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Summary of Priority area 2-A
Summary of Priority area 2-B
Summary of Priority area 2-C
Summary of Priority area 2-D
Summary of Priority area 2-E
Summary of Priority area 2-F
Summary of Priority area 2-G
Summary of Priority Area 2-A
Hospital bed capacity
During the past year, the Washington State Department of Health (DOH) has
contracted with the Washington State Hospital Association (WSHA) to
provide technical assistance with hospitals, with Harborview Medical
Center to provide web-based and emergency communications infrastructure
development, with Dr Nancy Auer of Swedish Medical Center to provide
expert medical consultation, and with Regional EMS and Trauma Care
Councils (EMSTCC) to coordinate the development and implementation of
regional hospital response plans. It is the responsibility of the regional
EMSTC Councils to ensure collaboration with the LHJ officials in their
region by ensuring integration of CDC and HRSA planning efforts. To
further ensure this collaboration, the local health officers and local
emergency management review all regional hospital bioterrorism response
plans. To ensure final integration with the state
Comprehensive Emergency Management Plan as well as revisions to ESF 8,
regional hospital response plans will be reviewed and formally approved by
state DOH. With guidance from DOH, the hospitals addressed the areas of
critical concern outlined in the 2002 HRSA guidance. Each region
developed their regional hospital plan within the framework of 500
infectious patients presenting throughout the region.
During FY 03 DOH, with assistance from WSHA, will
work with each of the nine regional hospital bioterrorism response
planning workgroups and regional EMSTCCs to modify and adapt their
regional hospital plans to address the new priorities identified in the
2003 HRSA guidance. DOH and the Joint Advisory Committee will coordinate
with regional health jurisdictions to identify potential redundancies or
resolve new issues regarding guidance for regional hospital plan
development. DOH and the Committee will continue to coordinate with and
integrate the regional hospital preparedness plan needs assessment results
with the regional public health emergency preparedness and response public
health jurisdiction efforts.
In 2002 the
population of Washington State Washington States was estimated at
6,041,700. Based on this estimate and the criteria of preparing for
500 infectious patients per million-population,
the state would need to prepare a response for 3,021 patients. Currently,
each of the nine emergency response regions in the state has developed a
hospital preparedness plan for response to at least 500 patients.
According to this planning process, the state is preparing to respond to
4,500 infectious patients. The department plans to have each emergency
preparedness and response region continue preparing for an influx of 500
patients. Based on the current planning process and the official 2002
population estimates for each region,
(Section omitted in accordance with R.C.W. 42.17.310(1)(ww)) in the
state meets the current requirement.
Section omitted in
accordance with R.C.W. 42.17.310(1)(ww)).
DOH, in conjunction with the WSHA, local health jurisdictions (LHJs), and
EMS/TC Council will facilitate hospital emergency response plan amendments
to accommodate this increase, in conjunction with the development of the
regional public health response plan during the coming year.
As each region
developed its hospital preparedness and response plan during FY03, the
region focused its priorities on surge capacity and response to an
incident of bioterrorism. The regional planning efforts were necessarily
broad and consequently are adaptable to other public health emergencies
that would involve responding to chemical, radiological, and explosive
incidents. DOH, local public health, and WSHA will continue to work with
each of the regional hospital preparedness planning groups to evaluate the
planned response to all-hazards public health emergencies and initiate
upgrades and appropriate regional hospital plan changes where needed.
DOH will work with
all public health and hospital planning activities to include inpatient,
outpatient, critical care, and pre-hospital response. This will also
include working with system partners – EMS, hospitals, community and
migrant health centers, rural health centers, tribal health clinics,
outpatient facilities, poison control centers, military and veterans
health care facilities, and other health care provider organizations – so
that the full spectrum of patient care is incorporated into the overall
response to an all-hazards emergency situation.
During FY 03, DOH
will continue to work with the Washington State DOH Emergency Preparedness
and Response Advisory Committee to ensure that plans include the use of
and coordination with facilities and organizations outside of the hospital
setting for temporary patient overflow during a public health emergency.
