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Ascend Presentation
 

Ascend Presentation

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    Ascend Presentation Ascend Presentation Presentation Transcript

    • Accelerating Scalable Community Emergency Network Demonstration Ascend links regional healthcare facilities with private and public assets under a unified vision that results in an integrated, scalable medical evacuation solution during a regional emergency .
    • Agenda
      • Introduce U.S. Air Ambulance
      • Provide historical context for discussion
      • Discuss our concept for a regional approach to emergency management
      • Outline steps we will take to implement ASCEND for Indiana
      • Headquartered in Sarasota, FL
      • 23 years experience
      • Licensed ground and air ambulance provider
      • 180 employees
      • 97,000 patients, 100% safety record
      U.S. Air Ambulance Corporate Overview
        • Preferred provider for U.S. Department of State
        • Contractor EMS program for Iraq, DoD
        • Consultant to cruise line industry
        • Last five years for DHS – evacuations of foreign nationals
        • Hurricane Katrina – FEMA
        • Hurricane Wilma – U.S. Marshals Service
        • Hurricanes Gustav and Ike – four private hospital evacuations
        • Proprietary software development
        • Developer of unique service HELP
      Relevant Corporate Experience
    • Epicenter – The area of an emergency which is unsafe or uninhabitable External Emergencies Have an Epicenter Epicenter
    • Epicenter Scale EMAC Federal Local Regional Statewide Border States Interstate State Interstate Measures of Emergencies - Scale
    • Scale EMAC Federal Local Regional Statewide Border States Interstate General Population Transportation Disadvantaged Population Assisted Living Long Term Care Medical Long Term Care Medical General Medical ALS / ICU Medical Special Needs Scope Medical Nonmedical State Interstate Epicenter Measures of Emergencies – Scope
    • Our Products - HELP Scale EMAC Federal Local Regional Statewide Border States Interstate General Population Transportation Disadvantaged Population Assisted Living Long Term Care Medical Long Term Care Medical General Medical ALS / ICU Medical Special Needs Scope Medical Nonmedical State Interstate HELP
    • HELP Provides Additional Resources for Large Scale Disaster HELP provides access to transportation assets and receiving hospitals outside the Region Second Tier Providers Mobilized for Hospital Hospital Network Outside of Emergency Zone
    • Our Products - SPEAR Special Patients Emergency Ambulance Response Scale EMAC Federal Local Regional Statewide Border States Interstate General Population Transportation Disadvantaged Population Assisted Living Long Term Care Medical Long Term Care Medical General Medical ALS / ICU Medical Special Needs Scope Medical Nonmedical State Interstate SPEAR HELP
    • SPEAR Program Many special needs patients cases cannot be transferred at the regional level. For instance, a large burn incident may require coordinating the transfer of multiple patients throughout the United States to verified burn centers. Special Patient Emergency Ambulance Response Program Verified Burn Center Patients Dispersed From a Major Burn Incident to Verified Burn Centers
    • Our Products - ASCEND Accelerating Scalable Community Emergency Network Demonstration Scale EMAC Federal Local Regional Statewide Border States Interstate General Population Transportation Disadvantaged Population Assisted Living Long Term Care Medical Long Term Care Medical General Medical ALS / ICU Medical Special Needs Scope Medical Nonmedical State Interstate SPEAR HELP ASCEND
      • January 6, 2005 2:40 AM
      • Two trains collided in Graniteville, South Carolina,
      • - Small population 7,000
      • 1 train carried 92 tanks of chlorine gas,1 tank ruptured
      • – Upgraded tank
      • 90 tons of chlorine gas forms a deadly cloud that
      • flowed toward a sleeping public
      • - Low wind speed 2 mph
      • 3:00 AM - Sheriff notified
      • 3:45 AM - State Emergency Management Notified
      • 5:09 AM - Local emergency system notified residents to
      • evacuate
      • 9:00 AM - Local EOC set up and available to assist
      • 5,400 people evacuated
      • 330 people self presented to the hospital ER for treatment
      • - ER was unable to identify the chemical for several hours
      • 525 people were treated in ER, 300 in first three hours
      • 71 hospitalized, 25 ICU, 8 vented, 9 people died
      Are Local Communities Ready For Accelerating Emergency?
      • Chlorine Tank Explosion – National Planning Scenario
      • In 2007, terrorists used chlorine gas 7 times on U.S. troops
      • In urban area – 100,000 hospitalized
      • 10,000 vents required
      • 10,000 people die
      Accident or Terrorism – Major Local Implications National Planning Scenarios 1 Improvised Nuclear Device 2 Major Earthquake 3 Aerosol Anthrax 4 Major Hurricane 5 Pandemic Influenza 6 Radiological Dispersal Device 7 Plague 8 Improvised Explosive Device 9 Blister Agent 10 Food Contamination 11 Toxic Industrial Chemicals 12 Foreign Animal Disease 13 Nerve Agent 14 Cyber Attack 15 Chlorine Tank Explosion
    • 1993 Midwest Floods 2005 Hurricane Katrina 1994 Northridge Earthquake Natural Disasters Have Accelerated During Last Four Decades
    • Terrorism Against Americans 1961 – First U.S. Aircraft Hijacking 1974 – Patty Hearst Kidnapping 1979 – Iran, U.S. Embassy Hostages 1983 – Lebanon and Kuwait U.S. Embassy Bombings 1988 – Pan Am Flight 103 1993 – World Trade Center Bombing 1995 - Oklahoma City Bombing 1996 – Saudi Khobar Towers Bombing 1996 – Centennial Olympic Park Bombing 1998 - Unabomber 1998 - Kenya and Tanzania U.S. Embassy Bombing 2000 - U.S.S. Cole Bombing 2001 – 9/11 Coordinated Attacks World Trade Center and Pentagon 2001 – Anthrax Attacks 2002 – Beltway Sniper Attacks 2009 – Fort Hood Shootings Terrorism Against Americans Has Escalated Probability of Dirty Bomb Attack in Next Decade – 40 percent Iran 1979 Oklahoma City 1979 U.S.S. Cole 2000 New York 2001
      • 2002 Analysis - Dirty Cobalt Bomb in Manhattan:
        • 400 square Miles Contaminated
        • Manhattan uninhabitable
        • 1 in 100 Die from Cancer
      • Hurricane Katrina Not Unprecedented:
        • Hurricane Katrina: 200 B
        • Kobe, Japan Earthquake: 500 B
      • 2009 New Madrid Earthquake Study (6.9 R):
        • Trillion dollars in losses
        • 130 hospitals destroyed
        • 80,000 lives lost
      Kobe, Japan 1995 7.2 Richter Scale New Madrid Earthquake 1811 8.3 Richter Scale 1895 6.8 Richter Scale Possibility of Unprecedented Disaster is Very Real
    • Nation is Not Ready to Combat New Madrid Earthquake
      • Reliance on NDMS assets for evacuations
          • will not arrive for 72 hours
          • limited capacity
          • not fully effective for special needs
          • patients
      • National ambulance contract inadequate
          • musters 600 ambulances
          • relies on unplanned coordination
          • of the Joint Field Office
      • EMACs were not effective in coordinating 66,000
      • personnel during Hurricane Katrina and have not
      • yet built that capability
      • Multiple jurisdictional, technical, and regulatory
      • roadblocks that inhibit an effective response
      • must be overcome
      • As late as 2008 Hurricane Gustav:
      • Our four customers in New Orleans were all told
      • by FEMA and the State that they could not get
      • ambulances for four days
      • 1997-Metropolitan Medical Response System (MMRS)
      • Emergency preparedness systems
      • Respond to public health crisis
      •  
      • 2001-Emergency Management Performance Grants (EMPG)
      • Expanded to all-hazards planning
      • Fill gaps not covered by other federal programs
      •  
      • 2002-Hospital Preparedness Program (HPP)
      • Bio-terror attacks and pandemics
      • Primary focus expanded to all-hazards
      •  
      • 2002-Bioterrorism Training and Curriculum Development Program ( BTCDP)
      • Train healthcare workforce
      • Bioterrorism to all-hazards
      •  
      • 2003-Urban Area Security Initiative (UASI)
      • High-risk, high-threat urban areas
