Public Health Emergency Preparedness: Public Health Emergency Preparedness: Planning and Practicing for a DisasterPlanning and Practicing for a Disaster

Monday, February 9Monday, February 9thth, 2009, 20091:00-2:30 pm EST1:00-2:30 pm EST

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AgendaAgenda

PART ONE PART ONE Introduction, Introduction, Karen Migdail Karen Migdail Disaster Preparedness Tools: Hospital Surge Model Disaster Preparedness Tools: Hospital Surge Model

and Mass Evacuation Transportation Model, and Mass Evacuation Transportation Model, Tom Rich Tom Rich National Mass Patient and Evacuee Movement, National Mass Patient and Evacuee Movement,

Regulating, and Tracking System Initiative, Regulating, and Tracking System Initiative, F. Christy F. Christy Music Music

Moderated Q&A, Moderated Q&A, Karen MigdailKaren Migdail PART TWO PART TWO Hospital Disaster Drills, Hospital Disaster Drills, Mollie JenckesMollie Jenckes User’s Perspective of Hospital Disaster Drills, User’s Perspective of Hospital Disaster Drills, Cindy Cindy

NotobartoloNotobartolo Moderated Q&A and closing statements,Moderated Q&A and closing statements, Karen Migdail Karen Migdail

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AHRQ Disaster Preparedness Tools: AHRQ Disaster Preparedness Tools: Hospital Surge Model Hospital Surge Model

and and Mass Evacuation Transportation ModelMass Evacuation Transportation Model

Tom RichTom RichSenior AssociateSenior Associate

Abt Associates Inc.Abt Associates Inc.

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Surge Model: PartnersSurge Model: Partners

Dr. Sally Phillips, AHRQ Project OfficerDr. Sally Phillips, AHRQ Project Officer Office of the Assistant Secretary for Office of the Assistant Secretary for

Preparedness and Response (ASPR)Preparedness and Response (ASPR) Gryphon Scientific (Rocco Casagrande, Gryphon Scientific (Rocco Casagrande,

Principal Investigator)Principal Investigator) Weill Medical College, Cornell University Weill Medical College, Cornell University

(Nathaniel Hupert, Co-Principal (Nathaniel Hupert, Co-Principal Investigator)Investigator)

Project Steering CommitteeProject Steering Committee

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Surge Model: ScenariosSurge Model: Scenarios BiologicalBiological

– AnthraxAnthrax– SmallpoxSmallpox– FluFlu– Food Contamination (under development)Food Contamination (under development)– Plague (under development)Plague (under development)

ChemicalChemical– ChlorineChlorine– MustardMustard– SarinSarin

Nuclear / RadiologicalNuclear / Radiological– 1 Kiloton Yield (KT) or 10 KT nuclear device1 Kiloton Yield (KT) or 10 KT nuclear device– Radiological dispersion device (“Dirty bomb”)Radiological dispersion device (“Dirty bomb”)– Radiological point sourceRadiological point source

Conventional explosive (under development)Conventional explosive (under development)

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Surge Model OutputsSurge Model Outputs

Based on …Based on …– The scenarioThe scenario– The number and type of casualties The number and type of casualties

requiring hospitalizationrequiring hospitalization The Hospital Surge Model estimatesThe Hospital Surge Model estimates

– Number of patients in the hospital by day Number of patients in the hospital by day and hospital unitand hospital unit

– Resource requirements for patients, by Resource requirements for patients, by resource, day, and hospital unitresource, day, and hospital unit

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Hospital ResourcesHospital Resources

Durable equipmentDurable equipment Human resourcesHuman resources PharmacyPharmacy Consumable Consumable

suppliessupplies Personal protective Personal protective

equipmentequipment

Psychological Psychological SupportSupport

HousekeepingHousekeeping Lab / RadiologyLab / Radiology MortuaryMortuary NutritionNutrition

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Key Assumptions and Key Assumptions and ConsiderationsConsiderations

Time delay between incident and hospital arrivals (for biological Time delay between incident and hospital arrivals (for biological and radiological scenarios, based on dispersion models)and radiological scenarios, based on dispersion models)

