The Joplin Tornado - California Hospital AssociationThe Joplin Recovery: One Year Later Leslie Porth, RN, MPH Vice President, Health Planning Missouri Hospital Association Robert Patterson

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The Joplin Recovery: One Year LaterLeslie Porth, RN, MPHVice President, Health Planning Missouri Hospital Association

Robert PattersonAdministrative Director Mercy Emergency Medical Services, Joplin

Regina Thomas, CBCPDisaster Recovery Coordinator Freeman Health System

The Joplin TornadoHospital Preparedness, Response, Recovery

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Strategic PreparednessLeslie Porth, MPH, RN

Plan

DoCheck

Act

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Preparedness

Equipment Manage statewide web-based disaster

management system: EMSystems Coordinate and standardize equipment

– Hospital– Regional

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Preparedness

Education Plan, coordinate and conduct all-hazards and

specific hazard education Develop subject matter experts Share and promote best practices

Exercises Train exercise evaluators Coordinate regional exercises

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Planning Mutual Aid Agreement “All-hazards” approach Facilitate incident command

system Facilitate and develop

regional planning

Preparedness

HCC

Source: Medical Surge Capability and Capacity, Barbera & Mcintyre

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Expected outcomes Realistic and practical Adaptable and flexible End-user value Meaningful results Sustainable

Planning: Regional Health Care Coalitions

Purpose Provide a mechanism for

coordination and communication during planning and response

NOT command and control

Include all health care organizations

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Partnership Development2010 2011 2012

Participate in regionalplanning

88% 95% 95%

Participate in a health care coalition

43% 69% 85%

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5:41 p.m., May 22, 2011

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161 Fatalities … 1000s Injured

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St. John’s Mercy Hospital and EMS Response

Robert Patterson Director, Emergency Medical Services

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Hospital Destruction• Direct hit to St. John’s

Regional Medical Center• Windows/walls blown out• Portions of roof pulled off• Building infrastructure

severely damaged• Massive debris • 86 physician offices

destroyed or severely damaged

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The Evacuation• Patient Locations 1 surgery in progress 1 patient in PACU 24 ER patients 28 critical care patients

• Three Evacuation Points West side of building outside

emergency department East side of building Conference Center — later

to Rehab Building

Patients carried down dark stairways on doors, backboards, wheelchairs, wooden chairs and mattresses — 90 minutes

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• Memorial Hall Operational for 1 week

with EMS Strike Team• McAuley High School Overflow operation for

48 hours• Brady Rehabilitation

Center

Emergency Care

Medications, medical supplies and personnel deployed

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• Ambulatory and wheel chairs to the rehabilitation services building

• Critical to Freeman Health System

• Emergency tornado injuries treated on the street outside St. John’s Medical Center

Triage

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Triage Tags — Tracking

Criticism over lack of use of triage tags and tracking Scanners and tags not available — trailer

and supplied destroyed Triage and tracking is not real time

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Triage Opportunities Triage tags on every ambulance Receiving hospitals report patients received in

the EMSystem Tethered scanners Adopt a common tag — state or regionally Use triage tags on a regular basis Triage colors used in radio and phone reports in

daily practice

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Local EMS Normal Operations

Director Newton Co. EMS Director Metro Emergency Transport

System (METS) EMS Share Medical Director, protocols, use

same equipment and ambulances Normal ambulances staffed 11

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EMS Operations Available —Post Impact

Seven EMS employees, numerous hospital employees, police department and fire department personnel lost homes Family plan is critical Staffed 21 ambulances Transported 250 patients in the first hour

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Initial Local Challenges

• Triage and tracking• Limited radio communications • Intermittent/unreliable cell service• Severity was initially underestimated• Access difficult for mutual aid ambulances• “Injured drawn to emergency lights like moths

to a flame.”• EMS Sector overwhelmed — consider scribe• Multi-state response

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• Over 100 different ambulances from seven states were in the area for the first two weeks

