Lessons Learned from the Field of Lessons Learned from the Field of Emergency PreparednessEmergency Preparedness

Thursday, November 6, 200812:00-1:30 pm EST

2

Questions Questions

To pose a question to the Panelists, please To pose a question to the Panelists, please post it in the post it in the Q&A Q&A panel on the right hand side panel on the right hand side of your screen and press send. of your screen and press send.

To expand or decrease the size of any panel on To expand or decrease the size of any panel on the right hand side of your screen, click the the right hand side of your screen, click the arrow shape in the upper-left corner of the arrow shape in the upper-left corner of the panel. panel.

To pose a question to WebEx’s technical To pose a question to WebEx’s technical support, you can also post it in that support, you can also post it in that Q&AQ&A panel panel and press send. and press send. Or you can dial Or you can dial

1-866-229-32391-866-229-3239.. 3

AgendaAgenda

I.I. Introduction, Introduction, Cindy DiBiasi Cindy DiBiasi

II.II. Identifying and Preparing Alternate Care Identifying and Preparing Alternate Care Sites, Sites, Terri GillTerri Gill

III.III. Resource Allocation in an Emergency, Resource Allocation in an Emergency, Nancie McAnaughNancie McAnaugh

IV.IV. Inventorying Emergency Preparedness Inventorying Emergency Preparedness Resources, Resources, Christian FellerChristian Feller

V.V. Q&AQ&A

4

Terri GillTerri GillSenior Emergency Services CoordinatorSenior Emergency Services Coordinator

Emergency Preparedness OfficeEmergency Preparedness OfficeCalifornia Department of Public HealthCalifornia Department of Public Health

5

Identifying and Preparing Government Identifying and Preparing Government Authorized Alternate Care Sites in CaliforniaAuthorized Alternate Care Sites in California

California Surge Standards California Surge Standards and Guidelines Projectand Guidelines Project

The Surge Standards and Guidelines The Surge Standards and Guidelines Project:Project:

– Convened a broad group of stakeholders Convened a broad group of stakeholders and interested parties to develop and interested parties to develop comprehensive guidelines and standards comprehensive guidelines and standards for surge capacity planning. for surge capacity planning.

– Developed standards and guidelines that Developed standards and guidelines that would serve as the basis for emergency would serve as the basis for emergency planning and operations.planning and operations.

6

Alternate Care SitesAlternate Care Sites

One focus of the Surge Standards and One focus of the Surge Standards and Guidelines Project was to look beyond Guidelines Project was to look beyond hospitals for surge capacity.hospitals for surge capacity.

Defined Alternate Cares Sites (ACSs) to Defined Alternate Cares Sites (ACSs) to reflect the legal requirements and reflect the legal requirements and operational needs for the Stateoperational needs for the State– A government-authorized ACS is a location not A government-authorized ACS is a location not

currently providing healthcare services currently providing healthcare services – Outpatient and inpatient care will vary Outpatient and inpatient care will vary – These specific sites are not part of the assets These specific sites are not part of the assets

of an existing facilityof an existing facility

7

The Rocky Mountain Regional The Rocky Mountain Regional Care ModelCare Model

The Rocky Mountain Regional Care Model for The Rocky Mountain Regional Care Model for Bioterrorist Events was used to identify areas to Bioterrorist Events was used to identify areas to focus on to plan for surge in Alternate Care focus on to plan for surge in Alternate Care Sites including:Sites including:– Site SelectionSite Selection– StaffingStaffing– SuppliesSupplies

Prioritized components to determine which items Prioritized components to determine which items were critical and which could be reasonably were critical and which could be reasonably accommodated. accommodated.

This model helped us to develop tools specific to This model helped us to develop tools specific to California.California.

8

California’s DefinitionsCalifornia’s Definitions

California’s definitions are based on an California’s definitions are based on an operational approach to surge planning.operational approach to surge planning.

Definitions recognize that all licensed Definitions recognize that all licensed healthcare facilities and expansions of healthcare facilities and expansions of such facilities must operate under such facilities must operate under existing/modified statutory and existing/modified statutory and regulatory standards and that regulatory standards and that government authorized alternate care government authorized alternate care sites are not governed by these statutes sites are not governed by these statutes and regulations.and regulations.

9

Roles and Responsibility for Roles and Responsibility for Alternate Care SitesAlternate Care Sites

The California Emergency Services Act recognizes The California Emergency Services Act recognizes the role of the State and its political subdivisions to the role of the State and its political subdivisions to mitigate the effects of an emergency. mitigate the effects of an emergency.

From this authority, local governments can contract From this authority, local governments can contract with local public and private entities to establish an with local public and private entities to establish an ACS. ACS.

