Skip Navigation U.S. Department of Health and Human Services www.hhs.gov
Agency for Healthcare Research Quality www.ahrq.gov
Archive print banner

Planning and Practicing for a Disaster

This resource was developed by AHRQ as part of its Public Health Emergency Preparedness program, which was discontinued on June 30, 2011. Many of AHRQ's PHEP materials and activities will be supported by other Federal agencies. Notice of transfer to another agency will be posted on this site.

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to www.ahrq.gov for current information.

Slide Presentation


This is the text version of a Webcast slide presentation titled Planning and Practicing for a Disaster that took place on February 9, 2009.

Select to access the slide presentation (PowerPoint® file, 6 MB).


Slide 1

Public Health Emergency Preparedness: Planning and Practicing for a Disaster

Monday, February 9th, 2009
1:00-2:30 pm EST

On the top of the slide are the logos for the Department of Health & Human Services (HHS) and the Agency for Healthcare Research and Quality (AHRQ).

Slide 2

Questions

  • To pose a question to the Panelists, please post it in the Q&A panel on the right hand side of your screen and press send.
  • To expand or decrease the size of any panel on the right hand side of your screen, click the arrow shape in the upper-left corner of the panel.
  • To pose a question to WebEx's technical support, you can also post it in that Q&A panel and press send. Or you can dial 1-866-229-3239.

Slide 3

Audio Broadcast

The slide informs all attendees that:

  • Today's audio is streaming over your PC's speakers or headphones.  If you cannot or do not wish to participate in this manner please follow these steps to join the Teleconference:
    • Step 1: Leave the Audio Broadcast (a screenshot of the tool bar is shown with 'Leave Audio Broadcast' selected from the drop down menu entitled 'Communicate', located on the toolbar)
    • Step 2: Click the request Teleconference button (a screenshot is shown of the 'Request' button that appears at the bottom of the participant panel on the right side of the Webex interface)
    • Step 3:  Dial in using the information (a screenshot is shown of the 'Join Teleconference' box, where the toll-free, Event, and Attendee ID numbers are all displayed).

Slide 4

Agenda

Part One 

  • Introduction, Karen Migdail
  • Disaster Preparedness Tools: Hospital Surge Model and Mass Evacuation Transportation Model, Tom Rich
  • National Mass Patient and Evacuee Movement, Regulating, and Tracking System Initiative, F. Christy Music
  • Moderated Q&A, Karen Migdail

Part Two 

  • Hospital Disaster Drills, Mollie Jenckes
  • User's Perspective of Hospital Disaster Drills, Cindy Notobartolo
  • Moderated Q&A and closing statements, Karen Migdail

Slide 5

Audio Broadcast

The slide informs all attendees that:

  • Today's audio is streaming over your PC's speakers or headphones.  If you cannot or do not wish to participate in this manner please follow these steps to join the Teleconference:
    • Step 1: Leave the Audio Broadcast (a screenshot of the tool bar is shown with 'Leave Audio Broadcast' selected from the drop down menu entitled 'Communicate', located on the toolbar)
    • Step 2: Click the request Teleconference button (a screenshot is shown of the 'Request' button that appears at the bottom of the participant panel on the right side of the Webex interface)
    • Step 3:  Dial in using the information (a screenshot is shown of the 'Join Teleconference' box, where the toll-free, Event, and Attendee ID numbers are all displayed)."

Slide 6

AHRQ Disaster Preparedness Tools: Hospital Surge Model and Mass Evacuation Transportation Model

Tom Rich, Senior Associate
Abt Associates Inc.

Slide 7

Surge Model: Partners

  • Dr. Sally Phillips, AHRQ Project Officer
  • Office of the Assistant Secretary for Preparedness and Response (ASPR)
  • Gryphon Scientific (Rocco Casagrande, Principal Investigator)
  • Weill Medical College, Cornell University (Nathaniel Hupert, Co-Principal Investigator)
  • Project Steering Committee

Slide 8

Surge Model: Scenarios

  • Biological:
    • Anthrax
    • Smallpox
    • Flu
    • Food Contamination (under development)
    • Plague (under development)
  • Chemical:
    • Chlorine
    • Mustard
    • Sarin
  • Nuclear/Radiological:
    • 1 Kiloton Yield (KT) or 10 KT nuclear device
    • Radiological dispersion device  ("Dirty bomb")
    • Radiological point source
  • Conventional explosive (under development)

