1. Catastrophic Health Incident Response Planning

2. Catastrophic Incident Response Community
Emergency Operations
EMS
Hospitals
High
Impact
Incident
Law
Enforcement
Fire
Public
Administration
Public Works
Citizen
Volunteers
Public Health

3. Catastrophic Incidents
TIME (min) 15 30 45 60 90
>120
Self-evacuee’s
% bypass
public safety
“Upside down triage”
Bystanders transport 80% of
casualties (11% of admits)
EMS transports 20% of
casualties (88% of admits)
EMS
Approx. 20%
of causalities
Public
Safety
Arrival
Source: Davis, 2004

4. Catastrophic Incidents
TIME (min) 15 30 45 60 90
>120
Self-evacuee’s
% bypass
public safety
“Upside down triage”
Bystanders transport 80% of
casualties (11% of admits)
EMS transports 20% of
casualties (88% of admits)
EMS
Approx. 20%
of causalities
Public
Safety
Arrival
GOAL - Protect The Hospitals
Source: Davis, 2004

5. Psychological vs. Medical “Footprint”
The size of the psychological “footprint” greatly exceeds medical “footprint”
psychological
“footprint”
> 4:1
medical
“footprint”
“Not all victims should be
evaluated in the
emergency department” !

6. Statewide Catastrophic Health Incident Response Plan (CHIRP)
“Chance favors the prepared mind.”
Louis Pasteur

7. CHIRP Scope A catastrophic incident may result from:
natural events (hurricanes, floods, etc.)
large-scale accidents such as a plane crash
manmade/terrorism events
Size of incident is not the determining factor, capacity and capability to respond is most important factor

8. CHIRP Provisions Provides for: Incident response strategy
Preparedness, prevention, response, recovery
Roles and responsibilities
Coordination of regional response
Alternate Care Sites
Expansion of medical care capacity and capability

9. Statewide CHIRP All hazards plan utilizing principles from;
National Response Framework (NRF)
National Incident Management System (NIMS)
National Preparedness Guidance (NPG)
Incorporate plans and resource from regional:
Law enforcement, emergency management, EMS, fire/rescue, hospitals, and public health

10. Catastrophic Incident Response Plans reside at the regional level
Statewide CHIRP
Concept of operations
Develop, exercise and maintain regional catastrophic response plans which support local plans, and draw on regional, state, and federal assets
Catastrophic Incident Response Plans
reside at the regional level

11. Regional CHIRP Provisions
Incident management priorities
Protect, restore critical infrastructure, resources
Conduct law enforcement operations
Protect property, mitigate impacts
Facilitate recovery
Source: FEMA Photo Library

12. Operational Goals Provide chain of command Attend to all victims
Minimize injury/illness, damage/loss of property & records
Provide maximum safety
Integrate with community emergency plans
Maintain and restore normal services
Provide supportive action
All operational goals are built into the Emergency Operations Plan (EOP)

13. Statewide and Federal Assets
Concept of Operations
Statewide and Federal Assets
Coordinates
Regional
Catastrophic Incident Response Plans
Enhances
Local/County
Communications
Risk/Public Information
Special Needs Populations
Volunteer Credentialing
Patient Tracking
Alternate Treatment Sites
Training/Exercises
Local/County
Emergency
Response Plans

14. Concept of Operations Statewide Regional Local Ambulance Response Plan
Hospital
Response
Plan
Public
Health
Response
Plan
Behavioral
Health
Response
Plan
Mass
Fatality
Response
Plan
Regional
Catastrophic Incident Response Plans
& Multi-Agency Coordinating Teams
Local
Communications
Risk/Public Information
Special Needs Populations
Volunteer Credentialing
Patient Tracking
Alternate Treatment Sites
Training/Exercises
Local Emergency
Response Plans

15. Planning Targets Rural Areas Smaller Urban Areas Major Urban Areas
Minimum 100 total casualties per incident
Smaller Urban Areas
Minimum 250 total casualties per incident
Major Urban Areas
500 casualties per million population

16. Planning Assumptions
CHIRP will knit together existing plans, not replace them.
Agency Mass Casualty Plans
Fire Departments and EMS Agencies
Hospitals
Law Enforcement Agencies
Field Operations Guide (FOG)
Medical Examiner Disaster Plans
MMRS Regional MCI Plans

17. Assumptions Triage / Treatment Standards
Basic Principles of Disaster Medicine must apply
Level of care will be less than day to day medicine as we know it
Standards
Will see and care for larger patient / staff ratios

18. Regional Catastrophic Health Incident Response Plan Components
Prehospital (MCI) Response Plan
Alternate Medical Treatment Site Plan
Hospital Response Plan
Mass Fatality Plan (FEMORS)
Lab Surge Capacity Plan
Healthcare Professional Surge Capacity Plan
Disaster Behavioral Health Plan

