Region 9 Health Care System Plan
Resource Coordination for
All-Hazards Preparedness & Response
June 30, 2012
TABLE OF CONTENTS
Purpose / Scope / Region 9 Overview...................................................................4
Planning Assumptions ...........................................................................................5
1.0 CONCEPT OF OPERATIONS ......................................................................5
1.1
Incident Command ................................................................................5
1.2
Health Care System Partner Roles & Responsibilities ..........................6
1.2.1 Emergency Medical Services ................................................................6
1.2.2 Hospitals ...............................................................................................6
1.2.3 Local Health Jurisdictions .....................................................................7
1.2.4 Emergency Management ......................................................................7
1.2.5 Medical Reserve Corps ........................................................................8
1.2.6 Governmental & Tribal Partners ............................................................8
1.2.7 Community Health Centers ...................................................................8
1.2.8 Bordering State or Canadian Partners ..................................................9
1.2.9 Other partners .......................................................................................9
2.0 SYSTEM RESPONSE & RESOURCE COORDINATION .............................9
3.0 COMMUNICATIONS ...................................................................................10
3.1
Alerting and Patient Distribution ..........................................................10
3.2
Emergency Communication Systems .................................................10
3.3
Media / Public Communications ..........................................................11
4.0 SURGE CAPACITY.....................................................................................12
4.1
Bed tracking ........................................................................................13
4.2
Alternate Care Facilities ......................................................................13
4.3
Federal Medical Stations .....................................................................13
5.0 CRITICAL ISSUES ......................................................................................13
5.1
Security ...............................................................................................13
5.2
At-Risk Populations .............................................................................14
5.3
Behavioral Mental Health ....................................................................14
5.4
Diseases of Significant Concern .........................................................14
5.5
Medical Evacuation / Shelter in Place .................................................14
5.6
Pharmaceutical Resources / Caches ..................................................14
5.7
Patient Decontamination .....................................................................14
5.8
Medical Waste Disposal ......................................................................15
5.9
Mass Fatality .......................................................................................15
6.0 RECOVERY ................................................................................................15
6.1
Communication ...................................................................................15
6.2
Facility Re-entry Authorization ............................................................15
7.0 TRAINING ...................................................................................................15
8.0 PLAN MAINTENANCE ................................................................................16
8.1
Maintaining, Exercising and Updating this Plan ..................................16
9.0 ACRONYMS ...............................................................................................17
Region 9 Health Care System Coordination Plan
June 30, 2012
Page 2
APPENDICES
Appendix A Regional Health Care System 24/7 Contact Information ***SRHD is currently
working on using Access to manage / print this list for improved accuracy; not yet
available. Anticipated Spring 2013.***
Appendix B
Regional Communication Systems & Plan:
instructions on how to access & use resources ***in progress, anticipated Winter
2012/3 by somebody at CCC (was June Watson, who has been reassigned)***
Appendix C
Map: PHEPR Regions, hospitals & LHJs
Appendix D
Memoranda of Understanding: hospitals, local health jurisdictions
Appendix E
Disaster Medical Control Center
Appendix F
Pharmaceutical Resources / Caches ***in review by stakeholders, anticipated by
Jan 1st***
Appendix G
Medical Reserve Corps Deployment & Activation Process ***in progress,
anticipated by Dec 2012 by DaveB***
Appendix H
Alternate Care Facility Request Protocol, Deployment Manual & Inventories
Appendix I
Cross-border EMS Plan
Appendix J
Forward Movement of Patients Plan / National Disaster Medical System
Appendix K
Appendix L
Mass Fatality Plan ***in progress for Spokane County, anticipated Jan 2013 by
Susan Sjoberg with regional plan to follow***
Trauma Designations
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June 30, 2012
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PURPOSE
The Region 9 Health Care System Coordination Plan is an operational resource tool for
Region 9 health care system partners to reference in planning, response and recovery efforts.
It provides guidelines for coordinating the emergency response of health care system partners.
SCOPE
The plan describes the roles and functions of critical response partners (hospitals, local health
jurisdictions, emergency medical services, law enforcement, county emergency managers,
etc), as well as information on how to initiate a response with those partners. The plan and its
appendices address general operational concepts, inter-agency communication, memoranda
of understanding (acquisition of resources, staff sharing, etc), DMCC activation, WHEERS, &
WATrac protocols, and information on how to request an alternate care facility trailer cache.
This plan does not supersede any local or internal emergency response plans. Rather, it is
intended to augment and support plans across agencies and disciplines to assist in a
coordinated emergency response in the event of a mass casualty incident.
REGION 9 OVERVIEW
Washington State Public Health Emergency Preparedness and Response (PHEPR) Region 9 is comprised
of over 25% of the counties in Washington State: Adams, Asotin, Columbia, Ferry, Garfield, Lincoln, Pend
Oreille, Spokane, Stevens, and Whitman Counties, as well as the Kalispel and Spokane Tribes, and the
Colville Tribe within Ferry County. The population in this region is roughly 10% of the state’s population
(640,000/6,830,000). Columbia & Grant Counties are the state’s 2 least populous, while Spokane County
has the 4th highest population in the state. Geographically, Region 9 is approximately 30% of the state and
extends from the Canadian to the Oregon borders, with Idaho bordering completely on the east. The East
Region emergency medical services (EMS) boundaries are the same, with the exception of Columbia
County which is in a neighboring EMS region.
There are 21 hospitals in Region 9, 18 of which are WA State DOH trauma-designated facilities (see
Appendix L). Five hospitals are in Spokane County; among them are one Trauma II center (Providence
Sacred Heart) and three Trauma III centers. The other 13 hospitals are in the 9 rural counties of the region.
St Joseph Regional Medical Center (SJRMC) in Lewiston Idaho is a Trauma III center outside of
Washington Region 9 but within the East Region EMS system. See Appendix C for a health care system
overview map.
The other 3 hospitals: Spokane Veteran’s Administration Medical Center, Eastern State Hospital, and
Shriners Hospital for Children, are not first-response hospitals. These facilities will accept stable patients in
the event that additional beds are needed. This effort would be coordinated through the DMCC as described
comprehensively in Appendix E. See Appendix L for Trauma Designations.
The EMS system is a comprised of the following elements:
 77 licensed agencies: 33 EMS transporters, 44 EMS aid providers
 14 licensed affiliate agencies without vehicles
 1965 individual providers: 1677 Basic Life Support (BLS), 288 Advanced Life Support (ALS)
Region 9 has many other health care system partners, including 6 community health centers with 20 delivery
sites, 8 public health jurisdictions, 30 authorized community mental health agencies within 3 regional support
networks (RSNs), 1 medical examiner county (Spokane), 2 coroner counties (Stevens & Whitman) and 7
prosecutor / coroner counties, as well as numerous supportive and specialty services (Inland Northwest
Blood Center, Dsi Spokane Renal Centers, etc).
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PLANNING ASSUMPTIONS
A mass casualty event could overwhelm the capacity of regional health care partners and
resources (staff, supplies, equipment). Development of this plan assumes the following:

