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Exercise Operation PREP Overview


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Exercise Operation PREP Overview

  1. 1. Operation PREP November 15 th , 2006 <ul><ul><li>New England Center for Emergency Preparedness </li></ul></ul><ul><ul><li>Dartmouth Medical School </li></ul></ul>
  2. 2. Overview <ul><li>Introduction and Background </li></ul><ul><li>Exercise Objectives </li></ul><ul><li>Activities and Observations </li></ul><ul><li>Reactions and Lessons Learned </li></ul><ul><li>Recommendations </li></ul><ul><li>Conclusions, future directions </li></ul>
  3. 3. Introduction and Background <ul><ul><li>Cooperation of multiple organizations is key to a successful disaster response. </li></ul></ul><ul><ul><li>In a disaster, organizations that don’t often work together will have to. </li></ul></ul><ul><ul><li>Practice will ensure this collaboration and cooperation are effective </li></ul></ul><ul><ul><li>Hanover/Lebanon Region, Wednesday, November 15 th , 2006: Functional exercise to practice cooperation of multiple partners </li></ul></ul>
  4. 4. Partners <ul><li>Town of Hanover </li></ul><ul><li>City of Lebanon </li></ul><ul><li>Dartmouth-Hitchcock Medical Center (DHMC) </li></ul><ul><li>Dartmouth College </li></ul><ul><li>Northern New England Metropolitan Medical Response System (NNE MMRS) </li></ul><ul><li>New England Center for Emergency Preparedness (NECEP) </li></ul>
  5. 5. Hospital Objectives <ul><li>Demonstrate: </li></ul><ul><li>Ability to respond to an infectious respiratory disease epidemic </li></ul><ul><li>Critical ICS sections </li></ul><ul><li>Ability to communicate both internally and externally </li></ul><ul><li>Ability to coordinate with senior leadership at DHMC </li></ul><ul><li>Ability to secure the facility set up external triage at the Emergency Department </li></ul>
  6. 6. Hospital Objectives <ul><li>Demonstrate: </li></ul><ul><li>Ability to track patients using HC Standard </li></ul><ul><li>Decision-making process for requesting community ACC </li></ul><ul><li>Ability to identify patients to discharge or transfer to ACC in order to create hospital surge capacity </li></ul><ul><li>Decision-making process for transfer of 25 patients to community ACC </li></ul><ul><li>Ability to vaccinate health care workers to allow continuity of care in an infectious disease outbreak situation </li></ul>
  7. 7. Community Objectives <ul><li>Practice: </li></ul><ul><li>Setting up an Emergency Operations Center and implementing Incident Command Structure </li></ul><ul><li>Communicating with hospitals and State agencies </li></ul><ul><li>Setting up an Acute Care Center (ACC) </li></ul><ul><li>Admitting 50 patients to the ACC </li></ul><ul><li>Tracking these 50 patients using new software: Health Care Standard (HCS) for patient tracking and Athenahealth for Electronic Medical Records </li></ul>
  8. 8. Activities and Observations <ul><li>Tested implementation and functionality of the Epidemic Respiratory Infection Readiness Plan. </li></ul><ul><li>An All Hazards plan should be developed to fit all events. </li></ul><ul><li>Individual department plans exist, but are not collated into an all-hazards plan </li></ul><ul><li>ICS staff should be flexible about how they use the plans. </li></ul>Hospital Objective: Demonstrate ability to respond to an infectious respiratory disease epidemic
  9. 9. Activities and Observations <ul><li>First time DHMC has used ICS in functional exercise. </li></ul><ul><li>Majority of staff in the EOC felt they understood the chain of command, and felt confident in their ability to fulfill their role. </li></ul><ul><li>Excellent staff turnout at the EOC </li></ul><ul><li>For effective decision-making in the EOC, only key staff should participate in conversations with the IC. </li></ul>Hospital Objective: Demonstrate critical ICS sections Diagram Source:
  10. 10. Activities and Observations <ul><li>Phone lines in the EOC were functional </li></ul><ul><li>Cell phones were not always operational </li></ul><ul><li>Email was used extensively for internal communication. </li></ul><ul><li>HANs had to be redistributed as only one member of staff was registered to receive them </li></ul><ul><li>Patient tracking software worked well for internal and external communications. </li></ul><ul><li>DHMC needs to incorporate a centralized emergency communications plan in their EOP. </li></ul>Hospital Objective: Demonstrate ability to communicate both internally and externally; ability to coordinate with hospital senior leadership
