Bioterrorism Hospital Preparedness Program:  HRSA Work Plan

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• Summary
  • Program direction and system integration
  • Hospital and pre-hospital systems
  • State EPR organization
  • Tribes
  • Border states and Canada
  • Washington State DOH Hospital Bioterrorism Preparedness Coordinator (1.0)
  • Washington State DOH Hospital Bioterrorism Preparedness Medical Director (.25 FTE)
  • Fiscal Year 3 staffing plan for HBPP program functions
     
    • Critical Benchmark 1
      • Strategies
      • Tasks
      • Timeline
      • Responsible parties
      • Evaluation

Summary

Program Direction and System Integration
During FY 03 the public health, hospital, and pre-hospital systems continue working together to develop, implement, and support statewide emergency planning efforts.  The Washington Emergency Management Council’s Committee on Terrorism (COT) is responsible for the development and implementation of the statewide Emergency Preparedness and Response (EPR) plan, for response to and mitigation of the effects of man-made or natural disasters.  Public and private organizations at the federal, state, and local level are involved in the COT and actively participate in this statewide emergency planning effort.  A regional planning process, including regional hospital plans, regional Emergency Medical Services (EMS) and trauma care plans, and regional public plans (currently in development) has identified gaps in local and regional emergency response capacity.  Hospital needs have also been identified through a needs assessment conducted in FY 02. The Washington State Department of Health (DOH) PHEPR Joint Advisory Committee has targeted the hospital gaps and needs for amelioration as part of the overall Washington Emergency Preparedness plan for FY 03.  The DOH Hospital Bioterrorism Preparedness Program will also continue to coordinate EPR efforts with the CDC Cooperative Agreement Focus Areas and the four Metropolitan Medical Response System (MMRS) cities in Washington state.  During FY 03 DOH will also review and comment as appropriate on DHHS-furnished documents regarding the development of the National Incident Management System (NIMS).

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Hospital and Pre-hospital Systems
The hospital and the pre-hospital systems in Washington state have collaborated on general disaster response initiatives for over ten years.  Hospital and pre-hospital agencies are required by law to work cooperatively in designing and implementing local and regional EMS and trauma care plans and systems, which must have DOH approval.  Regional EMS and trauma care councils are also required to plan for inter-regional patient care response, and EMS and trauma system response to mass casualty incidents at all levels.  

EMS and trauma care regions were originally established based on patient flow patterns in Washington State.  They are currently the focal point for pre-hospital and hospital trauma care service planning, implementation, and service provision statewide.  Regional hospital planning has built on this existing infrastructure during FY 02.

Hospital and pre-hospital agencies in Washington are also collaborating in planning system changes supporting improved patient care at the scene, pre-hospital determination of patient facility destination, and facility requirements regarding the treatment of both emergent and trauma patients. Existing tools, including the Washington State Trauma Triage Tool (TTT), facilitate this work; MPD-approved regional Patient Care Procedures (PCPs), regional patient care protocols, and County Operating Procedures (COPs).  Training for responses to mass casualty incidents is provided under contract from DOH for both hospital and pre-hospital personnel.  Local emergency management personnel are included in the planning for both the local and regional EMS/TC systems, which determines the most appropriate methods of cooperation for all aspects of the patient care response system in the state.  In addition, local Mass Casualty Incident (MCI) planning conducted through local emergency management agencies regularly includes local EMS/TC council (e.g., hospital and pre-hospital) participation.  Additionally, in the near term, increased emphasis will be placed on increasing participation by local public health, tribes, military and veteran’s health care facilities, and other HRSA-identified partners in statewide planning and exercises.

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State EPR organization
Please see section below about ongoing collaboration between DOH and other local, state and regional healthcare and health services agencies regarding statewide emergency preparedness planning.  The organizational chart for the Governor’s Domestic Security Infrastructure, showing the relationship of DOH, the Washington State DOH PHEPR Joint Advisory Committee, Washington State Emergency Management Committee, the Committee on Terrorism, and other state, local, and federal agencies involved in EPR planning and implementation in Washington State, is attached as Appendix (1).

As noted, all terrorism-related EPR efforts in Washington State are coordinated through the Washington State Emergency Management Council (EMC), and more specifically through its Committee on Terrorism (COT). The Governor has charged EMC and COT with: (1) developing a statewide strategy for preventing, planning, and responding to threats and acts of terrorism, and; (2) providing a forum for general coordination and the exchange of information among federal, state, and local entities.

 DOH has worked closely with the COT to determine the appropriate disposition of these resources from the federal, state, and local levels. This will be integrated with the Washington State DOH Public Health Emergency Preparedness and Response plan, and will meet the program requirements for effective and coordinated implementation of the DOH Hospital Bioterrorism Preparedness Program.  DOH will work with the EMC and the COT to further describe and implement the roles of public health departments, hospitals, and supporting health care systems in the development of statewide and regional incident management systems, as specified in Cross-Cutting Benchmark #1-1.

