The MemorialCare “PIC” System

1. The MemorialCare “PIC” System A Disaster Management Structure for Non-Employed Medical Staffs James D. Leo, M.D., FACP, FCCP Chair, Physician Disaster Task Force Long Beach Memorial Medical Center

2. The Challenge of an MCI • 9/11: The challenge of overwhelming volume of casualties • Hurricane Katrina: Damage to hospital facilities • Potential for impaired communication • Potential for impaired access to facility • Potential need for rapid “internal triage” to create capacity for large volume MCI

3. The Challenge of an MCI • Potential need for difficult ethical decisions – rationing limited resources • Potential need for MD’s on site to decide on the care/transfer of other MDs’ patients • Previously, no system in place to handle such exigencies

4. Genesis of PIC • Water pipes weren’t meant to hold 200 lbs • Critical communications failure • Nurses unable to call out of hospital • Patients in hospital cut off from physician care Dr. Acker

5. Necessity Innovation • Solution: Utilize IM housestaff present in hospital • Assigned one intern or resident to each floor to respond to urgent patient care needs • Physician Leader circulated to troubleshoot and provide needed support • Outcome: no patient harm • Result: The “PIC” system was born

6. PIC System • PIC = Physician-In-Charge • 3 primary PIC’s for a MCI: • TSIC: Trauma Surgeon-in-Charge • ORSIC: Operating Room Surgeon-in-Charge • HPIC: Hospital Physician-in-Charge • Secondary: Floor PIC’s

7. TSIC (Trauma Surgeon-in-Charge) • Situated in the ED • Forms Trauma Teams for each incoming trauma patient • Each team headed by a trauma surgeon • TSIC controls utilization of vital/potentially limited resources: • Blood products • Interventional radiology services • Works with ORSIC to control flow to OR

8. ORSIC (Operating Room Surgeon-In-Charge) • Responsible for patient flow through OR’s • Coordinates use of blood products if supply overwhelmed • Works with HPIC to monitor and coordinate blood product availability and use • Formation of operative teams when subspecialty surgical services required

9. HPIC (Hospital Physician-in-Charge) • Typically, CMO or designee • Assigns physicians in Physician Labor Pool to appropriate area of hospital • Designates ICU PIC’s, Floor PIC’s • Assigns additional MD’s as floor physicians • Each PIC provided a handheld radio for communication with HPIC

10. ICU and Floor PIC’s • Immediately round with unit lead nurse to identify all patients that can be transferred to lower level of care • Calls info (# of patients/# of movable patients) to HPIC • Oversees MD’s assigned to floor in caring for incoming and existing patients • Communicates blood product and IR needs to HPIC

11. Medical Staff Rules/Regs • Previously, no provision for MD’s not on case to make decisions re: care/transfer • In a MCI, difficult triage decisions likely need to be made • Authored new section of Medical Staff Rules and Regulations allowing PICs to make treatment and transfer decisions without having to contact patient’s MD • Approved by MEC’s/BOD

12. Disaster Flow

13. “A Unique Hospital Physician Disaster Response System For a Non-employed Medical Staff” James D. Leo, MD, FCCP; Desiree Thomas, RN, MSH, CCRN; Ginger Alhadeff, BA, RN, MA March/April 2009