      • Prepare, response and prevent all emergencies
      •  
      • 2005-Regional Catastrophic Preparedness Grant Program (RCPGP )
      • Catastrophic incident preparedness
      • Regional all-hazard planning
      •  
      Through Grants, DHS and HHS are Influencing National Direction
    • Air Ambulance locations 2009 America Has Vast Emergency Response Resources
      • America has the resources to
      • combat a national catastrophe:
      • 45,000 Ground Ambulances
      • 50,000 Paratransit Vehicles
      • 70,000 Medically Equipped Buses
      • 150,000 Fire Trucks
      • 800 Rotor Wing Ambulances
      • 300 Fixed Wing Ambulances
      • 525 Military and Reserve C-130 Aircraft
      • 5,000 Hospitals
      • 17,000 Nursing Facilities
      • 3,000 County Emergency Managers
      • 800,000 Police Officers
      • 400,000 National Guard troops
      • Over 1 million Active Military Personnel
      • Stationed in the U.S.
    • Two Dimensions of an Emergency – Speed and Scale SPEED vs. SCALE Static Time Response Velocity Time Response Acceleration Time Response
    • Effective Medical Response Must Integrate Six Functions To maximize emergency medical response capability, regions must integrate six functions into a Community Emergency Network (CEN) that acts as one seamless unit Emergency Management Emergency Medical Service Health Care Facilities Inter-facility Transport Special Needs Transport Emergency Support CEN
    • Interdependent Medical Response Chain Pre-hospital Ambulances Frontline Hospital ER Inpatient Hospital Admissions Inter-facility Transport Regional Hospitals Regional Hospitals Inventory Interstate Transport Interstate Receiving Hospitals Interstate Special Needs Transport Patient Flow Evacuation Expansion Emergency Acceleration
    • Pre-hospital Ambulances Epicenter – The area of an emergency which is unsafe or uninhabitable Link 1 – Pre-hospital Ambulance Network Epicenter
    • Front Line Hospitals – Functioning Hospitals nearest the Epicenter Link 2 – Front Line Hospital Emergency Rooms During a community emergency, front line hospitals’ primary emergency function is to provide stabilization and first definitive medical care to persons coming from the epicenter that require medical treatment. Pre-hospital Ambulances Frontline Hospital ER
    • Emergency Room Hospital Admission Self Present Discharge Ambulance Net Patient In-Flow Accelerates In a large scale emergency, the pace of patient arrival to front line hospitals will accelerate, potentially overwhelming ERs and creating the need to initiate ER surge capability
    • CEN Responds Early To Shared Info As the front line hospital’s ER becomes inundated with self presenters, first respond ambulances react by diverting. In addition, before a hospital in-patient levels reach divert status, inter-facility ambulances respond to relieve front line hospital of stable patients. Pre-hospital Ambulances Frontline Hospital ER Inpatient Hospital Admissions ABC Hospital ER Hospital Wait Time hrs: 2.4 Capacity: 92% Capacity %: 122 Net Admit RPH: 17 Net Arrival RPH: 21 At Capacity: 3.4 Hrs Acceleration %: 82 Bed Divert: Burn Critical ER Capacity 85% Inter-facility Requirement: 20 ALS 11 BLS ER Hospital
    • Pre-hospital Ambulances Frontline Hospital ER Inter-facility Transport Regional Hospitals Regional Hospitals Inventory Inpatient Hospital Admissions Links 4-6 Interfacility Transport and Regional Hospitals
      • As the emergency progresses:
        • First response ambulances relay knowledge about
        • patients coming in the epicenter.
        • Front line hospitals relay information about the
        • conditions they are treating.
