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4/12/2013 Powerful Discovery Tools Through Technology M. Thomas Quail, MS Ed, R.N. LNC, NREMT May 1, 2013 Quail MT 2013 NOTE This handout does not include all slides and examples shown during webinar. 2 DISCLAIMER ~ CREDITS The information

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Quail MT 2013

Powerful Discovery Tools Through Technology

  • M. Thomas Quail, MS Ed, R.N. LNC, NREMT

May 1, 2013

NOTE This handout does not include all slides and examples shown during webinar.

2

DISCLAIMER ~ CREDITS

The information presented here has been obtained from expert resources. References have been included if available, to provide credit where credit is due. The content of such pages are in no way an official publication of the lecturer’s employer, or agency the lecturer may be affiliated. The opinions expressed in this presentation are solely that of the lecturer and not of the lecturer’s employer, or agency the lecturer may be affiliated with.

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Today’s Technology

 Cell Phones  Text Messaging  Time & Time Devices  Land Lines (Fixed Phone)  PSAPs  Audio Tapes  CMED  Air Medical Units  Cameras  GPS  Geo-Tagging  Transponders  Event Data Recording  Photography  Photographs  FOI Requests  E-Mail  Hand Held Devices  ECG  Pyxis  EMR  Media  Incident Location

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Cell Phones

911 Calls

 Routing  Call Transferred  Recorded  Delays  GPS-after 2005

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Subscriber Identification Module

SIM Card

  • Microchip
  • Removable
  • Contact Names
  • Phone Numbers
  • Text Messages*- Privacy Laws
  • Retrievable

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Itemized Cell Phone Bill

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Official U.S. Time

 Synchronized

 Atomic Clock or  Greenwich Mean Time (GMT).

 Accuracy =Nano-Seconds  State Police & Aircraft (Air medical units)  Cell Phone Bill - rounded up 1-2 minutes

8 Quail MT 2013

Official U.S. Time

 WARNING: Many agencies use different methods to

record time

 Accuracy: Important  Investigating allegations of delay in a patient’s

treatment, transfer, or transport of care.

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Synchronizing Clocks/Watches

Inquire

 How the time recorded was determined?  Are the clocks synchronized?  Who performs that task?  How often are the clocks synchronized?  Are there logs to determine when the clocks

were last synchronized?

 What reference source is used to accomplish

this task? (ie GMT, Atomic Clock)

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Synchronizing Clocks/Watches

 Personal Watch  Actual Time

10:08

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Fixed Telephone Line (Land line) 911 calls

 Rural: Regional Dispatch Center Routed

 Dispatcher in the same community.  Captures Callers Address / Number

  • PSAP : Public Safety Answering Point
  • 24 hr. Switchboards

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Public Safety Answering Point (PSAP)

 Capture: Name, Number & Address.  Emergency units: Dispatched

 Voice  Text  Pager  Laptop

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Public Safety Answering Point (PSAP)

 Electronic Log  Entering Text  Backup System

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Audio Tapes/ Recorded Calls

All 911 Calls

 Tape Cassette  CD  Encrypted  Storage

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RECORD REQUEST

 Electronic & Paper Records/Logs  Time Discrepancies –How Determined  Multiple Dispatchers  Raw Voice Data-NO Edits  Include Encryption Files

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Coordinated Medical Emergency Direction (CMED)

 CMED Centers  Network of Radio Towers  Entry Notification  Recorded

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Air Medical Units

Photo:labelscar.com 18

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CAMERA TECHNOLOGY

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EXAMPLES:

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CAMERAS

Homeland Security

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PUBLIC

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Business

Quail MT 2013 Photo: REUTERS 22

Business

Banks / ATMs Residential

Photo: pysih.com Photo:cctvcamerapros.com Photo:consumerist.com 23

Traffic

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Police

Micro-Cameras Dashboard Cameras

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Facial Recognition

Quail MT 2013 Photo:CBS.com 27

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AIRPORTS

Photo:FaceIt software Photo:jaunted.com Photo:technologynews.com Photo:mysanantonio.com Photo:pentagonmemorial.org 28 Quail MT 2013

Transit System

Boston Metro (July 17, 2012)

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Transit System

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Transit System

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Transit System

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CAMERAS

 Owner  Security Supervisor  Raw Data Footage  10-15 minutes before/after event  Still photographs  How is the time determined

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Global Positioning System (GPS)

GPS: Developed DOD

Current Location Time Velocity

Public Safety Departments Captured Electronic Record

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Dispatch Center

GPS Map

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GEO-TAGGING

 Geographical Identification Data added:

Photographs & Video.