The patient’s assumed length of stay in the Emergency The patient’s assumed length of stay in the Emergency Department (ED), in the Intensive Care Unit (ICU), and on the Department (ED), in the Intensive Care Unit (ICU), and on the floor varies by scenario and severity of condition floor varies by scenario and severity of condition

Per patient per day resource consumption based on historical Per patient per day resource consumption based on historical data to treat similar patients, and expert elicitationdata to treat similar patients, and expert elicitation

No capacity or resource limitations at the hospitalNo capacity or resource limitations at the hospital

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Illustrative Output: Hospitalized Illustrative Output: Hospitalized Patients by Day and UnitPatients by Day and Unit

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For More InformationFor More Information To run the Hospital Surge Model, go To run the Hospital Surge Model, go

to: to: hospitalsurgemodel.ahrq.govhospitalsurgemodel.ahrq.gov User ManualUser Manual Model Description DocumentModel Description Document

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Mass Evacuation Transportation Mass Evacuation Transportation Model: PartnersModel: Partners

Dr. Sally Phillips, AHRQ Project OfficerDr. Sally Phillips, AHRQ Project Officer ASPRASPR11, HRSA, HRSA22, FEMA, FEMA33, DoD, DoD44

Partners Healthcare (Drs. Paul Biddinger and Partners Healthcare (Drs. Paul Biddinger and Richard Zane)Richard Zane)

Project Steering CommitteeProject Steering Committee New York City Office of Emergency New York City Office of Emergency

ManagementManagement Los Angeles Emergency Preparedness Los Angeles Emergency Preparedness

DepartmentDepartment1 1 ASPR: Office of the Assistant Secretary for Preparedness and Response ASPR: Office of the Assistant Secretary for Preparedness and Response 2 2 HRSA: Health Resources and Services AdministrationHRSA: Health Resources and Services Administration3 3 FEMA: Federal Emergency Management Agency FEMA: Federal Emergency Management Agency 4 4 DoD: Department of DefenseDoD: Department of Defense 1414

Model OutputsModel Outputs Based on…Based on…

– Number of vehicles assigned to the evacuation -- Number of vehicles assigned to the evacuation -- buses; wheel chair vans; Basic Life Support (BLS) buses; wheel chair vans; Basic Life Support (BLS) and Advanced Life Support (ALS) ambulancesand Advanced Life Support (ALS) ambulances

– Location of evacuating and receiving facilitiesLocation of evacuating and receiving facilities– Number and type of patients to be evacuatedNumber and type of patients to be evacuated– Surge capacity assumptionsSurge capacity assumptions

The Model estimatesThe Model estimates– The time required to transport all patients to the The time required to transport all patients to the

receiving facilitiesreceiving facilities

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Key Assumptions and Key Assumptions and ConsiderationsConsiderations

A planning model – not an operational tool to A planning model – not an operational tool to produce a vehicle schedule or patient produce a vehicle schedule or patient transport rostertransport roster

Does not consider physical constraints within Does not consider physical constraints within the hospitals (e.g., the number of elevators)the hospitals (e.g., the number of elevators)

Assumes appropriate staff are available in the Assumes appropriate staff are available in the vehiclesvehicles

Travel time estimates require latitude and Travel time estimates require latitude and longitude of evacuating and receiving facilitieslongitude of evacuating and receiving facilities

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Web Implementation of the Web Implementation of the ModelModel

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Illustrative Results: Effect of Advanced Illustrative Results: Effect of Advanced Life Support (ALS) Ambulance Life Support (ALS) Ambulance

AvailabilityAvailability

0

1

2

3

4

5

0 10 20 30 40 50 60 70

Number of Advanced Life Support (ALS) units

Evac

uatio

n Ti

me

(day

s)

Data from Los AngelesData from Los Angeles pilotpilot testtest 1818

For More InformationFor More Information

To run the Mass Evacuation To run the Mass Evacuation Transportation Model, go to: Transportation Model, go to: massevacmodel.ahrq.govmassevacmodel.ahrq.gov

User ManualUser Manual Model Description DocumentModel Description Document

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Poll Question #1Poll Question #1 A short poll will appear on your A short poll will appear on your

screen. Please take a few seconds screen. Please take a few seconds to answer the poll and provide to answer the poll and provide valuable feedback! valuable feedback!

