Catastrophic Health Incident Response Planning

1. Catastrophic Health IncidentResponse Planning

2. Catastrophic Incident Response Community Emergency Operations EMS Hospitals High Impact Incident Law Enforcement Fire Public Administration Public Works Citizen Volunteers Public Health

3. Catastrophic Incidents TIME (min) 0 60 90 15 30 >120 45 Self-evacuee’s 50 - 80% bypass public safety “Upside down triage” Bystanders transport 80% of casualties (11% of admits) EMS transports 20% of casualties (88% of admits) EMS Approx. 20% of causalities Public Safety Arrival Source: Davis, 2004

4. Catastrophic Incidents TIME (min) 0 60 90 15 30 >120 45 Self-evacuee’s 50 - 80% bypass public safety “Upside down triage” Bystanders transport 80% of casualties (11% of admits) EMS transports 20% of casualties (88% of admits) EMS Approx. 20% of causalities Public Safety Arrival GOAL - Protect The Hospitals Source: Davis, 2004

5. ! “Not all victims should be evaluated in the emergency department” Psychological vs. Medical “Footprint” • The size of the psychological“footprint” greatly exceeds medical“footprint” psychological “footprint” > 4:1 medical “footprint”

6. Statewide Catastrophic Health Incident Response Plan (CHIRP) “Chance favors the prepared mind.” Louis Pasteur

7. CHIRP Scope • A catastrophic incident may result from: • natural events (hurricanes, floods, etc.) • large-scale accidents such as a plane crash • manmade/terrorism events • Size of incident is not the determining factor, capacity and capability to respond is most important factor

8. CHIRP Provisions • Provides for: • Incident response strategy • Preparedness, prevention, response, recovery • Roles and responsibilities • Coordination of regional response • Alternate Care Sites • Expansion of medical care capacity and capability

9. Statewide CHIRP • All hazards plan utilizing principles from; • National Response Framework (NRF) • National Incident Management System (NIMS) • National Preparedness Guidance (NPG) • Incorporate plans and resource from regional: • Law enforcement, emergency management, EMS, fire/rescue, hospitals, and public health

10. Statewide CHIRP • Concept of operations • Develop, exercise and maintain regional catastrophic response plans which support local plans, and draw on regional, state, and federal assets Catastrophic Incident Response Plans reside at the regional level

11. Source: FEMA Photo Library Regional CHIRP Provisions • Incident management priorities • Protect, restore critical infrastructure, resources • Conduct law enforcement operations • Protect property, mitigate impacts • Facilitate recovery

12. Operational Goals • Provide chain of command • Attend to all victims • Minimize injury/illness, damage/loss of property & records • Provide maximum safety • Integrate with community emergency plans • Maintain and restore normal services • Provide supportive action All operational goals are built into the Emergency Operations Plan (EOP)

13. Concept of Operations Statewide and Federal Assets Coordinates Regional Catastrophic Incident Response Plans Enhances Local/County Communications Risk/Public Information Special Needs Populations Volunteer Credentialing Patient Tracking Alternate Treatment Sites Training/Exercises Local/County Emergency Response Plans

14. Concept of Operations Statewide Ambulance Response Plan Hospital Response Plan Public Health Response Plan Behavioral Health Response Plan Mass Fatality Response Plan Regional Catastrophic Incident Response Plans & Multi-Agency Coordinating Teams Local Communications Risk/Public Information Special Needs Populations Volunteer Credentialing Patient Tracking Alternate Treatment Sites Training/Exercises Local Emergency Response Plans

15. Planning Targets Rural Areas Minimum 100 total casualties per incident Smaller Urban Areas Minimum 250 total casualties per incident Major Urban Areas 500 casualties per million population

16. Planning Assumptions • CHIRP will knit together existing plans, not replace them. • Agency Mass Casualty Plans • Fire Departments and EMS Agencies • Hospitals • Law Enforcement Agencies • Field Operations Guide (FOG) • Medical Examiner Disaster Plans • MMRS Regional MCI Plans

17. Assumptions • Triage / Treatment • Basic Principles of Disaster Medicine must apply • Level of care will be less than day to day medicine as we know it • Standards • Will see and care for larger patient / staff ratios

18. Regional Catastrophic Health Incident Response Plan Components • Prehospital (MCI) Response Plan • Alternate Medical Treatment Site Plan • Hospital Response Plan • Mass Fatality Plan (FEMORS) • Lab Surge Capacity Plan • Healthcare Professional Surge Capacity Plan • Disaster Behavioral Health Plan

19. 1 2 3 4 Injury Severity • 10 percent immediate deaths Of those surviving: • 20 percent emergent (severe multi-system injuries) • 30 percent urgent (able to defer definitive treatment once stabilized) • 50 percent mild or moderate (the “walking wounded’)

20. Practical Options • Expand via • Mobile facilities-expand in place or deploy to incident site • Convert existing buildings to temporary hospitals • Use of shuttered hospitals [closed, obsolete,mothballed, bankrupt, etc.] • Add beds to existing facilities • Build temporary facilities • Develop protocols addressing emergency standard of care procedures

21. Alternative Care Sites Plan Region 5 Domestic Security Taskforce Central Florida MMRS Central Florida UASI

22. Funding Sources • State Homeland Security Grants (DHS) • Centers for Disease Control Grants (CDC) • DHHS – ASPR Grants (ASPR) • Urban Area Security Initiative Grants (UASI) • Metropolitan Medical Response System Grants (MMRS)

23. ACS Cache Locations 1 2 3 4 5 ASPR Funded 6 7

24. MCI Cache Locations MCI MCI DHS Funded 100 Pt Caches MCI MCI

25. MCI Cache Locations MCI MCI UASI 100 Pt Caches MCI MCI UASI

26. All MCI Cache Locations MCI 250 Pt Cache MCI UASI UASI MCI UASI MCI

27. Hospital Cache Locations Speedway Hospital Hospital Spaceport Hospital Hospital Hospital Theme Parks Hospital Cruise ship Port Hospital Hospital MMRS Funded

28. County Cache Locations County UASI Funded 100 Pt Caches & Enhance Regional 500 Pt Cache County County County Region County

29. All Cache Locations 1 Regional Cache – 500 pt 5 County Caches – 100 pt 8 Hospital Caches – 100 pt 6 Sm MCI Caches – 100 pt 1 Lg MCI Cache – 250 pt Total Surge – 2,650 pt MCI County Hospital MCI County UASI UASI Region 5 Medical Surge Strategy Required Capacity Surge 500 Pt / Million Pop. Regional Population ≈3 million population 1500 Pts. Hospital County Region County Hospital Hospital Hospital Hospital Hospital MCI UASI Hospital County MCI

30. Alternate Care Site Cache Trailers

32. First Aid and Casualty Collection Points for Mass Gathering Events.

33. State Medical Response Team

36. ZUMBRO Air Inflatable Quad Tents Temps Cots Westcots carts, tables & chairs

37. State Medical Response Teams Florida has Three Mobile Field Hospitals and One Rapid Response Hospital

38. State Medical Response Team Set-up

39. Leveraging Our Assets • Pandemic Influenza Caches • Points of Dispensing Caches • Special Needs Shelter Caches • Mass Casualty Caches • Local and Regional AMTS Caches • State Medical Response Team Cache

40. Questions?Discussion?

41. Federal Health and Medical Response Natural Disasters Transportation Disasters Terrorism Technological Disasters