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Accelerating Scalable Community Emergency Network Demonstration Ascend links regional healthcare facilities with private and public assets under a unified vision that results in an integrated, scalable medical evacuation solution during a regional emergency.
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Page 1: Ascend Presentation

Accelerating Scalable Community Emergency Network Demonstration

Ascend links regional healthcare facilities withprivate and public assets under a unified visionthat results in an integrated, scalable medical

evacuation solution during a regional emergency.

Page 2: Ascend Presentation

Agenda

Introduce U.S. Air Ambulance

Provide historical context for discussion

Discuss our concept for a regional approach to emergency management

Outline steps we will take to implement ASCEND for Indiana

Page 3: Ascend Presentation

Headquartered in Sarasota, FL

23 years experience

Licensed ground and air ambulance provider

180 employees

97,000 patients, 100% safety record

U.S. Air Ambulance Corporate Overview

Page 4: Ascend Presentation

Preferred provider for U.S. Department of State

Contractor EMS program for Iraq, DoD

Consultant to cruise line industry

Last five years for DHS – evacuations of foreign nationals

Hurricane Katrina – FEMA

Hurricane Wilma – U.S. Marshals Service

Hurricanes Gustav and Ike – four private hospital evacuations

Proprietary software development

Developer of unique service HELP

Relevant Corporate Experience

Page 5: Ascend Presentation

EpicenterEpicenter

Epicenter – The area of an emergency which is unsafe or uninhabitable

External Emergencies Have an Epicenter

Page 6: Ascend Presentation

Epicenter

Scale

EMAC Federal Local Regional Statewide Border States Interstate

State Interstate

Measures of Emergencies - Scale

Page 7: Ascend Presentation

Scale

EMAC Federal Local Regional Statewide Border States Interstate

General Population

Transportation Disadvantaged Population

Assisted Living

Long Term Care

Medical Long Term Care

Medical General

Medical ALS / ICU

Medical Special Needs

Scope

Medical

Nonmedical

State Interstate

Epicenter

Measures of Emergencies – Scope

Page 8: Ascend Presentation

Scale

EMAC Federal Local Regional Statewide Border States Interstate

General Population

Transportation Disadvantaged Population

Assisted Living

Long Term Care

Medical Long Term Care

Medical General

Medical ALS / ICU

Medical Special Needs

Scope

Medical

Nonmedical

State Interstate

HELP

Our Products - HELP

Page 9: Ascend Presentation

HELP Provides Additional Resources for Large Scale Disaster

HELP provides access to transportation assets and receiving hospitals outside the Region

Hospital Network Outside of Emergency Zone

Second Tier Providers Mobilized for Hospital

Page 10: Ascend Presentation

Scale

EMAC Federal Local Regional Statewide Border States Interstate

General Population

Transportation Disadvantaged Population

Assisted Living

Long Term Care

Medical Long Term Care

Medical General

Medical ALS / ICU

Medical Special Needs

Scope

Medical

Nonmedical

State Interstate

SPEAR

HELP

Our Products - SPEAR

Special Patients Emergency Ambulance Response

Page 11: Ascend Presentation

SPEAR Program

Many special needs patients cases cannot be transferred at the regional level. For instance, a large burn incident may require coordinating the transfer of multiple patients throughout the United States to verified burn centers.

Verified Burn Center

Patients Dispersed From a Major Burn Incident to Verified Burn Centers

Special Patient Emergency Ambulance Response Program

Page 12: Ascend Presentation

Scale

EMAC Federal Local Regional Statewide Border States Interstate

General Population

Transportation Disadvantaged Population

Assisted Living

Long Term Care

Medical Long Term Care

Medical General

Medical ALS / ICU

Medical Special Needs

Scope

Medical

Nonmedical

State Interstate

SPEAR

HELPASCEND

Our Products - ASCEND

Accelerating Scalable Community Emergency Network Demonstration

Page 13: Ascend Presentation

January 6, 2005 2:40 AM

• Two trains collided in Graniteville, South Carolina, - Small population 7,000

• 1 train carried 92 tanks of chlorine gas,1 tank ruptured – Upgraded tank

• 90 tons of chlorine gas forms a deadly cloud that flowed toward a sleeping public - Low wind speed 2 mph

• 3:00 AM - Sheriff notified

• 3:45 AM - State Emergency Management Notified

• 5:09 AM - Local emergency system notified residents to evacuate

• 9:00 AM - Local EOC set up and available to assist

• 5,400 people evacuated

• 330 people self presented to the hospital ER for treatment - ER was unable to identify the chemical for several hours

• 525 people were treated in ER, 300 in first three hours

• 71 hospitalized, 25 ICU, 8 vented, 9 people died

Are Local Communities Ready For Accelerating Emergency?