• Thirteen helicopters in the area after weather pattern cleared

Regional EMS Response

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Forward Staging Area — North

Mutual aid ambulances and medical personnel staged in Springfield

EMS strike teams deployed to Joplin from staging — delayed response due to weather pattern and access to the area

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EMS Strike Team Leader Training• Important to success of mission• Maintain a roster of trained EMS providers who

are credentialed• Strike team leaders take responsibility of the

personnel under their team• Also ensure adequate equipment,

communications, demobilization• Identification of key roles

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Staging Areas Local

• Initially at Lowe’s store near I-44• 12 hours later moved Old Ford dealership (no power) Freeman Hospital East METS EMS headquarters

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Staging AreasPlan for needs early• Communications while in staging• Shelter• Briefing location• Facilities• Nutritional needs

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Alternative Modes of Transportation

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Air Medical Response

Communication issues Integration into IC operations (NIMS education

for flight crews) Logistics (fuel, oxygen, duty time, medical

supplies, maintenance, crew quarters) Safety (landing zone locations, collision

avoidance, auto launch, media access & control) Utilization Air branch director training

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Statewide Mutual Aid Plan

Regional coordinators Communications plan Forward staging areas Upstream and downstream

communications with state EMS Bureau EMS must have a seat at the State

Emergency Operations Center

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Missouri Hospital AssociationResponse Roles

Activation of hospital Mutual Aid Agreement Patient tracking (all patients were located

within one week) Communication Coordination with MO-1 DMAT Emergency preparedness coalitions

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Ongoing Challenges • Situational awareness • Communications• Presence in the ICC• Crowd control — traffic• Pharmacy recovery • IT — server recovery• Safety and security • Safety of volunteer

responders• Ongoing weather conditions

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Situational Awareness• Magnitude of the event • Landmarks not

recognizable• Mapping important• GPS devices and

smart phones• Spray paint street

names on curbs

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Communications• Alerting systems helpful for notification• EMSystem beneficial tool• EMS mutual aid frequency• Better use of federal designated

frequencies, e.g. MTAC, VTAC, etc.• Ham radio operators not utilized

effectively• Communications trailers, equipment

beneficial36

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Communications

Texting — Social Media Communications between ICC’s PBX — 2500 calls handled via Springfield

Command Center IT needs for Incident Command Centers

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Incident Command Centers• EMS is an important function of

the Operation Division of ICS• The IC must have good working

knowledge of assets in the staging areas both in air and on ground

• Medical sector command concept• Additional command sites:

• City of Joplin • St. John’s Mercy Springfield• Freeman Health System

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Hospital Based EMS Challenges

Non-traditional activities1. Building security2. Security of pharmaceuticals3. Recovery of servers

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Dignitary Visits

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Care of Volunteers

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Lessons Learned:Mercy Hospital — Joplin• Practice and drill Drill until you fail Include HAM operators

• Add slippers/shoes to weather plan• Store supplies in strategic locations• Make emergency supplies portable• Create go bags (paper, pen, gloves, flashlights,

water, batteries, cell phone chargers) for each floor

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Lessons Learned:Mercy Hospital — Joplin (cont.)• Address security needs early and plan for

lockdown with immediate security reinforcement or crowd diversion procedure

• Take time to establish operational periods of one to two hours and stop to review progress

• Monitor for unauthorized individuals, such as vendors or media trying to make access to the facility

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Lessons Learned:Mercy Hospital — Joplin (cont.)• Mercy Emergency Management Committee —

healthcare coalitions• Building design — location of ICU’s, stairwell design• No command center left after the tornado — have

back-up off site• Hold elective surgeries during warnings• No morgue facility available — mass fatality plan

important• No unique identification of patients between Mercy

and others

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Lessons Learned:Mercy Hospital — Joplin (cont.)