Under the CDPH Pandemic Influenza Response Plan, Under the CDPH Pandemic Influenza Response Plan, local health departments (LHD) are responsible for local health departments (LHD) are responsible for identifying and planning for the operations of identifying and planning for the operations of government authorized ACSs.government authorized ACSs.

It is NOT the expectation that LHDs operate ACSs.It is NOT the expectation that LHDs operate ACSs. Local governmentLocal government has the responsibility to set-up has the responsibility to set-up

and operate ACS. and operate ACS.

10

Development of an Alternate Care Site Development of an Alternate Care Site Planning TeamPlanning Team

Need for public and private partnershipNeed for public and private partnership Broad participation across stakeholder Broad participation across stakeholder

typestypes Help from existing healthcare providers Help from existing healthcare providers

is criticalis critical All hazards approachAll hazards approach

11

Planning for Alternate Planning for Alternate Care SitesCare Sites

Patient Care in Patient Care in Alternate Care SitesAlternate Care Sites

The Standard of Care is a moving target based on The Standard of Care is a moving target based on what a reasonable person with like training would do what a reasonable person with like training would do under similar circumstances.under similar circumstances.

Healthcare delivery in alternate care sites will vary Healthcare delivery in alternate care sites will vary from traditional hospital care and will be dependent on from traditional hospital care and will be dependent on available resources. available resources.

Based on local surge needs, each identified ACS will Based on local surge needs, each identified ACS will include some mix of the following types of patients:include some mix of the following types of patients:

– OutpatientOutpatient

– InpatientInpatient

– Critical/AcuteCritical/Acute

12

State Alternate Care Site State Alternate Care Site CachesCaches

The alternate care site cache of supplies and equipment was The alternate care site cache of supplies and equipment was designed using an all-hazards approach to provide for 10-14 designed using an all-hazards approach to provide for 10-14 days of care for 50 patients. days of care for 50 patients.

Each ACS Cache contain items separated into 9 groups:Each ACS Cache contain items separated into 9 groups:

– IV FluidsIV Fluids– Bandages and Wound ManagementBandages and Wound Management– Airway Intervention and ManagementAirway Intervention and Management– ImmobilizationImmobilization– Patient Bedding, Gowns, Cots, MiscellaneousPatient Bedding, Gowns, Cots, Miscellaneous– Healthcare Provider Personal Protective Equipment (PPE)Healthcare Provider Personal Protective Equipment (PPE)– Exam SuppliesExam Supplies– General SuppliesGeneral Supplies– Defibrillators and Associated Supplies – A special group that Defibrillators and Associated Supplies – A special group that

will be vendor managed off-sitewill be vendor managed off-site

13

ConclusionsConclusions

Alternate Care Sites are a last resort when the Alternate Care Sites are a last resort when the healthcare delivery system cannot meet healthcare delivery system cannot meet patient care needspatient care needs

Alternate Care Sites pose a difficult challenge Alternate Care Sites pose a difficult challenge

Creativity in meeting this need is necessaryCreativity in meeting this need is necessary

It is important to capitalize on models that It is important to capitalize on models that have already been developedhave already been developed

California is working with local government to California is working with local government to better understand how the State can helpbetter understand how the State can help

14

Poll Question #1Poll Question #1

A short poll will appear on your A short poll will appear on your screen. Please take a few seconds screen. Please take a few seconds to answer the poll and provide to answer the poll and provide valuable feedback! valuable feedback!

If you are unable to respond to the If you are unable to respond to the poll during this event, please e-mail poll during this event, please e-mail your answer to your answer to emergencypreparedness@academyemergencypreparedness@academyhealth.orghealth.org..

15

Questions Questions

To pose a question to the Panelists, please To pose a question to the Panelists, please post it in the post it in the Q&A Q&A panel on the right hand side panel on the right hand side of your screen and press send. of your screen and press send.

To expand or decrease the size of any panel on To expand or decrease the size of any panel on the right hand side of your screen, click the the right hand side of your screen, click the arrow shape in the upper-left corner of the arrow shape in the upper-left corner of the panel. panel.