Speaker's Notes:

The Hospital Surge Model estimates the resource requirements to treat casualties from the scenarios shown on this slide, which correspond to the National Planning Scenarios

Slide 9

Surge Model Outputs

  • Based on...
    • The scenario.
    • The number and type of casualties requiring hospitalization.
  • The Hospital Surge Model estimates:
    • Number of patients in the hospital by day and hospital unit.
    • Resource requirements for patients, by resource, day, and hospital unit.

Speaker's Notes:

To use the Model, you need to specify the scenario and the number and/or type of casualties.  For example, you can specify that 100 persons will be hospitalized for flu or that 20 will be hospitalized for a "moderate" case of flu (meaning that they are admitted to the floor) and that 80 will be hospitalized for a "severe" case of flu (meaning that they are admitted to the ICU).  The number you specify could represent the number that a single hospital would be assumed to have to treat.  Or, you can use the Hospital Surge Model at the county, State, or regional level, in which case the number of hospitalizations would be the total expected number region-wide.  The Model outputs the resource requirements by day to treat the patients. 

Slide 10

Hospital Resources

  • Durable equipment
  • Human resources
  • Pharmacy
  • Consumable supplies
  • Personal protective equipment
  • Psychological Support
  • Housekeeping
  • Lab / Radiology
  • Mortuary
  • Nutrition

Speaker's Notes:

Resource requirements estimates are provided for about 60 different resources that are grouped into the categories shown on this slide.  Only hospital resources are considered in the Model—not resources to get patients to the hospital or resources needed once patients are discharged.  Outside of the Model, the resource requirements—in particular the peak demand for a resource—should be compared to the supply of that resource—either at a specific hospital or across a region.  The differences between requirements and availability can be used to assess preparedness and guide purchasing or hiring decisions.

Slide 11

Key Assumptions and Considerations

  • Time delay between incident and hospital arrivals (for biological and radiological scenarios, based on dispersion models).
  • The patient's assumed length of stay in the Emergency Department (ED), in the Intensive Care Unit (ICU), and on the floor varies by scenario and severity of condition.
  • Per patient per day resource consumption based on historical data to treat similar patients, and expert elicitation.
  • No capacity or resource limitations at the hospital.

Speaker's Notes:

All models are based on assumptions.  All of the assumptions are documented in the Model Description report, which is available on the AHRQ Web site.  I just wanted to highlight a few.  The assumptions on length of stay in the ICU and the floor, the likelihood that a patient will have to be treated in the ICU (or move back to the ICU after being on the floor), and the per patient per day resource requirements are based on documented cases of treated persons (if available) or expert opinion if no data exist. 

The per patient per day resource requirements assume an optimal level of care.  As a result, the HSM [Hospital Surge Model] assumes there are no capacity or resource constraints.  In essence, the Model estimates the resources that will be needed to treat hospitalized persons—not the number of patients that can be treated with your limited resources. 

Slide 12

Illustrative Output: Hospitalized Patients by Day and Unit

The slide displays a graph that shows for an anthrax attack the estimated number of patients in each Hospital department, emergency department, intensive care unit, and the hospital floor, in which 1000 patients total would require hospitalization for a 43 day period.  Below the graph is a table that shows the same data in tabular form.

Speaker's Notes:

The Hospital Surge Model has been implemented on an easy to use Web site, where you specify the scenario and the number of casualties to treat.  Outputs are presented in graphic and tabular form (so that they can be pasted into a spreadsheet).  This graph shows for an anthrax attack the estimated in which 1000 patients would require hospitalization. The Web site also provides graphics on the resource requirements by day, including when the peak demand is. 

The next step in the use of the Model is to compare the resource requirements to resource availability, so that shortfalls can be assessed.

Slide 13

For More Information

  • To run the Hospital Surge Model, go to:
    • http://hospitalsurgemodel.ahrq.gov
  • User Manual
  • Model Description Document

Speaker's Notes:

There is no login or password for the Hospital Surge Model.

Contact information is on the Web site.  Please contact us with questions or suggestions for improving the model.

