Lessons Learned from the Field of Emergency Preparedness

1. Lessons Learned from the Field of Emergency Preparedness Thursday, November 6, 2008 12:00-1:30 pm EST

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3. Questions • To pose a question to the Panelists, please post it in the Q&A panel on the right hand side of your screen and press send. • To expand or decrease the size of any panel on the right hand side of your screen, click the arrow shape in the upper-left corner of the panel. • To pose a question to WebEx’s technical support, you can also post it in that Q&A panel and press send. Or you can dial 1-866-229-3239. 3

4. Agenda • Introduction, Cindy DiBiasi • Identifying and Preparing Alternate Care Sites, Terri Gill • Resource Allocation in an Emergency, Nancie McAnaugh • Inventorying Emergency Preparedness Resources, Christian Feller • Q&A 4

5. Terri Gill Senior Emergency Services Coordinator Emergency Preparedness Office California Department of Public Health Identifying and Preparing Government Authorized Alternate Care Sites in California 5

6. California Surge Standards and Guidelines Project • The Surge Standards and Guidelines Project: • Convened a broad group of stakeholders and interested parties to develop comprehensive guidelines and standards for surge capacity planning. • Developed standards and guidelines that would serve as the basis for emergency planning and operations. 6

7. Alternate Care Sites • One focus of the Surge Standards and Guidelines Project was to look beyond hospitals for surge capacity. • Defined Alternate Cares Sites (ACSs) to reflect the legal requirements and operational needs for the State • A government-authorized ACS is a location not currently providing healthcare services • Outpatient and inpatient care will vary • These specific sites are not part of the assets of an existing facility 7

8. The Rocky Mountain Regional Care Model • The Rocky Mountain Regional Care Model for Bioterrorist Events was used to identify areas to focus on to plan for surge in Alternate Care Sites including: • Site Selection • Staffing • Supplies • Prioritized components to determine which items were critical and which could be reasonably accommodated. • This model helped us to develop tools specific to California. 8

9. California’s Definitions • California’s definitions are based on an operational approach to surge planning. • Definitions recognize that all licensed healthcare facilities and expansions of such facilities must operate under existing/modified statutory and regulatory standards and that government authorized alternate care sites are not governed by these statutes and regulations. 9

10. Roles and Responsibility for Alternate Care Sites • The California Emergency Services Act recognizes the role of the State and its political subdivisions to mitigate the effects of an emergency. • From this authority, local governments can contract with local public and private entities to establish an ACS. • Under the CDPH Pandemic Influenza Response Plan, local health departments (LHD) are responsible for identifying and planning for the operations of government authorized ACSs. • It is NOT the expectation that LHDs operate ACSs. • Local government has the responsibility to set-up and operate ACS. 10

11. Planning for Alternate Care Sites • Development of an Alternate Care Site Planning Team • Need for public and private partnership • Broad participation across stakeholder types • Help from existing healthcare providers is critical • All hazards approach 11

12. Patient Care in Alternate Care Sites • The Standard of Care is a moving target based on what a reasonable person with like training would do under similar circumstances. • Healthcare delivery in alternate care sites will vary from traditional hospital care and will be dependent on available resources. • Based on local surge needs, each identified ACS will include some mix of the following types of patients: • Outpatient • Inpatient • Critical/Acute 12

13. State Alternate Care Site Caches • The alternate care site cache of supplies and equipment was designed using an all-hazards approach to provide for 10-14 days of care for 50 patients. • Each ACS Cache contain items separated into 9 groups: • IV Fluids • Bandages and Wound Management • Airway Intervention and Management • Immobilization • Patient Bedding, Gowns, Cots, Miscellaneous • Healthcare Provider Personal Protective Equipment (PPE) • Exam Supplies • General Supplies • Defibrillators and Associated Supplies – A special group that will be vendor managed off-site 13