Response partners will respond as detailed in their emergency response plans.

Health care system partners will coordinate closely to ensure continuation of critical
services.

Emergency response will require the participation of many health care system partners,
as well as coordination with multiple community, government, health care and first
responder agencies to ensure a successful response.

Roles and responsibilities of medical surge response partners are guided by Emergency
Support Function 8.
1.0 CONCEPT OF OPERATIONS
1.1 Incident Command System / National Incident Management System
In compliance with Assistant Secretary of Preparedness and Response (ASPR) requirements,
health care system partners use Incident Command System (ICS) utilized by the National
Incident Management System (NIMS) to manage incident response.
ICS may be initiated by a dispatch entity, hospital, law enforcement, public health, or
emergency management and will evolve as necessary to effectively manage a multi-partner
incident response. The appropriate agency/agencies will assume the Incident Command (IC)
or Unified Command (UC) roles, and the ICS structure will be scalable and flexible according
to the needs of the incident and considering span of control protocols.
All dispatch centers in Region 9 are Emergency Medical Dispatch (EMD) trained by authorized
training agencies. They are NIMS compliant and use ICS on a daily basis.
Additionally, many public health agencies, hospitals and other partners have varying levels of
ICS training and implementation experience. Hospitals may utilize the Incident Command
System or Hospital ICS (HICS) with community partners to respond to and manage significant
events internally and as part of a community response. Health care system partners are
responsible to share appropriate training with key staff to effectively fulfill ICS roles.
In many cases law enforcement and EMS may arrive at nearly the same time. Either one may
begin the use of ICS, again with the appropriate lead agency/agencies assuming a Command
role. In a large-scale emergency response it is likely that UC will be necessary to leverage the
expertise of the key responding agencies.
In the event of a pandemic or other public health emergency, the local health jurisdiction may
establish ICS as needed and assume a Command role.
An Emergency Operations Center (EOC) or Emergency Coordination Center (ECC) can be
opened to provide strategic overview and coordination of the incident. The EOC may or may
not contain a Joint Information Center (JIC) as deemed necessary to support multiagency/jurisdiction communication to the media and public.
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1.2 Health Care System Partner Roles & Responsibilities
1.2.1 Emergency Medical Services
The dispatch protocol for an MCI is summarized below.