Page 14: Ascend Presentation

National Planning Scenarios1 Improvised Nuclear Device2 Major Earthquake3 Aerosol Anthrax4 Major Hurricane5 Pandemic Influenza6 Radiological Dispersal Device7 Plague8 Improvised Explosive Device9 Blister Agent

10 Food Contamination11 Toxic Industrial Chemicals12 Foreign Animal Disease13 Nerve Agent14 Cyber Attack15 Chlorine Tank Explosion

• Chlorine Tank Explosion – National Planning Scenario

• In 2007, terrorists used chlorine gas 7 times on U.S. troops

• In urban area – 100,000 hospitalized

• 10,000 vents required

• 10,000 people die

Accident or Terrorism – Major Local Implications

Page 15: Ascend Presentation

1993 Midwest Floods

2005 Hurricane Katrina

1994 Northridge Earthquake

Natural Disasters Have Accelerated During Last Four Decades

Page 16: Ascend Presentation

Terrorism Against Americans

1961 – First U.S. Aircraft Hijacking1974 – Patty Hearst Kidnapping1979 – Iran, U.S. Embassy Hostages1983 – Lebanon and Kuwait U.S. Embassy Bombings1988 – Pan Am Flight 1031993 – World Trade Center Bombing1995 - Oklahoma City Bombing1996 – Saudi Khobar Towers Bombing1996 – Centennial Olympic Park Bombing1998 - Unabomber1998 - Kenya and Tanzania U.S. Embassy Bombing2000 - U.S.S. Cole Bombing2001 – 9/11 Coordinated Attacks World Trade Center and Pentagon2001 – Anthrax Attacks2002 – Beltway Sniper Attacks2009 – Fort Hood Shootings

Terrorism Against Americans

1961 – First U.S. Aircraft Hijacking1974 – Patty Hearst Kidnapping1979 – Iran, U.S. Embassy Hostages1983 – Lebanon and Kuwait U.S. Embassy Bombings1988 – Pan Am Flight 1031993 – World Trade Center Bombing1995 - Oklahoma City Bombing1996 – Saudi Khobar Towers Bombing1996 – Centennial Olympic Park Bombing1998 - Unabomber1998 - Kenya and Tanzania U.S. Embassy Bombing2000 - U.S.S. Cole Bombing2001 – 9/11 Coordinated Attacks World Trade Center and Pentagon2001 – Anthrax Attacks2002 – Beltway Sniper Attacks2009 – Fort Hood Shootings

Terrorism Against Americans Has Escalated

Probability of Dirty Bomb Attack in Next Decade – 40 percent

Iran1979

Oklahoma City 1979

U.S.S. Cole 2000

New York 2001

Page 17: Ascend Presentation

2002 Analysis - Dirty Cobalt Bomb in Manhattan:• 400 square Miles Contaminated• Manhattan uninhabitable• 1 in 100 Die from Cancer

Hurricane Katrina Not Unprecedented:• Hurricane Katrina: 200 B• Kobe, Japan Earthquake: 500 B

2009 New Madrid Earthquake Study (6.9 R): • Trillion dollars in losses• 130 hospitals destroyed• 80,000 lives lost

Kobe, Japan 1995 7.2 Richter Scale

New Madrid Earthquake 1811 8.3 Richter Scale 1895 6.8 Richter Scale

Possibility of Unprecedented Disaster is Very Real

Page 18: Ascend Presentation

Nation is Not Ready to Combat New Madrid Earthquake

• Reliance on NDMS assets for evacuations• will not arrive for 72 hours • limited capacity• not fully effective for special needs patients

• National ambulance contract inadequate• musters 600 ambulances • relies on unplanned coordination of the Joint Field Office

• EMACs were not effective in coordinating 66,000 personnel during Hurricane Katrina and have not yet built that capability

• Multiple jurisdictional, technical, and regulatory roadblocks that inhibit an effective response must be overcome

• As late as 2008 Hurricane Gustav: Our four customers in New Orleans were all told by FEMA and the State that they could not get ambulances for four days

Page 19: Ascend Presentation

1997-Metropolitan Medical Response System (MMRS)• Emergency preparedness systems• Respond to public health crisis 

