1. Call in using your telephone.
November
Call in using your telephone.
Dial , access code:

2. Agenda Welcome, Introductions & Agenda Overview - Ed Dzedzy
Healthcare Coalition Strategic Planning Activities - Travis Nichols
Active Shooter Presentation Panel
Brian Schaeffer, Spokane Fire Department
Adam Richards, Deaconess Hospital
John Silano & Barbara Stumph, Rockwood Clinic
Ed Hoffman, SPD Chaplain
Nick Leute, Shriners Hospital for Children
Matt Schiller, Center for Personal Protection & Safety
Ebola: What You Need To Know - Susan Sjoberg
Ebola Virus Disease in West Africa - Kari L. Jones, MD
Final Comments and Winter Reminder

3. Planning for Sustainability
Healthcare
Public Health
Emergency Management
Where does the Healthcare Coalition fit in?

4. Planning for Sustainability
Relationship Development
Emergency Support Function 8
WATrac
Alternative Care Facilities
Continuity of Operations Planning
NIMS Compliance
Disaster Medical Coordination Center
Lots of regional planning efforts: Healthcare Coalition, Emergency Medical Services, Homeland Security, Public Health, Fire Services, Law Enforcement, etc) = enhanced collaboration. A network of caloboration. A system of response.
We bring knowledge and best practices together
TTX in a box: emergency credentialing
We provide healthcare system situational awareness
We provide the response tools necessary for a coordinated, efficient healthcare system and emergency management response
We connect your needs with available resources
We access resources that you can't

5. Planning for Sustainability
Office of the Assistant Secretary for Preparedness and Response 
We are currently a single funding source organization. It is clear that to remain sustainable we must diversify our financial base.
100%
Region 9 Healthcare Funding

6. Planning for Sustainability
We are currently a single funding source organization. Despite the excellent work we do, the quality granite, it is not a sustainable operational model.
Region 9 Healthcare Funding is 100% Assistant Secretary for Preparedness and Response. Photo: Lake Omak Washington, Colville Reservation

7. Planning for Sustainability
Insert Gantt Chart Here

8. Planning for Sustainability
The Region 9 Healthcare Coalition (HCC) is a network of healthcare organizations, providers and regional partners who are committed to strengthening the healthcare system for emergencies. The purpose of the HCC is to develop a coordinated and effective medical and public health system response to all hazards through:
effective communications systems and protocols.
strategic acquisition and management of resources.
collaborative prevention, mitigation, preparedness, response and recovery.

9. Planning for Sustainability
Business Plan
Mission Statement
Targeted Communications Strategy
Hospital Memorandum of Understanding
Identify Alternative Funding Sources
Founding Documents
Structuring goals from 2014 Strategic Planning Workshop
Look to audience to find out what I important to you as members of the coalition
What trainings we can provide
What services we can support such as continuity of operations planning.

10. August 6 2014 Deaconess Hospital Shooting
Media coverage provided courtesy of KXLY Spokane
Author: Jeff Humphrey, KXLY4
Rob Kauder, Internet Content
Kylee Cruz, KXLY4

11. Active Shooter Presentation Panel
Brian Schaeffer, Spokane Fire Department
Adam Richards, Deaconess Hospital
John Silano & Barbara Stumph, Rockwood Clinic
Ed Hoffman, Spokane Police Department
Nick Leute & Keith Rogers, Shriners Hospital for Children
Matt Schiller, Center for Personal Protection & Safety

12. July 8th 2014, “A day disrupted”

13. Deaconess overview Approximately a 380 bed hospital
Level III Trauma Center
Stroke Accredited from JC and Washington State
CP Accreditation by SCPC and Washington State
Bariatric/Joint COE
Part of the Rockwood Health System
~22 bed ER, at this time 50% smaller for renovation
~30K ER Visits in 2013
18 Operating Rooms
ED Construction: started April 2014-April 2015

