Download - NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009
![Page 1: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/1.jpg)
1
![Page 2: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/2.jpg)
Mass Medical CareDuring an Influenza Pandemic:
Establishing Influenza Care Centers
PRESENTATION AND WORKBOOK
NACCHO Advanced Practice Center (APC)
Road Shows Albuquerque, New Mexico
August 11-12, 2009
![Page 3: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/3.jpg)
APC Toolkit
3
![Page 4: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/4.jpg)
Toolkit Sections
1. Concept of Operations2. Command and Control 3. Communications4. Staffing and Training5. Clinical Standards,
Protocols and Operations
6. Infection Control
7. Fatalities and Morgue8. Facilities9. Equipment and
Supplies10. Security11. Transportation
4
![Page 5: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/5.jpg)
Toolkit Tools
5
![Page 6: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/6.jpg)
Today’s Objectives• Present highlights of the toolkit.• Focus on your local area
requirements for mass medical care.• Use the workbook to start
your planning.
6
![Page 7: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/7.jpg)
What Are Expectations or Requirements?• In California:
– Hospitals surge to care for seriously ill or injured.
– Public health activates ACS/ICCs to care for moderately acute ill or injured patients, thereby taking the load off hospitals.
– (Originally, hospitals were expected to set up and run the ACS...).
• What are State-wide expectations or requirements for ACS activation?
7
![Page 8: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/8.jpg)
What’s the Status of Current Planning ?• Healthcare Surge Plan (area-wide)?• Hospital surge plans?• Mass dispensing site (s) operational plan?• Alternate Care Site (ACS) operational plan?
8
![Page 9: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/9.jpg)
ACS Planning Resources• APC Toolkit – based on SCC’s ICC.
http://www.sccgov.org/portal/site/phd/agencychp?path=%2Fv7%2FPublic%20Health%20Department%20(DEP)%2FAdvanced%20Practice%20Center%20(APC)
• CA Dept Public Health Standards and Guidelines for Healthcare Surge During Emergencies, Volume 2 http://bepreparedcalifornia.ca.gov/NR/rdonlyres/640A3732-2667-4F61-B044-413478888816/0/volume2_ACS_FINAL.pdf
• CA Government-Authorized Alternate Care Site Operational Tools Manual. http://bepreparedcalifornia.ca.gov/NR/rdonlyres/C2AD6528-F781-4D8C-B900-828A1C2C6F0C/0/Operational_ACS_Ops_Tool_FINAL.pdf
• Seattle-King County APC Video http://www.kingcounty.gov/healthservices/health/preparedness/%7e/media/health/publichealth/documents/hccoalition/AltCareVideo.ashx
9
![Page 10: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/10.jpg)
Elements of Planning: Interconnected Decisions
10
![Page 11: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/11.jpg)
Influenza Care Centers (ICC)• For pandemic planning, Santa Clara
County established the concept of Influenza Care Centers (ICC).
• ICCs are alternative care sites designed to address the needs of moderateacuity patients in a pandemic.
11
![Page 12: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/12.jpg)
ICC Pandemic Planning Assumptions:
• Local hospital capacity will not meet hospitalization demand:– Bed capacity limits (adult and pediatric acute
care, adult critical care, pediatric & neonatal critical care).
– Ventilator limits (all ventilators, including disposable, mass casualty ventilators).
12
![Page 13: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/13.jpg)
ICC Pandemic Planning Assumptions:• Illness, hospitalizations, fatalities
– 25-35% popn clinically ill
– 13-22% require hospitalization
– 2.5-5.0% fatalities
• 12 months w/illness, hospitalizations, fatalities evenly distributed each quarter.
