1
Results of survey of hospitals
on the impact of Hospital Preparedness Program (HPP) grant funding to date,
and suggested priority areas for deliverables beyond budget period 5 (BP-5)
Prepared for presentation at the Statewide Administrative Meeting (SAM), Saratoga Springs, March 17 – 18, 2016
2
Introduction The Office of Health Emergency Preparedness (OHEP) held its annual Statewide Administrative Meeting (SAM) on March 17-18, 2016 in Saratoga Springs, NY. In preparation for the SAM, a planning committee was convened to develop an agenda that would meet the needs of OHEP, the Hospital Preparedness program (HPP), and the participants of the HPP grant program included in the meeting attendance. The planning committee requested that a number of people in attendance speak to the needs and opinions of their constituencies as part of a panel presentation. Specifically, the panel participants were to focus on the following:
How has participation in this program enhanced the preparedness of your constituent organization?
Has your participation in the HPP program fostered collaboration between your sector/partners and other sectors/partners?
Beyond BP-5, what priorities would you like to see considered as deliverables for your sector?
To accurately reflect the views of hospitals, a brief survey was designed to gather their input on these questions. The survey was developed by the Hospital Association participant selected to serve on the panel. The survey was reviewed by other Hospital Associations, including HANYS. In order to have results available for the March 17th panel, the survey was launched on Friday afternoon, March 11, and closed on Tuesday afternoon, March 15th. A power point presentation was developed to provide some of the results and key findings. This report provides complete results from the survey, including all of the answers to open-ended questions. In a few cases, responses to these open-ended questions disclosed the region where the hospital is located. In these cases, the response has been modified to ensure the respondent’s anonymity. Finally, spelling and typographical errors have been fixed to facilitate ease of reading. Results Hospital Associations distributed 110 e mails to their hospital members briefly stating the purpose for the survey, and providing a link to it. The online tool SurveyMonkey was used to carry out this study. There were 39 responses (35% response rate). Effectiveness of HPP grant funding to date The first question asked “How effective has the Hospital Preparedness Program grant been in supporting your hospital's emergency preparedness activities since the grant began?” There were 39 responses to this question. The results are summarized below.
3
Notably, 97% of those responding reported that the HPP grant has been either very effective, or effective, in supporting their hospital’s emergency preparedness activities.
Table 1
Responses to question: “How effective has the Hospital Preparedness Program grant been in supporting your hospital's emergency preparedness activities since the grant began?”
Choices Number selecting
Percent selecting
Very effective; the grant funds have been essential to enable our preparedness activities
29 74.36
Effective; the grant funds helped support and expand activities that we would have undertaken even without the funding
9 23.08
Ineffective; the grant funds have not helped us increase our preparedness
1 2.56
Total 39 100.00
Figure 1
Effective; the grant funds helped support and
expand activities that we would
have undertaken even without the
funding23%
Ineffective; the grant funds have not helped us increase our preparedness
3%
Very effective; the grant funds have been essential to
enable our preparedness activities74%
Responses to question: "How effective has the Hospital Preparedness Program grant been in supporting your hospital's emergency
preparedness activities since the grant began?”
4
The next question focused on whether the grant funds had enhanced collaboration with other sectors and partners. The responses to this question are provided below. The vast majority (91%) reported that the HPP grant funds have fostered collaboration.
Table 2
Responses to question: “Have the grant funds been of help in fostering your hospital's collaboration with other sectors and partners (i.e., EMS, long term care, OEMs, etc.)?”
Choices Number selecting
Percent selecting
Yes, the grant funds have been very important in helping to foster our hospital's collaboration
22 64.71
The grant funds have been important, but most of this collaboration would have taken place even without the grant
9 26.47
The grant funds have not fostered our hospital's collaboration with other sectors and partners.
3 8.82
Total 34 100.00
Figure 2
Yes, the grant funds have been very important in helping to foster our hospital's collaboration
65%
The grant funds have not fostered our hospital's
collaboration with other sectors and
partners.9%
The grant funds have been
important, but most of this collaboration
would have taken place even without
the grant26%
Have the grant funds been of help in fostering your hospital's collaboration with other sectors and partners
(i.e., EMS, long term care, OEMs, etc.)?
5
The next question asked: “What have been the top three benefits to your hospital as a result of participating in the Hospital Preparedness Program grant over the last years?” A total of 33 people answered this question, listing 92 benefits. Their responses are included in Appendix 1. Some of the most frequently cited benefits related to training, exercises, enhanced collaboration, sharing of information, and the ability to purchase needed resources. The list reflects a wide range of positive impacts from the HPP funds, and clearly indicates the value of the grant in increasing hospital preparedness. Priorities and activities after BP-5 The following prompt was provided for the respondents: “Although legislative changes and funding modifications are difficult to project into the future, please give your opinion about the top three priorities that you would like to see included in deliverables after BP-5. These may be priorities and activities that have been part of the grant in previous years, or new ones that you would like to see as part of the deliverables after BP-5.” A total of 26 people responded to this prompt, listing 67 priorities and activities. These are included in Appendix 2. Many respondents cited a desire for more drills and exercises, additional training and education, and continued collaboration with other sectors and partners involved with emergency preparedness. Respondents were asked to provide answers to this prompt: “Use the text box below to identify an example of a cross sector collaboration that you would like to see expanded or launched in your region beyond BP-5.” The 23 responses are included in Appendix 3. Responses included a focus on active shooter and other regional exercises, and increased situational awareness. Respondents were asked to answer the following question: “How important is continued funding after BP-5 to your ability to maintain and increase your preparedness?” The responses for the 31 people who answered this question are included below. All respondents (100%) reported that continued funding was either essential or helpful. For Figure 3, the segment for “The grant funds have not had an impact on our hospital’s level of preparedness” has been left off, since no one selected that response.
6
Table 3
Responses to question “How important is continued funding after BP-5 to your ability to maintain and increase your preparedness?”
Choices Number selecting
Percent selecting
The grant funds are essential for us to remain optimally prepared, and to continue to focus on training, drills, exercises, cross sector collaboration, etc.
27 87.10
The grant funds are helpful; however, we will continue to remain as prepared as we have been even without the grant funds.
4 12.90
The grant funds have not had an impact on our hospital's level of preparedness.
0 0.00
Total 31 100.00
Figure 3
Final comments
At the end of the survey, a final prompt was provided to respondents, as follows: “Finally, use the text box below if you would like to make additional comments or expand on any of your responses.” Comments were made by 10 people, and these are provided in Appendix 4.
The grant funds are essential for us to remain optimally prepared, and to
continue to focus on training, drills, exercises, cross
sector collaboration, etc.87%
The grant funds are helpful; however, we
will continue to remain as prepared as we have been even without the
grant funds.13%
How important is continued funding after BP-5 to your ability to maintain and increase your preparedness?
7
Appendix 1
Responses to the question “What have been the top three benefits to your hospital as a result of participating in the Hospital Preparedness Program grant over the last years?”
Sharing of best practices and lessons learned at regional meetings Decon supplies Improved communications with all agencies that participate in the program. Providing an atmosphere that encourages and promotes training Payroll for training Educational opportunities Training Flexible use of grant funds to support hospital priorities Education opportunities for associates in EM Awareness Part time emergency preparedness coordinator on site Provided funds for EP projects Help with training cost Equipment Buying resources Regional Plans We have purchased portable generators for offsite locations Grant money for target hardening (ie CCTV, access) Collaboration with non-hospital agencies Decontamination equipment acquisition Funding Emergency Preparedness Coordinator position Well done exercises Training Provide funding to purchase equipment and services Involvement in regional partnerships Development of plans Salary The funds themselves Strengthening preparedness efforts in various areas, including but not limited to disaster mental health and Ebola preparedness Better plans and exercises Universal emergency preparedness equipment across non-related sites Cooperation and coordination with all regional Hospitals (would not otherwise be strong) Acquisition of new supplies without having to requisition through capital or budget Coalition building between hospitals and other healthcare, public health entities Training Providing dedicated funding for Preparedness.
8
Ability to acquire needed preparedness equipment Money to buy equipment Networking Emergency cache Support of regional & coalition exercises Assisting with emergency plan development Preparation Enabled many training opportunities to better prepare us Working with other hospitals Training Drills Collaboration We have benefitted from the training that we received with the virtual burn surge project Liaison with other organizations Preparation for pandemics Staff education in multitude of disaster programs such as decon operations, hazmat, disaster triage, etc. Up-grade to emergency two-way radio system Ability to buy resources with funds Technology Allow us to hire consultants to ensure we are using best practices Regional exercises Mutual Aid Equipment Funding for supplies (hazmat, HICS) Close network with local, regional and state EP stakeholders The facilitation of large Regional disaster exercises Mutual Aid Development Collaboration and solidified relationships with other facilities in the region Support purchase of emergency preparedness related equipment Emergency equipment If we did not have this Grant, we would have never had Health Care workers buy into Emergency Preparedness To train staff for a constantly changing atmosphere requiring emergency readiness Backing for participation in exercises Funds Staff Support of training and equipment to enhance preparedness Emergency Equipment purchases Financial coverage for needed supplies Enabled us to update plans and annexes Developing plans that are used throughout
9
Collaboration with partners Communication with other facilities Situational Awareness in the region Increased efficiency in which incident command can be set up and run Evacuation, sheltering in place equipment acquisition Funding of emergency training for staff Networking with other agencies Provide training to staff Funding allows for education and training Developing a working relationship with peers from other agencies Funds for training, exercises, etc. Collaboration with hospital and local health department partners throughout the region Money to buy emergency preparedness supplies Funds to support ongoing emergency preparedness initiatives Regional Resource and Knowledge Base Pooling Expanded education about Emergency Preparedness and resources
10
Appendix 2 Responses to the prompt: “Although legislative changes and funding modifications are difficult to project into the future, please give your opinion about the top three priorities that you would like to see included in deliverables after BP-5. These may be priorities and activities that have been part of the grant in previous years, or new ones that you would like to see as part of the deliverables after BP-5.” Regional mutual aid agreement Active shooter training Improve Communications and link us together better. Preparedness for world=wide infectious virus issues including Ebola influenza and Zika Active shooter requirement Continue program Collation building All hazards preparedness at the hospital level Training & drills focused on large scale chemical/radiological attacks More incremental exercise and vouchering Assistance in allocating mandatory supplies regional drill (like WRECK IT) Training classes Emerging infectious diseases Training Special populations management Support of exercise activities Chempack excerise Technologies for hospital systems More two way communication between government entities and healthcare facilities Education and Training Burn Surge More focused collaboration with EMS (although lack of grant funding for EMS may preclude this) State and regional exercises Training and exercises related to chemical or radiological terrorist attacks Regional exercises Healthcare specific COOP and BCP planning tools Mental health training More real time drills Preparedness for patient surge issues Increased funding Training Community exercises that present escalating events EMPs Education for all levels of personnel Evacuation training and equipment
11
Information sharing Maintenance of existing equipment Regional Exercises and Planning Evacuation response Support for regional health care emergency communication systems Stormwest type drill (non snow or ice) Real time data exchange Regional Exercises MCI Surge Emerging infectious disease preparedness Subregional meetings Training and preparation for electromagnetic pulses Education - hands on and classroom/web Equipment Decon Better training; maybe even a certification process Preparedness for any terrorist involved event Increase educational opportunities Exercises Mass Casualty Incident Management Cyberattacks Telemedicine support for outlying facilities Improvements to communications Area drills Replacement of outdated / old technology COOP HPODs Disaster Mental Health Mass fatality management Hazardouus materials preparedness Training and preparation for cyber attacks
12
Appendix 3
Respondenses to the prompt: “Use the text box below to identify an example of a cross sector collaboration that you would like to see expanded or launched in your region beyond BP-5.” Hospital to regional partnerships (public health, emergency services, NGOs (Name of county) Police To improve Sit Stat from the Fire Services & EMS to the Hospitals. MCI incident involving a terrorist event or active shooter State/county/local PD training in regards to shooting incidents NYC & LI maro region meetings Regional exercise WRECK-IT Regional Exercise Regional hospitals with county OEMs County to state line mutual aid during surge. I would like to see an alert system developed so each hospital could alert appropriate staff in an emergency WRECK-IT plain language we already do more than the rest of the state out here in the Western Region Long term care WRECK-IT Exercise Program Not sure Develop or purchase a solution where all partners in emergency management are sharing information in real time More collaboration with local emergency management Continue to support our ESF-8 More hospital & EMS collaboration Active shooter Strong MOUs forged between specialty hospitals.
13
Appendix 4
Covered in previous question responses. Thank you. The Grant process was a good idea and it should be improved upon, the needs are only getting greater. The program is essential in being able to remain properly prepared We need better coordination at grants distribution, see policies change for submission of materials We would like to see the deliverable address more realistic and purposeful issues The grant funding is absolutely critical to us continuing a effective emergency preparedness program Increase the $ size of the grants to make complying worthwhile The reduction of the RRC's from 8 to 3 drastically reduced the impact and benefit that the RRC/RTC's have. The deliverables process in cumbersome, specifically with regard to uploading NYSDOH training certificates when DOH already has the sign in sheets Without the grant and the deliverables, I doubt many of our hospitals would be able to maintain a robust preparedness program within our hospitals. As resources become more scarce, our leadership would focus on immediate patient care initiatives rather than maintaining a strong preparedness program.
