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TOPOFF 2 Hospital Lessons Learned May 2005. Leslee Stein-Spencer R.N., M.S. HOSPITALS – ALL SHAPES AND SIZES. 46 hospitals within the City of Chicago 187 total state-wide Range in size from 62 to 800+ beds Specialty hospitals: ventilator rehab psychiatric VA.

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TOPOFF 2 Hospital Lessons Learned May 2005

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    1. TOPOFF 2Hospital Lessons LearnedMay 2005 Leslee Stein-Spencer R.N., M.S.

    2. HOSPITALS – ALL SHAPES AND SIZES • 46 hospitals within the City of Chicago • 187 total state-wide • Range in size from 62 to 800+ beds • Specialty hospitals: ventilator rehab psychiatric VA

    3. ABOUT THE EMS SYSTEM: • A system established to direct care from the scene to the hospital doors • Established in 1972 by Illinois state statute • Administered by the Illinois Department of Public Health (IDPH) • All hospitals participate in an EMS System • 11 EMS Regions-62 EMS Systems

    4. EMS SYSTEM PARTICIPANTS • Hospitals, trauma centers and hospitals approved for pediatrics • Fire departments (EMS and First Responders) • Private and Volunteer ambulance providers • Specialized vehicle providers

    5. EMS SYSTEM STRUCTURE • In addition, hospitals select their “level” of participation in system management: “Resource”, “Associate” & “Participating” • In Chicago, there are 3 Resource Hospitals: Advocate Illinois Masonic (North) Northwestern (Central) University of Chicago ( South)

    6. FUNCTIONS OF THE EMS SYSTEM • Communication (telemetry, cell phone, MERCI radio) • Medical oversight for all pre-hospital and hospital to hospital care • Lead for communication for disasters and coordination of bed and medical resource availability

    7. NORMAL OPERATIONS • For normal operations and small-scale disasters, patients are transported to the closest appropriate hospital – comprehensive or trauma center • Resource Hospitals oversee transport instruction for disasters that can be managed using only regional hospital resources

    8. DISASTER OPERATIONS • In the event of a large scale disaster, state statute has created the: “State Emergency Medical Disaster Plan” • Nationally, all accredited hospitals are required to have an “Emergency Management Plan” (EM Plan) Disasters: How To Book

    9. EM PLANS… • Describe how the hospital will respond to both internal and external disasters and emergencies • Address 4 phases of emergency management activities: • mitigation (prevention), • preparedness, • response & • recovery

    10. EM PLANS… • Identify a wide range of hazards Severe Weather UTILITY FAILURE FACILITY FIRE MASS CASUALTY Bomb Threat TELEPHONE OUTAGE

    11. EM PLANS… • Include procedures addressing how the hospital will respond to disaster events • Are tested at least twice yearly and modified as necessary (communications and FSE) • Identifies the State Medical Disaster Plan for major incidents

    12. IDPH State Medical Disaster Plan • Provide assistance to allow EMS personnel and health care facilities to work together • Provide assistance when local resources are overwhelmed

    13. HOW DOES IT WORK? • Local medical resources become overwhelmed • Local official from the affected area contacts the State to request assistance • IDPH activates the plan • IOHNO operational in Springfield


    15. The Emergency Medical State Disaster Plan • Builds on the existing regional management system • Designates one regional Resource Hospital as “POD” or “lead” in the event of a large disaster

    16. State Medical Disaster Plan Disaster POD Hospitals Lead Hospital in Region: Responsible for disaster coordination of medical response/resources Assess blood, beds,special needs that are available in the Region Coordinate Regional RMERT teams Serves as Point of contact: Resource/Associate/Participating IOHNO Hospital Public Information

    17. EMERGENCY MEDICAL DISASTER PLAN - PHASE I Queries regional resource availability: • ED beds • Blood • Beds (monitored & unmonitored) • Ventilators (adult, pediatric and universal) • Regional Emergency Medical Response Teams (ReMERT) • Ambulances • Decontamination capability • Isolation capability • Pharmaceutical cache • Helicopter landing pad capability