Slide 14

Mass Evacuation Transportation Model: Partners

  • Dr. Sally Phillips, AHRQ Project Officer
  • ASPR1, HRSA2, FEMA3, DoD4
  • Partners Healthcare (Drs. Paul Biddinger and Richard Zane)
  • Project Steering Committee
  • New York City Office of Emergency Management
  • Los Angeles Emergency Preparedness Department

1 ASPR: Office of the Assistant Secretary for Preparedness and Response.
2 HRSA: Health Resources and Services Administration.
3 FEMA: Federal Emergency Management Agency.
4 DoD: Department of Defense

Speaker's Notes:

The Mass Evacuation Transportation Model is also a model that estimates resource requirements—namely, the transportation resources needed to move patients from one or more evacuating facilities to receiving facilities.  The Model was developed as part of a larger project that Christy Music will be speaking about later in this Webcast. 

Slide 15

Model Outputs

  • Based on...
    • Number of vehicles assigned to the evacuation—buses; wheel chair vans; Basic Life Support (BLS) and Advanced Life Support (ALS) ambulances.
    • Location of evacuating and receiving facilities.
    • Number and type of patients to be evacuated.
    • Surge capacity assumptions.
  • The Model estimates:
    • The time required to transport all patients to the receiving facilities.

Speaker's Notes:

There are a substantial number of inputs for the Model. It will take more time to set up and run than the Hospital Surge Model.  The output is the time required to move all patients to the receiving facilities.  However, thru repeated runs of the Model, you can also determine the number of vehicles or surge capacity needed to move all the patients within a particular time constraint (e.g., 24 hours).

Slide 16

Key Assumptions and Considerations

  • A planning model—not an operational tool to produce a vehicle schedule or patient transport roster.
  • Does not consider physical constraints within the hospitals (e.g., the number of elevators).
  • Assumes appropriate staff are available in the vehicles.
  • Travel time estimates require latitude and longitude of evacuating and receiving facilities.

Speaker's Notes:

Again, the Model description document lists all the assumptions in the Model.  This is a planning model—not an operational tool that produces a vehicle schedule or a roster of which patients are taken to which receiving facilities.  We do not model the physical constraints within a hospital that affect how quickly patients can be moved from their bed to a vehicle.  Instead, you merely specify the amount it takes to move patients from their beds to a vehicle.  This is clearly a limitation of the model, particularly for no-advanced warning evacuations.  With regard to geographic coordinates, there are Web sites (listed in the User Manual) that allow you to enter an address and get the corresponding lat/long.

Slide 17

Web Implementation of the Model

The slide shows the scenario input Web page for the Mass Evacuation Transportation Model.

Speaker's Notes:

This is a modified version of the input page so that it would fit all on one page.

Slide 18

Illustrative Results: Effect of Advanced Life Support (ALS) Ambulance Availability

The slide shows a graph of evacuation time (in days) versus the number of Advanced Life Support (ALS) units.  The data was taken from the Los Angeles pilot test where there was a no-warning evacuation caused by an earthquake and it was assumed that 5 percent of the ALS units would be assigned to the evacuation.

Speaker's Notes:

Rather than just running the Model once and getting the estimated evacuation time, the best way to use the Model is to see the sensitivity of individual inputs to the evacuation time.  For many hospitals or jurisdictions, the key input will be the number of Advanced Life Support ambulances that are assumed to be available for the evacuation.   In the NYC pilot test (which was an advanced warning evacuation), we assumed that 40 percent of the City's ambulances would be assigned to the evacuation, with the remainder saved for other emergencies as they arise during the day; in Los Angeles (which was a no-warning evacuation caused by an earthquake), we assumed that 5 percent would be assigned to the evacuation.

Slide 19

For More Information

  • To run the Mass Evacuation Transportation Model, go to:
    • http://massevacmodel.ahrq.gov
  • User Manual
  • Model Description Document

Speaker's Notes:

There is no login or password for the Model.

Contact information is on the Web site.   Please contact us with questions or suggestions for improving the Model.

