2. It Takes a Healthcare Village

3. Presentation Objectives Show attendees that the hospitals cannot take care of all patients in a disaster Identify key decision makers in Kitsap County related to planning of patient care during disasters Discuss Kitsap County Continuum of Patient Care During Disasters Identify how general and medical sheltering needs can be tiered to meet the needs of the community Describe how medical sheltering is different from Alternate Care Facilities Define process for developing and roll out of Disaster Ready Clinic curriculum

6. Licensed Bed Count Harrison Medical Center Bremerton253 Silverdale 44 Naval Hospital Bremerton100 Hospital Beds397 Kitsap County Population According to US Census data for 2012, Kitsap County has: 254,991 Residents Do the Math!

7. The Three Legged Stool Kitsap Public Health Kitsap DEM Harrison Medical Center

8. Kitsap Continuum of Patient Care Coordination * Includes Clinics and Urgent Cares represented in KCHD NDC planRevised 12/08/11 Telephone Triage Family Home Care Professional Home Care Triage & Treatment Centers * Major Clinics Urgent Care Centers Alternate Care Facilities (Acute Care) Harrison Medical Center Navy Hospital Long Term Care Home Coroner/Funeral Homes Tier 1 Tier 2 Tier 3 Tier 4 LTC Sheltering (Stage 1) Alternate Care Sheltering (Chronic Care – Stage 2) Other Medical Sheltering (e.g., ARC, KMHS)

9. Tier 1 Telephone Triage Family Home Care Professional Home Care LTC Sheltering (Stage 1) Other Medical Sheltering (e.g., ARC, KMHS)

10. Tier 2 Triage & Treatment Centers * Major Clinics Urgent Care Centers

11. Tier 3 Alternate Care Facilities (Acute Care) Harrison Medical Center Navy Hospital Alternate Care Sheltering (Chronic Care – Stage 2)

12. Tier 4 Long Term Care Home Coroner/Funeral Homes

13. Disaster Ready Clinics/Triage and Treatment Sites Because of geography, discussions began in 2010 with Evergreen Earthquake exercise to ready Peninsula Community Health Services (PCHS), only federal community health center in Region 2. Local Disaster Medical Assistance Team trained PCHS in triage and treatment. 136 volunteers were utilized to practice this new skill during Evergreen Earthquake. Biggest lesson learned was that clinic staff did not know how to lift and move patients.

14. January 2012 Held joint meeting for major clinic leadership in Kitsap County to include: Group Health Cooperative Harrison Urgent Care and Primary Care Centers Kitsap Children's Clinic Pacific Surgery Center Peninsula Community Health Services Silverdale Surgery Center Sound Family Health The Doctors Clinic Virginia Mason – Winslow

15. February – May 2012 Public Health was able to engage an intern to develop Disaster Ready Clinic curriculum components to include: Triage & Treatment using the START algorithm Incident Command System Patient Lifting and Moving Disaster Mental Health

16. June 2012 Virginia Mason Clinic on Bainbridge Island stepped forward to volunteer to pilot the curriculum Set aside 2 hours for entire staff to be trained in four modules Provided feedback on curriculum Staff suggested basic preparedness information be included It was clear that the patient movement module is best trained in a hands- on environment

17. Fall 2012 Developed fifth module to include basic preparedness for staff with introduction of Joplin video to grab everyones attention. Discussion with EMS at MCI planning meeting about the future of triage and treatment in Kitsap County. Winter 2013 Brought clinic leadership back together to describe program roll-out, including different teaching modalities for curriculum. All original clinic leaders plus more were in attendance at the meeting and have agreed to have their clinics trained by year end 2013.

18. April 2013 Train-the-trainer course conducted. Trainers can be from clinic staff or volunteers. Trainers can be part of Medical Reserve Corps. Remainder of 2013 Coordinate training with clinics Communicate progress with EMS Identify and engage clinics that will participate in future MCI exercises The Future Maintain clinic engagement to remain Disaster Ready

19. Final Curriculum Modules Introduction including Joplin Video and Basic Preparedness for staff Triage and Treatment Incident Command System Patient Lifting and Moving Disaster Mental Health

20. Whats in it for the clinics? Understand that during disasters, patients are coming whether they are ready or not. They agreeIts better to be ready. Clinics understand that the hospital resources need to be kept for those who need them most. Clinics will receive triage kits through ASPR funding. Once trained, DEM will provide clinics with signage that indicates they are a Disaster Ready Clinic. Media discussions to highlight clinic engagement. Closer linkage with the hospitals, public health, and DEM.

21. Better able to provide Kitsap County residents with the right type of patient care during times of disaster. Curriculum being utilized throughout the region. Whats in it for the community?

22. The role of the Community Health Center is to protect the surge capacity of hospitals so they can see the most critical patients. We should be seeing the walking wounded and worried well. Zena Kinne, Director – Quality Peninsula Community Health Services

23. Kitsap Continuum of Patient Care Coordination * Includes Clinics and Urgent Cares represented in KCHD NDC planRevised 12/08/11 Telephone Triage Family Home Care Professional Home Care Triage & Treatment Centers * Major Clinics Urgent Care Centers Alternate Care Facilities (Acute Care) Harrison Medical Center Navy Hospital Long Term Care Home Coroner/Funeral Homes Tier 1 Tier 2 Tier 3 Tier 4 LTC Sheltering (Stage 1) Alternate Care Sheltering (Chronic Care – Stage 2) Other Medical Sheltering (e.g., ARC, KMHS)

24. Review of Presentation Objectives Show attendees that the hospitals cannot take care of all patients in a disaster Identify key decision makers in Kitsap County related to planning of patient care during disasters Discuss Kitsap County Continuum of Patient Care During Disasters Identify how general and medical sheltering needs can be tiered to meet the needs of the community Describe how medical sheltering is different from Alternate Care Facilities Define process for developing and roll out of Disaster Ready Clinic curriculum

25. Thank you!