13
![Page 14: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/14.jpg)
-4000
-2000
0
2000
Week
No. o
f Bed
s
Avail Hosp beds 920 229 -461 -1,150 -1,841 -2,301 -2,301 -1,841 -1,150 -461 229 920Avail ICU beds 204 76 -51 -205 -358 -486 -538 -486 -358 -205 -51 76
1 2 3 4 5 6 7 8 9 10 11 12
0
5000
10000
15000
20000
Week
Case
s
Deaths 56 225 394 563 731 844 844 731 563 394 225 56Hospitalizations 256 1,023 1,790 2,556 3,324 3,835 3,835 3,324 2,556 1,790 1,023 256Illnesses 1,125 4,500 7,875 11,250 14,625 16,875 16,875 14,625 11,250 7,875 4,500 1,125
1 2 3 4 5 6 7 8 9 10 11 12
Surge and Capacity Challenges
14
![Page 15: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/15.jpg)
Estimate # Patients, Sample – Albuquerque, New Mexico
• Estimated (Albuquerque) population 600,000
• 600,000 x .25 = 150,000 = # clinically ill
• 150,000 (# clinically ill) x .22 = 33,000 = # require hospitalization
• 33,000 (# require hospitalization) / 4 = 8,250 pts / quarter = (12-week pandemic “wave”)
15
![Page 16: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/16.jpg)
Estimate # Beds for Flu Patients Sample – Albuquerque, New Mexico• # of local area (Albuquerque) hospital beds
– University of New Mexico Hospital - 431– Heart Hospital of New Mexico - 55– Presbyterian Hospital - 453– The Children's Center at Presbyterian Hospital - 81– Lovelace Women's Hospital - 185– Kaseman Presbyterian Hospital – 252– Specialty Hospital of Albuquerque - 82– Kindred Hospital-Albuquerque – 61
• Total = 1,519 beds
• In hospital surge, 50% for flu patients = 760 beds(total includes ICU beds).
16
![Page 17: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/17.jpg)
Estimate # of ACS Patients, Sample – Albuquerque, New Mexico
ACS Patients – 12 Week Pandemic Albuquerque, New Mexico Example
Week # Hospitalizations Percentage Used
1 82.5 1.0 %
2 371.25 4.5 %
3 660 8.0 %
4 825 10 %
5 990 12 %
6 1196.25 14.5 %
7 1196.25 14.5 %
8 990 12 %
9 825 10 %
10 660 8.0 %
11 371.25 4.5 %
12 82.5 1.0 %
8,250 100%
Cumulative hospitalizations weeks 1-7, would be 5322 patients with a total of 60 available beds. An ACS is needed to care for 4 ,562 patients during peak weeks 5, 6, and 7.
17
![Page 18: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/18.jpg)
Workbook – Estimate # Patients• Estimated population: ________
• _____ x .25 = ______ = # clinically ill
• _______ (# clinically ill) x .22 = ________ = # require hospitalization
• _______ (# require hospitalization) / 4 = ______ pts / quarter = (12-week pandemic “wave”)
18
![Page 19: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/19.jpg)
Workbook: Estimate # Patients• # of local area hospital beds __________
• In hospital surge, 50% for flu patients
• = _________ beds
(total includes ICU beds).
19
![Page 20: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/20.jpg)
Workbook: Estimate # ACS/ICC Patients
• # beds available for flu patients _______________
• # patients / quarter = __________• Figure % of pts/qtr for each week. (Use
%’s shown).• Identify peak weeks.• Subtract # beds available from the
#hospitalized (cumulative – add the weeks up to and including the peak week).
• This is the number to plan for at the ACS/ICC.
ACS Patients – 12 Week Pandemic
# Patients /Quarter = 12 Weeks __________
Week # Hospitalizations Percentage Used
1 1.0 %
2 4.5 %
3 8.0 %
4 10 %
5 12 %
6 14.5 %
7 14.5 %
8 12 %
9 10 %
10 8.0 %
11 4.5 %
12 1.0 %
100%
20
![Page 21: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/21.jpg)
Toolkit Sections
1. Concept of Operations2. Command and Control 3. Communications4. Staffing and Training5. Clinical Standards,
Protocols and Operations
6. Infection Control
7. Fatalities and Morgue8. Facilities9. Equipment and
Supplies10. Security11. Transportation
21
![Page 22: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/22.jpg)
1. Concept of OperationsStep 1 – Describe the ICC, Objectives
– Standard of Care– Level of Care
Step 2 – Operational PeriodsStep 3 – ActivationStep 4 – De-activation
22
![Page 23: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/23.jpg)
ICC ObjectivesPrimary objectives for the establishment of an ICC
include, but are not limited to, the following: • Decompression of acute care hospital inpatient
beds (receiving site for hospital discharge patients who are not able to be cared for at home)
• Used instead of acute care hospital inpatient beds (inpatient care for moderate-acuity patients and palliative care)
23
![Page 24: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/24.jpg)
Standard of Care• Standard of care during a healthcare surge is the utilization
of skills, diligence and reasonable exercise of judgment in furtherance of optimizing population outcomes that a reasonably prudent person or entity with comparable training, experience or capacity would have used under the circumstances. During a healthcare surge, the standard of care will shift from focusing on patient-based outcomes to population-based outcomes*.
