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Hospital Disaster Preparedness. Special Committee on Disaster Preparedness Planning December 13, 2006. What We Are Preparing For: All Hazards. B ioterrorism, O ther I nfectious D isease O utbreaks, and O ther P ublic H ealth T hreats and E mergencies. Goals of Preparedness.

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Hospital disaster preparedness

Hospital Disaster Preparedness

Special Committee on Disaster Preparedness Planning

December 13, 2006


What we are preparing for all hazards

What We Are Preparing For:All Hazards

Bioterrorism, Other Infectious Disease Outbreaks, and Other Public Health Threats and Emergencies


Goals of preparedness

Goals of Preparedness

Enhance our surge capacity response

Collaboration and integration of plans of all emergency response partners

Ability to maintain services in a sustained event


Dual use of funds philosophy

“Dual Use of Funds” Philosophy

“Preparing for the unthinkable will prepare us for the most likely”



Recipients of hrsa funds
Recipients of HRSA* Funds

  • Hospitals

  • EMS

  • Community Health Centers

  • Tribal Health Clinics

  • Healthcare Facilities (nursing homes, assisted living, etc) (limited funding)

  • Physician Offices (limited funding)

    *HRSA: Health Resources and Services Administration (DHHS)


Personal protective equipment

Personal Protective Equipment

Personal Protective Equipment for biological events is stockpiled in the 7 regions

Rural regions have 20,000 changes +

Urban regions have 50,000 changes +

There is a state stockpile of an additional 1,000 “kits” (airborne, contact and droplet precautions)

One kit serves 25 patients for one day

Hospitals have also received Medical PAPRs

recommended for aerosolized procedures


A irborne i nfectious i solation aii capacity
Airborne Infectious Isolation (AII) Capacity

  • Most hospitals have reached the State Goal of:

    • 2 AII rooms in the Emergency Department

    • 1 AII room on the Medical Surgical Unit

    • 1 AII room in the Intensive Care Unit

    • AII rooms with 1 ante room per 100 staffed beds

    • 2% of all staffed beds are AII

  • Increase from 400 AII rooms to 1200 AII rooms

  • Creation of additional 670+ NPSC rooms


Clinic demonstration project

Single Entrance Capability

Lockdown Capability

Triage Area

Waiting Rooms

Mechanical Ventilation

AII Rooms

Education/Training

Patient Flow

Administration

Respiratory Etiquette

PPE

Education

Surveillance

Surge Capacity

Reports

Implementation Issues

Incremental Costs

“One Year After” Report

Clinic Demonstration Project


Inpatient surge capacity
Inpatient Surge Capacity

  • May 2004 Exercise

    • 11,000 staffed beds

    • 11.000 surge beds

      • 4,100 surge beds pre-positioned at hospitals (built to certain clinical specifications) 20% have mattresses

  • Inpatient and Outpatient Surge Capacity Plan


Ip op surge capacity plan
IP/OP Surge Capacity Plan

  • Assignment of beds, staff, supplies and equipment, base don Level of incident

  • Beds designated for RED, YELLOW and BLACK patients

  • GREEN patients to be treated at Alternative Outpatient Treatment Sites


Chemical decontamination

Chemical Decontamination

All hospitals have a portable decontamination shelter

…decontamination suits

…pre and post decon patient kits

…decontamination training

Funds available to construct/renovate fixed decon rooms


Chempacks

ChemPacks

ChemPacks are placed strategically throughout the state, containing nerve agent antidotes.

ChemPacks are available within 1 hour of request

--- There are HOSPITAL packs (immediate and long-term treatment)

--- There are EMS packs (immediate treatment in the field)


Incident command system

Incident Command System

ICS is the structure used by all emergency responders

Hospitals are required to be compliant with the “National Incident Management System” (NIMS) Elements 7, 9, 10, 11 in order to receive federal funds after August 31, 2007

All hospitals have adopted the top 8 positions


Regional trauma advisory councils

Regional Trauma Advisory Councils

EMS and First Responders are being trained in the Wisconsin EMS Emergency Preparedness Plan

…including training for triage, using START and JumpSTART (pediatric) protocols

START: Simple Triage and Rapid Treatment

and also Pediatric education for Pre-Hospital Professionals (BLS and ABLS)


Triage tuesday
“Triage Tuesday”

  • On one designated day all patients brought by ambulance along with those coming to the hospital ED will be “triaged and tagged”

  • Purpose: better integration of EMS and hospital triage


Interim pharmaceutical stockpile
Interim Pharmaceutical Stockpile

  • Interim Pharmaceutical Stockpiles (IPS) are strategically placed around the state

  • The IPS can be deployed within 4 hours of request

  • IPS contains

    • Amoxicillin

    • Doxycycline

    • Ciprofloxacin

    • (no pediatric dosages at the present time; instructions for dispensing in tablet format)


Ips pharmaceuticals
IPS Pharmaceuticals

  • Intended recipients:

    • Hospital staff and family

    • Medical Staff and family

    • First Responders and family

  • Purpose: maintain integrity of healthcare and critical services infrastructure

  • Strategic National Stockpile (SNS) arrives within 12 hours with medications for the general public (to be dispensed by public health)


