Houston Pre Hospital presentation final by UMlK884


									         Pre- Hospital Response

Lori Upton, RN BSN MS CEM
Southeast Texas Regional Advisory Council
Houston Region
   1997: Houston named one of the first 4
    MMRS cities in the Nation
    ◦ Support the integration of emergency management,
      health, and medical systems into a coordinated
      response to mass casualty incidents caused by any
    ◦ Reduce the consequences of a mass casualty
      incident during the initial period of a response by
      having augmented existing local operational
      response systems before an incident occurs.
   Hospital Receiving Group (HRG) formed
    ◦ “Big 8” identified by HFD
   HRG identified planning priorities
    ◦   Common communications
    ◦   Healthcare planning template
    ◦   Common equipment and training
    ◦   Executive support
    ◦   Mutual Aid Agreements
   Tropical Storm Allison - June 2001
    ◦ Extensive flooding and subsequent evacuation
    ◦ Texas Medical Center “off-line” with ripple effect
      throughout community
    ◦ Hospitals responding individually within systems
    ◦ No formal coordinating entity
   After TS Allison
    ◦ Addition of 20 acute care facilities
    ◦ Sharing of work to date
    ◦ Sharing of plans
   After 9-11
    ◦ Addition of Community Hospital Sub-Committee
      50+ member institutions
      Eventually merged all into HAHEMC
   HPP Grant
    ◦ DSHS pass through funding to RACS
    ◦ Houston CEO meeting
      RAC = fiduciary agent
      HAHEMC members to develop planning body for grant
   Regional Bioterrorism Task Force
    ◦ Year 1 grant focus on bioterrorism
    ◦ Chair, co-chair and committee members elected
    ◦ Gap analysis and planning priorities identified
   The Regional Emergency and Hospital
    Preparedness Council (RHPC)
    ◦ Officially formed in 2002
    ◦ Members: Hospitals, EMS, Public Health,
      City/County, State and Federal
    ◦ Mission of providing collaborative planning and
      response to emergencies, in a multi-disciplinary
      approach, and to preserve the medical
      infrastructure of the region.
    ◦ Continued discussions on need for a coordinating
   Regional coordinating entity for health and
    medical called into service for first time
   Disaster Unified Medical Command (DUMC)
    ◦ Leap of Faith
      No formal plan – concept
      No formal structure
      No recognized authority
    ◦ Commitment
      Commitment to succeed
      Commitment to mission
      Commitment to medical
   Catastrophic Medical Operations Center
    ◦   Initial plan put into writing
    ◦    MOUs drafted and signed
    ◦   Formal structure developed
    ◦   Initial training developed and held
    ◦   Infrastructure support from City of Houston
   Local and Regional asset
   Co-located in the HEC
   Recognized by the MACG for health and medical
   NIMS Compliant
   Command authority
   Logistical and Operational Components
   Stand up when requested by EOC, EMC, State, or
    other jurisdictions of authority
   CMOC is a collaboration of healthcare, special
    needs, EMS transportation, and public health
    specialists working together under a NIMS
    compliant structure within the Unified Area
    Command to address ESF 8 services of a
    multi-geographical region.
   Status
    ◦ Operational arm of RHPC
    ◦ RHPC: Merged with the Southeast Texas
      Regional Advisory Council in 2012 to serve
      as the regional preparedness coalition for
      health and medical
   Coordination of medical care and resources in
    response to the needs of the community
   Protect the medical infrastructure of the region
   Provide assistance and serve as safety-net for all
    healthcare facilities
   Serve as the central point for redistribution of
    staff and supplies
   Identify and utilize hidden surge capacity
   Coordination and distribution of transportation
   Integration of public health epidemiologic trends
   City of Houston, Harris County, Fort Bend
    County, Montgomery County, Brazoria
    County, and Jefferson County Offices of
    Emergency Management
   Houston Area Hospital Emergency
    Preparedness Collaborative
   Southeast Texas Regional Advisory Council
   City of Houston, Harris County, Fort Bend
    County, Montgomery County, and DSHS
    Region 6/5S Department of Health and
    Human Services
   The Texas Medical Center
   Houston-Galveston Area Council
    28 Counties
     277 cities
  9.3 Million (36%)
  120+ hospitals
500+ nursing homes
 36th Largest State     Land mass could contain:

 22nd Largest World    New Hampshire, New Jersey,
                       Connecticut, Delaware, Rhode
       Economy               Island, and D.C.
   Medical requests for
    ◦ transportation
    ◦ patient placement
    ◦ facility resource requests
   Evacuation assistance
   Patient tracking/reporting
   Epidemiological trending
   Ambulance Staging
   Forward Coordinating Teams
   CMOC must be activated by an authorized
    governmental entity.

   It can be activated 24/7 by calling the City of
    Houston Office of Emergency Management at
    713-884-4450 and requesting “activation of
    the CMOC”
   Katrina
    ◦ Transportation and transfer of 1100 patients into
      healthcare facilities
   Rita
    ◦ 29 healthcare facilities evacuated
    ◦ 121 Nursing Home evacuations
    ◦ Coordination of 34 Counties and 2 States
    ◦ Transportation and transfer of an additional
      2400+ patients into healthcare settings
    ◦ Hospital diversion rate = 0%
    ◦ Post event QA – 0.08% error rate
   Ike
◦ Evacuation and repatriation of
  56 hospitals
◦ Evacuation and repatriation of
  220 nursing homes
◦ Transportation and transfer of
  15,000+ individuals
◦ Oxygen Strike Teams
◦ Type 2 Ambulance Staging
◦ Dialysis and Medical Special
  Needs Transport circuit
◦ 4 Forward Coordinating Units
   While the CMOC has no jurisdictional authority in the
    region, the CMOC works with governing entities in
    the preparedness and planning, activation,
    mobilization, coordination of response, and
    mitigation of adverse effects to ensure emergency
    events do not adversely affect the quality, capacity,
    and continuity of healthcare operations

   The CMOC coordinates the assignment and
    transportation of all patients into healthcare facilities
    within the region based on capacity and capability of
    the facilities. Single-point coordination enables safe,
    efficient utilization of the region’s healthcare
    resources resulting in increased surge capacity.
   Collaboration of key response partners, working
    together under one system (health, medical and pre-
    hospital) have been demonstrated to be an effective
    method of preserving fragile medical infrastructure

   By having the subject matter experts at the “same
    table” working together, instead of in silos, the health
    and general well-being of the community can be
    preserved without turf wars or conflicting priorities.
 “A state of mindful attention among a group
of actors that evolves from common training,
intense communication, and a distinct culture
derived from shared experience”

“Developing these auto-adaptive systems…
depend fundamentally on their access to
timely, valid information and their ability to
engage in information search, exchange,
absorption, and adaptation.”
       Lori Upton, RN BSN MS CEM
    Director of Regional Preparedness
Southeast Texas Regional Advisory Council
             Houston, Texas

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