        • The community network assesses the potential for a
        • coordinated response and prepare to participate in the
        • emergency.
      Shared Information Epicenter Front Line Hospital All Members of the CEN Share Info Early Inter-facility Transporter Special Needs Patient Transporter Support Services Regional Hospital
    • Management Software ASCEND Software Component
    • Regional Hospitals Accept Patients, Share Emergency Resources
      • As the velocity of intake increases at front line hospitals, Inter-facility transfers must occur. With the aid of a Seamless Emergency Operations Center (SEOC), the region coordinates patient movement:
        • Front line hospitals identify patient transfer needs
        • Regional hospitals identify available beds
        • Logistics identifies and coordinates inter-facility transfers and
        • obtains resources from outside the region as needed.
      Epicenter Stabilized Patients Surge Resources Front Line Hospital Regional Hospital Shared Information, Analysis, and Coordination of Resources Seamless Emergency Operations Center
    • Command Center ASCEND Seamless Operations Center
    • SEOC Assists Local EOC Epicenter Stabilized Patients Surge Resources Shared Information And Coordination of assets Hospital Hospital Hospital Hospital Local Emergency Operations Center Front Line Regional Front Line The SEOC provides the Local EOC invaluable real-time information to make critical decisions and assists the EOC with real-time analysis. Some hospitals may find themselves inside the epicenter and require full evacuation of their hospitals. Shared Information, Analysis, and Coordination of Resources Seamless Emergency Operations Center
    • Regional Response Integrates with Federal Response Pre-hospital Ambulances Frontline Hospital ER Inpatient Hospital Admissions Inter-facility Transport Regional Hospitals Regional Hospitals Inventory Interstate Transport Interstate Receiving Hospitals
    • Region Accesses HELP as Need Surpasses Regional Capability
      • If the velocity of patients entering the regional medical system continues to exceed the region’s capacity to treat them, SEOC can coordinate patient movement through HELP :
        • Network of interstate ambulances and receiving hospitals
        • 24 hour response as opposed to NDMS 72 hour response
      Epicenter Front Line Hospital Stabilized Patients Surge Resources Regional Hospital Stabilized Patients Surge Resources Regional Hospital Regional Ambulances Shared Information, Analysis, and Coordination of Resources Seamless Emergency Operations Center Local EOC HELP Patient Transporters (over 600 companies) HELP Receiving Facility Network (600 Facilities) HELP Areomedical Staging Center
    • SEOC Manages National Special Needs Transfers Many special needs patients cases cannot be transferred at the regional level. For instance, a large burn incident may require coordinating the transfer of multiple patients throughout the United States to verified burn centers. Pre-hospital Ambulances Frontline Hospital ER Inpatient Hospital Admissions Inter-facility Transport Regional Hospitals Regional Hospitals Inventory Interstate Transport Interstate Receiving Hospitals Interstate Special Needs Transport Verified Burn Center Patients Dispersed From a Major Burn Incident to Verified Burn Centers
    • Proposed Steps
        • Unify and Implement Regional goals
        • Codify and Implement Software Solution
        • Prepare and Implement Operations
      • Facilitation / consultation
        • Facilitate Unified vision
        • Document current status vs. goal
        • Outline steps to reach unified goals
        • Create Integrated critical path
        • Establish incremental milestones
        • Overcome operational, technical and legislative roadblocks.
        • Develop detailed protocols and procedures
      Outline Of ASCEND Service: Integrated Critical Path Integrated Incremental Milestones Detailed Protocols and Procedures Unified Region-Wide Vision Hospitals Pre-hospital Ambulances Inter-facility Transporters Local and State EOC’s
        • Software Solution
          • Outline current enterprise solutions
          • Create bridge software solution
          • Codify Protocols into an Enterprise Software System
          • Provide Training and Exercises on ASCEND software
      Outline Of ASCEND Service: ASCEND EWA Phoenix Salamander
        • Provide Logistical Operations Center
        • Provide HELP Solution
        • Provide Special Needs Patients solutions
      Operations Outline Of ASCEND Service: