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 healthcare
system that coordinates all components of health delivery, supporting
Emergency Support Function #8, to realize greater national healthcare
preparedness, response, and recovery.
Hospital Preparedness Program (HPP) and
Public Health Emergency Preparedness
(PHEP) Capabilities
PHEP 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
Medical Materiel Management and
Distribution
10 Medical Surge
10 Medical Surge
11 Non-Pharmaceutical Interventions
11
12 Public Health Laboratory Testing
12
9
Public Health Surveillance and
Epidemiological Investigation
14 Responder Safety and Health
13
15 Volunteer Management
9
13
14 Responder Safety and Health
15 Volunteer Management
HPP Capabilities
• Capability 1: Healthcare System Preparedness
•
The ability of a community’s healthcare system to prepare, respond, and recover
from incidents that have a public health and medical impact in the short and long
term
• Capability 2: Healthcare System Recovery
•
Collaboration with Emergency Management and other community partners
(public health, business, or education) to develop efficient processes and
advocate for the rebuilding of public health, medical, and mental/behavioral
health systems to at least a level of functioning comparable to pre-incident levels
and improved levels where possible
HPP Capabilities
• Capability 3: Emergency Operations Coordination
•
The ability for healthcare organizations to engage with incident management at
the Emergency Operations Center or with on-scene incident management during
an incident to coordinate information and resource allocation for affected
healthcare organizations
• Capability 5: Fatality Management
•
The ability to coordinate with organizations (law enforcement, healthcare,
emergency management, and medical examiner/coroner) to ensure the proper
recovery, handling, identification, transportation, tracking, storage, and disposal
of human remains and person effects; certify cause of death; and facilitate access
to mental/behavioral health services for family members, responders, and
survivors of an incident
HPP Capabilities
• Capability 6: Information Sharing
•
The ability to conduct multijurisdictional, multidisciplinary exchange of public
health and medical related information and situational awareness between the
healthcare system and local, state, Federal, tribal, and territorial levels of
government 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 of
healthcare 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 support
healthcare organizations with the medical preparedness and response to
incidents 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
•
[email protected], 307.689.3942
• Region 2 – Sean Peverley
•
[email protected], 307.277.3070
• Region 3 – Cindy Osborne
•
[email protected], 307.421.5230
• Region 4 – Mike Fleming
•
[email protected], 307.880.5878
• Region 5 – Anna Venable
•
[email protected], 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 a
Tiered Approach
• Annual hospital-level training of staff for all key personnel as it related to
the safe identification, treatment, and management of a suspected or
confirmed Ebola patient
• Annual exercises which must include 1-2 healthcare coalitions and be
Homeland Security Exercise and Evaluation Program (HSEEP) compliant
• Receive and participate in training, peer review, and readiness
assessments
• Provide support, outreach, and training to healthcare coalitions
• Participate in an on-site Infection Control Assessment and follow-up
assessments
•
Healthcare Coalitions
• Healthcare coalition (HCC) responsibilities may include:
Assist in the provision of PPE training for members and regional
stakeholders
• Facilitate participation in annual exercises conducted by the EAHs
• Purchase PPE (in accordance with CDC guidelines) and maintain the
ability to share, in real-time, situational awareness of PPE inventory with
members or other HCCs
• Ensure competency of healthcare workers within each region to identify,
assess, and manage the treatment of suspected or confirmed Ebola
patients
• Assist healthcare facilities, EMS agencies, and other regional
stakeholders to ensure adequate plans exist to address highly
contaminated 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, technical
assistance, and support
• Consult
on Ebola and other highly infectious disease planning
initiatives
• Serve
as an advisor to healthcare facilities and planners in
developing internal processes and procedures
• Assessment
infrastructure
of
local
and
regional
infection
prevention
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
[email protected]
307.777.6904 or 307.274.6274