Preparing for the Next Disaster:  A Hospital Leadership Forum

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Community-Based Mass Prophylaxis: A Planning Guide for Public Health Preparedness. Planning guide helps communities nationwide prepare for vaccine and drug dispensing in the event of a bioterrorism or other public health eme

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Preparing for the Next Disaster: A Hospital Leadership Forum

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1. Preparing for the Next Disaster: A Hospital Leadership Forum Sally Phillips, RN, PhD November 29-30, 2006

2. Community-Based Mass Prophylaxis: A Planning Guide for Public Health Preparedness Planning guide helps communities nationwide prepare for vaccine and drug dispensing in the event of a bioterrorism or other public health emergency: Provides framework for understanding dispensing operations Applies dispensing concepts to be run on the Bioterrorism and Epidemic Outbreak Response Model (BERM) Discusses command and control framework for dispensing clinics based on CDC’s National Incident Management System Available in print (1-800-358-9295) or on the Web (http://www.ahrq.gov/research/cbmprophyl/cbmpro.htm) This planning guide and the related modeling tools on the next slide are being used extensively throughout the country. The guide and the project director Dr. Nathaniel Hupert participate with the CRI and the stockpile training initiatives. It is on the AHA web site and has been downloaded over 1000 times. This planning guide and the related modeling tools on the next slide are being used extensively throughout the country. The guide and the project director Dr. Nathaniel Hupert participate with the CRI and the stockpile training initiatives. It is on the AHA web site and has been downloaded over 1000 times.

3. Planning and Response Bioterrorism and Epidemic Outbreak Response Model (BERM) Tool provides basis for Mass Prophylaxis Model calculations--change input values at any time to observe effect on staffing, campaign length, and population coverage estimates (TRIPOD/NYC OEM/ NYCDHMH) Computer Staffing Model for Bioterrorism Response Computer model designed to give estimates of staff needed to operate a mass prophylaxis center given specific population size and staff limitations of a jurisdiction--can be downloaded as spreadsheet or accessed on Web: http://www.ahrq.gov/research/biomodel.htm The BERM model and the associated Point of Dispensing plans that were developed were due to be tested on Sept. 12 in NYC. It had been developed with the OEM and the health department and was later tested in a large scale exercise in May of 2002 and in the PODEX exercise last month with the stockpile that was featured on CNN. The staffing model allows modeling and senario based decisions for the staffing needed associated with the dispensing plans. If these tools had been put in place in NJ as they are in NYC, TOPOFF3 would have looked very different.The BERM model and the associated Point of Dispensing plans that were developed were due to be tested on Sept. 12 in NYC. It had been developed with the OEM and the health department and was later tested in a large scale exercise in May of 2002 and in the PODEX exercise last month with the stockpile that was featured on CNN. The staffing model allows modeling and senario based decisions for the staffing needed associated with the dispensing plans. If these tools had been put in place in NJ as they are in NYC, TOPOFF3 would have looked very different.

4. Evidence-Based Tool: Evaluation of Hospital Disaster Drills Helps hospitals to: Identify strengths and weaknesses in their responses during a disaster drill Improve their ability to fulfill required emergency management plans Based on need to: Plan drill objectives Train observers Document drill activities Debrief all participants This report and evaluation tool has been requested extensively from our clearinghouse. It is serving and the basis for a simple afteraction reporting tool for hospitals and health systems to use for reporting to state and local officials , and within systems for improvement planning. The new reporting tool is supported by HRSA and will be provided to HRSA grantees in the next round of guidance. It could be integrated into the HCEEP reporting that ODP has currently.This report and evaluation tool has been requested extensively from our clearinghouse. It is serving and the basis for a simple afteraction reporting tool for hospitals and health systems to use for reporting to state and local officials , and within systems for improvement planning. The new reporting tool is supported by HRSA and will be provided to HRSA grantees in the next round of guidance. It could be integrated into the HCEEP reporting that ODP has currently.

