New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency...
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![Page 1: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/1.jpg)
New Lessons and Ideas from Receiving Hospitals in
the Gustav Evacuations
National Emergency Management Summit
Doug Brown – ACHEmergency Management Coordinator
Ron Crane – UAMSEmergency Preparedness Manager
March 5, 2009
![Page 2: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/2.jpg)
Road Map
• Chronology• Preparation• Patient Reception• Aftermath• Issues & Ideas• Lessons Learned
![Page 3: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/3.jpg)
Little Rock, we have a problem!
![Page 4: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/4.jpg)
CHRONOLOGY
![Page 5: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/5.jpg)
NDMS History of FCC Little Rock
• Activated in 2005 for Katrina & Rita– Received patients via Ground & Air
• Activated in 2008 for Gustav– Received patients via Air
• Little Rock, Arkansas FCC has had more activations and patient receptions than any other FCC / NDMS Jurisdiction
![Page 6: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/6.jpg)
PREPARATION
![Page 7: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/7.jpg)
Prior to Reception
• Metro Hospital Leadership met to discuss strategies & tactics
• Hospital Liaison Officer & Deputy selected to be onsite and interface with IC
• Creation of “Net Control” Position, pseudo COML
• Multiple communications platforms activated
![Page 8: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/8.jpg)
Preparation
• All Little Rock NDMS Reception Hospitals ready and prepared
• Massive EMS mutual aid response not just metro area, but statewide
• Great cooperation from Central Flying Service & Little Rock National Airport – served as the NDMS Reception Site
![Page 9: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/9.jpg)
Preparation Continued• Arkansas Department of Health on scene
and assisted with data management
• Local & Statewide Offices of Emergency Management provided support
• Little Rock Air Force Base personnel assisted with patient movement from planes to triage
• VA EMRT provided medical & transport support
![Page 10: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/10.jpg)
Activation• Thursday, August 28 – FCC receives
official alert notice of potential activation
• Friday, August 29 – Official activation notice for Little Rock FCC
• Saturday, August 30 – Notified to begin receiving patients by noon, first patients received at 22:57
• Sunday, August 31 – 12 additional flights till conditions deteriorate
![Page 11: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/11.jpg)
PATIENT RECEPTION
![Page 12: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/12.jpg)
Patient Reception
![Page 13: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/13.jpg)
Patient Reception
![Page 14: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/14.jpg)
Patient Reception
![Page 15: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/15.jpg)
NDMS Receiving Hospitals
• Arkansas Children’s Hospital
• Arkansas Heart Hospital• Baptist Medical Center –
Little Rock• Baptist Memorial – North
Little Rock• Central Arkansas
Veterans Healthcare System
• Conway Regional Medical Center
• North Metro Hospital• Saline Memorial - Benton• St. Vincent Infirmary• St. Vincent – Sherwood• University of Arkansas for
Medical Sciences• Jefferson Regional
Medical Center – Pine Bluff
![Page 16: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/16.jpg)
Receiving Hospital Totals
• Arkansas Children’s – 2• Arkansas Heart – 9• Baptist Little Rock – 42• Baptist N Little Rock – 25• Conway Regional – 9• Jefferson Regional – 6• North Metro – 7• Saline Memorial – 15
• St. Vincent – 46• St. Vincent North – 16• UAMS – 24• VA – 24
• GRAND TOTAL of 225
![Page 17: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/17.jpg)
Reception of Aircraft
• Over a 40 hour non-stop period the NDMS hospitals prepared for and received 13 total aircraft
• C-130 8/30 22:57• C-130 8/31 04:25• C-17 8/31 07:48• C-130 8/31 10:15
• C-17 8/31 13:00• C-130 8/31 14:00• C-130 8/31 14:30• C-130 8/31 16:40• C-130 8/31 19:50• C-17 8/31 19:55• C-17 (Canadian) 8/31
20:10• C-130 8/31 21:20• C-130 8/31 21:21
![Page 18: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/18.jpg)
AFTERMATH
![Page 19: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/19.jpg)
After the “Rush”
• Feeling very good about the work we did
• Created new paradigm…we think
• Very good coordination with local partners
• No real plan yet to get folks back…but, “it’s cool.”
• Downtime and turning off
• Solidified position as EM with “outsiders”
![Page 20: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/20.jpg)
The Dreaded Census
• Most hospitals are at or near capacity
• Administration beginning to ask what do we do for discharge
• Questions as to whether there is a plan for repatriation
• IKE!!!!
![Page 21: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/21.jpg)
Conference Call HELL• NDMS / HHS / USPHS / FEMA, State
Agencies, Louisiana Department of Health & Hospitals, Arkansas Hospital Association, Local Hospitals, Arkansas Department of Emergency Management, Red Cross, Arkansas Department of Human Services, Louisiana DRCs, and then Federal Contractors, plus other states that received a fraction of what we did!
