1. Surge Capacity Enhancement Plan Draft April 21, 2004

2. March 30, 2004 Vision A seamless system of healthcare surge capacity throughout the Commonwealth of Virginia, able to respond effectively and efficiently to public health emergencies of all types and all sizes, from small, but significant incidents to large-scale catastrophic disasters. A seamless system of healthcare surge capacity throughout the Commonwealth of Virginia, able to respond effectively and efficiently to public health emergencies of all types and all sizes, from small, but significant incidents to large-scale catastrophic disasters.

3. March 30, 2004 Definition The ability of the health system to expand beyond normal operations to meet a sudden increased demand The ability of the health system to expand beyond normal operations to meet a sudden increased demand Usually the result of a large scale public health emergency due to natural or man- made disaster Usually the result of a large scale public health emergency due to natural or man- made disaster Must respond to immediate short term surge and sustain response for extended period Must respond to immediate short term surge and sustain response for extended period

4. March 30, 2004 Scope of NOVA Plan Geographic Region Geographic Region 2.2 million population 2.2 million population Alexandria Alexandria Arlington Arlington Fairfax Fairfax Loudoun Loudoun Prince William Prince William Elements Hospitals Public Health Equipment Supplies Pharmaceuticals Staffing/Volunteers Mental Health/Crisis Intervention/Spec. Pop. Environmental Health Mass Fatalities Communications Quarantine/Isolation

5. March 30, 2004 Guiding Principals Used HRSA Guidelines of 500 additional beds per million population Used HRSA Guidelines of 500 additional beds per million population Anticipate likelihood of Biological/Chemical casualties exceeding 10,000 Anticipate likelihood of Biological/Chemical casualties exceeding 10,000 Hospital surge in place Hospital surge in place Count only on existing staff Count only on existing staff Planned degradation of Standard of Care Planned degradation of Standard of Care Expect no outside assistance before 72 hours Expect no outside assistance before 72 hours Set expectations and define limitations in advance Set expectations and define limitations in advance Best mitigation of surge breakdown will be communications in advance and during incident Best mitigation of surge breakdown will be communications in advance and during incident

6. March 30, 2004 Levels of Activation Phased levels of activation based on staffed bed capacity in region Phased levels of activation based on staffed bed capacity in region Each region will have a unique volume of causalities that can be managed at each level of activation. Each region will have a unique volume of causalities that can be managed at each level of activation.

7. March 30, 2004 Levels of Activation Level I: Utilization of all unoccupied staffed beds (Northern region: 531 casualties) Level II: 20% above regional staffed beds (Northern region: 1,010 casualties) Level III: Utilization of all ancillary medical facilities in region and/or activation of mobile capabilities (1000-5000 casualties) Level IV: Exceed regional capabilities requiring forward movement of patients.

8. March 30, 2004 Surge Capacity: Resources Hospital beds Hospital beds Isolation facilities Isolation facilities Personnel: Healthcare & non-HC Personnel: Healthcare & non-HC Pharmaceuticals Pharmaceuticals Supplies & Equipment Supplies & Equipment PPE PPE Decontamination Decontamination Vents, Oxygen, IVF’s, dressings, etc. Vents, Oxygen, IVF’s, dressings, etc.

9. March 30, 2004 Surge Capacity: Domains Pre-Hospital/EMS Pre-Hospital/EMS Hospital Hospital Community (Alternative Care Sites) Community (Alternative Care Sites) Public Health Public Health Mental Health Mental Health Mass Fatality/Mortuary Mass Fatality/Mortuary

10. March 30, 2004 Benchmarks (“Letter of the Law” and Beyond) HRSA Grant Guidelines: 500 adult/peds per 1 million population HRSA Grant Guidelines: 500 adult/peds per 1 million population For 7.3 million = capacity for 3650 additional patients For 7.3 million = capacity for 3650 additional patients Isolation Capacity= at least one facility with capacity to simultaneously treat 10 adults/peds with contagious disease Isolation Capacity= at least one facility with capacity to simultaneously treat 10 adults/peds with contagious disease

11. March 30, 2004 Results All Regions meet minimum Benchmark All Regions meet minimum Benchmark Benchmark Level 1 Level 2 Benchmark Level 1 Level 2 Northern: 1100 620 1180 Northern: 1100 620 1180 Northwest: 387 530 865 Northwest: 387 530 865 Eastern: 869 779 1371 Eastern: 869 779 1371 Central: 621 1086 1750 Central: 621 1086 1750 Southwest: 654 908 1470 Southwest: 654 908 1470 Statewide: 3650 3924 6635 Statewide: 3650 3924 6635

12. March 30, 2004 Isolation Capacity All Regions have some isolation capacity All Regions have some isolation capacity Isolation Beds Isolation Beds Northern155 Northwest118 Eastern248 Central87 Southwest150 Statewide Total: 758

13. March 30, 2004 Scalable Response to Disaster (= Levels of Surge Capacity)

14. March 30, 2004 Emergency Response Players Local Public Health Department EVENT Federal Government: CDC DoD FBI DHS Legislators State Agencies VDH VDEM State Police Fire/EMS Local Law Enforcement Local Emergency Management Healthcare Commmunity Local Hospitals

15. March 30, 2004 Planning Calendar May 30, 2004 Draft Plan completed for Northern Virginia Region May 30, 2004 Draft Plan completed for Northern Virginia Region June 30, 2004 SEPHLI Scholars (Tom Franck M.D., Lilian Peake M.D., Scott Benton, and Steve Harrison) expand project into State-wide Plan June 30, 2004 SEPHLI Scholars (Tom Franck M.D., Lilian Peake M.D., Scott Benton, and Steve Harrison) expand project into State-wide Plan July 30, 2004 Northern and State Plan completed and ready for exercise. July 30, 2004 Northern and State Plan completed and ready for exercise. September 2004 Virginia collaborates with MD and DC using Northern Region Plan as template to create unified NCR plan September 2004 Virginia collaborates with MD and DC using Northern Region Plan as template to create unified NCR plan

16. March 30, 2004 BACKUP SLIDES CRITICAL BENCHMARKS CRITICAL BENCHMARKS

17. March 30, 2004 HRSA Surge Benchmarks Critical BM #2-1: Hospital Bed Capacity Critical BM #2-1: Hospital Bed Capacity A system that allows the triage, treatment and disposition of 500 adult and pediatric patients per 1 million population, with acute illness or trauma requiring hospitalization from a biological, radiological or explosive terrorist incident. A system that allows the triage, treatment and disposition of 500 adult and pediatric patients per 1 million population, with acute illness or trauma requiring hospitalization from a biological, radiological or explosive terrorist incident. Enough staffed and equipped hospital beds to manage a surge of 500 acutely ill adult and pediatric patients per 1 million population. Enough staffed and equipped hospital beds to manage a surge of 500 acutely ill adult and pediatric patients per 1 million population.

18. March 30, 2004 HRSA Surge Benchmarks Critical BM #2-2: Isolation Capacity Critical BM #2-2: Isolation Capacity At least one negative pressure, HEPA filtering isolation facility per awardee; must be able to support the evaluation and treatment of 10 adult and pediatric patients at a time. At least one negative pressure, HEPA filtering isolation facility per awardee; must be able to support the evaluation and treatment of 10 adult and pediatric patients at a time.

19. March 30, 2004 HRSA Surge Benchmarks Critical BM #2-3: Healthcare Personnel Critical BM #2-3: Healthcare Personnel Response system that allows immediate deployment of 250 or more additional patient care personnel per 1 million population in urban areas, and 125 or more additional personnel per 1 million population in rural areas, that would meaningfully increase hospital patient care surge capacity. Response system that allows immediate deployment of 250 or more additional patient care personnel per 1 million population in urban areas, and 125 or more additional personnel per 1 million population in rural areas, that would meaningfully increase hospital patient care surge capacity.

20. March 30, 2004 HRSA Surge Benchmarks Critical BM #2-5: Pharmaceuticals Critical BM #2-5: Pharmaceuticals Local or regional systems whereby pharmacies have surge capacity to provide pertinent pharmaceuticals in response to bioterrorism or other public health emergencies. Local or regional systems whereby pharmacies have surge capacity to provide pertinent pharmaceuticals in response to bioterrorism or other public health emergencies. Critical BM #2-6: PPE Critical BM #2-6: PPE Adequate personal protective equipment for 250 or more healthcare personnel per 1 million population in urban areas, and 125 or more healthcare personnel per 1 million population in rural areas. Adequate personal protective equipment for 250 or more healthcare personnel per 1 million population in urban areas, and 125 or more healthcare personnel per 1 million population in rural areas. Critical BM #2-7: Decontamination Critical BM #2-7: Decontamination Adequate portable or fixed decontamination systems for 500 patients and workers per 1 million population. Adequate portable or fixed decontamination systems for 500 patients and workers per 1 million population.

21. March 30, 2004 HRSA Surge Benchmarks Critical BM #2-8: Mental Health Critical BM #2-8: Mental Health A system that provides for a graded range of acute psychosocial interventions and longer-term mental health services to 5,000 adult and pediatric clients and healthcare workers per 1 million population exposed to a WMD incident. A system that provides for a graded range of acute psychosocial interventions and longer-term mental health services to 5,000 adult and pediatric clients and healthcare workers per 1 million population exposed to a WMD incident.

22. March 30, 2004 HRSA Surge Benchmarks Critical BM #2-9: Trauma/Burn Care Capacity Critical BM #2-9: Trauma/Burn Care Capacity To be able to respond to a mass casualty incident due to terrorism, ensuring the capability of providing trauma care to at least 50 severely injured adult and pediatric patients per 1 million population per day. To be able to respond to a mass casualty incident due to terrorism, ensuring the capability of providing trauma care to at least 50 severely injured adult and pediatric patients per 1 million population per day. Critical BM #2-10: Communications and IT Critical BM #2-10: Communications and IT A secure and redundant communications system that ensures connectivity between during a terrorist incident A secure and redundant communications system that ensures connectivity between during a terrorist incident

23. March 30, 2004 HRSA Priority Area #3 Critical BM #3: EMS Critical BM #3: EMS Develop a mutual aid plan for upgrading and deploying EMS units in jurisdictions they do not normally cover, in response to a mass casualty incident due to terrorism. This plan must ensure the capability of providing EMS coverage for at least 500 adult and pediatric patients per 1 million population per day. Develop a mutual aid plan for upgrading and deploying EMS units in jurisdictions they do not normally cover, in response to a mass casualty incident due to terrorism. This plan must ensure the capability of providing EMS coverage for at least 500 adult and pediatric patients per 1 million population per day.