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Lessons Learned from the Field of Emergency Preparedness. Thursday, November 6, 2008 12:00-1:30 pm EST. 2. Questions. To pose a question to the Panelists, please post it in the Q&A panel on the right hand side of your screen and press send.

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lessons learned from the field of emergency preparedness

Lessons Learned from the Field of Emergency Preparedness

Thursday, November 6, 2008

12:00-1:30 pm EST

questions
Questions
  • To pose a question to the Panelists, please post it in the Q&A panel on the right hand side of your screen and press send.
  • To expand or decrease the size of any panel on the right hand side of your screen, click the arrow shape in the upper-left corner of the panel.
  • To pose a question to WebEx’s technical support, you can also post it in that Q&A panel and press send. Or you can dial

1-866-229-3239.

3

agenda
Agenda
  • Introduction, Cindy DiBiasi
  • Identifying and Preparing Alternate Care Sites, Terri Gill
  • Resource Allocation in an Emergency, Nancie McAnaugh
  • Inventorying Emergency Preparedness Resources, Christian Feller
  • Q&A

4

slide5
Terri Gill

Senior Emergency Services Coordinator

Emergency Preparedness Office

California Department of Public Health

Identifying and Preparing Government Authorized Alternate Care Sites in California

5

california surge standards and guidelines project
California Surge Standards and Guidelines Project
  • The Surge Standards and Guidelines Project:
    • Convened a broad group of stakeholders and interested parties to develop comprehensive guidelines and standards for surge capacity planning.
    • Developed standards and guidelines that would serve as the basis for emergency planning and operations.

6

alternate care sites
Alternate Care Sites
  • One focus of the Surge Standards and Guidelines Project was to look beyond hospitals for surge capacity.
  • Defined Alternate Cares Sites (ACSs) to reflect the legal requirements and operational needs for the State
    • A government-authorized ACS is a location not currently providing healthcare services
    • Outpatient and inpatient care will vary
    • These specific sites are not part of the assets of an existing facility

7

the rocky mountain regional care model
The Rocky Mountain Regional Care Model
  • The Rocky Mountain Regional Care Model for Bioterrorist Events was used to identify areas to focus on to plan for surge in Alternate Care Sites including:
    • Site Selection
    • Staffing
    • Supplies
  • Prioritized components to determine which items were critical and which could be reasonably accommodated.
  • This model helped us to develop tools specific to California.

8

california s definitions
California’s Definitions
  • California’s definitions are based on an operational approach to surge planning.
  • Definitions recognize that all licensed healthcare facilities and expansions of such facilities must operate under existing/modified statutory and regulatory standards and that government authorized alternate care sites are not governed by these statutes and regulations.

9

roles and responsibility for alternate care sites
Roles and Responsibility for Alternate Care Sites
  • The California Emergency Services Act recognizes the role of the State and its political subdivisions to mitigate the effects of an emergency.
  • From this authority, local governments can contract with local public and private entities to establish an ACS.
  • Under the CDPH Pandemic Influenza Response Plan, local health departments (LHD) are responsible for identifying and planning for the operations of government authorized ACSs.
  • It is NOT the expectation that LHDs operate ACSs.
  • Local government has the responsibility to set-up and operate ACS.

10

slide11

Planning for Alternate Care Sites

  • Development of an Alternate Care Site Planning Team
  • Need for public and private partnership
  • Broad participation across stakeholder types
  • Help from existing healthcare providers is critical
  • All hazards approach

11

patient care in alternate care sites
Patient Care in Alternate Care Sites
  • The Standard of Care is a moving target based on what a reasonable person with like training would do under similar circumstances.
  • Healthcare delivery in alternate care sites will vary from traditional hospital care and will be dependent on available resources.
  • Based on local surge needs, each identified ACS will include some mix of the following types of patients:
    • Outpatient
    • Inpatient
    • Critical/Acute

12

state alternate care site caches
State Alternate Care Site Caches
  • The alternate care site cache of supplies and equipment was designed using an all-hazards approach to provide for 10-14 days of care for 50 patients.
  • Each ACS Cache contain items separated into 9 groups:
    • IV Fluids
    • Bandages and Wound Management
    • Airway Intervention and Management
    • Immobilization
    • Patient Bedding, Gowns, Cots, Miscellaneous
    • Healthcare Provider Personal Protective Equipment (PPE)
    • Exam Supplies
    • General Supplies
    • Defibrillators and Associated Supplies – A special group that will be vendor managed off-site

13

conclusions
Conclusions
  • Alternate Care Sites are a last resort when the healthcare delivery system cannot meet patient care needs
  • Alternate Care Sites pose a difficult challenge
  • Creativity in meeting this need is necessary
  • It is important to capitalize on models that have already been developed
  • California is working with local government to better understand how the State can help

14

poll question 1
Poll Question #1
  • A short poll will appear on your screen. Please take a few seconds to answer the poll and provide valuable feedback!
  • If you are unable to respond to the poll during this event, please e-mail your answer to emergencypreparedness@academyhealth.org.

