[PPT] - TRACIE HEALTHCARE EMERGENCY PREPAREDNESS INFORMATION GATEWAY PowerPoint Presentation

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TRACIE

HEALTHCARE EMERGENCY PREPAREDNESS INFORMATION GATEWAY

ASPR

ASSISTANT SECRETARY ~

OR

PREPAREDNES S AND RESPONSE

Establishing Medical Operations Coordination Cells (MOCCs) for COVID-19

April 24, 2020

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Unclassified//For Public Use Access the recorded webinar here: https:// attendee.gotowebinar.com/recording/256769356898835472 Access speaker bios here: https://files.asprtracie.hhs.gov/documents/establishing-mocc-for- covid-19-webinar-speaker-bios.pdf Access Q and A here: https://files.asprtracie.hhs.gov/documents/asprtracie-ta-mocc-webinar-qa-final.pdf

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l!!lir..L TECHNICAL

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asprtracie.hhs.gov 1-844-5-TRACIE askasprtracie@hhs.gov

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ASPR TRACIE: Three Domains

Self-service collection of audience-tailored

materials

Subject-specific, SME-reviewed “Topic Collections”
Unpublished and SME peer-reviewed materials

highlighting real-life tools and experiences

Personalized support and responses to requests for

information and technical assistance

Accessible by toll-free number (1844-5-TRACIE),

email (askasprtracie@hhs.gov), or web form (ASPRtracie.hhs.gov)

Area for password-protected discussion among

vetted users in near real-time

Ability to support chats and the peer-to-peer

exchange of user-developed templates, plans, and

ther materials

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Resources

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ASPR

TRACIE COVID-19 Page

– Critical Care Surge Resources – Hospital Triage/ Screening Resources – Regional Support Resources

ASPR COVID-19 Page CDC COVID-19 Page Coronavirus.gov

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TRACIE

HEALTHCARE EMERGENCY PREPAREDNESS INFORMATION GATEWAY

ASPR

ASSISTANT SECRETARY ~

OR

PREPAREDNES S AND RESPONSE zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA

Moderator: Meghan Treber, MS ASPR TRACIE

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TRACIE

HEALTHCARE EMERGENCY PREPAREDNESS INFORMATION GATEWAY

ASPR

ASSISTANT SECRETARY ~

OR

PREPAREDNES S AND RESPONSE zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA

Melissa Harvey, RN, MSPH Hospital Team Lead, Healthcare Resilience Task Force; Director, Health System Management, Office of the Chief Medical Officer, U.S. Department of Homeland Security

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6 Saving Lives. Protecting Americans.

Executive Summary

Some hospitals are

verwhelmed with

COVID-19 patients, while successful mitigation has created excess capacity in nearby hospitals, creating an opportunity to transfer patients MOCCs are a strategy to

ptimize patient

distribution by augmenting EOCs with clinical experts that synthesize and coordinate healthcare capacity The MOCC strategy can be implemented nationwide (at sub-state, state-, and regional levels), through a modifiable toolkit, technical assistance, and federal funding, permitting flexibility for states while

ptimizing patient

distribution

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7 Saving Lives. Protecting Americans.zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA

zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA

MOCCs | Problem Statement

COVID-19 has resulted in asymmetrical hospital utilization: certain regions’ healthcare systems have experienced a surge in patients, while others have excess capacity.

What are we seeing?

Hospitals are the preferred location for seriously ill

Facilities with 50+ Beds

COVID-19 patients, due to existing patient care expertise and resources Most hot spots are geographically localized,

verwhelming local healthcare facilities

While some facilities are overwhelmed, successful mitigation in neighboring areas has created excess capacity in nearby hospitals, creating an opportunity to transfer patients

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Number of ICU Beds

above 90% control limit of national average below 90% control limit of national average within 90% control limit of national average

Patient transfer coordination, through dedicated staffing and data collection/analysis, can improve patient allocation at the sub-state, state, and federal levels

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8 Saving Lives. Protecting Americans.

A MOCC AIMS TO:

Move patients, to the at the right to improve staff, and right time, in the patient supplies provider right way well-being

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9 Saving Lives. Protecting Americans.

MOCCs | Concept

MOCCs can be activated at the Sub-State Regional, State, and Federal levels to facilitate patient movement and resource allocation during a surge

event. There are three types of MOCCs included in the concept: sub-state, Regional Medical Operations Coordination Centers (RMOCCs), State

Medical Operations Coordination Centers (SMOCCs), and Federal Medical Operations Coordination Centers (FMOCCs).

