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Securing Health.Emergency.Learning.Planning

Final Report Summary - S-HELP (Securing Health.Emergency.Learning.Planning)

Executive Summary:
The central aim of S-HELP (Securing Health Emergency Learning and Planning) project is to develop and deliver a holistic framed approach to healthcare preparedness, response and recovery. S-HELP is a people, process and technological solution to emergency situations. Through leveraging decision support (DS), the proposed S-HELP solution will extend beyond serving the requirements of the call “SEC-2013.4.1-4”. It will advance the knowledge base required for the development of a range of Decision Support (DS) tools and a Decision Support System (DSS) for the management of all Emergency Medicine activities.
Project Context and Objectives:
Project Background
Decision support systems (DSS) and other tools play a significant role in the management of crisis situations. Emergency management (EM) systems are normally complex and multifaceted as they need to deal with multiple types and multiple stages of disasters, various stakeholders, and numerous issues, and as an added complication there is no standard for evaluating and developing such systems. Furthermore, these systems often lack interoperability, with the sector categorising many emergency management systems as fragmented, localised, and technologically disconnected. EM itself is a complex process, dealing with unpredictable situations that are often hard to plan for – with time spent preparing plans that bear little relation or relevance to the challenges that emerge during a crisis. As a result, the health care practitioners and services that respond to crisis situations are often required to undertake rapid decision-making under extreme pressure. With this in mind, the health services require timely and valid information to support their decision-making during a crisis. These agencies are trying to contain the level of impact, while also challenged with the allocation of strained resources and casualty prioritisation. Large-scale disasters come with a high risk to human life and can have devastating long term effects. Therefore, it is vital during crisis situations that rapid and effective response is undertaken to try to reduce any potential damage. Taking into account the complexity of EM, and the high risks associated, should be the first priority in designing EM solutions. Future systems need to support rather than further complicate the execution of a response.
The central aim of S-HELP (Securing Health Emergency Learning and Planning) project is to develop and deliver a holistic framed approach to healthcare preparedness, response and recovery. S-HELP is a people, process and technological solution to emergency situations. Through leveraging decision support (DS), the S-HELP solution extends beyond serving the requirements of the call “SEC-2013.4.1-4”. It advances the knowledge base required and developed a range of Decision Support (DS) tools for the management for all of Emergency activities.
The S-HELP Decision Support System brings major benefits to emergency healthcare management, from learning and preparing for emergency incidents and analysing threats, to post evaluation, reporting and logistics management. It provides a unique mechanism to assist stakeholders and end-users to work together for co-ordinated, effective, evidence based decisions at all stages of EM including before an incident takes place, during the incident, immediately following an incident, and later post incident stages involving evaluation and the communication of information to the public.
The capability and impact of both the S-HELP tools and the DSS system was validated through the development and simulation of 3 selected scenarios, including a mass flooding, chemical explosion and biological contagion disasters at regional, cross-border and international levels to evaluate every function of the S-HELP DSS, and healthcare training.
Our S-HELP consortium covers the necessary expertise in health, security, emergency information management, taxonomy, DSS, psychology, simulated learning, knowledge management and disaster recovery. It includes scientists in their fields of research and SMEs, as well as key end-users from different countries for the tools requirements definition and the scenario simulation and end-user support organisations. We were supported by over a dozen of supporting end-users such as the Red Cross, by an international Scientific Advisory Board with world leading scientists in their respective and by our strategic partners such as the NSAI, the national standards body for Ireland.

Summary of Objectives
S-HELP project objectives between Month 1 and Month 36 are:
• Develop a holistic and integrated framework to enable a phased approach to the development of training, performance and validation methods coupled with the development of a platform to host their application (WP2).
• Define an interoperability standard to enable communication and coordination across different geographical areas and cultural settings (WP2).
• Facilitate a collaborative end user and supporting partner driven solution to meet the needs of different users (emergency medicine, management, response and decision-makers) from 4 countries in Europe and beyond (WP3, WP6).
• Be conducive to complementarities with other EU FP7 projects, not least COBACORE, HARMONIS of which FAC is a partner) and CATO (in which Vector Command is involved) (WP3, WP4).
• Define and apply an interoperability standard for multiple agencies jointly responding to a disaster (WP2).
• Advance the design and application of current beyond the state-of-the-art of available solutions, to improve preparedness, response and recovery in emergency situations (WP3, WP4, WP5, WP6).
• Deliver decision supporting tools for emergency preparedness, response and recovery, tested, evaluated and enhanced through quality, end user designed emergency scenarios (WP4, WP5).
• The tools will identify and incorporate ethical implications that may arise from quarantine, patient confidentiality, limited vaccine stocks, and limited access to high dependency or ventilation facilities (WP2).
• Advocate the dissemination of the project results to different stakeholders and promote significant exploitation programme to capitalise on marketing opportunities (WP7).



