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Alternate Treatment Sites (ATS): A Guide for Development

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  1. Alternate Treatment Sites (ATS): A Guide for Development McLean County Area EMS System (MCAEMS System)

  2. Your speakers • Alan Otto, MS, EFO • Emergency Preparedness Coordinator OSF St. Joseph Medical Center • Mark Lareau, RN, BSN • Emergency Disaster Preparedness Coordinator Advocate BroMenn Medical Center • Shay Simmons, MBA, USMC (Ret.) • Emergency Preparedness and Response Coordinator McLean Co Health Department • Greg Scott, RN, MS, EMT-P, CHEC • Director McLean County Area EMS System

  3. Learning Objectives Upon completion of this session, attendees should be able to: Identify 4 key stakeholders in the Alternate Treatment Sites (ATS) planning process Identify 5 planning assumptions inherent in establishing an ATS agreement Identify 4 benchmarks for potential ATS partners

  4. The McLean County ATS Experience Background Alan Otto, M.S., E.F.O. Emergency Preparedness Coordinator OSF St. Joseph Medical Center

  5. McLean County Illinois • The largest county by land area in Illinois. • A 2010 population of 169,572, increase of 12.7% from 2000. • Largest communities • Bloomington 2010 population = 76,610. Population change since 2000: +18.2%, and • Normal 2010 population = 52,497. Population change since 2000: +15.7% • Largest employers: • State Farm Insurance Companies (14,450) • Illinois State University (3,259) • Country Financial (2084) • Two Medical Centers • Advocate Bro Menn (221 bed level II trauma Center) • OSF St. Joseph (149 bed level II trauma Center

  6. Background Information MCAEMS System Hospitals Resource Hospitals (Designation rotates annually July 1 – June 30) Advocate BroMenn Medical Center (Normal) OSF St. Joseph Medical Center (Bloomington) Associate/ Participating Hospitals Advocate Eureka Hospital (Eureka) Dr. John Warner Hospital (Clinton) St. Margaret’s Hospital (Spring Valley) Cooperative Planning and Response Partner OSF St. James Medical Center (Pontiac)

  7. Background Information Alternate Treatment Site (ATS) Existing patient care facility Resources capable of treating Minor “Walking Wounded” patients Green Triage Tag Activated for sudden MCI, typically traumatic in nature Alternate Care Site (ACS) Facility not typically used for patient care Space used by hospitals to create additional “inpatient” beds Activated for more long term incidents, typically infectious in nature (e.g. infectious outbreak, pandemic)

  8. Historical MCI Response in McLean County Transport Team Leader assigned patient destinations All patients to Advocate BroMenn and OSF St. Joseph, equally divided. This “equal” division did not always result in equal load on each hospital Both hospitals “accepted” whatever rolled through the door. Both probably overloaded with yellow/red patients. Both were easily overloaded with green patients.

  9. Historical MCI Response in McLean County Inefficient patient care Some Red/Yellow patients possibly transferred to other hospitals Some Green patients possibly transported to other areas outside of the Emergency Department Inside the facility Outside the facility Delayed patient care Green patients would wait indefinitely Especially dangerous for Red/Yellow patients

  10. Problem Recognition • Hospitals easily overwhelmed by MCI or other incidents/events

  11. Problem Recognition • Must find other facilities to treat victims

  12. Why Consider ATS in Illinois? • Tornado-Joplin, Missouri • 161 deaths • 1150 injuries • Multiple Tornados-Birmingham, Alabama • 238 regional deaths (figures vary depending upon source) • UAB hospital in Birmingham took in 134 patients overnight • 1500 people seen in hospitals statewide

  13. Why Consider ATS in Illinois? • January 1999 blizzard • January 4, entire state declared disaster area • 43 deaths in Chicago area • ANY MCI OR PATIENT SURGE MAY INDICATE THE USE OF ATS!