RMOCC

Sub-State Level

SMOCC

State Level

FMOCC

Federal Level

HHS Region A HHS Region B

Region A

State A

Region B

State A

Region C

State A

State D

HHS Region B

State E

HHS Region B

State A

HHS Region A

State B

HHS Region A

State C

HHS Region A

Region D

State B

Region E

State B

Region F

State C

Region G

State C

Region H

State D

Region I

State D

Region J

State D

Region K

State E

Region L

State E

Region M

State E

State F

HHS Region B

Region N

State F

Region O

State F

Patient transfer coordination activity originates with the RMOCC. The SMOCC can help transfer patients to a facility in a neighboring sub-state region. The FMOCC can transfer patients to a neighboring state or Federal HHS Region if that is closer.

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MOCCs | General Activity Summary

MOCCs are cells within emergency operations centers (EOCs) at the sub-state, regional, state, and federal levels (FEMA/HHS regions) that facilitate patient movement and resource allocation.

MOCC PRIORITIES

Adding clinical staff to existing EOCs and RRCCs
Establishing stakeholder agreements that allow for collecting data regarding health system capacity, synthesizing the data to

understand the needs of the system, and determining areas of the system that may be overwhelmed.

Facilitating movement of patients, staff, and supplies between healthcare facilities and/or states

MOCC ROLE

Acting as a single point of contact (POC) for requests from multiple stakeholders such as healthcare facilities, RMOCCs, and SMOCCs
Reviewing, facilitating, and processing patient movement, staffing, and supply requests and providing medical consultation to

facilitate the decompression of health systems

MOCC DATA ACTIVITIES

Collecting, analyzing and disseminating information to and from stakeholders to develop comprehensive situational awareness
Establishing protocols, systems, and triggers to inform operational planning, stakeholder communications, and transfer decision

making

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~ - ~--~------ -

MOCCs | Toolkit

The MOCCs Toolkit contains information on funding a MOCC, standard operating procedures for each type of MOCC, including integration with ESF-8, roles and responsibilities, staffing, and transport coordination.

FUNDING

FEMA Public Assistance
FEMA Mission Assignment
ASPR Hospital Preparedness

Program

CDC Public Health Emergency

Preparedness/Crisis Agreement

STANDARD OPERATING TRANSPORT PROCEDURES COORDINATION

RMOCC

SMOCC

FMOCC
Transportation workflows and
transfer checklists

Each MOCC SOP includes details on:

MOCC Integration with ESF-8

Roles and Responsibilities Staffing Operations Patient Movement/Medical Resource Sharing

The MOCCs Toolkit will be located on ASPR TRACIE

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TRACIE

HEALTHCARE EMERGENCY PREPAREDNESS INFORMATION GATEWAY

ASPR

ASSISTANT SECRETARY ~

OR

PREPAREDNES S AND RESPONSE

Steven Mitchell, MD, FACEP Medical Director, Western Washington Regional COVID Coordination Center; Medical Director, Emergency Department, Harborview Medical Center

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Western Washington MOCC

First US COVID-19 case Jan

21 – Snohomish County, WA First US COVID-19 death Feb 29 – King County, WA First major outbreak late Feb/March1 – 167 cases at Long-Term Care Facility

101 residents, 50 staff, and

16 visitors

43 deaths
1. Epidemiology
f Covid-19 in a Long-Term Care

Facility in King County, Washington N Engl J Med 2020 Mar 27

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THE WALL STREET JOURNAL.

One Nursing Home, 3.5 Coronavirus Deaths: Inside the Kirkland Disaster '

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King County LTCF Outbreak

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'It's Pure Panic': A Wrenching Wait at

Nursing Home Where Coronavirus Took

Hold

Cut off from their relatives inside a virus-stricken nursing center, families are frantically searching for help and basic information.