15

questions1
Questions
  • To pose a question to the Panelists, please post it in the Q&A panel on the right hand side of your screen and press send.
  • To expand or decrease the size of any panel on the right hand side of your screen, click the arrow shape in the upper-left corner of the panel.
  • To pose a question to WebEx’s technical support, you can also post it in that Q&A panel and press send. Or you can dial

1-866-229-3239.

16

slide17
Nancie McAnaugh

Deputy Department Director

Missouri Department of Health and Senior Services

Resource Allocation in an Emergency: Using AHRQ Tools to Enhance State Planning Efforts

17

planning scenarios
Planning Scenarios

Pandemic Influenza

New Madrid Fault

Bioterrorism Events

Chemical Events

Explosive Events (Including Dirty Bombs)

18

missouri healthcare system
Missouri Healthcare System

20 Federally Qualified Health Centers

123 acute care hospitals

6 children’s hospitals

23 designated trauma centers

1 pediatric trauma center

  • 1,169 long term care facilities
  • 216 ambulance services
  • 193 home health agencies
  • 98 ambulatory surgical centers
  • 14 psychiatric hospitals

19

health care systems readiness scarce resource allocation committees
Health Care Systems Readiness/ Scarce Resource Allocation Committees

Initial planning efforts addressed pandemic influenza

As the subcommittee finished its initial efforts, the focus changed to allocation of scarce resources

20

agency for healthcare research and quality ahrq tools
Agency for Healthcare Research and Quality (AHRQ) Tools

Mass Medical Care with Scarce Resources

Altered Standards of Care in Mass Casualty Events

21

altered standards of care
Altered Standards of Care

What did we need to know to develop plans that provided an effective and fair medical response to a mass casualty event?

Were there key principles that professionals had agreed upon that should inform our planning for mass casualty events?

What were the critical issues that we needed to consider and address in planning for the provision of health and medical care in a mass casualty event?

22

mass medical care with scarce resources
Mass Medical Care with Scarce Resources

Pre-hospital Care

Hospital and Acute Care

Alternative Care Sites

Palliative Care

23

mass medical care with scarce resources1
Mass Medical Care with Scarce Resources

Model framework utilized by Scarce Resource Allocation Committee

Encouraged local public health agencies to utilize the tool in their discussions with their local emergency planning committees

Utilized the mass medical care tool to inform discussions with representatives of the trial attorneys association

24

planning outcomes
Planning Outcomes

Ventilator-Allocation Protocol

Statewide Emergency Medical Services Workgroup

Cross-Departmental Statute & Regulations Workgroup

Pandemic “grief” training for managers and supervisors

Creation of a statewide ethics consortium

25

challenges
Challenges

Transferring outcomes created with tools to rural Missouri settings

Getting buy-in from non-public health state partners on tools

Lack of public awareness regarding the limitations of the health care system

Pediatric issues

26

poll question 2
Poll Question #2
  • A short poll will appear on your screen. Please take a few seconds to share your feedback with AHRQ.
  • If you are unable to respond to the poll during this event, please e-mail your answer to emergencypreparedness@academyhealth.org.

27

slide28

Inventorying Emergency Preparedness Resources: A Regional Approach to Resource Management

Christian Feller

Aultman Hospital

Director of Safety and Emergency Management

Akron Regional Hospital Association

Emergency Management Chairman

28

emergency preparedness resource inventory tool epri description and uses
Emergency Preparedness Resource Inventory Tool (EPRI) Description and Uses

EPRI is an internet-based tool enabling first responders, healthcare and private / public entities the ability to compile an inventory of critical resources via a public domain database tool.

Provides flexible access to inventory data via a website.

Provides the ability to make emergency requests and tabulate responses.

Generates reports on quantity, location, discipline and availability.

Meets ASPR (Assistant Secretary for Preparedness and Response) guidelines for tracking of grant funded purchases.