If you are unable to respond to the If you are unable to respond to the poll during this event, please e-mail poll during this event, please e-mail your answer to your answer to emergencypreparedness@academyhealth.org. 2020

Questions Questions

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National Mass Patient and Evacuee National Mass Patient and Evacuee Movement, Regulating, and Tracking Movement, Regulating, and Tracking

InitiativeInitiative

F. Christy Music, MS, MT(ASCP)SBBF. Christy Music, MS, MT(ASCP)SBBProgram Director, Health and Medical SupportProgram Director, Health and Medical SupportOffice of the Assistant Secretary of Defense Office of the Assistant Secretary of Defense

(Homeland Defense & Americas’ Security Affairs), (Homeland Defense & Americas’ Security Affairs), Department of DefenseDepartment of Defense

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Create a National General Population Create a National General Population Evacuee & Patient Movement, Regulating, Evacuee & Patient Movement, Regulating,

Tracking SystemTracking System

Issue: Issue: Catastrophic incidents = need for large-scale Catastrophic incidents = need for large-scale general population & patient movement, general population & patient movement, regulating, and tracking regulating, and tracking

Issue: Issue: No interoperable, national (local, State, No interoperable, national (local, State, Federal, tribal) information systemFederal, tribal) information system

Tracking: Tracking: Locating and maintaining an audit Locating and maintaining an audit trail of person’s movement from initial entry trail of person’s movement from initial entry through final locationthrough final location

Regulating: Regulating: Matching transport needs to a Matching transport needs to a receiving locationreceiving location

Movement: Movement: Availability, reservation, use, and Availability, reservation, use, and release of transportation resourcesrelease of transportation resources 2323

National Mass Patient and Evacuee National Mass Patient and Evacuee Movement, Regulating, and Tracking Movement, Regulating, and Tracking

InitiativeInitiative

Purpose:Purpose: Build upon existing information systems Build upon existing information systems and develop a National General Population and develop a National General Population Evacuee and Patient Movement, Regulating, and Evacuee and Patient Movement, Regulating, and Tracking information system that is interoperable Tracking information system that is interoperable and shares data. and shares data.

Goal:Goal: Federal Sector (DoD Federal Sector (DoD11, HHS, HHS22, DHS, DHS33, FEMA, FEMA44) ) provide a national system for all jurisdictions’ use. provide a national system for all jurisdictions’ use.

Goal:Goal: Use a central IT platform or other technology to Use a central IT platform or other technology to share data among existing systems; build and share data among existing systems; build and insert modules that are needed. insert modules that are needed.

11 Department of Defense Department of Defense22 Department of Health and Human Services Department of Health and Human Services 33 Department of Homeland Security Department of Homeland Security 44 Federal Emergency Management Agency Federal Emergency Management Agency

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National Initiative CapabilitiesNational Initiative Capabilities

Near real-time location and tracking is needed: Near real-time location and tracking is needed: – Audit trail that tracks general population and Audit trail that tracks general population and

patients patients – Notice and tracking: general population Notice and tracking: general population

members members → → patientspatients– Tracking from first entry through final location. Tracking from first entry through final location.

Entry Point: Fixed facility, collection point, point of Entry Point: Fixed facility, collection point, point of injury, home, search and rescue, self-registration, injury, home, search and rescue, self-registration, etc.etc.

Incorporate regulating and movement information Incorporate regulating and movement information to perform operations during an event.to perform operations during an event.

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Expand Nation’s capacity to transport, Expand Nation’s capacity to transport, regulate, and track evacuees/patients.regulate, and track evacuees/patients.

Support local, State, tribal, and Federal Support local, State, tribal, and Federal command & control decision makers.command & control decision makers.

Deconflict intended use of general Deconflict intended use of general population/patient movement resources and population/patient movement resources and destinations.destinations.

Coordinate general population/patient Coordinate general population/patient management at all vertical and horizontal management at all vertical and horizontal levels of government.levels of government.

Effects of the National InitiativeEffects of the National Initiative

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Effects of the National InitiativeEffects of the National Initiative(continued)(continued)

Locate general population evacuees /patients: entryLocate general population evacuees /patients: entry→ → intermediate locationsintermediate locations→→ final destinations. final destinations.