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Characteristics and Outcomes of 21 Crit- ically Ill Patients With COVID-19 in Wash- ington State

Matt Arentz, MD1; Eric Yim, MD2; Lindy Klaff, MD2; et al

Author Affiliations I Article Information
JAMA. Published online March 19, 2020. doi:10.1001/jama.2020.4326
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Single LTCF - Single Hospital

Overwhelmed
No coordination
Not isolated example

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NORTHWEST HEALTHCARE

HARBORVIEW

MEDICAL CENTER

UW Medicine

[f]KingCounty

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Medical Operations Coordinating Cell

Disaster Medical Coordination Center
Regional COVID Coordination Center (RC3)

– Harborview Medical Center/King County – Northwest Health Response Network

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Regional COVID Coordinating Center – Western Washington

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Staffing Impacts: Resource Impacts: Ventilators

PPE

urveillance

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Health

Surveillance

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Settings

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Two Surveillance Pillars of the RC3

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Health System ..,__-..1 Level Loadin

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Two Coordination Pillars of the RC3

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WA HEALTH

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Emergency Response Platform - Microsoft

Constrained Resources

– Staffing – Beds

Critical Care
Acute Care

– Equipment

Ventilators
PPE

– COVID-19 patients

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Emergency Response Platform - Microsoft

Next Release

– Long Term Care Facilities

COVID-19 Impacts

– Positive Patients – Positive Health Care Workers » % of staff impacted

PPE availability

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TRACIE

HEALTHCARE EMERGENCY PREPAREDNESS INFORMATION GATEWAY

ASPR

ASSISTANT SECRETARY ~

OR

PREPAREDNES S AND RESPONSE

William Fales, MD, FACEP, FAEMS Medical Director, Division of EMS and Trauma, Michigan Department of Health and Human Services

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ASPR

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Michigan’s Healthcare Preparedness Program

Michigan Department of Health and Human Services

– Bureau of EMS, Trauma, and Preparedness

8 Regional Healthcare Coalitions

– Hospitals, EMS, LPH, EM, LTC, Tribal Health – Regional Coordinator, Assistant Coordinator, Medical Director (.25 FTE) – Regional Medical Coordination Center

Multi-Agency Coordination Center
Statewide use of EMResource by hospitals, EMS

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Michigan COVID-19

First 2 cases – March 10

Asymmetric epidemiology – SE Michigan – Extreme Activity – Rest of Michigan – Sporadic Activity – Comparable to other states Extreme conditions in SE MI – Peak hospitalizations: >4,400 – 12-days with >1000 on ventilation

1,223 on ventilation on one day

– Peak intubations in 1 day: 176

Source: John Hopkins Coronavirus Resource Center (Retrieved 4/21/2020)

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Michigan COVID-19

First 2 cases – March 10

Asymmetric epidemiology

– SE Michigan – Extreme Activity

– Rest of Michigan – Sporadic Activity – Comparable to other states

Extreme conditions in SE MI

– Peak hospitalizations: >4,400 – 12-days with >1000 on ventilation

1,223 on ventilation on one day

– Peak intubations in 1 day: 176

Source: John Hopkins Coronavirus Resource Center (Retrieved 4/21/2020)

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I I I I I I I I I

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Detroit vs. New York City

COVID-19 Daily Hospital Admissions New York City vs. Detroit

1800 1600 1400 1200 1000 800 600 400 200

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

NY City Detroit

Source: MI: EMResource NYC: NYC Department of Health and Mental Hygiene 26

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Detroit vs. New York City

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COVID-19 Daily Hospital Admissions Per 1 Million Population New York City vs. Detroit 40-Day Post-Outbreak Mortality

NY City: 646 deaths per million
Detroit: 919 deaths per million

100 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

NY City Detroit

Source: MI: EMResource NYC: NYC Department of Health and Mental Hygiene 27

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Michigan Healthcare Surge Strategy Goal

Save lives and reduce pain and suffering by optimizing

the use of the state’s healthcare resources – Extend conventional standards of care to as many patients as possible – Minimize the need for crisis standards of care

Especially while conventional capacity exists

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Michigan Healthcare Surge Strategy Components

Relief Hospitals
Alternate Care Sites

EMS

– Home Care Sites – Relief Personnel

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Relief Hospitals vs. Alternate Care Sites

Relief Hospitals: The objective is to extend the

conventional standard of care to as many citizens in need as possible (i.e., minimize the need to move into crisis standards of care).

Alternate Care Sites (ACS): The objective is to deliver

crisis standards of care (as close to the conventional standard of care as possible) in extreme conditions in which the conventional standard of care can not be provided at overloaded hospitals.