  14. National Benchmarks Largely Non-Existent But… • NIMS implementation guidance for the National Hospital Preparedness Program's (HPP) FY12 Funding Opportunity Announcements (Dated Dec 9, 2011), • Preparedness/Planning 4: Participate in interagency mutual aid and/or assistance agreements, to include agreements with public and private sector and nongovernmental organizations. • TJC standard EM.02.02.11 As part of its Emergency Operations Plan (EOP) the hospital prepares for how it will manage patients during emergencies

  15. Benchmarks Appear Largely Non-Existent But… • A basic premise of NIMS is that all incidents begin and end locally! • You are responsible for solving your problems.

  16. ATS Planning Participants • MCAEMS System • Includes Advocate BroMenn Medical Center and OSF St. Joseph Medical Center • American Red Cross of the Heartland • Illinois State University Student Health Services • McLean County Health Department • Bloomington Fire Department • Normal Fire Department

  17. ATS Planning/Implementation Takes Time • November 2006 - discussion of ATS by MCAEMS System members • 2006-2010 - background and preparatory discussion • August 2010 – first meeting with ATS stakeholders • August 2011 – policy submittal to IDPH • September 2011 – first test of policy • October 2011 – policy approval by IDPH

  18. The ATS Planning Process Mark Lareau, R.N., BSN, CHEC Emergency/ Disaster Preparedness Coordinator Advocate BroMenn Medical Center

  19. Concept Development • Realization of MCI response problems • Additional realizations about MCI response • Specialist could be at one hospital; patients needing that specialist could be sent to the other • Either hospital could have circumstances affecting its ability to take an equal number of patients • Hospital plans included sending Green patients to other areas within the hospital or clinics associated with the hospital

  20. Concept Development • Other realizations • Regional preparedness planning posed the question of how many Red/Yellow/Green patients could we take • Couldn’t answer because we were accustomed to taking whatever rolled through the door and never considered what we could manage • Preparedness efforts involve planning for sites for hospital surge/overflow patients • ACS vs. ATS

  21. Concept Development • What If… • …hospitals determined what they could take and directed EMS accordingly rather than taking whatever rolled through the door? • …those Green patients skipped the middleman and went straight to the clinics? • …we included other healthcare providers not associated with the hospitals?

  22. Planning Assumptions • Not formally stated but these were the assumptions from which we worked • Planning timeline • Policy Development • Hospitals determine patient destinations • Transport directly to final treatment site, rather than using hospital as an intermediate • Include ATS not previously considered • Written MOU's • Others were developed during the process

  23. Planning Assumptions cont. • Focus is on positive outcomes for patient care • Plan should align with everyday operations to the maximum extent possible • Plan must incorporate ICS principles and be in accordance with NIMS • Consensus planning (stakeholder representation) • Plan must be adaptable to “all-hazards” emergency operations

  24. Planning Timeline • MCAEMS System MCI Policy Development • ATS Policy Development • County EMA MCI Plan Revision • ACS Policy Development • Slight Deviation off the Timeline • Emergent Transfer of Medical Control • Resource hospital directly impacted during a drill • “Alternate Resource Hospital” can take temporary responsibility for Medical Control

  25. EMS MCI Policy Revisions • Defined an MCI • Early notification of hospitals, RHCC, IDPH • MABAS box alarm cards for EMS • Additional resources, including RMERT • Automatic notifications • Note: EMS response may include Casualty Collection Point (not the same as an ATS)

  26. ATS Policy Development • Continuing from/consistent with EMS MCI Policy • Using existing structure with Resource Hospital as the lead • Using existing resources that already treat these types of patients • Outline responsibilities of the Resource Hospital, EMS system hospitals, and ATS

  27. ATS Policy Development • Ideas discarded along the way • Resource Hospital and Alternate Resource Hospital each communicates with half of the hospitals and half of the ATS • This could lead to problems with two lines of communication • Resource Hospital tracking each patient vs. overall numbers

