Department of Emergency Medicine
Rhode Island Disaster Initiative (RIDI)
Overview
The fundamental role of RIDI was to enhance Rhode Island's ability to prepare for and respond to a disaster through applied research.
RIDI was Transitional
RIDI completed its research between 1999 and 2007. During that time, RIDI successfully elevated Rhode Island's disaster management capabilities and resources. RIDI generated recommendations based on experimental data and led to the insertion and evaluation of technologies that foster improved communication among all disaster response participants. Several current practices, including the Rhode Island Department of Health EMS Major Incident Protocol, the statewide Patient Tracking System / Public Health Emergency Management Suite (which also includes a hospital capacity and diversion dashboard, a chat and calendar function, and statewide EMS electronic patient care reports) all had their inception in RIDI concepts and practices.
RIDI transferred its findings and assets to the community and local operating entities to continue to manage and carry forward the mission. Although RIDI does not continue as an operating entity, the results of RIDI's efforts continue to benefit the EMS and Emergency Preparedness community in Rhode Island and beyond.
Support Role
As an organization, RIDI did not routinely provide first responder support to mass casualty incidents (MCI) but did, during Phase III of the initiative, bring operational technologies to the scene. These tools and technologies were used to improve disaster response, collect data, and beta-test new technology programs. Lifeguard EMS, a paramedic and emergency physician staffed response vehicle with mobile command post and critical care transport capability, provided a role model platform for best practices in response and support.
Filling the Gap
One of RIDI's goals was to fill the gap between ongoing solution efforts and the actual needs of first responders. Formulating a strategic approach based on a documented and thoroughly researched assessment of system and user requirements is a vital component of building successful, long-term solutions. The broad requirements of the disaster response system were determined through research of best practices, technologies and protocols. One example was the finding that traditional triage schemes were rarely used by experienced providers, who instead accurately and efficiently triage patients based on their skills and rapid first impression of need and resource availability. This finding was then incorporated in statewide MCI triage protocols with excellent effect, and is supported by the successful use of "First Impression Triage" in other systems.
Why Rhode Island?
Rhode Island is ideally sized both by population and geography to assess practices and deploy test technologies. With a population of approximately one million surrounding a metropolitan area, it forms a model whose results find applicability in many other states. Senators Jack Reed and Lincoln Chaffee, as well as Representatives Patrick Kennedy and Jim Langevin, were ardent supporters of RIDI and helped make it a reality.
Position
RIDI's place in the disaster response community
Our goal was to collaboratively develop and introduce best practices that prepare emergency responders for large-scale emergency incidents.
By providing needed research in the areas of readiness, technology, and training, RIDI realized its mission of integrating the operations of first responders (EMTs, firefighters, police officers and others) with disaster response tools and techniques. Emergency professionals now respond to incidents with standard protocols, equipment, methods, and material, providing Rhode Island residents and visitors with effective disaster response as a result of RIDI efforts and collaborations.
RIDI participated in many aspects of disaster response management, from readiness improvement to field data collection at incident sites. The sections below provide a visual representation of how RIDI interacted with disaster response organizations:
- Disaster Response: Measured readiness, identified shortfalls and tested solutions to improve the interaction between primary and secondary respondents
- Disaster Preparation: Training activities and resources for emergency professionals
- Responder Operations: Operations designed to assist first responders with technology and protocol development and training
Funding
RIDI was a federal government funded initiative. RIDI Phase II & III funds were administered by the Office of Naval Research.
Phase I
Senators Jack Reed and Lincoln Chaffee, as well as Representatives Patrick Kennedy and Jim Langevin, helped obtain congressional funding to establish and complete the RIDI project. The initial RIDI funds were administered by the Department of Health and Human Services, Office of Emergency Preparedness (DHHS-OEP) as the grant agency. DHHS-OEP contracted with the Chemical Biological Information Analysis Center (CBIAC) to coordinate and accomplish the RIDI Project. As a RIDI partner providing program management and oversight, the Battelle Memorial Institute administered the CBIAC through federal contract. RIDI Phase I was funded at $900,000. These funds were used to establish the organization and perform a statewide hazard, vulnerability and risk analysis, to collate current research in disaster management, to reach out to cross-disciplinary experts and begin the definition work for research carried out in Phase II.