The HRSA and CDC Advisory Committees were merged into one Washington State DOH PHEPR Joint Advisory Committee (Joint Advisory Committee) in March 2003.  The membership of the Joint Advisory Committee includes representatives from the entities, organizations, and disciplines specified in the Committee membership roster described in Appendix (2).

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Tribes
The membership of the Joint Advisory Committee includes representatives from the Governor’s Office of Indian Affairs and from federally recognized tribes within the state. Washington State has addressed the inter-system, inter-governmental, and inter-agency coordination and collaboration on disaster response through (1) state and local emergency management plans, and (2) regionally-developed and state-approved regional EMS and trauma care plans.  While these plans were originally developed with an emphasis on non-biological emergencies, they have formed the foundation for the state disaster and biological response capability. In general, these plans describe and direct the emergency response in their coverage area, and reference and incorporate existing mutual aid agreements into their response plan operational specifications. The emphasis in past disaster planning efforts has been first response capability, with less focus on the role of local, tribal, federal, and military hospitals, and migrant and community health centers in preparedness and response.

The Joint Advisory Committee is the primary means of ensuring hospitals and primary care facilities at every level, including the tribal level, are incorporated in current and ongoing planning for bioterrorism and disaster response across the state.  The Committee roster (in Appendix 2) includes, among others, the Washington State Hospital Association (WSHA), Washington State Medical Association, Washington State Nurses Association, Madigan Army Medical Center, Washington State Association of Local Public Health Officers, Association of Washington State Public Hospital Districts, Washington State Association of Community and Migrant Health Centers, Harborview Medical Center, and the Washington State Office of Indian Affairs.  Input and buy-in from these organizations and institutions are considered essential to both the development and implementation of hospital preparedness activities in the state. This kind of cooperation helps assure an integrated disaster response at the local, regional, tribal, and state levels. 

Beyond the overall policy role described here, the members of the Joint Advisory Committee bring to the table their perspectives from participation in local and regional planning efforts with local health agencies and hospitals.  DOH is expanding its outreach efforts to tribes and working to assure their participation in these local and regional efforts. Specifically:

• DOH is in the process of identifying tribal liaisons for public health emergency preparedness and response initiatives.
• New Eastern/Western Washington State program staff will work locally to ensure appropriate tribal representatives are invited to participate in training and meetings.
• Emergency Preparedness and Response Program plan information has been requested from other states in order to assess best practices for working with tribal governments. Responses from (29) states have been received to date.
• DOH staff has attended government-to-government training to better understand how to build partnerships with tribal governments.
• Please see Cross-Cutting Activities (F), Coordination with Indian Tribes. 

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Border States and Canada
Hospital and local public health emergency preparedness and response efforts in Washington State will continue during FY 03 to coordinate and cooperate with border states (Idaho, Oregon, and Alaska) and internationally with British Columbia, Canada.

Representatives from the British Columbia Ministry of Health have attended the Washington State Emergency Management Council’s Committee on Terrorism meetings to provide information to the Committee on Terrorism on the bioterrorism and disaster response system in British Columbia, and to establish a dialogue regarding cross-border cooperation and planning.  

In addition, the DOH contract with Harborview Medical Center to establish a redundant pre-hospital-to-hospital-to-hospital communications system in Washington State includes a requirement to establish a baseline of communications information regarding bioterrorism and disaster preparedness with surrounding governments (Oregon, Idaho, Alaska, and British Columbia) as the first step in coordinating response activities with these entities.  However, past experience has shown that attempts to coordinate activities between Washington State and the province of British Columbia have usually resulted in one or the other of the governments involved indicating that such cooperation should take place through the respective national systems first. Cooperation and coordination then becomes both elusive and inconclusive.  Recent national and international events, however, may make such province-to-state cooperation more acceptable (with less direct federal involvement) than has been seen in the past. New direct relationships are currently being explored through Washington State DOH, the British Columbia Ministry of Health, the Washington State Committee on Terrorism and its Canadian counterpart organizations. Washington State law authorizes the governor to enter into interstate compacts.  Compacts and agreements have been entered into with border states and the Dominion of Canada for traditional emergency management activities.  We are exploring the ability to amend these compacts and agreements to include public health emergencies.  Please also see Cross-Cutting Activities F, Border States. 