Hospital laboratory preparedness

Hospital Laboratory Preparedness

Wisconsin State Laboratory of Hygiene has trained hospital labs in the packaging and transport of biological and chemical specimens

Funding for BioSafety Cabinets and centrifuges with sealed carriers has been provided


Electronic laboratory reporting
Electronic Laboratory Reporting

  • 11 pilot projects: 9 hospitals and 2 clinics (more to follow)

  • “Lessons Learned” will help to establish real-time electronic laboratory reporting of communicable diseases to the State Health Department

  • Other surveillance projects are being funded by public health such as WEDDS, Electronic Health Record, Electronic Death Record


Communications redundancy
Communications Redundancy

  • 4 levels of communications redundancy

    • Landlines and cellular telephones

    • UHF/VHF two-way radio

    • Satellite Telephones (voice, email, data)

    • Amateur HAM Radio (internal and external communications)

  • Interoperability Plans


Legal workgroups
Legal Workgroups

  • Follow-up to issues not addressed in “Hospitals’ Guide to Mass Casualty Incidents” – a summary of federal and state law re: emergencies

  • Guide can be found at www.mbf-law.com

  • Phase II: identification of unresolved issues


State expert panels
State Expert Panels

  • … on Physician Offices

    • Infection Control Measures

    • Unusual Occurrences

    • Mass Casualty Guidelines

    • Alerting Protocols

  • … on Management of Decon Effluent: (each hospital to meet with its POTW to establish a plan)


State expert panels1
State Expert Panels

  • … on Disaster Reimbursement (dialogue between payors and providers

    • Billing and Coding Issues

  • …on Dispatch (consistent protocols for Dispatch in a mass casualty incident – any incident involving 5 or more patients being transferred to one or more hospitals)


State expert panel
State Expert Panel

  • …on Evacuation of Hospitals and Other Healthcare Facilities (one consistent state-wide protocol for shelter-in-place or evacuation)

  • … on Pediatric Preparedness (hospital and EMS )

    • “Midwest Pediatric Resources Directory”

    • Patient Tracking (in progress)

    • “Pediatric Guidelines” (in progress)

    • “Patient At Risk (in progress)


State expert panel1
State Expert Panel

  • … on Materials Management (supplying hospitals in a mass casualty incident)

  • … on Human Resources (protocols for the deployment of volunteers and a policy for your staff who choose to serve as volunteers)

  • … on Ventilator Capacity (enhancing the ability of hospitals to provide positive pressure ventilation)


State expert panel2
State Expert Panel

  • … on Disaster Ethics (addressing the multitude of decisions that will need to be made regarding triage, resource allocation and so much more)

  • … on Healthcare Facilities (assisting nursing homes, assisting living facilities and other such facilities enhance their preparedness levels)

  • … on Radiation Emergencies (protocols for hospitals, physician offices, EMS for the management of patients exposed to radiological agents)


Wisconsin disaster credentialing
Wisconsin Disaster Credentialing

  • A web-based, password-protected system to allow for

    • Primary Source Verification (all licensed HCWs)

    • Verification of quality and competency (physicians)

    • In compliance with JCAHO standards for Disaster and Temporary Privileging

  • Available to all hospital and local health departments

  • Wisconsin Emergency Assistance Volunteer Registry (WEAVR)


Burn plan
Burn Plan

  • There are limited burn beds in Wisconsin (Madison and Milwaukee)

  • Proposal is to establishing holding hospitals where there is trained staff (HRSA funded) to maintain patients for 72 hours before transfer to a burn center in collaboration with the American Burn Association


Physician disaster preparedness education
Physician Disaster Preparedness Education

  • Provide education to 2,000 clinics

  • Goals:

    • Establish/reinforce Infection Control relationships

    • “Infection Control Measures for Physician Offices”

    • Mass Casualty Checklist

    • Health Alert Protocols


Pandemic flu
Pandemic Flu

  • Hospital Pandemic Flu Policy and Protocols for

    • Pre-Pandemic Phase

    • Pandemic Phase

    • Post Pandemic Phase

  • Issues addressed in each Phase:

    --- Surveillance --- Emergency Response --- Communications --- Vaccine ---Antiviral --- Clinical Practice


Minimum level of readiness indicators
Minimum Level of Readiness Indicators

  • Your obligation is to be in compliance with these Indicators as appropriate for your type of facility

  • Further Indicators are being added: 1) training competencies, 2) management of radiological incidents, 3) ChemPack Distribution, 4) Behavioral Health, 5) Risk Communications, 6) Evacuation, 7) Patient Tracking, 8) Ethics, 9) Materials Management


Healthcare leadership
Healthcare Leadership

  • “To think that the worst will not happen is natural…

  • ...to lead in preparing for the worst is a moral imperative.”


Local healthcare is critical
Local Healthcare Is Critical

  • Despite all the preparations at the State or National level,

  • Every disaster is LOCAL.

  • What matters most to the community is not the state and national response...

  • …what will save lives is the response of the local organization


Contact information

Contact Information

Dennis Tomczyk

Director, Hospital Disaster Preparedness

Wisconsin Division of Public Health

608-266-3128

tomczdj@dhfs.state.wi.us