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
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EMS receives a call from dispatch and responds as directed.
EMS provides an assessment and size-up of the scene to the on-scene IC. Patient
Care Procedures (PCP) are adhered to.
The IC reports their findings to dispatch.
The IC determines whether or not an MCI exists. If yes, the county MCI plan is
implemented. For example, Spokane County would reference the Field Operations
Guide (FOG).
Additional resources, including the use of DMCC, are requested as needed.
As the above events are taking place, EMS providers triage patients according to
county protocol and/or DOH-approved Mass Casualty All-Hazards Field Protocols
and use uniform triage tags that identify patients by green, yellow, red or black.
The Combined Communication Center (CCC) coordinates notification and dispatch of required
agencies and resources, including notification of DMCC. Local health jurisdictions (LHJs) are
notified in events where a public health threat exists. The dispatch center is likely sending
resources (ambulances and other transport vehicles) to the scene.
1.2.2 Hospitals
Hospitals provide triage, assessment, decontamination, emergency care/treatment, and
isolation/quarantine of patients as stated in county Comprehensive Emergency Management
Plan (CEMP) requirements. Each hospital in Region 9 has developed an emergency response
plan to address internal plan activation, emergency staffing, surge capacity including additional
bed
expansion,
isolation
patient
management,
acquisition
of
additional
supplies/equipment/pharmaceuticals, emergency evacuation, shelter-in-place, fatality
management, and coordination with their local office of emergency management (EM) and
other hospitals in the region.
As patient numbers increase beyond the capacity of the impacted hospital, they will:




