PEDIATRIC SURGE TABLETOP EXERCISE KNOX/EAST TN HEALTHCARE COALITION - - PowerPoint PPT Presentation

KNOX/EAST TN HEALTHCARE COALITION APRIL 27, 2017

PEDIATRIC SURGE TABLETOP EXERCISE

KNO NOX/EAST T TN N HEALTHCA CARE RE C COALI LITION (KET H HC)

▪ Serves Knox and the 15 surrounding counties ▪ Over 1 million residents ▪ Participating organizations ▪ 20 acute care hospitals ▪ EMS ▪ Regional Medical Communications Center ▪ Local and State Emergency Management ▪ Local and State Public Health ▪ Regional Blood Bank ▪ Behavioral Health ▪ Homeland Security ▪ American Red Cross ▪ Regional Forensic Center

▪ HCCs serve as multiagency coordination groups that support and integrate with ESF-8 activities in the context of incident command system (ICS) responsibilities. ▪ Collaborate on healthcare emergency response and recovery planning, training, and exercising. ▪ Response actions include: ▪ Information sharing ▪ Resource coordination and management

HCC R CC ROLES AN AND R RESPONSIBILITIES

PEDIATRIC PROJECT OVERVIEW AND BACKGROUND

County Pediatric Population County Pediatric Population County Pediatric Population Anderson 16464 Grainger 5048 Morgan 4623 Blount 27376 Hamblen 14740 Roane 11285 Campbell 8949 Jefferson 11389 Sevier 19892 Claiborne 6775 Loudon 9868 Scott 5630 Cocke 7651 Monroe 9750 Union 4263 Knox 94490

Total Regional Pediatric Population: 258,193

Pediatric Hospital Beds: 137 NICU Beds: 121

PE PEDI DIATRIC PO POPU PULA LATION V VS H HOSPI PITAL L BEDS I IN KE KET H T HC

WH WHEN EN Y YOU A ARE A E AN A ADULT HO HOSPITAL DU AL DURING A A PEDIATRIC E EMERGE GENCY CY A AND D GE GET W WORD T THA HAT T EAST T T TN CHI HILD LDREN’S HO HOSPITAL L IS FULL…. ….

OVERALL APPROACH OVER ERALL AP APPROACH

Purchase Pediatric Simulator ETCH CPRC Coordinator to provide pediatric focused training to hospitals and EMS Focused on infants through 8 years Pediatric specific mass casualty supplies for region wide 911 EMS providers Provide each hospital with ED equipment and supplies for 20 pediatric patients over and above their required amounts Spring 2017: Tabletop Fall 2017: Full Scale

Training Supplies Exercise

▪ ETCH CPRC/Trauma Coordinator will deliver pediatric mock codes and training

• pportunities utilizing the HCC funded

Guamard Pediatric Hal Simulator. ▪ ETCH will cooperate with the 3 other CRPC’s to develop a standard trauma focused simulation and training with IRB approval and data collection methods that will allow a retrospective review of patient data pre and post training to attempt to document the benefits of simulation based training on the care of pediatric patients in Tennessee.

TRAINI NING NG P PLAN

▪ Purchase for each ambulance in the region: ~ 300 ▪ Partnership with Region 2 EMS Director’s Association ▪ Budget: $37,000 ▪ Pedi-Sleeve ▪ Pedi-capable Tourniquets

PE PEDI DIATRIC S SUPPLI PPLIES F FOR R EMS

▪ Tennessee maintains standards to ensure all emergency care facilities are ready for pediatric emergencies. ▪ All facilities with an Emergency Department are considered a Pediatric Emergency Care Facility ▪ Level of pediatric emergency care is self designated yearly with submission of the facility’s Annual Summary

PEDIATRI RIC C EMERGENCY CY C CARE RE F FACI CILITIES

There are four designations to choose from

PEDIATRI RIC C EMERGENCY CY C CARE RE F FACI CILITIES Basic Primary General CRPC

• Not required to

have 24 hour ED MD coverage

• No pediatric

admission capabilities

• 24 hour MD

coverage

• Surgical, anesthesia

and radiological requirements

• Basic pediatric

admission capabilities

• Ancillary staff

requirements/reco mmendations

• Pediatric admission

capabilities with a designated pediatric department/area

• May or may not

have a PICU

• CRPC

Coordinator

• Extensive

requirements regarding specialties, education,

• utreach, clinical

support and more!