Slide 20

Poll Question #1

  • A short poll will appear on your screen.  Please take a few seconds to answer the poll and provide valuable feedback!
  • If you are unable to respond to the poll during this event, please E-mail your answer to emergencypreparedness@academyhealth.org

Slide 21

Questions

  • To pose a question to the Panelists, please post it in the Q&A panel on the right hand side of your screen and press send.
  • To expand or decrease the size of any panel on the right hand side of your screen, click the arrow shape in the upper-left corner of the panel.
  • To pose a question to WebEx's technical support, you can also post it in that Q&A panel and press send. Or you can dial 1-866-229-3239.

Slide 22

National Mass Patient and Evacuee Movement, Regulating, and Tracking Initiative

F. Christy Music, MS, MT(ASCP)SBB
Program Director, Health and Medical Support
Office of the Assistant Secretary of Defense (Homeland Defense & Americas' Security Affairs), Department of Defense

February 2009

Slide 23

Create a National General Population Evacuee & Patient Movement, Regulating, Tracking System  

  • Issue:  Catastrophic incidents = need for large-scale general population & patient movement, regulating, and tracking.
  • Issue:  No interoperable, national (local, State, Federal, tribal) information system.
    • Tracking:   Locating and maintaining an audit trail of person's movement from initial entry through final location.
    • Regulating:   Matching transport needs to a receiving location.
    • Movement:   Availability, reservation, use, and release of transportation resources.

Slide 24

National Mass Patient and Evacuee Movement, Regulating, and Tracking Initiative

  • Purpose:  Build upon existing information systems and develop a National General Population Evacuee and Patient Movement, Regulating, and Tracking information system that is interoperable and shares data.
  • Goal:  Federal Sector (DoD1, HHS2, DHS3, FEMA4) provide a national system for all jurisdictions' use. 
  • Goal:  Use a central IT platform or other technology to share data among existing systems; build and insert modules that are needed.

1 Department of Defense.
2 Department of Health and Human Services.
3 Department of Homeland Security.
4 Federal Emergency Management Agency.

Slide 25

National Initiative Capabilities

  • Near real-time location and tracking is needed:
    • Audit trail that tracks general population and patients.
    • Notice and tracking: general population members → patients.
    • Tracking from first entry through final location. 
  • Entry Point:  Fixed facility, collection point, point of injury, home, search and rescue, self-registration, etc.
  • Incorporate regulating and movement information to perform operations during an event. 

Slide 26

Effects of the National Initiative

  • Expand Nation's capacity to transport, regulate, and track evacuees/patients.
  • Support local, State, tribal, and Federal command & control decisionmakers.
  • Deconflict intended use of general population/patient movement resources and destinations.
  • Coordinate general population/patient management at all vertical and horizontal levels of government.

Slide 27

Effects of the National Initiative (continued)

  • Locate general population evacuees/patients: entry → intermediate locations → final destinations. 
  • Provide near real-time updates (e.g. medical status).
  • Incorporate patient's Electronic Medical Record.
  • Track general population evacuees as they become patients during movement, requiring medical oversight en route.
  • Use by all jurisdictions (authorized users) in a disaster; available for routine use.

Slide 28

National Mass Patient and Evacuee Movement, Regulating, and Tracking Initiative History

  • Proposed  by DoD (2004); Noted as DHS Priority (2004): Secretary Ridge's Homeland Security Interagency Security Planning Effort.
    • Included patient mobilization planning for catastrophic events as a long-term initiative and identifies this effort as a high-priority (Reference: Secretary, Department of Homeland Security letter to Secretary, Department of Defense, September 22, 2004).
  • Funded by FEMA (tracking recommendations).
  • DoD asked AHRQ/HHS to apply these funds to the existing HAvBED contract.
    • HHS added funds (Mass Evacuation Transportation Model).
  • Began Winter 2005, Draft Report 2008, Final Report 2009.
  • Supported by DoD Evacuee-Patient Tracking Initiative—Interconnect DoD's ETAS1 and AHLTA-Mobile2 to HHS' JPATS3

1 Emergency Tracking Accountability System.
2 Armed Forces Health Longitudinal Technology Application-Mobile.
3 Joint Patient Assessment and Tracking System.

