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November 20 2014 Call in using your telephone. Dial 1.312.878.3080, access code: 543.383.432.

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Presentation on theme: "November 20 2014 Call in using your telephone. Dial 1.312.878.3080, access code: 543.383.432."— Presentation transcript:

1 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

4 Relationship Development Emergency Support Function 8 WATrac Alternative Care Facilities Continuity of Operations Planning NIMS Compliance Disaster Medical Coordination Center Planning for Sustainability

5 Office of the Assistant Secretary for Preparedness and Response Region 9 Healthcare Funding 100%

6 Planning for Sustainability Region 9 Healthcare Funding is 100% Assistant Secretary for Preparedness and Response. Photo: Lake Omak Washington, Colville Reservation

7 Planning for Sustainability

8 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. Planning for Sustainability

9 Business PlanMission Statement Targeted Communications Strategy Hospital Memorandum of Understanding Identify Alternative Funding Sources Founding Documents Structuring goals from 2014 Strategic Planning Workshop

10 August Deaconess Hospital Shooting Media coverage provided courtesy of KXLY Spokane Author: Jeff Humphrey, KXLY4 Reporter, Rob KauderRob Kauder, Internet Content Manager, Kylee CruzKylee Cruz, KXLY4 Reporter, news/shooting-reported-at- deaconess-hostpital/

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 8 TH 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 Operating Rooms ED Construction: started April 2014-April 2015

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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 : 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

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

23 The Three “I”s Identify Isolate Inform

24 Identify Ebola screening via telephone – 911 Dispatch and Combined Communication Center – Receptionists or appointment scheduler Ebola screening in-person

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 o Best method of contacting local health o Nearest healthcare facility capable of evaluating & caring for suspected Ebola patient o Local EMS transport provider for suspected Ebola patients Make sure staff who may provide Ebola response knows o Local Health Department 24/7 contact phone for Ebola o State Health Department 24/7 contact phone for Ebola , or o 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

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 ,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

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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 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 Hands washed Apron removed Hands washed Goggles removed Hands washed Hood removed Hands washed Gown removed Hands washed Mask removed Hands washed Gloves removed Hands washed 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 Photos courtesy of KTVU Channel 2

66 Are you ready for winter? Take these three steps to get ready: 1.Create an emergency preparedness kit for your car, home, & workplace. 2.Make a plan and practice with your family and those who depend on you. 3.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


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