HEALTHCARE COALITION DEVELOPMENTAL ASSESSMENT FACTORS
Hospital Preparedness Program (HPP) BP3 Measure Manual, Implementation Guidance for the HPP Program Measures Page | 60
Healthcare Coalition Developm
ental Assessment Factors
Healthcare Coalition Developmental Assessment (HCCDA) Factors
While the Hospital Preparedness Program (HPP)’s budget period 3 (BP3) program measure indicators assess the awardees’ ability to meet specific goals and objectives; the HCCDA factors assess how well the healthcare coalitions (HCCs) in an awardee’s jurisdiction are fully implementing activities and plans (e.g., training, exercising, resource development, progressing toward achieving program measures, and developing processes for onsite verification). The HCCDA will help demonstrate the ability and capability of the awardees’ HCCs to meet HPP goals and objectives.
HCC development is a relatively new concept, and the formulation of each HCC may progress at a different rate. The HCCDA was designed to:
Assess awardees’ processes of developing and forming HCCs.
Assess how awardees’ HCCs are functioning to meet HPP’s goals and objectives (e.g. programmeasures/indicators, oversight, and monitoring).
Assess the reliability of the awardees’ work plans and program indicators to monitor progressover time.
Table 7 contains the full list of HCCDA factors and their associated objective (preparedness, response, recovery, or mitigation).
Table 7. Healthcare Coalition Developmental Assessment Factors
Assessment Factors Objective #1: The HCC has established a formal self-governance structure, including leadership roles. Preparedness #2: The HCC has multi-disciplinary healthcare organization membership. Preparedness #3: The HCC has established its geographical boundaries. Preparedness #4: The HCC has a formalized process for resource and information management with its membership. Preparedness
#5: The HCC is integrated into the healthcare delivery system processes for their jurisdiction (e.g., EMS, referral patterns, etc.). Preparedness
#6: The HCC has established roles and responsibilities. Preparedness #7: The HCC has conducted an assessment of each of its member’s healthcare delivery capacities and capabilities. Preparedness
#8: The HCC has engaged its member’s healthcare delivery system executives. Preparedness #9: The HCC has engaged its member’s healthcare delivery system clinical leaders. Preparedness #10: The HCC has an organizational structure to develop operational plans. Preparedness #11: The HCC has an incident management structure (e.g., MACC, ICS) to coordinate actions to achieve incident objectives during response. Response
#12: The HCC demonstrates an ability to enhance situational awareness for its members during an event. Response
#13: The HCC demonstrates an ability to identify the needs of at-risk individuals (e.g., electrically dependent home-bound patients, chronically ill) during response. Response
#14: The HCC demonstrates resource support and coordination among its member organizations under the time urgency, uncertainty, and logistical constraints of emergency response.
Response
#15: The HCC members demonstrate an evacuation capability with functional patient tracking mechanisms. Response
HEALTHCARE COALITION DEVELOPMENTAL ASSESSMENT FACTORS
Hospital Preparedness Program (HPP) BP3 Measure Manual, Implementation Guidance for the HPP Program Measures Page | 61
Healthcare Coalition Developm
ental Assessment Factors
Assessment Factors Objective #16: The HCC utilizes an operational framework and set of indicators to transition from crisis standards of care, to contingency, and ultimately back to conventional standards of care. Recovery
#17: The HCC incorporates post-incident health services recovery into planning and response. Recovery
#18: The HCC ensures quality improvement through exercises/events and corrective action plans. Mitigation
#19: The HCC has an established a method (e.g., social network analysis) for incorporating feedback from its members to support group cohesion and improve processes. Mitigation
#20: Within the past year, what is your HCC’s MOST IMPORTANT accomplishment related to emergency preparedness, response recovery, and/or mitigation? (Choose one.)
□ Enhanced connectivity with Emergency Operations Center (EOC) andEmergency Operations Plan (EOP)
□ Improved leveraging of disparate funding streams
□ Increased ability to leverage resources and allocate scarce resources betweenHCC members
□ Increased availability of emergency response and recovery services for thejurisdiction; bridging response and recovery
□ Increased educational training opportunities for healthcare organizations
□ Increased emergency management skills among HCC organizations
□ Increased emergency preparedness of the jurisdiction targeted or served by theHCC, including at-risk populations
□ Increased exercising and readiness planning among HCC members (e.g., drillsand exercises)
□ Increased formal agreements for resource and information exchange
□ Increased information sharing between HCC members through integratedcommunication
□ Increased or enhanced sources of data needed for emergency preparednessand response
□ Increased volunteerism (e.g., Emergency System for Advance Registration ofVolunteer Health Professionals)
□ Other (Please describe) ______
NA
The section below provides some additional information regarding the interpretation and achievement of each of the Healthcare Coalition Developmental Assessment factors.
Viewpoint
www.thelancet.com Published online November 24, 2015 http://dx.doi.org/10.1016/S0140-6736(15)01063-6 1
The medical response to multisite terrorist attacks in ParisMartin Hirsch, Pierre Carli, Rémy Nizard, Bruno Riou, Barouyr Baroudjian, Thierry Baubet, Vibol Chhor, Charlotte Chollet-Xemard, Nicolas Dantchev, Nadia Fleury, Jean-Paul Fontaine, Youri Yordanov, Maurice Raphael, Catherine Paugam Burtz, Antoine Lafont, on behalf of the health professionals of Assistance Publique-Hôpitaux de Paris (APHP)
IntroductionFriday, Nov 13, 2015. It’s 2130 h when the Assistance Publique-Hôpitaux de Paris (APHP) is alerted to the explosions that have just occurred at the Stade de France, a stadium in Saint-Denis just outside Paris. Within 20 min, there are shootings at four sites and three bloody explosions in the capital. At 2140 h, a massacre takes place and hundreds of people are held hostage for 3 h in Bataclan concert hall (figure).
The emergency medical services (service d’aide médicale d’urgence, SAMU) are immediately mobilised and the crisis cell at the APHP is opened. The APHP crisis unit is able to coordinate 40 hospitals, the biggest entity in Europe with a total of 100 000 health professionals, a capacity of 22 000 beds, and 200 operating rooms. It is very quickly confirmed that the attacks are multiple and that the situation is highly scalable and progressing dangerously. These facts led to a first decision: the activation of the “White Plan” (by the APHP Director General) at 2234 h—mobilising all hospitals, recalling staff, and releasing beds to cope with a large influx of wounded people. The concept of the White Plan was developed 20 years ago, but this is the first time that the plan has been activated. It is a big decision, and timing is key: it would lose its effectiveness if taken too late. On the night of Friday Nov 13 to Saturday Nov 14, the activation of the White Plan had a critical effect. At no time during the emergency was there a shortage of personnel. During these hours, as the number of victims increased, with a sharp increase after the assault was launched inside the Bataclan, we were able to reassure the public and government that our abilities matched the demand. And when we felt that it might be necessary to deal with an influx of severely injured people, two further “reservoir” capacities were prepared: other hospitals in the area were put on alert, together with some university hospitals, more distant from Paris, but with the ability to mobilise ten helicopters to organise the transport of the wounded. These other two reservoirs have not been used, and we believe that despite this unprecedented number of wounded, the available services were far from being saturated. While hospitals were receiving and directing patients to specific institutions based on capacity and specialty, a psychological support centre was set up. 35 psychiatrists, together with psychologists, nurses, and volunteers were gathered in a central Paris hospital, Hôtel Dieu. Most of them had played a similar role during the attacks against Charlie Hebdo. Most of the emergency workers and health professionals working on the evening of Nov 13 had already been involved in serious crises, were used to working together, and had
participated, especially in recent months, in exercises or in updating emergency plans.