Project Results:
The S-HELP Final Framework
The S-HELP framework integrates a phased approach to development. Phase 1: Research and Analysis; Phase 2: Design and Development; Phase 3: Training and Implementation; Phase 4: Evaluation and Validation. Each phase prioritises one aspect of the S-HELP Work packages and these focus primarily but not exclusively on the research and technical development work packages (WP2-WP6). Each phase also provides the stakeholder perspectives pertaining to the work package as well as the outputs produced at that development phase.

Phase 1: Research and Analysis focuses on end-user requirements and discusses the implication of this objective from two stakeholder perspectives Practitioner (EM Practices) and Developer (System Specification). The outcomes at this phase relate to the specification of end-user requirements and the related outputs which contextualise these namely: The Strategic, Tactical, Operational Matrix prototype (STOMp); The S-HELP Capability Map; Commercial Tools Analysis; Approach to Effective Cognitive Processing and finally; The S-HELP Interoperability Standard.

Phase 2: Design and Development focuses ostensibly on the technical development activities of WP4 but also accounts for the provision of decision support (Developer) through the S-HELP tool-set to facilitate EM processes (Practitioner). The impacts of psychology on user interface design, as well as the agile approaches to user centred design leveraged by S-HELP developers. The outcomes of this phase are the S-HELP DSS tools and the agile approaches to design.

Phase 3: Training and Implementation focuses on the activities of WP5 First Responder training and comprises outcomes related to development of multiple training courses, the development of the Learning Management System and the technical and training documentation produced. The stakeholder perspectives focus on Knowledge Transfer (Developer) and Applied Learning (Practitioner).

Phase 4: Evaluation and Validation focuses on the activities of WP6 generally and scenario testing specifically. The outcomes delivered here relate to Best Practice Scenario Design, Verification and Validation and finally Commercialisation Opportunities and Adoption. The stakeholder perspectives discussed here relate to End-User Feedback (Developer) and Lessons-learned (Practitioner)
The FP7-SEC-2013.4.1-4 call requirements are indicative of the need for significant innovation in the field of emergency management decision support. This need is borne of a greater demand for more security as the vicissitudes of previously robust societies are impacted by the many threats of modern civilisation. The S-HELP DSS and associated framework is a response to the spectre of disaster which will contribute to the accrual of preparedness, response and recovery capacities and the security of societies heretofore.

S-HELP Tool-set

The S-HELP Decision Support System (DSS)
The S-HELP Decision Support System (DSS) is an emergency management software application to reduce the impact of major emergency incidents on public health by providing a faster, more efficient approach to decision-making through coordination, collaboration and interoperation between agencies, in line with current best practice. The benefits of the DSS include the coordination of a multi-agency response by using interoperability standards to ensure effective communication across sectors and international borders. The S-HELP approach involves the interaction of people, processes and technology to facilitate enhanced decision-making in a disaster situation. All aspects of this approach are integrated and interdependent, with the emphasis on an improved and valuable experience for the end-user.

The S-HELP DSS is structured to comprise 3 key support areas as follows:

Context: This provides an overview of all current and historical situations in the S-HELP system.

Selected feature: Situation Control Panel
The Situation Control Panel provides the user with a list that includes the name, type, latitude and longitude, and number of incidents in a situation, which it displays in the Incident Table. The Incident Map displays all active situations and their associated incidents.

Boards: The S-HELP DSS has four boards: Situation Log (see below description), Recognised Current Situation (RC), Strategic Aims and Key Issues, and an Actions board. These information management boards guide the decision-making process and provide users with a common operational picture. Implementations will be based on servers in UCC-BIS and on mobile command units, as well on portable devices for use by deployed teams or liaison officers.

