Doug Brown – ACH Emergency Management Coordinator Ron Crane – UAMS Emergency Preparedness Manager

1. New Lessons and Ideas from Receiving Hospitals in the Gustav EvacuationsNational Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator Ron Crane – UAMS Emergency Preparedness Manager March 5, 2009

2. Road Map • Chronology • Preparation • Patient Reception • Aftermath • Issues & Ideas • Lessons Learned

3. Little Rock, we have a problem!

4. CHRONOLOGY

5. NDMS History of FCC Little Rock • Activated in 2005 for Katrina & Rita • Received patients via Ground & Air • Activated in 2008 for Gustav • Received patients via Air • Little Rock, Arkansas FCC has had more activations and patient receptions than any other FCC / NDMS Jurisdiction

6. PREPARATION

7. Prior to Reception • Metro Hospital Leadership met to discuss strategies & tactics • Hospital Liaison Officer & Deputy selected to be onsite and interface with IC • Creation of “Net Control” Position, pseudo COML • Multiple communications platforms activated

8. Preparation • All Little Rock NDMS Reception Hospitals ready and prepared • Massive EMS mutual aid response not just metro area, but statewide • Great cooperation from Central Flying Service & Little Rock National Airport – served as the NDMS Reception Site

9. Preparation Continued • Arkansas Department of Health on scene and assisted with data management • Local & Statewide Offices of Emergency Management provided support • Little Rock Air Force Base personnel assisted with patient movement from planes to triage • VA EMRT provided medical & transport support

10. Activation • Thursday, August 28 – FCC receives official alert notice of potential activation • Friday, August 29 – Official activation notice for Little Rock FCC • Saturday, August 30 – Notified to begin receiving patients by noon, first patients received at 22:57 • Sunday, August 31 – 12 additional flights till conditions deteriorate

11. PATIENT RECEPTION

12. Patient Reception

13. Patient Reception

14. Patient Reception

15. NDMS Receiving Hospitals • Arkansas Children’s Hospital • Arkansas Heart Hospital • Baptist Medical Center – Little Rock • Baptist Memorial – North Little Rock • Central Arkansas Veterans Healthcare System • Conway Regional Medical Center • North Metro Hospital • Saline Memorial - Benton • St. Vincent Infirmary • St. Vincent – Sherwood • University of Arkansas for Medical Sciences • Jefferson Regional Medical Center – Pine Bluff

16. Receiving Hospital Totals • Arkansas Children’s – 2 • Arkansas Heart – 9 • Baptist Little Rock – 42 • Baptist N Little Rock – 25 • Conway Regional – 9 • Jefferson Regional – 6 • North Metro – 7 • Saline Memorial – 15 • St. Vincent – 46 • St. Vincent North – 16 • UAMS – 24 • VA – 24 • GRAND TOTAL of 225

17. Reception of Aircraft • Over a 40 hour non-stop period the NDMS hospitals prepared for and received 13 total aircraft • C-130 8/30 22:57 • C-130 8/31 04:25 • C-17 8/31 07:48 • C-130 8/31 10:15 • C-17 8/31 13:00 • C-130 8/31 14:00 • C-130 8/31 14:30 • C-130 8/31 16:40 • C-130 8/31 19:50 • C-17 8/31 19:55 • C-17 (Canadian) 8/31 20:10 • C-130 8/31 21:20 • C-130 8/31 21:21

18. AFTERMATH

19. After the “Rush” • Feeling very good about the work we did • Created new paradigm…we think • Very good coordination with local partners • No real plan yet to get folks back…but, “it’s cool.” • Downtime and turning off • Solidified position as EM with “outsiders”

20. The Dreaded Census • Most hospitals are at or near capacity • Administration beginning to ask what do we do for discharge • Questions as to whether there is a plan for repatriation • IKE!!!!

21. Conference Call HELL • NDMS / HHS / USPHS / FEMA, State Agencies, Louisiana Department of Health & Hospitals, Arkansas Hospital Association, Local Hospitals, Arkansas Department of Emergency Management, Red Cross, Arkansas Department of Human Services, Louisiana DRCs, and then Federal Contractors, plus other states that received a fraction of what we did!

22. ISSUES & IDEAS

23. Uh Oh…The BIG GAGGLE • Conference Calls reveal there is no real plan to repatriate patients • Much confusion amongst reception hospitals as to how to handle discharges • State and NGOs brought in…more confusion • Feds, although effort laudable, create more consternation and confusion

24. If you want something done right… • By September 17, most patients have not left LR Metro area • Incredible Frustration with Contractor • #$%* FEMA NUMBERS!!! • UAMS discharges all patients at 100% cost to themselves • Hospitals begin renting buses and directly contacting LA Hospitals directly

25. More of the same… • After 3 ½ weeks of interminable conference calls and numerous administrative strokes / MIs, patients finally begin moving • Federal requests difficult to accomplish • Family members / attendants accompanying patients now inpatients • Fatalities

26. Freak Accident or Vigilance?

27. Lessons Learned

28. What we learned…Bad News First • Headquarters ASPR/NDMS needs to speak to the “boots on the ground” • PROPS to TRANSCOM • Numerous studies, but who did they talk to? • REPATRIATION is not yet worked/figured out • REIMBURSEMENT is a HUGE issue STILL!!!

29. Lessons Learned • Pre-activation • During the Event • Post Event & Repatriation

30. Pre-activation • Monitor the weather…no matter where you are • Any storm with potential of land fall, we are closely watching • Bolster communications capability • Have a Go Team • PLAN! • Be wary of “politics”

31. HOSPITAL LIAISON • PARADIGM SHIFT • Remember, this is a Hospital Centric Op! • Able to provide situational awareness / operational intelligence • Protected hospitals during local surge events • Interfaced with IC • DON’T BE BULLIED!!!

32. COMMUNICATIONS • Interoperability is KEY! • Have a COML / Net Control in place • Multiple modes of comms • Radio for FACT • Conference Call for RUMOR CONTROL • Bed Census, etc.

33. During the Event… • Hospital Liaisons in place at reception site • Communications with multiple agencies other than hospitals • ADH & NDMS Area Emergency Manager (IC) worked very well to assist receiving hospitals • Don’t be tied to one bed census • Situational awareness KEY - WAITING

34. Post Event… • Until Repatriation / Reimbursement Issues worked out, be prepared to go it alone • Be careful of overextending your bed capacity in the event of long stays • Administration needs to be fully aware of consequences of receiving patients • No NDMS reimbursement for ancillary cost

35. Steps Forward / Proposal • Pre-assigned FEMA #s to all evacuated patients • CMS wavers to hospitals in not only impacted areas, but in reception areas too! • Go Teams to embarkation points • Ability to deal directly with evacuating hospitals

36. Steps Forward / Proposal • Ability for locals to pick a contractor(s) or repatriate themselves • Fatality Management • Need for Public Assistance / Individual Assistance

37. Ideas for moving Forward • Better process from activation to reception to include adequate notice from embarkation to reception sites • Better coordination on ground in impacted areas • Current NDMS Structure only identifies “broad” categories, need to rethink (dialysis)

38. Ideas for moving Forward • Hospital Liaison position greatly reduced need of subsequent transfers to different hospitals as opposed to Katrina • NDMS has failed to recognize the need to extend the flow of patients through the entire continuum of care including step down, LTAC, Skilled nursing, and alternative care

39. QUESTIONS???

40. Thank You Doug Brown Arkansas Children’s Hospital 501-680-3950 brownda1@archildrens.org Ron Crane UAMS 501-837-9682 rcrane@uams.edu