Healthcare Scenarios within the Tiered Response Plan

1. Healthcare Scenarios within the Tiered Response Plan

2. Presenters Brian Kaczmarski, Training and Exercise Coordinator Office of Preparedness and Emergency Health Care

3. Outline • Review of Tiers • Similarities to the Incident Command System • Scenarios • Review • Next Steps

4. Review of the 6 Tiers • Local health care organization • Area coordination • Regional coordination • Inter-jurisdictional (amongst the 7) and State • Interstate (FEMA Region 5) • Federal Support

5. Tier 1 • Local healthcare organization (HCO) – Incident Command – EOC • Hospital Liaison • Medical triage and management will continue at the HCO • Until event over or until can no longer handle • If overwhelmed, activate Tier 2

6. Tier 2 – Area Medical Coordination Center • Must notify all involved (those in Tier 1) that Tier 2 is activated • Assuming lead of medical coordination ONLY (ESF 8) • Job – coordinate medical resources from all area coalition partners. Maintain situational awareness • WI-TRAC, WISCOM and traditional modalities • Manage until overwhelmed • Consider the need for Tier 3 activation

7. Tier 3 - Regional Medical Coordination Center (RMCC) • Assume medical coordination lead from AMCC. Communicate transfer. • Is AMCC still communicating situational awareness or will it go to RMCC? • Communicate with EOCs that are activated • Encourage activation for those that are not • Job – coordinate medical resources from all region coalition partners. Maintain situational awareness • WI-TRAC, WISCOM and traditional modalities • Manage until overwhelmed. Consider the need for Tier 4 activation

8. Clarification between Tier 2 and Tier 3 Both coordinate info and patient movement • Different scales • Both are pre-determined centers • Multiple AMCCs within a region • ONE RMCC within a region

9. Tier 4 - State and Intra-regional response • Do neighboring regions need to get involved? • Does state need to coordinate? • WI-DHS and likely Wisconsin State Emergency Operations Center (SEOC) would be activated. • Declarations likely to occur here • Is state able to provide and coordinate adequate response? • Consider need for Tier 5 activation.

10. Tier 5- Interstate Regional Management Coordination • Emergency Management Assistance Compact (EMAC) • FEMA Region 5 , FEMA, US-DHS may be needed for coordination • Can Region 5 manage the resources needed and delivery of medical assets to support the response? • Consider Tier 6 activation

11. Tier 6 - Federal Support to Response • Impacted governor(s) request federal support • Federal assets coordinated under ESF 8 (Nat’l Response Framework) • U.S. Department of Health and Human Services Secretary’s Operation Center activated to coordinate

12. Similar to ICS? • Yes! • ICS/NIMS is a foundational element of the tiers • Traditional Emergency Management response • Local • Regional • State • Federal • Follows the National Response Framework

13. Why add this now? • Traditional emergency management response • Local EOC • Regional EOC • State EOC • Tiered Response Plan – Focuses ONLY on ESF 8 type resources - established in 2004 (recognized best practice) • Traditional response still needed, still continues

14. The Vision • Rapid activation and coordinated approach to managing patients from large-scale or unusual incidents • Increased collaboration between health care , emergency response, and public service sectors • Increased Communication Interoperability between all participants in the greater Health Care Coalition • Seamless integration with the national/federal system • …so that our state will be able to provide the best medicine in the worst of times!

15. Scenarios Let’s look at a few scenarios: • Collapse of the grandstands at the county fair • Outbreak of highly contagious disease at the local school • Chemical tanker spill in a high-traffic area

16. Grandstand Collapse Summary: • 55 green • 27 yellow • 19 red • Can your HCO handle this? • Can your AMCC handle this? • What tier would you anticipate needing? • What medical coordination needs would you anticipate?

17. School Outbreak Summary: • Highly contagious outbreak • Rapid spread • Several hundred exposures • Multiple jurisdictions involved • Significant spike in ED visits • Can one local HCO handle this? • Area? • What types of coordination needs might you have?

18. Tanker Spill in High Traffic Area Summary: • Anhydrous Ammonia spill in a high traffic area. • Large volume of individuals exposed. • Environmental issues. • Exposure issues; health issues, decon issues • Rapid surge to local, area, regional hospital • 25 people splashed with the chemical • 75+ overcome by fumes/plume • Accident causes MCI • 8 green • 5 yellow • 6 red

19. The Bottom Line • Ability to respond to large-scale disasters that overwhelm and exhaust our health systems and resources • Save lives—get the right patient to the right place at the right time—and improve patient outcomes in disasters and significant emergency events • At the regional level, coordinate public health and medical response to disasters and large scale events

20. Next Steps • Learn more about the Tiered Response Plan • http://www.phe.gov/preparedness/planning/mscc/handbook/documents/mscc080626.pdf • Educate your staff and local partners • Be involved in your regions healthcare coalition development

21. Questions? DHSHCC@wisconsin.gov

22. Resources • Portions of this presentation adapted from; “Introduction to Disaster Coordination Response Tiers” webcast recorded by Dr. Liu and Dr. Clark. • Link to webcast: http://dhsmedia.wi.gov/main/Play/368747a8e01e49568ac9d175c15d68501d