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Washington State DOH Hospital Bioterrorism Preparedness Coordinator (1.0 FTE)
This position coordinates the DOH activities necessary to improve the capacity of Washington State’s hospitals and healthcare system to respond to bioterrorist attacks as well as to other public health emergencies.  The Coordinator’s duties include the following:

• Direct the Washington State DOH Hospital Bioterrorism Preparedness Program;
• Coordinate the preparedness activities within the DOH-PHEPR to assist hospitals within the larger health care system to prepare for and respond to bioterrorist events or non-terrorist epidemics and outbreaks of rare diseases;
• Develop and facilitate implementation of hospital bioterrorism preparedness and response plan protocols (and with other participating healthcare entities);
• Develop statewide hospital protocol models;
• Collaborate with other states, Canada, and national organizations;
• Develop hospital partnerships and improve communications among hospitals and local health jurisdictions, local emergency management, and local EMS systems;

• Integrate planning and implementation efforts between the DOH Public Health Preparedness and Response Joint Advisory Committee, the Emergency Management Council’s Committee on Terrorism, the EMS & Trauma Care Steering Committee’s Hospital Technical Advisory Committee and other collaborating entities working to improve hospital preparedness;
• Provide hospital program staff support as appropriate to the Washington State DOH Public Health Preparedness and Response Joint Advisory Committee;
• Integrate the appropriate HRSA Priority Areas and Critical Benchmarks for hospital bioterrorism response planning criteria with statewide emergency preparedness and response plan development and implementation.

The Washington State DOH Hospital Bioterrorism Preparedness Coordinator CV is attached as Appendix (3).

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Washington State DOH Hospital Bioterrorism Preparedness Medical Director (.25 FTE)
This position is the physician medical director of the program, providing medical consultation and guidance to the Hospital Bioterrorism Preparedness Coordinator.  The medical director works collaboratively with the DOH Senior Public Health Official, and the Bioterrorism Coordinator, to:

• Provide medical consultation and guidance to the PHEPR Joint Advisory Committee in planning and implementation efforts directed to Washington State increasing hospital preparedness in:

• Temporary credentialing of healthcare providers to provide services in hospitals during a bioterrorism event or other public health emergency;

• Recruitment and training of healthcare practitioners;

• Managing and mobilizing healthcare practitioners to respond to a bioterrorism event.

• Assure integration of hospitals with the National Strategic Stockpile (SNS) program;
• Assure appropriate medical content and practice in hospital bioterrorism plans, protocols, and training curricula for healthcare practitioners;
• Act as liaison with the Washington State Medical Association, the Washington State Hospital Association and other healthcare entities; and

• Work with professional organizations to promote direct integration of bioterrorism Washington State awareness objectives into medical schools, nursing education and EMS provider curricula.

The Washington State DOH Hospital Bioterrorism Preparedness Medical Director’s CV is attached as Appendix (4).

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FY 03 Staffing Plan for HBPP Program Functions 
In addition to the Coordinator and Medical Director, additional program staff are necessary to ensure the minimum required professional expertise to effectively meet the HRSA Hospital Bioterrorism Preparedness Program requirements for FY 03, and to fully integrate hospital preparedness and response activities not only with CDC-funded public health preparedness and response activities but also with the Washington State regional and local health jurisdictions.  These staff are:

• 1 Hospital Health Services Consultant 3* – 1.0 FTE
• 1 Hospital Health Services Consultant 3* – 1.0 FTE
• 3 Public Health Services Consultant 3* (.25 FTE each x 3 positions =.75 FTE)
• Management Analyst 1 (Finance)* – 1.0 FTE
• Secretary Administrative – 1.0 FTE

(*) above denotes new requested position, reflecting significant increase in HRSA program requirements and funding.   Job descriptions for these positions are included as Appendix (5).

Although not formal a part of the state DOH Hospital Bioterrorism Preparedness Program, (HBPP), nor paid from HBPP funds, each DOH division (Health Services Quality Assurance, Environmental Health, Epidemiology, Health Statistics and Public Health Laboratories and Community and Family Health) has a PHEPR Division Coordinator.  This person has responsibility for preparation of his or her respective division’s portion of the Washington CEMP (ESF 8).  They work closely with the HBPP staff to provide assistance in developing and implementing those portions of the state EPR programs that relate to the work of their DOH division and to appropriate parts of the state CEMP.

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Critical Benchmark 1

Develop and maintain a financial accounting system capable of tracking expenditures by priority area, by critical benchmark, and by funds allocated to hospitals and other health care entities.

Strategies:  What overarching approach(es) will be used to undertake this activity?
As required under Washington State law, the Department of Health uses a uniform chart of accounts and procedures consistent with generally accepted accounting principles (GAAP) to record and report all department financial transactions. This system will track costs to a level that corresponds with the detail required in federal Standard Form 424A for each focus area. The financial system is updated on a daily basis to include all revenue, expenditure and journal voucher activity.

Tasks:  What key tasks will be conducted in carrying out each identified strategy?
Budgetary coding will be assigned to the HRSA grant and each of the six CDC Focus Areas and incorporated into the chart of accounts in the department’s financial accounting system.

Timeline:  What are the critical milestones and completion dates for each task?
Please see Appendix E, “HBPP FY 03 Workplan Timelines”.

Responsible Parties:  Identify the person(s) and/or entity assigned to complete each task.
Executive Staff, Office of the Secretary: Rick Buell and Kay Koth.

Evaluation Metric:  How will the agency determine progress toward Washington State successful completion of the overall recipient activity?
Review final chart of accounts for inclusion of necessary budget coding.

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 Go to Priority Area 2: Regional Surge Capacity for the Care of Adult and Pediatric Victims of Terrorism

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