19. Injury Severity Of those surviving: 10 percent immediate deaths
20 percent emergent (severe multi-system injuries)
30 percent urgent (able to defer definitive treatment once stabilized)
50 percent mild or moderate (the “walking wounded’) 1 2 3 4

20. Practical Options
Expand via
Mobile facilities-expand in place or deploy to incident site
Convert existing buildings to temporary hospitals
Use of shuttered hospitals [closed, obsolete,mothballed, bankrupt, etc.]
Add beds to existing facilities
Build temporary facilities
Develop protocols addressing emergency standard of care procedures

21. Alternative Care Sites Plan
Region 5 Domestic Security Taskforce
Central Florida MMRS
Central Florida UASI

22. Funding Sources State Homeland Security Grants (DHS)
Centers for Disease Control Grants (CDC)
DHHS – ASPR Grants (ASPR)
Urban Area Security Initiative Grants (UASI)
Metropolitan Medical Response System Grants
(MMRS)

23. ACS Cache Locations 1 2 3 4 5
ASPR Funded 6 7

24. MCI Cache Locations
MCI
MCI
DHS Funded
100 Pt Caches
MCI
MCI

25. MCI Cache Locations
MCI
MCI
UASI
100 Pt Caches
MCI
MCI
UASI

26. All MCI Cache Locations
250 Pt Cache
MCI
UASI
UASI
MCI
UASI
MCI

27. Hospital Cache Locations
Speedway
Hospital
Hospital
Spaceport
Hospital
Hospital
Hospital
Theme
Parks
Hospital
Cruise ship Port
Hospital
Hospital
MMRS Funded

28. County Cache Locations
UASI Funded
100 Pt Caches
&
Enhance
Regional
500 Pt Cache
County
County
County
Region
County

29. Required Capacity Surge
All Cache Locations
1 Regional Cache – 500 pt
5 County Caches – 100 pt
8 Hospital Caches – 100 pt
6 Sm MCI Caches – 100 pt
1 Lg MCI Cache – pt
Total Surge – 2,650 pt
MCI
County
Hospital
MCI
County
UASI
UASI
Region 5
Medical
Surge
Strategy
Required Capacity Surge
500 Pt / Million Pop.
Regional Population
≈3 million population
1500 Pts.
Hospital
County
Region
County
Hospital
Hospital
Hospital
Hospital
Hospital
MCI
UASI
Hospital
County
MCI

30. Alternate Care Site Cache Trailers

32. First Aid and Casualty Collection Points for Mass Gathering Events.

33. State
Medical
Response
Team

36. ZUMBRO
Air Inflatable
Quad Tents
Temps Cots
Westcots
carts, tables & chairs

37. State Medical Response Teams
Florida has Three Mobile Field Hospitals and One Rapid Response Hospital

38. State Medical Response Team
Set-up

42. Leveraging Our Assets Pandemic Influenza Caches
Points of Dispensing Caches
Special Needs Shelter Caches
Mass Casualty Caches
Local and Regional AMTS Caches
State Medical Response Team Cache

43. Questions? Discussion?

44. Federal Health and Medical Response
Natural Disasters
Transportation Disasters
Terrorism
Technological Disasters

45. National Disaster Medical Systems (NDMS)
A “federal asset” who’s major components are:
Medical Response
Patient Evacuation.
Definitive Medical Care

46. National Disaster Medical Systems (NDMS) Purpose
A Nationwide Medical Response System to:
Supplement state and local medical resources during disasters or major emergencies to deliver definitive medical care to victims of a disaster
Provide backup medical support to the DOD/VA medical care systems during an overseas conventional conflict.

47. National Disaster Medical Systems (NDMS)
Managed by a VA or DOD Federal Coordinator (FCC).
Can be activated by State (caution when doing this).
Brings those like assets which mirror the state: DMATS, DMORT, and NVAT.
Funded by HHS.
Participating civilian hospitals are reimbursed.

48. Disaster Medical Assistance Teams (DMATs)
A “federal AMTS”
Designed to deliver medical care to victims of - and responders to - a domestic disaster
Co-located with existing facility or stand alone

49. Partnerships
The NDMS is an interagency partnership between the Department of Health and Human Services (HHS), the Department of Defense (DoD), Department of Homeland Security (HS) and the Department of Veteran’s Affairs (VA).

50. Importance of NDMS Improves Federal Mission Readiness
Ability to Mobilize and Deploy Medical
Teams, Supplies, and Equipment
Ability to Provide Patient Evacuation
System
Ability to Provide Definitive Medical Care
Adds Value to America

51. Be Prepared for Anything