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Relief Hospital “Ask”

Hospitals have been previously asked to be able to

surge an additional 20% above average daily census – Increased to 50% “super surge”

Relief Hospitals provide 10% of their expanded

capacity to assist severely impacted hospitals – While preserving 50% of super-surge capacity

Many hospitals at very low census

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Relief Hospitals and Patient Redistribution

Intra-Health System Transfer

– Coordinated by specific health system

Intra-Regional Transfer

– Coordinated by Regional Medical Coordination Center

Statewide Transfer

– Coordinated by Inter-Hospital Coordination Unit

AKA: Medical Operations Coordination Cell (MOCC)

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Statewide Inter-Hospital Coordination Unit

State Emergency Operations Center

Planning Finance Operations Health Branch Inter-Hospital Coordination Unit

Physician Consultant EMS Coordination Group

Logistics

MDHHS Health Emergency Operations Center

Medical Operations Coordination Cell

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MOCCs and Patient Redistribution

Regional Medical Coordination Center

Relief hospitals declare status on

EMResource

RMCC receives request from

transferring hospital

RMCC identifies Relief Hospital(s)
Transferring hospital contacts

Relief Hospital directly

Relief Hospital accepts patient(s)
RMCC coordinates EMS PRN

Statewide Inter-Hospital Coordination Unit

▪ Relief hospitals declare status on EMResource ▪ IHCU receives request from RMCC on behalf of transferring hospital ▪ IHCU identifies Relief Hospital(s) ▪ Transferring hospital contacts Relief Hospital directly ▪ Relief Hospital accepts patient(s) ▪ IHCU coordinates EMS PRN

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Critical

2. Critical
3. Non-
4. Non-

Willing to Willing to Comment Care Bed - Care Bed - Critical Critical Take Take Non- COVID-19 non- Care Bed- Care Bed - COVID-19 COVID-19 COVID-19 COVID-19 non- Patients Patients COVID-19 No Yes 22

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3. Non-
4. Non-

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non-

Care Bed Care Bed COVID-19 COVID-19 COVID-19 -

non-

Patients Patients COVID-19 COVID-19 nton No No 24 3 No No Already exceeding critical .. No No Already exceeding critical .. 0 --

- Already exceeding critical

Already exceeding critical

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EMResource Relief Hospital Participation

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MOCC-Facilitated vs Direct Contact Transfers

MOCC Facilitated

Hospital has need to transfer
Regional /State MOCC

contacted

EMResource reviewed by MOCC

to identify Relief Hospitals

MOCC connects transferring

hospital to Relief Hospital

Relief Hospital accepts

patient(s)

MOCC coordinates EMS PRN

Direct Contact

▪ Hospital has need to transfer ▪ Regional /State MOCC bypassed ▪ EMResource reviewed by hospital to identify Relief Hospitals ▪ Transferring hospital contacts Relief Hospital directly ▪ Relief Hospital accepts patient(s) ▪ MOCC coordinates EMS PRN

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Patient Redistribution – 5 Key Elements

Transferring Hospitals

Coordinating entity (MOCCs) Situational awareness platform (EMResource) EMS Relief Hospitals

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Relief Hospital Recruitment Challenges

Why were so many hospitals in minimally impacted regions resistant to accept patients?

Fea
Fear of introducing bringing COVID-19 into their

hospital r of impending “storm” – “It’s just a matter of time till we’re Detroit”

Need for Epidemiologic Intelligence

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Michigan Patient Transfers (4/1 to 4/20)

SE MI SC/EC MI West and North MI Region 2N 2S 1 3 5 6 7 8 TOTAL Transferred In 322 457 41 27 38 15 34 25 959 Transferred Out 275 443 46 54 24 20 20 15 897 ~15% via MOCC-Facilitated / ~85% VIA Direct Contact ~30% Intra-System Transfers

Source: EMResource – Self-reported by hospitals

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Unclassified//For Public Use Bureau of EMS, Trauma & Preparedness

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MOCCs in Michigan

Role: Facilitation not control
Staffing at State MOCC

– Experienced paramedics / EMS control center

Remote component to SEOC
Physician role

– Consultative, problem solving, medical leadership

Use of statewide hospital status application essential

– Allows hospitals to connect directly

40

SLIDE 41

Unclassified//For Public Use

DHHS

Michigan Department or Health & Human Services

ASPR

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Summary

Relief Hospital concept works
Statewide MOCC successful in coordinating transfers
EMResource serves as an invaluable tool for

identifying Relief Hospitals

Decentralized approach where hospitals in need

contact hospitals with capacity requires minimal central coordination

Recruitment of Relief Hospitals can be challenging

41

SLIDE 42

Unclassified//For Public Use

TRACIE

HEALTHCARE EMERGENCY PREPAREDNESS INFORMATION GATEWAY

ASPR

ASSISTANT SECRETARY ~

OR

PREPAREDNES S AND RESPONSE

Ronald Stewart, MD Chair, Department of Surgery, UT Health San Antonio, Long School of Medicine Eric Epley, Executive Director/ CEO Southwest Texas Regional Advisory Council for Trauma (STRAC)

