Metropolitan Chicago Healthcare Council

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Metropolitan ChicagoHealthcare Council

• Emergency Preparedness Exercises 2009

Injects
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OBJECTIVE 1.

• Participating hospitals are able to safely
  evacuate a broad range of patients, staff, and
  visitors in accordance with existing evacuation
  plans.

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EVACUATING HOSPITAL Task 1.1 Priorities are
established with patient categories that need to
be evacuated first.

• Inject

• Expected Outcome

• A request comes in from the POD hospital wanting
  to know which patients are critical. They want
  to know how many of those patients are in each
  category.

• Evacuating hospital will be able to provide a
  listing of how many patients are critical (e.g.
  ICU, newborns).

4
EVACUATING HOSPITAL Task 1.1 Priorities are
established with patient categories that need to
be evacuated first.

• Inject

• Expected Outcome

• Evacuating hospital will be able to rapidly make
  decisions and provide a rationale for allowing
  certain types of patients to go home. They are
  able to discuss plans to arrange for
  transportation of these patients (e.g. contacting
  family members).

• There is increased tension among patients who
  feel that they can leave under their own power.

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EVACUATING HOSPITAL Task 1.2 Visitors are
provided with accurate, timely, and useful
instructions.

• Inject

• Expected Outcome

• Procedures for notifying visitors to leave the
  hospital are provided by the evacuating hospital.
  A means for getting the message to the visitors
  in a power outage are discussed.

• There are hundreds of visitors in many of the
  patient rooms and in the waiting room areas.

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EVACUATING HOSPITAL Task 1.2 Visitors are
provided with accurate, timely, and useful
instructions.

• Inject

• Expected Outcome

• Evacuating hospital activates staff to deal with
  upset parents. A strategy is developed to not
  make them part of the problem. Use of the Red
  Cross patient connection program is discussed.

• Many visitors are refusing to leave the hospital
  until they know what is going to happen to their
  loved ones. Parents in the pediatrics wing are
  especially upset.

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EVACUATING HOSPITAL Task 1.2 Visitors are
provided with accurate, timely, and useful
instructions.

• Inject

• Expected Outcome

• Security procedures for dealing with the visitors
  are discussed. Counselors are activated to deal
  with these visitors.

• Word has rapidly spread that the hospital is
  evacuating. There is a group of about 40
  visitors in the lobby demanding to accompany
  their loved ones. Three of these visitors have
  walked on their own to various parts of the
  hospital.

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EVACUATING HOSPITAL Task 1.2 Visitors are
provided with accurate, timely, and useful
instructions.

• Inject

• Expected Outcome

• The evacuating hospital begins to enter
  information regarding the destination hospital of
  patients who are evacuated.

• A HAN Alert is issued indicating that the Red
  Cross Patient Connection Program is activated.

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EVACUATING HOSPITAL Task 1.3 Staffing issues
are considered.

• Inject

• Expected Outcome

• Considerations regarding whether or not to call
  off staff are discussed.

• There is a clerical and nursing shift change
  scheduled to occur in one hour.

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EVACUATING HOSPITAL Task 1.3 Staffing issues
are considered.

• Inject

• Expected Outcome

• Hospital discusses safety precautions that are
  taken to protect staff.

• One elderly clerk has fainted after working in
  the building with indoor temperatures nearing 90

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EVACUATING HOSPITAL Task 1.3 Staffing issues
are considered.

• Inject

• Expected Outcome

• Human resource issues regarding the reassignment
  of staff are addressed.

• It is expected that the hospital will be
  completely evacuated within 8 hours. CDPH and
  IDPH inquire as to whether or not the staff from
  the evacuating hospital can fill any shifts to
  ease the burden on other surging hospitals.

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EVACUATING HOSPITALTask 1.4 Critical patients
are triaged and safely evacuated.

• Assumption

• Expected Outcome

• Inject cards will be distributed and patients
  will utilize props to simulate actual evacuation
  considerations.

• Evacuating hospital will apply tactical
  procedures as it pertains to a wide-range of
  patients with conditions in accordance with those
  patient profiles provided to the Great Lakes
  volunteers.

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EVACUATING HOSPITALTask 1.5 Facility recovery
issues are addressed.

• Inject

• Expected Outcome

• Indoor temperatures are expected to exceed 90
  and will persist for at least another 24 hours.

