Presentation on theme: "Call in using your telephone."— Presentation transcript:
1Call in using your telephone. NovemberCall in using your telephone.Dial , access code:
2Agenda Welcome, Introductions & Agenda Overview - Ed Dzedzy Healthcare Coalition Strategic Planning Activities - Travis NicholsActive Shooter Presentation PanelBrian Schaeffer, Spokane Fire DepartmentAdam Richards, Deaconess HospitalJohn Silano & Barbara Stumph, Rockwood ClinicEd Hoffman, SPD ChaplainNick Leute, Shriners Hospital for ChildrenMatt Schiller, Center for Personal Protection & SafetyEbola: What You Need To Know - Susan SjobergEbola Virus Disease in West Africa - Kari L. Jones, MDFinal Comments and Winter Reminder
3Planning for Sustainability HealthcarePublic HealthEmergency ManagementWhere does the Healthcare Coalition fit in?
4Planning for Sustainability Relationship DevelopmentEmergency Support Function 8WATracAlternative Care FacilitiesContinuity of Operations PlanningNIMS ComplianceDisaster Medical Coordination CenterLots 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 togetherTTX in a box: emergency credentialingWe provide healthcare system situational awarenessWe provide the response tools necessary for a coordinated, efficient healthcare system and emergency management responseWe connect your needs with available resourcesWe access resources that you can't
5Planning 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
6Planning 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
7Planning for Sustainability Insert Gantt Chart Here
8Planning 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.
9Planning for Sustainability Business PlanMission StatementTargeted Communications StrategyHospital Memorandum of UnderstandingIdentify Alternative Funding SourcesFounding DocumentsStructuring goals from 2014 Strategic Planning WorkshopLook to audience to find out what I important to you as members of the coalitionWhat trainings we can provideWhat services we can support such as continuity of operations planning.
10August 6 2014 Deaconess Hospital Shooting Media coverage provided courtesy of KXLY SpokaneAuthor: Jeff Humphrey, KXLY4Rob Kauder, Internet ContentKylee Cruz, KXLY4
11Active Shooter Presentation Panel Brian Schaeffer, Spokane Fire DepartmentAdam Richards, Deaconess HospitalJohn Silano & Barbara Stumph, Rockwood ClinicEd Hoffman, Spokane Police DepartmentNick Leute & Keith Rogers, Shriners Hospital for ChildrenMatt Schiller, Center for Personal Protection & Safety
13Deaconess overview Approximately a 380 bed hospital Level III Trauma CenterStroke Accredited from JC and Washington StateCP Accreditation by SCPC and Washington StateBariatric/Joint COEPart of the Rockwood Health System~22 bed ER, at this time 50% smaller for renovation~30K ER Visits in 201318 Operating RoomsED Construction: started April 2014-April 2015
15Timeline0000: Hospital Panic Alarms begin sounding at the Security deskAt that same time a cell phone call is received by security alerting them of a shooting0002: A call was made to 9110003: Units were dispatched0005: An overhead page was made at the hospital, a Code Blue was called.0005: Staging was established for responding units
160008: 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 down0009: I called my charge nurse in the ER0011: I called my co-chair of the EOP and alerted him0011: The ER responded to the Code Blue0012: Admin was updated on the situation0012: co-chair called the Safety officer who went to the scene
170014: staff begin manning hospital entrances and DHEC entrances 0015: I arrived back at the hospital, other directors met in the ED0016: Request for backboards was made, Trauma Activations announced0017: RTF arrived to the patients and began moving a patient to ER0020: Safety Officer on scene with PD and FD
180023: First patient arrives to ED 0023: Scene is formally declared safe from PD0025: Second patient declared on-scene0035: First patient is declared
19Active 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,
20Ebola: So Much Information Susan to Insert Slides Here
21Who Has a Role in this Ebola Issue? (clinically speaking) Outpatient Clinics/ Community ProvidersEmergency DepartmentsUrgent Care CentersVisiting nurses/home careHospitalsRegion 9 Healthcare CoalitionPublic Health
22Healthcare System Preparedness 3 Tiers of Ebola PreparednessEVD treatment facilities—hospitals with advanced readinessEVD screening/medical evaluation facilities—emergency departments and all hospitalsAll ambulatory care settings8 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.
24Identify Ebola screening via telephone Ebola screening in-person 911 Dispatch and Combined Communication CenterReceptionists or appointment schedulerEbola screening in-personResided 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
25Isolate If yes to Ebola exposure AND Ebola symptoms Isolate patient in private room with private toiletUse dedicated equipmentOnly essential personnel with designated roles should enter room & keep log of those who enterNo direct contact with patient until PPE in placeMinimum PPE: surgical face mask, face shield, impermeable gown, and two pairs of glovesAdditional PPE may be necessary based on the patient’s clinical status
26Inform: Contacts for Ebola Consultation Internally – know your protocolsEstablish relationship with local health BEFORE having a patient with a positive Ebola screen to determineBest method of contacting local healthNearest healthcare facility capable of evaluating & caring for suspected Ebola patientLocal EMS transport provider for suspected Ebola patientsMake sure staff who may provide Ebola response knowsLocal Health Department 24/7 contact phone for EbolaState Health Department 24/7 contact phone for Ebola , orNearest Ebola-capable acute healthcare facility and local EMS
27Preparedness Actions Across the Community Monitoring of travelers or othersIsolation/Quarantine planningEducation and GuidanceMessaging and Media – public and providersEMS – TransportDeath careHazardous Waste ManagementLab specimen shippingEbola Ready hospitalsBorder PatrolPublic Health, Healthcare Coalition and ESF 8 PartnersMonitoring – 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.