Unclassified//For Public Use

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SLIDE 43

~

University

..- Health System

Regional Disaster Response in Texas: Implementation of the RMOC Concept

Ronald M. Stewart, Eric Epley, Brian Eastridge, Dudley Wait, Joe Palifini, Dave Miramontes, Craig Cooley, Donald Jenkins, and the Southwest Texas Regional Advisory Council Team and Texas Emergency Medical Task Force Region Leaders ASPR Tracie Webinar, April 24, 2020

Unclassified//For Public Use

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SLIDE 44 Souchwe:Gt Te•as Region;;1il Aduisory Council

Introduction

Unclassified//For Public Use

Trauma system development
Routine, multiple small-scale disasters
Structured cooperation and communication

Trauma system infrastructure for

Disaster

Stroke, STEMI, Mental Health, Perinatal

Trauma System Complete Evolution to Emergency

Health Care System—Will use Trauma System and Emergency Health Care System interchangeably

Health Care Coalition
Right Patient ฀ Right Place ฀ Right Time

44

SLIDE 45

THE TEXAS TRAUMA SYSTEM

Unclassified//For Public Use

22 TRAUMA SERVICE AREAS ✤ REGIONAL ADVISORY COUNCILS ✤ TRAUMA CENTER DESIGNATIONS ✤ STANDARDS OF CARE ✤ HOSPITAL PREPAREDNESS GRANTS ✤ CONSISTENCY THROUGHOUT URBAN, SUBURBAN, RURAL AND FRONTIER

45

SLIDE 46 Southwest Teus Regional Ad1,1lsory Council

l\

The Committee -~\

n Trauma 1, ·

EHC System Complex Problem Solving

Maximally inclusive with respect to stakeholders
Dialogue and consensus centered upon:
What’s the right thing to do for the patient or population being served?
Timely
Structured cooperation
Communication – Robust and redundant
Actionable data
Bias for action
Performance improvement processes

Unclassified//For Public Use

46

SLIDE 47

911 Commission

1) FAILURE OF IMAGINATION 2) FAILURE OF POLICY

(A FAILURE TO HAVE THE RIGHT INFRASTRUCTURE IN PLACE)

3) FAILURE OF CAPABILITY

(A FAILURE TO HAVE THE RIGHT RESOURCES)

4) FAILURE OF MANAGEMENT

(THE FAILURE TO COORDINATE THE AVAILABLE RESOURCES, AND INFRASTRUCTURE)

Challenge of Large-Scale Disaster Preparation and Management

Unclassified//For Public Use

47

SLIDE 48

zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA

Southwest Te,cas Regional Advisory Council

Our Experience

A functioning regional trauma (EHC) system provides the framework for an effective response to large-scale disasters Education and drills are not enough Linked regional medical operations centers ( or MOCCs) critical to effective disaster response from all causes

Unclassified//For Public Use

48

SLIDE 49

.a!

Southwest Texas Regional Advisory Council

Managing Wide-Scale Disasters

Unclassified//For Public Use

49

Acute Health Care System

Critical for emergency

response and treatment of acute illness or injury

Mostly private and public mix
Services to individuals
Distributed and complex

network of providers

Decisions made clinically

within minutes to hours

Public Health System

Largely responsible for most

significant health improvements

Safety and wellbeing of

populations

Multidisciplinary science
Mainly public with centralized

communication

Decisions with deliberation

and testing usually takes days

Emergency Management System

Local State Federal Emergency Management Response

SLIDE 50

These Three Systems Must Function Seamlessly and Flawlessly Together Ac Acut ute H e Hea ealth C h Care S System m Publ ublic H Hea ealth h Emer ergency cy M Mana nagemen ent t

Unclassified//For Public Use

50

SLIDE 51

Communications

Problems Common to failures Disasters

Unworkable and

Must have a credible and

untested plans

workable solution to each of these problems—if we are to improve disaster response

Lack of coordinated response

Unclassified//For Public Use

51

SLIDE 52

MEDCOM OM

Trauma Transfers-500/mo
Air Medical Management
Trauma Team Paging
MCI load-balancing
Navigation of mental health

patients via Law Enforcement directly to psychiatric facilities

Unclassified//For Public Use

52

SLIDE 53

zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA

D D D D

How to Integrate Disaster Acute Care and Public Health Systems?

