Pandemic Influenza Response: Ketchikan's Alternate Care Site Exercise

Learner Objectives 1.Discuss the planning process required to supply and staff an Alternate Care Site (ACS). 2.List the staffing challenges of operating an Alternate Care Site. 3.Discuss lessons learned.

Polling Question #1 Participants, have you ever participated in setting up an Alternate Care Site, either in a drill or as a real event? A. Yes B. No

Where is Ketchikan Alaska? Ketchikan is on an island in Southeast Alaska

Primary Community Partners in the Exercise Ketchikan Fire Department (KFD) Ketchikan General Hospital (KGH) Ketchikan Indian Community (KIC) Ketchikan Public Health Nursing

Additional Community Partners in the Exercise  City of Ketchikan Law Enforcement Public Works Ketchikan Public Utilities  GuardianFlight, Inc.  Ketchikan Gateway Borough  Ketchikan Gateway Borough School District  Ketchikan Pastoral Association  Laidlaw Transit Inc.

 North Tongass Volunteer Fire Department  State of Alaska Behavioral Health  South Tongass Volunteer Fire Department  Temsco Helicopters, Inc.  University of Alaska at Anchorage (UAA), Certified Nursing Assistant (CNA) Program Additional Community Partners in the Exercise

Community Goal Our goal is to create an “All Hazards” plan—an Emergency Operations Plan (EOP) that will allow our managers to perform their duties with confidence and efficiency. This exercise will help guide our responders and managers and will provide us, the authors of the “New EOP,” a means to create a document that is useful for all types of events and for all departments or agencies involved.

City of Ketchikan Objective  To exercise evacuation policies and procedures  To test mutual aid agreements  To simulate an actual Emergency Operations Center (EOC) activation that will include a training session  To exercise large-scale incident management procedures  To assist any associated agency for the duration for the exercise This will help us in the completion of the “re-write of the emergency operations plan.”

Ketchikan Indian Community Tribal Health Clinic Objective To exercise and evaluate its ability to set up, staff, supply, and operate an Alternate Care Site for overflow of triaged “walking wounded” patients from the Ketchikan General Hospital ER.

Ketchikan General Hospital Objective To work with community partners to exercise and evaluate the:  Establishment and set up of the ACS  Supply and transport of resources to the ACS  Communication at the ACS  Record keeping of care/services rendered at the ACS

Ketchikan Public Health Nursing Objective For Alternative Care Sites, public health officials will take the lead in:  Establishment (identifying a site)  Set-up  Staffing  Operations

Funding  Funding was provided by The City of Ketchikan through the United States 2005 Homeland Security Grant and the Alaska Division of Homeland Security and Emergency Management. Grant # 2005-GE-T  Disposable supplies, sleeping bags, and pillows were provided by the Alaska State Hospital and Nursing Home Association grant.

12/05 to 10/06 Planning Timeline 6/06 site visit to the proposed site at Fawn Mountain School

KGH & KIC are located 3 miles north. Evacuation area (red) South Tongass Hwy: Fawn Mountain School is 4 miles south Bridges destroyed Ketchikan Creek The dam Mobile command post Scenario

Exercise: KPD

Mobile Command Center

Exercise: Set Up Tent & Security

Exercise: Tent & Patients A nurse was assigned to monitor patients awaiting transfer to Fawn Mountain Alternate Care Site (FM ACS). Ten influenza patients are taken to the isolation tent outside of the ER to await transportation to FM ACS.

Exercise: Materials  Materials Management readies supplies according to the pre-determined lists.  Categories include: CS Disposables, Equipment, Pharmacy-Meds Description Quantity Needed Per Day UOMOrder QuantityDispensed

Set Up Hospital maintenance staff  Transfers equipment and supplies to Fawn Mountain school  Sets up the beds, privacy curtains

Set Up: Signage

Bus Loading

Bus Leaves KGH

The influenza patients arrive. Bus arrives at Fawn Mountain ACS The cots are ready!

FM ACS Care: Registration Charts

FM ACS Care: Triage

FM ACS Care: Bed Board

FM ACS Care

Discharge Station

Pastoral Care

The Group Photo

KGH Command Center

KGH: Patients Arrive

KIC ACS

KIC ACS: Pharmacy

Helicopter: Fawn Mountain to KGH Depart FM ACS Arrive KGH

Road blocks  Funding sources through KGH were not available; Home Land Security Grant money withdrawn  Volunteer patients: age, family, rules  Timing of the exercise was shorter than planned  Other community events: Health Fair, Mass Immunization Clinic, Auction

Lessons Learned

 Staffing Hospital Community  Supplies Transport Trial  Registration Process  Equipment List  KIC Activate, communicate, transport  Medical Reserve Corp

Lessons Learned: Nutrition/Hydration  For the volunteer patients and staff  KGH, DEC, sack lunches

Lessons Learned: Participant Responses Actors in Fawn Mountain ACS Exercise (10 responses)  It's nice to know that we are preparing for a disaster before one appears. Thank you.  You did a great job practicing your job and taking care of us and fulfilling our needs, and I would enjoy doing this again.  They took really good care of me and made me feel comfortable.  I felt like I was well cared for and would definitely go to this hospital if I really did get sick. Everyone was nice.  You did a great job taking care of your patients.

Actors in Hospital Exercise: KGH & KIC (7 responses)  KIC staff were more thorough than KGH staff.  Great staff. Lessons Learned: Participant Responses

Lessons Learned: Dolls Blow up dolls before buying them outfits!

Lessons Learned  Emergency Operations Plan Completed Approved locally Currently pending State of Alaska “OK”

Ketchikan Healthcare Community Comes Together Ketchikan General Hospital Primary Care Providers Clinics Public Health EMS