  11. 11. Activities and Observations <ul><li>ED staff assigned by the EOC went outside to assess and triage the patients on the bus. </li></ul><ul><li>Patients were not allowed into the building in order to avoid potential contamination. </li></ul><ul><li>Identified need for specific instructions and protocol for establishing an external triage area during an infectious disease outbreak. </li></ul>Hospital Objective: Demonstrate ability to secure the facility and establish external triage at Emergency Department
  12. 12. Activities and Observations <ul><li>Entering the patients into the patient tracking system paralleled assessment of patients in the triage area. </li></ul><ul><li>HC Standard and current patient admitting system would need to be linked to avoid duplication of effort and be effective in a real event. </li></ul><ul><li>It did not appear that the patient tracking system would severely interfere with the flow of patients. </li></ul><ul><li>athenahealth was not tested at DHMC triage location as planned. </li></ul>Hospital Objective: Demonstrate ability to track patients
  13. 13. Activities and Observations <ul><li>Discussion of how to best utilize this facility </li></ul><ul><li>Decided to transfer all infectious Morbus patients to the ACC as a temporary isolation facility for further observation </li></ul><ul><ul><li>Goal: cohort and observe these patients until it could be determined if they were sufficiently ill to require critical care, and minimize exposure of staff and other patients. </li></ul></ul><ul><li>Decision-making process in this area was efficient, sound and very effective. </li></ul><ul><li>The IC discussed the possibility of using another facility as a clean facility for transferring non-infectious inpatients to create additional hospital surge capacity. </li></ul><ul><li>Protocol for requesting community assistance for medical surge is not included in hospital emergency response plans at this time </li></ul>Hospital Objective: Demonstrate decision-making process for requesting an Acute Care Center (ACC)
  14. 14. Activities and Observations <ul><li>Identified more than 60 inpatients for immediate discharge </li></ul><ul><li>Established a discharge center to immediately open necessary beds </li></ul><ul><li>Incident Commander cancelled elective procedures for the day; procedures scheduled for the following day were put on hold until further notice </li></ul><ul><li>Hesitant to cancel all procedures due to financial implications </li></ul><ul><li>All patients in one inpatient unit were moved to other areas of the hospital so that this unit could become an internal cohort unit if necessary </li></ul>Hospital Objective: Demonstrate ability to identify patients to discharge or transfer to ACC in order to create hospital surge capacity
  15. 15. Activities and Observations <ul><li>Physical transfer was not tested. </li></ul><ul><li>Discussion about how to transfer them to the ACC, including the possibility of instructing patients to drive themselves there. </li></ul><ul><li>Led to an in-depth discussion of liability on the part of the hospital and the need to treat and stabilize arriving patients. </li></ul><ul><li>Incident Commander did not want to tie up the ambulances transferring stable, non-critical patients. </li></ul><ul><li>Decided to stop running local transportation company shuttles and use those busses to transfer Morbus patients to the ACC. </li></ul><ul><li>Patients would be accompanied by staff members from Security and the Emergency Department. All staff on the bus, including the driver, were instructed to wear appropriate personal protective equipment (PPE). </li></ul>Hospital Objective: Demonstrate ability to transport 25 patients to community ACC
  16. 16. Activities and Observations <ul><li>Three 12-hour vaccination clinics where employees were provided the seasonal flu vaccine at no cost </li></ul><ul><li>Advertised to staff via the intranet </li></ul><ul><li>Participation was encouraged by department directors. </li></ul><ul><li>Clinics were patterned after the New Hampshire POD planning guidance. </li></ul><ul><li>2,890 employees were vaccinated </li></ul><ul><li>Average wait time of one minute. </li></ul><ul><li>A much larger number of employees could have been managed with the same level of staffing if necessary. </li></ul>Hospital Objective: Demonstrate ability to vaccinate health care workers to allow continuity of care in an infectious disease outbreak situation.
