1. National Mass Care Exercise: Evaluating Missouri’s Surge Capacity July 28, 2016 1 Conference Phone Number: 1-888/822-3280 Participant Code: 354537#

2. Housekeeping This offering is being recorded and will be made available following today’s delivery. Please mute your lines to reduce unintended feedback. Do not place your line on hold. Please utilize the webinar software to ask questions of the presenters. 2

3. National Mass Care Exercise Missouri to host the National Mass Care Exercise August 22-25, 2016 Scope: Test Missouri’s evacuation and mass care plans Selected to serve as the joint HPP/PHEP exercise ESF-8 (health and medical) involvement — state public health officials, healthcare coalitions and members’, and the Missouri Disaster Response System (MoDRS) 3

4. Scenario 7.7 earthquake affecting the New Madrid Seismic Zone Day 1 of exercise play: Monday, August 22 Three days post incident for purposes of mass care objectives ESF-8 leadership will disseminate a pre-exercise briefing on Friday, August 19, to health and medical partners and conduct a HAvBED query. 4

5. ESF-8 Objectives (state-level/HCC) Demonstrate the capability of the Medical-Incident Coordination Team (M-ICT) to exchange information among state ESF-8 and medical partners to enhance situational awareness, including resource requests. Determine the deployment prioritization of the regionally pre- positioned ESF-8 communications assets. Region C and the Southeast healthcare coalitions will establish recovery priorities for the respective regional healthcare systems. 5

6. ESF-8 Objectives (state-level/HCC) Each regional healthcare coalition will demonstrate: The capacity to establish an incident management structure to coordinate actions to achieve incident objectives during the response The ability to enhance situational awareness for its members during the response The capability of redundant means of communication for achieving and sustaining situational awareness Immediate Bed Availability (IBA) 6

7. ESF-8 Objectives (state-level/HCC) Missouri Disaster Response System (MODRS) Fatality strike team capacity Communications between sites Deployment of assets — request, movement, operations Just-in-time supply management Volunteer management 7

8. ESF-8 Objectives (state-level/HCC) Region A Regional Healthcare Coordination System Medical surge capacity 8

9. General Timeline Friday, August 19 HAvBED Query – Statewide **Encouraging hospitals to enter accurate data** Monday, August 22 SEOC/ERC activated Communications MODRS Deployment Tuesday, August 23 SEOC/ERC activated HCC Activation/Situational Awareness Hospital Surge: IBA Form M-ICT Activation Wednesday, August 24 Recovery in Regions E and C Medical Surge Coordination in Region A Thursday/Friday High-level hot washes among HPP, PHEP and State partners Please forward feedback from local and regional activities, as you deem appropriate 9

10. Surge Capacity Monitoring 10

11. HAvBED Federal program Hospital Available Beds for Emergency and Disasters 75% response benchmark Missouri conducts monthly drills to ensure appropriate hospital contacts receive the notification/request and can complete the query in the four hour requested timeframe. Currently, Missouri maintains a statewide response rate of 79% Beginning in August and going forward, participants will be encouraged to enter accurate bed information during the monthly queries. 11

12. HAvBED When a HAvBED request is activated at the federal level, two data points from each facility are collected and submitted. Available Staffed Beds, by category this is what is requested and populated by hospital staff during the live query. Bed Capacity, by category These are the total number of physical beds, by category. These numbers are entered into the Resource Detail View of EMResource on an annual basis, and updated as necessary when bed capacity information changes. Together, these numbers provide better perspective as to the hospital’s availability vs. their capacity. 12

13. Immediate Bed Availability Definition: The ability of healthcare coalition members to provide no less than 20 percent of staffed (and unstaffed*) beds within four hours of a disaster. Three components: Continuous monitoring across the health system Off-loading of patients who are at low risk for untoward events through reverse triage On-loading of patients from the disaster 13