In this report, we present the prehospital and hospital management of this unprecedented multisite attack in Paris from the viewpoint of the emergency physician, the trauma surgeon, and the anaesthesiologist. This is a testimony on behalf of the health professionals involved in the night of Nov 13.
The emergency physician’s perspective Triage and prehospital care were the duty of SAMU. In the minutes that followed the suicide bombing at the Stade de France, the Paris SAMU unit regulatory crisis team began to send out medical workers to the emergency sites from all eight units of SAMU in the Paris region and from the Paris fire brigade (Brigade de sapeurs-pompiers de Paris), alongside rescue workers and police. The regulatory crisis team was composed of 15 individuals to answer the calls, and five physicians. Their mission was to organise triage and dispatch mobile units (composed of a physician, a nurse, and a driver) to the wounded and to the most appropriate hospitals. As part of the White Plan and ORSAN (organisation de la réponse du système de santé en situations sanitaires exceptionnelles), 45 medical teams from SAMU and the fire brigade were divided between the sites (figure) and 15 were kept in reserve, since we did not know how and when this nightmare would end. This approach avoided early saturation of services—often, in emergency situations, all the resources are focused on the first crisis site, leaving a shortage for
Published Online November 24, 2015 http://dx.doi.org/10.1016/S0140-6736(15)01063-6
Assistance Publique-Hôpitaux de Paris, Paris, France (M Hirsch MsC); SAMU de Paris, Hôpital Necker-Enfants Malades, University Paris-Descartes Paris, France (Prof P Carli MD); Hôpital Lariboisière, University Paris-Diderot, Paris, France (Prof R Nizard MD); Hôpital de la Pitié Salpétrière, University Pierre & Marie Curie, Paris, France (Prof B Riou MD); Hôpital Saint-Louis, Paris, France (B Baroudjian MD, J-P Fontaine MD); Hôpital Avicenne, University Paris 13, Paris, France (Prof T Baubet MD); Hôpital Européen Georges Pompidou, Paris, France (V Chhor MD); Hôpital Henri Mondor, Créteil, France (C Chollet-Xemard); Hôtel Dieu, Paris, France (N Dantchev MD); Hôpital de la Pitié Salpétrière, Paris, France (N Fleury MsC); Hôpital Saint-Antoine, Paris, France (Y Yordanov MD), Hôpital Bicêtre, Paris, France (M Raphael MD); Hôpital Beaujon, University Paris-Diderot, Paris, France
Figure: Map of Paris attacks and prehospital emergency response
Bataclan medical teams
Stade de France (Saint-Denis)
medical teams
La Comptoir Voltaire
medical teams
Casa Nostra medical teams
3
4
8
9
15
6
Le Petit Cambodge, Le Carillon
medical teams
La Belle Equipe
medical teams
Viewpoint
2 www.thelancet.com Published online November 24, 2015 http://dx.doi.org/10.1016/S0140-6736(15)01063-6
(Prof C Paugam Burtz MD); Hôpital Européen Georges
Pompidou, University Paris-Descartes, Paris, France
(Prof A Lafont MD)
Correspondence to: Prof Antoine Lafont, Cardiology Department, Hôpital Europeen
Georges Pompidou, Paris, France [email protected]
For more on the APHP see http://www.aphp.fr/
For more on the White Plan see http://www.sante.gouv.fr/plan-
blanc-et-gestion-de-crise.html
For more on the ORSAN plan see http://www.sante.gouv.fr/
le-dispositif-orsan
following crisis sites. 256 wounded people were safely transferred to and treated in hospitals and the remaining patients arrived at hospitals by their own means. Three acute myocardial infarctions were treated. By the middle of the night, more than 35 surgical teams had operated on the most serious injuries (table).
Since the wounds were principally bullet related, the strategy applied was prehospital damage control to allow the fastest possible haemostatic surgery.1–4 This is the civil application of war medicine. Indeed, four out of five people shot in the head or the thorax will die. Among those without lethal wounds, damage control consists of maintaining the blood pressure at the lowest level ensuring consciousness (mean arterial pressure 60 mm Hg) using tourniquets, vasoconstrictors, antifibrinolytic agents (tranexamic acid), and prevention of temperature lowering instead of fluid filling (the demand for tourniquets was so high that the mobile teams came back without their belts).
After initial treatment the wounded were transferred by the Mobile Intensive Care Unit (MICU) teams to trauma centres or nearest hospitals when appropriate. Saint Louis Hospital is a few metres from two of the shooting sites (Le Petit Cambodge and Le Carillon restaurants, figure) and its physicians were able to take care of the patients immediately. Some wounded people were able to walk to the nearby Saint Antoine Hospital. To avoid overwhelming the hospital emergency
department as ambulances arrived, triage also took place at the hospital entrances.
Despite their brutality and appalling human toll (129 dead on sites, and more than 300 injured) the attacks were not a surprise. Since January, 2015, all state departments had known that a multisite shooting could happen, and although the police and intelligence services had prevented several attacks, that possibility remained. For 2 years, the prehospital teams of SAMU and the fire brigade had been developing treatment protocols for victims of gunfire wounds, and three field exercises have mobilised doctors to practise prehospital damage control. SAMU is characterised by the presence of physicians who are able not only to stratify risk according to gathered information and send the patient to the appropriate place, but also to act during the prehospital period. In a cruel irony, on the morning of the day of the attacks, SAMU and the fire brigade participated in an exercise simulating the organisation of emergency teams in the event of a multiple shooting in Paris. In the evening, when the same doctors were confronted with this situation in reality, some of them believed it was another simulation exercise. At the attack sites and in the hospital, the training received by the emergency and medical workers was a key factor in the success of treatment. Analysis of the experience of bombings in many other countries—Israel, Spain, England, and more recently in Boston, USA—as well as lessons learned from Paris, during the Charlie Hebdo attacks in January, were essential to improving the management and application of damage control. It is important to point out that the scientific publications that issued from these horrible events have had a huge effect on the improvement of medical strategies.5–7 But no simulation had ever anticipated such a boost in the scale of violence. During long periods of shooting, the streets surrounding the attacks remained difficult and dangerous for emergency intervention teams. Seriously injured hostages in the hands of terrorists or obstructed by fire could not be evacuated. Although emergency physicians have been receiving training in disaster medicine for more than 30 years, never before had such a number of victims been reached and so many wounded been operated on urgently. A new threshold has been crossed.