29

regional implementation
Regional Implementation

Identification of a region-wide issue.

Established objectives with attainable deadlines.

Development of a multidisciplinary committee.

Regional Coordinators, Emergency Management Agencies (EMA), Public Health, Hospitals

Evaluation of various resource management tools or response tools with included resource management components over a 9 month period.

Tools evaluated on the following criteria:

Affordability

Customizable

Internet Based

Security

Customer Support

Ease of Use

30

regional implementation cont d
Regional Implementation Cont’d

Identified EPRI as the emergency resource tool of choice based on the following criteria:

No cost while existing contracts are in place

Windows based

Remote (internet) hosted

Ability to back up information and hosting site redundancy

Password protected with various user levels

Strong reporting capabilities for all disciplines

NIMS (National Incident Management System) compliant

Customizable and able to integrate with various file types

Open ended infrastructure for mapping tie-ins

Free tech support while under contract

31

regional implementation cont d1
Regional Implementation Cont’d

Presented findings to regional steering committee for approval to move forward

Identified workgroups within specific disciplines to identify resources for input

Healthcare – All ASPR funded purchases over $250.00

Public Health – All CDC (Center for Disease Control) funded purchases over $250.00

EMA – All NIMS identified resources

Worked with Abt Associates to develop training modules and user manuals

Developed region specific standard operating procedures and guidelines and policies

Worked with Abt Associates to load initial data such as demographics and contacts

32

regional implementation cont d2
Regional Implementation Cont’d

Identified a pilot group to use for a 1 month period in order to identify operational opportunities for improvement.

Pilot test group consisted of the following:

3 Hospitals

2 Health Departments

2 EMAs

Pilot group evaluations to be completed by December 1, 2008. A full report to the regional steering committee during the December meeting.

Full media campaign to begin December 1st, 2008 in order to spark interest and engagement among various disciplines.

33

future plans
Future Plans

First quarter of 2009 all 33 regional hospitals will go live with EPRI.

Usage to be tied back to ASPR funding requirements

Public Health to be on-line by mid-summer of 2009

EMAs to be brought on-line as demand exists.

Use EPRI effectively in 2009 regional exercise.

Provide EPRI to all county emergency operations centers within the region.

34

future plans cont d
Future Plans Cont’d

Work with regional fire and police entities to provide data or pull data from the State of Ohio response plans.

Provide implementation assistance to other Ohio regions, so all state healthcare organizations have access to, and provide data for, EPRI.

Work collaboratively with adjacent state regions to develop a multi-state EPRI tool.

Continue to promote the implementation and usage of EPRI to all interested parties.

35

challenges1
Challenges

Eliminating “Resource Silos”

Not overstepping the EMA’s authority

Work output at a regional level

Elimination of grant funding

System ownership

36

strategies
Strategies

Continue to provide a secure method of data input, tracking and reporting.

Stress importance of EPRI being a tool to assist EMAs in resource identification and acquisition.

Continue to engage regional participants through projects that benefit individual entities.

Think long term when developing regional based tools and how they will be funded.

Provide key contacts and “system owners” that are funded by the region or have region interests in mind.

37

poll question 3
Poll Question #3
  • A short poll will appear on your screen. We appreciate your feedback!
  • If you are unable to respond to the poll during this event, please e-mail your answer to emergencypreparedness@academyhealth.org.

38

slide39
Q&A
  • If you have a question for any of today’s presenters, Terri Gill, Nancie McAnaugh, or Christian Feller, please type it into the Q&A panel to the right and press send.

39

next webcast
Next Webcast

Public Health Emergency Preparedness: Planning and Practicing for a Disaster

Winter 2009

To learn more go to the Webcast Web page at: http://www.academyhealth.org/knowledgetransfer/EPWebcasts.htm

40

for more information about
For more information about….
  • Today’s event including a recording and transcript, go to: http://www.ahrq.gov/prep/
  • AHRQ’s suite of emergency preparedness tools, go to: http://www.ahrq.gov/prep/
  • Public Health Emergency Preparedness: Planning and Practicing for a Disaster, please visit our Web site at: http://www.academyhealth.org/knowledgetransfer/EPWebcasts.htm
  • If you have a question regarding future Webcasts or utilizing AHRQ tools please e-mail us at emergencypreparedness@academyhealth.org.

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thank you
Thank you!
  • A brief feedback form will pop up when you close your browser. Please take a few moments to give us your feedback on today’s event.
  • Thank you!

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