During the initial planning process, each regional hospital planning
committee involved the participation of organizations such as the Red
Cross, Veteran’s Administration, emergency management, police, fire, and
other emergency response organizations to identify and coordinate the use
of external facilities for patient overflow.
WSHA, at the
request of DOH, developed and distributed to all hospital planning
partners a Memorandum of Understanding (MOU) to be used as necessary by
hospitals within the planning area. This MOU Washington States originally
designed as an intra-regional hospital facility tool and included
agreements for the care, transfer, and diversion of patients as well as
sharing equipment and supplies during an emergency. This MOU can be
further enhanced to serve as an interregional agreement. DOH will
continue to work cooperatively with bordering states and Canada to foster
an environment of mutual aid and response planning as physical and
environmental conditions dictate. Also see Crosscutting, “Border States”,
and Section 1.
Each regional
hospital planning group has considered patient flow within the region as
part of surge capacity planning. Regional hospital plans, as part of the
overall public health response, will be adapted to focus on the issue of
rural to urban patient flow where appropriate. Each planning region will
consider appropriate patient care procedures in relation to hospital
location, transportation routes and availability, and geographic
limitations. Urban to rural patient flow will also be considered in the
event that urban facility capacity is overwhelmed.
In conjunction
with WSHA, DOH will identify and coordinate priority areas in urban,
rural, and frontier portions of Washington State. Areas of particular
focus involve federally recognized tribal entities and community and
migrant health centers. During FY03, DOH plans to work with these
entities and clinics to assess their current capabilities to respond to
public health emergencies, particularly involving biological agents. This
assessment will determine capabilities and capacities, as well as needs
for improved planning, response, and coordination with the public health
and hospital systems in their respective geographic locales.
DOH plans to work with WSHA, regional public health,
and the regional hospital planning groups to develop models for
pre-hospital and hospital protocols, which address the general population
including children, pregnant women, the elderly, people with English as a
second language and other special needs groups, regarding biological,
chemical, radiological, or explosive exposures and incident response by
pre-hospital and hospital personnel. The following concepts are to be
pursued:
- Create regional and local disaster plans that
include specific protocols for medical and logistical management of
bioterrorism victims including those with special needs.
- Require adequate supplies of pharmaceuticals such
as antibiotics, antidotes and vaccines in dosages.
- Include specialized health care facilities in all
aspects of preparation, as they may become secondary sites for managing
casualties.
- Use maternal and child health phone lines, poison
control centers and other public health information resources in local
and regional planning efforts. Toll-free information lines can provide
updates on the situation, access to emergency health services and other
pertinent information. Poison control centers can be used as central
clearinghouses for information on toxicology, antidotes and treatment,
and decontamination procedures.
- Include medical personnel and others skilled at
evaluating and treating special patient populations as state, regional,
and local disaster team members. Ensure that all standards and
protocols developed address the needs of such populations.
- Prepare schools, childcare centers and
after-school programs to assess their populations and develop response
plans including, including notifying parents, providing or arranging
care for children whose parents cannot reach them, and rendering first
aid. Coordinate care with the Superintendent of Public Instruction and
the Department of Social and Health Services (DSHS) as appropriate.
- Evaluate and update the protocols with the
information as research and development efforts continue with respect to
appropriate and safe uses, dosages and interaction of pharmaceuticals
for children, pregnant women, the elderly and individuals with
disabilities.
- Coordinate with DSHS to prepare nursing homes,
assisted living facilities and other congregate care facilities to
assess their populations and to develop appropriate response plans.
Current state and Medical Program Director-approved
county EMS protocols, as well as Patient Care Procedures and County
Operating Procedures, address the issue of special needs patients during
patient transfers. During FY03, DOH plans to request EMS County Medical
Program Directors to review and update their current county Patient Care
Protocols regarding special needs patients and special needs patient
transfers with a focus on incidents involving biological, chemical,
radiological, and explosive terrorist acts, and to provide technical
assistance to Medical Program Directors in this area.
