Area and Regional Medical Coordination Developed by NCW HERC Presented by Robbie Deede

First Thank you to the “Regional Medical Coordination Planning” Team for all their work and effort in cumulating member input and development of this document.

Objectives Outline Area & Regional Med Coord in concept and reality Identify the "Purpose" of Area & Regional Med Coord Highlight "Triggers" in activating AMC & RMC Walkthrough Initiating Facility Assumptions, Considerations and Checks Walkthrough Receiving/Assisting Facility Assumptions, Considerations and Checks

Disclaimer Plan intended to provide concepts for advisory purposes Not replace or contradict internal plans No requirement to use Members are ultimately responsible for their facility This is intended to be a living document, within the NCW HERC Response Plan, with continued revisions and updates as identified

These are concepts you and your colleagues have identified as best practice to NCW HERC over the past year.

Background & Intent of the System Event happens ---> Incident Command is opened Events happen that become larger than we can handle by ourselves Tiered Coordination Structure 1. Local/Internal 2. Area (NCW HERC) 3. Regional 4. Intrastate 5. Interstate 6. Federal Area and Regional Medical Coordination "Centers" Designated site or entity, pre-determined coordinate movement and information Area: a county or two Regional: all twelve counties

Issues in Reality Designed from a different model Real-life events and exercises have never indicated passing of responsibility Pre-determination can be dangerous Area and Region lines blur very quickly. You must reach further to get needed result All facilities need to be ready to be coordinating entity

Purpose Aid overwhelmed facilities Provide a system to coordinate transportation and patients Provide a single point of contact during the event Centralize, enhance and expedite the flow of information Identify and prioritize the use of available resources Support normal referral process overwhelmed in an event

Scope & Authority Does not replace a county EOC, but ensure continuity until one can opened or in event EOC will not be opened Builds upon concepts of Hospital Mutual Aid No rules, statutes or codes that require participation Requires pre-incident discussions with EMS

Triggers to Activate Resource needs will exceed the responding facility’s capacity (Facility Dependent) An event that overwhelms resources Number of expected patients to exceed normal response or mutual aid resources (MCI incident) Healthcare facility’s ability to care for patients has been compromised (Hospital Evacuation or nursing home evacuation) Multi-jurisdictional infectious disease event (Epidemic/Pandemic Event)

Initiating Facility Considerations and Assumptions STOP ALL CURRENT TRANSFERS! Bring in Finance immediately Provide additional staff to your “Call Centers” Engage EMS Medical Director (patient support) Pre-identify multiple staging points for evacuation based on patient acuity Contact NCW HERC

Assumptions and Considerations Cont'd A physician will be designated as the referring physician Ensure patients being discharged or transferred with 24 hours of medications Incident command will remain at the facility where the incident is occurring until that facility requests another facility to assume incident command (Core ICS concept) An initiating facility can request another facility to assume incident command should the event no longer be manageable internally. Ensuring “closed-loop communication” is essential 

Assumptions and Consideration Cont'd Alternative standards of care considerations Only essential procedures Maximize ability for transport  Send medical staff with assigned patients  Report after safe transport, at receiving location Ensure the ED is able to accept patients presenting “On Diversion” status Alternate site Stabilize patients presenting to ED and add to overall count  

Initiating Facility Checklist Determine immediate need, activate internal incident command and notify essential internal partners. (CO-S-TR Guide for Initial Incident Actions) (see appendix A) Broadcast on WISCOM and WITRAC to alert of need: MCI capacity, bed availability, other intel PRN and establish common operational picture Notify essential external partners: NCW HERC, Regulating Agency, County Dispatch to notify Emergency Management, Emergency Medical Services (EMS), Public Health Cancel elective and non-essential procedures

Initiating Facility Checklist If transfer is needed:  Contact "Call Center" Triage patients to:  Discharge Transport to skilled nursing facility Low Acuity Hospital High Acuity Hospital Receive initial response from Responding Facilities and identify resources to activate Communicate resource needs and identified resource availability to "Call Centers" to coordinate approval for transfer/activation Inform responding facilities where resources are planned to be engaged immediately (closed-loop)

Receiving/Assisting Facility Considerations & Assumptions Bring in Finance immediately Accept 75% of current availability to prevent being overwhelmed Consider discharging patients Cancel elective and non-required procedures

Receiving/Assisting Facility Considerations & Assumptions Cont'd Designate a physician, likely Emergency Department physician, as accepting physician for all incoming transfers Ready to provide all resources identified as available (WITRAC) Ready to assume incident command at the initiating facility’s request Ready internal medical staff to assist medical surge staff

Receiving/Assisting Facility Checklist Receive WITRAC or WISCOM notification from Initiating Hospital Consider activating internal incident command Identify resource availability based on resource request and relay back to initiating facility Receive verification of resource engagement Begin process of staging/fulfilling need or request

Questions. Input. Critical elements missing Questions? Input? Critical elements missing? How would you like this formatted?  How can you plug this into your evac or surg plan? Talk about EMS