Ascend Presentation

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Ascend Presentation

  1. 1. 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.
  2. 2. 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
  3. 3. U.S. Air Ambulance Corporate Overview  Headquartered in Sarasota, FL  23 years experience  Licensed ground and air ambulance provider  180 employees  97,000 patients, 100% safety record
  4. 4. Relevant Corporate Experience  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
  5. 5. External Emergencies Have an Epicenter Epicenter Epicenter – The area of an emergency which is unsafe or uninhabitable
  6. 6. Measures of Emergencies - Scale Epicenter EMAC Federal Local Regional Statewide Border States Interstate State Interstate Scale
  7. 7. Measures of Emergencies – Scope General Population Transportation Disadvantaged Population Nonmedical Assisted Living Long Term Care Scope Epicenter Medical Long Term Care Medical General Medical Medical ALS / ICU Medical Special Needs EMAC Federal Local Regional Statewide Border States Interstate State Interstate Scale
  8. 8. Our Products - HELP General Population Transportation Disadvantaged Population Nonmedical Assisted Living Long Term Care Scope Medical Long Term Care Medical General Medical Medical HELP ALS / ICU Medical Special Needs EMAC Federal Local Regional Statewide Border States Interstate State Interstate Scale
  9. 9. HELP Provides Additional Resources for Large Scale Disaster HELP provides access to transportation assets and receiving hospitals outside the Region Second Tier Providers Hospital Network Outside Mobilized for Hospital of Emergency Zone
  10. 10. Our Products - SPEAR Special Patients Emergency Ambulance Response General Population Transportation Disadvantaged Population Nonmedical Assisted Living Long Term Care Scope Medical Long Term Care Medical General HELP Medical Medical ALS / ICU Medical Special Needs SPEAR EMAC Federal Local Regional Statewide Border States Interstate State Interstate Scale
  11. 11. SPEAR Program Special Patient Emergency Ambulance Response Program Patients Dispersed From a Major Burn Incident to Verified Burn Centers 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. Verified Burn Center
  12. 12. Our Products - ASCEND Accelerating Scalable Community Emergency Network Demonstration General Population Transportation Disadvantaged Population Nonmedical Assisted Living Long Term Care Scope Medical Long Term Care Medical General ASCEND HELP Medical Medical ALS / ICU Medical Special Needs SPEAR EMAC Federal Local Regional Statewide Border States Interstate State Interstate Scale
  13. 13. Are Local Communities Ready For Accelerating Emergency? 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
  14. 14. Accident or Terrorism – Major Local Implications National Planning Scenarios • Chlorine Tank Explosion – National Planning Scenario 1 Improvised Nuclear Device 2 Major Earthquake • In 2007, terrorists used chlorine gas 7 times on U.S. troops 3 Aerosol Anthrax 4 Major Hurricane • In urban area – 100,000 hospitalized 5 Pandemic Influenza 6 Radiological Dispersal Device • 10,000 vents required 7 Plague 8 Improvised Explosive Device • 10,000 people die 9 Blister Agent 10 Food Contamination 11 Toxic Industrial Chemicals 12 Foreign Animal Disease 13 Nerve Agent 14 Cyber Attack 15 Chlorine Tank Explosion
  15. 15. Natural Disasters Have Accelerated During Last Four Decades 1993 Midwest Floods 1994 Northridge Earthquake 2005 Hurricane Katrina
  16. 16. Terrorism Against Americans Has Escalated Probability of Dirty Bomb Attack in Next Decade – 40 percent Terrorism Against Americans Iran 1961 – First U.S. Aircraft Hijacking 1979 1974 – Patty Hearst Kidnapping 1979 – Iran, U.S. Embassy Hostages Oklahoma City 1983 – Lebanon and Kuwait 1979 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 U.S.S. Cole 1998 - Kenya and Tanzania 2000 U.S. Embassy Bombing 2000 - U.S.S. Cole Bombing 2001 – 9/11 Coordinated Attacks World Trade Center and Pentagon 2001 – Anthrax Attacks New York 2002 – Beltway Sniper Attacks 2001 2009 – Fort Hood Shootings
  17. 17. Possibility of Unprecedented Disaster is Very Real 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 1995 7.2 Richter Scale • Kobe, Japan Earthquake: 500 B 2009 New Madrid Earthquake Study (6.9 R): • Trillion dollars in losses • 130 hospitals destroyed • 80,000 lives lost New Madrid Earthquake 1811 8.3 Richter Scale 1895 6.8 Richter Scale
  18. 18. 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
  19. 19. Through Grants, DHS and HHS are Influencing National Direction 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
  20. 20. 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 Air Ambulance locations 2009 • 800,000 Police Officers • 400,000 National Guard troops • Over 1 million Active Military Personnel Stationed in the U.S.
  21. 21. Two Dimensions of an Emergency – Speed and Scale SPEED vs. SCALE Response Static Time Velocity Response Time Response Acceleration Time