Provide near real-time updates (e.g. medical status).Provide near real-time updates (e.g. medical status). Incorporate patient’s Electronic Medical Record.Incorporate patient’s Electronic Medical Record. Track general population evacuees as they become patients Track general population evacuees as they become patients

during movement, requiring medical oversight en route.during movement, requiring medical oversight en route. Use by all jurisdictions (authorized users) in a disaster; Use by all jurisdictions (authorized users) in a disaster;

available for routine use.available for routine use.

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National Mass Patient and Evacuee Movement, National Mass Patient and Evacuee Movement, Regulating, and Tracking Initiative HistoryRegulating, and Tracking Initiative History

Proposed by DoD (2004); Noted as DHS Priority (2004): Proposed by DoD (2004); Noted as DHS Priority (2004): Secretary Ridge’s Secretary Ridge’s Homeland Security Interagency Security Homeland Security Interagency Security Planning EffortPlanning Effort – Included patient mobilization planning for catastrophic events as a Included patient mobilization planning for catastrophic events as a

long-term initiativelong-term initiative and identifies this effort as a and identifies this effort as a high-priorityhigh-priority (Reference: Secretary, Department of Homeland Security letter to (Reference: Secretary, Department of Homeland Security letter to Secretary, Department of Defense, September 22, 2004).Secretary, Department of Defense, September 22, 2004).

Funded by FEMA (tracking recommendations)Funded by FEMA (tracking recommendations) DoD asked AHRQ/HHS to apply these funds to the existing DoD asked AHRQ/HHS to apply these funds to the existing

HAvBED contractHAvBED contract– HHS added funds (Mass Evacuation Transportation Model)HHS added funds (Mass Evacuation Transportation Model)

Began Winter 2005, Draft Report 2008, Final Report 2009Began Winter 2005, Draft Report 2008, Final Report 2009 Supported by DoD Evacuee-Patient Tracking Initiative – Supported by DoD Evacuee-Patient Tracking Initiative –

Interconnect DoD’s ETASInterconnect DoD’s ETAS11 and AHLTA-Mobile and AHLTA-Mobile22 to HHS’ to HHS’ JPATSJPATS33

282811 Emergency Tracking Accountability System Emergency Tracking Accountability System22 Armed Forces Health Longitudinal Technology Application-Mobile Armed Forces Health Longitudinal Technology Application-Mobile33 Joint Patient Assessment and Tracking System Joint Patient Assessment and Tracking System

National Initiative Advisory BoardNational Initiative Advisory Board

National Advisory Board:National Advisory Board: HSC HSC11, DoD, AHRQ, HHS, DHS, , DoD, AHRQ, HHS, DHS, DOTDOT22, VA, VA33, other Federal agencies, State (NY and CA) and , other Federal agencies, State (NY and CA) and private industry representativesprivate industry representatives

Developed recommendationsDeveloped recommendations for a system that could be for a system that could be used during a mass casualty evacuation to:used during a mass casualty evacuation to:– Locate and track general population evacuees/patientsLocate and track general population evacuees/patients– Improve decision making regarding:Improve decision making regarding:

General population evacuee and/or patient movementGeneral population evacuee and/or patient movement Resource allocationResource allocation Incident managementIncident management

Built planning toolBuilt planning tool for use before a mass for use before a mass casualty/evacuation incidentcasualty/evacuation incident– Estimate shortfalls in resources to transport patients and Estimate shortfalls in resources to transport patients and

general population evacueesgeneral population evacuees1 1 Homeland Security Council Homeland Security Council 2 2 Department of TransportationDepartment of Transportation33 Department of Veterans Affairs Department of Veterans Affairs

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National Mass Patient and Evacuee Movement, National Mass Patient and Evacuee Movement,

Regulating, and Tracking Initiative Regulating, and Tracking Initiative RecommendationsRecommendations

Build on existing systems; incorporate data and Build on existing systems; incorporate data and architectural standardsarchitectural standards

Activated system in major, multi-jurisdictional Activated system in major, multi-jurisdictional incidents; optional routine useincidents; optional routine use

Begin with local, State, and tribal entry; Federal Begin with local, State, and tribal entry; Federal entry lastentry last

Track location & health status/needs of any person Track location & health status/needs of any person encountering systemencountering system

Track at “touch points” (e.g. collection points, Track at “touch points” (e.g. collection points, hospitals, etc.) hospitals, etc.)

