# Presentation: 813729

## King County Healthcare System Emergency Response Planning

**Allison Schletzbaum, MSOD**
**King County Regional Medical Resource Center Project Manager**

**Notes:**
This presentation will:

Explain strengths & weaknesses of healthcare emergency planning
Explore Healthcare Coalitions
Identify Local Planning Priorities
Discuss Regional Challenges

This planning process is happing or will happen throughout each region, nationwide.  Directives to create Healthcare Coalitions is a federal directive from ASPR and is tied to federal grant dollars.

## Healthcare in King County

- There is no healthcare “system”
- 23 hospitals – 18 w/EDs
- 30 Community Health Clinics
- Unknown number of clinics and private doctors
- 2 tribal clinics
- 1100 long term residential care facilities
- 7000 individuals utilizing home care and home health services

**Notes:**
1.8 million people in King County, 500,000 of those are in the city limits of Seattle

## Role of Public Health

- Lead for Emergency Support Function 8 (ESF-8) – Health and Medical Support
- Neutral party in a competitive healthcare market
- Local health officer has authority based on the Washington Administrative Code

## Emergency management system in place for King County agencies and larger cities

Public Health, hospitals, first responders, EM partners have been preparing together for years

Strong health care assets including Emergency Medical System, Hospital Control, Public Health response

- Public Health, hospitals, first responders, EM partners have been preparing together for years
- Strong health care assets including Emergency Medical System, Hospital Control, Public Health response

**Coordinating Countywide Health System Response: *****Strengths***

**Notes:**
Bullet Point 1:  There are 31 city emergency management agencies and three fire zones with zone coordination centers, each with their own response structure.  The City of Seattle is one zone.  South county is another and east county is the third.

Bullet Point 3:  Hospital Control is a central coordinating point for patient movement during a mass casualty event.  Primary hospital control is Harborview Medical Center (only Level 1 Trauma Center in 4 states) and backup is Overlake Hospital.  This system is unique.  Very few areas in the country have a hospital control.  

## 
Planning has traditionally been hospital-centric, not health care system-oriented
Need for a Unified Command approach to manage the health and medical response
Health care system response capabilities appear inadequate for large-scale or catastrophic disasters
Limited capacity in the healthcare system, not set up for surge in demand

- Planning has traditionally been hospital-centric, not health care system-oriented
- Need for a Unified Command approach to manage the health and medical response
- Health care system response capabilities appear inadequate for large-scale or catastrophic disasters
- Limited capacity in the healthcare system, not set up for surge in demand

**Coordinating Countywide Health System Response: *****Weaknesses***

**Notes:**
Bullet Point 2: ESF-8 Unified Command includes the Public Health Officer, EMS Medical Director, Medical Examiner, and Executive Council Representation from the Healthcare Coalition, which we will discuss momentarily.

Bullet Point 3: Examples include staffing shortages and just-in-time inventory practices.

Bullet Point 4:  Most healthcare facilities, particularly hospitals, are stretched to capacity on a daily basis so meeting demand for surge capacity will prove particularly difficult.

## King County Healthcare Coalition

- The King County Healthcare Coalition is a network of healthcare organizations and providers that are committed to coordinating their emergency preparedness and response activities
- The purpose of the Coalition is to develop and maintain a comprehensive system that assures coordination, effective communications, and optimal use of available health resources in response to emergencies and disaster for all hazards

**Notes:**
LEVERAGE STRENGTHS AND ADDRESS WEAKNESSES

King County is rather far ahead of the rest of the nation in Healthcare Coalition planning.  The coalition has engagement from many health sectors and is growing rapidly.

Similar planning efforts in:

MN
NVHA
Houston
San Antonio
Parts of Florida

## Slide 7

**Notes:**
This diagram outlines the local response structure of the healthcare coalition.

At the bottom are the individual healthcare organizations.

These organizations feed into the Regional Medical Resource Center, or operational arm for the healthcare coalition, which we will discuss further in a second.

The RMRC receives it’s direction during an event from the Healthcare Coalition Executive Council.  Part of Unified Command.

The Public Health Emergency Operations Center is the response body of the lead agency for ESF-8.  Funnels medical resource requests from the RMRC up to the state level.
The Regional Communication & Emergency Coordination Center is run by King County and supports non-medical requests from the ESF-8 and all other ESF’s in King County.

The state funnels resource requests to the federal government.

## Proposed Unified Command Structure ESF-8

**Local Health Officer**

**Healthcare Coalition Executive Council**

**          ****EMS**
**       ****Medical        **
**       ****Director**

**Medical Examiner**

**Operations Section Chief**

**Planning Section Chief**

**Logistics Section Chief**

**Admin Section Chief**

*Unified Command*

**Medical Advisors****	**

**Legal Advisors**

**Joint Information Center**

**Public Health EOC Liaison**

- Proposed Unified Command Structure ESF-8

**Notes:**
This is the proposed structure of the ESF-8 response, or the RMRC box shown on the previous slide.  Unified command at the top.

Medical Advisor is provided by a practitioner to help guide strategic distribution of resources.  Prevents a first come, first served response that does not consider the integrity of the entire health system.

Legal Advisor assists with legal issues related to altered standards of care, insurance issues, etc.

Joint Information Center coordinates with all other joint information systems in the response to keep partners and the media informed of the health system status.

Public Health Liaison brokers the contact between the RMRC and the PHEOC, specifically resource requests.

## Hospitals 
Medical Groups 
Safety Net Providers
Home Health 
Long Term Care
Mental Health
Specialty Providers
Pediatrics

- Medical Groups
- Safety Net Providers
- Home Health
- Long Term Care
- Mental Health
- Specialty Providers
- Pediatrics

**Health Sector Engagement**

**Notes:**
The structure outlined previously will be populated from representatives from these health sectors.  This list represents all of the sectors involved in Healthcare Coalition planning.  As you can see from this list, hospitals are the part of the health system that people first think of, but they are the least disparate group on this list.  There are much more unique challenges in planning for the other sectors on this list.  These sectors are also represented in all of our planning efforts on different levels.

## Coalition Preparedness Structure

**Coalition Preparedness Structure**

**Notes:**
The healthcare coalition has many workgroups investigating separate planning issues.

Special Advisory Groups include:  insurers (exploring changes in coverage, formularies, and out-of-network payment), legal (exploring legislative issues, liability coverage for volunteers, altered standards of care, staff sharing)

Clinical Care Planning Groups:  Medical Directors (keeping medical decision makers engaged so they provide leadership during a response), critical care (altered/uniform standards of care), palliative care (end of life care issues)

Operational/Sector:  ambulatory care (engaging clinics), hospital committee (hospital planning committee in place for many years—very positive relationship among hospitals.  Unique), recently added mental health and long term care planner, pediatrics (planning for the pediatric population)

Regional surge capacity:  alternate care facilities (planning for locations to care for up to 750 patients to prevent health system overload), call center coordination (unifying medical and non-medical call centers to handle pandemic influenza call surges and prevent hospital/clinic visits where possible by providing phone triage, clinical guidance, and information)

These planning groups will be supported/operationalized by the RMRC and overarching guidance for all of these projects is provided by the Executive Council during a response.  During planning, these efforts are managed by the Healthcare Coalition Coordinating Group.

## Regional Medical Resource Center

- Supports the objectives of the Public Health EOC, the Coalition Executive Council, and Unified Command
- Provides situational awareness for the healthcare system
- Anticipates needs, monitors available resources and coordinates deployment where needed during emergencies

**Acquiring Image Trend Incident Management Software with ASPR funds to support RMRC**

**Notes:**
Office of the Assistant Secretary for Preparedness and Response

## Current Regional Planning Priorities

- Alternate Care Facilities
- Triggers
- Track patients and staff
- Puget Sound Call Center Coordination
- Distribute standardized guidelines
- Integrate medial and business call centers
- Health Sector Operational Planning
- Communication Protocols
- Public and Private Sector Coordination

**Notes:**
Alternate Care Facilities:  when do we operationalize and how do we track patients and staff?

Call Center:  how do we create standardized guidelines and integrate numerous technologies?

Operational Planning through the RMRC

Communications Protocols: Communications is always one of the biggest issues in any event.  Will the communications technologies we’ve invested in work?  Will the training of the staff on use of communication equipment carry us through?  Will it be interoperable?

Public and Private Sector Coordination: Inherent in our planning b/c hospitals are private and PH is public.  But much bigger than just this.  How do we continue to work with our CIP partners?

## Regional Challenges

- Situation Awareness
- Healthcare Providers
- Vulnerable Populations
- Critical Infrastructure
- Identifying, tracking, and distributing medical resources
- Communications and coordination
- Tracking disaster expenditures

**Notes:**
How do we reach out/coordinate with the disparate health system?  Hospitals are easy in comparison to all other healthcare sectors.

Vulnerable Pops:  How do we reach those who do not use mainstream media? Seattle Times  ‘Above the fold’ during windstorm.  Canvassing.  Continuing efforts.

Critical Infrastructure:  How do we continue to plan with CIP partners?  How do we lobby for our health system partners receiving appropriate service priority during a response (along with everyone else who needs priority)?

Medical Resources:  So many things to track and such high rate of supply turnover.  Just-in-time inventory issues.

Communications: Standard issues.

Tracking Disaster expenditures:  what reimbursements do healthcare organizations qualify for and how do they get what they are due?

## Questions? Contact Us

- Allison Schletzbaum, MSOD
- RMRC Project Manager
- aschletz@u.washington.edu
- (206) 731-6213
- Cynthia Dold, MPP, MPH
- Healthcare Coalition Program Manager
- cynthia.dold@metrokc.gov
- (206) 205-0456