An Attack Event - Response - Continuity of Operations - Recovery - Looking Ahead

1. An Attack Event - Response - Continuity of Operations - Recovery - Looking Ahead Middlesex Hospital 2018

2. About Middlesex Hospital • Main Hospital Campus • Historic Middletown, CT • Opened in 1904 • Licensed for 275 beds • 3500+ employees across the Health System • Top 100 Hospital by Thomson Reuters • 4 time Magnet awarded • Connecticut’s only Mayo Clinic Network member

3. About Middlesex Hospital • Services at the Main Campus • Inpatient Medical / Surgical • Inpatient Psychiatry • Pregnancy & Birth • Critical Care • 44 bed Emergency Department with 8 bed “CIU” • Sleep disorders center • Surgical Services • Outpatient Services

4. About Middlesex Hospital • Additional Middlesex Health System features • Outpatient & Cancer Center • Middletown, ~5 minutes from the main campus • Two stand-alone emergency receiving facilities • Marlborough, ~20 minutes east • Outpatient Lab and Radiology • Westbrook, ~30 minutes south on the shore • Outpatient Lab, Radiology, and Cancer Center

5. About Middlesex Hospital • Environmental Safety & Protective Services • Proprietary Security Force • 53 officers • Mix of per diem & full time • Based at 4 locations • Main Campus, Westbrook, Marlborough, Outpatient Center • Protective Items • Pepper gel, batons, handcuffs, MOAB • No firearms • Premysis, Avigilon, and Hugs

6. Office of Environmental Safety & Protective Services VP, HR VP, Operations Director, Environmental Safety & Protective Services Safety & Emergency Management Coordinator Division of Employee Health and Safety (Workers’ Comp / Employee Safety Manager) Division of Environmental Safety Division of Protective Services (Security Operations Manager) Division of Incident Management

7. Emergency Management • Hospital Incident Command System (HICS) • Typical organizational chart • Mass notification systems • Everbridge • Snapcomms • Activations • Average 12+ per year • Command Center • Protective Services vs. main conference room • Community • Middletown Fire Department - Local EMD

8. Prevention & Preparedness • Evacuation Plans • Lateral vs. vertical • Facility construction • Exercise planning • ED Garage Plans • Closing / restricting access • Cameras & Proximity Readers • Over 100 of each • Visitor Management • ID for all persons in facility

9. The Attack

10. The Attack

18. Response - Short Term • Our response: ED response - CCU - CIU • Employees came in from home: Security, nursing • Perimeter established by law enforcement: rapidly • Command and Control: need to remind operations and other sections to keep a rep in the command center • Unified command: providing a field liaison for Fire, PD, Fed, State • Plans used: Fire [evacuation], Surge [alternate care] • Crime scene challenges: Evidence collection, turning over, entry • Media control: Police & security officers • Joint Information Center: Briefings by City, with Middlesex

19. Response - Short Term • Fire Protection System • 3 sprinkler heads activated • 150 gallons/minute (3 @ 50 GPM) • Active for 60 minutes • 9000 gallons • Fire department hoses • 450 gallons/minute for 10 minutes • 4500 gallons + interior hose usage • Fire fighting foam • Stable mass of small air-filled bubbles • Water, foam concentrate, air • Lower density than oil, gas, or water • Increases absorption of water into sheetrock • Depth: ¾” over 32,000 square feet

20. Response - Mid Term • Temporary Emergency Department • Main Lobby • Many complicating factors • IT, supplies, pharmacy, clinical engineering, traffic direction and control • Media control • Hospital still open • Assess damage • Outside consultant • Plan cleaning and construction • Phasing based on needs, damage, population served • CT DPH presence • Daily

21. Response - Long Term • CT DPH mobile hospital • Delivered day of attack • Pros/cons of deploying • Regular updates • Staff, media • Emergency Department moved • From lobby to outpatient surgery • From outpatient surgery to ED with restrictions • No waiting room • No main entrance

22. Recovery • Crisis Services • Employee Assistance Program • Clean-up/renovation • Floors, surfaces • Equipment • HVAC returns • Environmental testing • Moisture • Supply salvaging • Most items discarded • Infection Prevention involvement

23. Noteworthy Successes • Relationships • Personal/local • Government • Relationships • Internal • We know each other and work together every day • The importance of emergency response structure • Command and control for scheduled and unscheduled events • Luck? Blessed? Meant to be??

24. Mitigation & Improvements • The new normal • Risk assessments • Consultant • Facilty hardening • Bollards, 3M film • Communications • Fire radios • Staff communication • Facility security • Cameras, locking departments, visitor management • Driving preoccupation with failure

25. Areas for Improvement • Immediate communications to staff • All employees- • On duty and off • Centralized communications • Migrate from Switchboard concept • Improve radio communications • Fire Department while inside Hospital • Continuity of Operations • Department level • Engage other departments for resilience • Depth

26. Thank Yous • Our staff • Our contractors • Belfor property restorations • Mystic Air • WT • Middletown Emergency Services • State and Middletown Health departments • CERT & MRC • Mayor’s office

27. Questions?