Minimum data elements to enter patient/general Minimum data elements to enter patient/general population datapopulation data

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National Mass Patient and Evacuee Movement, National Mass Patient and Evacuee Movement,

Regulating, and Tracking Initiative Regulating, and Tracking Initiative Recommendations (continued)Recommendations (continued)

Build system to accept more detailed Build system to accept more detailed demographic/medical informationdemographic/medical information

System accessible to emergency responders/planners System accessible to emergency responders/planners Incorporate current or planned Feeder Tracking Systems Incorporate current or planned Feeder Tracking Systems Data from point of injury or first entry through final Data from point of injury or first entry through final

dispositiondisposition Incorporate Feeder Institutional Records Systems Incorporate Feeder Institutional Records Systems

(“Check-In/Check Out”)(“Check-In/Check Out”)– Facilities with mandatory reporting, common software Facilities with mandatory reporting, common software

platforms, within an agency (e.g. VA hospitals, DoD platforms, within an agency (e.g. VA hospitals, DoD Military Treatment Facilities, Indian Health) Military Treatment Facilities, Indian Health)

– Single facility (hospital with “homegrown” system)Single facility (hospital with “homegrown” system) Eventually include public: Web-based registrationEventually include public: Web-based registration

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Supports Homeland Security Supports Homeland Security Presidential Directive – 21Presidential Directive – 21

Supports HSPD-21: Public Health and Medical PreparednessSupports HSPD-21: Public Health and Medical Preparedness Integrate all vertical and horizontal levels of government and Integrate all vertical and horizontal levels of government and

community componentscommunity components, achieving a much greater capability , achieving a much greater capability than we currently have. than we currently have. 

Response “…Response “…deployed in a coordinated mannerdeployed in a coordinated manner … … guided by guided by a constant and timely flow of relevant information during an a constant and timely flow of relevant information during an eventevent and rapid public health and medical response that and rapid public health and medical response that marshals all available national capabilities and capacities in a marshals all available national capabilities and capacities in a rapid and coordinated manner.” rapid and coordinated manner.”

Help ensure general population evacuee and patient Help ensure general population evacuee and patient movement is movement is “(1) rapid, (2) flexible, (3) scalable, (4) “(1) rapid, (2) flexible, (3) scalable, (4) sustainable, (5) exhaustive (drawing upon all national sustainable, (5) exhaustive (drawing upon all national resources), (6) comprehensiveresources), (6) comprehensive (e.g. (e.g. addresses needs of addresses needs of mental health and special needs populations), (7) integrated mental health and special needs populations), (7) integrated and coordinated, and (8) appropriateand coordinated, and (8) appropriate (correct treatment in (correct treatment in the most ethical manner with available capabilities).”the most ethical manner with available capabilities).”

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Initiative Recognized by Senior United Initiative Recognized by Senior United States Government (USG) OfficialsStates Government (USG) Officials

Initiative repeatedly recognized by White House and USG leaders as a Initiative repeatedly recognized by White House and USG leaders as a national biodefense preparedness and response prioritynational biodefense preparedness and response priority ( (Homeland Homeland Security Council / National Security Council Joint Biodefense Security Council / National Security Council Joint Biodefense Preparedness Deputies’ Committees (March and April 2008)Preparedness Deputies’ Committees (March and April 2008)– Nation’s planning will “...include creation of a national system for Nation’s planning will “...include creation of a national system for

the coordination and tracking of general population evacuee and the coordination and tracking of general population evacuee and patient movement from point of incident, fixed facilities, or patient movement from point of incident, fixed facilities, or collection points to their final destination.”collection points to their final destination.”

Supports HSC Mass Evacuation / Population Movement Policy Sub-Supports HSC Mass Evacuation / Population Movement Policy Sub-Policy Coordinating Committee, December 17, 2008. Policy Coordinating Committee, December 17, 2008.

Supports President Obama’s Campaign Promise to create a National Supports President Obama’s Campaign Promise to create a National Family Locator System to help families locate loved ones after a Family Locator System to help families locate loved ones after a disaster, and Prepare Effective Emergency Response Plans, to include disaster, and Prepare Effective Emergency Response Plans, to include medical surge.medical surge.