To pose a question to WebEx’s technical To pose a question to WebEx’s technical support, you can also post it in that support, you can also post it in that Q&AQ&A panel panel and press send. and press send. Or you can dial Or you can dial

1-866-229-32391-866-229-3239.. 16

Nancie McAnaughNancie McAnaugh Deputy Department DirectorDeputy Department Director

Missouri Department of Health and Senior ServicesMissouri Department of Health and Senior Services

17

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

Planning EffortsPlanning Efforts

Planning ScenariosPlanning Scenarios

Pandemic InfluenzaPandemic Influenza

New Madrid FaultNew Madrid Fault

Bioterrorism EventsBioterrorism Events

Chemical EventsChemical Events

Explosive Events (Including Dirty Explosive Events (Including Dirty Bombs)Bombs)

18

Missouri Healthcare SystemMissouri Healthcare System

20 Federally Qualified Health Centers20 Federally Qualified Health Centers 123 acute care hospitals123 acute care hospitals 6 children’s hospitals6 children’s hospitals 23 designated trauma centers23 designated trauma centers 1 pediatric trauma center1 pediatric trauma center

19

1,169 long term care facilities1,169 long term care facilities 216 ambulance services216 ambulance services 193 home health agencies193 home health agencies 98 ambulatory surgical centers98 ambulatory surgical centers 14 psychiatric hospitals14 psychiatric hospitals

Health Care Systems Readiness/ Scarce Health Care Systems Readiness/ Scarce Resource Allocation CommitteesResource Allocation Committees

Initial planning efforts Initial planning efforts addressed pandemic addressed pandemic influenzainfluenza

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

20

Agency for Healthcare Research Agency for Healthcare Research and Quality (AHRQ) Toolsand Quality (AHRQ) Tools

Mass Medical Care Mass Medical Care with Scarce Resourceswith Scarce Resources

Altered Standards of Altered Standards of Care in Mass Casualty Care in Mass Casualty EventsEvents

21

Altered Standards of CareAltered Standards of Care

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

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

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

22

Mass Medical Care with Mass Medical Care with Scarce ResourcesScarce Resources

Pre-hospital CarePre-hospital Care

Hospital and Acute CareHospital and Acute Care

Alternative Care SitesAlternative Care Sites

Palliative CarePalliative Care

23

Mass Medical Care with Mass Medical Care with Scarce ResourcesScarce Resources

Model framework utilized by Scarce Model framework utilized by Scarce Resource Allocation CommitteeResource Allocation Committee

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

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

24

Planning OutcomesPlanning Outcomes

Ventilator-Allocation ProtocolVentilator-Allocation Protocol

Statewide Emergency Medical Services Statewide Emergency Medical Services WorkgroupWorkgroup

Cross-Departmental Statute & Regulations Cross-Departmental Statute & Regulations WorkgroupWorkgroup

Pandemic “grief” training for managers and Pandemic “grief” training for managers and supervisorssupervisors

Creation of a statewide ethics consortiumCreation of a statewide ethics consortium

25

ChallengesChallenges

Transferring outcomes created with tools to rural Missouri Transferring outcomes created with tools to rural Missouri settingssettings

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

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

Pediatric issuesPediatric issues

26

Poll Question #2Poll Question #2

A short poll will appear on your A short poll will appear on your screen. Please take a few seconds screen. Please take a few seconds to share your feedback with AHRQ.to share your feedback with AHRQ.

If you are unable to respond to the If you are unable to respond to the poll during this event, please e-mail poll during this event, please e-mail your answer to your answer to emergencypreparedness@academyemergencypreparedness@academyhealth.orghealth.org..

27

Christian FellerChristian Feller

Aultman Hospital Aultman Hospital Director of Safety and Emergency ManagementDirector of Safety and Emergency Management

Akron Regional Hospital AssociationAkron Regional Hospital AssociationEmergency Management ChairmanEmergency Management Chairman

28

Inventorying Emergency Preparedness Inventorying Emergency Preparedness Resources: A Regional Approach to Resource Resources: A Regional Approach to Resource

ManagementManagement

Emergency Preparedness Resource Emergency Preparedness Resource Inventory Tool (EPRI) Description and UsesInventory Tool (EPRI) Description and Uses

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

Provides flexible access to inventory data via a Provides flexible access to inventory data via a website.website.

Provides the ability to make emergency requests and Provides the ability to make emergency requests and tabulate responses.tabulate responses.

Generates reports on quantity, location, discipline and Generates reports on quantity, location, discipline and availability.availability.

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

29

Regional ImplementationRegional Implementation

Identification of a region-wide issue.Identification of a region-wide issue.– Established objectives with attainable deadlines.Established objectives with attainable deadlines.

