Catastrophic Health Incident Response Planning

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

Catastrophic Incidents TIME (min) 15 30 45 60 90 >120 Self-evacuee’s 50 - 80% 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

Catastrophic Incidents TIME (min) 15 30 45 60 90 >120 Self-evacuee’s 50 - 80% 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

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” !

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

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

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

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

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

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

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)

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

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

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

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

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

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

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

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

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

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)

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

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

MCI Cache Locations MCI MCI UASI 100 Pt Caches MCI MCI UASI

All MCI Cache Locations 250 Pt Cache MCI UASI UASI MCI UASI MCI

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

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

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 – 250 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

Alternate Care Site Cache Trailers

First Aid and Casualty Collection Points for Mass Gathering Events.

State Medical Response Team

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

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

State Medical Response Team Set-up

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

Questions? Discussion?

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

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

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.

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.

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

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).

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

Be Prepared for Anything