The approach of the anaesthesiologistPitié-Salpêtrière Hospital is one of the five civilian level-one trauma centres in the APHP group involved in the treatment of patients after terrorist attack. It is located in the centre of Paris. The shock trauma room is included inside a post-anaesthesia care unit of 19 beds. The routine capacity of the emergency operating theatre is two operating rooms, which can be extended to three for multiple organ harvesting. After activation of the White Plan, which includes a process to call back all staff, but also because many physicians and nurses spontaneously arrived rapidly in the hospital, we were able to open ten operating rooms and treat injured
Absolute emergencies
Relative emergencies
Total
Ambroise Paré 1 6 7
Antoine Béclère 0 1 1
Avicenne 0 8 8
Beaujon 5 0 5
Bicêtre 1 6 7
Bichat 2 17 19
Cochin 0 7 7
HEGP 11 30 41
Henri Mondor 10 15 25
Hotel Dieu 0 31 31
Jean Verdier 0 2 2
Lariboisière 8 21 29
Pitié-Salpêtrière 28 25 53
Saint Antoine 6 39 45
Saint Louis 11 15 26
Tenon 0 10 10
Total 76 226 302
Absolute emergencies require immediate surgery or embolisation; relative emergencies may need surgery and/or embolisation, but not immediately. Numbers do not include psychological trauma and delayed admissions. Because some patients were secondarily transferred from one hospital to another, numbers do not add up. Data are from Assistance Publique-Hôpitaux de Paris (APHP), Nov 20, 2015. HEPG=Hôpital Européen Georges Pompidou.
Table: Numbers of admissions of absolute emergencies and relative emergencies in the APHP hospitals within the first 24 h
Viewpoint
www.thelancet.com Published online November 24, 2015 http://dx.doi.org/10.1016/S0140-6736(15)01063-6 3
patients (mostly with penetrating trauma), absolute emergencies (mostly admitted in the shock trauma unit), and relative emergencies (all admitted in the emergency department).
The number of admitted patients was far beyond what we could imagine we would treat at the same time. The resources available were never less than required, despite the unprecedented number of patients admitted during a very short period. Several factors may have contributed to these favorable outcomes. First, the injured patients arrived very quickly (in small groups of four or five) because we had worked for several months with the medical service of the French national police counter-terrorism department (RAID), prehospital emergency teams, and in-hospital trauma teams to be able to provide a fast-track service for penetrating trauma, particularly during a terrorist attack.8 Although penetrating traumas usually represent only 16% of our severe trauma cases,9 injuries from firearms, including war arms, are no longer rare events, and our anaesthesiologists and surgeons have been trained to appropriately treat these cases. Before the arrival of the first patients, the postoperative care unit was rapidly emptied and the surgical and medical care unit made several beds available. This was important since, after emergency surgery, patients could be directly admitted into the units, enabling the shock trauma room to be free for new patients, in accordance with the so-called one-way progression concept (no return to the emergency or shock trauma room). A rapid triage was organised at the entrance of the emergency department, directing absolute emergencies to the shock trauma unit and relative emergencies to the emergency department, and this second rapid triage was able to confirm the initial triage done a few minutes previously by the prehospital team. Each absolute emergency patient was cared for by a dedicated trauma team (anaesthesiologist, surgeon, fellow, and nurse), who decided whether or not to perform CT scans, radiology, and to send the patient to a prepared operating room where an operating team was available (with appropriate senior and fellow surgeons, anaes thesiologist and nurse anaesthetist, and operating room nurse). Other post-anaesthesia care units were reopened to receive patients once surgery was done.
A key element was the excellent cooperation of all care-givers under the supervision of two trauma leaders in the shock trauma unit and an operating room allocation leader, who were not directly involved in the care of the patients and who continuously communicated between each other and regularly collated information concerning the entire cohort of injured patients. Furthermore, hospital management could immediately provide logistic support. Another key element was related to the dramatic characteristic of the event—each participant wanted to do more than his or her best for the victims. And they did it! Only 9 h after the event, we were able to decrease the number of operating rooms to
six and send back home some of the more exhausted staff. Within 24 h, all emergency surgeries (absolute and relative emergencies) had been done and no victims were still in the emergency department or the shock trauma unit. The hospital was nearly ready to cope with another attack that we all feared could occur.
The point of view of the trauma surgeonIf I had to summarise the “winning formula” in the recent tragic hours that we lived, in an orthopaedic centre of APHP, I would say that spontaneity and profession alism were the key ingredients. When I arrived in Lariboisière Hospital 2 h after the beginning of the events, I was surprised to discover that at least six or seven of my colleagues of different specialties were already there in addition to the doctors on duty that night. The on-call anaesthetists and intensive care doctors were helped by three colleagues who joined them spontaneously. Extra nursing staff also came to help. All these extra personnel allowed us to open two operating rooms for orthopaedic surgery, one for neurosurgery, one for ear, nose, and throat surgery, and two for abdominal surgery. The first seriously injured patients were operated on within half an hour of admission. The triage of the later patients was done in two locations: in the postoperative care unit next to the operating rooms for the most seriously wounded patients, who were brought directly by the mobile medical units, and in the emergency department for the less critically wounded patients. Triage was done by the most experienced physician in each specialty. During the first night, we operated continuously. On Saturday Nov 14, the orthopaedic surgery team was helped spontaneously by two other teams. The sequence of operations was determined after the last patients were admitted, including five patients who came from hospitals in which orthopaedic surgery was not available. With the anaesthetists and the nursing staff we operated continuously all day long. On Sunday Nov 15, the usual services resumed.
On Monday Nov 16, when all the medical staff reviewed what had been done during the weekend, the common observation was that all but one of the patients were less than 40 years old. All the patients we received had had a high-energy ballistic trauma. All upper limb fractures had been treated with external fixation because of the open nature of the fractures and extensive bone loss.10 The two lower limb ballistic traumas were treated with plates. Nerve damage was frequent, including two patients with median nerve section, one with radial nerve section, one with cubital nerve section, and one with peroneal nerve section. Only one nerve was repaired; for the others, gaps of several centimetres were observed and secondary reconstruction will be needed.11 Vascular damage was not observed in our patients because patients with suspected problems of this sort were directed from the mobile medical unit to a hospital where vascular surgery was available. Psychiatrists were involved in treatment and had contact with all patients
Viewpoint
4 www.thelancet.com Published online November 24, 2015 http://dx.doi.org/10.1016/S0140-6736(15)01063-6
during this early period to assess for acute stress disorder and begin the follow-up of potential post-traumatic stress disorder.
