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Friday Program

MM. EMR Best Practices: Pearls of Wisdom To Increase Clinical Efficiency

08:00 – 09:45
For a full description, please see Wednesday’s description.
08:30 – 09:45

The Joplin Tornado

The past decades sent us a clear message that we are just here as hosts on this planet. Catastrophic disasters, man-made or natural, can claim millions of lives in a few seconds and there is nothing we can do about it. We can only stand and watch. Well, we can do something after it happened. We can help those who are endangered and their families. There is a lot we can do in the aftermath. The ability to respond effectively is something that we simply must develop.

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.

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

Describe the challenges of measuring surge at the health care organization level.
Discuss and weight the advantages and disadvantages of a no-notice surge assessment.
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.

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

Describe emergencies and disasters as a cyclic phenomenon with predictable stages (event, response, recovery, preparation).
Explain why disasters are a social construct with roots in the culture, economics and government of the affected community.
Discuss the negative consequences from limiting Emergency and Disaster leadership to response.
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.

Discuss the Gaylord Opryland response to the 2010 Flood: pre and post disaster.
Describe the lessons learned for evacuating a large-scale hotel.
Review the business end of hazard and risk mitigation.
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

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.

Describe the challenges of multi-level response and inter-agency and governmental partnerships.
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.

Cite real-life cases of evacuations and shelter in place due to projected direct impact storms.
Discuss utilization of patient safety systems before, during, and after evacuations.
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

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.

Develop problem-solving skills by working through actual challenges faced on deployments.
Discuss strategies for responding to deployment challenges.
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

We hope that this workshop will be helpful and educational. We need to send a message and involve more people who want to become professional responders in disasters to come as we are certain that there will be more and more of these. So we need each and every single one who could contribute to the endangered areas. The inclusion of ordinary citizens is crucial.