Preparedness: Where We Are And Where We Are Going

5th Annual Wyoming Infection Prevention Conference

April 21, 2015

10:30 – 11:30 am

Brittany Wardle, MPH

Hospital Preparedness Program Coordinator

Office of EMS

Wyoming Department of Health

Objectives

• Participants will gain a basic understanding of the Wyoming

Hospital Preparedness Program

• Participants will acquire an understanding of the healthcare

coalitions in Wyoming

• Participants will learn about Ebola preparedness and response

activities in Wyoming

Overview• Hospital Preparedness Program Overview

• Healthcare Coalitions

• Ebola Preparedness

• Ebola Preparedness and Response Activities

• Infection Preventionists and Emergency Preparedness

Hospital Preparedness Program (HPP) Overview• Mission: To improve healthcare preparedness and response by providing

leadership, funding, evaluation, and technical assistance to HPP awardees

• Vision: A robust, integrated federal, state, and local disaster healthcaresystem that coordinates all components of health delivery, supportingEmergency Support Function #8, to realize greater national healthcarepreparedness, response, and recovery.

Hospital Preparedness Program (HPP) and Public Health Emergency Preparedness (PHEP) CapabilitiesPHEP Capabilities HPP Capabilities

1 Community Preparedness 1 Healthcare System Preparedness

2 Community Recovery 2 Healthcare System Recovery

3 Emergency Operations Coordination 3 Emergency Operations Coordination

4 Emergency Public Information and Warning 4

5 Fatality Management 5 Fatality Management

6 Information Sharing 6 Information Sharing

7 Mass Care 7

8 Medical Countermeasure Dispensing 8

9Medical Materiel Management and

Distribution9

10 Medical Surge 10 Medical Surge

11 Non-Pharmaceutical Interventions 11

12 Public Health Laboratory Testing 12

13Public Health Surveillance and

Epidemiological Investigation13

14 Responder Safety and Health 14 Responder Safety and Health

15 Volunteer Management 15 Volunteer Management

HPP Capabilities• Capability 1: Healthcare System Preparedness

• The ability of a community’s healthcare system to prepare, respond, and recoverfrom incidents that have a public health and medical impact in the short and longterm

• Capability 2: Healthcare System Recovery• Collaboration with Emergency Management and other community partners

(public health, business, or education) to develop efficient processes andadvocate for the rebuilding of public health, medical, and mental/behavioralhealth systems to at least a level of functioning comparable to pre-incident levelsand improved levels where possible

HPP Capabilities• Capability 3: Emergency Operations Coordination

• The ability for healthcare organizations to engage with incident management atthe Emergency Operations Center or with on-scene incident management duringan incident to coordinate information and resource allocation for affectedhealthcare organizations

• Capability 5: Fatality Management• The ability to coordinate with organizations (law enforcement, healthcare,

emergency management, and medical examiner/coroner) to ensure the properrecovery, handling, identification, transportation, tracking, storage, and disposalof human remains and person effects; certify cause of death; and facilitate accessto mental/behavioral health services for family members, responders, andsurvivors of an incident

HPP Capabilities• Capability 6: Information Sharing

• The ability to conduct multijurisdictional, multidisciplinary exchange of publichealth and medical related information and situational awareness between thehealthcare system and local, state, Federal, tribal, and territorial levels ofgovernment and the private sector

• Capability 10: Medical Surge• The ability to provide adequate medical evaluation and care during incidents that

exceed the limits of the normal medical infrastructure within the community

HPP Capabilities• Capability 14: Responder Safety and Health

• The ability of healthcare organizations to protect the safety and health ofhealthcare workers from a variety of hazards during emergencies and disasters

• Capability 15: Volunteer Management• The ability to coordinate the identification, recruitment, registration, credential

verification, training, engagement, and retention of volunteers to supporthealthcare organizations with the medical preparedness and response toincidents and events

HPP Funding• Hospital Preparedness Program funding currently supports:

• Individual hospital and EMS agency grant awards• State level personnel, training, and exercise

• Regional Coordinators

• Federally required systems (Wyoming Activation of Volunteers in Emergencies (WAVE) and Hospital Available Beds in Emergencies and Disasters (HAvBED))

• Hospital Preparedness Program is transitioning (July 1, 2015) to using funding to support:• Healthcare coalitions and regional efforts

• State level personnel, training, and exercises

• Regional training• Regional caches (PPE, equipment, supplies, etc.)