Phase II
The second phase of RIDI also received unanimous support from the Rhode Island delegation, with funding at $1.499 million. Phase II backing flowed through the Department of Defense to the Navy and the Office of Naval Research (ONR). ONR contracted with CBIAC in a manner similar to Phase I to carry out Phase II of the RIDI project. The CBIAC contracted with Rhode Island Hospital's Research Administration Office for Phase II. University Emergency Medicine Foundation (UEMF) physicians continued to run the project.
Phase III
The Rhode Island delegation unanimously supported funding for Phase III at $2 million per year, with two years of funding to total $4 million. Due to fiscal constraints after the 2001 9/11 terror attacks, Congressional funding was limited to $1.2 million for the remainder of the project. Phase III funding was used to disseminate best practices and research findings through a demonstration project, including design and assembly of a specialized response vehicle (Lifeguard EMS), and conferences for first responders and first receivers.
Collaborators
Many organizations and entities throughout the state of Rhode Island collaborated with RIDI in order to generate beneficial return to all the disaster response participants within the state. Some organizations were particularly important because of their participation in disaster response and the extent of their network.
Other organizations were significant in assuring that RIDI's efforts represented an additive, useful component to the work being conducted through multiple federally and state-sponsored activities. A few of the key partners and relationships are described below.
Mission
To measurably improve emergency medical response to disasters through research, training and technology.
The Rhode Island Disaster Initiative (RIDI) began conceptually in 1999 with a meeting of EMS and disaster-oriented emergency physicians and other professionals who recognized the recurring shortfalls in disaster response. With the additional threats posed by terrorist activity, the dangers of secondary devices (intentional explosions that occur after the first responders arrive), hostage situations, and weapons of mass destruction, the RIDI team proposed a research project to address the gaps in medical response to disasters.
The primary objectives of the RIDI project were to:
- Identify vulnerabilities facing emergency medical responders in Rhode Island (and across the United States)
- Design measurable means of assessing care for victims of real and simulated disasters
- Apply resources to identify best practices and insert novel technologies
- Validate the identified best practices through testing
- Assess and communicate the validity of these results through a statewide demonstration project
These best practices were refined and validated during the demonstration phase, culminating in the publishing and distribution of research information enabling other regions to benefit from the RIDI project.
Status
Organization
RIDI was administered and operated by members of the Rhode Island medical community with affiliations at Rhode Island Hospital and the University Emergency Medicine Foundation.
Kenneth A. Williams, MD, FACEP - RIDI Principal Investigator, Project Medical Director
Dr. Williams' career in EMS began in the 1960s with Red Cross courses, followed by EMT and emergency department experience in New Jersey and Massachusetts in the 1970s. Dr. Williams attended Hampshire College in Amherst, MA, where his studies included technology assessment, public policy science, computer models of thermodynamic systems, and a National Science Foundation grant program to teach high school physics through alternative energy projects. He taught CPR and first aid courses during and after college, wrote a first aid textbook for preschool teachers and parents, and received a fellowship grant in exercise physiology.
After graduating from medical school at the University of Massachusetts in 1984, he completed residency in emergency medicine at the University of Pittsburgh in 1987, where he was a Chief Resident and received a resident research award from the Emergency Medicine Foundation. Returning to the University of Massachusetts as faculty in the emergency department, Dr. Williams served as Medical Director for UMASS Life Flight, Chief, Division of EMS, Director of Emergency Medicine Informatics, and received a National Library of Medicine Fellowship in Medical Informatics. He held a faculty appointment as Associate Professor of Clinical Emergency Medicine at the University of Massachusetts.
During his tenure at UMASS, Dr. Williams was also active in regional, national and international emergency medicine organizations, serving as EMS Medical Director for Central Massachusetts and in a variety of positions with the Massachusetts chapter of the American College of Emergency Physicians, the Massachusetts Dept. of Health Office for EMS, the Association for Air Medical Services, the Air Medical Physician Association, the National Association of EMS Physicians, the Alliance for Critical Care Transport, and the MA-2 Disaster Medical Assistance Team. He founded the New England Airmedical Alliance in 1989.
