# Presentation: 099266

## Lessons Learned from the Field of Emergency Preparedness

**Thursday, November 6, 2008**
**12:00-1:30 pm EST**

## Questions 

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## Agenda

- Introduction, *Cindy DiBiasi *
- Identifying and Preparing Alternate Care Sites, *Terri Gill*
- Resource Allocation in an Emergency, *Nancie McAnaugh*
- Inventorying Emergency Preparedness Resources, *Christian Feller*
- Q&A

## Terri Gill
Senior Emergency Services Coordinator
Emergency Preparedness Office
California Department of Public Health

- Senior Emergency Services Coordinator
- Emergency Preparedness Office
- California Department of Public Health

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

## California Surge Standards and Guidelines Project

- The Surge Standards and Guidelines Project:
- Convened a broad group of stakeholders and interested parties to develop comprehensive guidelines and standards for surge capacity planning.
- Developed standards and guidelines that would serve as the basis for emergency planning and operations.

## Alternate Care Sites

- One focus of the Surge Standards and Guidelines Project was to look beyond hospitals for surge capacity.
- Defined Alternate Cares Sites (ACSs) to reflect the legal requirements and operational needs for the State
- A government-authorized ACS is a location not currently providing healthcare services
- Outpatient and inpatient care will vary
- These specific sites are not part of the assets of an existing facility

## The Rocky Mountain Regional Care Model

- The Rocky Mountain Regional Care Model for Bioterrorist Events was used to identify areas to focus on to plan for surge in Alternate Care Sites including:
- Site Selection
- Staffing
- Supplies
- Prioritized components to determine which items were critical and which could be reasonably accommodated.
- This model helped us to develop tools specific to California.

## California’s Definitions

- California’s definitions are based on an operational approach to surge planning.
- Definitions recognize that all licensed healthcare facilities and expansions of such facilities must operate under existing/modified statutory and regulatory standards and that government authorized alternate care sites are not governed by these statutes and regulations.

## Roles and Responsibility for Alternate Care Sites

- The California Emergency Services Act recognizes the role of the State and its political subdivisions to mitigate the effects of an emergency.
- From this authority, local governments can contract with local public and private entities to establish an ACS.
- Under the CDPH Pandemic Influenza Response Plan, local health departments (LHD) are responsible for identifying and planning for the operations of government authorized ACSs.
- It is NOT the expectation that LHDs operate ACSs.
**Local government** has the responsibility to set-up and operate ACS.

- Development of an Alternate Care Site Planning Team
- Need for public and private partnership
- Broad participation across stakeholder types
- Help from existing healthcare providers is critical
- All hazards approach

**Planning for Alternate Care Sites**

## Patient Care in Alternate Care Sites

- The Standard of Care is a moving target based on what a reasonable person with like training would do under similar circumstances.
- Healthcare delivery in alternate care sites will vary from traditional hospital care and will be dependent on available resources.
- Based on local surge needs, each identified ACS will include some mix of the following types of patients:
- Outpatient
- Inpatient
- Critical/Acute

## State Alternate Care Site Caches

- The alternate care site cache of supplies and equipment was designed using an all-hazards approach to provide for 10-14 days of care for 50 patients.
- Each ACS Cache contain items separated into 9 groups:
- IV Fluids
- Bandages and Wound Management
- Airway Intervention and Management
- Immobilization
- Patient Bedding, Gowns, Cots, Miscellaneous
- Healthcare Provider Personal Protective Equipment (PPE)
- Exam Supplies
- General Supplies
- Defibrillators and Associated Supplies – A special group that will be vendor managed off-site

## Conclusions

- Alternate Care Sites are a last resort when the healthcare delivery system cannot meet patient care needs
- Alternate Care Sites pose a difficult challenge
- Creativity in meeting this need is necessary
- It is important to capitalize on models that have already been developed
- California is working with local government to better understand how the State can help

## 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](mailto:emergencypreparedness@academyhealth.org)_.

## 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*.

##  Nancie McAnaugh
  Deputy Department Director
      Missouri Department of Health and Senior Services

-   Deputy Department Director
-       Missouri Department of Health and Senior Services

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

## Planning Scenarios

- Pandemic Influenza
- New Madrid Fault
- Bioterrorism Events
- Chemical Events
- Explosive Events (Including Dirty Bombs)

## Missouri Healthcare System

- 20 Federally Qualified Health Centers
- 123 acute care hospitals
- 6 children’s hospitals
- 23 designated trauma centers
- 1 pediatric trauma center

-  1,169 long term care facilities
-  216 ambulance services
-  193 home health agencies
-  98 ambulatory surgical centers
-  14 psychiatric hospitals

## Health Care Systems Readiness/ Scarce Resource Allocation Committees

- Initial planning efforts addressed pandemic influenza
- As the subcommittee finished its initial efforts, the focus changed to allocation of scarce resources

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

- Mass Medical Care with Scarce Resources
- Altered Standards of Care in Mass Casualty Events

## Altered Standards of Care

- What did we need to know to develop plans that provided an effective and fair medical response to a mass casualty event?
- Were there key principles that professionals had agreed upon that should inform our planning for mass casualty events?
- What were the critical issues that we needed to consider and address in planning for the provision of health and medical care  in a mass casualty event?

