OPERATIONALIZING A REGIONAL UNIFIED MEDICAL COMMAND OVERVIEW AND

OPERATIONALIZING A REGIONAL UNIFIED MEDICAL COMMAND OVERVIEW AND LESSONS LEARNED FROM HURRICANES KATRINA AND RITA Douglas Havron, RN, BSN, CEN Administrative Director Regional Hospital Preparedness Council Trauma Service Area Q Houston, Texas

Hurricane Katrina August 26, 2005 (Friday) – 1 PM Category 2 (100 mph)

Hurricane Katrina August 26, 2005 (Friday) – 11 PM Category 2 (105 mph)

Hurricane Katrina August 27, 2005 (Saturday) – 10 AM Category 3 (115 mph)

Hurricane Katrina August 27, 2005 (Saturday) – 10 PM Category 3 (115 mph) – 7 mph

Hurricane Katrina August 28, 2005 (Sunday) – 7 AM Category 5 (165 mph) – 12 mph

Hurricane Katrina August 28, 2005 (Sunday) – 10 AM Category 5 (165 mph) – New Orleans calls evacuation

Hurricane Katrina August 28, 2005 (Sunday) – 6 PM Category 5 (165 mph) Tropical Force Winds hit New Orleans less than 8 hours after evacuation called

In the Beginning…. n Evolution n n HMMRS Grant Hospital Planning Group HRSA Funding Grant Hospital Preparedness Task Force Regional Hospital Preparedness Council

Corridor Designations Downtown Southeast Southwest North

TSA-Q: Vital Statistics n n n n n Regional Population 4. 5 million (2000 Census) Counties/Sq Miles 9 Counties/ >9500 Healthcare facilities 97 Trauma Centers Level I 2 Level II 0 Level III 7 Level IV 15 Pediatric Hospitals 2 ED visits per year 1. 75 Million (Abaris Group, 2005) Specialty Hospitals 41 (LTAC, Rehab, Psych, Surgical, Women’s) Hazard Vulnerability Assessment Surge Capacity Issues High Diversion rates

Regional Hospital Preparedness Council n Purpose n n n Regional Planning and Preparedness Coordinated Heath Care Response Multi-disciplinary Plan Implementation NIMS Compliant Structure Oversee regional HRSA requirements

Regional Hospital Preparedness Council n Requirements: n n n n Local and Regional HVA Coordination with Tribal Nations/International Borders Coordination with Special Needs Populations Planning for Rural Readiness Communities Credentialing Surge Capacity Isolation Capacity Pharmaceutical Cache

Regional Hospital Preparedness Council n Cross-jurisdictional n n n n Hospital “Corridors” – Acute, Specialty, LTAC Texas Medical Center Health Departments – City, County, State EMS Council of Governments (HGAC) VA/NDMS Liaison SNS Planning regions Offices of Emergency Management – City and County

Catastrophic Medical Operations Center n Mission n n Protect and maintain medical infrastructure of all regional healthcare facilities Provide appropriate transfer to healthcare facilities based on capacity and capability Identify and meet the healthcare needs of the region Maintain patient tracking records

Catastrophic Medical Operations Center n n City of Houston Office of Emergency Management Established Command Center n n n Phone Number E-mail Multidisciplinary Team n n n n n City of Houston Health Department Texas Medical Center Metro Red Cross HFD/HPD US Military Federal Agencies Established Transportation Sector Established Patient Tracking Mechanism

CMOC Command Structure

Local To Federal Span

Planning efforts MOAs n NIMS compliant Job Action Sheets n Hospital Surveys n Databases built n Relationships established n Redundant communication n Multidisciplinary Corridor Meetings n

Operational efforts n Established Command Center n n n Phone number E-mail account Multidisciplinary Team n n n n Public Health Corridor Leaders Texas Medical Center Transportation Special Needs Patient tracking mechanism Communication to the region’s healthcare entities

Hurricane Katrina n Mission and Objectives n Appropriate patient placement n Hospital Capacity § HMMRS § EMSystem n Hospital Capability § Trauma, Neuro, Ortho § Medical, OB, Cath Lab, Dialysis, etc n n Identify non-911 EMS availability Coordinate with GPT, VA Command NDMS

Hurricane Rita September 22, 2005 (Thursday) – 2 PM Category 5 (173 mph) – 9 mph

Major Evacuation Choke Points # of Lanes SH 59 SH 290 I-45 I-10 2 1 2 2 Total 7

Basic Evacuation Math Est. Evacuation Population Est. Evacuation Vehicles per Lane per Hour Total Vehicles per Hour Time to Clear Vehicles 1. 5 MM 750, 000 2, 000 14, 000 53 hours