• Regional Coordinators

• Federally required systems (Wyoming Activation of Volunteers in Emergencies (WAVE) and Hospital Available Beds in Emergencies and Disasters (HAvBED))

HEALTHCARE COALITIONS

Defining Healthcare Coalitions• Healthcare Coalition (HCC): A collaborative network of healthcare

organizations and their respective public and private sector response partners within a defined region

HCC Regions

HCC Regions by County• Region 1

• Campbell, Crook, Johnson, Sheridan, and Weston

• Region 2• Carbon, Converse, Fremont, Natrona, and Niobrara

• Region 3• Albany, Goshen, Laramie, and Platte

• Region 4• Big Horn, Hot Springs, Park, and Washakie

• Region 5• Lincoln, Sublette, Sweetwater, Teton, and Uinta

Healthcare Coalitions Objectives

• Serve as a multiagency coordinating group to assist with preparedness, response, recovery, and mitigation activities related to healthcare organization disaster operations

• Priority objective of the Healthcare Coalition includes sub-state regional, healthcare system emergency preparedness activities involving the member organizations. This includes planning, organizing and equipping, training, exercises, and evaluation

Coalitions in a Disaster

Regional Coordinators• Region 1 – Baerbel Merrill

• baerbel.merrill.@wyo.gov, 307.689.3942

• Region 2 – Sean Peverley• sean.peverley@wyo.gov, 307.277.3070

• Region 3 – Cindy Osborne• cindy.osborne@wyo.gov, 307.421.5230

• Region 4 – Mike Fleming• mike.fleming@wyo.gov, 307.880.5878

• Region 5 – Anna Venable• anna.venable@wyo.gov, 713.857.4460

Regional Coordinators

• Contracted through the Hospital Preparedness Program for up to

30 hours a month

• All Regional Coordinators act as the Lead for their respective regional

healthcare coalitions

• Facilitate the regional healthcare coalitions

• Schedule meetings, maintain agendas and minutes, address member

questions and concerns, sustain progress on coalition initiatives, and

facilitate coalition training and exercises

• Monitor NIMS compliance for hospitals within the coalition

• Participate in regional, state, and national activities

Healthcare Coalition Membership• Primary partner memberships:

• Behavioral/Mental Health

• Emergency Management

• Emergency Medical Services

• Hospitals

• Public Health

• Essential partner memberships:• Long-term care providers

• Private sector healthcare partners

• Specialty service providers (dialysis, pediatrics, women’s health, stand alone surgery, or urgent care)

• Support service providers (laboratories, pharmacies, blood blanks, or poison control)

• Primary care providers

• Community Health Centers

• Federal entities (VA hospitals or IHS facilities)

Healthcare Coalition Membership• Additional partner memberships:

• Local and state law enforcement and fire services

• Public Works

• Non-governmental organizations and/or Non-profit organizations

• Volunteer Organizations Active in Disaster (VOAD)

• Faith-based Organizations (FBO)

• Community-based Organizations (CBOs)

• Volunteer medical organizations (American Red Cross, Medical Reserve Corps, etc.)

• Other partnerships as relevant

Functions of the Healthcare Coalition• Coordinate regional healthcare system emergency preparedness activities

involving the member organizations

• Coordinate information sharing to ensure healthcare situational awareness

• Coordinate with emergency management to develop local and state emergency operations plans

• Identify and prioritize healthcare assets and essential services within a healthcare delivery area or region

• Perform resource assessments and manage resources

• Coordinate training and exercises for healthcare responders

• Participate with planning to address at-risk individuals

Challenges• Participation of members

• Employee turnover

• Time commitment

• Members with multiple roles

• Culture

• Personalities/egos

• Duplication of effort

• Limited resources

• Geographic distances

• Mandated by funding for some, not all

• Support and/or participation from leadership

• Reporting requirements

Benefits• Networking with essential contacts within the region

• Information and resource sharing

• Regional vulnerability assessments

• Regional planning, exercising, training, and evaluating

• Mutual aid agreements

• Partnerships

• Communication

• Funding

• Consistent, cohesive plans across the state

• Multiple perspectives from a variety of backgrounds

• Depth of expertise

EBOLA PREPAREDNESS

Ebola Activities• Preparedness activities began ramping up in June, July, and August

of 2014

• Information dissemination to partners

• Technical assistance

• WDH Incident Command System structure activated in November 2014

• Development of WDH processes, policies, and procedures

• PPE survey to hospitals and EMS – November 2014

• Teleconferences with WDH preparedness partners and county public

health representatives and community partners

Local Feedback: WDH Response

• Information sharing:

• Did you have the information you needed?

• Did you receive relevant information from WDH?

• Did you receive too much information from WDH?

• Were WDH processes, policies, and plans clearly explained?

Distributed effectively?

• What was helpful?

• What was not helpful or potentially hindered your local

preparedness efforts?

Lessons Learned• Need to coordinate information sharing across various WDH

programs

• Consistent messaging

• Utilization of subject-matter experts

• Establish the ICS structure earlier

• Effective and efficient methods of communication with different entities

• Clear processes, procedures, and expectations related to infectious disease response roles• Federal, State, and local

• Assumptions of local communication patterns may not be accurate

• Need for greater situational awareness of infectious disease preparedness across all Wyoming healthcare facilities

PPE Survey for Hospitals and EMS

• PPE Survey was conducted in November 2014 and distributed to all

Wyoming hospitals and EMS agencies

• Significant gaps were identified in the survey:

• Plans to address medical waste

• Fit testing

• PPE inventory

• PPE donning/doffing training

PPE Survey for Hospitals and EMS• Response rates

• EMS: 64%

• Hospitals: 85%

• Agencies that had the minimum PPE on hand to transfer/treat a suspected or confirmed Ebola patient• EMS: 14%