Selected feature: Situation Log
The situation log allows data to be prioritised and filtered. Only information that is relevant to an emergency event appears on the board. All available information is accounted for but the log facilitates the process of prioritising only what is needed. The log is an entry point for highly granular data about the situation, which is then filtered and prioritised before being pushed to the user, thereby helping to avoid cognitive overload.

Tools: This feature contains a toolset of S-HELP modules to provide additional emergency management and decision support capabilities based on the current active situation. The tools contained in this section are: Casualty, Decision Support, Crisis Communication Tool, data and Reporting, Geographical Information System (GIS), Knowledge Management System (KMS), Learning Management System (LMS), Twitter and Weather.

Selected feature: Decision Support Module
The Decision Support Module features queries aggregated by disaster phase, responder, resources and tasks which are all based on the S-HELP emergency management taxonomy. The user selects an Emergency Management Phase (1) to begin building a query, then chooses an Intervention (2) and clicks 'Get Tasks' to select a component of it. The user achieves an intervention by choosing and completing multiple tasks (3). The module allows the user to 'Filter by Responder' to choose the appropriate resources responder to achieve a particular task. By selecting 'Get Resources' in a specific task the user can access

S-HELP Scenarios
The scenarios were created and executed in three regions (i.e. Tel Aviv, Israel; Cork, Ireland; and Dublin, Ireland) during the final stages of system development. Thus, each scenario provided feedback for improvements to various modules of the tool-set and culminated with a scenario to test the integration of the system as a whole. The three scenarios include: (1) Biological Hazard Response, (2) Cross-Border Chemical Explosion and Bio-Hazard, and (3) Regional and Interregional Mass Flooding.

For each scenario, data was collected and analysed using survey analysis (i.e. 7-point Likert scale questionnaires) and observational research methods (including participant observation and video) with a group of external stakeholders from various health and emergency management organisations representing experts in their field. The findings from each scenario informed the improvements and continued development of the S-HELP system; validating the modules by assessing capabilities, functionality, and usability.

The results were positive in nature and provided critical feedback with suggestions for future improvements and capability refinement. The survey results, respondent comments, and observations have been used to create a number of lessons-learned in the context of scenario design and the S HELP project. The feedback and evaluations have been aligned with specific system improvements across the S-HELP tool-set. An overview of the results are outlined below:

Usability Key Findings
In general usability evaluation saw improvements over time with each subsequent scenario:
• Lower scores for 10 out of 12 modules in terms of the need for written instructions
• Lower scores for 8 out of 12 modules in terms of the need for support from a technical person
• Low scores for other usability statements saw improvements in final evaluation and further system development
• Three modules had lower scores across three usability statements, same as above, and in terms of perceptions of module complexity:
- Situation Module
- Casualty
- Actions Board

Utility Key Findings
• 10 out of the 12 modules with final high scores across utility statements
• Lower scores for Data & Reporting and Casualty module in terms of:
- Perceived usefulness
- Value for regular and occasional users
- Requirements matching
• Modules capabilities are job specific and not relevant to certain participants and their roles, thus the lower scores in these areas
• Situation module saw improvements across all utility statements with each subsequent scenario evaluation
• Dips in scores for specific utility statements improved with time and continued system development

Integrated Tool-set Key Findings
• High scores for perceptions of general tool-set integration with improvements from biological scenario
• Improvements observed with each subsequent scenario in relation to:
- Ability to quickly learn the skills to use the S-HELP tool-set
- Required learning in advance of use
- Perceptions of increased efficiency of decision making
- Efficient coordination and collaboration between different agencies within a country
- Efficient coordination and collaboration between different countries (Northern Ireland and Irish State)
• Lower scores for statements on: - Perceptions of ease-of-use and; - Perceptions of user confidence

Validation and assessment of the S-HELP DS tool-set
• Three different scenarios to test different modules and contexts
• Different regions and emergency responded roles
• In-depth analysis of: - Usability, - Utility, - Module-specific capabilities and - Integrated tool-set
• 24 survey types with 85 participants overall (620 surveys collected)
• Results used to inform each subsequent scenario exercise and design, system improvements, and plans for commercialisation and adoption
• High level of agreement across usability, utility, and integration aspects of the S-HELP DS tool-set
• Many issues addressed in final evaluation (flooding)
• Need for training, written instructions, and support from a technical person when implementing the S-HELP solution
• Development was user-centred and feedback from end-users, practitioners, and external advisers was collected at each stage
• Affirmations of the value and potential application of the S-HELP tool-set
• Confirmed the value of using simulated scenarios to demonstrate and test the system