activate their internal Emergency Operations Plan (EOP)
contact the DMCC
contact their county Medical Program Director (MPD)
contact local EM
Region 9 divides the DMCC role into 3 subregions. Ferry, Stevens and Pend Oreille counties
call Holy Family Hospital. Spokane, Lincoln and Adams counties call Deaconess Hospital.
Whitman, Columbia, Garfield and Asotin counties call Pullman Regional Hospital. Deaconess
Hospital is the backup for the other 2 DMCCs, and Holy Family Hospital is the back up for
Deaconess Hospital. All 3 DMCCs use the statewide WATrac bed tracking system, and have
discussed their respective relationships during a response, how they will share responsibilities
on a day-to-day basis, etc. During a mass casualty event, DMCC has the responsibility and
Region 9 Health Care System Coordination Plan
June 30, 2012
Page 6
authority to coordinate patient flow and disposition for hospital services, and serves as a
regional information initiation point and communication systems contact point for the hospitals.
DMCC will provide medical system status reports at the request of the impacted county’s EM
during a disaster. DMCC provides a Facility Situation Report, which indicates each hospital’s
capacity for receiving patients relative to their medical condition. Information required in
determining the appropriate receiving facility is available on WATrac and/or the DMCC Facility
Situation Report. DMCC will communicate with local, regional & state partners as described in
the DMCC plan. See Appendix E.
During a CBRNE (Chemical, Biological, Radiological, Nuclear and high-yield Explosive) event
each hospital works with their local EM. The EM may share responsibility with the local Health
Officer (HO), especially if the event involves a communicable disease or if the health of the
population is at risk due to the event. Hospitals will contact their local health jurisdictions in
accordance with their individual infection control policies and notifiable condition requirements.
1.2.3 Local Health Jurisdictions
The role of the 8 Local Health Jurisdictions (LHJs) is to assist in CBRNE events, as well as in
the recognition, surveillance, investigation, and prevention of the spread of communicable
diseases. Each LHJ is responsible for coordinating with other LHJs, Public Health Emergency
Preparedness & Response (PHEPR) regions, DOH, health care practitioners, hospitals,
veterinarians, other health care professionals, and disease-reporting agencies for disease
surveillance and control activities. Each county is required to have a written emergency
response plan for a CBRNE event, outlining the authority and the role of the LHJ. Included are
details on the relationships with local EM, as well as the relationships with the Washington
State Public Health Laboratory (WSPHL) and DOH. Each LHJ is required to have an
emergency response plan detailing lead responsibilities during public health responses.
1.2.4 Emergency Management
The impacted county’s office of emergency management (EM) will facilitate interagency
coordination, provide centralized situation assessment and public information, coordinate the
mobilization of local government resources in response to an emergency, and coordinate
community disaster recovery. In the event that responding agencies, including the hospitals,
have exhausted critical resources available through routine channels and through mutual aid,
local EM will request resources from Washington State EMD.
Washington State EMD is similarly responsible, though at the state level. The Washington
State EOC, located at Camp Murray, Washington, will coordinate emergency assistance to
local jurisdictions from state agencies (DOH), other counties, other states, or the federal
government.
1.2.5 Medical Reserve Corps
The Medical Reserve Corps (MRC) has two Rapid Response Teams (RRTs) and one reserve
team. The RRT does not replace local or regional first responders or other health professionals
within hospitals. Each team includes one Medical Doctor (MD) Team Leader, two Supervising
MDs and four registered nurses and are available to respond throughout the region. The RRT
may utilize the region’s medical surge / alternate care facility (ACF) trailers, medical supplies,
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and equipment, and would also be supported by local MRC volunteers recruited from each
county. An RRT may be requested through the local EM. The MRC Deployment Process is
attached in Appendix G.
1.2.6 Governmental & Tribal Partners
Region 9 works closely with law enforcement, fire services, city government offices and
county-level agencies where appropriate for planning purposes.
Along with the governmental agencies described above, federal partners who have a presence
in Region 9 include the Air National Guard, Fairchild Air Force Base, National Weather
Service, United States Postal Service, Department of Transportation, Federal Bureau of
Investigation and others. MOUs addressing staffing and medical surge capacities are in
progress with relevant partners.
National Disaster Medical System (NDMS) and other scalable surge capacity assistance
through the US Department of Health and Human Services may be requested by local EM to
state EMD if response capabilities are exceeded. State EMD will ask local EM to describe the
need and will then determine which asset(s) are necessary. This may include Disaster Medical
Assistance Teams (DMAT), Disaster Mortuary Operational Response Teams (DMORT),
International Medical Surgical Response Teams (IMSURT), National Veterinary Response
Teams (NVRT), Federal Medical Station (FMS), Strategic National Stockpile, Cross-Border
EMS Response, and others.
Region 9 actively pursues partnerships with and encourages participation from Kalispel Tribe,
Spokane Tribe, and the Confederated Tribes of the Colville Reservation within Ferry County.
1.2.7 Community Health Centers
There are 6 federally funded community health centers (CHC) within Washington Association
Community and Migrant Health Centers containing 20 delivery sites in Region 9: Columbia
Basin Health Association (1), Community Health Association of Spokane (CHAS) (6 sites),
Lake Roosevelt Community Health Center (2), NATIVE Project (1), Northeast Washington
Health Association (9), and the Yakima Valley Farm Workers / Spokane Falls Family Clinic (1).
There are other private and tribal health clinics, such as Northeast Washington Health
Programs, Camas Center Clinic and Columbia Basin Health Clinic, with whom Region 9 is
expanding partnerships through exercise participation and other outreach.
Partnership goals include training for clinics and staff to become “disaster ready” and are
ongoing with community health centers. Region 9 is implementing training programs to include
ICS, patient lifting, triage/treatment and disaster mental health to expand the response
capabilities of CHCs.
1.2.8 Bordering State or Canadian Partners
EMS: DOH has an extensive operational cross-border plan for moving emergency medical
services staff and resources across the Washington and British Columbia border (see
Appendix I). The Pacific Northwest Emergency Management Agreement is activated by the
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June 30, 2012
Page 8
local EOC, or its equivalent, to the state EOC. Similarly, DOH may request assistance from
state EOC.
Hospitals: Region 9 has inquired to Washington State Hospital Association, who in turn
inquired to DOH, regarding a statewide hospital agreement. Individual hospitals may or may
not have formal MOUs with interregional/state hospitals. See Appendix D for details.
Emergency Management: ***in progress, anticipated by end July 2012 by Darrell Ruby***
Public Health: Region 9 LHJs work with bordering state public health partners and are always
expanding those relationships to improve information sharing and enhance response
capabilities.
1.2.9 Other partners
The American Red Cross is the only non-profit, non-government agency required by
Congressional charter to undertake disaster relief activities to ease human suffering caused by
disasters. As such, they are the only organization in the country that responds to the
immediate, disaster-caused basic needs of anyone in our community, with a focus on
vulnerable populations who have no safety net. The Inland Northwest Chapter responds to
disasters in 12 counties: Adams, Ferry, Lincoln, Pend Oreille, Stevens, Spokane and Whitman
in WA, as well as Benewah, Boundary, Bonners, Kootenai and Shoshone in Idaho. Disaster
Action Teams respond to requests for assistance from fire and police on an average of once
every 48 hours.
There are many non-gov agencies, like ARC, Salvation Army….
Region 9 is continually developing relationships with the many supportive and specialty
services in our region. Examples of the broad base of health care system partners include:
 nursing homes
 blood centers
 long-term care facilities
 behavioral health services
 urgent care centers
 volunteer organizations
 non-profit organizations
 faith-based organizations
 physician clinics
 medical transportation providers
 renal services
 technical support
 coroners / medical examiners
MOUs will be referenced as they are developed.
2.0 SYSTEM RESPONSE & RESOURCE COORDINATION
When DMCC is notified that an MCI exceeds the surge capacity of the affected hospital,
DMCC will reference this plan and instruct the affected agency to reference this plan as well.
Then the following activities may occur:

DMCC will put WATrac in disaster mode to alert regional hospitals & partners of the
event.
Region 9 Health Care System Coordination Plan
June 30, 2012
Page 9

Placing WATrac in disaster mode triggers hospitals & health care system partners to
evaluate the level of response required and enhances situational awareness.

Situational awareness may be enhanced by the authority having jurisdiction.

If a patient is suspected of having been exposed to a CBRNE agent, or of having a
notifiable disease, hospitals will notify their local health jurisdiction, who will in turn
follow their agency plan for further notification.

Availability of facilities to receive patients will be coordinated through DMCC utilizing
WATrac.

East Region EMS PCP 3B addresses pediatric casualties, primarily that families will be
co-located to the highest trauma-designated hospital to address the needs of the most
critically injured family member.

Rapid Responder may be used for Spokane County hospitals, schools and some public
buildings to obtain detailed infrastructure mapping (shut-off valves, air ducts, etc).

Additional resources may be coordinated by the authority having jurisdiction.
3.0 COMMUNICATIONS
3.1 Alerting and Patient Distribution
As patient numbers increase beyond the individual hospital capacity, the hospital may activate
their EOP and contact the DMCC and local EM as needed. Patients may be distributed based
on the features of the event.
The DMCC plan is the primary resource document for patient distribution and can be
referenced in Appendix E.
The regional strategy for evacuating patients beyond the affected region is accomplished
through the NDMS Forward Movement of Patients Plan, which is coordinated through
Washington State EMD. See Appendix J.
3.2 Emergency Communication Systems
The 24/7 contact list is found in Appendix A. The Region has several alternate forms of
communication available. Preferred forms of communications may vary by discipline. The
alternate forms are listed below in approximate priority of preferred and attempted use.
Instructions for access and use are available in Appendix B.




Landlines
Cellular telephones
HEAR radios: Hospital-to-EMS communications on frequency 155.340 MHz. Hospitalto-hospital communication is available in some parts of the region on frequency 155.280
MHz.
Satellite telephones
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June 30, 2012
Page 10

