CMOC 101

In the beginning  1997: Houston named one of the first 4 MMRS cities in the Nation ◦ Support the integration of emergency management, health, and medical systems into a coordinated response to mass casualty incidents caused by any hazard. ◦ Reduce the consequences of a mass casualty incident during the initial period of a response by having augmented existing local operational response systems before an incident occurs.  Hospital Receiving Group (HRG) formed ◦ “Big 8” identified by HFD

Early work  HRG identified planning priorities – Common communications – Healthcare planning template – Common equipment and training – Executive support – Mutual Aid Agreements

First Challenge  Tropical Storm Allison – Extensive flooding and subsequent evacuation – TMC “off-line” with ripple effect throughout community – Hospitals responding individually within systems – No formal coordinating entity*

2001 Rapid Growth Spurt  After TS Allison ◦ Addition of 20 acute care facilities ◦ Sharing of work to date ◦ Sharing of plans  After 9-11 ◦ Addition of Community Hospital Sub-Committee  50+ member institutions  Eventually merged all into HAHEMC  HPP Grant ◦ DSHS pass through funding to RACS ◦ Houston CEO meeting  RAC = fiduciary agent  HAHEMC members to develop planning body for grant

RHPC was born  Regional Bioterrorism Task Force ◦ Year 1 grant focus on bioterrorism ◦ Chair, co-chair and committee members elected ◦ Gap analysis and planning priorities identified  The Regional Emergency and Hospital Preparedness Council (RHPC) ◦ Officially formed in 2002 ◦ Mission of providing collaborative planning and response to emergencies, in a multi-disciplinary approach, and to preserve the medical infrastructure of the region. ◦ Continued discussions on need for a coordinating entity

2005 Hurricanes Katrina and Rita  Regional coordinating entity for health and medical called into service for first time  Disaster Unified Medical Command (DUMC) – Leap of Faith No formal plan – concept No formal structure No recognized authority – Commitment Commitment to succeed Commitment to mission Commitment to medical community

2006 Evolution of a Concept  Catastrophic Medical Operations Center (CMOC) – Initial plan put into writing – MOUs drafted and signed – Formal structure developed – Initial training developed and held – Infrastructure support from City of Houston

What is CMOC CMOC is a collaboration of healthcare, special needs, EMS transportation, and public health specialists working together under a NIMS compliant structure within the Unified Area Command to address ESF 8 services of a multi- geographical region.

CMOC today  Status ◦ Operational arm of RHPC ◦ RHPC: 501c3 non-profit organization  Mission ◦ Coordination of medical care and resources in response to the needs of the community ◦ Protect the medical infrastructure of the region ◦ Provide assistance and serve as safety-net for all healthcare facilities ◦ Serve as the central point for redistribution of staff and supplies ◦ Identify and utilize hidden surge capacity ◦ Proper placement of patients in healthcare facilities based on the patient’s medical need and the facility’s capability and capacity ◦ Coordination and distribution of transportation assets ◦ Integration of public health epidemiological trends

CMOC today  Technologies – Emsystem – EmTrack – Pier – WebEOC – 800 Radio system – Hamm radio capabilities – Satellite phone capabilities – Dedicated address – Dedicated phone line Activation Response communications

CMOC today  Structure – NIMS Compliant – Operational with logistical and limited command functions Medical Operations Chief Logistics/Communications EMS/Transport Finance and Administration Public Health Special Populations Clinical – North – Southeast – Downtown – Southwest – TMC – RAC R

CMOC Org Chart Medical Operations Chief Logistics/CommsEMS/TransportPublic HealthF&AClinicalNorthSoutheastSouthwestDowntownTMCRAC R Special Population

Partnerships  City of Houston, Harris County, Fort Bend County, Montgomery County, Brazoria County, and Jefferson County Offices of Emergency Management  Houston Area Hospital Emergency Preparedness Collaborative  Southeast Texas Regional Advisory Council  City of Houston, Harris County, Fort Bend County, Montgomery County, and DSHS Region 6/5S Department of Health and Human Services  The Texas Medical Center  HGAC

Area of responsibility While the CMOC is housed inside the City of Houston Office of Emergency Management, it is a resource for the entire HGAC region, as well as any other region within RAC R and Q and has been designated by the Texas Department of State Health Services as Division 1.

