Shelter in Place and Evacuation Operations from Hurricane Response

1. Shelter in Place and Evacuation Operations from Hurricane Response Matthew Tumbleson NHDP-BC

2. Discuss the challenges to Sheltering in Place versus Evacuation for prolonged disasters. Describe how an increased Medical Surge can be managed by healthcare organizations in urban/rural areas during disasters. Identify Behavioral Health strategies to be used following and emergency or disaster. Implementation of changes to the Emergency Operations Plan based on lessons learned. Objectives Insert Name of Presentation Here

3. Shelter In PlaceHurricane Matthew

4. October 2016

5. October 2016 • October 5 (Census - 365) • Matthew is located near the Bahamas as a Category 4 storm • Facility moves to OPCON 4 • Daily leadership briefings begin • Evacuation order given by Gov. Nikki Haley (public evacuation) • De-risking efforts underway • October 6 (Census – 252) • Facility moves to OPCON 3 • Facility EOC Staffed 24/7 • Medical Evacuation exemption granted, Shelter in Place plan in place • October 7 (Census – 165) • Kids Camp and Staff Sheltering in place

6. October 2016 • October 8 (Census – 96) • Matthew comes ashore between Charleston and Myrtle Beach as a Cat 2 • Storm damage mitigation teams in place • Planning begins for return to normal operations • October 9 (Census – 155) • Rescue efforts in the surrounding areas underway (SC & NC) • Surge of Trauma Victims from both storm and clean-up efforts • October 10 (Census – 176) • Evacuation order lifted by Gov. Haley • Hospital begins normal operations at 10am.

7. Shelter In Place During the Sheltering process, Grand Strand found a significant increase in the number of Behavioral Health patients presenting for care. These patients were difficult to place once the evacuation order was given. Many identified as homeless or family-less with nowhere else to go during the event. The vast majority waited until it was too late to evacuate. Most identified the lack of information for this.

8. During the Storm • Communications • Coordination Calls/WebEx • Corporate • Division • State/Local/Regional • FEOC Staff • Incident Command & Support • Facilities Group • Mitigation of storm related damage • Infection Control • IT&S Rounding • Supply Chain management

9. During the Storm

10. Lessons Learned • Formalize Communications processes • Briefing process • Leadership notifications and Staff communications • Staff Support • Kids Camp • Sheltering of Staff • Sleeping areas • Team A/B • Pets • Security

11. Lessons Learned • Open the EOC as early as possible. • Prepare for both Shelter in Place and Evacuation • Provide additional Security for Surge • Go beyond the 96 hour plans (shoot for 2 weeks, if possible) • Drill, Drill, Drill

12. Evacuation Hurricane Florence

13. September 2018

14. September 2018 • September 1 (Census -329) • EOM began initial daily Executive leadership briefings for developing system • Preparedness messaging via closed Social Media to staff • Local Supply Chain, Food & Nutrition Services and Facilities began Hurricane Playbook initiation • September 7 (Census – 376) • Executive Leadership began communications to staff • FEOC joined coordination calls at state and corporate levels • Facility submitted for an exemption to Mandatory Medical Evacuation • Facility Moved to OPCON 4 • September 8 (Census – 356) • Virtual Opening of the FEOC • Daily reports from all Departments • Facility moved to OPCON 3

15. September 2018 • September 9 (Census – 323) • Physical opening of the FEOC • Incident Commander and FEOC Manager • Logistics & Support staff • September 10 (Census – 325) • Team A/B Notification for Activation • Continued messaging with closed Social Media groups • Mandatory Medical Evacuation exemption denied • Evacuation preparations begin at 14:31 • Activation of the State Mutual Aid Agreement • Facility moved to OPCON 1 • End of Operational Period – 91 patients placed (not yet moved)

16. September 2018 • September 11 (Census – 142, Evac/DC – 183) • Evacuations continue • Census at 142 • Patients continue to be placed with HCA & Non-HCA facilities • State and Local Operations moved to OPCON 2 • September 12 (Census – 50, Evac/DC – 275) • Evacuations continue • Final patient evacuated Sept 12, 2018 at 23:45 • Patient Story

17. Evacuation

18. Evacuation HCA Receiving Hospitals: • Coliseum Medical Center • Doctors Hospital of Augusta • Orange Park • Memorial Savannah • Memorial Satilla • North Florida Regional • Colleton • Fairview Park • Memorial Jacksonville • Eastside

19. Evacuation Non-HCA Receiving Hospitals: • Spartanburg • Providence • Greenville • Carolina Pines • AnMed • Self Regional • Palmetto Health • St. Francis • MUSC

20. Evacuation • Patient Volumes • Initial Census - 325 • Discharged - 129 • Evacuated – 196 • EMS Support • Ground (Ambulance, Ambu-Bus) • Air (Rotor-wing, Fixed- Wing) • Transport Considerations • Food and Supplies for patients on long transports • Downtime/Feeding for transport staff

21. September 2018 Total elapsed Evacuation time: 57 hours, 14 minutes

22. During the Storm

23. Kenopsia • n. the eerie, forlorn atmosphere of a place that’s usually bustling with people but is now abandoned and quiet—a school hallway in the evening, an unlit office on a weekend, vacant fairgrounds—an emotional afterimage that makes it seem not just empty but hyper-empty, with a total population in the negative, who are so conspicuously absent they glow like neon signs.

24. During the Storm • Communications • Coordination Calls/WebEx • Corporate • Division • State/Local/Regional • Transfer Center • FEOC Staff • Incident Command & Support • Facilities mitigation of storm related damage • IT&S Rounding • Supply Chain management

25. During the Storm

26. Food Distribution Center 400 Staff & 1261 Family

27. Food Distribution Center

28. Post Storm • September 15 (Census – 0) • SC DHEC deemed facility safe for re-entry & authorized service to resume • Re-opening communications to staff and community • Distribution Center for Staff/Family • September 16 (Census – 36 ED, 17 IP) • Patients Return • Main ED re-opened 8:00 am • Inpatient Services 11:00 am • September 17 (Census – 32 ED, 49 – IP) • South Strand Campus re-opened at 7:00 am

29. Post Storm • September 18 (Census – 56 ED, 117 IP) • North Strand FSED re-opened at 7:00 am • September 19 (Census – 276 IP) • All services re-opened • September 20 (Census – 288) • Food Distribution on-going • Hope Fund – FEMA expert • EAP return to on-site • Evaluation/AAR process

30. Reopening

31. Presidential Visit • President visits the disaster area • Secret Service & White House Medical Unit were in-house at Grand Strand for this visit

32. Aftermath

33. Aftermath

34. Aftermath

35. Aftermath

36. Before & After the Storm Before After

37. After the Storm Sunrise

38. Living Our Mission Above all else, we are committed to the care and improvement of human life.

39. Grand Strand Health None of our Emergency Operations efforts are effective in a vacuum. It takes a phenomenal team of experts in their respective fields. Build your team. Train your team. Accomplish the Unimaginable.

40. Contact Information Matt Tumbleson Emergency Operations Manager Grand Strand Health Email: matthew.tumbleson@hcahealthcare.com Phone: (843) 692-4990