Crisis and Challenge Preparedness and Overcrowding

1. Crisis and Challenge Preparedness and Overcrowding John R. Lumpkin, MD, MPH, FACEP Director Illinois Department of Public Health

3. Political Limited range of conventional weapons Guns, bombs Changing Face of Terrorism

4. Conventional Terrorism • Bullets • Bombs and blasts • Building collapse

7. Stages of a Medical Emergency Response • Planning • Identification • Notification • Mobilization • Treatment • Recovery

8. Emergency Medical Disaster Plan Statewide plan that coordinates medical resources EMS System-Wide Crisis Plan Mandate for hospitals to develop plans to recognize evolving trend of similar symptoms Illinois Pharmaceutical Plan Plan to supplement local resources by providing state and Federal pharmaceutical resources PlanningIDPH Emergency Plans

9. Stages of a Medical Emergency Response • Planning • Identification • Notification • Mobilization • Treatment • Recovery

10. Identification - Laboratory Capacity • IDPH laboratory capabilities in Springfield and Chicago • Chicago – Upgraded to biosafety level 3 facility • Upgrading to PCR technology • Approximately 30 hospital laboratories trained by IDPH on biological agents • Referral and confirmation to CDC laboratory for some agents

11. Impact of Surveillance on Survivability (Linear) Victims Directly Exposed 105 Fatalities With Early Warning and an Informed Public Health Response Fatalities With Traditional Public Health Response Number Dead = 0 Time Animal or Human Indicators Phase II Acute Illness Phase I Initial Symptoms Traditional Disease Detection Surveillance Effective Treatment Period t Modified from chart developed by Hopkins Bioterrorism Center

13. Agent comparison table

14. Stages of a Medical Emergency Response • Planning • Identification • Notification • Mobilization • Treatment • Recovery

15. Notification -IDPH Response System • Non-Emergency Communication • Broadcast fax services/program follow-up • Emergency Communication • 24-hour availability through IEMA • Internal duty officer for all major response programs • Health Alert Messages • Reach-back to CDC and federal agencies • Hospital Health Alert Network (HHAN)

16. IOHNO

17. Notification -Health Alert Network • Secure Intranet between state and local health departments • Satellite uplinks and downlinks • “Real-time” electronic messaging • Video teleconferencing • Broadcast fax capabilities

18. Stages of a Medical Emergency Response • Planning • Identification • Notification • Mobilization • Treatment • Recovery

19. Response -Rapid Response Team • Assist LHDs with outbreak investigation • Physician lead multi-disciplinary team • Composed of personnel representing epidemiology, communicable diseases, food protection, Laboratory and environmental health

20. Response -IMERT • Illinois Medical Emergency Response Team • Assist with emergency medical treatment at mass causality incidents • Located in each SIRT region and City of Chicago • Team composed of emergency physicians, emergency and trauma nurses, and EMT of various levels

21. Stages of a Medical Emergency Response • Planning • Identification • Notification • Mobilization • Treatment • Recovery

22. Treatment -National Pharmaceutical Stockpile • Less than 12 hour availability • Repackaging by Illinois resources • Over 250,000 individual packs within 24 hours • Includes hospital and other medical supplies

23. Hospital Preparedness • Staff Training and Education • Incorporate BT into • Disaster Planning • Infection control • Notification procedures • Security and Media • Community Wide Planning • Local Health Department • POD Hospital • EMS System

24. How Well Are We Prepared? The 1995 Chicago Heat Crisis Local Learning Experience

25. Casualties of the July 1995 heat wave in Chicago CNN: Chicago hospitals were unprepared for '95 heat wave The Chicago 1995 Heat Crisis • 465 certified heat-related deaths • 23/42 area hospitals on bypass • Patients waiting in ER >12 hours • Ambulance travel times >30 min. Excessive demands on medical resources Compromised delivery of services to non heat-related patients (MMWR/Aug 11/1995/44(31);577-579)

26. Assessment: Emergency Room Bypass • Contributing factors: regulatory strategies, management practices, communications & IT, other social issues • Current system of monitoring In search of an open ER.

27. ER Capacity & Utilization Illinois Emergency Rooms Illinois Emergency Room Visits (Millions) 228 217 Source: IDPH, IL Center for Health Statistics, Unpublished data from Annual Hospital Questionnaires

28. Ambulance Diversion in Illinois • Criteria developed by IDPH • System-wide crisis policy must be in place • Report to IDPH within 24 hours of diversion • Review of notifications for compliance with acceptable criteria • Corrective action plans and surprise inspections for hospitals out of compliance

29. Ambulance Diversion in Illinois • Three hospitals on simultaneous bypass within the same area triggers intervention • IDPH may require hospitals to go off bypass to accommodate critical situations • Crisis policies must be implemented, addressing executive-level decision making, staffing and other contingencies

30. Illinois’ Bypass Experience • Approximately 35% of Illinois EDs went on bypass at least once between June 2000 and May 2001 • A total of 797 bypass events occurred during this time frame, resulting in more than 6,500 hours of restricted access Source: IDPH Division of EMS and Highway Safety

31. Percentage of Total Regional Bypass Time Attributable to Individual Hospitals Region A & Other Regional Analysis • bypass burden = % differences per hospital • the “domino effect” = simultaneous bypass within close proximity Region B Source: IDPH, Division of Emergency Medical Services, unpublished data June 2000-May 2001

32. Illinois’ Bypass Experience Source: IDPH Division of EMS and Highway Safety

33. Illinois’ Bypass Experience Source: IDPH Division of EMS and Highway Safety

34. Illinois’ Bypass Experience Source: IDPH Division of EMS and Highway Safety

36. Can Hospital Bypass Be An Effective BT Early Warning System? • Bypass is a symptom of insufficient surge capacity • Separating ‘normal’ bypass impacts from true crisis events is key • Illinois’ system provides important checks and balances • Future information and communications system improvements will make bypass a reasonable early warning system for BT or chemical terror events

37. Statewide Electronic Emergency Management System • 24 hr/day real-time snapshot of hospital status • Automatic pager/e-mail notifications (ex. 3 hospitals on bypass simultaneously) • Eliminates delays in “cluster” notifications • Utilizes HHAN Portal

38. The Challenge that we face • “THE MANAGED-CARE-BASED HEALTH SYSTEM IS FAILING. MEDICAL INFLATION IS BACK. CONSUMER DISTRUST, PROVIDER HOSTILITY, COSTLY NEW TECHNOLOGIES AND POLITICAL OPPORTUNISM WILL NO LONGER ALLOW COSTS AND QUALITY TO BE CONTROLLED BY MOST EXISTING MANAGED CARE ARRANGEMENTS”

39. Overcrowding • Increase Demand • Utilization • Preference • Social and Economic Barriers • Changing Demographics • Loss of Surge Capacity • Decrease in Staffed Beds

40. Solutions Involve System Change • Who funds Surge Capacity? • To prevent Diversion • To assure appropriate Preparedness • How to staff Surge Capacity? • Training • Retention • Setting Facility Priorities • Emergency Response

41. Additional Information Illinois Department of Public Health Emergency Response Program 525 West Jefferson Street Springfield, IL 62761 Phone: 217/782-3984 Web: www.idph.state.il.us