Public Health Emergency Preparedness: Planning and Practicing for a Disaster

1. Public Health Emergency Preparedness: Planning and Practicing for a Disaster Monday, February 9th, 2009 1:00-2:30 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. • 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. 2

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4. Agenda PART ONE • Introduction, Karen Migdail • Disaster Preparedness Tools: Hospital Surge Model and Mass Evacuation Transportation Model, Tom Rich • National Mass Patient and Evacuee Movement, Regulating, and Tracking System Initiative, F. Christy Music • Moderated Q&A, Karen Migdail PART TWO • Hospital Disaster Drills, Mollie Jenckes • User’s Perspective of Hospital Disaster Drills, Cindy Notobartolo • Moderated Q&A and closing statements, Karen Migdail 4

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6. AHRQ Disaster Preparedness Tools: Hospital Surge Model and Mass Evacuation Transportation Model Tom Rich Senior Associate Abt Associates Inc. 6

7. Surge Model: Partners • Dr. Sally Phillips, AHRQ Project Officer • Office of the Assistant Secretary for Preparedness and Response (ASPR) • Gryphon Scientific (Rocco Casagrande, Principal Investigator) • Weill Medical College, Cornell University (Nathaniel Hupert, Co-Principal Investigator) • Project Steering Committee 7

8. Surge Model: Scenarios • Biological • Anthrax • Smallpox • Flu • Food Contamination (under development) • Plague (under development) • Chemical • Chlorine • Mustard • Sarin • Nuclear / Radiological • 1 Kiloton Yield (KT) or 10 KT nuclear device • Radiological dispersion device (“Dirty bomb”) • Radiological point source • Conventional explosive (under development) 8

9. Surge Model Outputs • Based on … • The scenario • The number and type of casualties requiring hospitalization • The Hospital Surge Model estimates • Number of patients in the hospital by day and hospital unit • Resource requirements for patients, by resource, day, and hospital unit 9

10. Durable equipment Human resources Pharmacy Consumable supplies Personal protective equipment Psychological Support Housekeeping Lab / Radiology Mortuary Nutrition Hospital Resources 10

11. Key Assumptions and Considerations • Time delay between incident and hospital arrivals (for biological and radiological scenarios, based on dispersion models) • The patient’s assumed length of stay in the Emergency Department (ED), in the Intensive Care Unit (ICU), and on the floor varies by scenario and severity of condition • Per patient per day resource consumption based on historical data to treat similar patients, and expert elicitation • No capacity or resource limitations at the hospital 11

12. Illustrative Output: Hospitalized Patients by Day and Unit 12

13. For More Information • To run the Hospital Surge Model, go to: hospitalsurgemodel.ahrq.gov • User Manual • Model Description Document 13

14. Mass Evacuation Transportation Model: Partners • Dr. Sally Phillips, AHRQ Project Officer • ASPR1, HRSA2, FEMA3, DoD4 • Partners Healthcare (Drs. Paul Biddinger and Richard Zane) • Project Steering Committee • New York City Office of Emergency Management • Los Angeles Emergency Preparedness Department 1 ASPR: Office of the Assistant Secretary for Preparedness and Response 2 HRSA: Health Resources and Services Administration 3 FEMA: Federal Emergency Management Agency 4 DoD: Department of Defense 14

15. Model Outputs • Based on… • Number of vehicles assigned to the evacuation -- buses; wheel chair vans; Basic Life Support (BLS) and Advanced Life Support (ALS) ambulances • Location of evacuating and receiving facilities • Number and type of patients to be evacuated • Surge capacity assumptions • The Model estimates • The time required to transport all patients to the receiving facilities 15

16. Key Assumptions and Considerations • A planning model – not an operational tool to produce a vehicle schedule or patient transport roster • Does not consider physical constraints within the hospitals (e.g., the number of elevators) • Assumes appropriate staff are available in the vehicles • Travel time estimates require latitude and longitude of evacuating and receiving facilities 16

17. Web Implementation of the Model 17

18. Illustrative Results: Effect of Advanced Life Support (ALS) Ambulance Availability Data from Los Angelespilottest 18

19. For More Information • To run the Mass Evacuation Transportation Model, go to: massevacmodel.ahrq.gov • User Manual • Model Description Document 19

20. 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. 20

21. 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. 21

22. National Mass Patient and Evacuee Movement, Regulating, and Tracking Initiative F. Christy Music, MS, MT(ASCP)SBB Program Director, Health and Medical Support Office of the Assistant Secretary of Defense (Homeland Defense & Americas’ Security Affairs), Department of Defense 22

23. Create a National General Population Evacuee & Patient Movement, Regulating, Tracking System Issue: Catastrophic incidents = need for large-scale general population & patient movement, regulating, and tracking Issue: No interoperable, national (local, State, Federal, tribal) information system • Tracking: Locating and maintaining an audit trail of person’s movement from initial entry through final location • Regulating: Matching transport needs to a receiving location • Movement: Availability, reservation, use, and release of transportation resources 23