28EbolaFacts, experiences, opinions, and some teaching from my time in Liberia.Kari Jones, MD
29ObjectivesGain an understanding of why Ebola has killed so many people in West AfricaAppreciate cultural differences as barriers to healthcare in both West Africa and the USShare a cautious common sense approach to EbolaDemonstrate effective PPERelieve some anxiety about Ebola in the US
31AfricaCountries affected by Ebola since it’s recognition
32Liberia: the only U.S. Colony in Africa Beginning in 1822, slaves were sent back to Liberia to form a free colonyBy mid 1940’s William Tubman was the democratic president for 30 years of growthThen unrest, coups and then civil war up until 2003200,000 killed and 800,000 displaced in 1990’sCurrently a democracy under Ellen Johnson Sirleaf
33IN Liberia vs USA 12x more likely to die in infancy 2.8x more babies per womanDie 21 years soonerUse 99% electricityMake 99% less incomeSpend 99.9% less on health care90 physicians in the country: 1 psychiatrist, 1 internist, 2 pediatricians, 3 OB’s~1400 nurses and 400 midwives as wellAbout 4.3 million people1:53,000 vs 1:400 physician to patient ratios
34Death toll to dateIn its latest toll, WHO said that through November 10th, 2,812 people had died in LiberiaIn Sierra Leone, 1,187 people had died as of November 11thGuinea, where the outbreak began late last year, counted 1,166 deaths also as of November 11th324 health care workers have died out of ~570 infected in all three countries
35Why 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. differsAnd notice as it gets it more complicated, the slides get very busy!
36Easy answers: Lack of health care workers Lack of protective equipment for the health care workersLack 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.)
37A 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 existenceLack of basic medical understanding in general populationThe cultural norm is very dependent on human touch, especially with the recently deceasedFear: people that sought treatment died
38And then, just to make it worse… People started to realize the illness was real and deadly and contagiousBut, 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 weeksHealth 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 suppliesThere 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)
40What was I doing in Liberia? Samaritan’s Purse: DART personnelMSF needed help, SP thought they could helpFoya was up north, several months old and running wellMonrovia (ELWA) was the new Ebola treatment center, and it was quickly growing
57Doffing 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 backHands washedFirst gloves removedApron removedGoggles removedHood removedHands washedGown removedMask removedGloves removedBoots sprayed and removedThen go wash your hands at bucket of bleach
58Ebola in the U.S. – Don’t Panic People understand basic medical issues herePeople believe what the government tells them about medical itemsWe can share information nationally in a rapid mannerWe have an infrastructure that can trace and follow possible sick contactsWe have facilities to isolate patientsWe have PPE for health care workersWe have excellent health care if admittedWe have no need to touch each other if we think we might get sick!
59Ebola in the U.S. – Don’t panic, but…. Cautious common senseProtect yourself if there is a real threat of EbolaYour safety is more important than the care of the patient (this is a hard concept to caring health care workers)Never hurryNever cut corners on safety (this isn’t the flu)
60How does this affect the County Health Departments? This is where the onus of work is going to be donecontact tracing and follow up is keyYou 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 fromIt 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 availableThe vast majority of new Ebola patients are mobile and able to get themselves to whichever facility you deem appropriateNeed a clean-up plan to follow after patient
61Opinions and ideas for every county Have a gutted ambulance available for transportHave bleach available for any encountersFor cleaning up wherever the patient wentFor disinfecting any vomit or diarrhea or blood that the patient puts outFor washing handsKnow when PPE is needed and when it’s notBe smart: if you’re the driver of a transport you will not be exposedIf you’re riding in the back with them, then you need PPEIf you’re assessing someone via questionnaire: you do not need PPEIf you are having contact with the patient: you need PPEIf you are a sanitation person cleaning up bodily fluids: you need PPEPPE should be done appropriately if it is going to be wornThere are risks to doffing inappropriately, so don’t do it if not neededIf you leave any part of you exposed, the PPE will not do it’s job
62Opinions and ideas continued… Maximize the safety of healthcare workersLimit the number of workers and locations that are exposed to an Ebola patientAssess 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 respondersBe prepared for the unexpectedAlways have gloves available, and goggles and mask if worried about EbolaIf 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
65#Snowstorm #BuffaloSnow #NYC Spokane, Adams, Asotin, Columbia, Lincoln and NE Tri Health DistrictPhotos courtesy of KTVU Channel 2
66Are 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.
67Thank you for attending! Next meeting: January :00 – 2:30 pm Enduris Training Center 1610 A Technology Boulevard Spokane, WA srhd.org/hcc