  17. 17. Results and Reactions - Hospital <ul><li>DHMC exercise participants demonstrated the capability to: </li></ul><ul><li>Initiate specialty teams within the ICS that were able to think and act independently, helping to address organization and community response. </li></ul><ul><li>Communicate with the NH DHHS on the phone, with hospital senior leadership through in-person briefings, and with hospital employees through email. </li></ul><ul><li>Create hospital surge capacity by transferring and discharging stable patients. </li></ul><ul><li>Utilize community medical surge capacity resources to maintain hospital capacity for critically ill patients. </li></ul><ul><li>Identify local transportation resources which could be used to move large numbers of patients in a safe and efficient manner. </li></ul><ul><li>Vaccinate large numbers of health care workers to maintain continuity of operations in an infectious disease outbreak. </li></ul>
  18. 18. Results and Reactions - Hospital <ul><li>Major areas for improvement: </li></ul><ul><li>Further training in ICS would be beneficial </li></ul><ul><ul><li>Desire to be collaborative will impede decision-making process in real event </li></ul></ul><ul><ul><li>Newly released HICS IV </li></ul></ul><ul><li>Emergency response plans need to be refined for flexibility, completeness </li></ul><ul><ul><li>Useful in all emergency situations </li></ul></ul><ul><ul><li>Cover all bases: communication, transportation, surge capacity </li></ul></ul>
  19. 19. Activities and Observations <ul><li>Hanover emergency planners set up EOC in new location – what to bring? </li></ul><ul><li>Practice with ICS – not all familiar with chain of command </li></ul><ul><li>Job Action Sheets and diagram assisted ICS set-up </li></ul><ul><li>Communication: cell phones, landlines, internet – did not test radios </li></ul>Community Objectives: Practice setting up Emergency Operations Center and implementing Incident Command Structure. Practice communicating with hospital and State.
  20. 20. Activities and Observations <ul><li>SNS resource tracking requirement </li></ul><ul><li>Efficiency: <1 minute per patient </li></ul><ul><li>Accountability: full record for each patient </li></ul>Community Objectives: Practice ability to track 50 patients in a POD
  21. 21. Activities and Observations <ul><li>Multiple organizations: NNE MMRS NH Strike Team, HFD </li></ul><ul><li>Besides Hanover FD, none of these people had ever worked together before </li></ul><ul><li>Determine ICS – Job Action Sheets and diagram helpful </li></ul><ul><li>Physical set up of Cabela’s cots – Supplied by Hanover </li></ul><ul><li>Receiving and unloading of medical supplies from DHMC </li></ul><ul><li>Secure facility </li></ul>Community Objectives: Practice setting up an Acute Care Center
  22. 22. Leverone Field House
  23. 25. Activities and Observations <ul><li>Local High School and Dartmouth students volunteered as “patients” </li></ul><ul><li>No acting – each received a patient card with a description of symptoms </li></ul><ul><li>Strike team admitted patients </li></ul><ul><li>No patient care given </li></ul><ul><li>Written orders to track activities, use of staff and supplies </li></ul>Community Objectives: Practice admitting 50 patients to ACC
  24. 27. Activities and Observations <ul><li>Patients given tag with bar code at triage (ED, NEHC) </li></ul><ul><li>Scanned at every point of contact – discharge facility, transfer, receiving </li></ul><ul><li>Handheld scanners (HCS) are multipurpose tool </li></ul><ul><li>HCS linked to WebEOC, monitors anything and everything </li></ul><ul><li>Athena tracks care given, resources used </li></ul>Community Objectives: Practice tracking 50 patients in ACC using patient tracking and electronic medical records software