Next Step: Develop the national systemNext Step: Develop the national system– Proposal : DoD, HHS, DHS/FEMA co-leadProposal : DoD, HHS, DHS/FEMA co-lead– Participation: American Red Cross, VA, DOJParticipation: American Red Cross, VA, DOJ11; State, tribal, local ; State, tribal, local

representatives, commercial industry, professional association.representatives, commercial industry, professional association.11Department of JusticeDepartment of Justice 3333

Poll Question #2Poll Question #2

A short poll will appear on your A short poll will appear on your screen. Please take a few seconds screen. Please take a few seconds to share your feedback with AHRQ.to share your feedback with AHRQ.

If you are unable to respond to the If you are unable to respond to the poll during this event, please e-mail poll during this event, please e-mail your answer to your answer to emergencypreparedness@academyhealth.org.

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Q&AQ&A

If you have a question for Tom Rich If you have a question for Tom Rich from Abt Associates and/or F. from Abt Associates and/or F. Christy Music from the Department Christy Music from the Department of Defense, please type it into the of Defense, please type it into the Q&AQ&A panel to the right and press panel to the right and press send.send.

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Part Two AgendaPart Two Agenda

I.I. Hospital Disaster Drills , Hospital Disaster Drills , Mollie Mollie JenckesJenckes

II.II. User’s Perspective of Hospital User’s Perspective of Hospital Disaster Drills , Disaster Drills , Cindy NotobartoloCindy Notobartolo

III.III. Moderated Q&A and closing Moderated Q&A and closing statements,statements, Karen Migdail Karen Migdail

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Mollie W. Jenckes, MHSc, BSNMollie W. Jenckes, MHSc, BSNResearch AssociateResearch Associate

Johns Hopkins UniversityJohns Hopkins University

Sara E. Cosgrove Christina L. CatlettSara E. Cosgrove Christina L. CatlettMollie W. Jenckes Karen A. RobinsonMollie W. Jenckes Karen A. RobinsonGary GreenGary Green Carolyn J. FeuersteinCarolyn J. FeuersteinKaren KohriKaren Kohri Eric B. BassEric B. BassEdbert B. HsuEdbert B. Hsu

Johns Hopkins UniversityJohns Hopkins UniversityEvidence-based Practice CenterEvidence-based Practice Center

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Training is Vital Training is Vital

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Background Background Hospitals are prepared for natural Hospitals are prepared for natural

and manmade disasters: and manmade disasters: – Transportation accidentsTransportation accidents– Structural collapseStructural collapse– EarthquakesEarthquakes

Why do hospitals hold disaster Why do hospitals hold disaster drills?drills? – To allow “hands-on” training in the To allow “hands-on” training in the

hospital disaster planhospital disaster plan– To build knowledge and To build knowledge and

understanding of roles understanding of roles – To identify strengths and To identify strengths and

weaknesses in responseweaknesses in response– To build familiarity with infrequently To build familiarity with infrequently

used equipmentused equipment– To fulfill requirements of the Joint To fulfill requirements of the Joint

Commission for Accreditation of Commission for Accreditation of Healthcare Organizations (JCAHO)Healthcare Organizations (JCAHO)

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Continuous Quality Improvement (CQI) ProcessApplied to Hospital Disaster Preparedness

Review/modifydisaster plan

Didactic education training (modular courses)

Skills/practical training (drills)

Report & analysis of strengths & weaknesses

Modification & re-engineering of

training interventions

Pre-courseknowledge exam

Post-courseKnowledge exam

Drill evaluation:(Institutional & Individual skills assessment)

(Re)define stakeholders & goals

Review/modifydisaster plan

Didactic education training (modular courses)

Skills/practical training (drills)

Report & analysis of strengths & weaknesses

Modification & re-engineering of

training interventions

Pre-courseknowledge exam

Post-courseKnowledge exam

Drill evaluation:(Institutional & Individual skills assessment)

(Re)define stakeholders & goals

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Methods:Methods:Expert Input/FeedbackExpert Input/Feedback