24. National Mass Patient and Evacuee Movement, Regulating, and Tracking Initiative Purpose: Build upon existing information systems and develop a National General Population Evacuee and Patient Movement, Regulating, and Tracking information system that is interoperable and shares data. Goal: Federal Sector (DoD1, HHS2, DHS3, FEMA4) provide a national system for all jurisdictions’ use. Goal: Use a central IT platform or other technology to share data among existing systems; build and insert modules that are needed. 1 Department of Defense 2 Department of Health and Human Services 3 Department of Homeland Security 4 Federal Emergency Management Agency 24

25. National Initiative Capabilities • Near real-time location and tracking is needed: • Audit trail that tracks general population and patients • Notice and tracking: general population members → patients • Tracking from first entry through final location. • Entry Point: Fixed facility, collection point, point of injury, home, search and rescue, self-registration, etc. • Incorporate regulating and movement information to perform operations during an event. 25

26. Effects of the National Initiative • Expand Nation’s capacity to transport, regulate, and track evacuees/patients. • Support local, State, tribal, and Federal command & control decision makers. • Deconflict intended use of general population/patient movement resources and destinations. • Coordinate general population/patient management at all vertical and horizontal levels of government. 26

27. Effects of the National Initiative(continued) • Locate general population evacuees /patients: entry→ intermediate locations→ final destinations. • Provide near real-time updates (e.g. medical status). • Incorporate patient’s Electronic Medical Record. • Track general population evacuees as they become patients during movement, requiring medical oversight en route. • Use by all jurisdictions (authorized users) in a disaster; available for routine use. 27

28. National Mass Patient and Evacuee Movement, Regulating, and Tracking Initiative History • Proposed by DoD (2004); Noted as DHS Priority (2004): Secretary Ridge’s Homeland Security Interagency Security Planning Effort • Included patient mobilization planning for catastrophic events as a long-term initiative and identifies this effort as a high-priority (Reference: Secretary, Department of Homeland Security letter to Secretary, Department of Defense, September 22, 2004). • Funded by FEMA (tracking recommendations) • DoD asked AHRQ/HHS to apply these funds to the existing HAvBED contract • HHS added funds (Mass Evacuation Transportation Model) • Began Winter 2005, Draft Report 2008, Final Report 2009 • Supported by DoD Evacuee-Patient Tracking Initiative – Interconnect DoD’s ETAS1 and AHLTA-Mobile2 to HHS’ JPATS3 1 Emergency Tracking Accountability System 2 Armed Forces Health Longitudinal Technology Application-Mobile 3 Joint Patient Assessment and Tracking System 28

29. National Initiative Advisory Board • National Advisory Board: HSC1, DoD, AHRQ, HHS, DHS, DOT2, VA3, other Federal agencies, State (NY and CA) and private industry representatives • Developed recommendations for a system that could be used during a mass casualty evacuation to: • Locate and track general population evacuees/patients • Improve decision making regarding: • General population evacuee and/or patient movement • Resource allocation • Incident management • Built planning tool for use before a mass casualty/evacuation incident • Estimate shortfalls in resources to transport patients and general population evacuees 1 Homeland Security Council 2 Department of Transportation 3 Department of Veterans Affairs 29

30. National Mass Patient and Evacuee Movement, Regulating, and Tracking Initiative Recommendations • Build on existing systems; incorporate data and architectural standards • Activated system in major, multi-jurisdictional incidents; optional routine use • Begin with local, State, and tribal entry; Federal entry last • Track location & health status/needs of any person encountering system • Track at “touch points” (e.g. collection points, hospitals, etc.) • Minimum data elements to enter patient/general population data 30

31. National Mass Patient and Evacuee Movement, Regulating, and Tracking Initiative Recommendations (continued) • Build system to accept more detailed demographic/medical information • System accessible to emergency responders/planners • Incorporate current or planned Feeder Tracking Systems • Data from point of injury or first entry through final disposition • Incorporate Feeder Institutional Records Systems (“Check-In/Check Out”) • Facilities with mandatory reporting, common software platforms, within an agency (e.g. VA hospitals, DoD Military Treatment Facilities, Indian Health) • Single facility (hospital with “homegrown” system) • Eventually include public: Web-based registration 31

32. Supports Homeland Security Presidential Directive – 21 Supports HSPD-21: Public Health and Medical Preparedness • Integrate all vertical and horizontal levels of government and community components, achieving a much greater capability than we currently have.  • Response “…deployed in a coordinated manner … guided by a constant and timely flow of relevant information during an event and rapid public health and medical response that marshals all available national capabilities and capacities in a rapid and coordinated manner.” • Help ensure general population evacuee and patient movement is “(1) rapid, (2) flexible, (3) scalable, (4) sustainable, (5) exhaustive (drawing upon all national resources), (6) comprehensive (e.g. addresses needs of mental health and special needs populations), (7) integrated and coordinated, and (8) appropriate (correct treatment in the most ethical manner with available capabilities).” 32