• Hospitals: 86%

• Agencies reporting their staff had received training in donning/doffing PPE• EMS: 63%

• Hospitals: 86%

PPE Survey for Hospitals and EMS• Fit testing

• Employers are required to, per the OSHA Respiratory Protection Standard (29 CFR 1910.134); ensure that fit testing and recordkeeping requirements have been met before using a respirator against hazardous exposures at work

• Agencies who require fit testing• EMS: 58%

• Hospitals: 96%

• Agencies who have performed fit testing for at least some of their personnel within the last year• EMS: 49%

• Hospitals: 79%

Local Lessons Learned: Audience Discussion

• Many local jurisdictions conducted Ebola exercises and provided

just-in-time PPE donning/doffing training:

• Did your facility conduct exercises or provide training?

• What kind of exercises?

• Who provided the training?

• What went well in your facility?

• What were the lessons learned in your facility?

EBOLA PREPAREDNESS AND RESPONSE ACTIVITIES

HPP Ebola Funding

• Funding from the Assistant Secretary for Preparedness and

Response (ASPR) to:

• Establish a nationwide, regional treatment network for Ebola and other

infectious diseases (Part B Funding)

• Support healthcare facilities that are capable of serving as Ebola

Treatment Centers (ETCs) or Ebola Assessment Hospitals (EAHs) (Part A

Funding)

• Support healthcare coalitions to prepare frontline hospitals and overall

healthcare system preparedness (Part A Funding)

HPP Ebola Funding

• Regional Ebola Treatment Centers

HPP Ebola Funding

• 5-Year Project Period: May 2015 – May 2020

• Funding awarded: $774,708

• Funding allocations:

• $500,000 to Ebola Assessment Hospitals*

• $250,000 to healthcare coalitions ($50,000/coalition)

• $24,000 travel, supplies, and indirect costs (state)

• Close collaboration with Public Health Emergency Preparedness and

Epidemiology and Lab Capacity Ebola funding

*Designation based on the CDC Framework for a Tiered Approach

CDC Framework for a Tiered Approach

Ebola Assessment Hospitals• Four hospitals in Wyoming have indicated interest in being

designated as Ebola Assessment Hospitals:• Campbell County Health – Gillette; Cheyenne Regional Medical Center –

Cheyenne; Memorial Hospital of Sweetwater County – Rock Springs; and Wyoming Medical Center – Casper

• HPP developed and distributed an Ebola Assessment Hospital Application on March 27, 2015:• Applications are due to the program by May 15, 2015

• Applications will be reviewed and scored by a WDH panel

• Final designations will be determined by Senior Administrators at WDH

Ebola Assessment Hospitals• Ebola Assessment Hospital (EAH) responsibilities may include:

• 5 year commitment

• Reporting to the Hospital Preparedness Program

• Meet capabilities and PPE needs as defined in the CDC Framework for aTiered Approach

• Annual hospital-level training of staff for all key personnel as it related tothe safe identification, treatment, and management of a suspected orconfirmed Ebola patient

• Annual exercises which must include 1-2 healthcare coalitions and beHomeland Security Exercise and Evaluation Program (HSEEP) compliant

• Receive and participate in training, peer review, and readinessassessments

• Provide support, outreach, and training to healthcare coalitions

• Participate in an on-site Infection Control Assessment and follow-upassessments

Healthcare Coalitions• Healthcare coalition (HCC) responsibilities may include:

• Assist in the provision of PPE training for members and regionalstakeholders

• Facilitate participation in annual exercises conducted by the EAHs

• Purchase PPE (in accordance with CDC guidelines) and maintain theability to share, in real-time, situational awareness of PPE inventory withmembers or other HCCs

• Ensure competency of healthcare workers within each region to identify,assess, and manage the treatment of suspected or confirmed Ebolapatients

• Assist healthcare facilities, EMS agencies, and other regionalstakeholders to ensure adequate plans exist to address highlycontaminated infectious waste

• Engage with the Wyoming Infection Prevention Advisory Group

Ebola Funding and Infection Preventionists• Opportunities for collaboration across healthcare facilities,

advisory groups, and healthcare coalitions

• Significant need for Infection Preventionist expertise, technicalassistance, and support

• Consult on Ebola and other highly infectious disease planninginitiatives

• Serve as an advisor to healthcare facilities and planners indeveloping internal processes and procedures

• Assessment of local and regional infection preventioninfrastructure

INFECTION PREVENTIONISTS AND EMERGENCY

PREPAREDNESS

Connecting IP to EP• Infection Preventionists are an essential partner in emergency

preparedness:

• Participation in disaster preparedness, response, and recovery

• Provide input for facility plans and participate actively in exercises

• Educate healthcare facility personnel on the role of IP in addressing mass

casualty, medical surge, pandemics, and other novel, highly infectious

diseases

• Provide training on appropriate infection prevention measures

• Assessing facility preparedness and emergency management plans

• Assessing facility physical infrastructure

Questions?

For more information:

Brittany Wardle, MPH

Hospital Preparedness Program Coordinator

brittany.wardle@wyo.gov

307.777.6904 or 307.274.6274