    18. EMERGENCY MEDICAL DISASTER PLAN - PHASE II Queries availability of specific types of hospital beds: • Intensive care • Medicine • Psychiatry • Surgery • Orthopedics • Burns • Spinal Cord Injury • Obstetrics/Gynecology • Pediatrics • Negative Pressure rooms • Total Beds

    19. TOPOFF2 “Dirty Bomb” Seattle, WA Canada Bioterrorism Chicago Federal Govt.

    20. Proposed Scenario • Covert bioterrorism attack in Illinois • Overt radiological attack on Seattle, occurring after recognition of biological attack • Infrastructure attack on King County, Washington • Cyber-attack on State of Washington Information System • 2 or more “take-down” sites in Illinois • Tertiary venues throughout the U.S.

    21. Biological AgentKey Facts to Consider • No scene • No bells and whistles • No warning that victims will be coming in • Increase in number of patients visit to ED • Maybe increase ambulance runs • Astute trained/observant clinicians in ED

    22. T2 Concept • Open exercise • Year long planning and exercises • Seattle gets the dirty bomb • Illinois gets the Plague • Canada gets a little of both

    23. TOPOFF • Stands for Top Officials: • Secretary Ridge • Governors • Mayors • Decision makers of homeland Security • Cabinet members • State and local agencies

    24. TOPOFF 2Scenario Outline • Terrorist cell enters the City and plans a biological attack • Biological agents released covertly at 3 separate sites • Disease outbreak occurs in City and collar counties • Disease outbreak is identified as Pneumonic Plague by IDPH • IDPH requests SNS

    25. Goals • …to assess, evaluate the current state of readiness for the following: • State • Emergency Mgmt • Fire/Police/EMS • Local Health Depts. • Hospitals

    26. Facts about the event • Fact: It will happen(*) • It will be a biological event • It is being written with the input from representatives from all departments playing • The State Medical Disaster Plan will be implemented throughout the State • All hospitals will play

    27. How the Game is Played • Slow release at predetermined sites • When Illinois “peaks” with the event a “dirty bomb” will go off in Seattle • Hospitals will start to see increase of patients • Distribution of the patients based on “mapping system” • Interjects will be utilized as necessary to move the drill in the right direction MSEL MSEL

    28. Roles of the Hospitals • You direct extent of play • Decide what and who you want to evaluate and play including: • Lab participation • Media Participation • Security Participation • Entire hospital units • Real vs. paper patients • Morgue • Communications

    29. Timeline 120 hospitals are playing throughout the state Hospital play begins 5p 5/12 Hospital play ends 5/14 at 5p Greatest hospital participation will be Tuesday and Wed with real and fax patients

    30. Local Health Departments • Will be actively playing in drill • Epidemiological investigations • Will need to talk to patients or see the “paper”patient charts

    31. Critiquers andData Collectors • 2 or more from each institution • Must attend a MANDATORY training session • Will be utilized for both fax and real patients • Critiquers will evaluate other hospitals: not their own

    32. TOPOFF Hospital Preparation • Evaluate physical environment internet capabilities walkie talkies alternate care sites Morgue expansion Media and PIO traffic patterns lockdown/victim entrance

    33. TOPOFF Hosp. Prep. Cont. • Evaluate operations • prepare multiple HEICS commanders and section leaders • prepare/designate support staff to assist with scribe duties • prepare/evaluate emergency credentialing • prepare/educate pharmacy to receive and distribute SNS and other cache

    34. TOPOFF Hosp. Prep. Cont. • Operations Cont. • Develop EHS protocol for staff prophylaxis and follow up • Store and monitor inventory of PPE availability-educate staff • Include mental health and social services in planning stage • Insure adequate food and water supply • Evaluate neg. pressure capacity

    35. TOPOFF Hosp. Prep. Cont. • Operations cont. • Prepare lab personnel-including chain of evidence • Consider/evaluate remote triage areas • Design staff plan for optimal exposure to exercise • Include community partners and neighboring hospitals