Trauma MEDCOM Communications Center
Regional Medical Operations Center
Integrated with Local Emergency Operations Center

(EOC)

Linked to State Emergency Operations Center

Unclassified//For Public Use

Linked to Federal Emergency Management System

53

SLIDE 54 Southwest Texas Regional Aduisory Council

Regional Medical Operations Center (RMOC)

Unclassified//For Public Use

Upregulated MEDCOM—dramatically enhanced data and comm Functional for 17 years in San Antonio

Essential elements
Formal agreements insuring collaboration
Representatives of all major stakeholders in one room-physical or virtual
Formal communication link to the Emergency Operations Centers (EOC)
Fault tolerant communications systems
Software systems –WebEOC software
Monitor and coordinate all critical hospital capacity

Monitor all critical public health data Monitor and coordinate all critical EMS agencies

Direct tie to the EOC and SOC
EMTF function—Ability to physically expand and adapt: Emergency Medical Task

Forces & Mobile Medical Units

54

SLIDE 55

Regional Medical Operations Center (RMOC)

Unclassified//For Public Use

55

SLIDE 56

Feasible Plan?: Must work in real world conditions

Unclassified//For Public Use

56

SLIDE 57 Southwest Te11as Regional Advisory Council

RMOC Abilities and Advantages

Situational Awareness—Regional Consciousness
Virtual expansion of bed capacity
Distribute to all regional facilities—not just a few –Many Hands Make Light Work
Proven many times over 15 years—distribution of 1,000s of patients over a few days
Enables health care regional response teams
Multi-agency rescue teams—swift water rescue, etc.
Mobile medical units—temporary hospital replacements or augments
Load balancing during a surge of patients
Network with other regions –8 RMOC equivalents in Texas
Integration of Public Health, Acute Care and Disaster Management Systems

Unclassified//For Public Use

57

SLIDE 58

Vancouver Seattle

Idaho Oregon Nevada

San Francisco

California

l.'ls Angeles

Montana No,!11 Dakota Minnesota South Dakcta Wyoming Wisconsin Iowa Ne~raska

Toronto

c ~New Y0rk

Boston

Detroit ·

ChicatJo ·i·

New 'r

ark

Denver

Oli io

St Louis

Kansas K~ntuci<y

Vitgin 1c1 tfor!t, Ca r0l1na

New Mexico Arl<ansas

Atla11ta

Oa!!as

Georgi& Texas

Houston Monterrey C

Gulf of

Miami

RMOC OC R Res espons nse a e and nd Funct unction t n to

COVID-19

19

Unclassified//For Public Use

58

SLIDE 59

INTERNAL REPORT - PHI DATA

This report contains Protected Health Information and is not intended for public distribution.

Date COVID+ Patients COVD+ in ICU

04/21/2020

82

04/20/2020

81

04/19/2020

81 Normal Participating HCS: COVID Data as of 0815, Zl-Apr-20 Vent/Bed Data as of 0910, 21-Apr-20 41 41 41 COVID+ on Ventilator 24 25 24

BTRAC

All Healthcare Systems

Available Vents I Total Vents Available Vents % 554 713 7896 514 710 7296

~
555

704 7996

Healthcare System Stress Score

I Available Staffed Total Staffed Available Staffed Beds Beds Beds % 1,752 4,730 3796 1,792 4,700 3896

-

7

1,635 4,707 3596 Severe

Unclassified//For Public Use

59

SLIDE 60

INTERNAL REPORT - PHI DAT A This report contains Protected Health Information and is not intended for public distribution.

San Antonio Healthcare Systems

COVI D-19 Patient Count

Positive Patients on 4/21/2020 Positive Patients Trend 312212020 - 412112020

3/22 3/27 411 4 / 6 4 /11 4 / 16 Systems Reporting Daily Morning Data Health Sys I He, al th Sys2 HS3 HS4 HSS HS6

PUI Patients on 4/21/2020 82 50 PUI Patients Trend 312012020 - 4/2112020

80 60 40

38

20

.__

_________________

_

4 /21 3/22 3/ 27 4/ 'I 4 / 6 4/1 I 4 /16 4/2 1 H

Tuesday, April Z1, 2020

STll=IAC

........... ,

.... _......,............,c....