  22. 22. 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 Health Care Facilities Emergency Medical Service CEN Emergency Support Special Needs Transport Inter-facility Transport
  23. 23. Interdependent Medical Response Chain Interstate Regional Receiving Frontline Inter-facility Hospitals Hospitals Hospital ER Transport Inventory Pre-hospital Regional Interstate Inpatient Interstate Ambulances Hospitals Transport Hospital Special Admissions Needs Transport Patient Flow Evacuation Expansion Emergency Acceleration
  24. 24. Link 1 – Pre-hospital Ambulance Network Pre-hospital Ambulances Epicenter Epicenter – The area of an emergency which is unsafe or uninhabitable
  25. 25. Link 2 – Front Line Hospital Emergency Rooms Frontline Hospital ER Pre-hospital Ambulances Front Line Hospitals – Functioning Hospitals nearest the Epicenter 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.
  26. 26. 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 Self Present Hospital Emergency Room Admission Discharge Ambulance
  27. 27. CEN Responds Early To Shared Info Frontline Hospital ER 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 Pre-hospital respond to relieve front line hospital of stable patients. Ambulances Inpatient Hospital Admissions ABC Hospital ER Hospital Wait Time hrs: 2.4 Hospital Capacity: 92% Capacity %: 122 Net Admit RPH: 17 Net Arrival RPH: 21 ER At Capacity: 3.4 Hrs Acceleration %: 82 Bed Divert: Burn Critical ER Capacity 85% Inter-facility Requirement: 20 ALS 11 BLS
  28. 28. Links 4-6 Interfacility Transport and Regional Hospitals Regional Frontline Inter-facility Hospitals Hospital ER Transport Inventory Pre-hospital Inpatient Regional Ambulances Hospital Hospitals Admissions
  29. 29. All Members of the CEN Share Info Early 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. Support Services Shared Information Special Needs Patient Transporter Epicenter Regional Front Line Inter-facility Hospital Hospital Transporter
  30. 30. ASCEND Software Component Management Software
  31. 31. 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. Seamless Emergency Operations Center Shared Information, Analysis, and Coordination of Resources Epicenter Stabilized Patients Surge Resources Front Line Regional Hospital Hospital
  32. 32. ASCEND Seamless Operations Center Command Center
  33. 33. SEOC Assists Local EOC 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. Seamless Emergency Operations Center Shared Information, Local Emergency Analysis, and Operations Center Shared Information Coordination And Coordination of Resources of assets Front Line Hospital Epicenter Stabilized Patients Surge Resources Front Line Regional Hospital Hospital
  34. 34. Regional Response Integrates with Federal Response Regional Interstate Frontline Inter-facility Hospitals Receiving Hospital ER Transport Inventory Hospitals Pre-hospital Inpatient Regional Interstate Ambulances Hospital Hospitals Transport Admissions
  35. 35. 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 Seamless Emergency Operations Center Shared Information, Local Analysis, and EOC Coordination of Resources HELP Areomedical HELP HELP Receiving Staging Center Patient Transporters Facility Network (over 600 companies) (600 Facilities) Epicenter Stabilized Patients Stabilized Patients Surge Resources Surge Resources Front Line Regional Regional Regional Hospital Hospital Hospital Ambulances
  36. 36. SEOC Manages National Special Needs Transfers Regional Interstate Frontline Inter-facility Hospitals Receiving Hospital ER Transport Inventory Hospitals Pre-hospital Inpatient Interstate Interstate Regional Ambulances Hospital Transport Special Hospitals Admissions Needs Transport Patients Dispersed From a Major Burn Incident to Verified Burn Centers 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. Verified Burn Center
  37. 37. Proposed Steps 1. Unify and Implement Regional goals 2. Codify and Implement Software Solution 3. Prepare and Implement Operations
  38. 38. Outline Of ASCEND Service: Facilitation / consultation 1. Facilitate Unified vision 2. Document current status vs. goal 3. Outline steps to reach unified goals 4. Create Integrated critical path 5. Establish incremental milestones 6. Overcome operational, technical and legislative roadblocks. 7. Develop detailed protocols and procedures Unified Region-Wide Vision Integrated Critical Path Local and Integrated Detailed Hospitals State Incremental Protocols and EOC’s Milestones Procedures Pre-hospital Inter-facility Ambulances Transporters
  39. 39. Outline Of ASCEND Service: Software Solution • Outline current enterprise solutions •Create bridge software solution •Codify Protocols into an Enterprise Software System • Provide Training and Exercises on ASCEND software ASCEND EWA Salamander Phoenix
  40. 40. Outline Of ASCEND Service: Operations •Provide Logistical Operations Center • Provide HELP Solution • Provide Special Needs Patients solutions

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