The JHU EPCThe JHU EPC11 assembled a multi assembled a multi-disciplinary team of experts for initial disciplinary team of experts for initial guidance and repeated feedback during guidance and repeated feedback during developmentdevelopment of modules:f modules:– Federal agencies (HRSAFederal agencies (HRSA22, CDC, CDC33, FEMA, FEMA44))– State agencies (MEMAState agencies (MEMA55, MD DHMH, MD DHMH66))– Hospitals (administrators, EMHospitals (administrators, EM77 physicians) physicians)– Disaster planning expertsDisaster planning experts– WMDWMD88 experts experts

11Johns Hopkins University Evidence-based Practice CenterJohns Hopkins University Evidence-based Practice Center22Health Resources and Services AdministrationHealth Resources and Services Administration33Center for Disease ControlCenter for Disease Control44Federal Emergency Management AgencyFederal Emergency Management Agency

55Maryland Emergency Management AgencyMaryland Emergency Management Agency66Maryland Department of Health and Mental HygieneMaryland Department of Health and Mental Hygiene77Emergency MedicineEmergency Medicine88Weapons of Mass DestructionWeapons of Mass Destruction 4141

Results:Results:Drill Evaluation ModulesDrill Evaluation Modules

There are 7 modules:There are 7 modules:– Training module (use of product)Training module (use of product)– Pre-drill planning modulePre-drill planning module– Command center zoneCommand center zone– Decontamination zoneDecontamination zone– Triage zoneTriage zone– Treatment zoneTreatment zone– De-briefing module…………..and 2 addendaDe-briefing module…………..and 2 addenda

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Data Collected in Each Data Collected in Each ModuleModule

Activity points documented within eachActivity points documented within eachzone module:zone module: Time pointsTime points Zone descriptionZone description PersonnelPersonnel Zone operations Zone operations CommunicationsCommunications Information flowInformation flow Security Security

Documentation and tracking Documentation and tracking Victim flowVictim flow Personal protective Personal protective equipment and safetyequipment and safety Equipment and suppliesEquipment and supplies Rotation of staffRotation of staff Zone disruptionZone disruption

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Biological Incident AddendumBiological Incident Addendum

Assesses:Assesses: Awareness that a biological Awareness that a biological agent caused the eventagent caused the event Appropriate and expert Appropriate and expert monitoringmonitoring Reporting mechanismsReporting mechanisms Meeting of health and safety Meeting of health and safety needs of patients and victimsneeds of patients and victims Availability of special suppliesAvailability of special supplies

Radiation Incident AddendumRadiation Incident Addendum

Assesses:Assesses: Awareness that radiation Awareness that radiation exposure caused the illnessexposure caused the illness Appropriate and expert Appropriate and expert monitoringmonitoring Reporting to State and Federal Reporting to State and Federal agenciesagencies Meeting of health and safety Meeting of health and safety needs of victims and staffneeds of victims and staff Availability of special suppliesAvailability of special supplies

AddendumsAddendums

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Field Trial ResultsField Trial Results Trials indicated wide acceptanceTrials indicated wide acceptance

Hospitals were able to document activities occurring as they Hospitals were able to document activities occurring as they happenedhappened

Modules allowed identification of areas that needed further Modules allowed identification of areas that needed further trainingtraining

In follow up exercises, In follow up exercises, hospitals are requestinghospitals are requestingrepeat use of the modulesrepeat use of the modules

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Evaluation of Hospital Disaster Drills: A Module-Based ApproachEvaluation of Hospital Disaster Drills: A Module-Based ApproachAHRQ Publication No. 04-0032 April 2004AHRQ Publication No. 04-0032 April 2004

Tool for Evaluating Core Elements of Hospital Disaster DrillsTool for Evaluating Core Elements of Hospital Disaster DrillsAHRQ Publication No. 08-0019 June 2008AHRQ Publication No. 08-0019 June 2008

Products AvailableProducts Available

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Poll Question #3Poll Question #3

A short poll will appear on your A short poll will appear on your screen. We appreciate your screen. We appreciate your feedback!feedback!

