FRIDAY, MAY 25 TH

At 5:41 p.m. on May 22, 2011, St. John’s – Mercy Hospital in Joplin, Missouri took a direct hit from an EF-5 tornado. Immediate activation of a statewide hospital mutual aid agreement enabled efficient and effective hospital response prior to Federal declarations and state executive orders. The mutual aid agreement provided the framework for hospitals across Missouri to immediately respond with regional assets for communication and medical surge while providing the structure and documentation needed for Federal reimbursement.

The tornado caused complete destruction of one hospital requiring the evacuation of 183 patients within 90 minutes of impact. Emergency medical services from four states quickly responded to begin triage, treatment and transport of patients and victims. The resulting surge during the next 12 hours at the neighboring hospital required treatment of approximately 500 patients in the emergency department, treatment and release of 400-600 patients in established triages and the provision of approximately 400 CT scans and 22 critical surgeries.

The secondary location for patient and victim transport was approximately 75 miles away. Two acute care hospitals in this community each received approximately 125 patients and victims through various modes of transportation. The statewide approach to emergency preparedness planning utilizing funds from the ASPR Hospital Preparedness Program and adopting the Medical Surge Capability and Capacity tier structure provided the foundation for an effective response. However, despite an overall successful response, debriefings and after-action reports identify lessons learned and opportunities for improvement.

This panel presentation will focus primarily on the following lessons learned and subsequent planning and preparedness policy changes,

  • Development of a chain-of-custody documentation system needs to accompany any resources provided through the MAA.
  • Development of a process, separate from technology and tools, to tag and track patients in a mass casualty event. Procedures need to be developed for a back-up plan for receiving hospitals to initiate patient tracking to support the efforts of impacted hospitals.
  • Continue to refine redundant systems for communication to increase likelihood of tactical communication capabilities with massive infrastructure loss.
  • Continue to refine mass casualty plans for sudden, catastrophic surge and basic field triage.

  1. Summarize the regional hospital response through the statewide mutual aid agreement.
  2. Identify specific lessons learned for managing an immediate surge of trauma patients during a mass casualty event.
  3. Identify specific lessons learned for managing patient identification and tracking during a mass casualty event.

  • Emergency Physicians
  • EMT/Paramedics
  • Health Education Specialists
  • Healthcare Executives
  • Nurses
  • Pharmacists
  • Physicians
  • Respiratory Therapists

08:30 – 09:45

Numerous challenges face hospitals preparing for disasters and public health emergencies, including rampant emergency department (ED) crowding, routine “boarding” of admitted patients in ED, frequent diversions of inbound ambulances, packed ICUs, and diminishing numbers of specialists willing to take ED call. All of these issues have an effect on the surge-ability of a health care facility. While every health care facility needs to be able to increase capacity quickly, the ability to do so is rarely quantified.

The Joint Commission requires hospitals to periodically conduct disaster drills, but these events are usually scheduled and often highly choreographed. This can provide a falsely reassuring view of surge capacity. As a result health care organizations may be caught off guard during true emergencies when readily foreseeable bottlenecks compromise their ability to manage a sudden influx of patients. To fill this gap, HHS/ASPR is collaborating with RAND Health to develop a no-notice assessment tool (including a scenario and performance metrics) that hospitals and healthcare coalitions can use to assess their operational capability to surge in response to a mass casualty incident. The overall goal is to create a simple and inexpensive assessment that can be used by a wide variety of hospitals on a regular basis to identify operational challenges and spur improvement.

This session will present an overview of the assessment tool, including its intent and key features, and provide participants the opportunity to offer feedback to HHS on the design, use, and possible expansion of the tool.

  1. Describe the challenges of measuring surge at the health care organization level.
  2. Discuss and weight the advantages and disadvantages of a no-notice surge assessment.
  3. Construct improvements to the current draft of a hospital surge stress test.

  • Emergency Physicians
  • EMT/Paramedics
  • Health Education Specialists
  • Healthcare Executives
  • Nurses
  • Pharmacists
  • Physicians
  • Respiratory Therapists

08:30 – 09:45

You’ve been tapped to lead an urgent, large-scale disaster response to a hard-hit community across the country—or around the world. The mission is difficult, the consequences are high. You have just a few hours to turn hundreds of team members into an effective and cohesive high-speed organization. Where do you start?

This session will discuss strategies used by ASPR Regional Emergency Coordinators who lead the Federal medical response in the field. How to “stand up” a command element, create a leadership presence and vision, and how to share it, will also be discussed.

This session will explore how to establish a shared mission culture that projects integrity, confidence, and competence and will look at the important difference between talking and doing, and having the courage to act decisively.

