PEDIATRIC SURGE TABLETOP EXERCISE KNOX/EAST TN HEALTHCARE COALITION APRIL 27, 2017
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
HCC R CC ROLES AN AND R RESPONSIBILITIES ▪ 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
PEDIATRIC PROJECT OVERVIEW AND BACKGROUND
PEDI PE DIATRIC PO POPU PULA LATION V VS H HOSPI PITAL L BEDS I IN KE KET H T HC County Pediatric County Pediatric County Pediatric Population Population 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
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…. ….
OVER ERALL AP APPROACH OVERALL APPROACH Purchase Pediatric Simulator Training 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 Supplies EMS providers Provide each hospital with ED equipment and supplies for 20 pediatric patients over and above their required amounts Spring 2017: Tabletop Exercise Fall 2017: Full Scale
TRAINI NING NG P PLAN ▪ ETCH CPRC/Trauma Coordinator will deliver pediatric mock codes and training opportunities 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.
PEDI PE DIATRIC S SUPPLI PPLIES F FOR R EMS ▪ Purchase for each ambulance in the region: ~ 300 ▪ Partnership with Region 2 EMS Director’s Association ▪ Budget: $37,000 ▪ Pedi-Sleeve ▪ Pedi-capable Tourniquets
PEDIATRI RIC C EMERGENCY CY C CARE RE F FACI CILITIES ▪ Tennessee maintains standards to ensure all emergency care facilities are ready for pediatric emergencies. There are four ▪ All facilities with an Emergency designations to choose Department are considered a from 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 CRPC • CRPC General Coordinator • Extensive Primary • Ancillary staff requirements requirements/reco • 24 hour MD regarding mmendations Basic coverage specialties, • Pediatric admission • Not required to • Surgical, anesthesia education, capabilities with a have 24 hour ED and radiological outreach, clinical designated requirements MD coverage support and pediatric • No pediatric • Basic pediatric more! department/area admission admission • May or may not capabilities capabilities have a PICU
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 S D SUPPLI PPLIES PLA PLANNING G GROUP P AND RA RATIONALE 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
PEDIATRIC ED SUPPLY CARTS- PEDI PE DIATRIC ED S D SUPPL PPLY C CARTS- ESTIMATED COST 79K FOR 21 CARTS ESTI TIMATE TED C COST 79K 79K F FOR 21 21 CAR CARTS Item (Number per Item (Number per cart) Item (Number per cart) 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 Diapers Size 1 (1 pk) Device EZ IO Pediatric Needles Pediatric Oral Rehydration Powder Diapers Size 2 (1 pk) (15) (20) EZ IO Stabilizers (20) Sippy Cups (20) Diapers Size 3 (1 pk) Buretrols (20) Pacifier Soothers (20) Diapers Size 4 (1 pk)
TABLETOP EXERCISE
OBJEC ECTIVES ES ▪ 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.
GUIDELI GU LINES ▪ Open, low stress, no-fault environment. ▪ Discussions are based on knowledge and CURRENT plans. ▪ This is a learning environment! Please share your ideas!
ASSUMPTI TIONS ▪ 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.
AGEND NDA 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
SCENARI RIO 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.
BRIEF EF GROUP D DISCUSSI SSION What initial notifications are initially made by the RMCC and how is the information disseminated?
REGIONA NAL MEDICAL C COMMUNI NICATIONS NS C CENT NTERS SEOC HOSPITALS Local EMA RMCC Ambulance Dispatch EMS 911 Centers Public Health Other Local FIRE & RMCC’s Law Enforcement
MODU DULE 1 1: INITI TIAL N NOTIFICATI TIONS A AND D PATIENTS ▪ 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.
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