– California Department of Public Health (CA DPH)
24
![Page 25: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/25.jpg)
Pandemic Levels of Care
At Home CareAt Home Care Isolation Oral Hydration Oral Antibiotics
Influenza Care CentersInfluenza Care Centers • Intermediate Care• IV & Oral Hydration• Oxygen• Nursing Services• MD on call
Hospital AdmissionsHospital Admissions Critical Care Ventilators Ancillary Services
25
![Page 26: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/26.jpg)
Level of Care Planning Decisions
26
![Page 27: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/27.jpg)
Workbook: Level of Care Planning Decisions
• Estimated # patients_______
• Level of Care at hospital (s) _________________
• Level of Care at the ACS/ICC ________________
27
![Page 28: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/28.jpg)
Operational Periods• Define and describe the Operational Periods in
terms of a likely pandemic cycle and daily operation.
• It is anticipated that an ICC will be operational from eight to fourteen weeks for the first wave of a pandemic influenza event and then for an additional eight to twelve weeks during the second wave.
• Operational periods = 12 hours.
• Staffing
28
![Page 29: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/29.jpg)
ACS Activation• Follows area’s event/emergency activation
procedures per NIMs.• Authority to activate/operational policy:• The Health Officer will notify the local officials of the intent to activate and
then coordinate implementation through the Medical-Health Branch of the
Operational Area Emergency Operations Center. Positions in the ICC are
filled according to National Incident Management System (NIMS). Once
ICCs have been activated, only patients routed to ICCs or those triaged on-
site for admission will be accepted. Patients that are admitted to an acute
care hospital at the time the ICC is activated will remain in the acute care
facility and will not be transferred to an ICC.
29
![Page 30: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/30.jpg)
Workbook: Activation• Describe how emergency operations are
activated per NIMS.
• Who has authority to activate the ACS?
• What patients are admitted upon activation?
30
![Page 31: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/31.jpg)
Deactivation
• Authority to de-activate.• NIMS position to oversee deactivation.• Exit strategy in catastrophic failure:
– Facility fire– Civil unrest, gun fire– Government, societal failure
31
![Page 32: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/32.jpg)
Workbook: Deactivation• Who has authority to deactivate the ACS?
• Which NIMS position oversees deactivation?
• Describe catastrophic failures that might occur:
32
![Page 33: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/33.jpg)
2. Command/Control • ICC organization• Hospital Incident Command (HICS)• Planning with:
– Hospital representatives– Emergency management
representatives– Fire and Law enforcement– Inventory managers
USE TOOL #2
33
![Page 34: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/34.jpg)
• Step 1 – Describe relationship of ICC to Public Health
• Step 2 – Describe relationship between ICC to the EOC – Medical Health Branch
• Step 3 – Prepare organizational charts
2. Command/Control USE TOOL #2
34
![Page 35: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/35.jpg)
ICC Organizational ChartGeneral Staff
ICC Division Manager
Safety Officer
Operations Section Chief
Finance/Admin Section Chief
(See below)
Medical Care Branch Director
(See below)
Infrastructure Branch Director
(See below)
Security Branch Director
(See below)
Logistics Section Chief
(See below)
Planning Section Chief
(See below)
35
![Page 36: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/36.jpg)
36
![Page 37: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/37.jpg)
Workbook – ICC Organization Chart
• The ACS/ICC is a field operation of __________________.
• The ACS/ICC Incident Commander reports to ____________.
