1. or,

3. * WSU home football games bring approximately 20,000 visitors to Pullman. * For some of the fans alcohol consumption and acute alcohol intoxication significantly increases the unscheduled care needs in the community. * Halloween is celebrated with gusto at WSU! * For example, in 2014, Halloween night brought 14 patients to the ED who required a period of observation for acute alcohol intoxication with the inability to care for self. * Apple Cup 2014 - There definitely was a patient surge as a direct result of the football game. The night shift saw more than 40 patients, with 32 arriving in a 5 hour period between 7:00 p.m. and 12:00 midnight. 8 patients (25%) were admitted with 2 of those requiring intubation. 22 patients were transported by EMS and several (unknown how many) were transported by Law Enforcement.

4. * A WSU home football game and Halloween on the same day/night.

5. * Hospital administration, department heads, and representatives of community partners were called together to develop a plan. * PRH staff * Pullman Fire/EMS * Pullman Police * WSU Police * WSU Emergency Services

6. * Provide a continuity of service to the community in light of the anticipated surge into the hospital and the emergency department in particular. * Coordinate efforts of PRH staff and pre-hospital providers for patient care.

7. Objectives ; * Recognize the historical surge of patients on home game weekends and Halloween and that both of this events happen on the same day this year. * Establish an ED observation unit in SDS for treatment and monitoring of certain patients. * Increase staffing levels in appropriate areas of the hospital in preparation for the surge. * Improve communications with pre-hospital providers to assist with patient care and destination. * Share action plan with area hospitals and public safety providers.

8. * PRH developed a hospital wide plan to care for the anticipated surge. The plan includes; increasing staffing levels in key areas, establish an ED observation unit in SDS, notify and communicating with area hospital and community public safety staff, and utilizing HICS concepts for event management. * The event window will be from 19:00 hrs Friday, October 30 through 07:00 hrs Sunday, November 1. * A WATrac event “Advisory Alert” will be sent to area hospitals and the other DMCCs in Region 9 * Pre-hospital care providers will communicate from the scene (or earliest possible time) to PRH with patient information to help with the placement and care of the patients. * The DMCC will be activated if the surge exceeds PRH capabilities and patients need to be transported to alternate hospitals.

10. “Patient surge is anticipated during the WSU / Stanford football game and Halloween weekend. Pullman Regional Hospital staffing has been increased from 1900 hours Friday through 0700 hours Sunday. Local hospitals and pre- hospital providers will be informed of any significant changes. DMCC may be activated if the patient surge exceeds anticipated numbers.”

11. * Weather ranged from 40 to 61 F – 52 at game time and raining. * Game attendance - 30012 * Hospital surge activity – 69 patients in 36 hours. * SDS overflow was a success * ED flow and patient treatment went well * May have been a little overstaffed at times

12. * Pre-planning for large community events with subsequent patient surge is beneficial for patients and staff. * Repurposing the SDS for ED observation patients works well. * Some of the SDS stretchers don’t work well for moving patients. * Some staff were not familiar with the ED charting system. * The time change for daylight savings caused problems with entering patients in Meditech and PYXIS. * The extra CC on during the busy time was great and should be done on every known weekend that we think the ED is going to see a patient surge. * Having security staff here was a benefit and should not be changed.

13. * Have a SANE RN on call. We had SANE exams both Friday night and Saturday night and that was a big staffing problem for the ED. * Materials needs to restock the ED both Saturday and Sunday on these weekends. PYXIS was running low by Sunday morning. * Change staffing times for the SDS area to end at noon on Sunday so that they have time to get rides home for the ETOH patients instead of moving them around again and refilling the ED. * All staff working the ED patient surge area need to know the ED charting system. * Consider moving patients to SDS once labs have been drawn and we are waiting on results if the ED DR approves. * Look into different ways to transport patients to the SDS area (see lessons learned). * Look into management of computer charting and PYXIS for transition from daylight savings time and back. * Have on extra housekeeping person Saturday and Sunday morning to help put ED and SDS back together before the next rush of patients.