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
Washington Hospital and EMS Emergency Radio System (WHEERS): WHEERS
ensures effective communication between field EMS (including MedStar) & hospitals,
though communication is limited throughout the region.
Amateur radios (HAM): All hospitals utilize the Amateur Radio Emergency Service
(ARES) and the Radio Amateur Civil Emergency Service (RACES). This emergency
communication service consists of licensed operators who have voluntarily registered
their qualifications and equipment for duty in public service. Amateur radio may be used
for communication between health care facilities and local, county and state emergency
organizations. Each EM has a list of approved operators for each county. Frequencies
vary by location, and specific radio repeaters are utilized according to each county’s
communication plan.
Video-conferencing: All Region 9 hospitals and many other health care system
partners have access to video conferencing. For example, TeleHealth is available via
the Inland Northwest Health Services (INHS) TeleHealth system.
Emergency Alert System (EAS): The Local Emergency Communications Committee
(LECC) for the Inland Northwest EAS region has determined that major media from
Spokane and Coeur d’Alene, Idaho have significant viewer and listener audiences in 13
counties in Washington, 10 counties in northern Idaho, and Lincoln and Sanders
counties in northwest Montana. This committee has established procedures for issuing
emergency messages or safety advisories to the public utilizing major media
(radio/television) from Spokane and Coeur d’Alene. The Inland Northwest Region EAS
plan has been distributed to emergency managers for these 25 counties to provide
guidance if activation of the major media is part of their emergency communications
procedures. EAS messages may be initiated through the appropriate 911
communications center for each jurisdiction. Kootenai County 911 and Spokane County
EM act as reciprocal backups for one another. Informational messages that do not
require program interruption may be initiated through county 911 communication
centers. ***this section being edited, anticipated by end July 2012 by Darrell Ruby***
Comprehensive Emergency Management Network (CEMNET): Washington State
Emergency Management Division operates a statewide, very high frequency (VHF) lowband radio system as the backup communication link between the state and local
EOCs. It also serves as a link to agencies such as: Department of Health, National
Weather Service, Harborview Medical Center, University of Washington Seismology
Lab, etc. Local emergency management jurisdictions are authorized to use the
designated CEMNET region channel for local operations, and hospitals may contact
their local EM to request emergency services.
3.3 Media / Public Communications
Hospital Public Information Officers (PIOs) will manage the information flow in coordination
with public health, emergency management and/or other appropriate partner PIOs. Most
hospitals, emergency management agencies and local health jurisdictions have designated
PIOs or spokespersons who maintain media contact information.
A JIC may be activated in support of the response. With guidance from response partners,
information will be coordinated and distributed via electronic, print and informal
communications (newspaper, radio, television, social media, etc) to educate and alleviate the
concerns of the general public. The JIC may also utilize a webpage and/or hotline with
Region 9 Health Care System Coordination Plan
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additional public information that can be regularly updated throughout the response and
recovery.
The Region 9 Health Care Coalition works closely with Frontier Behavioral Health, Coalition of
Responsible Disabled (CORD) and other supportive agencies to ensure that appropriate risk
communication messages are formatted and delivered in a variety of methods available to the
access and functional needs population.
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4.0 SURGE CAPACITY
Health care system partners operate under these MOUs, which are attached in Appendix D:
MOU
Agreement for
Region 9 hospitals
Shared equipment, supplies, resources &
staffing
Region 9 LHJs
Shared equipment, supplies, resources &
staffing
Region 9 Health care partners currently in development, may include
specialty & supportive services
Each hospital has internal plans for creating bed space and accessing auxiliary staff locally. As
an impacted agency foresees they will be stretched beyond their capacity to respond, they can
activate the related MOUs referenced above in accordance with the verbiage & terms of that
MOU.
In addition to these regional MOUs, hospitals experiencing equipment and supply shortages
may utilize established agreements and relationships with other agencies and/or vendors.
Each hospital has emergency delivery agreements established with suppliers of fuel for backup generator power, medical supplies, laundry service, medical gases, blood, food, potable
water, medical equipment rental, service equipment, etc. If an internal or external disaster
results in a shortage of essential supplies, 24/7 contacts can be made with the appropriate
suppliers.
In the event that hospitals exceed their established agreements and relationships, additional
staffing, equipment, supply and transportation requests may be made to EM, who will then
coordinate the request with state agencies.
The Region 9 Health Care Coalition has these medical surge equipment resources:
Asset
Capability
2 (two) Tier 2 Alternate Care Facility trailers
Basic medical needs / first shelter x 40 beds
each (30 beds, 10 bariatric cots), eBed
conversion kit for portable morgue set up
Additional medical surge resources are available from other community partners via the
impacted county’s EM.
Starting in June 2012, DOH is beginning an active process to develop protocols for crisis