![Page 22: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/22.jpg)
ISSUES & IDEAS
![Page 23: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/23.jpg)
Uh Oh…The BIG GAGGLE• Conference Calls reveal there is no real
plan to repatriate patients
• Much confusion amongst reception hospitals as to how to handle discharges
• State and NGOs brought in…more confusion
• Feds, although effort laudable, create more consternation and confusion
![Page 24: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/24.jpg)
If you want something done right…
• By September 17, most patients have not left LR Metro area
• Incredible Frustration with Contractor
• #$%* FEMA NUMBERS!!!
• UAMS discharges all patients at 100% cost to themselves
• Hospitals begin renting buses and directly contacting LA Hospitals directly
![Page 25: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/25.jpg)
More of the same…• After 3 ½ weeks of interminable
conference calls and numerous administrative strokes / MIs, patients finally begin moving
• Federal requests difficult to accomplish
• Family members / attendants accompanying patients now inpatients
• Fatalities
![Page 26: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/26.jpg)
Freak Accident or Vigilance?
![Page 27: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/27.jpg)
LESSONS LEARNED
![Page 28: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/28.jpg)
What we learned…Bad News First• Headquarters ASPR/NDMS needs to
speak to the “boots on the ground”
• PROPS to TRANSCOM
• Numerous studies, but who did they talk to?
• REPATRIATION is not yet worked/figured out
• REIMBURSEMENT is a HUGE issue STILL!!!
![Page 29: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/29.jpg)
Lessons Learned
• Pre-activation
• During the Event
• Post Event & Repatriation
![Page 30: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/30.jpg)
Pre-activation• Monitor the weather…no matter where you
are
• Any storm with potential of land fall, we are closely watching
• Bolster communications capability
• Have a Go Team
• PLAN!
• Be wary of “politics”
![Page 31: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/31.jpg)
HOSPITAL LIAISON• PARADIGM SHIFT
• Remember, this is a Hospital Centric Op!
• Able to provide situational awareness / operational intelligence
• Protected hospitals during local surge events
• Interfaced with IC
• DON’T BE BULLIED!!!
![Page 32: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/32.jpg)
COMMUNICATIONS
• Interoperability is KEY!
• Have a COML / Net Control in place
• Multiple modes of comms
• Radio for FACT
• Conference Call for RUMOR CONTROL
• Bed Census, etc.
![Page 33: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/33.jpg)
During the Event…• Hospital Liaisons in place at reception site
• Communications with multiple agencies other than hospitals
• ADH & NDMS Area Emergency Manager (IC) worked very well to assist receiving hospitals
• Don’t be tied to one bed census
• Situational awareness KEY - WAITING
![Page 34: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/34.jpg)
Post Event…
• Until Repatriation / Reimbursement Issues worked out, be prepared to go it alone
• Be careful of overextending your bed capacity in the event of long stays
• Administration needs to be fully aware of consequences of receiving patients
• No NDMS reimbursement for ancillary cost
![Page 35: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/35.jpg)
Steps Forward / Proposal
• Pre-assigned FEMA #s to all evacuated patients
• CMS wavers to hospitals in not only impacted areas, but in reception areas too!
• Go Teams to embarkation points
• Ability to deal directly with evacuating hospitals
![Page 36: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/36.jpg)
Steps Forward / Proposal
• Ability for locals to pick a contractor(s) or repatriate themselves
• Fatality Management
• Need for Public Assistance / Individual Assistance
![Page 37: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/37.jpg)
Ideas for moving Forward
• Better process from activation to reception to include adequate notice from embarkation to reception sites
• Better coordination on ground in impacted areas
• Current NDMS Structure only identifies “broad” categories, need to rethink (dialysis)
![Page 38: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/38.jpg)
Ideas for moving Forward
• Hospital Liaison position greatly reduced need of subsequent transfers to different hospitals as opposed to Katrina
• NDMS has failed to recognize the need to extend the flow of patients through the entire continuum of care including step down, LTAC, Skilled nursing, and alternative care
![Page 39: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/39.jpg)
QUESTIONS???
![Page 40: New Lessons and Ideas from Receiving Hospitals in the Gustav Evacuations National Emergency Management Summit Doug Brown – ACH Emergency Management Coordinator.](https://reader035.fdocuments.net/reader035/viewer/2022070409/56649e985503460f94b9b214/html5/thumbnails/40.jpg)
Thank YouDoug Brown
Arkansas Children’s Hospital
501-680-3950
Ron Crane
UAMS
501-837-9682