StateandRegionalConceptsofOperations(CONOPs)

NETECFaculty

Objectives

• Reviewtherequirementsandrolesoffrontlinefacilities,assessmenthospitals,State-designatedEbolaTreatmentCenters,RegionalEbolaandSpecialPathogenTreatmentCenters(RESPTC)andhealthcarecoalitionsinStateandregionalconceptsofoperations(CONOPs) forapatientwithasuspectedorconfirmedhighlyinfectiousdisease

• DiscussstrategiesforengagingkeystakeholdersinStateandregionalCONOPsplanning

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CDC’sTieredSystem

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NYCHealth+Hospitals’TieredSystem

FrontlineHealthcareFacilityQuicklyidentifiesandisolatespatientswithpossibleEbola

Notifiesfacilityinfectioncontrolandstateandcitypublichealthofficials

HasenoughPPEequipmentfor12-24hoursofcare

TransferspatienttoRegion2EbolaTreatmentCenter

QuicklyidentifiesandisolatespatientswithpossibleEbola

Notifiesfacilityinfectioncontrolandstateandcitypublichealthofficials

HasenoughPPEequipmentfor<8hoursofcare

TransferspatienttoRegion2EbolaTreatmentCenter

Region2EbolaTreatmentCenter

SafelyreceivesandisolatespatientswithconfirmedorsuspectedEbola

CaresforpatientswithEbolafordurationofillness

HasenoughEbolaPPEforatleast7daysofcare(willrestockasneeded)

Hassustainablestaffingplantomanageseveralweeksofcare

Ambulatory/OutpatientFacility

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WhatareConceptsofOperations?

• Outlineplansfortransportofhighlyinfectiouspatientsinstatesorregions.– Stateplansshoulddetailpatienttransportationlogisticsandcommunications.

– Regionalplansshouldfocusoncollaborationandcommunicationamongststatesinaparticularregion.

– CONOPsleadsshouldcommunicate,coordinateandcollaboratewithkeystakeholdersthroughouttheCONOPsprocess.

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NYCHealth+Hospitals’CONOPs

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CONOPsvs.IRG

VS.

ConceptofOperations(CONOPS) IncidentResponseGuide(IRG)

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NYCHealth+Hospitals’CONOPsEssentialElementsofInformation

Agency/Organization TypeofInformation

Sentto AgencybyNYCHealth+Hospitals

ReceivedbyNYCHealth+Hospitals

Within NYCHealth+Hospitals

AllofNYCHealth+Hospitalsintegratedhealthcarefacilities

NotificationofsuspectedorconfirmedEVDcase X

NewYorkCityFireDepartment(FDNY) TransportationofPUI(s)fromexternalhealthcarefacilitytooneofNYCHealth+Hospitalsfacilities ORintra-systemtransportation

X

NewYorkCityDepartmentofHealthandMentalHygiene(NYCDOHMH)– Laboratory

ClinicallaboratoryspecimentoruleoutorconfirmEVD X X

DepartmentofHealthandMentalHygiene(DOHMH) SituationalUpdateX

CentersforDiseaseControlandPrevention(CDC) SituationalUpdateX

FederalEmergencyManagementAgencyRegion (FEMA) SituationalUpdateX

NewYorkCityEmergencyManagement(NYCEM) SituationalUpdateX

NewYorkStateDepartmentofHealth(NYSDOH) SituationalUpdateX

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NYCHealth+Hospitals’CONOPsInternal&ExternalCommunication

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① Patient transfer determined by NYCDOHMH:• FDNYEMS notified • CMO at Bellevue Hospital Center notified• NYC Health + Hospital Leadership notified

② Transfer Hospital Facility will follow facility-specific Bio Isolation Transfer Card (BIT):• Transfer Team Dons PPE • Control of Transfer Area via

Hospital Police/Security• Hospital Liaison reports to the

Command Post • Identify Transfer Location

(based on BIT)• Await HazTac Personnel to

hand-off Patient • HazTac Personnel Accepts

Patient • HazTac Transport Patient to

Treatment Facility (Bellevue)

Transfer Hospital Facility

③ FDNYEMS arrival at Transfer Hospital Facility:• HazTac Officer meets

Hospital Liaison• Transfer Point Confirmed with

Liaison • HazTac Personnel Don PPE • HazTac Officer supervises

transfer • Ensure response of Clean

Ambulance • Both Ambulances driven by

clean personnel ONLY • HazTac Doffing and Decon

per FDNY EMS protocols

Note 1: Any patient assessment and treatment shall be initiated according to FDNY EMS policies, procedures and protocols.

Note 2: DOHMH shall notify the OLMC Physician of patient results determined by treatment hospital facility.