    36. TOPOFF Hosp. Prep. Cont. • Management Approach • Create checklists/check often • Encourage critical thinking & creative problem solving • Stress- not a test-no wrong ans. • Buy-in from highest level

    37. TOPOFF Hosp. Prep. Cont. • Misc. • Security issues • Patient/family information issues • EMTALA/COBRA considerations • Identification of fatalities • Pediatric considerations • High Risk population/special needs • Cafeteria staff-how much food • Engineering-DECON

    38. Response-Hosp.Prep. • Will need to maintain hospital functions • Be constantly aware of the fatigue factor • Reassure public and pts. that this is a drill • Be sure entire staff is aware • Be sure that MEDICAL STAFF is aware • Be sure that MEDICAL STAFF is aware • Be sure that MEDICAL STAFF is aware

    39. RESPONSE • Establish “All hands on deck” philosophy. • Disasters are no longer the realm of the ED……they belong to everyone now. • Consider potential of losing your ED • Consider potential of house-wide contamination • Consider exercising internal issues that need attention (i.e. concurrent power failure, communication, staff)

    40. RECOVERY • Require after action reports from all players and all departments (consistent format) • Develop plans to address after-action recommendations • Develop means to capture financial costs • Develop ways to support staff during and after crisis • Remember to look after yourselves as well.

    41. TOPOFF II • If you can’t say it with an acronym don’t say it at all. • JIC • JOC • VNN • MSEL • SIMCELL • HHAN • IOHNO • ROC • Color Alert/CODE Whatever

    42. Soooo Just remember: This is Biggest! Bestest! Funnest! Disaster Drill That YOU will ever have the opportunity to play in !

    43. Sooo who played in Illinois? • 5 counties Kane Dupage Cook Chicago Lake • 5 Local Emergency Management Offices & IEMA

    44. Players • FBI • CFD, CPD, ISP • Hospitals and Hospital Associations • MABAS • Various pre-hospital providers • DOJ/ODP • USPHS, CDC and lots of federal organizations • Lawyers from multiple organizations • Gov. of Illinois • “Mayor” of Illinois

    45. Who Played Cont? • 62 hospitals for Epi purposes both real and fax patients • 4 additional hospitals including VA and specialty hospitals • 120 hospitals receiving either faxed patients or participating in the communications portion of the SMDP

    46. TOPOFF 2Overview: May 12th – 16th • May 10th-----plague released at the United Center, Union station, O'Hare International Terminal • May 11th-----Mothers day ( MAT) • May 12th-----Dirty Bomb released in Seattle • IOHNO, SEOC, 911 EOC open • May 12th evening---Patients start to show up at area hospitals in Chicago Metro area • May 14th- End of Hosp. Play • May 15th- SNS • May 16th –Hot Wash

    47. IDPH and Hospital Play Summary of Play Events: • Monday: IOHNO opens at 3 pm 2:30 pm broadcast fax sent out to all hospitals announcing red alert 4:30 pm broadcast fax sent out stating that the nation is not on red alert 5 p.m. 24 hospitals begin play receiving real and faxed patients 10 p.m. broadcast fax alerting hospitals to respiratory like illness Region X implements System-Wide Crisis policy • Tuesday: JIC opens hospital play begins with paper and real patients SMDP implemented Ongoing Broadcast Fax’s throughout the day including Illinois going to red alert

    48. Hospital Play Cont. Wednesday: JOC Opens last update for SMDP requested at 2p (results by 4p) last patient was suppose to be 5p…DOJ calls for drill to end earlier Thursday: EMTALA requirements waived for Ill.TOPOFF hospitals-T.Tompson. Midway Airport airplane crash

    49. HospitalLessons Learned • Dedicate a person to check on faxes • Runners for distribution of faxes/memo’s • Fax's large and need to be numbered • Look at some type of video conferencing during a disaster • Concern over allocation of drugs and supplies for personnel • Isolation of patients for special procedures