DOH plans to
coordinate with WSHA, local health jurisdictions, and emergency
preparedness and response oversight committees to ensure that the needs of
non-English speaking populations are addressed through education, public
service announcements, and information distribution regarding pre-event,
event, and post-event actions and concerns.
As part
of the regional hospital planning effort, hospitals are developing methods
to respond to a large influx of contaminated patients. As a part of any
hospital response plan to increase capacity, excess morgue capacity is
essential, particularly when dealing with highly contagious biological
agents or other weapons of mass destruction. Assuring consistency with ESF
8 of the CEMP, proper human remains decontamination, isolation, and final
disposition protocols will need further refinement after consultation with
local medical examiners to determine regional capabilities for disposition
of human remains. Proper record keeping is critical in mass mortality
situations, and plans will be developed in coordination with the state’s
Center for Health Statistics.
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Critical Benchmark 2-1
Establish
a system that allows the triage, treatment, and disposition of 500 adult
and pediatric patients per 1,000,000 population (or no fewer that 500
patients per awardee jurisdiction), with acute illness or trauma requiring
hospitalization from a biological, chemical, radiological, or explosive
terrorist incident.
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Strategies: What overarching approach(es) will be used to undertake this
activity?
Issues required to be
addressed:
-
500 patients per 1,000,000 population
-
Surge capacity considering biological,
chemical, radiological, and explosive events
-
Priority given to biological events
-
ddress patient flow from rural to urban
areas
-
Special population considerations.
Strategy to
address issues will be the upgrade of approved regional hospital plans to
increase and improve regional public health and hospital capacity in order
to meet FY 03 planning requirements. Washington State plans to continue
smallpox vaccinations to hospital and health care workers in order in
insure a safe response to a possible smallpox incident. Also, Washington
State will be integrating into mass vaccination plans the lessons learned
from State I smallpox vaccination efforts.
Issues recommended
to be addressed :
-
All components of the health care system
considered (critical care, inpatient, outpatient, and pre-hospital)
-
Foster mutual aid among health care
facilities
-
Where appropriate, develop intrastate
and interstate agreements
-
Address patient flow from urban to rural
areas
-
Identification of major rural and urban
priorities
-
Address jurisdictions with frontier
areas
-
Alternate off-site surge capacity
-
Translation for non-English speaking population and hearing impaired
Strategy to
address issues will be the upgrade of approved regional hospital plans to
increase and improve regional public health and hospital capacity in order
to meet FY 03 planning requirements.
Optional issues:
·
Decontamination and disposal of human remains
Strategy to
address issue will include the upgrade of approved regional hospital plans
to increase and improve regional public health and hospital capacity in
order to meet FY 03 planning requirements.
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Tasks: What
key tasks will be conducted in carrying out each identified strategy?
The following tasks are to be conducted to carry out the
strategies specified above
-
Hospitals will work with public health regions to upgrade
regional hospital plan portion of regional public health plans.
- Hospitals will increase capacity of patient care
through equipment purchases and training program implementation, per FY
02 hospital assessments.
- Capacity expansion activities will focus on
biological preparedness and response in particular and all-hazards
preparedness and response in general.
- All preparedness
and response activities will cover the inclusion of organizations such
as the Red Cross, local schools, churches, armories, etc. in order to
incorporate facilities outside of the hospital to assist in increased
surge capacity.
- Community and migrant health centers, tribal
clinics, EMS services, and hospitals will coordinate preparedness and
response assessment and planning activities.
- Develop MOUs/MOAs to foster inter-jurisdictional
cooperation.
- Work with neighboring states in developing similar
cooperative agreements in consultation with the governor’s office.
- Evaluate statewide issues and regional planning
activities to determine areas of concern with respect to urban, rural,
and frontier issues in responding to a public health emergency involving
a terrorist attack.
- Identify needs
regarding rural to urban patient flow through coordination with
hospital, community and tribal clinic, military and veterans facilities,
and LHJ response activities.
- Develop response activities to address special
needs populations such as children, elderly, physically and mentally
handicapped, hearing and visually impaired, pregnant women, and other
patients with special health care needs.
-
Address
increased morgue capacities and human remains decontamination within
each region through equipment purchases and response planning.
