Crisis and Challenge Preparedness and Overcrowding John R. Lumpkin, MD, MPH, FACEP Director Illinois Department of Public Health

Changing Face of Terrorism Political Political Limited range of conventional weapons Limited range of conventional weapons  Guns, bombs

Conventional Terrorism Bullets Bombs and blasts Building collapse

Stages of a Medical Emergency Response Planning Identification Notification Mobilization Treatment Recovery

Planning IDPH Emergency Plans Emergency Medical Disaster Plan  Statewide plan that coordinates medical resources EMS System-Wide Crisis Plan  Mandate for hospitals to develop plans to recognize evolving trend of similar symptoms Illinois Pharmaceutical Plan  Plan to supplement local resources by providing state and Federal pharmaceutical resources

Stages of a Medical Emergency Response Planning Identification Notification Mobilization Treatment Recovery

Identification - Laboratory Capacity IDPH laboratory capabilities in Springfield and Chicago Chicago – Upgraded to biosafety level 3 facility Upgrading to PCR technology Approximately 30 hospital laboratories trained by IDPH on biological agents Referral and confirmation to CDC laboratory for some agents

Impact of Surveillance on Survivability Time Number Dead Animal or Human Indicators 10 5 (Linear) Victims Directly Exposed = 0 Fatalities With Early Warning and an Informed Public Health Response Fatalities With Traditional Public Health Response Effective Treatment Period Surveillance Traditional Disease Detection Phase II Acute Illness Phase I Initial Symptoms t Modified from chart developed by Hopkins Bioterrorism Center

Agent comparison table

Stages of a Medical Emergency Response Planning Identification Notification Mobilization Treatment Recovery

Notification - IDPH Response System Non-Emergency Communication  Broadcast fax services/program follow-up Emergency Communication  24-hour availability through IEMA  Internal duty officer for all major response programs  Health Alert Messages  Reach-back to CDC and federal agencies  Hospital Health Alert Network (HHAN)

IOHNO

Notification - Health Alert Network Secure Intranet between state and local health departments Satellite uplinks and downlinks “Real-time” electronic messaging Video teleconferencing Broadcast fax capabilities

Stages of a Medical Emergency Response Planning Identification Notification Mobilization Treatment Recovery

Response - Rapid Response Team Assist LHDs with outbreak investigation Physician lead multi-disciplinary team Composed of personnel representing epidemiology, communicable diseases, food protection, Laboratory and environmental health

Response - IMERT Illinois Medical Emergency Response Team Assist with emergency medical treatment at mass causality incidents Located in each SIRT region and City of Chicago Team composed of emergency physicians, emergency and trauma nurses, and EMT of various levels

Stages of a Medical Emergency Response Planning Identification Notification Mobilization Treatment Recovery

Treatment - National Pharmaceutical Stockpile Less than 12 hour availability Repackaging by Illinois resources Over 250,000 individual packs within 24 hours Includes hospital and other medical supplies

Hospital Preparedness Staff Training and Education Incorporate BT into  Disaster Planning  Infection control  Notification procedures  Security and Media Community Wide Planning  Local Health Department  POD Hospital  EMS System

How Well Are We Prepared? The 1995 Chicago Heat Crisis Local Learning Experience

CNN: Chicago hospitals were unprepared for '95 heat wave Casualties of the July 1995 heat wave in Chicago The Chicago 1995 Heat Crisis 465 certified heat-related deaths 23/42 area hospitals on bypass Patients waiting in ER >12 hours Ambulance travel times >30 min. Excessive demands on medical resources Compromised delivery of services to non heat-related patients ( MMWR/Aug 11/1995/44(31); )

Assessment: Emergency Room Bypass In search of an open ER. Contributing factors: regulatory strategies, management practices, communications & IT, other social issues Current system of monitoring

Illinois Emergency RoomsIllinois Emergency Room Visits (Millions) ER Capacity & Utilization Source: IDPH, IL Center for Health Statistics, Unpublished data from Annual Hospital Questionnaires

Ambulance Diversion in Illinois Criteria developed by IDPH System-wide crisis policy must be in place Report to IDPH within 24 hours of diversion Review of notifications for compliance with acceptable criteria Corrective action plans and surprise inspections for hospitals out of compliance

Ambulance Diversion in Illinois Three hospitals on simultaneous bypass within the same area triggers intervention IDPH may require hospitals to go off bypass to accommodate critical situations Crisis policies must be implemented, addressing executive-level decision making, staffing and other contingencies

Illinois’ Bypass Experience Approximately 35% of Illinois EDs went on bypass at least once between June 2000 and May 2001 A total of 797 bypass events occurred during this time frame, resulting in more than 6,500 hours of restricted access Source: IDPH Division of EMS and Highway Safety

Percentage of Total Regional Bypass Time Attributable to Individual Hospitals Region A Region B Source: IDPH, Division of Emergency Medical Services, unpublished data June 2000-May 2001 & Other Regional Analysis bypass burden = % differences per hospital the “domino effect” = simultaneous bypass within close proximity

Illinois’ Bypass Experience Source: IDPH Division of EMS and Highway Safety

Illinois’ Bypass Experience Source: IDPH Division of EMS and Highway Safety

Illinois’ Bypass Experience Source: IDPH Division of EMS and Highway Safety

Can Hospital Bypass Be An Effective BT Early Warning System? Bypass is a symptom of insufficient surge capacity Separating ‘normal’ bypass impacts from true crisis events is key Illinois’ system provides important checks and balances Future information and communications system improvements will make bypass a reasonable early warning system for BT or chemical terror events

Statewide Electronic Emergency Management System 24 hr/day real-time snapshot of hospital status Automatic pager/ notifications (ex. 3 hospitals on bypass simultaneously) Eliminates delays in “cluster” notifications Utilizes HHAN Portal

The Challenge that we face “THE MANAGED-CARE-BASED HEALTH SYSTEM IS FAILING. MEDICAL INFLATION IS BACK. CONSUMER DISTRUST, PROVIDER HOSTILITY, COSTLY NEW TECHNOLOGIES AND POLITICAL OPPORTUNISM WILL NO LONGER ALLOW COSTS AND QUALITY TO BE CONTROLLED BY MOST EXISTING MANAGED CARE ARRANGEMENTS”

Overcrowding Increase Demand  Utilization  Preference  Social and Economic Barriers  Changing Demographics Loss of Surge Capacity  Decrease in Staffed Beds

Solutions Involve System Change Who funds Surge Capacity?  To prevent Diversion  To assure appropriate Preparedness How to staff Surge Capacity?  Training  Retention Setting Facility Priorities  Emergency Response

Additional Information Illinois Department of Public Health Emergency Response Program 525 West Jefferson Street Springfield, IL Phone: 217/ Web: