TheAll-HazardsApproachto&UseofHICSinManagingHighlyInfectiousDiseasePatients

NickCagliuso&ShellySchwedhelm

Agenda

1.All-HazardsEmergencyManagement2. The3Cs3.HospitalIncidentCommandSystem(HICS)

1.Command&GeneralStaff4. TheEbolaPreparedness&ResponseParadox5. ReadinessStrategies

1.Leadership2.Training,Education&Exercises3.CommunityOutreach

6. LessonsLearned7.NETECResources

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Objectives

• Describethe“all-hazards”approachtomanagingthecareofhighlyinfectiousdisease(HID)patients

• DescribetheuseoftheHospitalIncidentCommandSystem(HICS)inthecareofHIDpatients

• DescribethekeyelementsofsustainingreadinesstocareforHIDpatients

• DescribethenextstepsinbuildingnationalresilienceforsafelyandeffectivelymanaginganinfluxofHIDpatients

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All-HazardsEmergencyManagement

• Natural– Weather

• Technological– Power Outage

• Intentional– Terrorism

• Mitigation• Preparedness • Response• Recovery

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The3Cs

• Communication• Coordination• Collaboration

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1st C:Communication

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2nd C:Coordination

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3rd C:Collaboration

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LessonLearned:TheEbolaPreparedness&Response

Paradox• LowPatientCount• HighResourceDemand• LowResourceCapacity• HighRiskPerception• LittleornoexperiencewithEVDPUIsorconfirmedcases– Emory,NebraskaandNYCHealth+Hospitals/BellevuehaveallsuccessfullytreatedconfirmedEbolapatients

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• Incidentmanagementsystem• Applicabletoanyhospital• Tooltomanage

–Threats–Plannedevents–Emergencyincidents

• Structure–Modular–Scalable

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Incident CommanderOrganize and direct the Hospital Command Center.

Give overall strategic direction for Incident management and support activities, including emergency response and recovery

Ø Oversee and convene command structure

Ø Implement Biocontainment Unit activation checklist

Ø Interagency coordination during transport

Ø Identify Medical Specialist Role (Infectious Disease MD)

Ø Identify Campus Mitigation Strategies

Ø Collaborate with community and national agencies as needed (e.g.. health dept.; CDC; etc.)

Ø Determine Planning Cycle and define routine briefing times

Ø Collaborate with research leaders to access experimental drugs if needed

HID Go Kit

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Public Information Officer (PIO)

Conduit for information to internal and external stakeholders, including media as approved by Incident Command. Ø Risk communication strategiesØ Determine internal and external

messagesØ Collaborate with medical staff and

family on messagingØ Establish information lines/hotlinesØ Monitor and manage social mediaØ Who, what, where, when, how, why?

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OperationsDevelop and implement strategy and tactics to carry out objectives established by Incident Command. Organize, assign, and supervise

Medical Care, Security, HazMat, and Business Continuity.

Ø Surge capacity planØ Just in Time Personal Protective Equipment (PPE) training Ø Staffing backfill planØ Special project team (s)

Ø Protocol updatesØ New issue process/procedure development

Ø Morgue PlanØ Laboratory PlanØ Behavioral Health Plan

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Planning Oversee all incident-related data gathering and analysis regarding

incident operations and resources; develop alternatives for tactical operations, conduct planning meetings, and prepare

Incident Action Plan for each operational period.

Ø Define Incident Action Plan Objectives

Ø IT screening tool development for entry areas of health system

Ø Define plans for evacuation, severe weather, etc. if needed while activated

Ø Medical record audits

Ø Employee Health/Occup. Health Support for Temperature Monitoring during activation

Ø HR issues requiring resolution during activation

Ø Care of the family-nurse concierge 15

Logistics Responsible to organize and direct operations associated with

maintenance of physical environment, materiel and service support activities.

Ø Waste Management PlanØ Facilities Plan (negative pressure, HVAC, etc.)Ø Security Plan (transport, unit security)Ø Biomed Plan (autoclave and other equipment)Ø PPE management (# sets on hand, back orders, etc.)Ø Linen Plan (scrubs, linens)Ø Food Plan (patient and staff)Ø Supply & Medication lists and availability

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Finance Finance Section Chief is to monitor utilization of assets and

accounting for expenditures.Supervise documentation of expense and cost reimbursement.

Ø Cost center developmentØ Expense trackingØ Charge code developmentØ Funds flow, fast track purchases as needed for equipment

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ReadinessStrategies

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• UseofJust-in-TimeChecklists• JobActionSheets

• Physician&NursingBackfillPlan• Depth• Recruit&orientstaffinotherspecialties(e.g.,nephrology)

• Addressbackfillissuesinadvance• RVUs&compensationissues

ReadinessStrategies

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Leadership

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• LeadbyExample• Sharedgovernance• Relationship-basedcare

• Communication• Dailyteambriefing• Dailyhuddlecommunication(verbal&email)

• StandardOperatingProcedures(SOPs)• Staffownership

• Plan,practice,learnandadaptforyouruniquesituation

No Hierarchy… & Lots of Tools

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Waste StreamØ It’s not all solid wasteØ It does not always require a high tech solution

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Waste StreamØ It’s not always planned

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Training, Education,& Exercises

Multiple Scenarios and Partners

Radiology Department

Operating Room Staff – Care of a PUI

Local Responders and the United States Air Force

Provider Down Policy

“Practice makes PERMANENT, not perfect.”Dale Carnegie, 1888-1955 24

Community OutreachØ OMMRS TrainingØ ToursØ Presentations at local and

national conferencesØ Schools – pre-school – collegeØ Business leadersØ Churches

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Lessons Learned

Ø Incident Command structure is important

Ø Bricks and mortar may need adjustments

Ø Daily briefings assured everyone on same page and provided touch point with all team members

Ø Problem solving was constant

Ø Leadership matters

Ø Interprofessional teamwork is essential

Ø No cost structures exist

Ø Business continuity planning is important…”what if”, “what if”,…

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HSEEPExerciseTypes

• Discussion-based– Seminars– Workshops– Tabletop exercises– Games

• Operations-based– Drills– Functional exercises– Full-scale exercises

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NETECExerciseResources• 4end-users;2exercisetypes

– Discussion-based– Operations-based

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