1. Medical Surge 101Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Brian Kaczmarski Training and Exercise Coordinator Office of Preparedness and Emergency Health Care 062215 Medical Surge 101- An Overview 1

2. Medical Surge 101 Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Definition The Medical surge capability is the ability to provide adequate medical evaluation and care during incidents that exceed the limits of the normal medical infrastructure within the community. This encompasses the ability of healthcare organizations to survive an all-hazards incident, and maintain or rapidly recover operations that were compromised. 2 2013 HPP CPG document

3. Medical Surge 101 Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services The Tiers Apply the definition from previous slide to the disaster tiers: Tier 1- How do you medically surge within the walls of your organization? When are you ‘overloaded?’ Tier 2- What’s your ‘area?’ Is it defined? How do you surge within your area? When are you overloaded? Tier 3- What’s your ‘region?’ How do you surge within your region? When is the region overloaded? Tier 4- Multi-region? State? Tier 5- FEMA Region 5 Tier 6- Federal Response 3

4. Medical Surge 101 Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Functions of Medical Surge 1. The Healthcare Coalition assists with the coordination of the healthcare organization response during incidents that require medical surge 2. Coordinate integrated healthcare surge operations with pre-hospital Emergency Medical Services (EMS) operations 3. Assist healthcare organizations with surge capacity and capability 4. Develop Crisis Standards of Care Guidance 4 2013 PHEP CPG document

5. Medical Surge 101 Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Function 1 The Healthcare Coalition assists with the coordination of the healthcare organization response during incidents that require medical surge Ensure healthcare coordination Incident Command Ensure situational awareness (Info Sharing) What is your platform for communicating? Use the tiered response plan for coordination 5

6. Medical Surge 101 Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Function 2 Coordinate integrated healthcare surge operations with pre-hospital Emergency Medical Services (EMS) operations How do EMS and the health care organization communicate? Patient status and transport status WISCOM Do healthcare organizations understand EMS protocols around triage and CBRNE protocols? 6

7. Medical Surge 101 Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Function 2 - continued Coordinated disaster protocols for triage, transport, documentation, CBRNE Triage methodologies Transport of mass casualties (Where? Is it the best possible transport? Or will they need to be re- transported?) Disaster documentation (WI-TRAC, WISCOM) CBRNE exposure care 7

8. Medical Surge 101 Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services CBRNE Exposure Care Suggested resources: Standards for Personal Protective Gear for first Responders: http://www.dhs.gov/files/programs/gc_1218226975457.s htm#0 http://www.dhs.gov/files/programs/gc_1218226975457.s htm#0 NFPA 472: Standards for Competence of Responders to Hazardous Materials/Weapons of Mass Destruction Incidents, 2008 NIOSH Personal Protective Equipment for Emergency Response: http://www.cdc.gov/niosh/topics/emres/ppe.html http://www.cdc.gov/niosh/topics/emres/ppe.html 8

9. Medical Surge 101 Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Function 3 Assist healthcare organizations with surge capacity and capability Task 1 - Assist healthcare organizations with decisions regarding surge management by ensuring processes exist to provide healthcare organizations with ongoing communication regarding the status of the incident and the status of medical surge operations when requested (Info Sharing) Task 2 - Develop a process for healthcare organizations to provide multi- agency coordination regarding resource decisions during medical surge operations (Info Sharing, Resource Management) Task 3 - Develop, refine, and sustain processes that assist healthcare organizations to maximize medical surge capacity and capability during response operation (Emergency Operations Coordination) 9

10. Medical Surge 101 Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Medical Shelters Many states have resources and plans to set up medical shelters/tents in an impacted area as a solution to support the medical surge Wisconsin does have limited capacity to do this (more later) However, this is NOT Wisconsin’s preferred model for Medical Surge. 10

11. Medical Surge 101 Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Wisconsin’s Medical Surge Model Patient off-loading and on-loading through the Disaster Response Tiers. Through area and regional medical coordinating centers (AMCC and RMCC), the intent is to systematically off-load the patients to outlying areas or regions that are capable of meeting the needs of the clients. Another way to think of it; Instead of surging resources IN to the impacted area, we are pushing the patients OUT to where the resources are This likely will be in unison with resources coming in 11

12. Medical Surge 101 Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Wisconsin’s Medical Shelter Model Wisconsin DMAT (Disaster Medical Assistance Team) Part of NDMS (National Disaster Medical System) a federally-coordinated system that provides medical capabilities in the event of a large-scale emergency that overwhelms normal local medical resources. In Wisconsin, this team is actually an MRC (Medical Reserve Corp) 12

13. Medical Surge 101 Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Wisconsin DMAT Resources Mobile Medical Care Facility (MMCF) Capacity to bring in and set up a total of 4 Mobile Medical Units (MMU) that, combined, form a 40 bed medical care center Burn supplies for 20 patients Pediatric equipment PPE to safely operate within a CBRNE incident 13

14. Medical Surge 101 Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services 14

15. Medical Surge 101 Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Wisconsin National Guard (WING) Resources Related to Medical Surge: Force Package Mission 15

16. Medical Surge 101 Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services In summary… Know and understand the Disaster Coordination Response Tiers Critical to understanding medical surge in Wisconsin Patient off and on loading This will occur WHILE resources are brought in Get the right people to the right place for the best possible outcome 16

17. Medical Surge 101 Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services For More Information HPP CPG- http://www.phe.gov/preparedness/planning/hpp/reports/do cuments/capabilities.pdf http://www.phe.gov/preparedness/planning/hpp/reports/do cuments/capabilities.pdf 17

18. Medical Surge 101 Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services Upcoming Medical Surge Training Opportunities Introduction to Disaster Coordination Response Tiers- now available; http://dhsmedia.wi.gov/main/Play/368747a8e01e49 568ac9d175c15d68501d http://dhsmedia.wi.gov/main/Play/368747a8e01e49 568ac9d175c15d68501d Medical Surge 201 – Forthcoming. Check PCA Training Tab Healthcare Scenarios within the Tiered Response Plan- Forthcoming. Check PCA Training Tab 18

19. Medical Surge 101 Division of Public Health, Public Health Preparedness Wisconsin Department of Health Services For More Information: Brian Kaczmarski Training & Exercise Coordinator Office of Preparedness and Emergency Healthcare Wisconsin Division of Public Health brian.kaczmarski@wisconsin.gov Cell: 608-215-1025 19