5. EPRI Emergency Preparedness Resource Inventory (EPRI) Web-based tool helps local, regional, or State planners assemble an inventory of critical resources that would be useful in responding to public health emergencies Also includes implementation report, technical manual, and appendix http://www.ahrq.gov/research/epri The next set of slides are examples of the tools and models that have been released this year that have primarily resulted from the $10 million investments from HHS in FY02/03. This is primarily a planning tool that many public health and Medical individuals at the state and local level involved in hospital and regional preparedness have adopted and adapted. It has potential to be the basis of a national system and could be linked with ODP for broad regional preparedness since it not only addresses health and medical resources, but fire houses, ambulances, mortuary, clergy, etc. In a case like a pandemic flu, if emergency preparedness plans included these kind of indept inventory items, the response to an emergency for Pandemic would be greatly enhanced.The next set of slides are examples of the tools and models that have been released this year that have primarily resulted from the $10 million investments from HHS in FY02/03. This is primarily a planning tool that many public health and Medical individuals at the state and local level involved in hospital and regional preparedness have adopted and adapted. It has potential to be the basis of a national system and could be linked with ODP for broad regional preparedness since it not only addresses health and medical resources, but fire houses, ambulances, mortuary, clergy, etc. In a case like a pandemic flu, if emergency preparedness plans included these kind of indept inventory items, the response to an emergency for Pandemic would be greatly enhanced.

6. Mass Casualty Response: Alternate Care Site Selector Tool helps regional planners locate and rank potential alternative sites during a bioterrorism or other public health emergency Available as an Excel spreadsheet; includes recommendations for supplies, equipment, and personnel Included in report, Rocky Mountain Regional Care Model for Bioterrorist Events: http://www.ahrq.gov/research/altsites.htm Dr. Cantrill and his team have been very helpful in the planning, staffing and equipping support of the Medical Contingency Stations with Dr. Claypool. Many commuities are self reporting that they are using the tool and recommendations from this project as they preselect alternative sites for surge capacity.Dr. Cantrill and his team have been very helpful in the planning, staffing and equipping support of the Medical Contingency Stations with Dr. Claypool. Many commuities are self reporting that they are using the tool and recommendations from this project as they preselect alternative sites for surge capacity.

7. The Decontamination of Children Video/DVD The Decontamination of Children: Preparedness and Response for Hospital Emergency Departments Trains emergency responders and hospital emergency department staff to decontaminate children after being exposed to hazardous chemicals during a bioterrorist attack or other disaster Produced for AHRQ by Children’s Hospital, Boston

8. Federal Integrated System Initiatives Standardized “Real Time” National Bed Availability and Patient Tracking System- Prototype Integrated Patient Tracking/Locator Model Models and Tools for Mass Casualty Surge Requirements National Mass Patient Movement, Regulating and Tracking System These 4 projects are an example of system models that are disparate, all relate to a national response to a mass casualty event that are not currently linked but could easily be in a next generation research agenda. The last project has some of the systems integration elements in place with the 3 above but still only at the prototype level.These 4 projects are an example of system models that are disparate, all relate to a national response to a mass casualty event that are not currently linked but could easily be in a next generation research agenda. The last project has some of the systems integration elements in place with the 3 above but still only at the prototype level.

9. National Mass Patient and Evacuee Movement, Regulating, and Tracking System

10. National Mass Patient and Evacuee Movement, Regulating, and Tracking System Co lead with AHRQ ( Sally Phillips) and DoD ( Christy Music) Other key partners: DHHS, DOT, DVA, DHS, GSA, State and local stakeholders

11. Key Project Goals Build a planning tool for use BEFORE a mass casualty / evacuation incident to estimate shortfalls in resources to transport patients and evacuees Develop recommendations for a system (“The National System”) that could be used DURING a large scale, multi-jurisdictional mass casualty / evacuation incident to locate, track, and regulate patients and evacuees Improve decision making regarding: Patient and/or evacuee movement Resource allocation Incident management

12. Key Questions That The National System Will Address Incident Commanders: How many and what type of people have been affected? Emergency Operations Centers: How many and what type of patients exist? To which hospitals are they transported? How many evacuees are in the system? DOD: What Federal transportation and other assets will be needed to supplement local and state assets to transport patients and evacuees? Public Health Department / Relief Organizations: How many people are in shelters and what are their specific medical needs? The Public: Where is my loved one? Remember that DOD is funding this project, so their question (what Federal assets will be needed) is especially important. Remember that DOD is funding this project, so their question (what Federal assets will be needed) is especially important.