Dr. Williams accepted a position at Brown University and the University Emergency Medicine Foundation in 1997, and holds an appointment as Associate Professor of Emergency Medicine at Brown University and is Director of the Division of EMS and EMS Fellowship at Brown, and Medical Director for the LifePACT Critical Care Transport ambulance service at Rhode Island Hospital. He is also Medical Director for the Rhode Island Department of Health Center for EMS, Past-President of the Air Medical Physician Association (2000-2002), Past-President of the Rhode Island Chapter, American College of Emergency Physicians, and Chair-Elect of the National Association of EMS Officials Medical Director's Council. Dr. Williams, along with other project leaders, began planning for the Rhode Island Disaster Initiative in 1999.
Dr. Williams' research and publications cover a range of topics, including EMS and medical informatics, and include many papers and textbook chapters. He has delivered several hundred lectures as an invited speaker at international, national, and local medical conferences.
Selim Suner MD, MS, FACEP - Principal Investigator
Dr. Suner graduated from Brown Medical school in 1992 after obtaining a degree in Biomedical Engineering in 1988. He then completed an emergency medicine residency program at Rhode Island Hospital and is currently an attending physician at Rhode Island Hospital and a Professor in the Departments of Emergency Medicine, Surgery and Engineering at Brown. Dr. Suner's main research interest is in the areas of disaster and mass gathering medicine.
Dr. Suner served as commander of the Rhode Island Disaster Medical Assistance Team (DMAT) and served during multiple disaster deployments of the Office of Emergency Preparedness, including the Ice Storms in upstate New York, Eqyptair 990 crash off of Massachusetts and the September 11th World Trade Center attacks. Dr Suner also serves as the chair for the emergency preparedness committee at Rhode Island Hospital and participates in many state-level committees working on disaster and terrorism issues. He coordinates the Brown Academies in Emergency Medicine, including a Disaster Fellowship. Dr. Suner is a leader, both nationally and within the state, in training for incidents related to weapons of mass destruction. He teaches in multiple seminars throughout the country as well as a senior medical school seminar on weapons of mass destruction.
Francis Sullivan MD, FACEP - Principal Investigator
Dr. Sullivan received an MD at Medical University of South Carolina in Charleston in 1976. He completed a categorical internship in internal medicine, served on active duty with the USPHS for two and a half years, returning to complete training in internal medicine at MUSC. He completed a year of fellowship training in critical care medicine with Division of Anesthesiology and Respiratory / Critical Care, where he was also involved in cardiac resuscitation research. He has been an attending physician in emergency medicine in the Brown University-affiliated hospital system since 1983, currently predominantly at Rhode Island Hospital. He has been consistently involved in local prehospital care training and issues, now concentrating on their interface with the Brown University Program in Emergency Medicine residency. In addition to being an active member of the Rhode Island Disaster Medical Assistance Team (DMAT), he participated in the World Trade Center deployment as one the first three responding teams.
Charlie Seekell - RIDI Project Manager
Mr. Seekell graduated from the University of Rhode Island with a Masters degree in Marine Affairs. A retired Coast Guard officer, he has participated in the response to numerous major disasters, including the crash of Eygpt Air 900 and World Airways Flight 30. In addition, Mr. Seekell has been involved in the emergency and security planning efforts for a number of large-scale events, such as the Tall Ships visits. Mr. Seekell has also served on the Radiological Emergency Response Plan Commission for the town of Plymouth, Massachusetts. Mr. Seekell was employed by the Battelle Memorial Institute during the RIDI project
Additional Investigators
Greg Jay, MD, PhD
Bert Woolard, MD
Research Staff
The project research efforts and administration were supported by a number of staff affiliated with the Brown University Medical School and UEMF.
Research Assistants
Whit Hill, BA, NREMT-P, CCEMT-P
Flor Trespalacios
Phase I Research Interns
Zachary Litvack
Jordan Bonamo
Lifeguard EMS
Lifeguard EMS embodied the readiness aspects of RIDI through daily critical care transport of patients in Rhode Island and beyond, using a custom ambulance built to serve as a role model for safety, flexibility, and training. LifePACT, as the service is now named (Pediatric and Adult Critical care Transport) sustains the RIDI model and continues to offer critical care transport services for adults and children between hospitals and at incident scenes (upon mutual aid request).