New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Manageme

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New Lessons and Ideas from Receiving Hospitals in
the Gustav EvacuationsNational Emergency
Management Summit

• Doug Brown ACH
• Emergency Management Coordinator
• Ron Crane UAMS
• Emergency Preparedness Manager
• March 5, 2009

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Road Map

• Chronology
• Preparation
• Patient Reception
• Aftermath
• Issues Ideas
• Lessons Learned

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Little Rock, we have a problem!
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CHRONOLOGY
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NDMS History of FCC Little Rock

• Activated in 2005 for Katrina Rita
• Received patients via Ground Air
• Activated in 2008 for Gustav
• Received patients via Air
• Little Rock, Arkansas FCC has had more
  activations and patient receptions than any other
  FCC / NDMS Jurisdiction

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PREPARATION
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Prior to Reception

• Metro Hospital Leadership met to discuss
  strategies tactics
• Hospital Liaison Officer Deputy selected to be
  onsite and interface with IC
• Creation of Net Control Position, pseudo COML
• Multiple communications platforms activated

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Preparation

• All Little Rock NDMS Reception Hospitals ready
  and prepared
• Massive EMS mutual aid response not just metro
  area, but statewide
• Great cooperation from Central Flying Service
  Little Rock National Airport served as the NDMS
  Reception Site

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Preparation Continued

• Arkansas Department of Health on scene and
  assisted with data management
• Local Statewide Offices of Emergency Management
  provided support
• Little Rock Air Force Base personnel assisted
  with patient movement from planes to triage
• VA EMRT provided medical transport support

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Activation

• Thursday, August 28 FCC receives official alert
  notice of potential activation
• Friday, August 29 Official activation notice
  for Little Rock FCC
• Saturday, August 30 Notified to begin receiving
  patients by noon, first patients received at
  2257
• Sunday, August 31 12 additional flights till
  conditions deteriorate

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PATIENT RECEPTION
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Patient Reception
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Patient Reception
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Patient Reception
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NDMS Receiving Hospitals

• Conway Regional Medical Center
• North Metro Hospital
• Saline Memorial - Benton
• St. Vincent Infirmary
• St. Vincent Sherwood
• University of Arkansas for Medical Sciences
• Jefferson Regional Medical Center Pine Bluff

• Arkansas Childrens Hospital
• Arkansas Heart Hospital
• Baptist Medical Center Little Rock
• Baptist Memorial North Little Rock
• Central Arkansas Veterans Healthcare System

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Receiving Hospital Totals

• Arkansas Childrens 2
• Arkansas Heart 9
• Baptist Little Rock 42
• Baptist N Little Rock 25
• Conway Regional 9
• Jefferson Regional 6
• North Metro 7
• Saline Memorial 15

• St. Vincent 46
• St. Vincent North 16
• UAMS 24
• VA 24
• GRAND TOTAL of 225

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Reception of Aircraft

• Over a 40 hour non-stop period the NDMS hospitals
  prepared for and received 13 total aircraft
• C-130 8/30 2257
• C-130 8/31 0425
• C-17 8/31 0748
• C-130 8/31 1015

• C-17 8/31 1300
• C-130 8/31 1400
• C-130 8/31 1430
• C-130 8/31 1640
• C-130 8/31 1950
• C-17 8/31 1955
• C-17 (Canadian) 8/31 2010
• C-130 8/31 2120
• C-130 8/31 2121

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AFTERMATH
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After the Rush

• Feeling very good about the work we did
• Created new paradigmwe think
• Very good coordination with local partners
• No real plan yet to get folks backbut, its
  cool.
• Downtime and turning off
• Solidified position as EM with outsiders

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The Dreaded Census

• Most hospitals are at or near capacity
• Administration beginning to ask what do we do for
  discharge
• Questions as to whether there is a plan for
  repatriation
• IKE!!!!

