1. HPP Coalition Surge Test July 25, 2017 CAPT Kevin Sheehan, USPHS HHS Region IX ASPR/HPP

2. Q & A Overview of the Coalition Surge Test (CST)
Agenda
Overview of the Coalition Surge Test (CST)
Hands-on Demo of the CST
CST Based Performance Measures
Q & A

3. Overview of the Coalition Surge Test
Elements of the Coalition Surge Test include:
HPP BP-1 Annual Requirement for all funded HCCs
Hospital Evacuation Scenario – low to no-notice
Evacuating hospital seeks assistance from HCC partners
Exercise Materials developed by HPP – MS Excel Tools
Two Phases to the Exercise
Phase 1 – Table Top Exercise and Facilitated Discussion
Phase 2 – After Action Review
Eight Performance Measures linked to execution of CST

4. Role of the HCC in this exercise
Collaborate & coordinate with health care response entities to identify clinically appropriate beds for evacuating patients
Communicate & coordinate with medically appropriate transportation
Identify essential elements of information that helps inform situational awareness among HCC members and partners

5. Exercise Scenario

6. What makes up the CST (tools)?
Two MS Excel Spreadsheets
Evacuating Facility (EVAC Tool)
Regional Healthcare Coordination Center (LEAD Tool)
Trusted Insider / Peer Assessor Handbook – MS Word
Search: HCC Surge Test (phe.gov)

7. Coalition Surge Test (CST) Structure of the Exercise
Two Phases to the CST:
Phase 1:
Table Top Exercise with Functional Elements – 90 mins
Evacuating hospital needs to find beds for their patients
Receiving hospitals provide bed availability
Facilitated Discussion – 90 mins
Peer Assessors will lead the facilitated discussion with data collected during the exercise
Commence shortly after the exercise concludes
Phase 2:
After Action Review – mins
Assessment of strengths and weaknesses & corrective actions
Must occur within 30 days after Phase 1 concludes
The CST tests a coalition’s ability to work in a coordinated way to find appropriate destinations for patients using a simulated evacuation of at least 20 percent of a coalition’s staffed acute-care bed capacity. The entire CST takes approximately four hours to complete and includes the two following phases:
Phase 1: Table Top Exercise with Functional Elements and Facilitated Discussion. The exercise starts 60 minutes after the assessment team notifies one or more hospitals or other patient-care facilities that they need to stand up their facility command centers. The exercise ends when all patients are placed or after 90 minutes, whichever comes first, after which participants will join a facilitated discussion that explores issues raised during the exercise. The facilitated discussion may include: patient transportation planning, receiving health care facility capacity, patient tracking and public information, the needs of vulnerable patients, and continuity of operations.
Phase 2: After Action Review. An after action review concludes the CST and consists of an assessment of strengths and weaknesses and corrective action planning. Ideally, this should occur immediately after Phase 1, but it can be scheduled for a later date to maximize health care executive participation; however, it must occur within 30 days of Phase 1.

8. CST Exercise Requirements
Annual requirement for HCCs beginning in BP-1
Low / no-notice
Simulated evacuation of 20 percent of the HCCs’ staffed acute care bed capacity
20 percent surge – parallels Immediate Bed Availability (IBA)
Consistent with Health Care Preparedness and Response Capabilities
The BP-1 FOA will require each HCC in the HPP to participate in an evacuation exercise using the CST annually, all hospitals in HPP are required to participate. Not all hospitals are required to be evacuating hospitals, some will be evacuating hospitals but most will be receiving hospitals.
Low/no-notice: The CST includes a low- to no-notice exercise requirement. Low- to no-notice exercising is important in ensuring that HCCs can transition quickly and efficiently into “disaster mode” and provide a more realistic picture of readiness than pre-announced exercises. At least one month in advance, a trusted insider will identify the assessment team and inform HCC members that the CST will occur within a two-week window. HCC members will not know the exact date and time, and they will not know whether they are playing the role of “evacuating” or “receiving” facility until 60 minutes before the start of the exercise.
20% surge - The CST tests a coalition’s ability to work in a coordinated way to find appropriate destinations for patients using a simulated evacuation of at least 20 percent of a coalition’s staffed acute-care bed capacity. For example, if there are 1,000 staffed acute-care beds in your coalition, your evacuation target is 200 patients.
Consistent with Immediate Bed Availability guidance in the Health Care Preparedness and Response Capabilities – Capability 4: Medical Surge, Objective 2: Respond to a Medical Surge
These are the definitions we have in the implementation guidance:
•                     Executives: An executive is a decision-maker for his/her respective organization and should have decision-making power to include, but not limited to, allocating or reallocating resources, changing staffing roles and responsibilities, and modifying business processes in his/her organization. Typical titles of executives with decision-making power include Chief Executive Officer, Chief Operating Officer, Chief Medical Officer, Chief Clinical Officer, Chief Nursing Officer, Director of Public Health, or Chief of EMS, among others.
•                     Participating: A member organization or executive is considered to be participating if they are physically or remotely connected to the conduct of the After Action Review in real time.

9. CST Exercise Participants
Trusted Insider & Peer Assessors
Four core members of the HCC
All acute care hospitals
Public Health
EMS
Emergency Management
Evacuating & Receiving Hospitals/Facilities
Healthcare Executives in After Action Review
Other HCC members (non-hospital)
All four core members of the HCC will be needed to participate in this exercise
At least one hospital shall participate as the evacuating hospital, more than one may be needed
The remaining hospitals in the HCC will play as receiving hospitals – their participation shall be to provide their bed availability, participate in the facilitated discussion and the after action review.
Other HCC members (non-hospital) can participate in information sharing and participate as well in the facilitated discussion and after action review.
These are the definitions we have in the implementation guidance:
•                     Executives: An executive is a decision-maker for his/her respective organization and should have decision-making power to include, but not limited to, allocating or reallocating resources, changing staffing roles and responsibilities, and modifying business processes in his/her organization. Typical titles of executives with decision-making power include Chief Executive Officer, Chief Operating Officer, Chief Medical Officer, Chief Clinical Officer, Chief Nursing Officer, Director of Public Health, or Chief of EMS, among others.
•                     Participating: A member organization or executive is considered to be participating if they are physically or remotely connected to the conduct of the After Action Review in real time.

10. Benefits of Exercising with the Coalition Surge Test
Coalition Surge Test will allow for:
Increased collaboration, cooperation, and communication
Limited prep time for trusted insider & peer assessors
Standard exercise structure/scenario for all HCCs nationwide
Engagement at coalition level vs. individual hospital level
Low / no-notice requirement will benefit the HCC in preparing for no-notice events (e.g., floods, fires, earthquakes)
Uniform tools (MS Excel spreadsheets) for collecting exercise data in real-time, saving & sharing data, and analyzing for later review/analysis
The Coalition Surge Test (CST) is a user-friendly peer assessment low/no-notice exercise that helps health care coalitions identify gaps in their surge planning. Low/no-notice exercising is important in assuring that health care coalitions can transition quickly and efficiently into “disaster mode” and provide a more realistic picture of readiness than pre-announced exercises. The exercise is designed to be challenging and is intended to support continuous improvement.

11. BP-1 CST-Based Performance Measures
Total of 8 performance measures:
Health Care Coalition (x2)
Evacuation Hospital (x2)
Receiving Hospital (x2)
Transportation Based (x2)

12. HCC Based Performance Measures
#14: Percent of core HCC members who participate in Phase 1 of the CST (Table Top Exercise and Facilitated Discussion)
#15: Percent of core HCC members executive participation in Phase 2 of the CST - After Action Review

13. Evacuating Hospital Based Performance Measures
#16: Percent of patients from evacuating hospital(s) identified as either:
Discharged home
Needing to evacuate to a receiving facility
#17: Time to report the total number of evacuating patients.

14. Receiving Hospitals Based Performance Measures
#18: Percent of evacuating patients with appropriate bed identified at a receiving hospital or health care facility.
#19: Time for receiving hospitals in the HCC to report the total number of beds available to receive patients.

15. Transportation Related Performance Measures
#20: Percent of evacuation patients with acceptance for transport to another facility that have an appropriate mode of transportation identified.
#21: Time to identify appropriate mode of transportation for the last evacuating patient.