• Logistics and support is provided by: __________________________
USE TOOL #2 and TOOL #5
37
![Page 38: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/38.jpg)
3. Communications • Step 1 – Determine ICC needs.• Step 2 – Describe methods.• Step 3 – Consider communications:
– Within the ICC– Between the ICC and other ICCs– Between the ICC and hospitals/healthcare
providers– Between the ICC and the EOC
USE TOOL #3TOOL #18
38
![Page 39: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/39.jpg)
3. Communications • Wireless Laptop
Computer • (5) Portable 800 MHz
radios (EMS Frequencies)
• Access to existing landline fax machines
• Access to existing landline phones
• Access to internet-accessible computers
• Access to a television with cable or satellite service
• Access to a radio• Handheld Patient
Tracking Devices• Wireless router
USE TOOL #3TOOL #18
39
![Page 40: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/40.jpg)
4. Staffing and Training • Step 1 – Determine staff ratios.• Step 2 – Describe functional roles.
(Tool 4 – Functional Roles Matrix)
• Step 3 – Determine training requirements for categories of positions.
• Step 4 – Identify types of support staff needed.
USE TOOLS #4 and #5
40
![Page 41: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/41.jpg)
4. Staffing and Training
• Local public health agency employees will not be sufficient for staffing the ICCs. The broader health care community, city governments, and community volunteers must provide human resources to ensure adequate staffing of the ICCs.
USE TOOLS #4 and #5
41
![Page 42: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/42.jpg)
4. Staffing and Training• The recommended staffing patterns are based on
the following scenario for Santa Clara:
• Total number of patients per ICC = 450
• 12-hour shifts for all staff
• Patient population includes 50% patients on IV fluids (n=225) and 60% on Oxygen via nasal cannula (n=270)
• Each ICC is divided into sections (treatment units) of up to 40 patients each.
USE TOOLS #4 and #5
42
![Page 43: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/43.jpg)
4. Staffing the ICC Position Staff-Patient Ratio ICC (450 patients) ICC Treatment Unit
(40 patients; 10-12 units)
Medical Doctors
1 : 50-60
8-9
<1
Registered Nurses 1 : 15-20 23-30 2-3
Respiratory Therapists
1 : 20-30 15-23 2
Caregivers (Health Technicians)
1 : 5 90 8-9
Clerical 1 : 20 23 2
Social Workers 1 : 60 8 <1
Pharmacists 1 : 60 8 <1
USE TOOLS #4 and #5
43
![Page 44: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/44.jpg)
Workbook: Staffing• Number of patients (beds) in the ICC = (#)• Using staffing ratio chart, determine
staffing ratios to be used.• Review and revise Tool #5 Job Action
Sheets• Identify community support for staffing.
USE TOOLS #4 and #5
44
![Page 45: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/45.jpg)
ACS Staffing RatiosPosition Staff-Pt
RatioICC (450)
Santa Clara(Toolkit
Example SCC needs twelve 450 bed ICCs )
ICC (100) (22% of SCC
ICC)
(Any town, USA
Example)
ICC (___)= ___ % of SCC ICC
(450)
Staff Ratio as % of SCC’s Staff-Patient
Ratio Medical Doctors 1: 50-60 8-9 per ICC 1-2
Registered Nurses 1: 15-20 23-30 per ICC 5-7
Respiratory Therapists 1: 20-30 15-23 per ICC 3-5
Care Givers (Health Technicians)
1: 5 90 per ICC 20
Clerical 1: 20 23 per ICC 5
Social Workers 1: 60 8 per ICC 2
Pharmacists 1: 60 8 per ICC 2
Workbook: Staffing USE TOOLS #4 and #5
45
![Page 46: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/46.jpg)
4. Training • ICC Orientation – Just in Time
Training• Pre-event Clinical Operations
Training – Public Health Clinical ICC Staff
• Pre-event Clinical Skills Training
USE TOOLS #4 and #5
46
![Page 47: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/47.jpg)
5. Clinical Standards, Protocols and Operations• Standing Orders
• General• Admitting• Asthma• Heart Failure• Diabetes• Pregnancy• Palliative Care
• Clinical Triage
• Oxygen Delivery Alternatives
• Insulin and Blood Glucose Monitoring Sheet
• Pharmacy Order Form
• Patient disposition log
• ICC Intake Assessment Form
47
![Page 48: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/48.jpg)
Elements of Planning: Interconnected Decisions
48
![Page 49: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/49.jpg)
5. Clinical Standards, Protocols and Operations• Step 1 – Develop triage guidelines.• Step 2 – Describe admissions/intake process.• Step 3 – Describe pt./bed tracking.• Step 4 – Define documentation and patient charting.• Step 5 – Describe daily evaluation.• Step 6 – Describe pharmacy formulation protocols.• Step 7 – Describe discharge criteria/procedures.• Step 8 – Develop visiting rules/regulations.• Step 9 – ID housekeeping/environmental services.