If you are unable to respond to the If you are unable to respond to the poll during this event, please e-mail poll during this event, please e-mail your answer to your answer to emergencypreparedness@academyhealth.org. 4747

User’s Perspective of User’s Perspective of Hospital Disaster DrillsHospital Disaster Drills

Cindy Notobartolo, RN, BSNCindy Notobartolo, RN, BSNCorporate Director of Emergency Department, Safety Corporate Director of Emergency Department, Safety

and Security Servicesand Security ServicesSuburban Hospital, Bethesda, MarylandSuburban Hospital, Bethesda, Maryland

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Drill Planning and ExecutionDrill Planning and Execution

October 2008 designed, planned and October 2008 designed, planned and participated in a regional large scale participated in a regional large scale explosive event involving 40 military, explosive event involving 40 military, research, national, State, county and research, national, State, county and private entitiesprivate entities

Historically the evaluation tool was created Historically the evaluation tool was created or adapted from existing templatesor adapted from existing templates

Dissatisfaction with prior tools or the time Dissatisfaction with prior tools or the time needed to customize them for the eventneeded to customize them for the event

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Discovery of AHRQ Discovery of AHRQ Evaluation ToolEvaluation Tool

Logical frameworkLogical framework Flow and sequence match actual eventFlow and sequence match actual event Pre-populated fields and circle answersPre-populated fields and circle answers Comment sectionsComment sections Prompting questionsPrompting questions Diagram sectionsDiagram sections

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ModulesModules

Module based approach allows for Module based approach allows for individual selectionindividual selection

Range from Red Zone to Incident Range from Red Zone to Incident Command Center to Group Debriefing Command Center to Group Debriefing ModuleModule

We chose to integrate the AHRQ tool We chose to integrate the AHRQ tool with specific targeted evaluationwith specific targeted evaluation

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Suburban HospitalSuburban Hospital Founded in 1943Founded in 1943 Community based not for profit serving Community based not for profit serving

Montgomery County, MarylandMontgomery County, Maryland Trauma centerTrauma center Distinguished self with affiliations with National Distinguished self with affiliations with National

Institutes of Health and Johns Hopkins MedicineInstitutes of Health and Johns Hopkins Medicine Emergency Preparedness partnership with Emergency Preparedness partnership with

National Naval Medical Center, National Institutes National Naval Medical Center, National Institutes of Health Clinical Center and the National Library of Health Clinical Center and the National Library of Medicineof Medicine

MOUs with all other Montgomery County MOUs with all other Montgomery County Hospitals and Public Health ServicesHospitals and Public Health Services

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Incident Command CenterIncident Command Center

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Incident Command ModuleIncident Command Module

Prompted important time parameters such as Prompted important time parameters such as beginning and ending, response times of staffbeginning and ending, response times of staff

Allowed for picture of zone set-upAllowed for picture of zone set-up External evaluator easeExternal evaluator ease Able to target need for after action responseAble to target need for after action response Ease and efficiency of completion for post event Ease and efficiency of completion for post event

documentationdocumentation

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Future of the ToolFuture of the Tool

The tool is being recommended to The tool is being recommended to hospital Emergency Managershospital Emergency Managers

Receiving enthusiastic feedbackReceiving enthusiastic feedback Groups are sharing their use Groups are sharing their use

experiencesexperiences This will lead to more widespread useThis will lead to more widespread use

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Q&AQ&A

If you have a question for Mollie If you have a question for Mollie Jenckes from Johns Hopkins Jenckes from Johns Hopkins University and/or Cindy Notobartolo University and/or Cindy Notobartolo from Suburban Hospital, please type it from Suburban Hospital, please type it into the into the Q&AQ&A panel to the right and panel to the right and press send. press send.

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For more information about….For more information about….

Today’s event including a recording and Today’s event including a recording and transcript, go to: transcript, go to: http://www.ahrq.gov/prep/

AHRQ’s suite of emergency AHRQ’s suite of emergency preparedness tools, go to: preparedness tools, go to: http://www.ahrq.gov/prep/

If you have a question about utilizing If you have a question about utilizing AHRQ tools please e-mail us at: AHRQ tools please e-mail us at: emergencypreparedness@academyhealth.org. 5757

Thank you!Thank you!

A brief feedback form will pop up when A brief feedback form will pop up when you close your browser. Please take a you close your browser. Please take a few moments to give us your feedback few moments to give us your feedback on today’s event.on today’s event.

Thank you! Thank you!

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