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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.
DOH will contract and work closely with the lead LHJ in each region to
facilitate these efforts, with consulting assistance from WSHA. In
consultation with DOH, each lead LHJ will determine how best to develop
and manage the project as the unique needs of each region dictate.
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Evaluation
Metric: How will the agency determine progress toward Washington State
successful completion of the overall recipient activity?
- Tracking equipment purchases, training provision
and other capacity-building activities by region and facility.
- Active inclusion of new partners specified above
in response planning and assessment activities, per timeline.
- Inclusion of existing partners specified above in
increased surge capacity implementation, per timeline.
- Development and implementation of MOU/MOAs.
- Development of cooperative agreements with other
states and Canada in consultation with the governor’s office.
-
Development and implementation of response activities re: special needs
populations
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Summary of Priority Area 2-B
Hospital
Isolation Capacity
The protection of clinicians, other patients, staff, and the
general population from exposures to biological casualties in hospitals is
being addressed by the Washington State Department of Health (DOH) through
identifying resource requirements and procedures needed to provide
appropriate isolation. Facilities that receive biological casualties need
to have the ability to triage and separate them from the general patient
population so as to isolate and contain the harmful agent, while
continuing to provide appropriate care. During FY04, DOH, in conjunction
with the Washington State Hospital Association (WSHA) and hospitals plan
to expand on current procedures in place to provide protection for
hospital staff and non-infected patients.
According to hospital assessment results,
seventy-four percent of the hospitals in Washington State indicated that
they have negative pressure isolation room capabilities. Twenty-seven
percent indicate that their negative pressure isolation room capabilities
can accommodate 10 or more beds. In the upcoming year, DOH, in
conjunction with local health jurisdictions and WSHA, plans to conduct a
demographics-based risk assessment to determine the appropriate facilities
to be targeted for capital improvements in developing and implementing
mass isolation and decontamination capabilities regarding patients with or
at risk for communicable diseases (bioterrorism event), while concurrently
undertaking a review and possible revision of hospital licensing
requirements in this area. Current
Washington State hospital licensing rules
require a facility to have only one room of any size with negative air
pressure capability for the management of airborne diseases, and a general
“decontamination area” with shower and floor drain connected
to a sanitary
sewage system adjacent to the facility’s
emergency entrance. Discussions around this issue include
participation from hospitals, WSHA, local
health jurisdictions and other pertinent
agencies to review and evaluate the licensing
rules in an effort to determine if any
changes are necessary to
address air-filtered quarantine units and
general decontamination capabilities.
Based on the results of the needs identified in the
hospital emergency preparedness assessments and regional hospital plans,
and in conjunction with the demographic-based risk assessment, DOH plans
to build isolation capacities throughout Washington State using a
three-phase process over a three-year period. In the initial year, DOH
will work with local health jurisdictions, WSHA, and regional hospital
planning workgroups to identify appropriate facilities for initial
expansion. A similar process will be followed over the subsequent two
years.
Phase 1 (first year – 2004)
- Identify appropriate facilities using assessment
and planning needs analysis.
- Begin capital improvements to accommodate a
minimum of 10 patients at the first one-third of the hospitals
identified as needing such capacity.
- Begin identifying facilities for the second phase
of development.
- Begin identifying potential definitive isolation
facilities.
Phase 2 (second year – 2005)
- Finalize the identification of phase two
facilities.
- Begin capital improvements to accommodate a
minimum of 10 patients in the second one-third of the hospitals
identified as needing such capacity.
- Begin initial feasibility assessments and
identification of facilities for the final phase of development.
- Begin building capacities at identified definitive
isolation facilities.
Phase 3 (third year – 2006)
- Finalize the identification of phase three
facilities.
- Begin capital improvements to accommodate a
minimum of 10 patients in the final one-third of the hospitals
identified as needing such capacity.
- Complete capacity improvements for definitive
isolation facilities.