33. Initiative Recognized by Senior United States Government (USG) Officials • Initiative repeatedly recognized by White House and USG leaders as a national biodefense preparedness and response priority (Homeland Security Council / National Security Council Joint Biodefense Preparedness Deputies’ Committees (March and April 2008) • Nation’s planning will “...include creation of a national system for the coordination and tracking of general population evacuee and patient movement from point of incident, fixed facilities, or collection points to their final destination.” • Supports HSC Mass Evacuation / Population Movement Policy Sub-Policy Coordinating Committee, December 17, 2008. • Supports President Obama’s Campaign Promise to create a National Family Locator System to help families locate loved ones after a disaster, and Prepare Effective Emergency Response Plans, to include medical surge. • Next Step: Develop the national system • Proposal : DoD, HHS, DHS/FEMA co-lead • Participation: American Red Cross, VA, DOJ1; State, tribal, local representatives, commercial industry, professional association. 33 1Department of Justice

34. 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. 34

35. Q&A • If you have a question for Tom Rich from Abt Associates and/or F. Christy Music from the Department of Defense, please type it into the Q&A panel to the right and press send. 35

36. Part Two Agenda • Hospital Disaster Drills , Mollie Jenckes • User’s Perspective of Hospital Disaster Drills , Cindy Notobartolo • Moderated Q&A and closing statements, Karen Migdail 36

37. Mollie W. Jenckes, MHSc, BSNResearch AssociateJohns Hopkins University Sara E. Cosgrove Christina L. Catlett Mollie W. Jenckes Karen A. Robinson Gary Green Carolyn J. Feuerstein Karen Kohri Eric B. Bass Edbert B. Hsu Johns Hopkins University Evidence-based Practice Center 37

38. Training is Vital 38

39. Background Hospitals are prepared for natural and manmade disasters: Transportation accidents Structural collapse Earthquakes Why do hospitals hold disaster drills? To allow “hands-on” training in the hospital disaster plan To build knowledge and understanding of roles To identify strengths and weaknesses in response To build familiarity with infrequently used equipment To fulfill requirements of the Joint Commission for Accreditation of Healthcare Organizations (JCAHO) 39

40. Continuous Quality Improvement (CQI) ProcessApplied to Hospital Disaster Preparedness 40

41. Methods:Expert Input/Feedback The JHU EPC1 assembled a multi-disciplinary team of experts for initial guidance and repeated feedback during development of modules: Federal agencies (HRSA2, CDC3, FEMA4) State agencies (MEMA5, MD DHMH6) Hospitals (administrators, EM7 physicians) Disaster planning experts WMD8 experts 1Johns Hopkins University Evidence-based Practice Center 2Health Resources and Services Administration 3Center for Disease Control 4Federal Emergency Management Agency 5Maryland Emergency Management Agency 6Maryland Department of Health and Mental Hygiene 7Emergency Medicine 8Weapons of Mass Destruction 41

42. Results:Drill Evaluation Modules There are 7 modules: Training module (use of product) Pre-drill planning module Command center zone Decontamination zone Triage zone Treatment zone De-briefing module…………..and 2 addenda 42

43. Data Collected in Each Module Activity points documented within each zone module: • Time points • Zone description • Personnel • Zone operations • Communications • Information flow • Security • Documentation and tracking • Victim flow • Personal protective equipment and safety • Equipment and supplies • Rotation of staff • Zone disruption 43

44. Addendums • Biological Incident Addendum • Assesses: • Awareness that a biological agent caused the event • Appropriate and expert monitoring • Reporting mechanisms • Meeting of health and safety needs of patients and victims • Availability of special supplies • Radiation Incident Addendum • Assesses: • Awareness that radiation exposure caused the illness • Appropriate and expert monitoring • Reporting to State and Federal agencies • Meeting of health and safety needs of victims and staff • Availability of special supplies 44

45. Field Trial Results Trials indicated wide acceptance Hospitals were able to document activities occurring as they happened Modules allowed identification of areas that needed further training In follow up exercises, hospitals are requesting repeat use of the modules 45

46. Products Available Evaluation of Hospital Disaster Drills: A Module-Based Approach AHRQ Publication No. 04-0032 April 2004 Tool for Evaluating Core Elements of Hospital Disaster Drills AHRQ Publication No. 08-0019 June 2008 46

47. 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. 47

48. User’s Perspective of Hospital Disaster Drills Cindy Notobartolo, RN, BSN Corporate Director of Emergency Department, Safety and Security Services Suburban Hospital, Bethesda, Maryland 48

49. Drill Planning and Execution • October 2008 designed, planned and participated in a regional large scale explosive event involving 40 military, research, national, State, county and private entities • Historically the evaluation tool was created or adapted from existing templates • Dissatisfaction with prior tools or the time needed to customize them for the event 49

50. Discovery of AHRQ Evaluation Tool • Logical framework • Flow and sequence match actual event • Pre-populated fields and circle answers • Comment sections • Prompting questions • Diagram sections 50