1. Bethesda Hospitals’ Emergency Preparedness Collaborative: A Regional Model for National Responsiveness National Naval Medical Center National Institutes of Health, DHHS Uniformed Services University for the Health Sciences Suburban Hospital Healthcare System David K. Henderson, M.D. Deputy Director for Clinical Care Warren Grant Magnuson Clinical Center National Institutes of Health

2. Motivation? Events of September 11th, anthrax exposures, ongoing threats;Events of September 11th, anthrax exposures, ongoing threats; Healthcare organizations have well- formulated individual emergency response plans;Healthcare organizations have well- formulated individual emergency response plans; Drills and real emergency responses indicate communication and collaboration are often the weakest links in the response;Drills and real emergency responses indicate communication and collaboration are often the weakest links in the response; Increased interest by community and federal hospitals in responding in concert – effectively, efficiently and collaboratively;Increased interest by community and federal hospitals in responding in concert – effectively, efficiently and collaboratively; Outside resources available to support these “non-mission” activities.Outside resources available to support these “non-mission” activities.

3. The Partnership National Naval Medical CenterNational Naval Medical Center Suburban Hospital Healthcare SystemSuburban Hospital Healthcare System Uniformed Services University for the Health SciencesUniformed Services University for the Health Sciences Clinical Center, National Institutes of Health, DHHSClinical Center, National Institutes of Health, DHHS

4. The Vision The BHEPP will provide a comprehensive, transferable model. This template includes the following elements: Tools to guide the assessment of existing organizational assets;Tools to guide the assessment of existing organizational assets; Tools to identify required resources (e.g. workforce/ human resources needs, decontamination facilities, required patient care equipment and supplies, and initial and ongoing training/education needs);Tools to identify required resources (e.g. workforce/ human resources needs, decontamination facilities, required patient care equipment and supplies, and initial and ongoing training/education needs); Strategies for maintaining and/or enhancing existing response processes;Strategies for maintaining and/or enhancing existing response processes; Strategies for sustaining collaborative readiness,Strategies for sustaining collaborative readiness, Objective measures and methods for quantifying the success and exportability of the program.Objective measures and methods for quantifying the success and exportability of the program.

5. Similar kinds of proximity relationships exist among hospitals in numerous large cities throughout the country.Similar kinds of proximity relationships exist among hospitals in numerous large cities throughout the country. The design and implementation of such a partnership could provide a template for others;The design and implementation of such a partnership could provide a template for others; Similar planning activities might employ variants of our model, calling on the individual strengths of participating institutions.Similar planning activities might employ variants of our model, calling on the individual strengths of participating institutions. Potential Benefits…

6. Goals Provide a mechanism to integrate the partnership response with those of local, regional and national organizations engaged in emergency preparedness activities in our metropolitan area;Provide a mechanism to integrate the partnership response with those of local, regional and national organizations engaged in emergency preparedness activities in our metropolitan area; Develop model structures, enduring materials and performance measures to facilitate the exportation of the model.Develop model structures, enduring materials and performance measures to facilitate the exportation of the model. Provide a mechanism for our community to respond rapidly and successfully to any emergency situation – natural events and acts of terrorism and war;Provide a mechanism for our community to respond rapidly and successfully to any emergency situation – natural events and acts of terrorism and war;

7. Community HospitalCommunity Hospital Department of Defense Hospital and ReservationDepartment of Defense Hospital and Reservation Department of Defense Medical and Allied Health Professions UniversityDepartment of Defense Medical and Allied Health Professions University DHHS Research Hospital and ReservationDHHS Research Hospital and Reservation Strengths of the Partnership Lie in the Diversity of Its Partners…

8. Proximity;Proximity; Complementary institutional resources;Complementary institutional resources; Location relative to Washington, D.C.;Location relative to Washington, D.C.; Preexisting emergency preparedness plans;Preexisting emergency preparedness plans; The collaborative presence of the physical, human and intellectual resources necessary to be able to coordinate emergency healthcare for our community;The collaborative presence of the physical, human and intellectual resources necessary to be able to coordinate emergency healthcare for our community; Emergency preparedness expertise.Emergency preparedness expertise. Immediate Strengths…

9. Acute care community hospital with an active emergency room;Acute care community hospital with an active emergency room; Level II Trauma Center;Level II Trauma Center; Community preparedness experience;Community preparedness experience; Decontamination capacity.Decontamination capacity. Institutional Strengths – Suburban Hospital Healthcare System

10. Military hospital;Military hospital; Extensive decontamination capacity;Extensive decontamination capacity; Fenced facility;Fenced facility; Skilled, well-trained deployable workforce, including a large number of “in-residence” staffSkilled, well-trained deployable workforce, including a large number of “in-residence” staff Extensive preparedness training and practice.Extensive preparedness training and practice. Institutional Strengths – National Naval Medical Center

11. DoD facility, co-located at NNMC;DoD facility, co-located at NNMC; Students trained as EMTs;Students trained as EMTs; Faculty subspecialty expertise;Faculty subspecialty expertise; Will assume triage functionWill assume triage function Radiobiology Research Institute Radiobiology Research Institute Center for the Study of Traumatic Stress Center for the Study of Traumatic Stress Center for Disaster and Humanitarian Assistance Medicine Center for Disaster and Humanitarian Assistance Medicine Facility offers unique resources.Facility offers unique resources. Institutional Strengths – Uniformed University of the Health Sciences

12. Institutional Strengths – Clinical Center, National Institutes of Health Fenced facilityFenced facility Basic science expertiseBasic science expertise Staff familiar with containmentStaff familiar with containment Sophisticated diagnostic laboratoriesSophisticated diagnostic laboratories New, flexible clinical research facility that includes substantial surge capacityNew, flexible clinical research facility that includes substantial surge capacity Skilled campus HAZMAT / decontamination teamSkilled campus HAZMAT / decontamination team 1240 credentialed physicians representing extensive specialty/subspecialty expertise1240 credentialed physicians representing extensive specialty/subspecialty expertise

13. Command stations that are well-organized and that can integrate community resources expeditiously;Command stations that are well-organized and that can integrate community resources expeditiously; Pre-formed, integrated, flexible disaster plans that cross normal lines of standard operating procedures;Pre-formed, integrated, flexible disaster plans that cross normal lines of standard operating procedures; Software systems that can integrate a multifactorial emergency response to ensure that survivable patients can be transported to appropriate facilities;Software systems that can integrate a multifactorial emergency response to ensure that survivable patients can be transported to appropriate facilities; Appropriate resources to be able to address inevitable complex communication and integration issues.Appropriate resources to be able to address inevitable complex communication and integration issues. Assessing Partnership Needs…

14. Program Requirements Disaster ModelingDisaster Modeling Surge Capacity and Supply StockpileSurge Capacity and Supply Stockpile Decontamination Facilities and ProcessesDecontamination Facilities and Processes TransportationTransportation Communication and Public EducationCommunication and Public Education Workforce ManagementWorkforce Management Information TechnologyInformation Technology Ongoing Training and AssessmentOngoing Training and Assessment Program Transferability/ExportabilityProgram Transferability/Exportability

15. Program Requirements Disaster ModelingDisaster Modeling  Vulnerability assessment  Active drills  Tabletops Surge Capacity and Supply StockpileSurge Capacity and Supply Stockpile  Strategic national stockpile  DHHS contingency station

16. Model DHHS Medical Contingency Station Surge CapacitySurge Capacity  Nursing care for stabilized internal medicine, trauma, orthopedics and obstetrical patients  Designed space and support for medical evaluations  Support for nursing care of patients with special needs  Facilities for intravenous therapy and other medical treatments  CC would accept transfers from NNMC and Suburban  Station provides 250 beds; with this facility, CC could provide surge for at least 300 to 350 patients

17. DHHS Contingency Station – Implementation USPHS Commissioned Corps staff trained in set- up and monitoring – station designed to be available for use in four to six hoursUSPHS Commissioned Corps staff trained in set- up and monitoring – station designed to be available for use in four to six hours Stored at NIHStored at NIH Medical/surgical supplies, basic support supplies, pharmaceuticals, IVs, etc.Medical/surgical supplies, basic support supplies, pharmaceuticals, IVs, etc. CC would initially distribute NNMC/Suburban patients into existing clinical space using contingency station resourcesCC would initially distribute NNMC/Suburban patients into existing clinical space using contingency station resources  Single rooms  Day hospital rooms

18. If needed, Clinical Center has a gymnasium, a large atrium and numerous open spaces that could be used for surge.If needed, Clinical Center has a gymnasium, a large atrium and numerous open spaces that could be used for surge. StaffingStaffing  CC medical and nursing staff  Additional NIH physician/medical staff and scientific expertise  NNMC support (Medical Corps, etc.)  USUHS faculty, scientists, and medical students DHHS Contingency Station – Implementation

19. Program Requirements Decontamination Facilities and ProcessesDecontamination Facilities and Processes  NNMC as primary decon site  NIH and Suburban resources will participate, if necessary and available. TransportationTransportation  Assessment of institutional resources (vehicles, transportation routes, etc,)  Short-term solutions  Construction of connections that can be ‘dedicated’ in an emergency

20. Program Requirements Communication and Public EducationCommunication and Public Education  Communication with county and regional staff  Communication among partners  Public education Workforce ManagementWorkforce Management  “Captive” and volunteer staff Information TechnologyInformation Technology  Medical records and patient tracking  Inventory management  Communication redundancy

21. Program Requirements Ongoing Training and AssessmentOngoing Training and Assessment  Conjoint exercises  Development of milestones and performance measures Program Transferability/ExportabilityProgram Transferability/Exportability  Enduring materials  White paper  Performance measures

22. Barriers to Success Varied governanceVaried governance Disparate missionsDisparate missions Funding streamsFunding streams Code red securityCode red security Credentials and privilegesCredentials and privileges Patient trackingPatient tracking Information technology platformsInformation technology platforms

23. Accomplishments to Date Large scale coordinated disaster drill using radiological agent involving local, state and federal emergency preparedness organizations;Large scale coordinated disaster drill using radiological agent involving local, state and federal emergency preparedness organizations; Partnership with local and federal homeland security organizations;Partnership with local and federal homeland security organizations; Educational interface among partnersEducational interface among partners Planning for table top drill to include scenario involving biologic agentPlanning for table top drill to include scenario involving biologic agent Development of standard processes for selecting patients for surgeDevelopment of standard processes for selecting patients for surge Development of standard records for transferring surge patientsDevelopment of standard records for transferring surge patients

24. Performance Measures StructureStructure  MOA  Policies and Procedures  Equipment availability Process/FunctionProcess/Function  Completion of drills  Contingency station deployment OutcomesOutcomes  Transfer of patients  Communication failures

25. Future Plans Contingency Station ImplementationContingency Station Implementation Readiness DrillsReadiness Drills Export to other “partnerships”Export to other “partnerships”