Finally, we will discuss the concept of “servant leadership”, and how it empowers team commanders and responders to create the best possible outcomes for those in our care, and still care for our own responders.

  1. Explain the differences between coordination, management, command, and leadership. What is the right approach to direct, motivate, or inspire?
  2. Discuss how to lead when you’re “not in charge.”
  3. Explore tools and techniques to coordinate leadership efforts across the theater of operation – how to encourage leadership at all levels.
  4. Discuss how to recover from challenges and setbacks, and how to celebrate successes.

  • Certified Counselors
  • Dentists
  • Emergency Physicians
  • EMT/Paramedics
  • Environmental Health
  • Health Education Specialists,
  • Healthcare Executives
  • Industrial Hygienists
  • Marriage & Family Therapists
  • Morticians
  • Nurses
  • Pharmacists
  • Physicians
  • Respiratory Therapists
  • Social Workers
  • Veterinarians

08:30 – 09:45

This presentation will view emergency and disaster preparedness, response and recovery from a leadership perspective. It will argue that response is the least important, least successful and most expensive aspect of emergency management and that preparedness and mitigation are the cornerstones of a robust emergency management program.

Preparedness: Emphasis will be made on the critical role of preparedness and what leaders should be doing at the community and regional level to facilitate resiliency. This will include the need for better public education that addresses historic and cultural bias about disaster and how these inaccurate perceptions position communities for catastrophe.

Response: Best leadership practices for response will focus on the presenters personal experiences. Emphasis will again focus on response preparation and the realities of leadership during crisis.

Recovery: Viewing disaster as a cyclic and inevitable occurrence will be introduced. From this perspective the opportunities associated with recovery that positively affect community resiliency and preparedness will discussed.

  1. Describe emergencies and disasters as a cyclic phenomenon with predictable stages (event, response, recovery, preparation).
  2. Explain why disasters are a social construct with roots in the culture, economics and government of the affected community.
  3. Discuss the negative consequences from limiting Emergency and Disaster leadership to response.
  4. List the most effective leadership strategies for nurturing disaster resiliency within a community.

  • Certified Counselors
  • Dentists
  • Emergency Physicians
  • EMT/Paramedics
  • Environmental Health
  • Health Education Specialists,
  • Healthcare Executives
  • Industrial Hygienists
  • Marriage & Family Therapists
  • Morticians
  • Nurses
  • Pharmacists
  • Physicians
  • Social Workers
  • Veterinarians

08:30 – 09:45

On May 3, 2010, the Music Valley neighborhood of Nashville including the entire Opryland Hotel complex and its surrounding campus were flooded with 5 to 10 feet of water. The overflow of the Cumberland River, which is now being recognized as a 1000 year flood, had jumped its banks after two days of raining. Prior planning had identified the Opryland complex as a “NOT at RISK” location and a potential resource for the community. However this was not the case and local large scale response challenges emerged.

“Five Feet High and Rising,” is a Johnny Cash song about flooding and the progression of increased intensity. The Opryland Hotel needed to move 1500 guests to another area and assure their safety. This presentation will focus on the dynamic decisions and the strategic response of the Gaylord Opryland staff. Beyond the response, new ideas and planning concepts have been implemented from this first-hand experience.

  1. Discuss the Gaylord Opryland response to the 2010 Flood: pre and post disaster.
  2. Describe the lessons learned for evacuating a large-scale hotel.
  3. Review the business end of hazard and risk mitigation.
  4. Discuss the necessity of new local partnerships in large scale disasters.

  • Certified Counselors
  • Dentists
  • Emergency Physicians
  • EMT/Paramedics
  • Environmental Health
  • Health Education Specialists
  • Healthcare Executives
  • Industrial Hygienists
  • Marriage & Family Therapists
  • Morticians
  • Nurses
  • Pharmacists
  • Physicians
  • Social Workers
  • Veterinarians

08:30 – 09:45

The U.S. Environmental Protection Agency (EPA) mission is to respond to immediate threats from releases of hazardous substances and oil. The first priority is to eliminate any danger to the public. By the end of 2007, EPA had conducted over 9,400 removal actions1 at more than 6,900 sites. Over the last 40 years, the nature of the contaminants, number of responses by potentially responsible parties and the capacity and capability of States has varied.

Each of EPA’s 10 Regional Offices has developed a strong emergency response and removal program, tailored to work with and complement the varying capabilities of local and State agencies for responding to the types of oil and hazardous substances releases that occur in their Region. Each EPA Region deals with a unique mix of industries, geography, and State and local response agencies. Still, the program acts as a Federal safety net to allow for response to immediate threats when such response is necessary (e.g., when the nature, size or complexity of a spill is beyond the capacity or capabilities of the State or local responders).