14. Conclusions • Alternate Care Sites are a last resort when the healthcare delivery system cannot meet patient care needs • Alternate Care Sites pose a difficult challenge • Creativity in meeting this need is necessary • It is important to capitalize on models that have already been developed • California is working with local government to better understand how the State can help 14

15. Poll Question #1 • A short poll will appear on your screen. Please take a few seconds to answer the poll and provide valuable feedback! • If you are unable to respond to the poll during this event, please e-mail your answer to emergencypreparedness@academyhealth.org. 15

16. Questions • To pose a question to the Panelists, please post it in the Q&A panel on the right hand side of your screen and press send. • To expand or decrease the size of any panel on the right hand side of your screen, click the arrow shape in the upper-left corner of the panel. • To pose a question to WebEx’s technical support, you can also post it in that Q&A panel and press send. Or you can dial 1-866-229-3239. 16

17. Nancie McAnaugh Deputy Department Director Missouri Department of Health and Senior Services Resource Allocation in an Emergency: Using AHRQ Tools to Enhance State Planning Efforts 17

18. Planning Scenarios Pandemic Influenza New Madrid Fault Bioterrorism Events Chemical Events Explosive Events (Including Dirty Bombs) 18

19. Missouri Healthcare System 20 Federally Qualified Health Centers 123 acute care hospitals 6 children’s hospitals 23 designated trauma centers 1 pediatric trauma center • 1,169 long term care facilities • 216 ambulance services • 193 home health agencies • 98 ambulatory surgical centers • 14 psychiatric hospitals 19

20. Health Care Systems Readiness/ Scarce Resource Allocation Committees Initial planning efforts addressed pandemic influenza As the subcommittee finished its initial efforts, the focus changed to allocation of scarce resources 20

21. Agency for Healthcare Research and Quality (AHRQ) Tools Mass Medical Care with Scarce Resources Altered Standards of Care in Mass Casualty Events 21

22. Altered Standards of Care What did we need to know to develop plans that provided an effective and fair medical response to a mass casualty event? Were there key principles that professionals had agreed upon that should inform our planning for mass casualty events? What were the critical issues that we needed to consider and address in planning for the provision of health and medical care in a mass casualty event? 22

23. Mass Medical Care with Scarce Resources Pre-hospital Care Hospital and Acute Care Alternative Care Sites Palliative Care 23

24. Mass Medical Care with Scarce Resources Model framework utilized by Scarce Resource Allocation Committee Encouraged local public health agencies to utilize the tool in their discussions with their local emergency planning committees Utilized the mass medical care tool to inform discussions with representatives of the trial attorneys association 24

25. Planning Outcomes Ventilator-Allocation Protocol Statewide Emergency Medical Services Workgroup Cross-Departmental Statute & Regulations Workgroup Pandemic “grief” training for managers and supervisors Creation of a statewide ethics consortium 25

26. Challenges Transferring outcomes created with tools to rural Missouri settings Getting buy-in from non-public health state partners on tools Lack of public awareness regarding the limitations of the health care system Pediatric issues 26

27. Poll Question #2 • A short poll will appear on your screen. Please take a few seconds to share your feedback with AHRQ. • If you are unable to respond to the poll during this event, please e-mail your answer to emergencypreparedness@academyhealth.org. 27

28. Inventorying Emergency Preparedness Resources: A Regional Approach to Resource Management Christian Feller Aultman Hospital Director of Safety and Emergency Management Akron Regional Hospital Association Emergency Management Chairman 28

29. Emergency Preparedness Resource Inventory Tool (EPRI) Description and Uses EPRI is an internet-based tool enabling first responders, healthcare and private / public entities the ability to compile an inventory of critical resources via a public domain database tool. Provides flexible access to inventory data via a website. Provides the ability to make emergency requests and tabulate responses. Generates reports on quantity, location, discipline and availability. Meets ASPR (Assistant Secretary for Preparedness and Response) guidelines for tracking of grant funded purchases. 29