13. Patient / Evacuee Tracking: Key Principles Activated system Track location and health status/needs of any person encountering the system Track at “touch points”, which include overnight facilities, temporary staging areas/collection points, and (possibly) vehicles loading/unloading Require minimum data elements to login or update, but build system to accept more detailed demographic and medical information Build from person-level data, but accept aggregate (location-level) data System is accessible to both public and emergency responders / planners Data access and reporting must be tightly controlled Build on existing systems as much as possible Link to the low, mid-range, and high end system that we discussed last time. Link to the low, mid-range, and high end system that we discussed last time.

14. Success Depends on Integration with Existing Systems Current or Planned Feeder Tracking Systems Jurisdiction-specific systems (e.g., commercial systems) Agency-specific systems (e.g., DOD) Feeder Institutional Records Systems (“Check In / Check Out Systems”) All facilities with mandatory reporting (e.g., MDS, OASIS) All facilities using a common software platform (e.g., all hospitals running Vendor X’s software) All facilities within an agency (e.g., National Shelter System) Single facility (e.g., a hospital with a “homegrown” system) Our # 1 principle for the National system: The less we have to rely on new data entry and the more we rely on systems that are regularly used at the local level, the more likely the national system will actually work. “Success” means that complete and accurate data are in the incident-wide tracking database. What type of existing systems are we talking about? Tracking and institutional records systems. These are systems that are used on a regular basis by locals or agencies. E.g., a city may activate their local tracking system in an MCI of 6 or more casualties. We include institutional records systems because virtually all institutions have something like this – they use it everyday – it’s an essential part of their business. (The same holds for resource availability systems.) What does integration mean? Do to next slide. Our # 1 principle for the National system: The less we have to rely on new data entry and the more we rely on systems that are regularly used at the local level, the more likely the national system will actually work. “Success” means that complete and accurate data are in the incident-wide tracking database. What type of existing systems are we talking about? Tracking and institutional records systems. These are systems that are used on a regular basis by locals or agencies. E.g., a city may activate their local tracking system in an MCI of 6 or more casualties. We include institutional records systems because virtually all institutions have something like this – they use it everyday – it’s an essential part of their business. (The same holds for resource availability systems.) What does integration mean? Do to next slide.

15. Minimum Data Elements Unique identifier (a universal algorithm for assigning IDs would be ideal) Name, sex, DOB (if not available, substitute age range, race and notable physical characteristics to help identify the person) Health Status red, yellow, or green triage color (pre-hospital patient assessed by medical personnel) ICU, floor, or discharge ready/not admittable (hospital patient assessed by medical personnel) - acutely ill, ill, well with medical history (needing medical attention), healthy (evacuee assessed by non-medical personnel) Location (ID/name/type), Date, time

16. Other Important Data Arrival or departure (arriving at hospital vs. departing from hospital) Language (English, other) Special transportation needs: ALS/BLS ambulance, wheelchair Special medical needs: ventilator, oxygen, dialysis, current medications, cardiac monitor Contamination/radiation/contagious status Security/supervision needs/status (psychiatric patients, prisoners) Family unification code (to link family members to each other) Final "exit" status (dead, left with relatives, went home) Attached files (medical records and images)

17. Mass Evacuation Transportation Planning Model Purpose of the model Estimate total transportation and other assets needed to evacuate P/Es Estimate required Federal assets needed to supplement local assets Inputs Facilities to be evacuated Patient / evacuee acuity and mobility Location and capacity of receiving facilities Available vehicles and staff to carry out evacuation Model to be available on AHRQ web site This is a planning model – to provide estimates in your plans. Facilities include hospitals, staging areas, or a mass casualty scene Vehicles are typically ALS, BLS, wheelchair van, or busThis is a planning model – to provide estimates in your plans. Facilities include hospitals, staging areas, or a mass casualty scene Vehicles are typically ALS, BLS, wheelchair van, or bus

18. http://www.ahrq.gov/browse/bioterbr.htm

19. For More Information Contact: Sally Phillips, RN, PhD E-mail: [email protected]

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