• Ensure that staff have multiple, proper identification

• Cross credentialing • Have a process to manage credentialed

volunteers• Take care of staff needs quickly (job security,

money, clothes, EAP)• Control staffing day one through end of event

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• 60-bed tent-based hospital located on St. John’s campus

• Full imaging capabilities

• Operating Room• Intensive Care• Emergency Room• Joint Commission

Survey

Stage One Hospital Rebuild

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Temporary Hard Walled Facility• Moved from tent week of

October 3rd

• Heating and weather protection

• ED, OR’s, imaging, ICU all connected by interior corridors

• Heated floors

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• Operational April 15th

• 150 bed component hospital with expanded ED and ICU

• Pediatrics, OB departments• Process completed in 8½

months — fastest construction of a component hospital on record

Component Hospital

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Medical SurgeRegina Thomas, CBCP

Disaster Recovery Coordinator

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Freeman Health System • 446-bed, three hospital system providing

comprehensive medical and behavioral health services• Freeman West — Level II Trauma Center• Freeman East — 1.2 miles • Freeman Neosho — Level III, 20 miles• Ozark Center• Area includes more than 450,000 residents in

Missouri, Kansas, Oklahoma, and Arkansas• Locally owned, not-for-profit

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5 Blocks Between the Two Hospitals

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Freeman Health System Prepares

• Tornado warning procedures activated —5:11 p.m.• During shift change• Hospital at capacity, on diversion 1-2 days

prior• Close blinds/window coverings/doors• Provide pillows and blankets• Move patients to hallway• Identify oxygen-dependent patients

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Freeman Health System Prepares

• 5:34 p.m. — the storm arrives• Main power lost• Brief interruption to Pyxis access• Electronic documentation/internet

inoperable• Significant water leakage• Magnitude unknown

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Freeman Hospital West is Spared by a Few Blocks

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26th Street Residents Wiped Out

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13 Die at Greenbriar Nursing Home

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Infrastructure Issues• Oxygen and propane

• Retaining wall collapsed• 8-ft long• Landed on supply line• Tore loose bulk oxygen

fill station• Tore off wiring controls

for propane evaporator system

• 1” = no oxygen

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Infrastructure Issues

• Water and sewer• ≈ 8,000 main breaks• 40/12 lbs. pressure• Boilers, SP, ORs, ICU, CVICU, NICU, Medical 1-

3, OB, Cardiology, Nutrition• No cooling water loop = no freezers/coolers/

steam• No fire protection• No boilers• Dialysis — 5/20, no EDC

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Infrastructure Issues• Electrical

• Main feed — destroyed• Backup feed 1 — destroyed• Backup feed 2 — destroyed• Substation 1 — destroyed• Substation 2 — destroyed

• Generators• Not everywhere• No AC, food, or drink• Darkness• Beacon of Hope

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Infrastructure Issues

• Network

• All connections — destroyed

• Not all switches on emergency power

• 4 POTS lines — one worked a little

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Provider CO

West Campus

Provider CO

East Campus

Business Center

Freeman Neosho

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ED Realization of Disaster

Within minutes, hundreds of injured arrived on foot and in the back of trucks.

20 = 20090 = >700180 = >1,000

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Freeman Health System Response• Incident command established at 6:20 p.m.

• Location issues — split up• Boots on the ground

• Numerous triage & alternate care sites established• West Campus

• EMS entrance• Main ED entrance• Heart Institute

• Freeman East• Freeman Neosho

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Patient Care Challenges — Immediate

• Severity of the injuries• Life-threatening• Injured beyond recognition

• Emotional state of staff and patients• NOT the expected chaos; hushed• Patients offering others to be seen first• Staff stayed• No communication with outside• Best indication — where patients were coming from

• Number of staff available to provide care• Five deep• Shoulder to shoulder 65

Patient Care Challenges — 2 to 4 Hours

• Flooding in multiple patient rooms• Patients in halls

• Oxygen tanks depleted• Meals/refrigeration• Inundated with family and visitors

• Many injured• 3-4 family members average• Nowhere to go• Troubling news shared with patients