PEDIATRI RIC C EMERGENCY CY C CARE RE F FACI CILITIES

Basic, Primary and General facilities share the same requirements in regards to:

• Quality Improvement
• Tracking of patient transfers and outcomes
• Community education
• Collaboration with a CRPC

Different designation levels have varying requirements for:

• Staffing education
• Leadership guidelines
• Supplies

ED SUPPLIES PLANNING GROUP AND RATIONALE

▪ Working group with representatives and input from: East TN Children’s, TN EMS-C, UT Medical Center, Covenant Health, Tennova Healthcare. ▪ Focus planning on infants and children up to 8 years of age based on American Heart Association (AHA) guidelines and Tennessee’s Pediatric Emergency Care Facility Rules and Regulations. ▪ Pediatric Census Data was analyzed from two of the primary adult focused health systems in East TN to help determine the need and distribution of items throughout the 3 categories of pediatric patients on the SMART Triage Tape. ▪ Develop a standard cart that has supplies to meet initial patient management needs for pediatric surge. The cart will have supplies to meet the following patient groups: ▪ 8 patients from 3-10 kilograms ▪ 8 patients from 11-18 kilograms ▪ 4 patients from 19-32 kilograms

ED S D SUPPLI PPLIES PLA PLANNING G GROUP P AND RA RATIONALE

PEDIATRIC ED SUPPLY CARTS- ESTIMATED COST 79K FOR 21 CARTS

Item (Number per cart) Item (Number per cart) Item (Number per cart) Large Roll Up Locker (1) SMART Triage Tape (2) Packable Blankets (20) Pediatric NRB (20) Mattress Warmer (20) Wipes (20 pks) BBGs (20) C Collars (Stiff Neck Pediatric) (20) Diapers Newborn (1 pk) EZ IO Driver (1) Pediatric Specific Immobilization Device Diapers Size 1 (1 pk) EZ IO Pediatric Needles (15) Pediatric Oral Rehydration Powder (20) Diapers Size 2 (1 pk) EZ IO Stabilizers (20) Sippy Cups (20) Diapers Size 3 (1 pk) Buretrols (20) Pacifier Soothers (20) Diapers Size 4 (1 pk)

PE PEDI DIATRIC ED S D SUPPL PPLY C CARTS- ESTI TIMATE TED C COST 79K 79K F FOR 21 21 CAR CARTS

TABLETOP EXERCISE

▪ Evaluate internal organizational plans ability to respond to a pediatric mass casualty event. ▪ Discuss the internal and external communications systems utilized during such events. ▪ Evaluate the resource needs and methods for requesting additional support. ▪ Define the organization’s ability to coordinate with outside agencies. ▪ Discuss how to manage and recover from a pediatric mass casualty in the healthcare system. ▪ Evaluate organizational and coalition reunification plans.

OBJEC ECTIVES ES

▪ Open, low stress, no-fault environment. ▪ Discussions are based on knowledge and CURRENT plans. ▪ This is a learning environment! Please share your ideas!

GU GUIDELI LINES

▪ Scenario is plausible. ▪ No hidden agenda. ▪ All players receive information at the same time. ▪ The school explosion has occurred in your OWN community.

▪ East TN Children’s Hospital and UT Medical Center are at capacity and receiving the most critical patients from the scene.

ASSUMPTI TIONS

Time Activity 11:30 Registration and Lunch 12:00 Welcome, Opening Remarks, and Background Review 12:20 Module 1 Briefing, Discussion, and Brief-Back 1:15 Break 1:25 Module 2 Briefing, Discussion, and Brief-Back 2:25 Break 2:35 Module 3 Briefing, Discussion, and Brief-Back 3:35 Break 3:45 Hotwash

AGEND NDA

It is 12:50pm. Local EMS notifies the Regional Medical Communications Center (RMCC) of reports of a school explosion during an assembly. Initial reports indicate as many as 50 children and adults in the area at the time of the explosion. Estimated number of causalities is unknown, but 911 calls report that the situation is dire.

SCENARI RIO

What initial notifications are initially made by the RMCC and how is the information disseminated?