TOT

AL Patients on 4/21/2020

132

TOTAL Patients Trend 312212020 - 412112020

150

151

100 50

.__

__________________

_

3122 3/27 4 /1 4 16 4 /1 1 4 / 16 4/2 1

Unclassified//For Public Use

60

SLIDE 61

HOSPITALS: Due DAILY, 09:00 hrs Hospital PPE / IDR Materials Status Medical Dashboard (Bed and Ventilator Status) https://eris.strac.org/eoc7 / EMS: Due WEEKLY, Friday 12:00 hrs https://www.surveymonkey.com/r/EMSPPE2 ALL OTHER Coalition and ARHC Members: Due WEEKLY, Friday 12:00 hrs https ://www .surveymonkey.com/r/RMOCPPEOuery

19:00 04/12/20

Number of Regional Hospitals Reporting PPE Shortfall & Days Remaining Until Depletion 5 - 7 Da s 8 - 11 Da s 12 - 14 Da s 15+ Da s 8 14 5

*Data derived from facilities "Hospital PPE / IDR Materials Status" - Facilities listed, have indicated a disruption in their supply chain for any of the following PPE: N95s, Surgical Masks, Gowns, Gloves, Face Shields, Goggles Unclassified//For Public Use

61

SLIDE 62

1,015 Weekly COVID-19 Update Epidemiology Program

39

191

97

Tota l Cases Reported Total Deaths Repo rted E ver Hospita lized Admitted to ICU

VI

45 40 35

~

30

ro

u

0 25 ... 1:: 20

§ 15

z

10 5

2/3

Cases of COVID-19 by Date of Illness Onset (n=880)1 and Cumulative by Date Reported, Bexar County, 4/18/2020

Female(

)Ma le

51% 49% 2/10 2/17 2/24 3/2 3/9 3/16 3/23 3/30 4/6 4/13

Number of Cases
cumulative Cases

1 a.ased on co,r1pleted d31;ai 3s or 4/18/1020 ;;at 8:00 PM; . dditiomd c.rases 3re 1,111der feview.

1200

t

moo

V, QI VI ro

u 800

......

...

~ QI .0

"' - 600

E

""0

u;,

::, Nl

z

i,i, - 400 ~

"'

_, ...,

ro

"S

200

E

::,

u

CITY OF SAN ANTONIO

METROPOLITAN HEALTH DISTRICT

so

276

Mechanical Venti lation Recovered Percentage of Cases by Race/ethnicity

American Indian/Alaska Native
Asian
Black
White
Hispanic
Other

Cases by Age Group

!~ I

39%

4 n

1%

i: 300

§ 200

z 100

3%

0 +-------"-------"----~~~~-~~

---r-~

~ ~

.

17% 0-17 18-40 41-64 65+

Age Group in Years

Median ace - 46 years (age range: 0-100 years)

Unclassified//For Public Use

62

SLIDE 63

RMOCs

Mobile Drive Through COVID-19 Testing over 268,000 Square Miles

Unclassified//For Public Use

63

SLIDE 64

=

.§..111.\ntomo t,;prrss·:Xrws ,uesc.,e,

~: NEW5

Texas, San Antonio officials launch investigations of nursing home overrun by coronavirus

LaurenCa.n1. ba Apri1'1,2.Q.20 Updaced:Apf'd-'1,20202.12:pm

fWBinGi

'P COVJC>-19 ~ ui;tefldi:d lifo iil:5 w~ kriew it inTe.itas, ™Lmithequ@!tiOl'lsyouw.1nt .nswe.red, .illd the issues Y'MI think we :s;AQllid be lnvmlgadl'lg, lndod&- )'Our

email. :;iind :an £:itp,ess•Nll!WS journ:11Nt will

follow up.

Hot Spot Evaluation and Coordination

Unclassified//For Public Use

64

SLIDE 65

RMOC OC Func unction i in C n COVID-19 19 R Response se

Situational awareness
Integration of public health, acute health care and disaster

management functions

Actionable data from consolidating public health and acute health

care data sources

Controlling and coordinating hot-spots
Drive through testing management across the entire State
Ability to Load balance across multiple health systems and
rganizations

Unclassified//For Public Use

65

SLIDE 66

Unclassified//For Public Use

TRACIE

HEALTHCARE EMERGENCY PREPAREDNESS INFORMATION GATEWAY

ASPR

ASSISTANT SECRETARY ~

OR

PREPAREDNES S AND RESPONSE

John Quiroz, RN Nurse Manager, Los Angeles County Emergency Medical Services

Unclassified//For Public Use

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SLIDE 67

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ASPR

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Los Angeles (LA) County Medical Operations Coordination Cell (MOCC):