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• Auxiliary power• One operating elevator• Limited or no lighting in restrooms,

dressing rooms, and temporary care areas

• Decreased water pressure• Hemodialysis• Flushing toilets• Sterilizing equipment

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• Hand-venting• Lack of patient information• Volunteers arriving• Alternate holding area resources• Breeched water system — boil order• Portable radiology

• 800 x-rays• 400 CT scans

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• Critical patients triaged to ICU — no communication

• Lab tests • Difficult to match to patients• No network • Analyzers ok, no QC ranges• Handwritten results

• Nursing time — hundreds of procedures

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• Thousands of supplies diminished• Ortho supplies, splints• Chest and ET tubes• Tetanus• Morphine

• Emotional and physical trauma• Personal losses• Troubling news• The unknown

• Patient cleansing70


• Discharged patients — homeless• Arranging follow-up care — physician

offices gone• Discharged prescription needs• Ambulatory aids and home oxygen

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Immediate Hours Post-Tornado

• 467 registered patients treated at Freeman West, hundreds unregistered

• Treated 39 at Freeman Neosho

• Performed 22 life-saving surgeries in 12 hours

• Received 60 known patient transfers from St. John’s

• Transferred 64 patients

• 888 Freeman Health System and 100 non-Freeman clinical staff at the West Campus

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Four Days Later

• All Freeman entities fully operational

• Over 1,000 treated at Freeman Health System

• 124 transferred to surrounding hospitals

• Employee disaster relief store established for Freeman employees and families

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The Losses

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• Eleven patients expired at Freeman West• Two Freeman employees perished in the storm• Multiple Freeman employees lost friends/loved ones• 464 Freeman Health System employees and

volunteers were directly affected, 272 displaced from their homes

• 10 Freeman Health System facilities damaged/destroyed

• 8 of 14 Ozark Center facilities destroyed or significantly damaged

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The Losses

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Taking Care of Our Own

• Emotional needs of staff and volunteers

• 24-hr onsite counseling — 48 hours

• Debriefings

• Hotline — 9 months

• Support group sessions for staff — 1 year

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• 36 hours — all accounted• Fully-functioning distribution center

• Personal necessities• Cleaning supplies• Tools• OTC medications• Diapers, formula• Toys• 40 beds• 30,000 bottles of water• 4,000 pounds of food• 50 car seats• Financial assistance to 500 employees

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300 pair of shoes!

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• Emotional needs of community• Preschools — centers lost

• Children — more than 3,500 Joplin R-VIII children displaced

• Elderly — nursing homes lost

• First responders

• “Helping” organizations

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Taking Care of Joplin

• Ozark Center grants awarded since May 22, 2011 • Missouri Foundation for Health Emergency

Grant — $115k

• SAMHSA Emergency Response Grant (SERG) — $990,335

• Assertive Community Treatment Team —$1,000,000

• Governor’s award — $2,000,000

• FEMA ISP, CCP and RSP — $4,060,000

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• Emotional needs of community• Widespread, long-term

• Debriefings > 27 businesses and 700 citizens

• Hotline: 1,500/mo first 3 months

• Licensed staff to FEMA DRCs, shelters, et al.

• Grief counseling groups/critical incident stress debriefings to first responders

• Public education

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• Emotional needs of community• “Healing Joplin”

• 100 additional employees embedded in community• School support

• 5 licensed counselors, 5 community support workers• Support for school system’s efforts in School Wide

Positive Behavior Supports program to reduce drop outs, behavior referrals and in/out of school suspensions

• Evidence Based Practices:• TF-CBT (trauma focused cognitive behavior therapy)• AF-CBT (abuse focused cognitive behavior therapy)• TF-PCIT (trauma focused parent child interactive

therapy)• TG-CBT (trauma grief cognitive behavior therapy)• CPP (child and parent psychotherapy)

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Who is included in your disaster plan?

Emergency services

Local EOC

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Lessons Learned

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• Longevity• 113 hrs 10 min

• 12-hr shifts AFTER the first couple of days

• Redundancy on paper ≠ redundancy in real life

• “HCC” — it’s an idea, not a location

• Critical decisions may not have time to go through the HCC

• Beware of imposters

• Open room to Command Center staff only

• Find alternate location HR/staffing85

Lesson: Command Center Operation

83,000 Volunteers Come to Help within 90 Days

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• Volunteers• Woodwork• Validating credentials — impossible• Train operators to efficiently triage calls• Have a plan for how to use them: lifting teams, pet

watchers, traffic control, passing out blankets, etc.

• Professional Volunteers• How do you verify individuals’ names, credentials and

competencies?• Have a plan for accepting credentials and using clinical

volunteers who come when there are no lodging and food accommodations.

• Have a registration form ready to sign where individuals warrant their credentials.

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Lesson: Volunteers

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• Have legal look at your Good Samaritan Law.

• Site of Emergency (Missouri):

• Have person in authority declare facility the “site of an emergency.” This may implement the Missouri Good Samaritan Law (Section 537.037 RSMo) to protect volunteers. Consider having a provision in the Medical Staff By-Laws that allows this declaration to be made by the CEO or CMO.

Note: Florida has extended its Good Samaritan Law to cover in-hospital aid, while Texas has refused to do so. (See Harris v. Soha 15 So.3d 767)

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Lesson: Good Samaritan Law

• Remediation Contractors • Your insurance carrier will most likely have a

nationally approved remediation contractor, so don’t sign a contract with a company until you find this out. With an approved contractor, rates and responses will be pre-approved.

• Legal Hold Documents• Identify where they are and restrict destruction

until damage can be assessed and parties involved contacted, if necessary. Take photos of damage to the facility to prove extent of damage.

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Lesson: Insurance

• Gather copies of leases• The first documents the insurance company will ask

for are copies of leases to all damaged property.

• Locating replacement facilities• Get your insurance company involved in this process

— they will be paying part of the cost. Move quickly to nail down space.

• Temporary repairs• Make temporary repairs to preserve property, e.g.

roof repairs, but do not enter into any contract beyond that until you talk to your insurance carrier.

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Lesson: Insurance

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• Ask your insurance company to help locate repair contractors, but stay involved in the process. • Set forth in detail the materials to be used. • Have your people on-site to inspect work. • Get lien waivers or provide for them in contracts. • Slow down to get a good contract in place and don’t just

accept a “proposal.” • Watch mechanics liens. Be sure suppliers get paid. • If FEMA is going to be involved and perhaps pay part of

the cost, you will have to comply with the federal regulations on procurement of contractors by taking bids and having provision in the contracts that comply with 44 CFR 13.36(i).

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Lesson: Insurance

• Coverage• Plan for your own losses:

• Replacement vs. actual value• Consider total policy limit• Blanket policies give flexibility• Cover “tenant built improvements” on leased property

• Public Adjustors• These are commercial firms that seek to represent

insured’s in dealing with their insurance company. Know that they exist and that when a loss happens, they will be contacting you to represent you with the insurance company. They charge a percentage of the recovery. Most facilities will be better off with a good lawyer.

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Lesson: Insurance

9393

• Insurance claim and FEMA Officer• Designate a contact person (or persons

who can work well together) to deal with the insurance company and FEMA, as they will overlap

Lesson: Insurance

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• What construction improvements are going to be needed to meet any changed demands upon your system and how will they be financed?

