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Alternate Care Facility: Developing Medical Surge Capability in King County



Speaker:  Michael Loehr, Preparedness Director, Seattle/King County Public Health ...

Speaker:  Michael Loehr, Preparedness Director, Seattle/King County Public Health
Public Health - Seattle King County (PHSKC) and regional healthcare partners have developed
and tested Alternate Care Facility (ACF) capability to support medical surge needs during
disasters. The ACF design is modular, scalable, and mobile ranging from a 50-bed minimal care
site to three 250-bed inpatient care facilities. PHSKC coordinated with numerous healthcare,
emergency management, EMS, law enforcement and facilities partners to identify appropriate
roles, responsibilities and resources necessary to implement this capability. Plans have been
developed addressing medical supplies management, medical and non-medical staffing, scope of
care, site layout, coordination with EMS and local EOCs, communications and security. ACF modules are designed to address four levels of care, and include acute care, walk-in care,
pharmacy, pediatrics, lab, palliative care, limited behavioral health services and oxygen delivery.
Through this presentation, we will describe the partners involved in planning, share details
regarding the modular design, types of equipment acquired, the flow of patient care, medical
staffing model, and approximate costs for developing this capability



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Alternate Care Facility:  Developing Medical Surge Capability in King County Alternate Care Facility: Developing Medical Surge Capability in King County Presentation Transcript