• Facilities unit leader will discuss the process
  that is being planned and considerations for
  getting the building back on line to accept
  patients.

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OBJECTIVE 2.

• Receiving hospitals are able to activate
  effective medical surge procedures in response to
  an increase in patients from the heat wave and
  receipt of patients from an evacuated hospital.

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RECEIVING HOSPITALTask 2.1 Uses of
non-traditional hospital space will be utilized
to meet surge demands.

• Inject

• Expected Outcome

• HICS group will make decisions based on the
  following considerations patient condition,
  expected length of stay, available space. Areas
  to be utilized will be identified.

• As a result of the extended heat wave, the
  receiving hospital is currently at 10 over their
  normal bed capacity. The receipt of additional
  patients from the evacuating hospital is likely
  to increase that surge to over 20 of normal bed
  capacity.

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RECEIVING HOSPITALTask 2.1 Uses of
non-traditional hospital space will be utilized
to meet surge demands.

• Inject

• Expected Outcome

• Hospital staff will begin to perform the function
  of preparing non-traditional space for surge
  demands. Patients will be placed in the space.

• With the rapid arrival of patients, it is assumed
  that the hospital will exceed 25 of bed capacity
  within the hour. Elective surgeries have already
  been cancelled and currently admitted patients
  are being reviewed for rapid discharge.

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RECEIVING HOSPITALTask 2.2 Hospitals are able
to activate procedures to rapidly register
patients.

• Inject

• Expected Outcome

• The HICS incident commander contacts the ED and
  needs to be able to know where all patients are
  being transferred within the hospital.

• Hospital begins to conduct rapid registration of
  all patients.

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RECEIVING HOSPITALTask 2.3 Hospitals address
issues as they relate to evacuated patients
arriving without adequate records.

• Inject

• Expected Outcome

• Three patients arrive to the hospital without
  medical records or medication lists. Two of the
  three are non-ambulatory and one is on a
  ventilator.

• Receiving hospital HICS group identifies
  agency/hospital to contact and information
  needed. Calls are made to appropriate points of
  contact.

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RECEIVING HOSPITALTask 2.4 Critical patients
are triaged and admitted.
Assumption
Expected Outcome

• Receiving hospital will apply tactical procedures
  as it pertains to a wide-range of patients with
  conditions in accordance with those patient
  profiles provided to the Great Lakes volunteers.

• Inject cards will be distributed and patients
  will utilize props to simulate actual medical
  surge considerations.

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OBJECTIVE 3.

• Chicago first responder agencies and Hospitals
  are able to collectively establish command and
  control and coordinate response actions as it
  pertains to movement of patients and management
  of fatalities utilizing NIMS and ICS.

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JOINT OPERATIONS CENTERTask 3.1 Command and
control under unified command is established.

• Assumption

• Expected Outcome

• Upon activation of the JOC, OEMC, CFD, and CDPH
  will identify staffing of various ICS lead roles.

• An incident commander, section chiefs and
  branches/units are identified and staffed

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JOINT OPERATIONS CENTER Task 3.1 Command and
control under unified command is established.

• Inject

• Expected Outcome

• A call comes into the resource hospital
  indicating that power has been lost and they may
  need to evacuate. The resource hospital contacts
  the POD as this will likely require regional
  coordination of resources.

• The POD and resource hospital discuss the
  criteria for expanding this to a regional
  incident and how the coordination occurs at the
  POD level. Resource management between the POD
  and Chicago responder agencies is addressed.

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JOINT OPERATIONS CENTER Task 3.2 The patient
connection system is activated.

• Inject

• Expected Outcome

• OEMC coordinates with other agencies at the JOC
  to determine how to reunite families with
  patients who are evacuated.

• Over 50 calls have been received by the 911
  center from family members of those evacuated.
  They want to know where their loved ones were
  sent.

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JOINT OPERATIONS CENTER Task 3.2 The patient
connection system is activated.

• Assumption

• Expected Outcome

• CDPH issues a HAN alert to all Chicago hospitals
  advising them to utilize the patient connection
  system for this emergency.

• Red Cross representative in the JOC recommends
  the use of the Patient Connection system.
  Hospitals need to be notified.

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JOINT OPERATIONS CENTER Task 3.2 The patient
connection system is activated.

