NDMS 2005 Conference 2 May 2005

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NDMS 2005 Conference 2 May 2005 Medical
Surge Capacity -- Innovations in Community-Based
Solutions
Jim Cocke, CHE, CHFM, MBA Carolinas HealthCare
System Charlotte, NC
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Introduction

• Jim Cocke
• My job is Facility Safety Officer for Carolinas
  Medical Center in Charlotte, NC. CMC is an 800
  bed Level 1 Trauma Center and is part of CHS, the
  4th largest public not for profit hospital system
  in the US. There are over 1,500 beds in 7
  Charlotte hospitals

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Outline

• Background on Charlotte-Mecklenburg
• Relevant Agencies
• Exercises Findings
• Questions Discussion

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Three Key Points

• Trust and empower each other to action
• Contacting people
• Supporting each other

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Charlotte, NC is the county seat and nearly the
entirety of Mecklenburg County, County Size is
795,000 people on 526 square miles 120,000 people
enter the county daily to work
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The Metrolina area contains attractive targets in
nuclear, rail, sports venues, and banking, We
seem to have a singular distinction for the US
two nuclear plants within 25 miles Charlotte is
at the center of the largest consolidated rail
system in the United States, CSX and Norfolk
Southern Lowes Motor Speedway, Bank of America
Stadium concentrate an impressive array and
number of residents and visitors
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Fortune 500 Companies Headquartered in Charlotte
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Business Targets

• Charlotte is ranked fifth in the nation for the
  number of Fortune 500 companies headquartered in
  Charlotte
• Second largest financial center in the nation,
  behind only New York, with Bank of America,
  Wachovia, and a branch of Federal Reserve, with
  more than 1.3 trillion in assets (compared to
  128 billion)
• Second largest trading floor, after Wall Street

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Pace-setting Preparedness

• Advanced Local Emergency Response Team
• MED-1
• All Hazards Area Committee
• North Carolina Hospital Association
• Regional Advisory Committee
• State Medical Assistance Team
• Joint Medical Operations Committee

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ALERT

• ALERT was created in 1998 to support terrorism
  response activities where mass casualties might
  result from a weapon of mass destruction or other
  natural or man-made disaster.
• ALERT is a multi-agency terrorism response team
  designed to treat patients in a mass casualty
  setting.

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ALERT, continued

• Participants include over 100 representatives
  from local, state and federal law enforcement
  agencies, firefighters, paramedics, environmental
  health personnel, nurses, physicians, and
  chaplains.
• ALERT represents a unique cooperative effort
  among public safety organizations, and has served
  as a model to cities around the country who
  wished to form their own organizations to handle
  the aftermath of a terrorist incident.

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MED-1 Mobile Emergency Department-1

• Hospital surge capacity decreases and
  vulnerability increases with mass casualties
  disasters therefore, our emergency response
  leaders decided to create an alternative
  treatment facility to augment existing resources
  and to support the capabilities of local health
  care systems.
• The staff at Carolinas Medical Center developed
  Carolinas MED-1 over a three-year period to
  include the necessary and anticipated level of
  care required when disasters or mass casualty
  incidents occur.

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MED-1

• This one-of-a-kind mobile treatment facility
  serves as a prototype for other communities, as
  well as our federal government, looking to expand
  existing mobile health care program and to
  provide rapidly deployed full-capability mobile
  health care.
• (http//www.carolinasmed-1.org/Background.cfm)

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Alternate Care Facility

• Another key development in our surge capacity is
  our county Sheriffs offer to use one of the jail
  facilities as an alternate care facility for the
  hospital.
• We are now developing plans to stock and support
  this alternate care facility with capabilities of
  housing and treating up to an additional 250
  patients.
• The jail has a secure sallyport, is already
  furnished

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All Hazards Advisory Committee

• Connects the Local Emergency Planning and
  Advisory Committee into a much larger and
  enhanced environment
• Representatives from all concerned agencies
• All Hazards Plan for Charlotte-Mecklenburg

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Regional Advisory Committee

• Coordinating disaster planning and response
  resources for health care
• Metrolina Trauma Advisory Committee
• The Strategic Disaster Preparedness Plan for
  Metrolina Hospitals

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North Carolina Hospital Association

• A Mutual Aid Agreement among hospitals provides
  the needed legal underpinning and protections for
  the health care providers throughout North
  Carolina to appropriately support each other in
  disaster operations.
• This was a NCHA statewide success for 2004.
• 122 of 123 North Carolina hospitals ratified the
  state-wide mutual aid agreement

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SMAT II

• The State Medical Assistance Program created SMAT
  to provide mobile fast response teams for
  decontamination and medical assistance to
  declared disasters in North Carolina.
• NC has 8 SMAT II teams composed of up to 120
  trained and fully equipped nurses, EMTs, MDs and
  ancillary support personnel.

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SMAT II continued

• The team has a 34 foot box trailer equipped with
  medical equipment supplies, a 17 feet X 20 feet
  three-lane decontamination tent with raised
  floor, hot water generator, electrical power
  generator, and heaters.
• SMAT II response adds to the surge capacity of
  any medical and decontamination site in or out of
  M-TACs region.

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Major exercises

• NDMS 14 June 2003
• Summer Breeze 21 June 2004
• CIRA 17 January 2005

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National Disaster Medical System

• A simulated earthquake occurring in the central
  United States.
• Test the plans and capabilities
• Receiving, triaging, and transporting the patients

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Operation Summer Breeze

• Biological terrorism exercise
• Determine the response capability for a
  biological scenario
• Stress agencies players

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Catastrophic Incident Response Annex

• Evaluate federal and local catastrophic incident
  response
• Evaluate and provide input for the National
  Response Plan

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Findings

• Communications break-downs
• between hospitals, between hospitals and county
  EOC
• Opportunities for improved inter-operability
  interdependence
• amazing array of assets are only a POTENTIAL
  benefit to the community until we learn what to
  ask each other for.

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Joint Medical Operations Committee

• ARC
• Public Health
• Mental Health
• Hospital systems
• Medical Examiners office
• University student health

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Goals

• Enhance communications, interoperability, and
  interdependence
• Implement team to improve work toward goals

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Improvement in Communications

• Through face-time at meetings semi-annual
  exercises
• Names with faces with agencies
• Go to people in agencies
• The people resources you need

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Special needs shelter issues

• A great example was a set of calls earlier this
  year bringing together ARC, RAC, Public Health,
  DSS, Hospitals, and others to discuss special
  needs shelters.
• We had, during an area-wide electrical power loss
  from a winter storm, realized our inability to
  adequately address medical care needs of citizens
  evacuated from their homes or facilities.
• The agencies are working together to adapt
  measures to provide appropriate care earlier to
  reduce unnecessary transport or hospitalization.
• As we learn to work together more effectively in
  planning and implementation we hardwire the
  needed processes and systems to handle our
  communitys needs. This will lead to protecting
  our communitys surge capacity during natural
  disasters as well as wmd disasters.

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Hospital Protection Plan

• Improving critical incident stress management
  measures
• Police, security, and other facility staff
  controlling entrances
• Fire and facility staff establishing
  maintaining decontamination

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In summary

• These are the keys
• Strengthening interagency collaboration
• Identifying partners for needed changes
• Drilling for weaknesses strengths
• People are our greatest potential resource for
  surge capacity development and management
• call together right people the first time for
  planning and implementation
• trust and empower each other to action when
  needed, and
• support each other in reaching solutions
• Our communities have the right people do the
  right people know each other?