NEMA-ASTHO-GHSAC Joint Policy Workgroup Hurricane Matthew ESF 8 Brief January 11, 2017

North Carolina Healthcare Preparedness Regions Cherokee Graham Swain Clay Macon Jackson Haywood T r a n s y l v i Henderson Buncombe Madison Yancey M t c h e Avery McDowell Polk Rutherford Burke Cleveland Caldwell Watauga Ashe Wilkes Alleghany Alexander Lincoln Gaston Iredell Mecklenburg Rowan Stanly Union Cabarrus Hoke Cumberland Robeson Sampson Bladen Columbus Brunswick New Hanover Pender Duplin Onslow Carteret Jones Wayne Lenoir Craven Pamlico Greene Hertford Bertie Martin Pitt Gates Beaufort Hyde Washington Tyrell Dare C u k m d P q o w Davidson Guilford Randolph Montgomery Alamance Orange Durham Surry Yadkin Stokes Forsyth Davie Rockingham Caswell Harnett Johnston Wilson Nash Edgecombe Person Granville Vance Warren Franklin Halifax Northampton Anson Richmond Scotland Chatham Moore Lee Catawba Wake This is the mechanism we use to implement this program: Eight healthcare preparedness regions that are coalitions of hospitals, public health, EMS, emergency management, and ancillary healthcare partners at the local level The are managed out of eight lead hospitals in our state, moving east to west: Vidant, New Hanover, WakeMed, Duke, UNC, Wake Forest Baptist, CMC, and Mission These regional programs are responsible for two main areas: preparedness (planning, training, education, exercises) and response (equipment and personnel to respond during events) and the I think the context of this program is important as we talk about the medical side of the response. Within each of these eight regions, there are caches of assets and resources that can respond during an event that affects local, regional, or statewide events like Matthew. As we mentioned, as this program focus federally evolved, how we implement it at a state level has also evolved and the threats and hazards we face. Mountain Area Healthcare Preparedness Coalition Mid Carolina Regional Healthcare Coalition Triad Healthcare Preparedness Coalition CapRAC Healthcare Coalition Metrolina Healthcare Preparedness Coalition Eastern Healthcare Preparedness Coalition Duke Healthcare Preparedness Coalition Southeastern Healthcare Preparedness Region

State Medical Response System Operational Missions Medical sheltering Field medical care Alternate care facility Logistical/resource support Within each of the eight regions on the response side of the equation, these are the major operational priorities and missions we have been tasked to provide. Medical sheltering: state medical support shelters that are scalable to meet the unique needs of community members who need medical assistance, but not long term medical care in a hospital, staffed by healthcare organizations and local emergency medical services agencies and medical volunteers (picture bottom right) Field medical care: field medical stations in support of MCIs (picture bottom left) Alternate care facilities: for affected healthcare facilities Other logistical/resource support generators, HVAC units, cots, etc. Transportation support through scalable ambulance strike teams, mass evacuation buses, etc. These are the main capabilities we provided during Matthew through our healthcare preparedness regions/coalitions

Hurricane Matthew Missions Duration: Oct. 3-23, 2016 Personnel: 210 Sheltering support Transportation EMAC assistance Medical sheltering Field medical stations/ mobile hospitals Medical support to healthcare and shelters Logistical support to shelters CISM assistance to responders Strength of response was the result of partnerships with health care organizations and local emergency medical services agencies This is a high level overview of the missions and assets and resources deployed during Matthew. The important thing to note is the range of missions as the forecast changed. Initially, we were not forecasted to experience significant direct impact from the storm. We supported evacuating healthcare facilities from South Carolina through sheltering assistance (cots, supplies, and personnel) and in transportation through mass evacuation buses that deployed from NC to assist with several healthcare facilities. When it appeared that our colleagues in Florida communities were going to be heavily impacted, we spun up medical sheltering packages, transportation support, and components of the Mobile Disaster Hospital to deploy in support of the response there. As Matthews track changed and impact to NC was going to be more significant, Transportation assets staged and deployed through out event from mass evacuation buses and ambulance strikes teams across eastern NC two state medical support shelters were deployed (one located in Goldsboro and one in Johnston County outside of the impacted zone) 5-bed emergency department/field medical station to Kinston (highlight this bullet for purpose of presentation) CHS MED 1 mobile emergency department to Lumberton Medical supplies to healthcare organizations and shelters through personnel, oxygen, assistance with pharmaceuticals, etc. HVACs, generators, shower trailers all deployed to gen pop shelters Provided critical incident stress management debrifing support to first responders. Over a three week period, we had over 210 personnel deployed through approximately XX HCOs and XX local EMS agencies