15. Timeline
0000: Hospital Panic Alarms begin sounding at the Security desk
At that same time a cell phone call is received by security alerting them of a shooting
0002: A call was made to 911
0003: Units were dispatched
0005: An overhead page was made at the hospital, a Code Blue was called.
0005: Staging was established for responding units

16. 0008: I was at a meeting and visualized the dispatch message
0009: A call was made to the registration staff in DHEC alerting them to lock down
0009: I called my charge nurse in the ER
0011: I called my co-chair of the EOP and alerted him
0011: The ER responded to the Code Blue
0012: Admin was updated on the situation
0012: co-chair called the Safety officer who went to the scene

17. 0014: staff begin manning hospital entrances and DHEC entrances
0015: I arrived back at the hospital, other directors met in the ED
0016: Request for backboards was made, Trauma Activations announced
0017: RTF arrived to the patients and began moving a patient to ER
0020: Safety Officer on scene with PD and FD

18. 0023: First patient arrives to ED
0023: Scene is formally declared safe from PD
0025: Second patient declared on-scene
0035: First patient is declared

19. Active Shooter Presentation Panel
Brian Schaeffer, Spokane Fire Department,
Adam Richards, Deaconess Hospital,
John Silano & Barbara Stumph, Rockwood Clinic,
Ed Hoffman, Spokane Police Department,
Nick Leute & Keith Rogers, Shriners Hospital for Children,
Matt Schiller, Center for Personal Protection & Safety,

20. Ebola: So Much Information
Susan to Insert Slides Here

21. Who Has a Role in this Ebola Issue? (clinically speaking)
Outpatient Clinics/ Community Providers
Emergency Departments
Urgent Care Centers
Visiting nurses/home care
Hospitals
Region 9 Healthcare Coalition
Public Health

22. Healthcare System Preparedness
3 Tiers of Ebola Preparedness
EVD treatment facilities—hospitals with advanced readiness
EVD screening/medical evaluation facilities—emergency departments and all hospitals
All ambulatory care settings
8 hospitals in our state; Providence Sacred Heart Medical Center is the only one in eastern WA. There are currently no hospitals in Idaho working toward becoming treatment facilities.

23. The Three “I”s
Identify
Isolate
Inform

24. Identify Ebola screening via telephone Ebola screening in-person
911 Dispatch and Combined Communication Center
Receptionists or appointment scheduler
Ebola screening in-person
Resided in/traveled to an Ebola affected area, OR contact with a confirmed Ebola case within the past 21 days?
If yes—ask about presence of signs or symptoms of Ebola?
If positive screen, before making appointment, turn call over to clinical staff to evaluate whether concern for Ebola warrants referral to an Ebola-screening hospital

25. Isolate If yes to Ebola exposure AND Ebola symptoms
Isolate patient in private room with private toilet
Use dedicated equipment
Only essential personnel with designated roles should enter room & keep log of those who enter
No direct contact with patient until PPE in place
Minimum PPE: surgical face mask, face shield, impermeable gown, and two pairs of gloves
Additional PPE may be necessary based on the patient’s clinical status

26. Inform: Contacts for Ebola Consultation
Internally – know your protocols
Establish relationship with local health BEFORE having a patient with a positive Ebola screen to determine
Best method of contacting local health
Nearest healthcare facility capable of evaluating & caring for suspected Ebola patient
Local EMS transport provider for suspected Ebola patients
Make sure staff who may provide Ebola response knows
Local Health Department 24/7 contact phone for Ebola
State Health Department 24/7 contact phone for Ebola , or
Nearest Ebola-capable acute healthcare facility and local EMS

27. Preparedness Actions Across the Community
Monitoring of travelers or others
Isolation/Quarantine planning
Education and Guidance
Messaging and Media – public and providers
EMS – Transport
Death care
Hazardous Waste Management
Lab specimen shipping
Ebola Ready hospitals
Border Patrol
Public Health, Healthcare Coalition and ESF 8 Partners
Monitoring – 23 total in WA State, currently 12 – all low risk and most in King County. Of the 23, 21 have been monitored by public health and 2 by federal partners.
Lots of people and agencies involved. Schools and universities, military partners.

