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Although both disaster management and disaster medicine have been used for decades, their efficiency and effectiveness have been far from perfect. One reason could be the lack of systematic utilization of modern technologies, such as eHealth, in their operations. To address this issue, researchers’ efforts have led to the emergence of the disaster eHealth (DEH) field. DEH’s main objective is to systematically integrate eHealth technologies for health care purposes within the disaster management cycle (DMC).
This study aims to identify, map, and define the scope of DEH as a new area of research at the intersection of disaster management, emergency medicine, and eHealth.
An extensive scoping review using published materials was carried out in the areas of disaster management, disaster medicine, and eHealth to identify the scope of DEH. This review procedure was iterative and conducted in multiple scientific databases in 2 rounds, one using controlled indexed terms and the other using similar uncontrolled terms. In both rounds, the publications ranged from 1990 to 2016, and all the appropriate research studies discovered were considered, regardless of their research design, methodology, and quality. Information extracted from both rounds was thematically analyzed to define the DEH scope, and the results were evaluated by the field experts through a Delphi method.
In both rounds of the research, searching for eHealth applications within DMC yielded 404 relevant studies that showed eHealth applications in different disaster types and disaster phases. These applications varied with respect to the eHealth technology types, functions, services, and stakeholders. The results led to the identification of the scope of DEH, including eHealth technologies and their applications, services, and future developments that are applicable to disasters as well as to related stakeholders. Reference to the elements of the DEH scope indicates what, when, and how current eHealth technologies can be used in the DMC.
Comprehensive data gathering from multiple databases offered a grounded method to define the DEH scope. This scope comprises concepts related to DEH and the boundaries that define it. The scope identifies the eHealth technologies relevant to DEH and the functions and services that can be provided by these technologies. In addition, the scope tells us which groups can use the provided services and functions and in which disaster types or phases. DEH approaches could potentially improve the response to health care demands before, during, and after disasters. DEH takes advantage of eHealth technologies to facilitate DMC tasks and activities, enhance their efficiency and effectiveness, and enhance health care delivery and provide more quality health care services to the wider population regardless of their geographical location or even disaster types and phases.
Disasters are destructive events that threaten public health and the environment and disrupt and/or impede normal operations. They also impose considerable pressure on health care systems. The source of disasters can be natural or the result of human actions (eg, fires and terrorist attacks) [
Disaster management and disaster medicine are complementary disciplines that can significantly reduce the harmful effects of disasters. Disaster management conveniently encompasses 4 phases: mitigation, preparedness, response, and recovery [
Disaster management and disaster medicine have different roots, development, and priorities [
Although both areas emerged to work side by side, they sometimes fail to share their tools and personnel and have not collaborated smoothly in preparing for and responding to mass emergencies.
Neither disaster medicine nor disaster management routinely uses information or modern eHealth technologies [
Therefore, there is a pressing need for efficient disaster management and emergency medicine to mitigate human pain and suffering and the overall impact of disasters [
Despite the growth of information technology capacities and services (eg, new communication technologies, ubiquitous computing, the internet, and advanced smart devices [
DEH is an emerging field that was introduced earlier in the study by Norris et al [
DEH can be seen as a model telling us what, when, and how current eHealth technologies can be used in the DMC. These technologies include not only those used in established eHealth practices but also those recently made available by the rapid development in mobile and sensor technologies.
Disaster eHealth and its components.
Disaster eHealth: the application of information and eHealth technologies in a disaster situation to restore and maintain the health of individuals to their predisaster levels
Disaster management: the coordination and integration of all activities necessary to build, sustain, and improve the capabilities to prepare for, respond to, recover from, or mitigate against threatened or actual disasters or emergencies, regardless of cause [
Disaster medicine: a system of study and medical practice associated primarily with the disciplines of emergency medicine and public health [
eHealth: the cost-effective and secure use of information and communications technology in support of health and health-related fields, including health care services, health surveillance, health literature, and health education, knowledge, and research [
To undertake this research, a rigorous scoping study was conducted based on the framework of Arksey and O’Malley [
The scoping study framework for disaster eHealth.
This research is limited to publications from 1990 to 2016. This scoping study was undertaken in 2 complementary rounds: uncontrolled and controlled search. The uncontrolled search was commenced in multiple databases using free-text terms rather than indexed terms. This approach uses a search engine to identify documents of interest based on terms occurring in the papers’ titles, abstracts, or main bodies. This allowed us to extensively and fully explore the area and extract a broad range of articles to define the scope of DEH. However, to improve the accuracy of free-text search and to decrease the potential searching bias or missing data in the search, a controlled search was employed [
A sample of search terms and queries.