Professionalism was present at each level. While the operating room is often described as a difficult place—where the human factor is crucial—during this “stress test” difficulties vanished, working together appeared fluid and somehow harmonious. Trust and com-munication between different specialties and jobs were apparent. The common goal was so clear that no stakeholder tried to impose an individual view. Solidarity was observable inside the hospital but also between the different APHP hospitals: when a specialist was not available in one hospital the patient was transferred easily to another hospital where the expertise was available. The APHP network demonstrated its efficiency.
All operations were performed without any delay. The sterile supply chain was augmented to allow a fluid workflow, and administrative staff supported the medical work, finding logistic solutions when necessary (eg, patient registration, finding free beds, etc).
Timing might also have played a part in the success of the response. This disaster occurred at the beginning of a weekend and during the night. Some of the aspects might have been more difficult if it had happened during a working day, when the sterile stock is partly unavailable and when doctors and staff are already busy. Unfortunately, the current situation requires us to be prepared to face even more difficult situations in the future.
ConclusionThis is the legacy of history that led to the creation of the APHP hospital network as a single entity. Its huge size is regularly questioned, both internally and externally, as an obstacle to adaptation in a rapidly changing technological, medical, and social context. The decision circuits are complex, internal rivalries may develop, and changes are slow to spread. We sensed, however, that the size of the organisation could be an advantage in times of disaster. This advantage has now been demonstrated. No lack of coordination has been identified. No leakage or delay has occurred. No limit was reached. Furthermore, we believe that such a structure is not only an advantage in times of crisis, but also on a normal day. A large hospital complex is also able to produce powerful research, to process a considerable amount of data, and to play a major part in public health. What happened strengthens our belief that size can be combined with speed and excellence.
In the aftermath of this terrible experience, it is too early to report the details of the medical expense incurred
and the lessons that can be learned from this event. But we already know that as terrorism becomes more lethal and violent, nothing will prevent the medical community from understanding, learning, and sharing knowledge to become more effective in saving lives. However, we must remain humble and expect deaths to occur among the severely wounded patients in the upcoming days, despite the fact that we observed only four deaths (1%) among the 302 injuried patients, including two deaths on arrival at hospital.ContributorsAll authors contributed equally to this report.
Declaration of interestsWe declare no competing interests. We are all members of the Assistance Publique-Hôpitaux de Paris (APHP), MH is Director General of APHP.
AcknowledgmentsWe thank our colleagues, more than a thousand health-care professionals—including nurses, logistical and administrative staff, medical doctors, and pharmacists—who were committed during this major event to saving lives and supporting victims and their families, and in some cases were personally endangered. We acknowledge the teams of rescuers belonging to the fire brigade of Paris, the police forces, and volunteers.
References1 Duchesne JC, McSwain NE Jr, Cotton BA, et al. Damage control
resuscitation: the new face of damage control. J Trauma 2010; 69: 976–90.
2 Jenkins DH, Rappold JF, Badloe JF, et al. Trauma hemostasis and oxygenation research position paper on remote damage control resuscitation: definitions, current practice, and knowledge gaps. Shock 2014; 41 (suppl 1): 3–12.
3 Tourtier JP, Palmier B, Tazarourte K, et al. The concept of damage control: extending the paradigm in the prehospital setting. Ann Fr Anesth Reanim 2013; 32: 520–26.
4 Gates JD, Arabian S, Biddinger P, et al. The initial response to the Boston marathon bombing: lessons learned to prepare for the next disaster. Ann Surg 2014; 260: 960–66.
5 Aylwin CJ, König TC, Brennan NW, et al. Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005. Lancet 2006; 368: 2219–25.
6 Gutierrez de Ceballos JP, Turégano Fuentes F, Perez Diaz D, Sanz Sanchez M, Martin Llorente C, Guerrero Sanz JE. Casualties treated at the closest hospital in the Madrid, March 11, terrorist bombings. Crit Care Med 2005; 33 (1 suppl): S107–12.
7 Mathieu L, Ouattara N, Poichotte A, et al. Temporary and definitive external fixation of war injuries: use of a French dedicated fixator. Int Orthop 2014; 38: 1569–76.
8 RAID (Research, Assistance, Intervention, Dissuasion) Medical Service. Tactical emergency care during hostages’ crisis: care principles and feedback. Ann Fr Med Urg 2015; 5: 166–75.
9 Régnier MA, Raux M, Le Manach Y, et al. Prognostic significance of blood lactates and lactate clearance in trauma patients. Anesthesiology 2012; 117: 1276–88.
10 Rochkind S, Strauss I, Shlitner Z, Alon M, Reider E, Graif M. Clinical aspects of ballistic peripheral nerve injury: shrapnel versus gunshot. Acta Neurochir 2014; 156: 1567–75.
11 Katz JD. Conflict and its resolution in the operating room. J Clin Anesth 2007; 19: 152–58.
Capabilities and DeliverablesState-Wide Administrative Meeting (SAM)March 17-18, 2016
2
HPP and PHEP Capabilities and
Required Elements
Hospital
Deliverables
Long Term Care
Association Deliverables
CHCANYS Deliverables
RTC Deliverables
Home Care Association Deliverables
Health Emergency
Preparedness Coalition Activities
Hospital Association Deliverables
Adult Care Facility
Association Deliverables
3
Prioritization of Capabilities and Building Deliverableso Back to Front - Create Integration – Linkages
o First - Identify Healthcare provider/Population Preparedness Gaps o What are the hazards?
o What are the preparedness needs of the healthcare providers and the population?
o Next - what is needed to address/mitigate these gaps and needs? o Plans, Resources, Applications etc.
o Next - is it Realistic? o Is the mitigation strategy likely to succeed?
o Next - what/how can the Partners add value?
o Last - Retro fit the planned activity to the Capability!!!!o What are the HPP Requirements????
4
Examples of Deliverable Building
• Continuity Planning – Resilience!
• Healthcare facilities must provide healthcare services during and after incidents that may severely challenge their ability to deliver its MEFs!!!
• Identify status of Continuity/Resilience planning?
• Build the capability/capacity!
• RTCs lead training of health care facility COOP.
• HEPCS coordinate COOP on a coalition level.
• LAST – this contributes to HPP CAP 2 –Healthcare Recovery
• HEC Planning
• Infrastructure damage or a surge can result in
diminished patient/resident healthcare services!!!
• Identify status of inter facility coordination of
patient/resident movement?
• Identify planning and coordination processes -
facility planning, HEC - bed placement tool!
• Previous experiences - NYC-HEC, and new -
Hospital To Nursing Home Decompression!!
• Hospital, HEPC and LTCAs, Deliverables!
• LAST – this contributes to HPP CAPs 1, 2, 10
and PHEP 10.
5
Deliverable 7: Evacuation of Facilities in Disasters System (eFINDS) – TtT $500/pp
Hospitals that need to build capacity or need to replace an eFINDS trainer who can no longer fulfill this
responsibility will need to send staff person(s) to an eFINDS Train-the-Trainer (TtT) session offered in their region.