• Inject

• Expected Outcome

• Red Cross and CDPH coordinate communications with
  the evacuating hospital to determine the
  destination of "missing" patients.

• Calls begin to be received by the Red Cross
  (notional) from family members inquiring about
  the status of their loved ones who have been
  evacuated. There are some patients who have been
  evacuated who are not in the system.

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JOINT OPERATIONS CENTER Task 3.3 The movement
of patients is communicated and coordinated by
the JOC, POD, and Evacuating hospital.

• Inject

• Expected Outcome

• JOC agencies collectively address the need for
  ambulance surge utilizing private providers.

• CFD ambulances have been overwhelmed by runs
  involving those victims of heat-related stress.
  The POD has received a request to move 120 high
  priority patients from Rush.

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JOINT OPERATIONS CENTER Task 3.3 The movement
of patients is communicated and coordinated by
the JOC, POD, and Evacuating hospital.

• Inject

• Expected Outcome

• CFD ambulances have been overwhelmed by runs
  involving those victims of heat-related stress.
  The POD has received a request to move 120 high
  priority patients from Rush.

• PPERS identifies where resources will be drawn to
  move these patients using private ambulance
  companies.

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JOINT OPERATIONS CENTER Task 3.3 The movement
of patients is communicated and coordinated by
the JOC, POD, and Evacuating hospital.

• Inject

• Expected Outcome

• Calls come into the POD from the evacuating
  hospital. They are requesting to move some of
  the non-critical patients utilizing some of their
  shuttle buses. There are approximately 145 of
  these non-critical patients.

• IDPH discusses the steps involved in granting a
  waiver to the hospital to grant movement of these
  patients in alternate vehicles.

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JOINT OPERATIONS CENTER Task 3.4 Briefings are
conducted by Chicago unified command.

• Inject

• Expected Outcome

• The City's incident commander conducts a briefing
  to the JOC group and over conference call to all
  HICS groups that join the call. The briefing
  identifies the command structure, resources
  ordered, and questions/answers from the hospitals
  regarding coordination.

• Hospitals in the region are calling the JOC
  trying to find out what the City is doing to help
  coordinate this emergency. They are wondering if
  they should coordinate directly with the POD or
  the JOC.

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JOINT OPERATIONS CENTER Task 3.5 Fatality surge
is coordinated by Chicago unified command.

• Inject

• Expected Outcome

• The City unified command group discusses options
  and identifies facilities to move these bodies.
  It is also determined who will move these bodies.

• Every Chicago hospital is reporting that as a
  result of the heat wave, they have experienced an
  increase in fatalities after they were admitted,
  particularly among the elderly. They have begun
  stacking in the hospital morgues and 5 hospitals
  have reported that they have begun to move bodies
  into non-traditional spaces such as conference
  rooms that are being kept cool by air
  conditioning. They will soon be facing a crisis
  to get these bodies to an alternate morgue site
  or funeral home. The electronic death records
  process has greatly slowed down their ability to
  move them to funeral homes. The Cook County
  Morgue is near capacity and is not accepting any
  more non-ME cases. Initial estimates are that 175
  bodies are required to be moved.

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JOINT OPERATIONS CENTER Task 3.5 Fatality surge
is coordinated by Chicago unified command.

• Inject

• Expected Outcome

• Unified command formulates decisions to move
  these fatalities.

• The evacuating hospital's morgue has lost
  refrigeration capability and will need to move
  the 12 dead patients immediately.

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JOINT OPERATIONS CENTER Task 3.5 Fatality surge
is coordinated by Chicago unified command.

• Inject

• Expected Outcome

• The medical examiner addresses steps related to a
  body that shows up without identification.

• The evacuating hospital has taken it upon
  themselves to transport two bodies in a van to
  the Cook County Morgue. One of those bodies is
  delivered to the morgue without identification.

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EVACUATING and RECEIVING HOSPITALSTask 3.6
Hospitals are able to activate key HICS
positions.

• Inject

• Expected Outcome

• Operations and logistics sections are clearly
  defined. A liaison officer is coordinating
  communications with Chicago ICS.

• The heat wave has forced the hospital to activate
  HICS to manage the surge in patient volume. The
  announcement of an evacuation has forced the
  hospital to mobilize all key HICS positions and
  begin coordination.

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OBJECTIVE 4.

• Hospitals are able to effectively utilize
  existing HAvBed and ESAR-VHP systems for the
  management of resources.