## Mass Medical Care with Scarce Resources

- Pre-hospital Care
- Hospital and Acute Care
- Alternative Care Sites
- Palliative Care

## Mass Medical Care with Scarce Resources

- Model framework utilized by Scarce Resource Allocation Committee
- Encouraged local public health agencies to utilize the tool in their discussions with their local emergency planning committees
- Utilized the mass medical care tool to inform discussions with representatives of the trial attorneys association

## Planning Outcomes

- Ventilator-Allocation Protocol
- Statewide Emergency Medical Services Workgroup
- Cross-Departmental Statute & Regulations Workgroup
- Pandemic “grief” training for managers and supervisors
- Creation of a statewide ethics consortium

## Challenges

- Transferring outcomes created with tools to rural Missouri settings
- Getting buy-in from non-public health state partners on tools
- Lack of public awareness regarding the limitations of the health care system
- Pediatric issues

## 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](mailto:emergencypreparedness@academyhealth.org)__._

##    
Christian Feller
Aultman Hospital 
Director of Safety and Emergency Management
Akron Regional Hospital Association
Emergency Management Chairman

- Christian Feller
- Aultman Hospital
- Director of Safety and Emergency Management
- Akron Regional Hospital Association
- Emergency Management Chairman

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

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

- EPRI is an internet-based tool enabling first responders, healthcare and private / public entities the ability to compile an inventory of critical resources via a public domain database tool.
- Provides flexible access to inventory data via a website.
- Provides the ability to make emergency requests and tabulate responses.
- Generates reports on quantity, location, discipline and availability.
- Meets ASPR (Assistant Secretary for Preparedness and Response) guidelines for tracking of grant funded purchases.

## Regional Implementation

- Identification of a region-wide issue.
- Established objectives with attainable deadlines.
- Development of a multidisciplinary committee.
- Regional Coordinators, Emergency Management Agencies (EMA), Public Health, Hospitals
- Evaluation of various resource management tools or response tools with included resource management components over a 9 month period.
- Tools evaluated on the following criteria:
- Affordability
- Customizable
- Internet Based
- Security
- Customer Support
- Ease of Use

## Regional Implementation Cont’d

- Identified EPRI as the emergency resource tool of choice based on the following criteria:
- No cost while existing contracts are in place
- Windows based
- Remote (internet) hosted
- Ability to back up information and hosting site redundancy
- Password protected with various user levels
- Strong reporting capabilities for all disciplines
- NIMS (National Incident Management System) compliant
- Customizable and able to integrate with various file types
- Open ended infrastructure for mapping tie-ins
- Free tech support while under contract

## Regional Implementation Cont’d

- Presented findings to regional steering committee for approval to move forward
- Identified workgroups within specific disciplines to identify resources for input
- Healthcare – All ASPR funded purchases over $250.00
- Public Health – All CDC (Center for Disease Control) funded purchases over $250.00
- EMA – All NIMS identified resources
- Worked with Abt Associates to develop training modules and user manuals
- Developed region specific standard operating procedures and guidelines and policies
- Worked with Abt Associates to load initial data such as demographics and contacts

## Regional Implementation Cont’d

- Identified a  pilot group to use for a 1 month period in order to identify operational opportunities for improvement.
- Pilot test group consisted of the following:
- 3 Hospitals
- 2 Health Departments
- 2 EMAs
- Pilot group evaluations to be completed by December 1, 2008. A full report to the regional steering committee during the December meeting.
- Full media campaign to begin December 1st, 2008 in order to spark interest and engagement among various disciplines.

## Future Plans

- First quarter of 2009 all 33 regional hospitals will go live with EPRI.
- Usage to be tied back to ASPR funding requirements
- Public Health to be on-line by mid-summer of 2009
- EMAs to be brought on-line as demand exists.
- Use EPRI effectively in 2009 regional exercise.
- Provide EPRI to all county emergency operations centers within the region.

## Future Plans Cont’d

- Work with regional fire and police entities to provide data or pull data from the State of Ohio response plans.
- Provide implementation assistance to other Ohio regions, so all state healthcare organizations have access to, and provide data for, EPRI.
- Work collaboratively with adjacent state regions to develop a multi-state EPRI tool.
- Continue to promote the implementation and usage of EPRI to all interested parties.

##  Challenges

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

## Strategies

- Continue to provide a secure method of data input, tracking and reporting.
- Stress importance of EPRI being a tool to assist EMAs in resource identification and acquisition.
- Continue to engage regional participants through projects that benefit individual entities.
- Think long term when developing regional based tools and how they will be funded.
- Provide key contacts and “system owners” that are funded by the region or have region interests in mind.

## 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](mailto:emergencypreparedness@academyhealth.org)_.

## Q&A

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

## Next Webcast 

- 	**Public Health Emergency Preparedness: Planning and Practicing for a Disaster**
**Winter 2009**
- 	To learn more go to the Webcast Web page at: _[http://](http://www.academyhealth.org/knowledgetransfer/EPWebcasts.htm)__[www.academyhealth.org/knowledgetransfer/EPWebcasts.htm](http://www.academyhealth.org/knowledgetransfer/EPWebcasts.htm)_

## For more information about....

- Today’s event including a recording and transcript, go to: _[http://](http://www.ahrq.gov/prep/)__[www.ahrq.gov](http://www.ahrq.gov/prep/)__[/prep/](http://www.ahrq.gov/prep/)_
- AHRQ’s suite of emergency preparedness tools, go to: _[http://www.ahrq.gov/prep/](http://www.ahrq.gov/prep/)_
*Public Health Emergency Preparedness: Planning and Practicing for a Disaster*, please visit our Web site at: _[http://](http://www.academyhealth.org/knowledgetransfer/EPWebcasts.htm)__[www.academyhealth.org/knowledgetransfer/EPWebcasts.htm](http://www.academyhealth.org/knowledgetransfer/EPWebcasts.htm)_
- If you have a question regarding future Webcasts or utilizing AHRQ tools please e-mail us at _[emergencypreparedness@academyhealth.org](mailto:emergencypreparedness@academyhealth.org)_.

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