Searching terms | Uncontrolled search | Controlled search |
Search terms |
disaster management disaster disaster medicine ehealth e*health |
disaster medical informatics disaster medicine emergency management |
Search queries |
(ehealth OR e-health OR e*health) AND disaster (ehealth OR e-health OR e*health) AND “disaster medicine” |
(“Disasters”[Mesh]) AND “Medical Informatics”[Mesh]) “INSPEC Controlled Terms”: emergency management AND “INSPEC Controlled Terms”:disaster |
Both search procedures were iterative and captured relevant articles regardless of their research design, methodology, and quality (recommended by Valaitis et al [
Controlled and uncontrolled searching steps. CINAHL: Cumulative Index to Nursing and Allied Health Literature; EBSCO: Elton B Stephens Company.
In the uncontrolled search to facilitate the preliminary eligibility examination phase, Pareto analysis was used to exclude a larger number of articles in a shorter time without affecting the quality of the results. Pareto analysis is a well-established statistical technique in the business and management field known as 80/20 rule, that is, 20% of the major tasks and activities can generate 80% of the benefit of doing the entire job [
By following the Pareto formula [
Pareto analysis diagram in uncontrolled search.
After selecting the studies for the in-depth review, in controlled and uncontrolled rounds, their full text was added to EndNote (Web of Science Group) [
On each theme, a conventional content analysis was performed to interpret the findings of the theme. The analyses identify the opinions and general trends in eHealth adoptions and applications within disaster management and disaster medicine fields. Finally, the Delphi method was conducted in 2 rounds in which the fields ‘experts evaluated the initial DEH scope. The results of this evaluation are reflected in the reported DEH scope in this paper.
Identification of disaster type is necessary to select appropriate approaches to DEH for particular cases. The research results highlighted a high diversity in the literature with regard to disaster types. A comprehensive list of disaster types was extracted based on the CRED database [
Comparison of this disaster’s classifications with the research findings reveals that DEH can cover almost all types of disasters. As in the research we searched for eHealth applications within DMC, this, in turn, may be interpreted as eHealth can be used to support disaster management and disaster medicine activities across a wide range of disaster types, regardless of their sources. The detailed findings of the identified disaster types are presented in
On the basis of the frequency of disaster types found in the scoping results, eHealth technologies’ usage is distributed across a broad range of disaster types. Nevertheless, the use of eHealth in epidemics (39/349, 11.1%), terrorist incidents (38/349, 10.8%), hurricanes (37/349, 10.6%), and earthquakes (36/349, 10.3%) is discussed more than in other disaster contexts in the literature. This may mean that these areas are likely to be more researched either because of researcher interest or the frequency of their occurrence.
To identify the disaster phases on which eHealth technologies can be used, within the DEH scope, it was referred to as four-phase DMC: mitigation, preparedness, response, and recovery [
Identified disaster types in disaster eHealth scoping.
The scoping analysis indicates an extensive variability in the list of identified technologies from different domains, most commonly related to information system and telecommunication, but extended to areas such as artificial intelligence and robotics. To reduce this complexity, technologies were demonstrated in a hierarchical representation mapped to an existing hierarchical taxonomy of eHealth technologies. Among the consulted databases, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and EBSCO (Elton B. Stephens Company) Health databases have a taxonomy of eHealth from which PubMed was chosen because of its comprehensiveness, quality, and equality of depth and breadth of the field. In CINAHL, database subject headings for eHealth are slightly different and at a higher level. In the EBSCO Health database, only
PubMed places health care computer and digital technologies in the category of
DEH embraces a wide range of technologies to support health care activities in different disaster types and phases. A number of these technologies are specifically designed for health care environments such as
There is a vast range of eHealth technologies in the DEH scope. Among the identified eHealth technologies, our results indicate
Technologies within disaster eHealth scope. EHR: electronic health record; EMR: electronic medical record; GIS: geographic information system; GPRS: General Packet Radio Service; GSM: Global System for Mobile Communications; IS: information system; IT: information technology; PDA: personal digital assistant; PHR: personal health record; RFID: radio-frequency identification.
The identified eHealth technologies could serve specific functions within the DMC and DEH scope. Our thematic analysis identified these functions and highlighted the major ones and classified them based on their features and applications (
Technology functions within Disaster eHealth.