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JOINT OPERATIONS CENTER Task 4.1 Available bed
data is accurate and able to be accessed.

• Inject

• Expected Outcome

• The POD hospital is able to provide bed data to
  CFD for all hospitals within the EMS region.

• CFD EMS is aware of an increasing number of
  hospitals in Chicago that have gone on bypass.
  The EMS Chief needs information on available bed
  data to be able to effectively route patients.

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JOINT OPERATIONS CENTER Task 4.1 Available bed
data is accurate and able to be accessed.

• Inject

• Expected Outcome

• The POD hospital reaches out to other regional
  PODs and requests available bed data from the
  Christ Hospital POD and the Loyola POD.

• The Region 11 POD hospital indicates that many
  hospitals in the region are on bypass and
  beginning to exceed daily bed census by as much
  as 20.

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EVACUATING HOSPITALTask 4.2 ESAR - VHP is
utilized for the management of volunteers to meet
surge demands.

• Inject

• Expected Outcome

• CDPH assigns volunteers through the Illinois
  ESAR-VHP system to hospitals that have requested
  additional staff. Hospitals use the Illinois
  ESAR-VHP system to verify the credentials of the
  volunteers assigned to them.

• Hospitals across the city are experiencing staff
  shortages. Several affected hospitals have
  requested assistance in maintaining staffing.

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JOINT OPERATIONS CENTER Task 4.2 ESAR - VHP is
utilized for the management of volunteers to meet
surge demands.

• Inject

• Expected Outcome

• Facilities verify the credentials of the
  spontaneous volunteers using the Illinois
  ESAR-VHP system.

• Spontaneous volunteers have begun arriving at
  affected facilities.

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OBJECTIVE 5.

• Hospitals are able to communicate in operable and
  interoperable modes during an evacuation.

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EVACUATING HOSPITALTask 5.1 Internal
notifications are conducted to inform hospital
staff that an evacuation has been ordered.

• Inject

• Expected Outcome

• HICS communication unit will rapidly gather the
  information to be included in the message and
  broadcast the message to all appropriate staff in
  a facility without power.

• HICS has made the decision that an evacuation is
  warranted. At this point in time, numerous
  hospital departments have made cell phone calls
  to the command group seeking instruction.

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EVACUATING HOSPITALTask 5.2 Tactical operable
communications are effectively established.

• Inject

• Expected Outcome

• HICS communication unit will identify
  communication strategy to manage the evacuation
  within the hospital.

• Land line phones and public address systems are
  not working due to the power outage.

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EVACUATING HOSPITALTask 5.2 Tactical operable
communications are effectively established.

• Inject

• Expected Outcome

• All recipients of notification will acknowledge
  receipt of message. Message will be sent through
  either voice cellular, SMS text, Email, or text
  page.

• A call down to all HICS section chiefs and unit
  leaders will be conducted by the communications
  unit leader.

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EVACUATING and RECEIVING HOSPITALTask 5.3 HICS
and Chicago ICS agencies are able to establish
interoperable communications.

• Inject

• Expected Outcome

• A CDPH HAN Alert is issued indicating that Med
  Channel 9 will be utilized for the purposes of
  making broadcast announcements pertaining to the
  evacuation of City of Chicago hospitals.

• HICS command receive the HAN alert via cell
  phone, acknowledge receipt, and begin to monitor
  Med Channel 9.

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EVACUATING and RECEIVING HOSPITALTask 5.3 HICS
and Chicago ICS agencies are able to establish
interoperable communications.

• Inject

• Expected Outcome

• Two-way communication between the evacuating
  hospital and CDPH are established by providing
  brief situation reports. CDPH will acknowledge
  successful transmission of these reports.

• Inject The liaison officer at the hospital will
  need to communicate evacuation status with CDPH
  utilizing Med Channel 9.

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EVACUATING and RECEIVING HOSPITALTask 5.3 HICS
and Chicago ICS agencies are able to establish
interoperable communications.

• Inject

• Expected Outcome

• Hospitals utilize existing systems (landlines,
  cellular, paging, internet) for management of
  communications. Communication unit leader has
  the necessary contact information for the JOC.

• CDPH sends HAN to all area hospitals regarding
  evacuation. All hospitals not experiencing
  losses of power are requested to utilize routine
  communication devices.