• If bond financing is needed, begin the process as soon as possible with experienced people

• If entering into construction projects, use a known and trusted contractor

• Financing Ready for Expansion Plan• Keep rating agency up-to-date• Be within bond covenants• Have emergency cash on hand• Use consistent bond counsel and corporate financing

counsel 94

Lesson: Construction

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Freeman West Hospital Issues $25m in Bonds to Build-out the 5th and 6th Floors to Add 58 Beds

29 by April, 2012 and 29 by August, 2012

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• Identify ambulatory patients• Keep patients informed• Provide instructions• Common terminology — e.g. “tornado

warning”• Take drills seriously

• NLE 2011 — radio and media issues• Leaders need to consider labor pools in drills• Everyone needs to know controls that are in

place

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Lesson: Preparations

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• Waste management• Disposable bags• Body bags

• Security• Cameras — backup power• Identify needs for security personnel• Locking entrances isn’t always practical

• Resources• Know your lighting and gas capabilities • Consider dedicated backup water feed lines for boilers• Treat monthly gen tests as drills requiring staff response• Install more emergency outlets

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Lesson: Facilities

• Manual process conversion• PAR levels• Patient tracking/tagging• Radiology and lab reports• Lesser acuity patients

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Lesson: Surge

• Piping/hoses for dialysis• Portable radiology equipment• Hands-free lighting• Radios — hand-held and AM/FM

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Lesson: Equipment

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• System processes easily converted to manual• Know how to manually override critical equipment• Know if a key is needed and where it is — keep two• Updated downtime procedures for critical IT functions

• How easily can it convert to manual?• What forms/policies/procedures do I need?• Do I need additional staff?• How long can I function this way?• What resources do I need to transition back to

normal operations?

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Lesson: Equipment

• Isolation patients — consider time, donning with PPE

• Look for more central locations than the hallway• Patient identification — embossed manual tags• Lab and radiology reports – develop a plan to

track • Re-evaluate your par levels — 96 hour supplies• Triage — predetermined supplies, constant restock• Sustained increase in census — 1 year and

counting• Longevity in MOUs with outside agencies

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Lesson: Patient Care

• Staff assignments — be careful• Hospital ID and wallet• Hard copy staff phone numbers

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Lesson: Staff Considerations

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• Take care of your employees• Shocked, overworked, tired• Survivor guilt

• The effects are long-term —as of September, 2012:• 20 suicides since May 22, 2011• 20% increase in child sexual trauma• Alcohol and drug use is up 80%• There is a 50% increase in domestic violence• Gambling has increased 40%

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Lesson: Staff Considerations

• In progress — still in surge • Disaster Plan — report to work• Mass Fatality Plan — workers, location• Process on units for tornado watch

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One Year Later: Policies & Procedures

• All fiber underground• Diverse path to FNH• Offsite options for backup data

center location

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One Year Later: Network

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• Pumps for tanker truck connections are now on generator power

• More headlamps• Just in time caches ready for triage

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One Year Later: Infrastructure & Supplies

• Facility upgrades• Community outreach• Employee engagement• Patient satisfaction

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One Year Later

• Recently ranked #4 hospital in the state of Missouri• U.S. News & World Report• Recognized among best hospitals in SW Missouri• Named as a Best Regional Hospital for 2011-2012• Special designation in 5 high-performing specialties —

140 of 4,825 hospitals ranked in one• Gastroenterology• Nephrology• Neurology and Neurosurgery• Orthopedics• Pulmonology

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One Year Later

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Statewide Healthcare Response

A Call to Action

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Critical Access Hospital Response Early observation of inclement weather Incident Command activated within first hour Activated call trees to increase staff response Achieved double physician coverage for incoming ED patients Activated and set-up a portion of the 250 bed Med/Surg cache Med/Surg units were notified to initiate any discharges possible Activation and delivery of the PPE cache, surgical/pharmaceutical

supplies to Memorial Hall Responded to Neosho to assist with setting up the Communications

Trailer as a part of a Coalition response

Photo courtesy of: Cox Monett

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Trauma Facility Immediate Response Actions Within the first hour of the tornado strike Joplin, CoxHealth had:

Prepared to shelter-in-place as the storm was heading East A fully functional Incident Command established Supplies were sent from Springfield with the first EMS responders Established communication between EMS, CoxHealth IC, the

EMO, and MHA Additional ER staff were self-reporting for duty OR notified and put on standby for further details An ER strike team with 9 RN’s, 6 techs, 3 physicians equipped

with 2 vehicles full of supplies

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Key Response Initiatives —Immediate Established communication Discharged all possible patients to prep for expected surge Increased staffing in critical areas (OR, ED, Nursing, Lab, Radiology,

etc.) Held all non-critical or elective surgeries until the true scope is

identified and validated Established a satellite pharmacy in the ED Received more than 100 patients in 12 hours www.cohca.org

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Rapid Response Teams– Three deployed to Joplin

• One Deployed at Memorial Hall with staff from St. John’s Mercy Joplin

– Designed for rapid triage and treatment — 5 Bed ER• Staffed with six

medical providers for 24 hour operation

Immediate Response Phase: Coordination of Resources

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Mobile Medical Resources

24 Bed Tent Emergency Department Includes critical care services

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Missouri Hospital AssociationA Response Organization

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Response: First Few Hours

MHA’s Immediate Role Activate the MHA Mutual Aid Agreement

– Immediately deployed resources including mobile communications and trauma supplies — some of the first supplies into the area

Monitored current bed capacity and medical surge in Missouri hospitals

Situational awareness to all hospitals

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Activation of MHA Mutual Aid Agreement

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Response: First Day and Week Served as liaison with the state health and emergency operations staff.

Communicated the immediate needs of Freeman Health, including but not limited to:– Ambulances – Water

– Electricity – Communication

– Supplies – Staff

Advocated for priority service for health care system Briefings and support to the MoDRS and Mercy St. John’s Hospital MMU Provided situational awareness and updates on the patient load in

surrounding hospitals. Responded to calls from throughout the country with offers of assistance. Developed the Hospital Employee Relief Operation (HERO fund)

raised $463,760.00 for Missouri hospital employees

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RecoveryReflection and Lessons Learned

Statewide LessonsLeslie Porth, MPH, RN

Vice President, Missouri Hospital Association

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Statewide Lessons Learned

Communication Patient triage and tracking Tools without a system EMS Coordination MHA Mutual Aid Agreement Transition from response to recovery Staffing Used MAA instead of ESAR-VHP

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Patient Tracking and Mass Movement Planning Develop and implement statewide: triage system and tags standardized ambulance strike team leader

training MCI plan applicable to rural and metropolitan Mutual aid agreement for EMS Improved system for medical ESF-8

integration with local emergency operations

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Patient Tracking and Mass Movement Planning (cont.)

Review and analyze statewide: Feasibility of a statewide ambulance

contract Current patient-tracking technology and

system

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Regional and Statewide: Next Steps

Continue hospital-level support Align with Joint Commission EM standards Align with ASPR capabilities Continue current coalition and coordinating

council strategy Align with ASPR capabilities “Points of intersection” with the two metro plans Strategy for patient movement including

tracking, triage and distribution Standardize redundant communication algorithm

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Next Steps (cont.) Clarify MHA’s preparedness role

Decreasing HPP funds Member expectations

Further develop ESF8 response roles and plans Coalitions – impact vs. non-impact MHA DHSS Other statewide partners

– DMAT (now MoDRS)– Primary Care Association (FQHCs)– Kansas City and St. Louis coordinating entities

Integration of local to regional to state roles125

Lessons Learned

http://web.mhanet.com/uploads/media/2012_Lessons_Learned.pdf

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Presenters

Leslie Porth, MPH, R.N.Vice President of Health PlanningMissouri Hospital Association [email protected]

Bob Patterson Director, Emergency Medical ServicesMercy Hospital Springfield [email protected]

Regina Thomas, CBCPDisaster Recovery CoordinatorFreeman Health [email protected]

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Questions