Speaker's Notes:

Interconnect DoD's Emergency Tracking Accountability System (ETAS) and Armed Forces Health Longitudinal Technology Application-Mobile (AHLTA-Mobile) with HHS' Joint Patient Assessment and Tracking System (JPATS)

Slide 29

National Initiative Advisory Board

  • National Advisory Board:  HSC1, DoD, AHRQ, HHS, DHS, DOT2, VA3, other Federal agencies, State (NY and CA) and private industry representatives.
  • Developed recommendations for a system that could be used during a mass casualty evacuation to:
    • Locate and track general population evacuees/patients.
    • Improve decisionmaking regarding:
      • General population evacuee and/or patient movement.
      • Resource allocation.
      • Incident management.
  • Built planning tool for use before a mass casualty/evacuation incident.
    • Estimate shortfalls in resources to transport patients and general population evacuees.

1 Homeland Security Council.
2 Department of Transportation.
3 Department of Veterans Affairs.

Slide 30

National Mass Patient and Evacuee Movement, Regulating, and Tracking Initiative Recommendations

  • Build on existing systems; incorporate data and architectural standards.
  • Activated system in major, multi-jurisdictional incidents; optional routine use.
  • Begin with local, State, and tribal entry; Federal entry last.
  • Track location & health status/needs of any person encountering system.
  • Track at "touch points" (e.g., collection points, hospitals, etc.).
  • Minimum data elements to enter patient/general population data.

Slide 31

National Mass Patient and Evacuee Movement, Regulating, and Tracking Initiative Recommendations (continued)

  • Build system to accept more detailed demographic/medical information.
  • System accessible to emergency responders/planners.
  • Incorporate current or planned Feeder Tracking Systems.
  • Data from point of injury or first entry through final disposition.
  • Incorporate  Feeder Institutional Records Systems ("Check-In/Check Out").
    • Facilities with mandatory reporting, common software platforms, within an   agency (e.g. VA hospitals, DoD Military Treatment Facilities, Indian Health).
    • Single facility (hospital with "homegrown" system).
  • Eventually include public:  Web-based registration.

Slide 32

Supports Homeland Security Presidential Directive—21

Supports HSPD-21: Public Health and Medical Preparedness:

  • Integrate all vertical and horizontal levels of government and community components, achieving a much greater capability than we currently have. 
  • Response "...deployed in a coordinated manner ... guided by a constant and timely flow of relevant information during an event and rapid public health and medical response that marshals all available national capabilities and capacities in a rapid and coordinated manner." 
  • Help ensure general population evacuee and patient movement is "(1) rapid, (2) flexible, (3) scalable, (4) sustainable, (5) exhaustive (drawing upon all national resources), (6) comprehensive (e.g. addresses needs of mental health and special needs populations), (7) integrated and coordinated, and (8) appropriate (correct treatment in the most ethical manner with available capabilities)."

Slide 33

Initiative Recognized by Senior USG Officials

  • Initiative repeatedly recognized by White House and USG1 leaders as a national biodefense preparedness and response priority (Homeland Security Council/National Security Council Joint Biodefense Preparedness Deputies' Committees (March and April 2008).
    • Nation's planning will "...include creation of a national system for the coordination and tracking of general population evacuee and patient movement from point of incident, fixed facilities, or collection points to their final destination."
  • Supports HSC Mass Evacuation/Population Movement Policy Sub-Policy Coordinating Committee, December 17, 2008.
  • Supports President Obama's Campaign Promise to create a National Family Locator System to help families locate loved ones after a disaster, and Prepare Effective Emergency Response Plans, to include medical surge.
  • Next Step:  Develop the national system.
    • Proposal : DoD, HHS, DHS/FEMA co-lead
    • Participation: American Red Cross, VA, DOJ2; State, tribal, local representatives, commercial industry, professional associations

1 United States Government.
2 Department of Justice.

Slide 34

Poll Question #2

  • A short poll will appear on your screen.  Please take a few seconds to share your feedback with AHRQ.
  • If you are unable to respond to the poll during this event, please E-mail your answer to emergencypreparedness@academyhealth.org

Slide 35

Q&A

If you have a question for Tom Rich and/or F. Christy Music, please type it into the Q&A panel to the right and press send.