Description of Training: The NYSDOH, the Regional Training Centers (RTCs) and other Master Trainers
will continue to offer training sessions that provide comprehensive, hands-on training in the use of the
eFINDS application so that hospitals can meet this requirement and maintain personnel to serve as this
training resource. The training utilizes expanded teaching materials and aids which include:
eFINDS concept of operations
access to eFINDS: communications directory role assignments
scenarios, based on actual events and lessons learned
hospital-based training template
hands-on application demonstrations and training
teach-back, practice session
Provider: Regional Training Centers and other eFINDS Master trainers
Delivery of Training: In person sessions.
Target Audience: Facility trainers/educators, Emergency Management Coordinator, Emergency Department Staff, Facilities Management Personnel, Registration/intake
personnel; those staff members who may be involved with the evacuation of a
hospital.
Payment: $500 per person.
Target Completion: June 1, 2017 Element of Completion: Sign in sheet, certificate of completion or other evidence of participation.
Ref: HPP CAP 10, Med/Surge, F5 – evacuation and SiP operations,
PHEP CAP 10 Med/Surge – F1 P3 – Bed Tracking of
6Priority EXERCISES
Deliverable13: Health Emergency Preparedness Coalition (HEPC) Healthcare
Evacuation Center (HEC) Seminar $500 pp
Hospitals will participate in one (1) Health Emergency Preparedness Coalition (HEPC) Healthcare Evacuation Center (HEC) Plan seminar. The seminar level exercise will focus on discussion of the
HEPCs HEC plan, including its Concepts of Operation, roles and responsibilities of the partners, and
information sharing processes.
It is recommended that attendance and participation be face to face and may be at the full or sub region level, providing the meeting is authorized and conducted by the coalition. Attendance is highly
encouraged; however, if travel restrictions or other barriers exist virtual attendance is permitted.
Provider: NYSDOH Regional Point of Contact for the HEPC
Delivery of Session: In person and/or virtual. Seminars will be scheduled in coordination with the HEPC meetings, and may coincide with the day of the HEPC meeting,
but cannot be combined with the HEPC meeting.
Target audience: Hospital Emergency Management Coordinator in their respective coalition
region or other staff as authorized by the hospital
Target Date: December 31, 2016 Payment: $500 per targeted audience. At least one representative must participate
in this seminar in their respective HEPC region.
Element of Completion: Sign in sheet or other evidence of participation.
Ref: HPP CAP 3, Emergency Operations Coordination, HPP CAP 6, Information Sharing, HPP and PHEP CAP 10, Med/Surge – evacuation and shelter in place, HCCDA element 15.
7
HPP Requirements HSEEP
• Awardees must conduct preparedness exercises in accordance with the HSEEP guidance including:
• The fundamental principles Exercise program management– Exercise methodology
• Exercise design & development
• Exercise conduct
• Exercise evaluation and
• Improvement planning
AAR/IPs• HPP awardees must
submit required AAR/IPs
resulting from qualifying
exercises and real
incidents to [email protected]
with an email copy to their field project officers.
• Recommend using the
HPP AAR/IP provided
• NIMS
• HPP awardees must ensure that
the hospitals in their healthcare
coalitions are conducting the 11
hospital-related NIMS
implementation activities
• Must allocate funds to ensure
the 11 NIMS implementation
activities continue for hospitals
engaged in healthcare coalition
development.
• Awardees must report on status
of these activities in their
Budget Period 5 annual
progress reports..
8
HPP Requirements
• Awardees must ensure that their qualifying exercises meet HPP
criteria including:
• Healthcare Coalition Participation: Each identified healthcare coalition
must participate in at least one qualifying exercise. The exercise may
be at the sub-state regional level or the statewide level
• Hospital Participation: All HPP participating hospitals (and if possible,
other healthcare organizations) must participate in a qualifying
exercise. This should be in conjunction with their respective healthcare
coalition’s participation.
9
Qualifying Exercise
Must include an evaluation of capability targets for these four HPP capabilities including at-risk population considerations:
– Emergency Operations Coordination
– Information Sharing
– Medical Surge
– Recovery/Continuity of Operations
– Healthcare System Preparedness: F 7:At-Risk Populations
•
10
Order in FOA
CAP 1 Health Care System Preparedness
CAP 2 Health Care System Recovery
CAP 3 Emergency Operations Coordination
CAP 5 Fatality Management
CAP 6 Information Sharing
CAP 10 Medical Surge
CAP 14 Responder Safety and Health
CAP 15 Volunteer Management
OHEP Priority Order
CAP 1 Health Care System Preparedness
CAP 3 Emergency Operations Coordination
CAP 6 Information Sharing
CAP 10 Medical Surge
CAP 15 Volunteer Management
CAP 2 Health Care System Recovery
CAP 14 Responder Safety and Health
CAP 5 Fatality Management
11
OHEP Priority Order
CAP 1 Health Care System Preparedness
CAP 3 Emergency Operations Coordination
CAP 6 Information Sharing
CAP 10 Medical Surge
Hospitals: Coalition Meetings and Work Groups,
Training, ID and Other Regional
Exercises, NIMS, Active Shooter Plans
RTCs : Work Groups, Training
Coalitions: HEC Plan Exercises, MAPs,
Hospitals: EOC during Exercises, eFINDS
RTCs: eFINDS TtT
Coalitions: HEC Plan Exercises,
Hospitals: Automated/Hourly HAvBed submission
Coalitions: Incident related Info sharing,
Situational Awareness,
Associations: Situational Awareness Work Group
Hospitals: Exercises, Hospital to Nursing Home
Decompression, HAvBed
Coalition: Coordination of Resources
Associations: Hospital to NH Decompression plan
12
OHEP Priority Order
CAP 15 Volunteer Management
CAP 2 Health Care System
Recovery
CAP 14 Responder Safety
and Health
CAP 5 Fatality Management
Hospitals: Volunteer Management Plan
Hospitals: Phase 2 COOP training, plan
development, HVA, 96 hr plans
Associations: Phase 2 COOP training,
plan development
Regional Training Centers: training and
plan development
Coalitions: Intra and Inter Coalition
Coordination, Community level HVAs
Hospitals: PPE/Decon, NPIs.
