Coordinating a Regional Medical Response

1. Pre- Hospital Response Coordinating a Regional Medical Response Lori Upton, RN BSN MS CEM Southeast Texas Regional Advisory Council Houston Region Lori.Upton@SETRAC.org

2. In the beginning • 1997: Houston named one of the first 4 MMRS cities in the Nation • Support the integration of emergency management, health, and medical systems into a coordinated response to mass casualty incidents caused by any hazard.  • Reduce the consequences of a mass casualty incident during the initial period of a response by having augmented existing local operational response systems before an incident occurs. • Hospital Receiving Group (HRG) formed • “Big 8” identified by HFD

3. Early work • HRG identified planning priorities • Common communications • Healthcare planning template • Common equipment and training • Executive support • Mutual Aid Agreements

4. First Challenge • Tropical Storm Allison - June 2001 • Extensive flooding and subsequent evacuation • Texas Medical Center “off-line” with ripple effect throughout community • Hospitals responding individually within systems • No formal coordinating entity

5. 2001 Rapid Growth Spurt • After TS Allison • Addition of 20 acute care facilities • Sharing of work to date • Sharing of plans • After 9-11 • Addition of Community Hospital Sub-Committee • 50+ member institutions • Eventually merged all into HAHEMC • HPP Grant • DSHS pass through funding to RACS • Houston CEO meeting • RAC = fiduciary agent • HAHEMC members to develop planning body for grant

6. RHPC was born • Regional Bioterrorism Task Force • Year 1 grant focus on bioterrorism • Chair, co-chair and committee members elected • Gap analysis and planning priorities identified • The Regional Emergency and Hospital Preparedness Council (RHPC) • Officially formed in 2002 • Members: Hospitals, EMS, Public Health, City/County, State and Federal • Mission of providing collaborative planning and response to emergencies, in a multi-disciplinary approach, and to preserve the medical infrastructure of the region. • Continued discussions on need for a coordinating entity

7. 2005 Hurricanes Katrina and Rita • Regional coordinating entity for health and medical called into service for first time • Disaster Unified Medical Command (DUMC) • Leap of Faith • No formal plan – concept • No formal structure • No recognized authority • Commitment • Commitment to succeed • Commitment to mission • Commitment to medical community

8. 2006 Evolution of a Concept • Catastrophic Medical Operations Center (CMOC) • Initial plan put into writing • MOUs drafted and signed • Formal structure developed • Initial training developed and held • Infrastructure support from City of Houston

9. Catastrophic Medical Operations Center (CMOC) Local and Regional asset Co-located in the HEC Recognized by the MACG for health and medical coordination NIMS Compliant Command authority Logistical and Operational Components Stand up when requested by EOC, EMC, State, or other jurisdictions of authority

10. What is CMOC • CMOC is a collaboration of healthcare, special needs, EMS transportation, and public health specialists working together under a NIMS compliant structure within the Unified Area Command to address ESF 8 services of a multi-geographical region.

11. CMOC today • Status • Operational arm of RHPC • RHPC: Merged with the Southeast Texas Regional Advisory Council in 2012 to serve as the regional preparedness coalition for health and medical

12. Mission • Coordination of medical care and resources in response to the needs of the community • Protect the medical infrastructure of the region • Provide assistance and serve as safety-net for all healthcare facilities • Serve as the central point for redistribution of staff and supplies • Identify and utilize hidden surge capacity • Coordination and distribution of transportation assets • Integration of public health epidemiologic trends

13. Partnerships • City of Houston, Harris County, Fort Bend County, Montgomery County, Brazoria County, and Jefferson County Offices of Emergency Management • Houston Area Hospital Emergency Preparedness Collaborative • Southeast Texas Regional Advisory Council • City of Houston, Harris County, Fort Bend County, Montgomery County, and DSHS Region 6/5S Department of Health and Human Services • The Texas Medical Center • Houston-Galveston Area Council

14. CMOC Region 28 Counties 277 cities 9.3 Million (36%) 877,000/disabilities (24%) 120+ hospitals 500+ nursing homes 36th Largest State 22nd Largest World Economy Land mass could contain: New Hampshire, New Jersey, Connecticut, Delaware, Rhode Island, and D.C.

15. What kind of requests • Medical requests for assistance • transportation • patient placement • facility resource requests • Evacuation assistance • Patient tracking/reporting • Epidemiological trending • Ambulance Staging Management • Forward Coordinating Teams

16. Activation • CMOC must be activated by an authorized governmental entity. • It can be activated 24/7 by calling the City of Houston Office of Emergency Management at 713-884-4450 and requesting “activation of the CMOC”

17. CMOC Accomplishments Katrina Transportation and transfer of 1100 patients into healthcare facilities Rita 29 healthcare facilities evacuated 121 Nursing Home evacuations Coordination of 34 Counties and 2 States Transportation and transfer of an additional 2400+ patients into healthcare settings Hospital diversion rate = 0% Post event QA – 0.08% error rate

18. CMOC Accomplishments • Ike • Evacuation and repatriation of 56 hospitals • Evacuation and repatriation of 220 nursing homes • Transportation and transfer of 15,000+ individuals • Oxygen Strike Teams • Type 2 Ambulance Staging Management • Dialysis and Medical Special Needs Transport circuit • 4 Forward Coordinating Units

19. Successful Strategies • While the CMOC has no jurisdictional authority in the region, the CMOC works with governing entities in the preparedness and planning, activation, mobilization, coordination of response, and mitigation of adverse effects to ensure emergency events do not adversely affect the quality, capacity, and continuity of healthcare operations • The CMOC coordinates the assignment and transportation of all patients into healthcare facilities within the region based on capacity and capability of the facilities. Single-point coordination enables safe, efficient utilization of the region’s healthcare resources resulting in increased surge capacity.

20. Successful Strategies • Collaboration of key response partners, working together under one system (health, medical and pre-hospital) have been demonstrated to be an effective method of preserving fragile medical infrastructure • By having the subject matter experts at the “same table” working together, instead of in silos, the health and general well-being of the community can be preserved without turf wars or conflicting priorities.

21. Louise Comfort: Auto-adaptive systems “A state of mindful attention among a group of actors that evolves from common training, intense communication, and a distinct culture derived from shared experience” “Developing these auto-adaptive systems… depend fundamentally on their access to timely, valid information and their ability to engage in information search, exchange, absorption, and adaptation.”

22. Thank You Lori Upton, RN BSN MS CEM Director of Regional Preparedness Southeast Texas Regional Advisory Council Houston, Texas 281-822-4450 Lori.Upton@setrac.org