Slide 36

Part Two Agenda

  • Hospital Disaster Drills, Mollie Jenckes
  • User's Perspective of Hospital Disaster Drills, Cindy Notobartolo
  • Moderated Q&A and closing statements, Karen Migdail

Slide 37

Johns Hopkins University
Evidence-based Practice Center

Mollie W. Jenckes MHSc, BSN,
Research Associate, Johns Hopkins University

Sara E. Cosgrove
Christina L. Catlett
Mollie W. Jenckes
Karen A. Robinson
Gary Green
Carolyn J. Feuerstein
Karen Kohri
Eric B. Bass
Edbert B. Hsu

Slide 38

Training is Vital

The slide shows a picture of the US Airways flight that crash landed in the Hudson River in New York City on Friday, January 17, 2009 on the left.  Pictured on the right is the pilot of the same US Airways flight, Chesley B Sullenberger, III.

Speaker's Notes:

Who is this man? Chesley B Sullenberger, III (pictured on the right), the pilot of the USAirways jet (also pictured) who, based on his training and diligence, single-handedly saved up to 155 individuals on Friday, January 17, 2009, in New York City by landing his plane safely on the Hudson River.

Slide 39

Background

  • Hospitals are prepared for natural and manmade disasters: 
    • Transportation accidents
    • Structural collapse
    • Earthquakes
  • Why do hospitals hold disaster drills?
    • To allow "hands-on" training in the hospital disaster plan.
    • To build knowledge and understanding of roles.
    • To identify strengths and weaknesses in response.
    • To build familiarity with infrequently used equipment.
    • To fulfill requirements of the Joint Commission for Accreditation of Healthcare Organizations (JCAHO).

A photo on the top right side of the slide shows a structural collapse and a photo on the lower right shows an emergency transport of a critically injured patient.

Speaker's Notes:

Hospitals are complex institutions with multiple levels of staff with a wide range of backgrounds and training.  When disaster strikes, it is vital that tasks are pre-assigned and practiced through drills.  To make a difference, each drill must be evaluated.  Where is the emergency equipment kept?  How do I use it?  Where do I report?  What are my responsibilities?  How do we keep the patients safe?  These are questions that surface in the minds of each hospital worker, from maintenance personnel to physician director at the time of the emergency notification.  The photos on the right show a structural collapse (top), which will to emergency hospital admissions as the wreckage is cleared.  The lower photo shows emergency transport of a critically injured patient.

Slide 40

Continuous Quality Improvement (CQI) Process Applied to Hospital Disaster Preparedness

The slide shows the Continuous Quality Improvement (CQI) process diagram being applied to hospital disaster preparedness, which is a is a continuous process of developing training,  learning skills, analyzing the response, re-evaluating the training, reviewing and modifying the disaster planning as necessary, and re-entering the cycle

Speaker's Notes:

Disaster drills are one aspect of a continuous effort to improve protocols, including drilling, analyzing the success of the drill, and working towards improving the hospital disaster response.  This is a continuous process of developing training,  learning skills, analyzing the response, re-evaluating the training, reviewing and modifying the disaster planning as necessary, and re-entering the cycle.  The figure above shows this cycle.  The evaluation of the drill allows the hospital to identify the issues and improve the disaster preparations.

Slide 41

Methods: Expert Input/Feedback

  • The JHU EPC1 assembled a multi-disciplinary team of experts for initial guidance and repeated feedback during development of modules:
    • Federal agencies (HRSA2, CDC3, FEMA4)
    • State agencies (MEMA5, MD DHMH6)
    • Hospitals (administrators, EM7 physicians)
    • Disaster planning experts
    • WMD8 experts

1 Johns Hopkins University Evidence-based Practice Center.
2 Health Resources and Services Administration.
3 Centers for Disease Control.
4 Federal Emergency Management Agency.
5 Maryland Emergency Management Agency.
6 Maryland Department of Health and Mental Hygiene.
7 Emergency Medicine.
8 Weapons of Mass Destruction

Speaker's Notes:

Agencies at the different political levels—as well as different agencies within the Federal Government, State, and city—have perspectives, planning processes, and requirements that impact on hospitals.  In addition, the hospitals based administrators and care personnel know the capabilities of their institutions.  The JHU EPC received input from a wide range of experts to develop, review and strengthen the assessments contained in these Modules. 