Each year, more than 20,000 emergencies involving the release (or threatened release) of oil and hazardous substances are reported in the United States, potentially affecting both communities and the surrounding natural environment. Emergencies range from small scale spills to large events requiring prompt action and evacuation of nearby populations. EPA coordinates and implements a wide range of activities to ensure that adequate and timely response measures are taken in communities affected by hazardous substances and oil releases where state and local first responder capabilities have been exceeded or where additional support is needed.

EPA’s emergency response program responds to chemical, oil, biological, and radiological releases and large-scale national emergencies, including homeland security incidents. EPA conducts time-critical and non-time-critical removal actions when necessary to protect human health and the environment by either funding response actions directly or overseeing and enforcing actions conducted by potentially responsible parties. The Stafford Act (PL-93-288) provides the authority for the Federal government to respond to disasters and emergencies in order to provide assistance to save lives and protect public health, safety, and property.

  1. Explain how EPA works with State, local, and tribal governments, along with other Federal agencies, who play a critical role in preventing, preparing for, and responding to emergencies of all kinds.
  2. Discuss how the Stafford Act (PL-93-288) provides the authority for the Federal government to respond to disasters and emergencies in order to provide assistance to save lives and protect public health and safety.
  3. Recite an over view of the more than 20,000 emergencies involving the release (or threatened release) of oil and hazardous substances are reported in the United States.

  • Certified Counselors
  • Dentists
  • Emergency Physicians
  • EMT/Paramedics
  • Environmental Health
  • Healthcare Education
  • Healthcare Executives
  • Industrial Hygienists
  • Marriage & Family Therapists,Morticians
  • Nurses
  • Pharmacists
  • Physicians
  • Social Workers
  • Veterinarians

08:30 – 09:45

This presentation will include local, state and national perspectives of volunteer utilization in disaster events. There will be brief overview of the NY state event and MRC/ESAR-VHP and ARC involvement. Participants will be able to identify the ServNY program/structure, the conditions that lead up for the need for the deployment of volunteers in NYS, how the state implemented the response, the challenges and the lessons learned from the volunteer deployment and what changes will need to be more successful for a future deployment plan of operations.

From the local perspective, presenters will focus on the local response and how the local structures that are already in place responded to and partnered with ARC and state involvement. There will also be information from the American Red Cross national health services operations in general and the Enhanced Service delivery model (scope of practice) and Functional Needs support services. Presenters will focus on lessons learned and challenges such as type of storm, rolling event, start of ARC operations in NYC, Public Health role.

  1. Describe the challenges of multi-level response and inter-agency and governmental partnerships.
  2. Explain the ARC Enhanced Service delivery model (scope of practice) and Functional Needs support services and how that fits in with MRC and ESAR-VHP.

  • Certified Counselors
  • Dentists
  • Emergency Physicians
  • EMT/Paramedics
  • Environmental Health
  • Health Education Specialists
  • Healthcare Executives
  • Marriage & Family Therapists,Nurses
  • Pharmacists
  • Physicians
  • Psychologists
  • Social Workers

08:30 – 09:45

This presentation will identify a system of advanced preparation and coordination for safe evacuations of a Federal health care facility with a clinically complex patient population. It will describe geographic challenges and provide examples of integrated emergency management systems.

The presenters will discuss recommendations for increasing resiliency and ensuring sufficient logistical and clinical systems for shelter-in-place versus evacuation. Patient Safety protocols will be examined for shelter in place and evacuation of acute psychiatry, chronic spinal cord injury, palliative care, and homeless patients. This presentation includes an application of social media for employee, patient, and community information in real-time format.

The presenters give senior executive perspectives that will demonstrate systems of communication proven to be successful in sustaining operations and recovering staff and patients during and after hurricane events in an integrated multi-regional market.

  1. Cite real-life cases of evacuations and shelter in place due to projected direct impact storms.
  2. Discuss utilization of patient safety systems before, during, and after evacuations.
  3. Assess perspectives of senior leadership team and incident command leaders in sustaining facility operations and completing successful recovery efforts.

  • Certified Counselors
  • Dentists
  • Emergency Physicians
  • EMT/Paramedics
  • Environmental Health
  • Health Education Specialists
  • Healthcare Executives
  • Industrial Hygienists
  • Marriage & Family Therapists
  • Nurses
  • Pharmacists
  • Physicians
  • Social Workers

08:30 – 09:45

Both Canada and the United States have adopted national emergency response systems that incorporate the use of Emergency Support Functions (ESFs). ESFs provide the mechanisms for grouping functions most frequently used in providing Federal support to states, provinces, territories and other Federal departments and agencies prior to or during an emergency.