  28. Preliminary Ideas

  29. Preliminary Ideas

  30. ATS Policy Development • Pre-incident Responsibilities • Resource Hospitals and ATS maintain contact information • NIMS training • Notifications • MCI policy activated by EMS • EMS notifies Resource Hospital with casualty types and numbers • Early notifications to RHCC and IDPH

  31. ATS Policy Development • Determine need for other hospitals & ATS • Resource Hospital & Alternate Resource Hospital • Resource Hospital contacts EMS system hospitals and ATS • Hospitals report what they can take (Guidelines) • ATS chooses to participate, or not, and how many they can take

  32. ATS Policy Development • Resource Hospital directs Transport Team Leader on patient destinations • How many of Red/Yellow/Green patients to each hospital or ATS • Each hospital and ATS maintains log of MCI patients for tracking, family reunification, and possible reimbursement • If a Green patient deteriorates at an ATS, 9-1-1 is used

  33. Communications Interoperability • Phone • MERCI – 155.280 • “Disaster Channel” – Old Technology • Disaster phone line • StarCom • “Ham” radio • Sat phones

  34. Barriers to Policy Development • Time • Scheduling busy members from multiple agencies • Multiple drafts (no templates or benchmarks) • ATS buy-in • Recruitment/ Presentation • Acceptance of concept • Development and legal review of MOU • Liability • Financial • Training requirements

  35. Including Key Stakeholders • Advocate BroMenn Medical Center • American Red Cross of the Heartland • Bloomington Fire Department • Illinois State University Student Health Services • McLean County Area EMS System Office • McLean County Health Department • Normal Fire Department • OSF St. Joseph Medical Center

  36. Engaging Stakeholders Shay Simmons, MBA, USMC (Ret.) Emergency Preparedness Coordinator McLean County Health Department

  37. Emergency Planning and Response in McLean County • McLean County Disaster Council (MCDC) • Established 1969 • MCAEMS System Hospital Preparedness Work Group

  38. McLean County Disaster Council Members • State Farm Insurance Companies • Country Financial • AFNI, Inc • Ameren IP • Central Illinois Regional Airport • City of Bloomington • Town of Normal • Village of LeRoy

  39. McLean County Disaster Council Members, cont’d. • McLean County Area EMS System • McLean County EMA • McLean County Health Department • OSF St. Joseph Medical Center • Advocate BroMenn Medical Center • McLean County METCOM • Illinois State University

  40. McLean County Disaster Council Members, cont’d. • Illinois Wesleyan University • Heartland Community College • American Red Cross • Salvation Army • United Way/PATH 211 • Faith in Action • ARES

  41. McLean County Disaster Council Members, cont’d. • TSA • FBI • Illinois National Guard • Illinois State Police • And many more….

  42. McLean County Disaster Council Committees • Drill • MABAS/Mass Casualty • Emergency Communications • By-laws • Incident Command Training • Terrorism/Pandemic • Special Needs • LEPC

  43. Emergency Planning and Response in McLean County • Drills/exercises as well as real-world • H1N1 • “Snowmageddon” • Stability and Continuity • Leverages long-standing relationships • Emphasizes established MOU's

  44. Identifying Stakeholders • EMS and fire departments • County EMA/ESDA offices • Hospitals and other healthcare facilities • Local and State Public Health Departments • NGOs such as the American Red Cross

  45. Identifying Potential ATS Sites • Considerations • Facility capabilities • Time constraints • Legal and financial barriers • Lack of benchmarks

  46. ATS Site Benchmarks • Ability to deploy trained, credentialed personnel in support of surge capacity • Accommodations and capability • Supply and re-supply capability • Communications capability

  47. ATS Selection • Facilities already established within the community • Acute care walk-in clinics • Advocate BroMenn Medical Group • ISU Health Services • OSF Prompt Cares • Existing workforce • Need for ICS training