter landing site. The patient receives two IVs and a breathing tube en route to the helicopter landing area.







Message: Patient condition and care information, medications / treatments administered

Message: Time of departure, ETA



38




Bayport Police dispatch towing company to the crash scene for removal of crash vehicle and restoration of crash scene

Bayport Police

Towing company

Request Resources (EDXL-RM?)

39a




The Fisherville Hospital ED physician and the Central City Hospital trauma surgeon request a verbal patient update and order additional treatments to be given en rout to the landing zone (female patient). Patient care is transferred to the flight crew for transport to the Central City Hospital Trauma Center. ETA and other updated information is provided to the ER.

Hospital

Ambulance

Message: Request for patient update

39b







Ambulance

Hospital

Message: Patient condition and care information, medications / treatments administered


39c







Hospital

Ambulance

Message: Order additional treatments

39d







Ambulance

Med-Flight-1 system

Message: Patient condition and care information









Med-Flight-1 system

Hospital

Message: Patient condition and care information

Message: Departure time and ETA








A private towing company arrives at the scene removing vehicles and debris















Bayport Police restore the roads to normal operation



























General Requirements

  1. (Initially pull from past SWG meetings, presentations, meeting minutes etc. Drive out additional through use case exercise)

  2. Requirements need to capture multiple orgs / professions coming into the scene, with initial situation information provided, and then expanded, and revised over the course of the incident. Capability is required for providing updated and expanded situation information during the course of a situation / event / incident.

  3. An Acknowledgment message from each recipient is required to be sent back to the sender of any message regardless of whom or what system originated the message (e.g. AACN, PSAP, dispatcher, 1st responder unit) and regardless of the type of message sent (e.g. whether the message provided alerts, notifications, situation information or updates to any information), to verify that the content of the message has been received by the recipient system.




IN Scope

  1. Telematics” / AACN vehicle data (e.g. “on-Star”) – For initial analysis, the scope of situation reporting for this scenario use case is focused on standardization of information-sharing initially initiated by the PSAP. The standard will focus on standardization of information originally sourced from a 911 centers / PSAP out to those who need it, as well as subsequent information sharing among actors as the situation progresses. This does not exclude situation information generated from other sources in other scenarios (such as field reports provided to FEMA and consolidated for decision-maker reporting).

OUT of Scope

  1. “Telematics” / AACN vehicle data (e.g. “on-Star”) - For initial analysis, the scope of situation reporting for this scenario use case will NOT be focused on standardization of information FROM the AACN system or citizens/callers TO the PSAP. It is assumed in this use case that the AACN system transmits information to the service provider monitoring / call center, which in turn make a phone call to a PSAP reporting the crash situation. Standardization focus for this use case begins with PSAP information-sharing.

    1. It is recognized that a standard is required to allow PSAP’s to directly receive data feeds from such sensors / applications (including vehicle systems like “on-star”, long-haul freight, trains and other devices such as personal health monitors). However, another effort is under discussion to address this requirement. Depending upon the outcome of that discussion, a separate standard may be “plugged into” the Situation Reporting standard. Another option may be for the Situation Reporting standard to take on definition of those requirements / messages to standardize data feed from these device(s).

  2. Reference use case step 11: The message / signal sent to the light system commanding the light to turn to “green” are out of scope of this standard.



Required Messages / Message Types

The following messages / message types were identified in the development of use examples. Each use example may contain one or many messages / message types.



  1. An Acknowledgment message from each recipient is required to be sent back to the sender of any message regardless of whom or what system originated the message (e.g. AACN, PSAP, dispatcher, 1st responder unit) and regardless of the type of message sent (e.g. whether the message provided alerts, notifications, situation information or updates to any information), to verify that the content of the message has been received by the recipient system.

  2. .



Messages / Message Types identified by other scenario teams

The following messages identified by other groups for review with the Train Derailment scenario team:





Open Issues

    1. Telematics” data - For initial analysis, data provided by vehicle systems is not in scope of this use case. It is assumed that the vehicle system transmits information to the service provider call center , who in turn make a phone call to a PSAP reporting the derailment situation.

      It is recognized that a standard is required to allow PSAP’s to directly receive data feeds from such sensors / applications (including vehicle systems like “on-star”, long-haul freight, trains and other devices such as personal health monitors). However, another effort is under discussion to address this requirement. Depending upon the outcome of that discussion, a separate standard may be “plugged into” the Situation Reporting standard. Another option may be for the Situation Reporting standard to take on definition of those requirements / messages to standardize data feed from these device(s). In either case, close coordination between these efforts is required.




Closed Issues



Other Notes



Use Case List

Use Case ID

Use Case Name

Primary Actor(s)







































Use Case Template

Use Case ID:




Use Case Name:

Train Derailment incident reported

Created By:




Last Updated By:

Tim Grapes

Date Created:

May 22, 2007

Date Last Updated:

May 22, 2007

USE CASE DEFINITION:

Use Case Description:

Several reports of a Train Derailment incident received: RR GPS reports a Train Derailment / crash incident to the railroad company. Citizens via cell phone calls report Train Derailment incident to enhanced 911 / PSAP and requested local responders

Ref. Chronology Step(s)




Business Process Supported

Emergency Planning, Preparedness, Mitigation, Response, Management, and Recovery

Actors:

Sender(s):

Recipient(s):



Preconditions/trigger:



Postconditions:



Normal Info Flow:



Alternative Info Flows:



Exceptions:




Includes:




Priority:




Frequency of Use:




Business Rules:




Special Requirements:




Assumptions:




Notes and Issues:





Use Case Template

Use Case ID:




Use Case Name:




Created By:




Last Updated By:




Date Created:




Date Last Updated:




USE CASE DEFINITION:

Use Case Description:




Ref. Chronology Step(s)




Business Process Supported

Emergency Planning, Preparedness, Mitigation, Response, Management, and Recovery

Actors:

Sender(s):

Recipient(s):



Preconditions/trigger:



Postconditions:



Normal Info Flow:



Alternative Info Flows:



Exceptions:




Includes:




Priority:




Frequency of Use:




Business Rules:




Special Requirements:




Assumptions:




Notes and Issues:





Use Case Template Instructions

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