ESFs describe the roles and responsibilities of Federal departments and agencies, and are allocated to Federal government institutions in a manner consistent with their respective mandates, policies and legislation. While the ESF architecture used in the United States and Canada is similar, there are significant and important variations between the two countries where the delivery of public health, medical and human services is concerned.

In Canada, the Public Health Agency of Canada is assigned the lead for ESF #5 of the Federal Emergency Response Plan, “Public Health and Essential Human Services”. In the U.S. National Response Framework, the Department of Health and Human Services is assigned as the ESF Coordinator as well as the primary agency for ESF #8, “Public Health and Medical Services.” In this session, the two complementary ESFs will be compared and contrasted to provide an analysis of the similarities and differences regarding their scope, concepts of operations and delivery arrangements, and the session will also highlight any perceived gaps in emergency planning in the public health and medical fields.

Participants at this session will gain a better understanding of the ESF concepts in both countries, as well as learn how the two ESFs are expected to interact during a cross-border emergency where public health, medical, and human services aspects are involved. In addition, both countries are in the beginning stages of working out the details of how both medical personnel and medical countermeasures could be shared with the other country.

An update on this work will also be presented in the context of each countries’ ESF.

  1. Recite an understanding of how ESFs in Canada and the U.S. are structured regarding the Federal response to public health, medical, and human services aspects of an emergency in each country.
  2. List ESF resources used in Canada and the United States and how they may augment and support the primary Federal government programs, arrangements and other measures used to deliver ESFs.
  3. Explain how the Canadian and U.S. ESF resources and assets are deployed and utilized in the event of a cross-border emergency.

  • Certified Counselors
  • Dentists
  • Emergency Physicians
  • EMT/Paramedics
  • Environmental Health
  • Health Education Specialists
  • Healthcare Executives
  • Industrial Hygienists
  • Marriage & Family Therapists
  • Nurses
  • Pharmacists
  • Physicians
  • Social Workers

08:30 – 09:45

This fun, interactive session will challenge participants to solve problems faced during actual responses. Attendees will be presented with a challenge faced by ESF 8 responders during a deployment. Participants will then be able to pick one solution, using the Audience Response System, and see the responses of other audience members before finding out how the real-life responders reacted.

  1. Develop problem solving skills by working through actual challenges faced on deployments.
  2. Discuss strategies for responding to deployment challenges.
  3. Develop problem solving skills and new strategies to respond to disasters and public health emergencies.

  • Emergency Physicians
  • EMT/Paramedics
  • Healthcare Education
  • Healthcare Executives
  • Nurses
  • Pharmacists
  • Physicians

10:00 – 12:15

Global disasters during the past decade remind us that catastrophic disasters, both natural and manmade, continue to claim the lives of millions. The ability to respond effectively varies substantially between citizens, governments, nongovernmental organizations and international organizations.

Dr. Isaac Ashkenazi of the Harvard School of Public Health has drawn lessons about training professional responders from the recent disasters, including physicians, nurses, EMT/ Paramedics, Pharmacists, Dentists, Environmental Health and other allied healthcare professionals. He discusses the limits of government preparedness the inclusion of ordinary citizens in preparedness planning for disasters.

In developing training for professional responders, leaders must understand that mistakes will be made and that they ensure the lessons of those mistakes are shared so others can learn from them. In an environment demanding perfection, where mistakes are forbidden, they get hidden, and the result is a culture of blame, not learning. Dr. Ashkenazi’s research has focused on urban terrorism and the increasingly complex role of governmental disaster response in foreign crisis situations, such as in Haiti’s devastating earthquake, the Japanese Tsunami and Earthquake and others.

This session will review his recent research, including “Disaster Response: A Decade of Lessons Learned Post 9/11” and the speaker’s personal experience of key lessons learned, including strategies for future U.S. international engagement.

  1. Discuss the complexities of international disaster response.
  2. Differentiate the roles of citizens, government trained responders and nongovernmental or private sector actors.
  3. Explain general lessons learned and their application for improved USG international response.

  • Certified Counselors
  • Dentists
  • Emergency Physicians
  • EMT/Paramedics
  • Environmental Health
  • Health Education Specialists
  • Healthcare Executives
  • Industrial Hygienists
  • Marriage & Family Therapists
  • Morticians
  • Nurses
  • Pharmacists
  • Physicians
  • Psychologists
  • Respiratory Therapists
  • Social Workers
  • Veterinarians

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