Slide 42

Results: Drill Evaluation Modules

  • There are 7 modules:
    • Training module (use of product)
    • Pre-drill planning module
    • Command center zone
    • Decontamination zone
    • Triage zone
    • Treatment zone
    • De-briefing module..............and 2 addenda

Speaker's Notes:

The Modules are designed to focus evaluation on the areas most likely to come into play under the disaster setting.  Each Module is designed to stand alone, and each can be used independently for a limited scenario.  Evaluators using the Modules must first receive training in their proper use.

Slide 43

Data Collected in Each Module

  • Activity points documented within each zone module:
    • Time points
    • Zone description
    • Personnel
    • Zone operations
    • Communications
    • Information flow
    • Security
    • Documentation and   tracking
    • Victim flow
    • Personal protective equipment and safety
    • Equipment and supplies
    • Rotation of staff
    • Zone disruption

Speaker's Notes:

Reviewing in detail the actions taken in each zone; command center, decontamination, triage, treatment, the EPC team identified the elements that required documentation in order to properly evaluate (assess) the hospital response in these areas.

Slide 44

Addendums

  • Biological Incident Addendum assesses:
    • Awareness that a biological agent caused the event.
    • Appropriate and expert monitoring.
    • Reporting mechanisms.
    • Meeting of health and safety needs of patients and victims.
    • Availability of special supplies.
  • Radiation Incident Addendum assesses:
    • Awareness that radiation exposure caused the illness.
    • Appropriate and expert monitoring.
    • Reporting to State and Federal agencies.
    • Meeting of health and safety needs of victims and staff.
    • Availability of special supplies.

Speaker's Notes:

Due to the rising threat of biological and radiation incidents, addendums cover all the key points to assess each of these, including type of exposure, prophylaxis, notification of hospital epidemiologist and State and Federal (CDC) experts, and other issues.

Slide 45

Field Trial Results

  • Trials indicated wide acceptance.
  • Hospitals were able to document activities occurring as they happened.
  • Modules allowed identification of areas that needed further training.
  • In follow up exercises, hospitals are requesting repeat use of the modules.

A photo in the lower right section of the slide shows a snapshot of activity at a field trial, where every effort is made to present a realistic situation.

Speaker's Notes:

Field trials were held with hospitals throughout Maryland participating.  Through distribution at HHS, the Modules have been used in different States across the country.  The illustration at lower right shows a mock patient in moulage being treated.  This is a snapshot of activity at a field trial, where every effort is made to present a realistic situation.

Slide 46

Products Available

Evaluation of Hospital Disaster Drills: A Module-Based Approach
AHRQ Publication No. 04-0032, April 2004

Tool for Evaluating Core Elements of Hospital Disaster Drills
AHRQ Publication No. 08-0019, June 2008

On the left hand side the slide shows the front cover of the Evaluation of Hospital Disaster Drills: A Module-Based Approach, AHRQ Publication, released in April of 2004.  The right hand side of the screen shows the internal contents and CD-Rom for the Tool for Evaluating Core Elements of Hospital Disaster Drills, AHRQ Publication, released in June of 2008.

Speaker's Notes:

The Modules were published and distributed through the AHRQ.  Each Module was printed in a different color, to facilitate distribution and collection of Modules during an evaluation.  A CD-ROM is included in the package.  In 2007, the EPC Team was requested to review the full Modules and produce an abridged edition.  Working with input from an Advisory Committee of experts across the US, the JHU-EPC Team identified the most vital elements in each Module, resulting in abridged Modules with a reduced data collection set limited to core items.  The complete Modules volume and the CD-ROM with the colored inserts are pictured here, and the AHRQ publication numbers for both are listed.  The full publication is available on the AHRQ Web site, and is packaged with a CD-ROM that provides a spreadsheet to enter evaluator responses.

Slide 47

Poll Question #3

  • A short poll will appear on your screen.  We appreciate your feedback!
  • If you are unable to respond to the poll during this event, please E-mail your answer to emergencypreparedness@academyhealth.org

Slide 48

User's Perspective of Hospital Disaster Drills: AHRQ Tool for Evaluating Core Elements of Hospital Disaster Drills

Cindy Notobartolo, RN, BSN
Corporate Director of Emergency Department, Safety and Security Services
Suburban Hospital, Bethesda, MD

Slide 49

Drill Planning and Execution

  • October 2008 designed, planned and participated in a regional large scale explosive event involving 40 military, research, national, State, county and private entities.
  • Historically the evaluation tool was created or adapted from existing templates.
  • Dissatisfaction with prior tools or the time needed to customize them for the event.

Speaker's Notes:

For years as part of the National Capital Region, we have held complex multi-casualty disaster exercises.  In October 2008 we designed, planned, and participated in a large scale explosive event involving over 40 military, research, national, State, county, and private entities.  It was to include thousands of participants and hundreds of casualties. Each year we struggled with evaluation tools which could take time to customize and many times just did not meet our needs.

Slide 50

Discovery of AHRQ Evaluation Tool

  • Logical framework
  • Flow and sequence match actual event
  • Pre-populated fields and circle answers
  • Comment sections
  • Prompting questions
  • Diagram sections

Speaker's Notes:

Not long before the October event, a colleague who is today in our listening audience, sent me the link to AHRQ.  I was extremely excited when I reviewed the Tool.  Having been a nurse and emergency manager, I found it to have a logical framework, a flow that matched an actual event, pre-populated fields, circle answers, as well as diagram sections. This can be very helpful and I will mention more about that in a minute.

Slide 51

Modules

  • Module based approach allows for individual selection.
  • Range from Red Zone to Incident Command Center to Group Debriefing Module.
  • We chose to integrate the AHRQ tool with specific targeted evaluation.

Speaker's Notes:

The module-based approach allows for allocating sections to specific evaluators. Since they range from triage zones to Incident Command Center it is easier look for improvement needs.  I particularly liked the Group Debriefing Module.  Many times at the end of an event the questions tend to be vague such as "What went well?" instead of "Did people have a good understanding of their roles, as defined in the disaster plan?" "Were there problems with information flow throughout the hospital?"

Slide 52

Suburban Hospital

  • Founded in 1943.
  • Community-based not-for-profit serving Montgomery County, Maryland.
  • Trauma center.
  • Distinguished self with affiliations with NIH and Johns Hopkins Medicine.
  • Emergency Preparedness partnership with National Naval Medical Center, National Institutes of Health Clinical Center and the National Library of Medicine.
  • MOUs with all other Montgomery County Hospitals and Public Health Services.

Slide 53

Incident Command Center

The slide shows a picture of Suburban Hospital's Incident Command Center. In this picture, there are many people working toward achieving command and control of the incident. Making the process more effective through every exercise refines your ability when a real disaster occurs.

Slide 54

Incident Command Module

  • Prompted important time parameters such as beginning and ending, response times of staff.
  • Allowed for picture of zone set-up.
  • External evaluator ease.
  • Able to target need for after action response.
  • Ease and efficiency of completion for post event documentation.

Speaker's Notes:

I had the experience of using the Incident Command Module to evaluate our ICC during the exercise.  It prompted important time parameters such as beginning and end and response time of staff.  The drawing of the zone set-up allowed for evaluation to see if communication equipment was properly placed as well as room flow.  One of our outside evaluators determined a triage area was too crowded and selected an alternate.  There definitely is an ease of use and efficiency in completions of the post event documentation.  The longer the time the more difficult it is to remember the gaps that should be addressed.

Slide 55

Future of the Tool

  • The tool is being recommended to hospital Emergency Managers.
  • Receiving enthusiastic feedback.
  • Groups are sharing their use experiences.
  • This will lead to more widespread use.

Speaker's Notes:

Up to this point it is not a widely known tool but is now being passed enthusiastically to hospital emergency managers.  I have shared my experience with many of my colleagues. I truly believe this will lead to more wide spread use and acceptance.

Slide 56

Q&A

If you have a question for Mollie Jenckes and/or Cindy Notobartolo, please type it into the Q&A panel to the right and press send.

Slide 57

For more information about....

Slide 58

Thank you!

  • A brief feedback form will pop up when you close your browser. Please take a few moments to give us your feedback on today's event.
  • Thank you!

Current as of May 2009

 

 

The information on this page is archived and provided for reference purposes only.

 

AHRQ Advancing Excellence in Health Care