FDNY EMS

② Activation of the Special Pathogens Unit via DOHMH/FDNY Transfer to Bellevue: • Assemble SPP Receiving

Team • Prepare 55 Gallon Bio-Waste

Drums • SPP Liaison Report to the

Command Post • SPP Team Don PPE to

Receive Patient from FDNY • Standby at the Transfer Point

Receiving Hospital Facility (Bellevue)

② After receiving notification from NYCDOHMH for transport from transfer facility to treatment facility, FDNY EMS dispatch initiates:• Briefing with Hospital Liaison

prior to Patient Transfer • Confirm Transfer Point • Decontamination Corridor

Prepared • Deployment of Haz-Tac Units

and Resources to Transfer Hospital Facility

③ Transfer Facility Decontamination as per NYC

Health + Hospital protocol

④ Haz-Tac Team Doff and Decon per FDNY EMS protocols and procedures.

Note; All disposable materials will be bagged in prepared 55 Gallon Bio-Waste Drums and disposed according to NYC Health + Hospital Regulated Waste Protocol.

Note: See “Ebola Treatment Facility (Bellevue)

Transportation Protocol” for continuation of receiving facility

transport procedures.

Intra-System Transportation Protocol

Note: See Appendix H: NYC Health + Hospitals Facility-Specific Bio

Isolation Transfer Cards

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RegionIVCONOPS

• Builtuponestablishedrelationships.• Sharedmorematureplanstojumpstartplanninginlessadvancedstatesandfacilities.

• Ledpartnerstoresources,butdidnotforcethemtofollow.

• Understoodthatplanningisanongoingprocess.

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RegionIVLessonsLearned

• Needforsoundandexercisedcommunicationpathways.

• Essentialtohave“PlanB”fortransport.

• Justbecausesomethingworkeddoesnotmeanitisfinished.

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RegionIV“A-ha”MomentsandPromisingPractices

• Don’tforgetaboutyourFieldProjectOfficer.

• Importanttoaccountfordifferinglevelsofexperience.

• Activesupportfromleadershipmakestheprocesseasier.

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RegionVIICONOPSContentExample

• PromulgationStatementandSignatures

• Purpose,Scope,Situation,andAssumptions

• OrganizationandAssignmentofResponsibilities

• Direction,Control,andCoordination

• AirTransportationPlantoRegionalTreatmentCenter

• GroundTransportationPlantoRegionalTreatmentCenter

• WasteManagement

• MortuaryAffairs

• AdministrationandFinance

• TrainingandExercise

• PlanDevelopmentandMaintenance

• AuthoritiesandReferences

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Easyplacetofind24hourcontactinformation

RegionVIICONOPSDevelopment

• EmbarkedonprocesswithanumberofconferencecallswithASPRFPO,ASPRREC,andstateofficialsrepresentingentireregion.

• Anin-personmeetingwasheldtoshareaboutstateplansandbeginasection-by-sectionrevisionofaRegionalCONOPSPlanthatallparticipantscouldagreeupon.Thistookseveralfollowupphoneconferencemeetingstocomplete.

• Detailsthatwerestate-specificwereoftenremovedtobedescribedindetailinthestateCONOPSplans.

• Goal:AnewstateofficialcouldutilizethedocumentintheeventofaEbolaorotherdangerous,highlyinfectiousdiseaseevent.

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Resources

• NETEC– www.netec.org

• RegionalETC– 10RegionalCenters

• CDC• LocalPublicHealth• LocalMedicalResponseSystem– i.e:OMMRS

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PollQuestion1

WhatisthecurrentstatusofyourStateCONOPs?a) Noplanb) Inprogressc) Completed) Unsure

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PollQuestion2

WhatisthecurrentstatusofyourRegional CONOPs?a) Noplanb) Inprogressc) Completed) Unsure

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CONOPSWorkshop

• Divideparticipantsintogroupsbasedontheirrespectiveregions.– CONOPsPlanningTemplatewillserveascatalyst

• Groupstodiscuss:– What’sonekeysuccessoftheCONOPSplanning/developmentprocess?

– What’sonekeychallengeoftheCONOPsplanning/developmentprocess?

– ForthosewithoutaRegionalorStateCONOPs:• Why?What’syournextstep?

• Reconveneallparticipantsforhotwash.19

CONOPSWorkshopHotWash

• Eachgrouptoshare:– Onesuccess– Onechallenge– HowcanNETECassist?

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DevelopmentStrategies

• In-personmeetings,withafacilitatororpolicydevelopmentteamifpossible.

• Periodicweb-conferencingwithrevisionstothedocumentsegmentbysegment.

• CONOPsmeetingsmightbeplannedtocoordinatewithexistingtrainingorplanningdatestoreducetravelexpenses.

• Setgroundrules.Bringupissuesastheyarise,don'tletthemfester.

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HospitalStrategies

• Thinkaboutwhatdetailsareimportantinthedifferentdocuments.TheStateCONOPsmaybemuchmoredetailedthantheregionalCONOPs.

• CONOPsplanningisanexerciseinplanning,documentation,andrelationshipbuildingwithpeerinstitutionsandcommunitypartners.

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Engagement

• Celebratethecompletionoftheplan.• PlantomeetatleastannuallytoshareyourkeylearningsfromthepastyearandtoupdateanynecessaryitemsintheCONOPSaccordingly.

• Knowyourpartnersattheregional,state,andlocallevel.

• SharethecontentsofyourCONOPSdocumentsandconstantlyseekfeedbackandsuggestions.

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