BRIEF EF GROUP D DISCUSSI SSION

RMCC

HOSPITALS

Other RMCC’s 911 Centers

Ambulance Dispatch

Local EMA

Public Health

Local FIRE & Law Enforcement

EMS

REGIONA NAL MEDICAL C COMMUNI NICATIONS NS C CENT NTERS

SEOC

▪ It’s now 1300 and the first 5 patients start arriving at the hospital. ▪ Review the first 5 patient scenarios in your packet on page 22. ▪ Sample required resources for the patients are listed on pages 26 & 27. ▪ Consider your staffing and supply resources with the initial patients. ▪ Begin addressing Module 1 Questions on page 7. UTMC and ETCH will start on page 15. ▪ Discussion = 40 minutes.

MODU DULE 1 1: INITI TIAL N NOTIFICATI TIONS A AND D PATIENTS

1. Is this considered a pediatric disaster? Would your emergency operations plan/hospital command center be activated? Would the county EOC be activated? How is the initial EMS response managed and prioritized? 2. Describe specific communications needs and how to address them? 3. What are your staffing, supply, and environmental needs at this point? 4. How will your organization meet the current demand for pediatric care (beds, staffing, supplies, etc.) considering the specific details listed in the initial 5 patients scenarios? 5. What outside resources need to be considered at this time (blood products, fatality resources, EMS for transfers, others)? 6. For UTMC and ETCH ONLY: How will you communicate between ETCH and UTMC? How will you relate critical information to EMS regarding capacity at each facility for the most critical patients (i.e. which patients should go to ETCH and which should go to UTMC?) 7. For UTMC and ETCH ONLY: What will be your messaging to EMS and other hospitals in the region at this time regarding patient transfers? How will you spread the information?

MO MODUL ULE 1 1: QUEST STION ONS

▪ It’s now 1330 and you have received word from the RMCC that you will receive 5 additional pediatric patients to arrive in the next 3-4 mins. Parents, the media, and concerned citizens are descending on your

• rganization.

▪ Review the patient scenarios 6-10 in your packet on page 24. ▪ Sample required resources for the patients are listed on pages 26 & 27. ▪ Consider your staffing and supply resources with the additional patients. ▪ Begin addressing Module 1 Questions on page 9. UTMC and ETCH will start on page 17. ▪ Discussion = 40 minutes.

MODULE 2: R RECEIPT PT O OF REMAINI NING NG P PATIENTS NTS

1. How will you handle the increasing number of injured? Worried well? Hysterical parents? Staff members who may have had children involved in the incident? Describe specific communications needs and how to address them? 2. Where and how will you set up triage, family reunification, media areas, and other response areas at the scene and at the 3. Where will you identify and admit all unaccompanied pediatric patients? 4. How will you keep track of all the pediatric patients and reunify them with the appropriate family members? 5. What supply and resource needs will be critical to address based on the specific additional patient scenarios? 6. How is the community working together? Is there a competition for resources? How are you communicating with staff, patients, families, etc.? 7. If there were numerous fatalities involved, what is the capacity of the local medical examiner and regional forensic center to manage the event?

MO MODUL ULE 2 2: QUEST STION ONS

▪ Parents and community members will likely initially assume their children have been transferred to your organizations. How will you handle the increasing number of injured? Worried well? Hysterical parents? Staff members who may have children involved in the incident?

MODULE 2: 2: AD ADDITIONAL U UTMC AN AND ET ETCH CH QUESTION

▪ It’s now 1530 and you have received word from the RMCC that all patients have been cleared from the scene. Patients have been sent to numerous hospitals throughout the region. EMS resources are becoming limitedly available to assist with patient transfers. ▪ Consider your recovery needs during this phase of the event. ▪ Begin addressing Module 1 Questions on page 12. UTMC and ETCH will start

• n page 20.

▪ Discussion = 40 minutes.

MODU DULE 3 3: RECOVE VERY

• 1. With limited EMS resources available, how do you prioritize which pediatric patients

should be transferred to a higher level of care and which ones you can continue to manage internally? How does EMS manage and prioritize their resources during this phase considering the potential long commutes to out-of-area facilities?

• 2. How will the mental health needs of the staff, patients, and community be

addressed?

• 3. What steps need to be addressed to assure your organization can return to normal
• perations?
• 4. If this were a terrorist or criminal event, what additional measures would need to be

considered throughout this scenario? What would be different if the explosion resulted in hazardous materials contamination?

MO MODUL ULE 3 3: QUEST STION ONS

▪ What went well? ▪ Opportunities for Improvement? ▪ What new areas/skills/plans do we need to develop?

HOTWASH

THA HANK Y YOU F FOR R PARTI TICI CIPATI TING!

KETCOALITION.ORG