Hospitals: New DMH module
Welcome to the
NYSDOH SAM 2016
SAM 3/17-18/16Mike Primeau, Director
Office of Health Emergency Preparedness
3
BP-4 Accomplishments Response
• EVD Response
• Demobilized Screening Operations at JFK on 11/10/16
• Supported NYC Legionella Outbreak in August 2015
• Supported Papal Visit in NYC in September 2015
4
BP-4 Accomplishments Response
• Advanced Party of the HEC deployed to NYC supporting
Hurricane Joaquin preparedness activities in October 2015
• Supported Seneca POD Operations
(Hep A – 2,758 Vaccinations) (November 2015)
• Water Issues
(Hoosick Falls, Petersburgh-PFOA, Ithaca-Lead)
• Zika
5
BP-4 Accomplishments Planning
• HEC Application Development
• HEC Plan Update
• HEC Facility Guidance Document Updated
• Regional HEC Plans Developed
6
BP-4 Accomplishments Planning
• Input to State OEM Mitigation Plan
• Input to State OEM REP Plan
• Input to Human Services Functional Group
7
BP-4 Accomplishments Planning
• Continued to Develop HEPCs
• e-FINDS System Updates
• Continue Developing State Burn Plan
8
BP-4 Accomplishments Training
• RTCs delivered a lot of training including: COOP, e-FINDS,
ICS, Pediatric Disaster Response etc…
• DOH Staff, NIMS/ICS, Disaster Mental Health, NY Responds
etc…
• Monthly Clinical Operations
• Monthly MCMs
9
BP-4 Accomplishments Training
• MERITS with LHDs
• HEC for Regional Offices
• Facility Profile Application in MARO
• e-FINDS
10
BP-4 Accomplishments Exercises
• EVD ConOps TTX in a 10 (7) Sub Regional Planning Areas
• HEC Functional Exercise in NYC in August 2015
• Statewide BURN TTX in November 2015
• e-FINDS Drills
11
BP-4 Accomplishments Exercises
• REP Nuclear Power Plant Drills
• WRECK-IT in the Western Region in October 2015
• LHD POD Exercises
• CHEMPACK Sustainment throughout the State
12
SAM 3/17/16Mike Primeau, Director
Office of Health Emergency Preparedness
14
BP-5 Vision
• Close out year for this Project Period
• Contract with the same set of Partners
(+3 new/old Hospitals - total 139)
• Deliverables very similar, Planning, Training, Exercising
15
BP-5 Vision
• No LHD POD Exercises
• WRECK-IT II Western Region
• Begin to Plan for the next Project Period (7/1/17)
16
New Project Period
• Healthcare Preparedness Capabilities Refresh
• Need a NCTE
17
Pushing for in Next PP
• NCTE in BP-1 of new PP
• Increase in Base Funding
• Clear Preparedness Capabilities
(both Healthcare and Public Health)
18
OHEP Vision
• Continue to improve the Emergency Preparedness Lifecycle
amongst all ESF-8 Partners (Planning-Training-Exercising)
• Improve Emergency Response Capability at State DOH
• Continue to develop HEPCs
• Hire additional State Items
19
OHEP Priorities Healthcare Preparedness
Capability Priorities (Current)
• Healthcare System Preparedness
• Medical Surge
• Emergency Operations Coordination
• Information Sharing
• Volunteer Management
20
OHEP Priorities Healthcare Preparedness
Capability Priorities (Current)
• Emergency Operations Coordination
• MCM Dispensing
• Medical Material Management and Distribution
• Public Health Laboratory Testing
• Public Health Surveillance and Epidemiological Investigation
21
OHEP Priorities Beyond BP-5
• Grant Driven
• DOH Needs (HVAs) (CPGs)
• Partner Needs (HVAs), other requirements (Joint
Commission, CMS etc…)
22
23
Welcome to the
NYSDOH SAM 2016
24
SAM 3/18/16Mike Primeau, Director
Office of Health Emergency Preparedness
25
HEPCs BP-5 and Beyond
• Add additional ESF-8 Partners
• Provide coordination for Preparedness Activities
(Planning, Training, Exercises)
• Information Sharing during Response
• Provide a beneficial service
March 21, 2016
Healthcare Coalition Developmental
Assessment Factors (HCCDA Factors)
March 21, 2016 2
1. Review the methods in evaluating healthcare coalition progress based on national standards
2. Review the HCCDA Factors
3. Consider the HCCDA Factors within the realm of real-life case studies
Objectives
March 21, 2016 3
ASPR Healthcare Preparedness Capabilities –Healthcare Coalition during Disaster Cycle
3
March 21, 2016 4
Assessment Measures of CoalitionsCapability Based
Assessment
• program measure
indicators assess the
Awardees’ ability to
meet specific goals
and objectives
HCCDA Factor Assessment
• assess how well the
coalitions are
functioning within
the program
• help inform the
ability and
willingness of the
Coalition in meeting
the goals and
objectives of the
program4
March 21, 2016 5
HCCDA Factors - Preparedness
5
Standard Operating
Guide(SOG)
March 21, 2016 6
HCCDA Factors - Preparedness
6
EmergencyOperation
Plan(EOP)
March 21, 2016 7
HCCDA Factors – Response
7
March 21, 2016 8
• Main points:
– Integration
– Situational Awareness to
inform decision-making
Response Phase
8
March 21, 2016 9
HCCDA Factors – Recovery & Mitigation
9
March 21, 2016 10
Factor #20 Important Accomplishments
10
March 21, 2016 11
DO WE SEE VALUE ADDEDOF COALITION FUNCTIONS
IN REAL EVENTS?
March 21, 2016 12
The medical response to multi-site
terrorist attacks in Paris Hirsch et al., The Lancet, November 24, 2015
Nytimes.com Lancet.com
“This is a testimony on behalf of the health professionals involved in the night of November 13th“
March 21, 2016 13
Preparedness - Planning
• Activation of the “White Plan”• Developed 20 years ago, 1st time activated• Based on coordination of 40 hospitals
“…the activation of the White Plan had a critical effect. At no time during the emergency was there a shortage of personnel.”
HCCDA Factor # 10 – “Develop Operational Plans”…and previous
March 21, 2016 14
Preparedness - Exercises
• Development of gunshot wound treatment protocols• Field exercises to practice pre-hospital management• Previously worked together in exercises and updating of
emergency plans.
“…In a cruel irony, on the morning of the day of the attacks, SAMU (the EMS coordinating unit) and fire brigades participated in an exercise simulating….the event of a multiple shooting.”
HCCDA Factor # 18 – “quality improvement through exercises”
March 21, 2016 15
Forging New Partnerships for
Healthcare Preparedness Brown J., Domestic Preparedness Journal
cbsnews.com cnn.com
“….It was about the relationships. It’s not just about better integration of public health and medical, it’s about all of that community“ Susan Fanelli, California DOH Assistant Director
March 21, 2016 16
Preparedness – Financial Impacts
• Cost-benefit analysis of staff time vs. organizational impact
• Cost of closing down in an emergency
“I think resilience and preparedness is a financial equation that most healthcare executives don’t understand. They see it as a line item……If you’re not prepared and you have damage where you can’t accept patients, that’s an even bigger number.”
HCCDA Factor # 8 – “engage executives”
March 21, 2016 17
Preparedness – Growing membership
• CMS Emergency Preparedness Rule• Requires more comprehensive disaster planning for
many types of health care facilities.
“Encourage coalitions to seize the opportunity to rally these critical partners for collective planning, training and exercises.”
HCCDA Factor # 2– “multi-disciplinary organization membership”
March 21, 2016 18
Thank you!