Mobile Asset Overview-MDH Two 5-bed Mobile Emergency Departments (hard structure) 21-bed Emergency Department (soft structure) with X-ray unit, clinical lab, pharmacy and medical supply (hard structures) and logistical support (soft structures) 12-bed ICU with medical supply and logistical support unit (hard structures) One Operating Room including C-Arm and Operating Microscope with surgical processing, medical supply and logistical support (hard structures) In addition to the regional capabilities listed above, North Carolina was the caretaker of a DHS asset, Mobile Disaster Hospital, and are now the owner of the asset outright due to a transfer to NC from DHS. This is an asset that assists in maintaining healthcare continuity of healthcare operations through a combination of hard structured slide out trailers and temporary structures and soft-sided structures in tents. These are the capabilities that are provided through this asset and portions of this, and a similar asset managed out of CHS MED-1 which will be discussed on next slide, were also deployed during Matthew. Over 150 patients seen during 10 days on station

Lenoir County Response Hurricane Matthew, 2016 Lenoir County Response NCBM Feeding 20K Kitchen Lenoir Memorial Hospital Fueling Station - NCEM Mobile Hospital – OEMS Trailer of Water – 15 Pallets Trailer of MRE’s – 26K NCTF 9 Swiftwater Rescue RRT4 Shower Facilities NC ALE Security Ambulance Strike Team Light Tower Landing Zone EastCare Helo USCG Helo FINAL – 10/19/2016 7 Patients transported by EastCare 1 Patient transported by USCG AST transported 5 Patients to MDH from southside ALS Units transported 1 patient to Craven Regional Total treated and released was 64 Incident total patients - 77 Lenoir Community College The State Emergency Response Team used predictive analysis to determine what structures would be flooded as well as the duration and depth of flooding. This allowed us to ensure medical assets were in place on both sides of the flooded area. Southwood Memorial Church Southwood Elementary School Deep Run Baptist Church Trailer of Water – 15 Pallets Trailer of MRE’s – 26K Deep Run is located further down in the county and is not shown on this map.

Mobile Asset Overview-MED 1 Carolinas MED-1 Overview: 4 Critical Care Beds (ICU capable with ventilator and hemodynamic monitoring capability). Built in central monitor for all monitored beds 1 or 2 Bed Operating Room/Resuscitation Room. All invasive capability found in CMC Level I Trauma Center available including digital ultrasound. The OR has a separate entrance 10 additional patient beds Wi-Fi, satellite communications Medical equipment includes X-ray, ultrasound, I-stat laboratory, IV Pumps, CBC Diff Machine The external tent structure houses up to 100 additional patients, these would be lower acuity patients or those who have no place to go (pending census allows) Full Emergency Department Pharmacy Developed, owned, and operated by Carolinas Healthcare System. Deployable for special events via contract or under the direction of the State Emergency Response Team via MOU System-funded, NOT federally-funded During Matthew response, augmented medical surge to affected hospital in Lumberton that had critical services disrupted In 9 days, 220 patients, including one delivery of healthy baby

EMAC Deployed 20 Disaster Nurses from Tennessee to NC Shelters Deployed 6 Mental Health Counselors from South Carolina to NC Shelters EMAC Personnel were Outstanding - NC needs to do a better job in Tracking & Management

Worked with Healthcare Ready to identify potential Mobile Pharmacies PRESCRIPTIONS Medical Personnel in Shelters worked with Walmart and local Pharmacies to provide Refills to Shelter Occupants Healthcare Ready, a Business EOC partner, shared locations of open Pharmacies so we could determine which were closest to Shelters (Rx Open) Worked with Healthcare Ready to identify potential Mobile Pharmacies

Lessons Learned Importance of partnerships Flexibility of program and organizations to respond to evolving threats Modular and scalable response component Mission Ready Packages developed and tested pre-event Focus moving forward on training/education/exercise to inform planning Data resources during planning phases to inform response

Questions