28. Ebola
Facts, experiences, opinions, and some teaching from my time in Liberia.
Kari Jones, MD

29. Objectives
Gain an understanding of why Ebola has killed so many people in West Africa
Appreciate cultural differences as barriers to healthcare in both West Africa and the US
Share a cautious common sense approach to Ebola
Demonstrate effective PPE
Relieve some anxiety about Ebola in the US

30. AFRICA

31. Africa
Countries affected by Ebola since it’s recognition

32. Liberia: the only U.S. Colony in Africa
Beginning in 1822, slaves were sent back to Liberia to form a free colony
By mid 1940’s William Tubman was the democratic president for 30 years of growth
Then unrest, coups and then civil war up until 2003
200,000 killed and 800,000 displaced in 1990’s
Currently a democracy under Ellen Johnson Sirleaf

33. IN Liberia vs USA 12x more likely to die in infancy
2.8x more babies per woman
Die 21 years sooner
Use 99% electricity
Make 99% less income
Spend 99.9% less on health care
90 physicians in the country: 1 psychiatrist, 1 internist, 2 pediatricians, 3 OB’s
~1400 nurses and 400 midwives as well
About 4.3 million people
1:53,000 vs 1:400 physician to patient ratios

34. Death toll to date
In its latest toll, WHO said that through November 10th, 2,812 people had died in Liberia
In Sierra Leone, 1,187 people had died as of November 11th
Guinea, where the outbreak began late last year, counted 1,166 deaths also as of November 11th
324 health care workers have died out of ~570 infected in all three countries

35. Why is Ebola so bad in West Africa?
This seems easy, but is really a complicated question!!
And as we go through answers, think about how the U.S. differs
And notice as it gets it more complicated, the slides get very busy!

36. Easy answers: Lack of health care workers
Lack of protective equipment for the health care workers
Lack of sanitation and electricity to provide clean patient care facilities; made worse during the rainy season (This didn’t really seem to play a role)
No health care infrastructure to handle a national crisis (county health departments are not found in Liberia in the form you see them in the U.S.)

37. A little more complicated…
Distrust after a civil war: was their someone behind the illnesses? People would go for treatment and never come home. (This was a big factor!!)
Prominent health care officials denying it’s existence
Lack of basic medical understanding in general population
The cultural norm is very dependent on human touch, especially with the recently deceased
Fear: people that sought treatment died

38. And then, just to make it worse…
People started to realize the illness was real and deadly and contagious
But, there was no place for them to contain the sick patients (let alone provide good medical care)
They closed the 3 main hospitals in Liberia: no health care was available for a couple weeks
Health care workers were most affected at the beginning due to lack of knowledge and protection, so subsequently it was hard to convince other health care workers to work. (locally and internationally)
The health care provided was minimal at best due to lack of personnel and PPE and supplies
There was no way to protect family members who were had to take care of them at home (ponder that a bit: leave your relative at a center knowing they will probably die but you all will be okay or take them home again)

39. And that is where my story begins!

40. What was I doing in Liberia?
Samaritan’s Purse: DART personnel
MSF needed help, SP thought they could help
Foya was up north, several months old and running well
Monrovia (ELWA) was the new Ebola treatment center, and it was quickly growing

42. This is the inside of a newer center…
Not quite the same ambiance as the CDC poster, but still better than ELWA

43. Patient Amenities

44. Patients all have names

45. Cleaning never ends

46. The Newest Treatment Center

47. This was the ELWA 2 treatment center
Yes, that’s a person laying on the ground in front of the window, most likely passed away.
Sort of reminds me of a jail cell