 Coordinates: Latitude &Longitude  Altitude, Bearing, Distance  Accuracy: 1 meter (~3 feet)

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4/12/2013 13 GEO-TAGGING

Photo:en.wikipedia.org 37

GEO-TAGGING

Photo:en.wikipedia.org 38

GEO-TAGGING

Photo:en.wikipedia.org 39

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GEO-TAGGING

Photo:en.wikipedia.org 40

TRANSPONDERS

Photo: flicker.com Photo:zug.com Photo:zug.com Photo:howstuffworks.com 41

TRANSPONDER STATEMENT

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4/12/2013 15 Event Data Recorder (EDR) Since 1998

Quail MT 2013 Photo:cdc.gov Photo:jean-jabari.blogspot.com 43

Event Data Recorder (EDR)

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Event Data Recorder (EDR)

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Event Data Recorder (EDR)

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Event Data Recorder (EDR)

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Event Data Recorder (EDR)

 Vehicle Demographics  "x" seconds of pre-crash data  Speed of vehicle (MPH)  Crash severity (delta-V)  Safety belt status (buckled/unbuckled)  Engine throttle % & speed  Accelerator pedal %  Brake switch status (on/off)  Brake lamps status

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Event Data Recorder (EDR)

 Time between events  Cruise control status  Yaw rate (deg/sec) (if equipped)  Traction control button (if equipped)  Shift gear position (if equipped)  Seat track position (if equipped)  Airbag Warning Lamp "On" Time Before Event (min)  Tire pressure  Many other valuable parameters

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Event Data Recorder Report

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Photographs/ Photography

Image 1 Image 2

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Complaint Investigations Freedom of Information Act (FOI)

Many state agency documents are public records and are available through a FOI request  Closed Investigations  Closed Complaints against the Licensee  Service Records (Ambulance)  Inspection Records (Hospitals & Nursing Homes)  Surveyors Reports

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E-Mail Records

Discoverable Specific Request

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Handheld Devices

Complex “mini” computers Information

Sophisticated multimedia messaging Internet access history GPS Pictures-Tagged Records Text Data Much More

Photo:sangeethamobiles.com 54

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Hospitals

  • Electronic Time Clocks
  • Paging System
  • Specific Equipment
  • Patient Medications
  • Supplies
  • Access Rooms & Specialized Areas
  • EMRs esp. Psyc. records
  • Online Training
  • Cell Phones, Texting, etc.

Photo:fotolia.com

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EQUIPMENT~ CLOCKS

Cardiac Monitor-Defibrillator Electrocardiogram (ECG) Clock

Internal clock Checked every shift Time Accuracy  Q? Was the monitor/defibrillator checked?

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Cardiac Monitor-Defibrillator- Electrocardiogram (ECG) Clock

Photo: Medtronic 57

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Cardiac Monitor-Defibrillator- Electrocardiogram (ECG) Clock

Quail MT 2013 Photos: Medtronic 58

Pyxis

Photo:webmm.ahrq.gov Photo:carefusion.com Photo:carefusion.com

Photo: fotolia.com

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Pyxis Reports

Reports Overview Inventory Reports Detailed account of the status of inventory throughout the Station. Generated for the selected Station. Activity Reports Provide detailed transaction history for the Station. Generated by item name, item ID, user name, user ID, patient name, patient ID, transaction type, and date range. Document transactional information. System Reports Monitor and track system-wide data at the Stations. List information for users. Allow you to view the data in your database.

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Pyxis Activity Report

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Pyxis Reports

SUSPICIOUS ACTIVITY Specific Nurse Activity

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ELECTRONIC MEDICAL (HEALTH) RECORDS (EMR/EHR)

 File: Audit Trail  Program: A Detailed Log  Runs in Background  Used: To ensure records are not changed,

  • r if changed what was the change

 Discoverable

Photo:cutcaster.com 63

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EMR AUDIT FILE

Metadata: Replicates Each Step/Change Preserves the Original Content Printable Version Monitors

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AUDIT RECORD ~ SAMPLE 1

Quail MT 2012 Quail MT 2013 65

AUDIT RECORD ~ SAMPLE 2

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MISC.

Local Media Incident Location

Conduct Interviews Take Photographs Cameras

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CONCLUSION

Technology continues improve Know Current Technology Use to your advantage. Be aware of the obstacles

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CONTACT INFORMATION tom.quail@state.ma.us 617-624-5743

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Webinar Evaluation Form

Title: Powerful Discovery Tools through Technology Instructor: Tom Quail

  • 1. How would you rate the instructor? ___Excellent ___Good ___Average___ Poor
  • 2. Comments about this webinar:
  • 3. What are your suggestions for future topics?

Please return this form by email to contactus@medleague.com or by fax to 908-806-4511 or by mail to Patricia Iyer Associates, 260 Route 202-31, Suite 200, Flemington, NJ 08822.

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Contact hour form: Powerful Discovery Tools through Technology

Name: Address: Street, City, Zip:

  • 1. The defense requests audit files from an electronic source. What is the defense looking for?
  • a. To see if a frequent review was conducted by the agency.
  • b. To see if suspicious activity occurred.
  • c. To see the original content of the records.
  • d. To see if the patient received medication.
  • 2. What could you find from the emergency agency’s records, logs, and audio recordings of a

911 Call?

  • a. The exact county where the emergency occurred.
  • b. A possible delay in dispatching the appropriate emergency resources.
  • c. The dispatch center is in the same community as the emergency.
  • d. The dispatcher knows your exact location and phone number.
  • 3. There is video footage from a trauma center’s ambulance bay. What is most important?
  • a. Where are the cameras located?
  • b. Are there still images available?
  • c. Who has access to the backup footage?
  • d. How is the time determined?

A check for $15.00 written to Taylor College should be sent if you wish one nursing contact

  • hour. You may call in a credit card number, if you prefer, to 1-800-743-4006. Please contact

Norman Heavens with any questions. Do not send $15.00 to Patricia Iyer Associates. Norman Heavens, Taylor College, PO Box 93666. Los Angeles, CA 90093-0666