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Critical Benchmark #2-2
Upgrade
or maintain airborne infectious disease isolation capacity to have at
least one negative pressure, HEPA filtered isolation facility per awardee,
to be placed in accord with the findings of the awardee’s needs
assessments. Such facilities must be able to support the initial
evaluations and treatment of 10 adult and pediatric patients at a time
having a clinical contagious syndrome suggestive of smallpox, plague, or
hemorrhagic fever, prior to movement to a definitive isolation facility.
Strategies: What overarching approach(es) will be used to undertake this
activity?
Required:
Recommended:
-
Inventory of all fixed and mobile hospital isolation
capabilities and facility operational characteristics
Optional:
-
Propose equipment purchases or capital improvements to increase
isolation capacities
Tasks: What key tasks will be conducted in carrying out each identified
strategy?
-
Hospitals will upgrade filtration capabilities by purchasing
appropriate equipment.
-
Hospitals will upgrade filtration
capabilities by making appropriate facility physical improvements.
-
Hospitals will increase patient isolation capacity by making fixed
negative pressure isolation improvements.
-
Hospitals will increase patient
isolation capacity by purchasing portable negative pressure isolation
equipment.
-
Hospital needs assessment analyses will determine the number of current
fixed and mobile isolation unit capabilities.
-
Hospital
needs assessment analyses will assist the efforts to determine
appropriate equipment types and locations for capitol improvement.
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.
DOH will work closely with the lead LHJ in each region to facilitate these
efforts. In consultation with DOH, each lead LHJ is to determine how best
to develop and manage the project as the unique needs of each region
dictate. DOH will also work with WSHA to assist in coordination and
technical expertise regarding appropriate expenditure and use of funds as
it relates to hospital preparedness.
Evaluation
Metric: How will the agency determine progress toward Washington State
successful completion of the overall recipient activity?
Progress will be determined based on decisions made regarding numbers of
isolation facilities to be developed and the timeframe involved in that
development. Decisions regarding numbers and locations of facilities will
be based on information contained in the hospital emergency preparedness
assessments, regional hospital plans, regional public health plans, and in
conjunction with the demographic-based risk assessment information from
the bioterrorism threat assessment information.
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Summary of Priority Area 2-C
Health care personnel
A
description of the process for establishing a response system that allows
the immediate deployment of additional patient care personnel that would
meaningfully increase hospital patient care surge capacity. Back to top
Critical Benchmark 2-3
Establish
a response system that allows the immediate deployment of 250 or more
additional patient care personnel per 1,000,000 population in urban areas,
and 125 or more additional patient care personnel per 1,000,000 of
population in rural areas, that would meaningfully increase hospital
patient care surge capacity. Back to top
Strategies: What overarching approach(es) will be used to undertake this
activity?
The department and the local public health jurisdictions have gained some
experience working together to identify volunteers for the smallpox
vaccination initiative. Work on this critical benchmark will build upon
that experience and
(Section omitted in accordance with R.C.W. 42.17.310(1)(ww))
The local health jurisdictions, in cooperation with their Hospital
Bioterrorism Planning Region partners, will have the central roll in
identifying and mobilizing volunteers when needed from previously
constructed, electronically stored lists.
(Section omitted in accordance with R.C.W. 42.17.310(1)(ww))
is the goal. This activity will also include developing procedures for
assuring the identity of volunteers at the site of the emergency and for
determining the legitimacy of other individuals who present themselves at
the scene as volunteer clinicians. Back to top
Tasks:
What key tasks will be conducted in carrying out each identified strategy?
- Define information content for the system
including types of clinicians and the relative proportion of each type
relative the target total number for the region to be included.
- Identify security and confidentiality requirements
for the system. If needed, obtain additional authority to implement
security and confidentiality requirements.
- Design system operation accommodating, if
necessary, differences in capacities of smaller, rural local health
jurisdictions.
- State and local roles and responsibilities for
system maintenance and operation established
- Using basic provider contact information from the
system identify volunteers and add additional specialty and provider
contact information to the system.
- Develop agreements between planning regions for
mutual support if emergency need exceeds number of clinician volunteers
available within the region.
- Test system in context of planned summer 2004
emergency exercise.
