Accelerating Scalable Community Emergency Network Demonstration
ASCEND links regional healthcare facilities with private and public assets under a unified vision that results in a integrated, scalable medical evacuation solution during a regional emergency.
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
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
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
EpicenterEpicenter
Epicenter – The area of an emergency which is unsafe or uninhabitable
External Emergencies Have an Epicenter
Epicenter
Scale
EMAC Federal Local Regional Statewide Border States Interstate
State Interstate
Measures of Emergencies - Scale
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
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
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
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
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
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
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?
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
1993 Midwest Floods
2005 Hurricane Katrina
1994 Northridge Earthquake
Natural Disasters Have Accelerated During Last Four Decades
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
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
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
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
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.
Two Dimensions of an Emergency – Speed and Scale
Static
Time
Response
Velocity
Time
Response
Acceleration
Time
Response
SPEED vs. SCALE
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
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
EpicenterEpicenter
Pre-hospitalAmbulances
Epicenter – The area of an emergency which is unsafe or uninhabitable
Link 1 – Pre-hospital Ambulance Network
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
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
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
Pre-hospitalAmbulances
FrontlineHospital ER
Inter-facility Transport
Regional Hospitals
Regional HospitalsInventory
Inpatient Hospital Admissions
Links 4-6 Interfacility Transport and Regional Hospitals
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
ManagementSoftware
ASCEND Software Component
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
Command Center
ASCEND Seamless Operations Center
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.
Regional Response Integrates with Federal Response
Pre-hospitalAmbulances
FrontlineHospital ER
Inpatient Hospital Admissions
Inter-facility Transport
Regional Hospitals
Regional HospitalsInventory
InterstateTransport
InterstateReceivingHospitals
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
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
Proposed Steps
1. Unify and Implement Regional goals
2. Codify and Implement Software Solution
3. Prepare and Implement Operations
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
Outline Of ASCEND Service:
Software Solution
•Outline current enterprise solutions
•Create bridge software solution
•Codify Protocols into an Enterprise Software System
• Provide Training and Exercises on ASCEND software
HospitalIntegrationSoftware
HospitalIntegrationSoftware
Pre-hospitalEMS
Software
Pre-hospitalEMS
Software
ASCEND
•Provide Logistical Operations Center
• Provide HELP Solution
• Provide Special Needs Patients solutions
Operations
Outline Of ASCEND Service:
Accelerating Scalable Community Emergency Network Demonstration
Contact Info:
Clif CarothersPresident, U.S. Air Ambulance
800-863-7090