24/7 Medical & Health Coordinator for the County

and Region I

Coordinate Patient Transfers and Transportation
Coordinate medical and heath resource management
911 Providers, Hospitals, LTC, Clinics, Dialysis, Surgical

67

SLIDE 68

Unclassified//For Public Use

ASPR

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Los Angeles County and Region I

68

ifornia Reg1 ions

Coastal OES Region n

Southem

:e.s Regiion I

Inland

OES Region IV

Soutiheim Santa B'arbara

O'ES Reg Ion VI

I

Kerrn

Los Angeles

SLIDE 69

Unclassified//For Public Use

ASPR

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Normal Operations vs Emergency and Disaster Response

Normal Operations

DHS

Hospital and Clini System

EMTALA Transfers
Air Medical
Hyperbaric Chamber
MCI Patient

Destinations

Transfer/Transport

c

Emergency Disaster

Hospital evacuations
Resource Request
Alternate Care Sites

– Mercy – LASH – Isolation/Quarantine

Transfer/Transport
Prehospital

Care Policy

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SLIDE 70

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ASPR

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Keys to Success

24/7 Base of Operations
Communications

– Telephony, Radio, Internet, ReddiNet

DOC Room to expand operation during disaster
Information System to document and analyze all lines
f business.
Trained and talented staff
Planning and exercise

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SLIDE 71

Unclassified//For Public Use

TRACIE

HEALTHCARE EMERGENCY PREPAREDNESS INFORMATION GATEWAY

ASPR

ASSISTANT SECRETARY ~

OR

PREPAREDNES S AND RESPONSE

John Hick, MD Hennepin Healthcare, MN

Unclassified//For Public Use

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SLIDE 72

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ASPR

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Minnesota SHCC

Statewide Healthcare Coordination Center
Located at State EOC as well as virtual – roughly

40 people directly engaged including regional leads

Joint MDH, HSEM, MHA, 8 regional MN coalition

construct

Main areas of planning / response:

– – – – – Referrals and transfers Alternate care sites Long term care – reactive and proactive PPE policy and acquisition Ventilator / medical supply acquisition

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SLIDE 73

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ASPR

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Referrals and Transfers

Single phone number for LTC issues including hospital discharge and

COVID + patient support (e.g. assisted living transfer to COVID + designated SNF)

Co-located with SEOC public hotline but different staffing / numbers
Single (separate) phone number for ICU referrals

– Mainly for greater MN but also inter-metro – Awareness of resources on MnTrac and real-time health system information – Also provides direct connection to critical care consultation – May also be used to make triage decisions if referral needed and no resources available (care-in-place recommendations) – May also be used to distribute load

73

SLIDE 74

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ASPR

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Staffing

Call-taker

– Medical background preferred – – Gatekeeper for referral to SME May connect caller with resources and then referrals handled per usual

Shift Supervisor

– – Clinical background and experience with bed placement (e.g. house nursing supervisor) Manages information / resource availability with facilities and more complicated situations

Clinician on-call

– – Critical care Contacts with each major health system critical care for ECMO and other resource allocation situations

Unit supervisor

– Works with SHCC manager on overall operations, processes, protocols

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ASPR

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Triggers

LTC

– – – Difficulty

btaining

hospital discharges for LTC patients Achieved and hotline

perational

(Note – hotline also coordinates connections to infection prevention/control, MDH Health Regulation Division, palliative care consultations, and can trigger strike team evaluation / staffing support / transfer support)

ICU

– – – < 10% ICU beds available statewide Request from MHA or a coalition due to difficulty coordinating destinations Further triggers for engagement of clinician at request or when no ICU beds available for reasonable match

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ASPR

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Other uses / considerations

Matching to EMS transport services
Patient ICU transfer considerations

– Need for higher level of care – first priority – ECMO, ventilators, etc.

Patients presenting to facility that lacks appropriate resources at

baseline – – Load balancing – second priority

Convalescent patients
Intubated and stable patients (regional – if significant capacity under-

utilized) Risk/benefit considerations Resource movement – e.g. ventilators (vs. anesthesia machines) or staff (virtual or in-person)

76

SLIDE 77

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ASPR

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Question & Answer

77

SLIDE 78

Unclassified//For Public Use

ASPR

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Contact Us

asprtracie.hhs.gov 1-844-5-TRACIE askasprtracie@hhs.gov

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