48. Preparation for moving to the morgue

49. Walk out of ELWA 2 and it’s a sunny day in Monrovia

50. Nancy’s house: an Ebola treatment center

51. Joy can be found anywhere!

52. The last fire

53. Leaving Liberia

54. Donning the PPE

55. Donning continued

56. Donning complete

57. Doffing the PPE Hood removed Hands washed Gown removed Mask removed
Each step is preceded by handwashing with bleach 0.05% or hand spraying with 0.5%
Whole body is sprayed: front and back
Hands washed
First gloves removed
Apron removed
Goggles removed
Hood removed
Hands washed
Gown removed
Mask removed
Gloves removed
Boots sprayed and removed
Then go wash your hands at bucket of bleach

58. Ebola in the U.S. – Don’t Panic
People understand basic medical issues here
People believe what the government tells them about medical items
We can share information nationally in a rapid manner
We have an infrastructure that can trace and follow possible sick contacts
We have facilities to isolate patients
We have PPE for health care workers
We have excellent health care if admitted
We have no need to touch each other if we think we might get sick!

59. Ebola in the U.S. – Don’t panic, but….
Cautious common sense
Protect yourself if there is a real threat of Ebola
Your safety is more important than the care of the patient (this is a hard concept to caring health care workers)
Never hurry
Never cut corners on safety (this isn’t the flu)

60. How does this affect the County Health Departments?
This is where the onus of work is going to be done
contact tracing and follow up is key
You are the number everyone can call if they think they have an Ebola patient.
Should have a plan known by all as to what steps to take depending on where the call comes from
It should be simple, and safe: remember, if no one is touching the patient, then no one is going to catch it.
Should have the questionnaire to screen patients readily available
The vast majority of new Ebola patients are mobile and able to get themselves to whichever facility you deem appropriate
Need a clean-up plan to follow after patient

61. Opinions and ideas for every county
Have a gutted ambulance available for transport
Have bleach available for any encounters
For cleaning up wherever the patient went
For disinfecting any vomit or diarrhea or blood that the patient puts out
For washing hands
Know when PPE is needed and when it’s not
Be smart: if you’re the driver of a transport you will not be exposed
If you’re riding in the back with them, then you need PPE
If you’re assessing someone via questionnaire: you do not need PPE
If you are having contact with the patient: you need PPE
If you are a sanitation person cleaning up bodily fluids: you need PPE
PPE should be done appropriately if it is going to be worn
There are risks to doffing inappropriately, so don’t do it if not needed
If you leave any part of you exposed, the PPE will not do it’s job

62. Opinions and ideas continued…
Maximize the safety of healthcare workers
Limit the number of workers and locations that are exposed to an Ebola patient
Assess health care workers’ ability to appropriately don and doff the PPE independently (supervised, but doffing done on their own)
Provide practice of care that minimizes risk of exposure to virus as patient’s viral load increases (DNR, DNI, minimal tubes and drains)
Emergency responders
Be prepared for the unexpected
Always have gloves available, and goggles and mask if worried about Ebola
If we get an Ebola patient in Washington: I hope they are triaged in one ER room and transported to a facility that has already demonstrated the infrastructure to manage them safely and well.
I have no idea why a hospital in Washington would currently keep an Ebola patient: it could be done, but it seems unnecessary

63. Survivor!!!

64. The End
Thank you

65. #Snowstorm #BuffaloSnow #NYC
Spokane, Adams, Asotin, Columbia, Lincoln and NE Tri Health District
Photos courtesy of KTVU Channel 2

66. Are you ready for winter?
Take these three steps to get ready:
Create an emergency preparedness kit for your car, home, & workplace.
Make a plan and practice with your family and those who depend on you. 
Stay informed and be aware of the weather approaching so you are prepared for whatever Mother Nature throws our way.

67. Thank you for attending!
Next meeting: January :00 – 2:30 pm Enduris Training Center 1610 A Technology Boulevard Spokane, WA srhd.org/hcc