  25. 28. Results and Reactions - Community <ul><li>Strike team worked well together, especially considering they have never done so before this exercise! </li></ul><ul><li>Need some non-medical personnel at the ACC to handle administrative and custodial duties </li></ul><ul><li>Need simple instructions on how to set up an ACC; very few people know exactly how to do it! </li></ul>
  26. 29. Results and Reactions - Community <ul><li>Supplies are a big issue: how do we get the supplies to the people who need them? </li></ul><ul><li>DHMC coordinated the supplies they sent with the Logistics Trailer inventory </li></ul><ul><li>State Logistics Trailer was unavailable for the exercise </li></ul><ul><li>Pre-printed admission and discharge forms </li></ul>
  27. 30. Results and Reactions - Community <ul><li>Clear lines of communication between State, local and hospital EOC’s, and ACC are a must </li></ul><ul><li>Not always clear who should call which organization for what information </li></ul><ul><li>Periodic practice and training in ICS and review of emergency response plans will make this process more familiar and comfortable during an actual incident </li></ul>
  28. 31. Recommendations <ul><li>Planning </li></ul><ul><ul><li>DHMC should review current emergency response plans, and ensure they are flexible enough to be useful during a public health emergency. </li></ul></ul><ul><ul><li>DHMC should develop annexes to this plan, including an emergency communications plan, and mass transportation. </li></ul></ul><ul><ul><li>DHMC should review medical surge capacity plans and protocol for requesting assistance from the community. </li></ul></ul><ul><ul><li>NNE MMRS should review the ACC Concept of Operations document in relation to NIMS and HICS guidance to ensure compatibility. </li></ul></ul>
  29. 32. Recommendations <ul><li>Operational </li></ul><ul><ul><li>Additional education and practice in ICS is needed by both DHMC staff and the NH Medical Strike Team. </li></ul></ul><ul><ul><li>Before any IT systems are used, staff will require extensive training in them. Just-in-time training should be created where appropriate. </li></ul></ul>
  30. 33. Recommendations <ul><li>Training and Education </li></ul><ul><ul><li>NNE MMRS should continue to educate medical strike team members on ICS and procedures for opening and operating an ACC. </li></ul></ul><ul><ul><li>DHMC should continue to education staff on ICS, emphasizing new HICS IV guidance </li></ul></ul>
  31. 34. Recommendations <ul><li>Future Exercises </li></ul><ul><ul><li>Additional exercises should exercise other components of hospital and community surge capacity, including staff shortages, and supply use. </li></ul></ul><ul><ul><li>Incorporate additional partners and stakeholders in future exercises, including those from neighboring states. </li></ul></ul>
  32. 35. Conclusion <ul><li>Collaboration is key to success </li></ul><ul><ul><li>Fire, police, emergency managers, hospital, EMS, local physicians and nurses, nursing home facilities, Visiting Nurses Association, schools, businesses </li></ul></ul><ul><li>Supplies </li></ul><ul><ul><li>What do you have? </li></ul></ul><ul><ul><li>What do you need? </li></ul></ul><ul><ul><li>How can you get it? (Hint: be creative) </li></ul></ul><ul><li>Practice makes perfect! </li></ul>
  33. 36. Resources <ul><li>NNE MMRS: </li></ul><ul><ul><li>Guidance for planning exercises and drills, medical surge capacity documents, including ACC Concept of Operations </li></ul></ul><ul><li>NECEP: http:// </li></ul><ul><li>Department of Homeland Security: </li></ul><ul><li>Centers for Disease Control: </li></ul><ul><li>Department of Health and Human Services: </li></ul><ul><li>Contact: </li></ul><ul><ul><li>Reiley Lewis MPH </li></ul></ul><ul><ul><li>New England Center for Emergency Preparedness </li></ul></ul><ul><ul><li>Colburn Hill, HB 7462 </li></ul></ul><ul><ul><li>One Medical Center Drive </li></ul></ul><ul><ul><li>Lebanon, NH 03756 </li></ul></ul><ul><ul><li>Office: (603) 653-1189 </li></ul></ul><ul><ul><li>[email_address] </li></ul></ul>