New Lessons and Ideas from Receiving Hospitals in

the Gustav Evacuations

National Emergency Management Summit

Doug Brown – ACHEmergency Management Coordinator

Ron Crane – UAMSEmergency Preparedness Manager

March 5, 2009

Road Map

• Chronology• Preparation• Patient Reception• Aftermath• Issues & Ideas• Lessons Learned

Little Rock, we have a problem!

CHRONOLOGY

NDMS History of FCC Little Rock

• Activated in 2005 for Katrina & Rita– Received patients via Ground & Air

• Activated in 2008 for Gustav– Received patients via Air

• Little Rock, Arkansas FCC has had more activations and patient receptions than any other FCC / NDMS Jurisdiction

PREPARATION

Prior to Reception

• Metro Hospital Leadership met to discuss strategies & tactics

• Hospital Liaison Officer & Deputy selected to be onsite and interface with IC

• Creation of “Net Control” Position, pseudo COML

• Multiple communications platforms activated

Preparation

• All Little Rock NDMS Reception Hospitals ready and prepared

• Massive EMS mutual aid response not just metro area, but statewide

• Great cooperation from Central Flying Service & Little Rock National Airport – served as the NDMS Reception Site

Preparation Continued• Arkansas Department of Health on scene

and assisted with data management

• Local & Statewide Offices of Emergency Management provided support

• Little Rock Air Force Base personnel assisted with patient movement from planes to triage

• VA EMRT provided medical & transport support

Activation• Thursday, August 28 – FCC receives

official alert notice of potential activation

• Friday, August 29 – Official activation notice for Little Rock FCC

• Saturday, August 30 – Notified to begin receiving patients by noon, first patients received at 22:57

• Sunday, August 31 – 12 additional flights till conditions deteriorate

PATIENT RECEPTION

Patient Reception

Patient Reception

Patient Reception

NDMS Receiving Hospitals

• Arkansas Children’s Hospital

• Arkansas Heart Hospital• Baptist Medical Center –

Little Rock• Baptist Memorial – North

Little Rock• Central Arkansas

Veterans Healthcare System

• Conway Regional Medical Center

• North Metro Hospital• Saline Memorial - Benton• St. Vincent Infirmary• St. Vincent – Sherwood• University of Arkansas for

Medical Sciences• Jefferson Regional

Medical Center – Pine Bluff

Receiving Hospital Totals

• Arkansas Children’s – 2• Arkansas Heart – 9• Baptist Little Rock – 42• Baptist N Little Rock – 25• Conway Regional – 9• Jefferson Regional – 6• North Metro – 7• Saline Memorial – 15

• St. Vincent – 46• St. Vincent North – 16• UAMS – 24• VA – 24

• GRAND TOTAL of 225

Reception of Aircraft

• Over a 40 hour non-stop period the NDMS hospitals prepared for and received 13 total aircraft

• C-130 8/30 22:57• C-130 8/31 04:25• C-17 8/31 07:48• C-130 8/31 10:15

• C-17 8/31 13:00• C-130 8/31 14:00• C-130 8/31 14:30• C-130 8/31 16:40• C-130 8/31 19:50• C-17 8/31 19:55• C-17 (Canadian) 8/31

20:10• C-130 8/31 21:20• C-130 8/31 21:21

AFTERMATH

After the “Rush”

• Feeling very good about the work we did

• Created new paradigm…we think

• Very good coordination with local partners

• No real plan yet to get folks back…but, “it’s cool.”

• Downtime and turning off

• Solidified position as EM with “outsiders”

The Dreaded Census

• Most hospitals are at or near capacity

• Administration beginning to ask what do we do for discharge

• Questions as to whether there is a plan for repatriation

• IKE!!!!

Conference Call HELL• NDMS / HHS / USPHS / FEMA, State

Agencies, Louisiana Department of Health & Hospitals, Arkansas Hospital Association, Local Hospitals, Arkansas Department of Emergency Management, Red Cross, Arkansas Department of Human Services, Louisiana DRCs, and then Federal Contractors, plus other states that received a fraction of what we did!

ISSUES & IDEAS

Uh Oh…The BIG GAGGLE• Conference Calls reveal there is no real

plan to repatriate patients

• Much confusion amongst reception hospitals as to how to handle discharges

• State and NGOs brought in…more confusion

• Feds, although effort laudable, create more consternation and confusion

If you want something done right…

• By September 17, most patients have not left LR Metro area

• Incredible Frustration with Contractor

• #$%* FEMA NUMBERS!!!

• UAMS discharges all patients at 100% cost to themselves

• Hospitals begin renting buses and directly contacting LA Hospitals directly

More of the same…• After 3 ½ weeks of interminable

conference calls and numerous administrative strokes / MIs, patients finally begin moving

• Federal requests difficult to accomplish

• Family members / attendants accompanying patients now inpatients

• Fatalities

Freak Accident or Vigilance?

LESSONS LEARNED

What we learned…Bad News First• Headquarters ASPR/NDMS needs to

speak to the “boots on the ground”

• PROPS to TRANSCOM

• Numerous studies, but who did they talk to?

• REPATRIATION is not yet worked/figured out

• REIMBURSEMENT is a HUGE issue STILL!!!

Lessons Learned

• Pre-activation

• During the Event

• Post Event & Repatriation

Pre-activation• Monitor the weather…no matter where you

are

• Any storm with potential of land fall, we are closely watching

• Bolster communications capability

• Have a Go Team

• PLAN!

• Be wary of “politics”

HOSPITAL LIAISON• PARADIGM SHIFT

• Remember, this is a Hospital Centric Op!

• Able to provide situational awareness / operational intelligence

• Protected hospitals during local surge events

• Interfaced with IC

• DON’T BE BULLIED!!!

COMMUNICATIONS

• Interoperability is KEY!

• Have a COML / Net Control in place

• Multiple modes of comms

• Radio for FACT

• Conference Call for RUMOR CONTROL

• Bed Census, etc.

During the Event…• Hospital Liaisons in place at reception site

• Communications with multiple agencies other than hospitals

• ADH & NDMS Area Emergency Manager (IC) worked very well to assist receiving hospitals

• Don’t be tied to one bed census

• Situational awareness KEY - WAITING

Post Event…

• Until Repatriation / Reimbursement Issues worked out, be prepared to go it alone

• Be careful of overextending your bed capacity in the event of long stays

• Administration needs to be fully aware of consequences of receiving patients

• No NDMS reimbursement for ancillary cost

Steps Forward / Proposal

• Pre-assigned FEMA #s to all evacuated patients

• CMS wavers to hospitals in not only impacted areas, but in reception areas too!

• Go Teams to embarkation points

• Ability to deal directly with evacuating hospitals

Steps Forward / Proposal

• Ability for locals to pick a contractor(s) or repatriate themselves

• Fatality Management

• Need for Public Assistance / Individual Assistance

Ideas for moving Forward

• Better process from activation to reception to include adequate notice from embarkation to reception sites

• Better coordination on ground in impacted areas

• Current NDMS Structure only identifies “broad” categories, need to rethink (dialysis)

Ideas for moving Forward

• Hospital Liaison position greatly reduced need of subsequent transfers to different hospitals as opposed to Katrina

• NDMS has failed to recognize the need to extend the flow of patients through the entire continuum of care including step down, LTAC, Skilled nursing, and alternative care

QUESTIONS???

Thank YouDoug Brown

Arkansas Children’s Hospital

501-680-3950

brownda1@archildrens.org

Ron Crane

UAMS

501-837-9682

rcrane@uams.edu