30. Regional Implementation Identification of a region-wide issue. Established objectives with attainable deadlines. Development of a multidisciplinary committee. Regional Coordinators, Emergency Management Agencies (EMA), Public Health, Hospitals Evaluation of various resource management tools or response tools with included resource management components over a 9 month period. Tools evaluated on the following criteria: Affordability Customizable Internet Based Security Customer Support Ease of Use 30

31. Regional Implementation Cont’d Identified EPRI as the emergency resource tool of choice based on the following criteria: No cost while existing contracts are in place Windows based Remote (internet) hosted Ability to back up information and hosting site redundancy Password protected with various user levels Strong reporting capabilities for all disciplines NIMS (National Incident Management System) compliant Customizable and able to integrate with various file types Open ended infrastructure for mapping tie-ins Free tech support while under contract 31

32. Regional Implementation Cont’d Presented findings to regional steering committee for approval to move forward Identified workgroups within specific disciplines to identify resources for input Healthcare – All ASPR funded purchases over $250.00 Public Health – All CDC (Center for Disease Control) funded purchases over $250.00 EMA – All NIMS identified resources Worked with Abt Associates to develop training modules and user manuals Developed region specific standard operating procedures and guidelines and policies Worked with Abt Associates to load initial data such as demographics and contacts 32

33. Regional Implementation Cont’d Identified a pilot group to use for a 1 month period in order to identify operational opportunities for improvement. Pilot test group consisted of the following: 3 Hospitals 2 Health Departments 2 EMAs Pilot group evaluations to be completed by December 1, 2008. A full report to the regional steering committee during the December meeting. Full media campaign to begin December 1st, 2008 in order to spark interest and engagement among various disciplines. 33

34. Future Plans First quarter of 2009 all 33 regional hospitals will go live with EPRI. Usage to be tied back to ASPR funding requirements Public Health to be on-line by mid-summer of 2009 EMAs to be brought on-line as demand exists. Use EPRI effectively in 2009 regional exercise. Provide EPRI to all county emergency operations centers within the region. 34

35. Future Plans Cont’d Work with regional fire and police entities to provide data or pull data from the State of Ohio response plans. Provide implementation assistance to other Ohio regions, so all state healthcare organizations have access to, and provide data for, EPRI. Work collaboratively with adjacent state regions to develop a multi-state EPRI tool. Continue to promote the implementation and usage of EPRI to all interested parties. 35

36. Challenges Eliminating “Resource Silos” Not overstepping the EMA’s authority Work output at a regional level Elimination of grant funding System ownership 36

37. Strategies Continue to provide a secure method of data input, tracking and reporting. Stress importance of EPRI being a tool to assist EMAs in resource identification and acquisition. Continue to engage regional participants through projects that benefit individual entities. Think long term when developing regional based tools and how they will be funded. Provide key contacts and “system owners” that are funded by the region or have region interests in mind. 37

38. Poll Question #3 • A short poll will appear on your screen. We appreciate your feedback! • If you are unable to respond to the poll during this event, please e-mail your answer to emergencypreparedness@academyhealth.org. 38

39. Q&A • If you have a question for any of today’s presenters, Terri Gill, Nancie McAnaugh, or Christian Feller, please type it into the Q&A panel to the right and press send. 39

40. Next Webcast Public Health Emergency Preparedness: Planning and Practicing for a Disaster Winter 2009 To learn more go to the Webcast Web page at: http://www.academyhealth.org/knowledgetransfer/EPWebcasts.htm 40

41. For more information about…. • Today’s event including a recording and transcript, go to: http://www.ahrq.gov/prep/ • AHRQ’s suite of emergency preparedness tools, go to: http://www.ahrq.gov/prep/ • Public Health Emergency Preparedness: Planning and Practicing for a Disaster, please visit our Web site at: http://www.academyhealth.org/knowledgetransfer/EPWebcasts.htm • If you have a question regarding future Webcasts or utilizing AHRQ tools please e-mail us at emergencypreparedness@academyhealth.org. 41

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