1. The Story of the Toronto Central Local Integrated Network 2010 G20 Dashboard Why we should look at it Again Laurie Mazurik MD FRCPC MBA Project Lead, Pandemic Orange

2. Special Acknowledgement http://www.torontocentrallhin.on.ca/ In 2010 TCLHIN went to extraordinary lengths to support their Stakeholders as they prepared for very real threats to their ability to deliver patient care during the 2010 G20 Summit. The journey was a fascinating exploration of relationships and innovative thinking. All those involved applaud their initiative and leadership.

3. Laurie Mazurik MD (The Story Teller) Specialist in Emergency Medicine, Sunnybrook Hospital, Toronto Critical Care Transport Physician (Air and Land) Strategic Lead, Disaster and Emergency Preparedness Sunnybrook Member of Ontario SARS Operation Centre 2003 Conducted over 40 mass casualty health care system simulations since 2003 TCLHIN Lead for 2010 G20 Summit Preparations

4. Why worry.

5. There is lots of money to prepare 1 billion dollars for security (prevention) ~Almost 0$ for health care. It’s a good “learning” opportunity

6. We learned What a HIRA is. Do you know? That Security/Police thought the best place to hold protest marches is as close to 6 major Toronto hospitals as possible (They were the usual Protest Areas) How to CUUS and SBAR That Information is the new gold

7. We learned what a HIRA was

8. Threats

9. Lots of hints about concerns International Politics Lingering Worry http://goo.gl/xTsLvP

10. We Did become Worried Overcrowded ED’s

11. Let’s Think SMART We just need Information IMS…no so effective We are not like police or military who use a hierarchal system daily We think triage, capacity and patient flow We can live with “liaison” and “in-charge”

12. 12 A Dashboard with SIX sources of Information Toronto EMS: Riot at Queen’s Park Protest. Tear Gas Used. Some people may have serious injuries from falls. Health Network: Code Orange: HSC, Sinai: TGH: Clinics: Open CCAC:Delay 6hr ALERTS Media: 1000’s riot Ministry of Health Bulletins Contact Lists

13. Speak in SBAR,CUUS and Capacity 13 Consistent and Easy to Use

14. SBAR: Acronym S=situation: Briefly describe the current situation. B=background: State the pertinent history. A=assessment: Summarize the facts and what you think the problem is R=recommendation: What you think needs to be done in order to be address the problem safely and effectively

15. Situation In critical events it is very difficult to get timely,credible information It is disparate Incomplete

16. Background There 3 main sources of information Media = fast not always credible EMS =relatively fast, credible, does not include ambulatory surge Phone who you know= piece meal, usually they don’t know either

17. Assessment If a critical incident occurs we will have a delayed indecisive and response Will not be able to provide EMS with credible information to justify diversion of selected ambulances away from hospitals

18. Recommendation Capture and Share Credible information in real- time Work with EMS to distribute surges across ALL health care resources Preserve Acute Care CRITICAL Services that other hospitals do not have

19. Talk about Capacity and set thresholds for Alerts N= normal capacity =Green Yellow 10-20% over N= Yellow >20% = Red Overwhelmed Unable to Provide Service

20. Critical Language used:CUUS Key Phrases must be understood by ALL to mean “STOP and Listen”-we have a potential problem Example: United Airlines “CUUS” Program I am Concerned I am Uncomfortable This is Unsafe I am Scared

22. TC LHIN Background Submit Situational Report Overall Capacity EDTrauma Critical Care STEMI Acute Stroke NeurosurgeryDialysis Labour & Delivery Paediatrics SHSC NA Mount Sinai Hospital NA Toronto General NA TEGH NA St. Michael’s Walk-in only St. Joseph’s Health Centre NA Hospital for Sick Children NA Women’s College Hospital NA

23. TC LHIN Background Submit Situational Report Overall Cap EDTrauma Critica l Care STEMI Acute Stroke NeurosurgDialysis Labour & Delivery Paediatrics SHSCNA Mount Sinai Hospital NA Toronto General NA TEGHNA St. Michael’s St. Joseph’s Health Centre NA Hospital for Sick Children NA Women’s College Hospital NA NICU Triggers Telco between TCLHIN Leads, Hospital Leads, TEMS, CritiCall, ORNGE & MOH

24. We Build “Smart System” Based it on Media Display Systems Used Terminology we could understand Defined the Data we wanted in real-time The way in which we wanted it reported and displayed Set thresholds for Alerts or Alarms Approached the TCLHIN to help us

25. The G20 Dashboard

26. Build Capacity Based Action Plans

27. Hospitals

28. How did it perform? Hospital security provided info faster than media or police Coordinated diversion of ambulances to “open” hospitals Everyone understood the plan

29. Now We want to Build a New Prototype with End-user Input Giving Health Care Providers a chance to capture data and exchange ideas across a greater network

30. Hospitals

31. Add or track internal Hospital Dashboards UnitStaffBedsPharmSuppliesOtherStatus ED Trauma Critical Care OR ALERTS

32. Integrated Syndromic Surveillance

33. MASAS Multi-Agency Situational Awareness System

34. Increase portability with Tablet and Smart Phone formats

35. Value Track trends Look at Consequences Identify Predictable Patterns Build Strategies to Mitigate Examine what others do in a broader network Build/Test Models

36. Next Steps: Engagement

37. Join The CBRNE Collaborative Time Limited Offer Explore the actual G20 Dashboard and give us feedback Do the polls in our e- learning modules and join some discussions Share your ideas and lets grow them together.