Hurricane Rita n Mission and Objectives n n n Assist with evacuation of facilities in storm surge areas Assist with evacuation of facilities in 100 -year flood zone Assist with evacuation of “At-Risk” Facilities Facility specific resource requests Assist with evacuation of medial special needs Other specific requests (ie: dialysis, technologically dependent)

Hurricane Rita n Hospitals in Evacuation Zone of Category 5 Kindred Bay Area Hospital Triumph Hospital East Houston Christus St. John Hospital UTMB Galveston Mainland Medical Center San Jacinto Methodist Clear Lake Medical Center Clear Lake Rehab Hospital Memorial Hospital Southeast Triumph Hospital Baytown East Houston Regional Medical Center Cornerstone of Houston – Clear Lake

Hurricane Rita n Revised Mission and Objectives n n Re-unification of evacuated facilities, including patients and staff Coordination with state and federal initiatives Facility specific resource requests Assist with evacuation of newly affected facilities

Hurricane Rita n Additional Hospitals/Facilities Requiring Evacuation: Christus St. Elizabeth’s Memorial Hermann Baptist Cleveland Regional Tyler County Hospital Memorial Hermann Orange Christus St. Mary’s Bayshore Matagorda Sabine County Hospital Doctor’s Hospital Parkway Doctor’s Hospital Tidwell Livingston Memorial Jasper Memorial Hospital Jasper Dickerson Hospital Newton, Texas Port Arthur, Texas Kinder, Louisiana

Hurricane Rita n Operations n n Appropriate patient placement from evacuated areas n Hospital capabilities n Hospital capacity n Transport method n Transport time Allocate resources to 911 calls, hospital requests, shelter needs, etc

Accomplishments n 29 healthcare facilities evacuated during Hurricane Rita n Coordination with 34 Counties and 2 States n Transportation and transfer of 3300+ patients into alternative healthcare settings for patients that could not be placed otherwise

Accomplishments n Tracking of thousands requesting assistance with alternative sheltering for Special Needs n Patient tracking and special needs database n Secondary transfers due to inappropriate initial placement -. 08% (n=2/2400)

Benefits to Region n The CMOC allows for a single point of contact for the hospitals in the region, eliminating duplicate requests for information from multiple agencies. n Communication with 97 facilities was achieved utilizing EMSystem® which provides a means for information sharing with all hospitals, public health, and EMS on regional developments, facility capacity, total patient volumes, resource needs, and significant events.

Benefits to Region n De-identified data can be provided in periodic briefings regarding the status of all hospitals to other command centers and local, state, and federal governing agencies. n Coordinating placement using a systematic method of patient placement based on hospital capability, capacity, current patient volumes, and the patient’s needs prevents hospitals from becoming overwhelmed

Regional Lessons Learned n Significant surge capacity can be found when: n n n Patients are transferred to LTAC, specialty hospitals, and other long term care environments Hidden surge capacity exists within hospitals Surge capacity greater when patients are dispersed evenly Surge capacity is increased when patients are placed in appropriate healthcare facilities, rather than the closest facility Establish early communications with other metropolitan command centers

CMOC Lessons Learned n Enough expertise, flexibility and support to accommodate changing missions n Regional intra-agency communication with redundant systems n Hospital maps for out of region or out of state EMS providers n NDMS system n Sufficient numbers of trained staff for the duration of the mission n Administrative buy-in to allow hospital and EMS employees to work in the CMOC

Recommendations n Based on the operations demonstrated by the RHPC in the Houston region, it is suggested that a regional Unified Medical Command be implemented in the daily operations of all communities. By having the ability to concurrently monitor hospitals’ capabilities and capacities, as well as direct all transporting EMS agencies, the RHPC has proven that a coordinated patientfocused collaborative healthcare response decreases the overall burden of healthcare delivery to all healthcare providers, patients, and families.

Closing Comments Healthcare is one of the most important infrastructures in all communities and should have a seat in the Emergency Operations Center, just as public works, police, fire/EMS, and transportation during an event. It would serve this country well if the JCAHO, medical, nursing, and hospital administrative organizations mandated the integration of medical command into the emergency operations centers of every community.

Catastrophic Medical Operations Center cmoc@cityofhouston. net 713 -884 -4408 Douglas Havron, RN, BSN, CEN 832 -492 -3300 Doug. Havron@settrac. org