Alternate Care Facility: Developing Medical Surge Capability in King County

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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

  1. 1. Partners in Preparedness Conference A il 26 2011April 26, 2011 Alternate Care Facilities: Developing Medical Surge CapabilityDeveloping Medical Surge Capability in King County
  2. 2. OBJECTIVES  Define and explain the purpose of ACFsp p p  Describe current ACF capability in King Countyp y g y  Identify circumstances for use – likely scenarios  Identify challenges with developing, operating and sustaining ACFs statewide  Review proposed Strategies for Success
  3. 3. 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
  4. 4. ACF - Definition N di l f ilit d i d i dNon-medical facility designed, equipped and staffed to deliver care to patients In 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 N t t f i ti h lth f ilit Not part of an existing healthcare facility
  5. 5. ACF Program Goal - KC Develop capability to activate and operateDevelop 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 biliticapabilities
  6. 6. Current Capability in KC
  7. 7. Circumstances for Activation 1. Loss of Local Inpatient Capacity Hospitals or nursing homes / 1. Loss of Local Inpatient Capacity damaged/destroyed, and Remaining inpatientRemaining inpatient facilities can not absorb the load, and, Transporting patients out of region is not sufficient
  8. 8. Circumstances for Activation 2 Surge in Patient Demand  Disaster generates 2. Surge in Patient Demand widespread illness or injuries that exceed local it l lsurge capacity levels 3 A bi ti f b th3. A combination of both
  9. 9. Potential Scenarios Earthquakeq Loss of capacity, Loss of Transport Capability, Surge in Patient Demand Severe Weather, Structure Fire Loss of Capacity, Loss of Supporting Infrastructure Specific Hazards (Pandemic, Radiological Contamination, BT) S i P ti t D d i bilit t t t t f iSurge in Patient Demand, inability to transport out of region Providing assistance to other regions RITN, Evacuating victims with medical needs
  10. 10. Levels of Care Tier 2 Example: Nursing home evacuation (1 or more)  Limited number of patients start with 50 bed Limited number of patients, start with 50 bed module  Basic inpatient nursing care  No acute medical conditions
  11. 11. Levels of Care Tier 3Tier 3 Example: Hospital Evacuation after a major EQ  I ti t i i f t bl ti t Inpatient nursing services for stable patients  Expanded pharmaceutical services O h il bl 6l NP Oxygen therapy available to 6l. NP  At least one additional care module: di t i b l t b h i l h lthpediatric, ambulatory care, or behavioral health  Urgent capability for inappropriate patients  treat and f ASAP!transfer ASAP!
  12. 12. Levels of Care Tier 4 All modules activated, all services provided
  13. 13. Staffing Model Administrative and Logistical Per HICS standard org chart Medical Reserve Corps Patient Care Providers Medical Reserve CorpsMedical Reserve Corps Staff from evacuating facilities Staff from local hospitals / clinics
  14. 14. Staffing Model I ti t N i C M d l Day (12 hr) Evening/night Inpatient Nursing Care Model Day (12 hr) Evening/night (12hr) Inpatient RN 2 2 LPN 5 4LPN 5 4 Nursing Assistant / Certified Nursing Assistant / Medical Assistant 3 3 Housekeeping 1 1 Total (50 bed activation) 11 = ideal *9* = minimum 10 = ideal *8* = minimum
  15. 15. Equipment and Supplies E Bed CotsE Bed Cots CribsCribs
  16. 16. Equipment and Supplies MedLox O2 Distribution System National Oxygen Kit (NOK)
  17. 17. Equipment and Supplies 3 Manual ACLS Defibrillators3 Manual ACLS Defibrillators 3 AEDs3 AEDs 2 122 12--lead ECG Unitslead ECG Units 6 I6 I--Stat AnalyzersStat Analyzers 12 HemoCue WBC systems12 HemoCue WBC systems12 HemoCue WBC systems12 HemoCue WBC systems 3 Braun IV Pumps3 Braun IV Pumps 3 Ultraclave sterilizers3 Ultraclave sterilizers Di it l XDi it l X R i tR i tDigital XDigital X--Ray equipmentRay equipment
  18. 18. Equipment and Supplies Broselow Pediatric SystemSystem  2 each - Broselow Carts  2 each - Broselow Packs  5 each - Broselow Tapes
  19. 19. Equipment and Supplies  Blood Pressure Units Ga e and Bandages  Blood Pressure Units  Cervical Collars  X ray Illuminators  IV Supplies  Gauze and Bandages  Sutures  Syringes M  IV Supplies  Catheters  Otoscopes O h h l  Microscopes  Sanitizers  Ambu Bags  Ophthalmoscopes  Scales  Suction Pumps, tubing and canisters  Backboards  Patient Lifts  Wheelchairs canisters  Stethoscopes  And much more………  Traction Splints  Various Forceps  Various Tubes
  20. 20. Readiness Contracts M di l S li & O Medical Supplies & Pharmaceuticals  PSS  Oxygen  Airgas  Cardinal  McKesson  Other  Home Depot  Patient Feeding, Portable Toilets & Showers, Mobile  Home Depot  Grainger  Keeney’s Laundry  Bishop Services  OK’S Cascade y  Abbey Party Rents  Honey Bucket OK S Cascade  Mountain Mist
  21. 21. Strategies for Success
  22. 22. Building and Sustaining Capability  ACFs MUST be part of a medical surge strategy  Integration with Disaster M di l C t l C t dMedical Control Centers and inpatient care sector essential  Innovative staffing plans
  23. 23. Building and Sustaining Capability  Expertise in medical planning and logistics required  Storage and maintenance l i d i tplans required - ongoing costs  Training and exercises are critical
  24. 24. Key Questions:  What’s the statewide strategy for building and What s the statewide strategy for building and maintaining this capability?  What scenarios are we What scenarios are we planning for?  ACF vs transport to other areas? ACF vs. transport to other areas?  Role of federal assets and l id?mutual aid?  How do we keep it affordable?
  25. 25. Comprehensive ACF Strategy 1 Establish clear understanding among healthcare1. Establish clear understanding among healthcare and PH regarding the purpose of ACFs in WA  Support LTC facility evacuation only? 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 sectorswith healthcare sectors
  26. 26. Comprehensive ACF Strategy 3 Establish statewide consistency and interoperability3. Establish statewide consistency and interoperability of equipment and supplies 4. Develop a statewide storage plan 5. Develop statewide transportation capability to rapidly mobilize equipment and suppliesrapidly mobilize equipment and supplies
  27. 27. Comprehensive ACF Strategy 6 A t f t t id t l id i ACF t t6. Account for statewide mutual aid in our ACF strategy, and expand mutual aid to hospitals and LTC facilities 7. Develop statewide efficiencies for ACF training and exercise development and implementationexercise development and implementation 8 E t bli h th h ld f ti f d l t8. Establish thresholds for requesting federal assets (FMS, DMAT) as integral parts of ACF capability
  28. 28. Questions? Tamlyn Thomas, RN STAT ICU Resource Nurse UWMC Emergency Management Coordinator University of Washington Medical Center Michael Loehr, MRP, CBCP Preparedness Director P bli H lth S ttl & Ki C tPublic Health – Seattle & King County

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