standards of care. This section will be updated with information as those protocols are
developed. At this time, Region 9 understands that crisis standards of care may be invoked
following both a Governor’s Proclamation and an Executive Order.
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4.1 Bed tracking
WATrac, the statewide bed tracking system, is continually gaining traction in Region 9.
Hospitals have been offered training on the capabilities available within WATrac, and efforts to
strengthen WATrac usage are ongoing. In a mass casualty response, phones will also be used
to get accurate bed counts.
4.2 Alternate Care Facilities
Region 9 has 2 medical surge trailers equipped with supplies to establish two 40-bed alternate
care sites during medical surge events. These trailers meet the Tier 2 requirements for
Alternate Care Facility (ACF) standard of DOH and can provide triage, first aid / minor
treatment. Activation of the ACF is coordinated in consultation with local EM and Spokane
Regional Health District (SRHD) as the regional lead for this asset. The deployment manual is
attached in Appendix H.
MOUs exist for the sharing of staff, equipment, and transferring of patients. Most hospitals
within the region have identified on-site or off-campus locations where an ACF could be set up.
4.3 Federal Medical Station (FMS)
Region 9 is still developing protocols for how we would support an FMS. Questions that need
to be addressed are the locations (40,000 square feet / 1 acre needed), staffing and what
capabilities will be addressed.
5.0 CRITICAL ISSUES
5.1 Security
Most hospital emergency response plans indicate a reliance on local police, Washington State
Patrol, and/or other agency contracts for facility security during a large-scale event. Building
and personnel security procedures are addressed in individual emergency response plans.
Each hospital is responsible for its own policies and procedures for employee identification.
5.2 Access and Functional Needs Populations
All hospitals address access and functional needs populations in their individual emergency
response plans, including but not limited to communication, mobility, behavioral and mental
health, and age-related issues.
All hospitals have a provision for securing interpreters. Fact Sheets for limited-Englishspeaking populations are available in various languages, on bioterrorism agents and specific
communicable diseases, through region LHJs and state DOH.
5.3 Behavioral Mental Health
Region 9 has a Behavioral Mental Health Response Plan to provide an effective, organized
system to manage the consequences of disaster impacts on the public and emergency
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responders. The plan is activated in consultation with local EM and the local RSN. The plan
can be reviewed on the Health Care Coalition website at www.srhd.org/hcc.
In addition, Sacred Heart Medical Center and Eastern State Hospital employ mental health
personnel, and each county has a mental health agency. Mental health resource information
may be available on a regional basis through the Regional Support Network (RSN).
5.4 Diseases of Significant Concern
Local health jurisdictions will coordinate a response for any outbreak of a significant condition
such as: Pandemic Influenza, Smallpox, etc. that public health requires reporting. Each
hospital has an internal plan for early recognition of these conditions and has an established
partnership with their LHJ.
5.5 Medical Evacuation / Shelter in Place
Hospital shelter-in-place and evacuation procedures are outlined in each location’s emergency
response plan.
Each city / county’s EM may be contacted to activate resources
(transportation, etc) for evacuation. DMCC may serve as a resource to facilities involved in
evacuation to assist with patient destination coordination.
During an evacuation, some hospitals house patients at an adjacent medical building, assisted
living facilities, and other area hospitals. In their emergency response plans, each hospital
addresses alternate care in the event of an evacuation.
5.6 Pharmaceutical Resources / Caches
A plan is currently in development regarding pharmaceutical resources. See Appendix F.
5.7 Patient Decontamination
Each hospital’s process for patient decontamination is included in each hospital’s Infection
Control Policy and/or EOP. Fire services are a primary resource for decontamination support.
5.8 Medical Waste Disposal
All facilities utilize medical waste disposal vendors. When they are overwhelmed, a request for
additional containers will be made to the impacted county’s EM. The waste is bagged, stored
and disposed of in accordance with legal requirements and LHJ or Center for Disease Control
(CDC) guidance.
5.9 Mass Fatality
According to Washington state law (RCW 68.50.010), coroners (or medical examiner’s
appointed under RCW 36.24.190) have jurisdiction over certain deaths in their jurisdictions,
such as sudden, unexpected, violent, suspicious or unnatural deaths, and deaths due to a
suspected contagious disease which may be a public health hazard. Deaths occurring from
natural causes where the decedent has been seen by a qualified medical practitioner within 36
hours of death are not normally investigated by the county coroner/medical examiner.
Region 9 Health Care System Coordination Plan
June 30, 2012
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The Spokane County Medical Examiner’s Office has verbal contracts with surrounding
counties to assist in providing autopsy service under normal operating circumstances, though
resources are limited.
The Spokane County plan, though not yet complete, can be seen in Appendix K. Development
of a regional plan will follow completion of the Spokane County plan.
6.0 RECOVERY
6.1 Communication
When it is determined that the situation is contained, through the local EM or the on-scene IC /
UC, DMCC will communicate to health care agencies via WATrac, phone, radio or other
communication methods that the disaster or situation has been contained and the region has
returned to a normal state of operation.
6.2 Facility Re-entry Authorization
If a facility has been evacuated as a result of the event, Hospital Administration, and/or health
care agencies in conjunction with lead local, state and/or federal agencies, will authorize reentry of the facility in accordance with their internal re-entry guidelines.
7.0 TRAINING
Effective use of this coordination plan requires region-wide training in the use of WATrac bed
tracking so that DMCC can make informed medical decisions regarding patient movement.
Some additional training areas identified in the 2012 Health Care Coalition functional exercise
include: WHEERS, ICS, patient tracking and evacuation planning.
Health care system response partners need to be familiar with this plan and how it can assist
during an MCI response. This plan is trained to annually through the Health Care Coalition
general membership meetings and other contact with partners.
8.0 PLAN MAINTENANCE
8.1 Maintaining, Exercising, and Updating the Plan
The master version of the Plan will be maintained on the Health Care Coalition website
(www.srhd.org/hcc) and will be shared with regional health care, EMS, emergency
management, and other response partners.
Health care agencies participate in annual local and/or regional exercises. Best practices and
lessons learned, identified in after action reports and improvement plans, will be utilized in
updating this plan and in planning the necessary training to support the effective use of this
plan. Spokane Regional Health District will collaborate with the Region 9 Hospital Planning
Committee, public health, emergency management, EMS and other appropriate community
partners in updating this plan. The plan will be reviewed and updated annually or after
identification of best practices and lessons learned in regional drills and exercise.
Region 9 Health Care System Coordination Plan
June 30, 2012
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Health care system leadership & response partners are regularly engaged in the planning
process by collaborating with the following groups & agencies. All recommendations are
considered by the committee. Common planning partners are:
Region 9 Health Care Coalition
Region 9 Hospital Planning Committee
East Region EMS & Trauma Care Council
Region 9 Exercise Planning Team
Region 9 Homeland Security
Local Emergency Planning Committees
Local Health Jurisdictions
County Emergency Management
Contributors
 Providence Health care
 Deaconess Hospital
 Spokane Regional Health District
 Region 9 Health Care Coalition
 City of Spokane Fire Department
 Spokane County Department of Emergency Management
 Combined Communication Center
 Spokane Medical Examiner
 American Red Cross
 Medical Reserve Corps
 Frontier Behavioral Health / Regional Support Network
 East Region EMS & Trauma Care Council
Approvals ***need a way to track these electronically – any suggestions?***
 Susan Sjoberg, Spokane Regional Health District Region 9 Public Health Lead
 Ed Dzedzy, Region 9 Health Care Coalition Chair
 Adam Richards, Deaconess Hospital Emergency Department Director / DMCC
 Robbie Thorn, Providence Holy Family / Sacred Heart Hospitals Emergency
Department Director / DMCC
 Jeff Ewing, Providence Holy Family / Sacred Heart Hospitals Security Manager
 Nancy Webster, East Region EMS & Trauma Care Council President
 Kim Burke, East Region EMS Executive Director
 Tom Mattern, Spokane County Emergency Manager
Distribution
 Region 9 hospitals
 Region 9 local health jurisdictions
 Region 9 Coordinating Group / emergency management agencies
 Region 9 Health Care Coalition membership
 Region 9 public health lead: Spokane Regional Health District
 East Region EMS & Trauma Care Council
 Washington State Department of Health
 others as approved by the Health Care Coalition chair
Region 9 Health Care System Coordination Plan
June 30, 2012
Page 17
9.0 ACRONYMS
ACF: Alternate Care Facility
ALS: Advanced Life Support
ARES: Amateur Radio Emergency Service
BLS: Basic Life Support
CBRNE: Chemical, Biological, Radiological,
Nuclear and High-yield Explosive
CCC: Combined Communications Center
CDC: Center for Disease Control
CEMP: Comprehensive Emergency
Management Plan
CHAS: Community Health Association of
Spokane
CHC: Community Health Clinic
CEMNET: Comprehensive Emergency
Management Network
CORD: Coalition of Responsible Disabled
DMAT: Disaster Medical Assistance Team
DMCC: Disaster Medical Control Center
DMORT: Disaster Mortuary Operational
Response Team
DOH: Department of Health
EAS: Emergency Alert System
ECC: Emergency Coordination Center
ED: Emergency Department
EM: Emergency Manager / Management
EMD: Emergency Management Division
(state)
EMS: Emergency Medical Services
EOC: Emergency Operations Center
FMS: Federal Medical Station
FOG: Field Operations Guide
HICS: Hospital Incident Command System
HO: Health Officer
Region 9 Health Care System Coordination Plan
June 30, 2012
IC:
Incident Commander
ICS: Incident Command System
IMSURT: International Medical Surgical
Response Team
JIC: Joint Information Center
LECC: Local Emergency Communications
Committee
LHJ: Local Health Jurisdiction
MCI: Mass Casualty Incident
MD: Medical Doctor
MOU: Memorandum of Understanding
MPD: Medical Program Director
MRC: Medical Reserve Corps
NDMS: National Disaster Medical System
NIMS: National Incident Management System
NVRT: National Veterinary Response Team
PCP: Patient Care Procedure
PHEPR: Public Health Emergency
Preparedness and Response
PIO: Public Information Officer
RACES: Radio Amateur Civil Emergency
Service
RCW: Revised Code of Washington
RRT: Rapid Response Team
RSN: Regional Support Network
SJRMC: St Joseph Regional Medical Center
UC: Unified Command
VHF: Very High Frequency
WA: Washington
WHEERS: Washington Hospital and EMS
Emergency Radio System
WSPHL: Washington State Public Health
Laboratory
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