49
![Page 50: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/50.jpg)
5. Clinical Protocols & Patient Care Tools
Tool 6 – Oxygen Delivery Alternatives Tool 7 – Clinical Triage Guidelines during Pandemic Critical Resources State Tool 8 – Influenza Care Center Intake Assessment Tool 9 – General Standard Orders Tool 10 – Standing Orders for Asthma Tool 11 – Standing Orders for Heart Failure Tool 12 – Standing Orders for Diabetes Tool 13 – Standing Orders for Pregnancy Tool 14 – Standing Orders for Palliative Care Tool 15 – Admitting Orders Tool 16 – Consent to Treatment Form Tool 17 – Medication Tracking Sheet-Family Tool 18 – EMSystem Tool 19 – EMTrack Tool 20 – Patient Disposition Log Tool 21 – Daily Patient Assessment Flow Tool 22 – Change Orders Tool 23 – Insulin and Blood Glucose Monitoring Tool 24 – Pharmacy Order Form Tool 25 – Medication Administration Record Tool 26 – Visitor Guidelines and ICC Etiquette Tool 27 – Patient Discharge Form
USE ALL THESE TOOLS
50
![Page 51: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/51.jpg)
5. Patient Care• Triage guidelines and admission• Admission/intake process
– Standardized Orders– Admission protocols
• Bed and patient tracking• Medical records/patient charts• Daily evaluation and treatment• Transfer dispositions
51
![Page 52: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/52.jpg)
5. Patient Care• Pharmacy protocols• Discharge protocols• Family care giving guidelines• Visitor guidelines• Environmental services
52
![Page 53: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/53.jpg)
Workbook: Clinical Protocols and Patient Care• Convene a workgroup: physicians, RNs,
EMS• Determine patient care “flow”• Review protocols
– Santa Clara County in the APC Toolkit
– New York Medical College, School of Public Health
53
![Page 54: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/54.jpg)
8. Facilities• Step 1 - Determine criteria for facility
selection.• Step 2 – List recommended facilities.• Step 3 – Diagram ICC layout.• Step 4 – ID other required facility areas
needed.• Step 5: Conduct a site visit; coordinate with
facility operators.
54
![Page 55: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/55.jpg)
Facility Criteria USE TOOL#28 and #29
1. Location and size 2. Infrastructure and equipment capacity:
a. Communications b. Unimpeded wireless connectivity c. Electrical power with back-up generator capability d. Climate control e. Adequate parking and loading ramps f. Sufficient material handling equipment (MHE) –fork lift pallet jacks
3. Patient care requirements: a. Separate rooms with large floor space for patient care b. Billeting for personnel (and possibly family members) c. Bathrooms with shower capabilities for patients d. Kitchens and food service for staff and patients; Potable water; Refrigeration; Ice
making capabilities 4. Available services:
a. Laundry facilities b. Waste removal (to include bio-hazard)
5. Security: a. Perimeter security b. Capable of being secured and secure storage for controlled substances
55
![Page 56: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/56.jpg)
SCC’s ICC Facility Requirements
Substantial square footage with
large open areas. Sites geographically distributed
around the county. Hotels: surge support.
56
![Page 57: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/57.jpg)
ACS Ward Layout USE TOOL#28 and #29
70’
50’
5’ aisles in each direction
5’ access aisle along one side
Table Table
Drug Cabinets Supply
Shelves
Patient Cart
Supply Cart Nursing
Station
Bay 1 Bay 2 Bay 3
Bay 5 Bay 4
57
![Page 58: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/58.jpg)
ACS Bay Layout USE TOOL#28 and #29
Bin
Chair
Bin
Chair
Bin
Chair
Bin
Chair
Bin
Chair
Bin
Chair
Bin
Chair
Bin
Chair
O2 Tank & Stand
20’
20’
58
![Page 59: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/59.jpg)
Workbook – Facilities • List facilities that may be used as an
ACS/ICC in your area:
USE TOOL#28 and #29
59
![Page 60: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/60.jpg)
6. Infection Control• Step 1 – Determine necessary PPE for ICC
staff.• Step 2 – Determine necessary PPE for ICC
visitors.• Step 3 – Describing environmental cleaning
procedure(s).• Step 4 – Develop procedures for disposal of
biohazard waste.
60
![Page 61: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/61.jpg)
7. Fatalities - Morgue• Step 1 – ID operational area for temporary
morgue.
• Step 2 – ID required equipment/supplies.
• Step 3 – Determine type of staffing.
• Step 4 – Describe how bodies are transferred.
• Step 5 – Describe personal property procedure.
• (See Mass Fatality Toolkit)
61
![Page 62: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/62.jpg)
9. Equipment & Supplies • Step 1 – Develop inventory list, consider local
resources & scope of ACS/ICC care.
• Step 2 – Determine storage and maintenance.
• Step 3 – Describe process for implementing: ordering and moving supplies.
USE TOOL#3
62
![Page 63: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/63.jpg)
63
![Page 64: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/64.jpg)
Equipment & Supplies• Warehouse Storage
– Electrical items – on shelves, plugged in, temperature controlled area
– Maintenance items (i.e. Glucometer) need periodic inspection, stored in bulk containers, temperature controlled.
– Pharmaceuticals, temperature controled or in refrigerator.
– Stack-limited items, heavy/bulky, palletized, stored on pallet racks, 10’ wide aisles.
– Bulk items, smaller, lighter, easily damaged, stored in bulk containers, stacked densely, w/o aisles.
64
![Page 65: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/65.jpg)
10. Security• Step 1 - Describe role of Security at ICC.
• Step 2 – Describe Access Control.
• Step 3 – Describe Crowd Control.
• Step 4 – Describe Traffic Control.
• Step 5 – Describe role of Law Enforcement Interface
• Step 6 – ID sources of security personnel.
USE TOOL#28 and #29
65
![Page 66: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/66.jpg)
Access Control • Staff, visitors, support, media, officials.• Anticipate theft of pharmaceuticals, medical
supplies.• Anticipate individuals who try to
surreptitiously remove a patient or bring a patient in to the ICC.
• Anticipate media attempting entry.• Badging, log-in and out.
66
![Page 67: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/67.jpg)
Crowd Control/Traffic Control• High volumes of ill
people.• Highly emotional
people.• Neighborhood
concerns.• Protestors, provide
escorts.
• Patient parking• Staff parking.• Patient
loading/unloading.• Ambulance• Delivery• Media area.
67
![Page 68: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/68.jpg)
11.Transportation• Step 1 – Describe policy for transporting
patients to the ICC.• Step 2 – Describe policy for transporting from
the ICC to hospital.• Step 3 – Describe how transportation
requirement will be met.• Step 4 – Describe communications for
transportation operations.• Planning with OEM Logistics
68
![Page 69: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/69.jpg)
ContactsOlivia NunezSanta Clara CountyPublic Health Preparedness976 Lenzen AvenueSan Jose, CA 95126(408) 792-5266 sccphd.org/APC
Laurie FriedmanSYA Group, Inc.1126 Broadway, Suite 4Burlingame, CA [email protected]
Rocio Luna, MPHDirector, PH Preparedness and Data
ManagementSanta Clara County Public Health
Department976 Lenzen AvenueSan Jose, CA 95126Main Line (408) 792-5040
69
![Page 70: NACCHO Advanced Practice Center (APC) Road Shows Albuquerque, New Mexico August 11-12, 2009](https://reader030.vdocuments.net/reader030/viewer/2022033108/56815084550346895dbe812c/html5/thumbnails/70.jpg)
70