1. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services Healthcare Scenarios within the Tiered Response Plan 1

2. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services Presenters Brian Kaczmarski, Training and Exercise Coordinator Office of Preparedness and Emergency Health Care 2

3. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services Outline Review of Tiers Similarities to the Incident Command System Scenarios Review Next Steps 3

4. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services Review of the 6 Tiers 1.Local health care organization 2.Area coordination 3.Regional coordination 4.Inter-jurisdictional (amongst the 7) and State 5.Interstate (FEMA Region 5) 6.Federal Support 4

5. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services Tier 1 Local healthcare organization (HCO) – Incident Command – EOC Hospital Liaison Medical triage and management will continue at the HCO Until event over or until can no longer handle If overwhelmed, activate Tier 2 5

6. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services Tier 2 – Area Medical Coordination Center Must notify all involved (those in Tier 1) that Tier 2 is activated Assuming lead of medical coordination ONLY (ESF 8) Job – coordinate medical resources from all area coalition partners. Maintain situational awareness WI-TRAC, WISCOM and traditional modalities Manage until overwhelmed Consider the need for Tier 3 activation 6

7. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services Tier 3 - Regional Medical Coordination Center (RMCC) Assume medical coordination lead from AMCC. Communicate transfer. Is AMCC still communicating situational awareness or will it go to RMCC? Communicate with EOCs that are activated Encourage activation for those that are not Job – coordinate medical resources from all region coalition partners. Maintain situational awareness WI-TRAC, WISCOM and traditional modalities Manage until overwhelmed. Consider the need for Tier 4 activation 7

8. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services Clarification between Tier 2 and Tier 3 Both coordinate info and patient movement Different scales Both are pre-determined centers Multiple AMCCs within a region ONE RMCC within a region 8

9. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services Tier 4 - State and Intra-regional response Do neighboring regions need to get involved? Does state need to coordinate? WI-DHS and likely Wisconsin State Emergency Operations Center (SEOC) would be activated. Declarations likely to occur here Is state able to provide and coordinate adequate response? Consider need for Tier 5 activation. 9

10. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services Tier 5- Interstate Regional Management Coordination Emergency Management Assistance Compact (EMAC) FEMA Region 5, FEMA, US-DHS may be needed for coordination Can Region 5 manage the resources needed and delivery of medical assets to support the response? Consider Tier 6 activation 10

11. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services Tier 6 - Federal Support to Response Impacted governor(s) request federal support Federal assets coordinated under ESF 8 (Nat’l Response Framework) U.S. Department of Health and Human Services Secretary’s Operation Center activated to coordinate 11

12. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services Similar to ICS? Yes! ICS/NIMS is a foundational element of the tiers Traditional Emergency Management response Local Regional State Federal Follows the National Response Framework 12

13. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services Why add this now? Traditional emergency management response Local EOC Regional EOC State EOC Tiered Response Plan – Focuses ONLY on ESF 8 type resources - established in 2004 (recognized best practice) Traditional response still needed, still continues 13

14. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services The Vision ▫ Rapid activation and coordinated approach to managing patients from large-scale or unusual incidents ▫ Increased collaboration between health care, emergency response, and public service sectors ▫ Increased Communication Interoperability between all participants in the greater Health Care Coalition ▫ Seamless integration with the national/federal system ▫ …so that our state will be able to provide the best medicine in the worst of times! 14

15. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services Scenarios Let’s look at a few scenarios: ▫ Collapse of the grandstands at the county fair ▫ Outbreak of highly contagious disease at the local school ▫ Chemical tanker spill in a high-traffic area 15

16. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services Grandstand Collapse Summary: 55 green 27 yellow 19 red Can your HCO handle this? Can your AMCC handle this? What tier would you anticipate needing? What medical coordination needs would you anticipate? 16

17. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services School Outbreak Summary: Highly contagious outbreak Rapid spread Several hundred exposures Multiple jurisdictions involved Significant spike in ED visits Can one local HCO handle this? Area? What types of coordination needs might you have? 17

18. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services Tanker Spill in High Traffic Area Summary: Anhydrous Ammonia spill in a high traffic area. Large volume of individuals exposed. Environmental issues. Exposure issues; health issues, decon issues Rapid surge to local, area, regional hospital 25 people splashed with the chemical 75+ overcome by fumes/plume Accident causes MCI 8 green 5 yellow 6 red 18

19. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services The Bottom Line Ability to respond to large-scale disasters that overwhelm and exhaust our health systems and resources Save lives—get the right patient to the right place at the right time—and improve patient outcomes in disasters and significant emergency events At the regional level, coordinate public health and medical response to disasters and large scale events 19

20. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services Next Steps Learn more about the Tiered Response Plan http://www.phe.gov/preparedness/planning/mscc/hand book/documents/mscc080626.pdfhttp://www.phe.gov/preparedness/planning/mscc/hand book/documents/mscc080626.pdf Educate your staff and local partners Be involved in your regions healthcare coalition development 20

21. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services DHSHCC@wisconsin.gov Questions? 21

22. Wisconsin Healthcare Coalitions Health Emergency Preparedness Wisconsin Department of Health Services Resources Portions of this presentation adapted from; “Introduction to Disaster Coordination Response Tiers” webcast recorded by Dr. Liu and Dr. Clark. Link to webcast: http://dhsmedia.wi.gov/main/Play/368747a8e01e49568ac9d 175c15d68501d http://dhsmedia.wi.gov/main/Play/368747a8e01e49568ac9d 175c15d68501d 22