-
Identify
and initiate system changes determined to be needed as a result of the
exercise.
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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.
- Department of Health, Health Professions Quality
Assurance and Information Resource Management. Local Health
Jurisdictions. State Emergency Management Division, WSHA, WSMA, and
other professional health care provider organizations as appropriate
- Local Health Jurisdictions. DOH, Health
Professions Quality Assurance.
- Local Health Jurisdictions.
-
Local
Health Jurisdictions. Local exercise site participants. Department EOC,
ESF#8 desk.
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Evaluation Metric: How will the agency determine progress toward
Washington State successful completion of the overall recipient activity?
- System development completed.
- System contains names and contact information of
LHJ recruited volunteer clinicians sufficient to meet Critical Benchmark
standards.
- Exercise demonstrates ability of system to
generate number and type of clinician volunteers needed.
-
System
modifications to optimize performance based upon test experience
recommended.
Summary of Priority Area 2-D
Credentialing and Supervision
A
description of the process for developing a system that allows clinicians
to practice in facilities where they do not normally work, in emergency
situations.
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Critical Benchmark 2-4
Develop a
system that allows the credentialing and supervision of clinicians not
normally working in facilities responding to a terrorist incident.
Strategies: What overarching approach(es) will be used to undertake this
activity?
This system will be developed to operate in coordination with the
(Section omitted in accordance with R.C.W. 42.17.310(1)(ww))
to be established under Critical Benchmark #2-3. The system must address
clinician qualifications to practice in Washington State some of which is
already permissible under current licensing laws. The system must also
address clinician privileges to practice at the site of an emergency,
supervision of volunteer clinicians. Washington State has authorities and
procedures in place that provide a solid starting place for most of these
issues. State Bioterrorism Hospital Preparedness Plan staff will take the
lead in organizing the work convening the interest groups to work through
the issues, and coordinating with the emergency management division of the
military department and other stakeholders.
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Tasks: What key tasks will be conducted in carrying out each identified
strategy?
- Existing state Emergency Management statutes and
many professional licensing laws contain provisions that enable
clinicians who are licensed out-of-state to practice in Washington State
in declared emergencies. However, means for identifying experienced
volunteers should be determined in consultation with state EMD.
- Issues of clinician liability will have to be
addressed. The current EMD statute has a liability protection provision
covering EMD authorized emergency volunteers but may not be funded to
address a large-scale emergency response situation.
- Supervision requirements will be assessed through
a review of the practice acts governing physicians, physician
assistants, advanced registered nurse practitioners, registered nurses,
licensed practical nurses, pharmacists, mental health professionals,
emergency medical technicians, and paramedics. Recommendations for next
steps will be prepared.
- Verification of volunteer provider credentials
for those who are licensed in Washington State can be done using the
state provider look-up system. The availability of comparable
verification systems in neighboring states and means of accessing them
will be determined.
- Clinician privileging is the prerogative of
individual hospitals. Procedures for obtaining emergency privileges
from the local hospitals will be developed in consultation with the
Washington State Hospital Association.
- Discussion with third party payers including
Medicaid will be undertaken through the Association of Washington State
Health Plans to assess payment and reimbursement issues.
-
Once
development is complete operating procedures for the system will be
distributed locally through the bioterrorism planning regions
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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.
- DOH BHPP and HSQA, state and local EMD
- DOH BHPP, HSQA, EMD
- DOH BHPP, HSQA, professional licensing boards,
professional associations.
- DOH BHPP, HSQA, Local health jurisdictions
- DOH BHPP, HSQA, Washington State Hospital
Association, WSMA, and other professional health care provider
organizations
- DOH OS, BHPP, Association of Washington State
Health Plans
-
DOH BHPP
Evaluation Metric: How will the agency determine progress toward
Washington State successful completion of the overall recipient activity?
Progress toward Washington State completion of activity will be measured
by successfully meeting the timelines specified above.
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Summary of Priority Area 2-D
Pharmaceutical Caches
Development of a statewide plan to provide pharmaceutical surge capacity
at the local and regional levels, including coordination with existing
pharmaceutical cache resources in the state (Strategic National Stockpile
and MMRS).