14. Suggested Surge Strategies Organizational Activities Prioritize critical and non-essential services, redirecting resources most appropriately. Identify patients suitable for early discharge to reduce census, making beds available for higher acuity patients. Defer elective procedures to maximize facility staff, space and supplies. Adjust staffing ratios and/or configurations based on minimum staffing requirements. Supplement staffing through agency support, activation of the MHA Mutual Aid Agreement and/or Show-Me Response. Utilize on-site alternate care sites, within existing licensure parameters, for patient triage and treatment. Regional or State-level Activities Coordinate patient transfers and/or supplementation of resources through health system or regional hospital support. Request the arrangement of a community-based or regional alternate care site. 14

15. 15 Medical Surge Former Construct Additional Surge MED/SURG/OB Step Down ICU Additional Surge ICU Step Down MED/SURG/OB New Construct 20% Source: ASPR Hospital Preparedness Program staff

16. 16 Immediate Bed Availability: Aspirational Stroke/MIs High Acuity Psychiatric Patients ICU Patients Acute Surgical Patients Imminent OB Delivery Convalescing Awaiting Discharge Behavioral Health Issues Social Issues Post Operative Patients Elective Procedures Cancelled Home Community Health Centers Long Term Care Acute 20% Hospital(s) HCC Partners Source: ASPR Hospital Preparedness Program staff

17. Measuring Surge Capacity During the NMCE Friday HAvBED Query – please enter accurate bed availability Please consider updating your bed capacity details prior to the NMCE This information can be found on your hospital resource detail view. All hospitals will be prompted to do so by calendar year end. Tuesday Immediate Bed Availability Form activated at 8:30 a.m. Sequence: Notice/Banner activated on EMResource visible to all users The notice will prompt the emergency preparedness contact, or the most appropriate person determined by each facility, to select the “IBA” icon at the top of the EMResource page to launch the form. The form will collect: the contact information of the person completing the form the surge planning considerations that have been evaluated by the organization in identifying their immediate bed availability the bed availability, following the notional implementation of the surge strategies 17

18. IBA Form Details 18

19. Description/Definition Definition: The ability of healthcare coalition members to provide no less than 20 percent of staffed (and unstaffed*) beds within four hours of a disaster. Purpose: This statewide query is being activated to collect individual hospital bed capacity data that will be aggregated at the healthcare coalition level. Provide information for exercise play Analyze to determine if Missouri HCCs have met the 20% benchmark 19

20. Suggested Surge Strategies Surge Strategies Considered (Yes/No) Prioritize critical and non-essential services Early Patient Discharge Adjust staffing ratios Cancellations of outpatient surgeries Supplemental staffing On-site alternate care sites Note: Only organizational strategies have been listed 20

21. Collection of staffed and unstaffed bed data Complete this section based on the number of staffed beds that could be made available in each category after surge strategies are put in place. Adult ICU Adult Medical Surgical Pediatric ICU Pediatric Medical Surgical Psychiatric Complete this section based on the number of unstaffed beds* that could be made available in each category after surge strategies are put in place. Adult ICU Adult Medical Surgical Pediatric ICU Pediatric Medical Surgical Psychiatric * regional and state partners may evaluate mutual aid and Show Me Response as possible solutions to expand surge capacity 21

22. Demographic/Contact Information Name Position/Job Title Phone Number Email Address Facility Name Region Address City 22

23. Comments Please provide your feedback on this process and how it could be improved for future surge planning activities. 23

24. Not to exceed without waiver (Licensed Beds) Physical beds (Bed Capacity) Staffed and unstaffed available beds after surge strategies have been put in place (IBA) Staffed, available beds (HAvBED) 24

25. Contact Information Paula Nickelson Missouri Department of Health and Senior Services Paula.Nickelson@health.mo.gov Ian Saxton Mid-America Regional Council isaxton@MARC.ORG John Whitaker St. Louis Area Regional Response System john.whitaker@ewgateway.org Jaclyn Gatz, MPA Missouri Hospital Association jgatz@mhanet.com 25

26. Questions 26