CMOC Region 28 Counties 277 cities 9.3 Million* (36%) 877,000/disabilities* (24%) 120+ hospitals 500+ nursing homes 36 th Largest State 22 nd Largest World Economy Land mass could contain: New Hampshire, New Jersey, Connecticut, Delaware, Rhode Island, and D.C.

What kind of requests  Medical requests for assistance – transportation – patient placement – facility resource requests  Evacuation assistance  Patient tracking/reporting  Epidemiological trending

Activation  CMOC must be activated by an authorized governmental entity.  It can be activated 24/7 by calling the City of Houston Office of Emergency Management at and requesting “activation of the CMOC”

Activations  Activation may occur for the following reasons: – Mass casualty incident in which resources in the area are not sufficient or are anticipated to exceed the need – Severe weather/hurricane threatening the medical infrastructure/community – Biological outbreak – Situational awareness during high profile events – Evacuation of healthcare facilities in need of assistance – As a “safety net” to ensure healthcare entities and community resources remain viable

Leadership Staff  Ops Chief  Logistics and Communication  EMS and Transportation Sector  Clinical Sector  Finance, Administration, and Documentation  Special Populations  Public Health

Operational Staff Roles  Working under the Clinical Director – North Corridor – Southeast Corridor – Southwest Corridor – Downtown Corridor – TMC – RAC R

Staff Credentials and Qualifications  IS 100, 200, 700 and 800  IS 300 and 400 for Chief, Clinical  Clinical/operations background in healthcare facilities  Ability to handle stressful/high energy situations  Critical thinking skills  Ability to be flexible to changing situations  Ability to multi-task and remain focused

Duties  Report and sign in on scheduled shift  Works closely with Clinical Director to ensure the hospitals are appropriately and adequately utilized in our community response  Serve as the link to communications between the CMOC and Hospital clinicians  Initiates patient tracking mechanism  Disseminate information to the hospitals on the number of patients and clinical presentations, based on acuity from the incident

Duties  Determine available bed capacity and surge capacity by hospital, based on early discharge or evacuation needs  Coordinate patient manifests for transfer/receiving  Identify resource needs of facilities and facilitate resource requests  Identify accepting facilities based on patient need and facility capability  Assist in indentifying transport asset type necessary for the mission

Duties  Request assistance and information as needed through EMS Medical Director, Public Health Authority, etc  Respond to requests from Departments of Health  Relay any special information obtained to appropriate personnel in the receiving facility (i.e., information regarding toxic decontamination, exposure, clinical recommendations, or any special emergency conditions).  Establish mechanism and supply patient tracking/bed availability data reports on a routine basis

Successful Strategies  While the CMOC has no jurisdictional authority in the region, the CMOC works with governing entities in the preparedness and planning, activation, mobilization, coordination of response, and mitigation of adverse effects to ensure emergency events do not adversely affect the quality, capacity, and continuity of healthcare operations  The CMOC coordinates the assignment and transportation of all patients into healthcare facilities within the region based on capacity and capability of the facilities. Single- point coordination enables safe, efficient utilization of the region’s healthcare resources resulting in increased surge capacity.

Success Strategies Collaboration of key response partners, working together under one system (health, medical and pre-hospital) have been demonstrated to be an effective method of preserving fragile medical infrastructure By having the subject matter experts at the “same table” working together, instead of in silos, the health and general well- being of the community can be preserved without turf wars or conflicting priorities.

What is right for health and medical? Coordinating entity with SME – Technology adjuncts – Communication and situational awareness – Common operating picture – Shared goals and restrictions – Adaptation and innovation – Commitment to the cause

Louise Comfort: Auto-adaptive systems “A state of mindful attention among a group of actors that evolves from common training, intense communication, and a distinct culture derived from shared experience” “Developing these auto-adaptive systems… depend fundamentally on their access to timely, valid information and their ability to engage in information search, exchange, absorption, and adaptation.”