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Critical Benchmark 2-5
Establish
local or regional systems whereby pharmacies based in hospitals or
otherwise participating in the local or regional health care response plan
have surge capacity to provide pertinent pharmaceuticals in response to
bioterrorism or other public health emergencies.
Strategies: What overarching approach(es) will be used to undertake this
activity?
The strategy in the grant year will be to involve all of the key
stakeholders to work collaboratively in exploring various options for
providing pharmaceutical surge capacity and developing a plan for full
implementation in ensuing years. The plan will complement the Strategic
National Stockpile(SNS) planning as well as the current Chempack
activities.
Tasks: What key tasks will be conducted in
carrying out each identified strategy?
-
A series of meetings/workshops
will be held to explore options and assess the feasibility of
providing pharmaceutical surge capacity prior to receipt of the
Strategic National Stockpile. Key participants will include, among
others, the State Hospital Association, the State Pharmaceutical
Association, the State Pharmacy Board, and representatives of each of
the state’s nine public health emergency preparedness regions.
Workshops will focus on such topics as options for providing needed
pharmaceuticals, logistical issues, contractual arrangements,
inventory management, stock rotation, storage issues, costs, etc.
-
Based upon the results of the
meetings/workshops, a plan will be developed and documented for
implementation of this capacity. The plan will identify participants
in the system and outline roles and responsibilities as well as key
operational elements. The plan will be coordinated with all other
local, regional and state plans for dealing with incidents of
bioterrorism or other public health emergencies.
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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.
1.
DOH staff, Pharmacy Board, State Hospital Association, State
Pharmaceutical Association, nine Regional Emergency Response
Coordinators. State SNS Coordinator.
2.
DOH hospital bioterrorism staff and State
SNS Coordinator.
Evaluation Metric: How will the agency determine
progress toward Washington State successful completion of the overall
recipient activity?
1.
Number of meetings/work sessions held.
2.
Completion of implementation plan.
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Personal Protection and Decontamination
The state of Washington State has 91 licensed
hospitals that are part of the local and regional EPR hospital plans.
During FY 02 DOH allocated funds for eight complete sets (184
ensembles) of personal protective equipment (PPE) to 23 hospitals
statewide. In partnership, the Committee on Terrorism Equipment
Subcommittee allocated funds to purchase portable decontamination
shelters for the same 23 hospitals. This immediately created a
regional level of interoperability and supported the emergency
preparedness and response capacity of hospitals statewide.
The first 23 facilities were chosen by focusing
on the regional threat assessments, the ODP (formerly DOJ) risk
assessment, participation in the regional planning process, and
strategic location within the region and state..
Washington State Department of Health (DOH) will
continue the collaborative efforts begun during FY 02, while refining
them fit the FY 03 CDC/HRSA and ODP grant requirements to ensure
consistency with the Washington State strategy for emergency
preparedness and response. In addition, the 2002/2003 regional
Bioterrorism needs assessment identified that PPE, decontamination,
and training were the hospital’s top three areas of need in regard to
emergency preparedness and response.
Any equipment purchased with funds under this
priority must meet and be consistent with the standards currently in
place for Washington State regarding equipment interoperability.
The Washington State PPE standard was determined
by evaluating several aspects of first responder and hospital
operations and based on a minimum 12 responder model. Considerations
included:
-
Appropriate minimum level of protection
-
Level of training for staff members
-
Grooming standards (for example, N-95’s or tight-fitting face
masks cannot be worn if the wearer has a beard)
-
Physical condition of team member (i.e., N-95’s and
tight-fitting masks increase the stress on the
cardiovascular system)
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Critical Benchmark 2-6 & 2-7
Critical Benchmark 2-6: Ensure
adequate personal protective equipment (PPE) to protect 250 or more
health care personnel per 1,000,000 population in urban areas, and 125
or more health care personnel per 1,000,000 population in rural areas,
during a biological, chemical or radiological incident.