  • Partners in Preparedness Conference April 26, A il 26 2011 Alternate Care Facilities: Developing Medical Surge Capability in King County
  • OBJECTIVES Define and explain the purpose of ACFs p p p Describe current ACF capability in King County p y g y Identify circumstances for use – likely scenarios Identify challenges with developing, operating and sustaining ACFs statewide Review proposed Strategies for Success
  • Where did we start? December 2006 Windstorm  evacuation of several nursing home facilities Quick realization: a medical needs shelter cannot be thrown together overnight! As a group of us started working together, we realized how extensive a project this really is
  • ACF - Definition Non-medical facility d i d equipped N di l f ilit designed, i d and staffed to deliver care to patientsIn King County: g y Designated and activated by the Local Health Officer (LHO) LHO receives input from Healthcare Executives Activated in support of local inpatient healthcare facilities Not N t part of an existing healthcare facility t f i ti h lth f ilit
  • ACF Program Goal - KC Develop capability to activate and operate two 250-bed ACFs simultaneously Flexible locations – have several sites to choose from Scalable – by number of patients, level of care, supplies and staff needed Mobile – encourage sharing of resources, tools and capabilities biliti
  • Current Capability in KC
  • Circumstances for Activation1. Loss of Local Inpatient Capacity Hospitals or nursing homes damaged/destroyed, and / Remaining inpatient facilities can not absorb the load, and , Transporting patients out of region is not sufficient
  • Circumstances for Activation2.2 Surge in Patient Demand Disaster generates widespread illness or injuries that exceed local surge capacity l l it levels3.3 A combination of both bi ti f b th
  • Potential ScenariosEarthquake qLoss of capacity, Loss of Transport Capability, Surge in Patient DemandSevere Weather, Structure FireLoss of Capacity, Loss of Supporting InfrastructureSpecific Hazards (Pandemic, Radiological Contamination, BT)Surge in Patient Demand, i bilit t tS i P ti t D d inability to transport out of region t t f iProviding assistance to other regionsRITN, Evacuating victims with medical needs
  • Levels of CareTier 2Example: Nursing home evacuation (1 or more) Limited number of patients start with 50 bed patients, module Basic inpatient nursing care No acute medical conditions
  • Levels of CareTier 3Example: Hospital Evacuation after a major EQ I Inpatient nursing services f stable patients ti t i i for t bl ti t Expanded pharmaceutical services O Oxygen therapy available to 6l. NP h il bl 6l At least one additional care module: pediatric, ambulatory care, or b h i l h lth di t i b l t behavioral health Urgent capability for inappropriate patients  treat and transfer ASAP! f
  • Levels of CareTier 4All modules activated, all services provided
  • Staffing ModelAdministrative and Logistical Per HICS standard org chart Medical Reserve Corps Patient Care Providers Medical Reserve Corps Staff from evacuating facilities Staff from local hospitals / clinics
  • Staffing ModelInpatient Nursing CI ti t N i Care M d l Model Day (12 hr) Evening/night (12hr) Inpatient RN 2 2 LPN 5 4 Nursing Assistant / 3 3 Certified Nursing Assistant / Medical Assistant Housekeeping 1 1 Total (50 bed activation) 11 = ideal 10 = ideal *9* = minimum *8* = minimum
  • Equipment and SuppliesE Bed CotsCribs
  • Equipment and SuppliesMedLox O2 Distribution SystemNational Oxygen Kit (NOK)
  • Equipment and Supplies3 Manual ACLS Defibrillators3 AEDs2 12-lead ECG Units 12-6 I-Stat Analyzers I-12 HemoCue WBC systems3 Braun IV Pumps3 Ultraclave sterilizers Digital X-Ray Di it l X-R equipment i t
  • Equipment and Supplies Broselow Pediatric System  2 each - Broselow Carts  2 each - Broselow Packs  5 each - Broselow Tapes
  • Equipment and Supplies Gauze Ga e and Bandages  Blood Pressure Units Sutures  Cervical Collars Syringes  X ray Illuminators Microscopes M  IV Supplies Sanitizers  Catheters Ambu Bags  Otoscopes Backboards  Ophthalmoscopes O hh l Patient Lifts  Scales Wheelchairs  Suction Pumps, tubing and canisters Traction Splints  Stethoscopes Various Forceps  And much more……… Various Tubes
  • Readiness Contracts Medical S M di l Supplies & li  Oxygen O Pharmaceuticals  Airgas  PSS  Cardinal  McKesson  Other  Home Depot Patient Feeding, Portable  Grainger Toilets & Showers, Mobile  Keeney’s y Laundry  Abbey Party Rents  Bishop Services  Honey Bucket  OK S OK’S Cascade  Mountain Mist
  • Strategies for Success
  • Building and Sustaining Capability ACFs MUST be part of a medical surge strategy Integration with Disaster Medical C t l C t M di l Control Centers and d inpatient care sector essential Innovative staffing plans
  • Building and Sustaining Capability Expertise in medical planning and logistics required Storage and maintenance plans required - ongoing costs l i d i t Training and exercises are critical
  • Key Questions: What s What’s the statewide strategy for building and maintaining this capability? What scenarios are we planning for? ACF vs. transport to other areas? vs Role of federal assets and mutual aid? l id? How do we keep it affordable?
  • Comprehensive ACF Strategy1.1 Establish clear understanding among healthcare and PH regarding the purpose of ACFs in WA  Support LTC facility evacuation only?  Support hospital evacuations?  Accept walk-ins (outpatient capacity)?  Accept kids, psych?2. Clarify roles of Disaster Medical Control Centers and local PH in decision making, coordination with healthcare sectors
  • Comprehensive ACF Strategy3.3 Establish statewide consistency and interoperability of equipment and supplies4. Develop a statewide storage plan5. Develop statewide transportation capability to rapidly mobilize equipment and supplies
  • Comprehensive ACF Strategy6.6 Account for statewide mutual aid in our ACF strategy, A t f t t id t l id i t t and expand mutual aid to hospitals and LTC facilities7. Develop statewide efficiencies for ACF training and exercise development and implementation8.8 Establish thresholds for E t bli h th h ld f requesting f d l assets ti federal t (FMS, DMAT) as integral parts of ACF capability
  • Questions?Tamlyn Thomas, RNSTAT ICU Resource NurseUWMC Emergency Management CoordinatorUniversity of Washington Medical CenterMichael Loehr, MRP, CBCPPreparedness DirectorPublic Health Seattle King CountyP bli H lth – S ttl & Ki C t