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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

    14. HOW DOES IT WORK? STEP ONE IDPH NOTIFIES THE POD HOSPITAL OF PLAN ACTIVATION– PHASE 1 OR 2 STEP TWO POD HOSPITAL INITIATES THE PHONE TREE FOR THE REGION STEP FOUR POD HOSPITAL REPORTS INFORMATION GATHERED TO IDPH STEP THREE REGIONAL HOSPITALS AND EMS PROVIDERS COLLECT INFORMATION ON RESOURCE AVAILABILITY

    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