Potential Impact:
S-HELP enhances the protection of public health and establishes common grounds for interoperability by significantly advancing the existing knowledge base required for the development of next generation Decision Support (DS) tools and a user-centred Decision Support System (DSS) for better Preparedness, rapid Response and coordinated Recovery in emergency situations. It offers an evidence-based solutions to improve Health Services performance in emergency management, developing a holistic framework to guide stakeholder needs analysis, and integrating an advanced DS tool-set. The project executed multi-scenario based end user trainings, alongside ‘what-if’ analysis. It simulated 3 multi-factorial and multi-agency scenarios (a chemical explosion; mass flooding; regional bio-hazard), and modelled the situational and projected evolution of the 3 emergencies to communicate coordinate and collaborative problem solving across agencies. S-HELP also manages end-user knowledge and validates performance in order to use project DS tools and solutions effectively in preparing for, responding to and recovering from an incident. This has a direct societal and economic benefit helping to safeguard public health, contribute to improved emergency management processes and also brings economic benefits in terms of the operational benefits gained. S-HELP disseminates and exploits the DS tools and solution to complement the role of Health Services in emergency situations. S-HELP will also significantly advance the current state-of-the-art in decision support for Health Services, benefitting from an end-user driven consortium with leading health research, technology and commercial experts.

Main Dissemination Achievements
M1-M18
• Development of general communication tools for different stakeholders groups (e.g. factsheets, press releases).
• Set-up and maintenance of the project website (www.fp7-shelp.eu).
• Provision of dissemination templates to all consortium members (e.g. for posters, presentations).
• First scientific dissemination of initial S-HELP results, by partners, at conferences and other events.
• Initial contacts with end-users and policy-makers through the network of S-HELP partners.
• Elaboration and submission of Dissemination and Exploitation plan (D7.2).
• Support to end-user workshop dissemination.
• Website analysis has been conducted on the website to date to help refine the content and structure of the website.
• An S-HELP public wiki has been created, by UCC-BIS, to serve as a source of EM information for consortium members as well as external parties that are interested in the S-HELP project and related areas. It will therefore serve as an awareness tool and as a central resource for the different stakeholders.
• The use of social media has been implemented through the creation of Twitter accounts and a LinkedIn group. Twitter has been used to disseminate project information and create connections to relevant parties, with an aim to expand the S-HELP network.
• Active press contacts have been established and will be widened and optimised
• A series of S-HELP videos have been created and made available on the website.
• Networking activities have been undertaken including a number of workshops with project stakeholders.
• A publication club has been established to collaboratively maximise the dissemination outputs of the project.
• Signification FP7 and H2020 collaboration through dissemination activities, particularly with RESILENS. S-HELP and RESILENS jointly mentored 6 postgraduate students to undertake a project in Critical Infrastructure Resilience.
M19 – M36:
• Growth of overall online dissemination in the second period of the project.
• Website visitor numbers increased to 2273 in the past twelve months.
• 13 unique new items posted on website.
• Twitter followers grew from 112 to 362
• Creation of an S-HELP LinkedIn page – and growth to 13 followers
• Creation of two animated videos – CCT and Overview of S-HELP
• Collaboration, ideas exchange and cross-fertilisation with other EU projects
• Presentations at conferences and workshops
• Publications (x6) papers published
• Creation and dissemination of second newsletter
• Increase in number of end-user dissemination exercises
• Round table meeting (described in detail in D7.7)
• Organisation and hosting of successful Final Event
• Communication and dissemination of the event across consortium networks
• Video showcase of the S-HELP project as demonstrated at the final event, Dublin January 27th 2017
• Creation and submission of D7.12 report from event.

The goal of S-HELPs exploitation stream is to build an awareness of the S-HELP project to a community of stakeholders. It disseminates the S-HELP project and it promotes the tool-set to potential customers, simultaneously building an awareness of the S-HELP DS Tool-set and its benefits. It comprises the following streams: General dissemination, Scientific dissemination, Collaboration and Network Exchange, End User and Supporting Partners, and Establishment of a formal communication network.






List of Websites:
http://www.fp7-shelp.eu/project

For a detailed description of all support modules and tools available on the S-HELP DSS, please contact Dr. Karen Neville, S-HELP PI, Email: KarenNeville@ucc.ie