2001-Emergency Management Performance Grants (EMPG)• Expanded to all-hazards planning• Fill gaps not covered by other federal programs 

2002-Hospital Preparedness Program (HPP)• Bio-terror attacks and pandemics• Primary focus expanded to all-hazards 

2002-Bioterrorism Training and Curriculum Development Program (BTCDP)• Train healthcare workforce• Bioterrorism to all-hazards 

2003-Urban Area Security Initiative (UASI)• High-risk, high-threat urban areas• Prepare, response and prevent all emergencies 

2005-Regional Catastrophic Preparedness Grant Program (RCPGP)• Catastrophic incident preparedness• Regional all-hazard planning 

Through Grants, DHS and HHS are Influencing National Direction

Page 20: Ascend Presentation

Air Ambulance locations 2009

America Has Vast Emergency Response Resources

America has the resources to combat a national catastrophe:

• 45,000 Ground Ambulances

• 50,000 Paratransit Vehicles

• 70,000 Medically Equipped Buses

•150,000 Fire Trucks

• 800 Rotor Wing Ambulances

• 300 Fixed Wing Ambulances

• 525 Military and Reserve C-130 Aircraft

• 5,000 Hospitals

• 17,000 Nursing Facilities

• 3,000 County Emergency Managers

• 800,000 Police Officers

• 400,000 National Guard troops

• Over 1 million Active Military Personnel Stationed in the U.S.

Page 21: Ascend Presentation

Two Dimensions of an Emergency – Speed and Scale

Static

Time

Response

Velocity

Time

Response

Acceleration

Time

Response

SPEED vs. SCALE

Page 22: Ascend Presentation

Effective Medical Response Must Integrate Six Functions

To maximize emergency medical response capability, regions must integrate six functions into a

Community Emergency Network (CEN) that acts as one seamless unit

Emergency Management

Emergency Medical ServiceHealth Care Facilities

Inter-facility Transport

Special Needs TransportEmergency SupportCEN

Page 23: Ascend Presentation

Interdependent Medical Response Chain

Pre-hospitalAmbulances

FrontlineHospital ER

Inpatient Hospital Admissions

Inter-facility Transport

Regional Hospitals

Regional HospitalsInventory

InterstateTransport

InterstateReceivingHospitals

InterstateSpecialNeeds

Transport

Patient Flow

Evacuation Expansion

Emergency Acceleration

Page 24: Ascend Presentation

EpicenterEpicenter

Pre-hospitalAmbulances

Epicenter – The area of an emergency which is unsafe or uninhabitable

Link 1 – Pre-hospital Ambulance Network

Page 25: Ascend Presentation

Front Line Hospitals – Functioning Hospitals nearest the Epicenter

Link 2 – Front Line Hospital Emergency Rooms

During a community emergency, front line hospitals’ primary emergency function is to provide stabilization and first definitive medical care to persons coming from the epicenter that require medical treatment.

Pre-hospitalAmbulances

FrontlineHospital ER

Page 26: Ascend Presentation

Emergency RoomEmergency RoomHospital Admission

Self Present

Discharge

Ambulance

Net Patient In-Flow Accelerates

In a large scale emergency, the pace of patient arrival to front line hospitals will accelerate, potentially overwhelming ERs and creating the need to initiate ER surge capability

Page 27: Ascend Presentation

CEN Responds Early To Shared Info

As the front line hospital’s ER becomes inundated with self presenters, first respond ambulances react by diverting. In addition, before a hospital in-patient levels reach divert status, inter-facility ambulances respond to relieve front line hospital of stable patients.Pre-hospital

Ambulances

FrontlineHospital ER

Inpatient Hospital Admissions

ABC Hospital

ER HospitalWait Time hrs: 2.4 Capacity: 92%Capacity %: 122 Net Admit RPH: 17Net Arrival RPH: 21 At Capacity: 3.4 Hrs Acceleration %: 82 Bed Divert: BurnCritical ER Capacity 85%

Inter-facility Requirement: 20 ALS 11 BLS

ER

Hospital

Page 28: Ascend Presentation

Pre-hospitalAmbulances

FrontlineHospital ER

Inter-facility Transport

Regional Hospitals

Regional HospitalsInventory

Inpatient Hospital Admissions

Links 4-6 Interfacility Transport and Regional Hospitals

Page 29: Ascend Presentation

As the emergency progresses:

• First response ambulances relay knowledge about patients coming in the epicenter.

•Front line hospitals relay information about the conditions they are treating.

•The community network assesses the potential for a coordinated response and prepare to participate in the emergency.