Development of a multidisciplinary committee.Development of a multidisciplinary committee.– Regional Coordinators, Emergency Management Agencies (EMA), Public Regional Coordinators, Emergency Management Agencies (EMA), Public

Health, HospitalsHealth, Hospitals

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

Tools evaluated on the following criteria:Tools evaluated on the following criteria:– AffordabilityAffordability– CustomizableCustomizable– Internet BasedInternet Based– SecuritySecurity– Customer Support Customer Support – Ease of UseEase of Use

30

Regional Implementation Cont’dRegional Implementation Cont’d

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

– No cost while existing contracts are in placeNo cost while existing contracts are in place

– Windows basedWindows based

– Remote (internet) hostedRemote (internet) hosted

– Ability to back up information and hosting site redundancyAbility to back up information and hosting site redundancy

– Password protected with various user levelsPassword protected with various user levels

– Strong reporting capabilities for all disciplinesStrong reporting capabilities for all disciplines

– NIMS (National Incident Management System) compliantNIMS (National Incident Management System) compliant

– Customizable and able to integrate with various file typesCustomizable and able to integrate with various file types

– Open ended infrastructure for mapping tie-insOpen ended infrastructure for mapping tie-ins

– Free tech support while under contractFree tech support while under contract

31

Regional Implementation Cont’dRegional Implementation Cont’d

Presented findings to regional steering committee for approval to Presented findings to regional steering committee for approval to move forwardmove forward

Identified workgroups within specific disciplines to identify Identified workgroups within specific disciplines to identify resources for inputresources for input– Healthcare – All ASPR funded purchases over $250.00Healthcare – All ASPR funded purchases over $250.00– Public Health – All CDC (Center for Disease Control) funded purchases over Public Health – All CDC (Center for Disease Control) funded purchases over

$250.00$250.00– EMA – All NIMS identified resourcesEMA – All NIMS identified resources

Worked with Abt Associates to develop training modules and Worked with Abt Associates to develop training modules and user manualsuser manuals

Developed region specific standard operating procedures and Developed region specific standard operating procedures and guidelines and policiesguidelines and policies

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

32

Regional Implementation Cont’dRegional Implementation Cont’d

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

Pilot test group consisted of the following:Pilot test group consisted of the following:– 3 Hospitals3 Hospitals

– 2 Health Departments2 Health Departments

– 2 EMAs2 EMAs

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

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

33

Future PlansFuture Plans

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

– Usage to be tied back to ASPR funding Usage to be tied back to ASPR funding requirementsrequirements

Public Health to be on-line by mid-summer of Public Health to be on-line by mid-summer of 20092009

EMAs to be brought on-line as demand EMAs to be brought on-line as demand exists.exists.

Use EPRI effectively in 2009 regional Use EPRI effectively in 2009 regional exercise.exercise.

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

34

Future Plans Cont’dFuture Plans Cont’d

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

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

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

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

35

ChallengesChallenges

Eliminating “Resource Silos”Eliminating “Resource Silos” Not overstepping the EMA’s authorityNot overstepping the EMA’s authority Work output at a regional levelWork output at a regional level Elimination of grant fundingElimination of grant funding System ownershipSystem ownership

36

StrategiesStrategies

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

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

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

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

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

37

Poll Question #3Poll Question #3

A short poll will appear on your A short poll will appear on your screen. We appreciate your screen. We appreciate your feedback!feedback!

If you are unable to respond to the If you are unable to respond to the poll during this event, please e-mail poll during this event, please e-mail your answer to your answer to emergencypreparedness@academyemergencypreparedness@academyhealth.orghealth.org.. 38

Q&AQ&A

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

39

Next Webcast Next Webcast

Public Health Emergency Preparedness: Public Health Emergency Preparedness: Planning and Practicing for a DisasterPlanning and Practicing for a Disaster

Winter 2009Winter 2009

To learn more go to the Webcast Web page To learn more go to the Webcast Web page at: at: http://http://

www.academyhealth.org/knowledgetransfer/www.academyhealth.org/knowledgetransfer/EPWebcasts.htmEPWebcasts.htm

40

For more information about….For more information about….

• Today’s event including a recording and Today’s event including a recording and transcript, go to: transcript, go to: http://http://www.ahrq.govwww.ahrq.gov/prep//prep/

• AHRQ’s suite of emergency preparedness AHRQ’s suite of emergency preparedness tools, go to: tools, go to: http://www.ahrq.gov/prep/http://www.ahrq.gov/prep/

• Public Health Emergency Preparedness: Public Health Emergency Preparedness: Planning and Practicing for a DisasterPlanning and Practicing for a Disaster, please , please visit our Web site at: visit our Web site at: http://http://www.academyhealth.org/knowledgetransfer/Ewww.academyhealth.org/knowledgetransfer/EPWebcasts.htmPWebcasts.htm

• If you have a question regarding future If you have a question regarding future Webcasts or utilizing AHRQ tools please e-Webcasts or utilizing AHRQ tools please e-mail us at mail us at emergencypreparedness@academyhealth.orgemergencypreparedness@academyhealth.org..

41

Thank you!Thank you!

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

Thank you! Thank you!

42