1. NEMA-ASTHO-GHSAC Joint Policy Workgroup
Hurricane Matthew ESF 8 Brief
January 11, 2017

2. North Carolina Healthcare Preparedness Regions
Cherokee
Graham
Swain
Clay
Macon
Jackson
Haywood T r a n s y l v i
Henderson
Buncombe
Madison
Yancey M t c h e
Avery
McDowell
Polk
Rutherford
Burke
Cleveland
Caldwell
Watauga
Ashe
Wilkes
Alleghany
Alexander
Lincoln
Gaston
Iredell
Mecklenburg
Rowan
Stanly
Union
Cabarrus
Hoke
Cumberland
Robeson
Sampson
Bladen
Columbus
Brunswick
New
Hanover
Pender
Duplin
Onslow
Carteret
Jones
Wayne
Lenoir
Craven
Pamlico
Greene
Hertford
Bertie
Martin
Pitt
Gates
Beaufort
Hyde
Washington
Tyrell
Dare C u k m d P q o w
Davidson
Guilford
Randolph
Montgomery
Alamance
Orange
Durham
Surry
Yadkin
Stokes
Forsyth
Davie
Rockingham
Caswell
Harnett
Johnston
Wilson
Nash
Edgecombe
Person
Granville
Vance
Warren
Franklin
Halifax
Northampton
Anson
Richmond
Scotland
Chatham
Moore
Lee
Catawba
Wake
This is the mechanism we use to implement this program:
Eight healthcare preparedness regions that are coalitions of hospitals, public health, EMS, emergency management, and ancillary healthcare partners at the local level
The are managed out of eight lead hospitals in our state, moving east to west: Vidant, New Hanover, WakeMed, Duke, UNC, Wake Forest Baptist, CMC, and Mission
These regional programs are responsible for two main areas: preparedness (planning, training, education, exercises) and response (equipment and personnel to respond during events) and the I think the context of this program is important as we talk about the medical side of the response.
Within each of these eight regions, there are caches of assets and resources that can respond during an event that affects local, regional, or statewide events like Matthew.
As we mentioned, as this program focus federally evolved, how we implement it at a state level has also evolved and the threats and hazards we face.
Mountain Area Healthcare Preparedness Coalition
Mid Carolina Regional Healthcare Coalition
Triad Healthcare Preparedness Coalition
CapRAC Healthcare Coalition
Metrolina Healthcare Preparedness Coalition
Eastern Healthcare Preparedness Coalition
Duke Healthcare Preparedness Coalition
Southeastern Healthcare Preparedness Region

3. State Medical Response System Operational Missions
Medical sheltering
Field medical care
Alternate care facility
Logistical/resource support
Within each of the eight regions on the response side of the equation, these are the major operational priorities and missions we have been tasked to provide.
Medical sheltering: state medical support shelters that are scalable to meet the unique needs of community members who need medical assistance, but not long term medical care in a hospital, staffed by healthcare organizations and local emergency medical services agencies and medical volunteers (picture bottom right)
Field medical care: field medical stations in support of MCIs (picture bottom left)
Alternate care facilities: for affected healthcare facilities
Other logistical/resource support generators, HVAC units, cots, etc. Transportation support through scalable ambulance strike teams, mass evacuation buses, etc.
These are the main capabilities we provided during Matthew through our healthcare preparedness regions/coalitions

4. Hurricane Matthew Missions
Duration: Oct. 3-23, 2016
Personnel: 210
Sheltering support
Transportation
EMAC assistance
Medical sheltering
Field medical stations/ mobile hospitals
Medical support to healthcare and shelters
Logistical support to shelters
CISM assistance to responders
Strength of response was the result of partnerships with health care organizations and local emergency medical services agencies
This is a high level overview of the missions and assets and resources deployed during Matthew.
The important thing to note is the range of missions as the forecast changed.
Initially, we were not forecasted to experience significant direct impact from the storm. We supported evacuating healthcare facilities from South Carolina through sheltering assistance (cots, supplies, and personnel) and in transportation through mass evacuation buses that deployed from NC to assist with several healthcare facilities.
When it appeared that our colleagues in Florida communities were going to be heavily impacted, we spun up medical sheltering packages, transportation support, and components of the Mobile Disaster Hospital to deploy in support of the response there.
As Matthews track changed and impact to NC was going to be more significant,
Transportation assets staged and deployed through out event from mass evacuation buses and ambulance strikes teams across eastern NC
two state medical support shelters were deployed (one located in Goldsboro and one in Johnston County outside of the impacted zone)
5-bed emergency department/field medical station to Kinston (highlight this bullet for purpose of presentation)
CHS MED 1 mobile emergency department to Lumberton
Medical supplies to healthcare organizations and shelters through personnel, oxygen, assistance with pharmaceuticals, etc.
HVACs, generators, shower trailers all deployed to gen pop shelters
Provided critical incident stress management debrifing support to first responders.
Over a three week period, we had over 210 personnel deployed through approximately XX HCOs and XX local EMS agencies

5. Mobile Asset Overview-MDH
Two 5-bed Mobile Emergency Departments (hard structure)
21-bed Emergency Department (soft structure) with X-ray unit, clinical lab, pharmacy and medical supply (hard structures) and logistical support (soft structures)
12-bed ICU with medical supply and logistical support unit (hard structures)
One Operating Room including C-Arm and Operating Microscope with surgical processing, medical supply and logistical support (hard structures)
In addition to the regional capabilities listed above, North Carolina was the caretaker of a DHS asset, Mobile Disaster Hospital, and are now the owner of the asset outright due to a transfer to NC from DHS.
This is an asset that assists in maintaining healthcare continuity of healthcare operations through a combination of hard structured slide out trailers and temporary structures and soft-sided structures in tents.
These are the capabilities that are provided through this asset and portions of this, and a similar asset managed out of CHS MED-1 which will be discussed on next slide, were also deployed during Matthew.
Over 150 patients seen during 10 days on station

6. Lenoir County Response
Hurricane Matthew, 2016
Lenoir County Response
NCBM Feeding 20K Kitchen
Lenoir Memorial Hospital
Fueling Station - NCEM
Mobile Hospital – OEMS
Trailer of Water – 15 Pallets
Trailer of MRE’s – 26K
NCTF 9 Swiftwater Rescue
RRT4 Shower Facilities
NC ALE Security
Ambulance Strike Team
Light Tower
Landing Zone
EastCare Helo
USCG Helo
FINAL – 10/19/2016
7 Patients transported by EastCare
1 Patient transported by USCG
AST transported 5 Patients to MDH from southside
ALS Units transported 1 patient to Craven Regional
Total treated and released was 64
Incident total patients - 77
Lenoir Community College
The State Emergency Response Team used predictive analysis to determine what structures would be flooded as well as the duration and depth of flooding. This allowed us to ensure medical assets were in place on both sides of the flooded area.
Southwood Memorial Church
Southwood Elementary School
Deep Run Baptist Church
Trailer of Water – 15 Pallets
Trailer of MRE’s – 26K
Deep Run is located further down in the county and is not shown on this map.

7. Mobile Asset Overview-MED 1
Carolinas MED-1 Overview:
4 Critical Care Beds (ICU capable with ventilator and hemodynamic monitoring capability). Built in central monitor for all monitored beds
1 or 2 Bed Operating Room/Resuscitation Room. All invasive capability found in CMC Level I Trauma Center available including digital ultrasound. The OR has a separate entrance
10 additional patient beds
Wi-Fi, satellite communications
Medical equipment includes X-ray, ultrasound, I-stat laboratory, IV Pumps, CBC Diff Machine
The external tent structure houses up to 100 additional patients, these would be lower acuity patients or those who have no place to go (pending census allows)
Full Emergency Department Pharmacy
Developed, owned, and operated by Carolinas Healthcare System.
Deployable for special events via contract or under the direction of the State Emergency Response Team via MOU
System-funded, NOT federally-funded
During Matthew response, augmented medical surge to affected hospital in Lumberton that had critical services disrupted
In 9 days, 220 patients, including one delivery of healthy baby

8. EMAC Deployed 20 Disaster Nurses from Tennessee to NC Shelters
Deployed 6 Mental Health Counselors from South Carolina to NC Shelters
EMAC Personnel were Outstanding - NC needs to do a better job in Tracking & Management

9. Worked with Healthcare Ready to identify potential Mobile Pharmacies
PRESCRIPTIONS
Medical Personnel in Shelters worked with Walmart and local Pharmacies to provide Refills to Shelter Occupants
Healthcare Ready, a Business EOC partner, shared locations of open Pharmacies so we could determine which were closest to Shelters (Rx Open)
Worked with Healthcare Ready to identify potential Mobile Pharmacies

10. Lessons Learned Importance of partnerships
Flexibility of program and organizations to respond to evolving threats
Modular and scalable response component
Mission Ready Packages developed and tested pre-event
Focus moving forward on training/education/exercise to inform planning
Data resources during planning phases to inform response

11. Questions