Shared Information

Epicenter

Front Line Hospital

Inter-facilityTransporter

Special NeedsPatient Transporter

Support Services

Regional Hospital

All Members of the CEN Share Info Early

Page 30: Ascend Presentation

ManagementSoftware

ASCEND Software Component

Page 31: Ascend Presentation

Regional Hospitals Accept Patients, Share Emergency Resources

As the velocity of intake increases at front line hospitals, Inter-facility transfers must occur. With the aid of a Seamless Emergency Operations Center (SEOC), the region coordinates patient movement:

• Front line hospitals identify patient transfer needs

• Regional hospitals identify available beds

• Logistics identifies and coordinates inter-facility transfers and obtains resources from outside the region as needed.

Epicenter Stabilized Patients

Surge ResourcesFront Line

HospitalRegional Hospital

Shared Information,Analysis, and Coordinationof Resources

Seamless Emergency Operations Center

Page 32: Ascend Presentation

Command Center

ASCEND Seamless Operations Center

Page 33: Ascend Presentation

SEOC Assists Local EOC

Epicenter

Stabilized Patients

Surge Resources

Shared Information And Coordination

of assets

HospitalHospital

Hospital

Hospital

Local EmergencyOperations Center

Shared Information,Analysis, and Coordinationof Resources

Seamless Emergency Operations Center

Front Line Regional

Front Line

The SEOC provides the Local EOC invaluable real-time information to make critical decisions and assists the EOC with real-time analysis.

Some hospitals may find themselves inside the epicenter and require full evacuation of their hospitals.

Page 34: Ascend Presentation

Regional Response Integrates with Federal Response

Pre-hospitalAmbulances

FrontlineHospital ER

Inpatient Hospital Admissions

Inter-facility Transport

Regional Hospitals

Regional HospitalsInventory

InterstateTransport

InterstateReceivingHospitals

Page 35: Ascend Presentation

Epicenter

Front Line Hospital

Stabilized Patients

Surge ResourcesRegional Hospital

Stabilized Patients

Surge ResourcesRegional Hospital

Regional Ambulances

Shared Information,Analysis, and Coordinationof Resources

Seamless Emergency Operations Center

Local EOC

HELPPatient Transporters (over 600 companies)

HELP Receiving Facility Network(600 Facilities)

HELPAreomedical

Staging Center

Region Accesses HELP as Need Surpasses Regional Capability

If the velocity of patients entering the regional medical system continues to exceed the region’s capacity to treat them, SEOC can coordinate patient movement through HELP:

• Network of interstate ambulances and receiving hospitals

• 24 hour response as opposed to NDMS 72 hour response

Page 36: Ascend Presentation

SEOC Manages National Special Needs Transfers

Many special needs patients cases cannot be transferred at the regional level. For instance, a large burn incident may require coordinating the transfer of multiple patients throughout the United States to verified burn centers.

Pre-hospitalAmbulances

FrontlineHospital ER

Inpatient Hospital Admissions

Inter-facility Transport

Regional Hospitals

Regional HospitalsInventory

InterstateTransport

InterstateReceivingHospitals

InterstateSpecialNeeds

Transport

Verified Burn Center

Patients Dispersed From a Major Burn Incident to Verified Burn Centers

Page 37: Ascend Presentation

Proposed Steps

1. Unify and Implement Regional goals

2. Codify and Implement Software Solution

3. Prepare and Implement Operations

Page 38: Ascend Presentation

Facilitation / consultation

1. Facilitate Unified vision

2. Document current status vs. goal

3. Outline steps to reach unified goals

4. Create Integrated critical path

5. Establish incremental milestones

6. Overcome operational, technical and legislative roadblocks.

7. Develop detailed protocols and procedures

Outline Of ASCEND Service:

UnifiedRegion-Wide

Vision

Hospitals

Pre-hospitalAmbulances

Inter-facilityTransporters

Local and State

EOC’s

Integrated Critical Path

Integrated Incremental Milestones

DetailedProtocols and

Procedures

Page 39: Ascend Presentation

Software Solution

• Outline current enterprise solutions

•Create bridge software solution

•Codify Protocols into an Enterprise Software System

• Provide Training and Exercises on ASCEND software

Outline Of ASCEND Service:

ASCEND

EWAPhoenix

Salamander

Page 40: Ascend Presentation

•Provide Logistical Operations Center

• Provide HELP Solution

• Provide Special Needs Patients solutions

Operations

Outline Of ASCEND Service:


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