The identified technologies and their applications support different attributes that could be important in disaster management or disaster medicine activities. On the basis of the thematic and content analysis results,
Feature name
Accessibility
Accountability
Accuracy
Availability
Awareness
Collaboration
Completeness
Computerization
Confidentiality
Consistency
Continuity
Control
Cooperation
Coordination
Effectiveness
Efficiency
Immediacy
Integration
Interoperability
Localization
Optimization
Protection
Quality
Readiness
Real time
Recognition
Relevancy
Reliability
Responsibility
Robustness
Safety
Scalability
Security
Sustainability
Telemetry
Usability
Web base
On the basis of
Clinical purposes: All the tasks and activities, the objectives of which are rooted in providing or expanding disaster health care services for the population.
Administrative purposes: All the tasks and activities, the objectives of which directly or indirectly facilitate providing or expanding disaster health care services for the wider population and can cover health care administrative procedures from admitting patients to discharging them or making patient information transfer possible.
Education and training purposes: Covers activities where the main purpose is to train and prepare citizens or special groups such as responders for different disaster phases.
Research purposes: The cases where their aims are directly or indirectly related to investigation and research. They intend to improve quality, cost-effectiveness, and equity of access to health care services within the DMC.
On the basis of these definitions, a number of example activities for each group of disaster phases are shown in
Disaster eHealth activities examples with regard to disaster eHealth purposes.
Purpose and disaster phase | Sample of activity | |
|
||
|
Mitigation | Medical planning |
|
Preparedness | Transferring and sharing of medical information |
|
Response | Remote triaging of injured patients before arriving at hospitals |
|
Recovery | Helping injured patients to recover at home |
|
||
|
Mitigation | Preparing humanitarian aid program |
|
Preparedness | Disseminating predisaster warnings |
|
Response | Providing automation to help responders on documentation during disaster response |
|
Recovery | Identifying and locating missing children |
|
||
|
Mitigation | Educating people on the foundational elements of preparedness |
|
Preparedness | Training the practitioner on disaster skills |
|
Response | Providing continuous medical education for practitioners without enough experience |
|
Recovery | Providing tele-education supports and services |
|
||
|
Mitigation | Studying the previous disasters and research on the probability of their occurrence and their consequences |
|
Preparedness | Carrying research on required competencies for the response time |
|
Response | Not applicable |
|
Recovery | Conducting studies to identify the long-term impacts of disasters on people’s health |
The review revealed a wide range of DEH stakeholders, targets, or users of the specified technologies and functions at local, national, and international levels. The
Disaster eHealth stakeholders.
On the basis of the different parties and their needs in each phase of a disaster and the supported technologies and functions, DEH covers a diverse spectrum of services and purposes within the DMC. These services, from a high-level view, can be categorized into 3 levels:
Operational-level services: The function of this group of services is to support or control operations against rules and standards and encompass day-by-day decisions. Although diversity in these services can create islands of automation, they make operations more efficient. A large number of services in DMC and DEH can be categorized under this level, such as rapid victim identification, victim tracking, damage assessment, and critical resource distribution.
Tactical-level services: The purpose of this range of services is to support management and provide interconnection among different parties or organizations through diverse information management tools. These services take care of medium-term planning and are used in creating procedures. Under this level of service are categorized DSSs as well as capacity assessment databases, health information exchange, and appropriate allocation of resources.
Strategical-level services: The purpose of these level services is to support the system as a whole, and their output is mostly policies and overall structural decisions, either among an organization’s functions or among other organizations. For this group of services, information planning tools are used, and integrated infrastructure and global compatibility are essential. Above all, few services are available for this stage not only in DEH but also in conventional disaster management and medicine. These services cover long-term, complex, and nonroutine planning in DMC and DEH, such as planning for vulnerable population needs and safety, long-term care, or cloud-based coordination. To be useful, strategy must translate into tactics and delivery so that services defined at this level will have related examples at both the tactical and operational levels.
According to this classification and explanation, we can place these services for each disaster phase within the DEH scope. Some examples are presented in
Disaster eHealth service level examples.
Service level and disaster phase | Sample of service | |
|
||
|
Mitigation |
Enhancing patient education and empowerment Analyze out-of-hospital emergency medical services |
|
Preparedness |
Preparing back-up communications systems Education and training of health workers |
|
Response |
Monitor, aggregate, and analyze social media data Cloud-base coordination |
|
Recovery |
Long-term care Injured people information |
|
||
|
Mitigation |
Information integration Medical record sharing within and across institutions |
|
Preparedness |
Resource database Decision support systems for bioterrorism preparedness |
|
Response |
Dynamic information collection Coordinating the distribution of the available medical resources |
|
Recovery |
Supply chain management Integrate the delivery of care after disasters |
|
||
|
Mitigation |
Organize medical resources Analyze daily operations in emergency departments |
|
Preparedness |
Remote sensing Response plans that rely on local hospitals |
|
Response |
Situational awareness Electronic triage tag |
|
Recovery |
Psychiatrist video conferencing Evaluation and identification of psychological problems |
eHealth can facilitate health care data exchange and dissemination, improving communication, support, and education among communities, health care professionals, and their patients [
In this study, the initial scope of the DEH is defined. DEH tries to maximize health care engagement in and integration into the DMC because an effective and successful response is almost unachievable without appropriate levels of different sectors’ readiness, including health care. By integrating health care into the predisaster phases, health care can be shifted from a reactive to a proactive system when disasters occur. In this regard, the variation of eHealth technologies within the DEH scope offers a broad range of functions and applications to facilitate health care management and delivery. For example, as education and communication play a vital role, telehealth and social networks could be useful in raising public awareness or providing remote and special clinical education for physicians. The importance of this application in educating the general population [
The technologies themselves can also be integrated to optimize the outcome. For example, the collected data through IoT could be aggregated by cloud computing and then analyzed with big data analytics tools to support strategic disaster management planning or possibly scenario prediction. Such a framework for technology integration was proposed by Madanian and Parry [
More recently, the IoT, big data, and cloud computing have attracted an exponential interest in automatic data gathering, integration, and analysis for data sharing and decision support applications. The usage of specific eHealth technologies, such as
In our research, we explicitly identified DEH stakeholders as technology users or targets who can benefit from DEH. These groups could be involved in DMC for a variety of purposes and in different positions. From a broader perspective, we can have the following groups:
DEH seeks to enhance clinical and nonclinical personnel’s disaster-related awareness, education, elements, standards, and procedures, mainly in disaster mitigation and preparedness phases. This could possibly result in better response and in meeting wider health care demands, as health care teams are familiar with the very concept of disaster.
For disaster management and disaster medicine people, DEH may facilitate technology adoption in their fields, one of the consequences of which, possibly, is rapid communication and data sharing among involved parties in DMC. This results in enhancing access to precise information in a timely manner, which, in turn, may lead to improving the quality of decisions while decreasing the decision-making time.
DEH may also appeal to the general population who may be affected by different types of disasters. DEH, based on its defined goal, raises disaster awareness among all people, especially communities in disaster-prone areas. Therefore, population empowerment can be enhanced, and the population can access and use information, become familiar with disaster consequences, and be prepared for them. This will increase preparedness against disasters and if any disasters strike their areas, they are able to take care of their basic health care requirements until disaster responders arrive. Then, as disaster responders have proper training and are equipped with different types of eHealth technologies, they are able to transfer timely and accurate information from disaster sites to top authorities so that they can make appropriate decisions. This, in turn, provides better health care services to disaster casualties.
Preparedness and planning to reduce the harmful effects of disasters is becoming one of the highest priorities of governments. These activities are features of disaster management and disaster medicine; disciplines that despite their long standing still generate many debates about their effectiveness and capabilities in responding properly to health care demands in major disasters [
This research, along with other studies such as by Sieben et al [
The DEH domain has been introduced mainly to facilitate addressing the current challenges within disaster management and disaster medicine that hinder their operations and created many debates regarding their efficiency and effectiveness. DEH emergence contributes to the design of a systematic model for eHealth technologies that are currently used in nondisaster circumstances but have the potential to be used in disaster situations along with those technologies that were previously used in DMC and had a significant impact on DMC operations.
DEH takes advantage of eHealth technologies to facilitate DMC tasks and activities, enhance their efficiency and effectiveness, and improve health care delivery to a wider population regardless of disaster types and phases.
In this research, we extensively reviewed the academic literature to define the DEH scope. We have built our scope mostly based on available international hierarchies to make easier embedding DEH into disaster management, disaster medicine, and eHealth fields. Some of the international hierarchies that we referred to are the disaster types offered by CRED and PubMed Medical Informatics taxonomies. However, this work is mostly limited to academic and scientific publications, and gray literature is not extensively reviewed.
eHealth technologies are developing rapidly, and the COVID-19 pandemic has revealed some of the eHealth potentials in practice on addressing health care issues. Therefore, we would consider and continue to work on the DEH model and add the most recent applications, such as contact tracing, into the model in the near future.
Cumulative Index to Nursing and Allied Health Literature
Centre for Research on the Epidemiology of Disasters
disaster eHealth
disaster management cycle
decision support system
Elton B Stephens Company
electronic health record
Internet of Things
None declared.