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Conference Call HELL

• NDMS / HHS / USPHS / FEMA, State Agencies,
  Louisiana Department of Health Hospitals,
  Arkansas Hospital Association, Local Hospitals,
  Arkansas Department of Emergency Management, Red
  Cross, Arkansas Department of Human Services,
  Louisiana DRCs, and then Federal Contractors,
  plus other states that received a fraction of
  what we did!

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ISSUES IDEAS
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Uh OhThe BIG GAGGLE

• Conference Calls reveal there is no real plan to
  repatriate patients
• Much confusion amongst reception hospitals as to
  how to handle discharges
• State and NGOs brought inmore confusion
• Feds, although effort laudable, create more
  consternation and confusion

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If you want something done right

• By September 17, most patients have not left LR
  Metro area
• Incredible Frustration with Contractor
• FEMA NUMBERS!!!
• UAMS discharges all patients at 100 cost to
  themselves
• Hospitals begin renting buses and directly
  contacting LA Hospitals directly

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More of the same

• After 3 ½ weeks of interminable conference calls
  and numerous administrative strokes / MIs,
  patients finally begin moving
• Federal requests difficult to accomplish
• Family members / attendants accompanying patients
  now inpatients
• Fatalities

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Freak Accident or Vigilance?
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Lessons Learned
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What we learnedBad News First

• Headquarters ASPR/NDMS needs to speak to the
  boots on the ground
• PROPS to TRANSCOM
• Numerous studies, but who did they talk to?
• REPATRIATION is not yet worked/figured out
• REIMBURSEMENT is a HUGE issue STILL!!!

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Lessons Learned

• Pre-activation
• During the Event
• Post Event Repatriation

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Pre-activation

• Monitor the weatherno matter where you are
• Any storm with potential of land fall, we are
  closely watching
• Bolster communications capability
• Have a Go Team
• PLAN!
• Be wary of politics

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HOSPITAL LIAISON

• PARADIGM SHIFT
• Remember, this is a Hospital Centric Op!
• Able to provide situational awareness /
  operational intelligence
• Protected hospitals during local surge events
• Interfaced with IC
• DONT BE BULLIED!!!

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COMMUNICATIONS

• Interoperability is KEY!
• Have a COML / Net Control in place
• Multiple modes of comms
• Radio for FACT
• Conference Call for RUMOR CONTROL
• Bed Census, etc.

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During the Event

• Hospital Liaisons in place at reception site
• Communications with multiple agencies other than
  hospitals
• ADH NDMS Area Emergency Manager (IC) worked
  very well to assist receiving hospitals
• Dont be tied to one bed census
• Situational awareness KEY - WAITING

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Post Event

• Until Repatriation / Reimbursement Issues worked
  out, be prepared to go it alone
• Be careful of overextending your bed capacity in
  the event of long stays
• Administration needs to be fully aware of
  consequences of receiving patients
• No NDMS reimbursement for ancillary cost

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Steps Forward / Proposal

• Pre-assigned FEMA s to all evacuated patients
• CMS wavers to hospitals in not only impacted
  areas, but in reception areas too!
• Go Teams to embarkation points
• Ability to deal directly with evacuating
  hospitals

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Steps Forward / Proposal

• Ability for locals to pick a contractor(s) or
  repatriate themselves
• Fatality Management
• Need for Public Assistance / Individual
  Assistance

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Ideas for moving Forward

• Better process from activation to reception to
  include adequate notice from embarkation to
  reception sites
• Better coordination on ground in impacted areas
• Current NDMS Structure only identifies broad
  categories, need to rethink (dialysis)

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Ideas for moving Forward

• Hospital Liaison position greatly reduced need of
  subsequent transfers to different hospitals as
  opposed to Katrina
• NDMS has failed to recognize the need to extend
  the flow of patients through the entire continuum
  of care including step down, LTAC, Skilled
  nursing, and alternative care

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QUESTIONS???
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Thank You

• Doug Brown
• Arkansas Childrens Hospital
• 501-680-3950
• brownda1_at_archildrens.org
• Ron Crane
• UAMS
• 501-837-9682
• rcrane_at_uams.edu