The Story of the Toronto Central Local Integrated Network

2010 G20 DashboardWhy we should look at it Again

Laurie Mazurik MD FRCPC MBA

Project Lead, Pandemic Orange

Special Acknowledgement

http://www.torontocentrallhin.on.ca/

In 2010 TCLHIN went to extraordinary lengths to support theirStakeholders as they prepared for very real threats to their ability to deliver patient care during the 2010 G20 Summit.

The journey was a fascinating exploration of relationships and innovative thinking. All those involved applaud their initiative and leadership.

Laurie Mazurik MD (The Story Teller)

• Specialist in Emergency Medicine, Sunnybrook Hospital, Toronto

• Critical Care Transport Physician (Air and Land)• Strategic Lead, Disaster and Emergency

Preparedness Sunnybrook• Member of Ontario SARS Operation Centre 2003• Conducted over 40 mass casualty health care system simulations since 2003

• TCLHIN Lead for 2010 G20 Summit Preparations

Why worry.

There is lots of money to prepare

1 billion dollars for security (prevention)

~Almost 0$ for health care. It’s a good “learning” opportunity

We learned

• What a HIRA is. Do you know?• That Security/Police thought the best place to

hold protest marches is as close to 6 major Toronto hospitals as possible (They were the usual Protest Areas)

• How to CUUS and SBAR

• That Information is the new gold

Queens Park

PMHTGH

TWH

Legal Protest SiteDundas Square

Legal Protest Site Nathan Philips

Square Legal Protest Site Queen’s Park - South

SMH

Security Planning

Zone 1(Red or Summit Site)

Zone 2(Yellow or Outer Zone)

Limited-access area surrounding summit site

No hospital in the Red or Yellow zone Perimeter fencing

Zone 3(Community)

MSH

We learned what a HIRA was

ThreatsScenario Likelihood Impact to

Hospitals

Heat wave/ Power outage

low high

Mass casualty event – Code Orange

low high

Unlawful protest with use of irritant gases

moderate high

Transportation interruptions

high moderate

Lots of hints about concerns

International Politics Lingering Worry

http://goo.gl/xTsLvP

We Did become Worried

Overcrowded ED’s

Let’s Think SMART

We just need Information IMS…no so effective

• We are not like police or military who use a hierarchal system daily

• We think triage, capacity and patient flow

• We can live with “liaison” and “in-charge”

1212

A Dashboard with SIX sources of Information

Toronto EMS:Riot at Queen’s Park Protest. Tear Gas Used. Some people may have serious injuries from falls.

Health Network:Code Orange:HSC, Sinai: TGH: Clinics: OpenCCAC:Delay 6hr

ALERTS

Media:1000’s riot Ministry of Health Bulletins

Contact Lists

Speak in SBAR,CUUS and Capacity

13

Consistent and Easy to Use

SBAR: Acronym

• S=situation: Briefly describe the current situation.

• B=background: State the pertinent history.• A=assessment: Summarize the facts and

what you think the problem is• R=recommendation: What you think needs to

be done in order to be address the problem safely and effectively

Situation

• In critical events it is very difficult to get timely,credible information

• It is disparate

• Incomplete

Background

• There 3 main sources of information• Media = fast not always credible• EMS =relatively fast, credible, does not

include ambulatory surge• Phone who you know= piece meal, usually

they don’t know either

Assessment

• If a critical incident occurs we will have a delayed indecisive and response

• Will not be able to provide EMS with credible information to justify diversion of selected ambulances away from hospitals

Recommendation

• Capture and Share Credible information in real-time

• Work with EMS to distribute surges across ALL health care resources

• Preserve Acute Care CRITICAL Services that other hospitals do not have

Talk about Capacity and set thresholds for Alerts

• N= normal capacity =Green• 10-20% over N= YellowYellow• >20% = Red• Overwhelmed• Unable to Provide Service

Critical Language used:CUUS

• Key Phrases must be understood by ALL to mean “STOP and Listen”-we have a potential problem

• Example: United Airlines “CUUS” Program

I am Concerned I am Uncomfortable This is Unsafe I am Scared

TC LHIN Background

Submit Situational Report

Overall Capacity ED Trauma Critical

Care STEMI Acute Stroke Neurosurgery Dialysis Labour &

Delivery Paediatrics

SHSC NA NA

Mount Sinai Hospital

NA NA

Toronto General

NA NA NA NA

TEGH NA NA NA NA

St. Michael’s

Walk-in only

St. Joseph’s Health Centre

NA NA NA NA

Hospital for Sick Children

NANA

Women’s College Hospital

NANA NA NA NA NA NA

TC LHIN Background

Submit Situational Report

Overall Cap

ED TraumaCritical Care

STEMIAcute Stroke

Neurosurg DialysisLabour

& Delivery

Paediatrics

SHSC NA NA

Mount Sinai Hospital

NA

Toronto General

NA NA NA NA

TEGH NA NA NA NA

St. Michael’s

St. Joseph’s Health Centre

NA NA NA NA

Hospital for Sick Children

NANA

Women’s College Hospital

NANA NA NA NA NA NICU

Triggers Telco between TCLHIN Leads,Hospital Leads, TEMS,CritiCall,ORNGE & MOH

We Build “Smart System”

• Based it on Media Display Systems

• Used Terminology we could understand

• Defined the Data we wanted in real-time

• The way in which we wanted it reported and displayed

• Set thresholds for Alerts or Alarms

• Approached the TCLHIN to help us

The G20 Dashboard

Build Capacity Based Action Plans

Hospitals

How did it perform?• Hospital security

provided info faster than media or police

• Coordinated diversion of ambulances to “open” hospitals

• Everyone understood the plan

Now We want to Build a New Prototype with End-user Input

Giving Health Care Providers a chance to capture data and exchange ideas across a

greater network

Hospitals

Add or track internal Hospital Dashboards

Unit Staff Beds Pharm Supplies Other Status

ED

Trauma

Critical Care

OR

ALERTS

Integrated Syndromic Surveillance

MASAS Multi-Agency Situational Awareness System

Increase portability with Tablet and Smart Phone formats

Value

• Track trends

• Look at Consequences

• Identify Predictable Patterns

• Build Strategies to Mitigate

• Examine what others do in a broader network

• Build/Test Models

Next Steps: Engagement

Join The CBRNE Collaborative

Time Limited Offer

• Explore the actual G20 Dashboard and give us feedback

• Do the polls in our e-learning modules and join some discussions

• Share your ideas and lets grow them together.