Critical Benchmark 2-7: Ensure
that adequate portable or fixed decontamination systems exist for
managing 500 adult and pediatric patients and health care workers per
1,000,000 population, who have been exposed to biological, chemical or
radiological agents.
Strategies: What overarching approach(es) will be
used to undertake this activity?
The primary focus of this strategy is to equip
hospitals with a minimum number of PPE ensembles and provide them with
portable decontamination shelters to triage and manage patients
affected by a biological, chemical, or radiological incident.
To achieve this, the following approaches will be
implemented:
-
Continue with the phased approach for allocations.
-
Analyze and use the findings from the 2002/2003 needs
assessments to focus equipment allocations and acquisitions.
-
Continue to develop the training process currently in
place for PPE and decontamination.
-
Develop a train-the-trainer component to ensure adequate
number of available trained hospital staff at each facility.
These
recommendations will be accomplished by phasing in capacity over a
three-year period. Each year facilities will be identified according
to criteria based on regional risk, demographics and needs assessment.
Funds for equipment will be allocated in each phase to approximately
one-third of the 91eligible hospitals in order to provide each with
the minimum level of PPE, decontamination and detection equipment.
Tasks: What key tasks will be conducted in
carrying out each identified strategy?
1. Phase I-2002 (23 hospitals received
eight sets PPE from HRSA grant; the same 23 hospitals received decon
systems from EMD grant,).
2. Phase II-2003 (23 hospitals receive
PPE from EMD grant; 23 hospitals receive decon systems and
supplementary PPE from HRSA grant).
3. Phase III-2004 (23 hospitals receive
PPE from EMD grant; 23 hospitals receive decon systems from HRSA
grant).
4. Phase IV-2005 (23 hospitals receive
PPE from EMD grant; 23 hospitals receive decon systems from HRSA
grant).
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.
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DOH, EMD, Committee on Terrorism Equipment
Subcommittee
-
DOH, EMD, Committee on Terrorism Equipment
Subcommittee
-
DOH, EMD, Committee on Terrorism Equipment
Subcommittee
-
DOH, EMD, Committee on Terrorism Equipment
Subcommittee
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Evaluation metric
- 23 hospitals receive PPE and decon systems
- 23 hospitals receive PPE and decon systems
- 23 hospitals receive decon systems
- 22 hospitals receive decon systems
Summary of Priority Area 2-F:
Mental Health
DOH will develop and implement a plan to address
the mental health and special needs of health care workers and others
who are victims of a bioterrorist attack or other disaster, and to
create sustainable systems to meet the ongoing information needs of
special populations. Partners in this activity will include: DOH
Division of Community and Family Health (including programs providing
prevention services to children and families, women and other special
populations), Governor’s Office on Indian Affairs, Washington State
Department of Social and Health Services (including offices of Aging
and Adult Services, Children and Family Services, Developmental
Disabilities Division, Mental Health Services, Deaf Services,
Residential Care Services), Washington State Council of the Blind,
state minority commissions, Washington State Human Rights Commission,
Washington State Office of Public Instruction, Washington State
Department of the Military (Emergency Management Division, Public
Education Unit), Washington State Coalition for the Homeless, American
Red Cross (local offices), and other state, regional and local
entities serving special populations.
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Critical Benchmark 2-8
Establish a system that provides for a graded range of acute
psychosocial interventions and longer-term mental health services to
5,000 adult and pediatric clients and health care workers per
1,000,000 population exposed to a biological, chemical, radiological
or explosive terrorist incident.
Strategies: What overarching approach(es) will be
used to undertake this activity?
DOH will develop a plan to provide consultation,
technical assistance and participation on workgroups and advisory
committees, review and comment on relevant materials developed, and
recruitment of external medical experts as needed. Services to
children need to be designed to serve them in the context of their
families.
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Tasks: What key tasks will be conducted in
carrying out each identified strategy?
DOH will undertake the following activities to
address the needs, including informational needs of non-English
speaking populations, children, the elderly, pregnant women,
individuals with disabilities and their families.
-
Develop regional and local disaster plans that include specific
protocols for medical and logistical management of bioterrorism
victims who are within one or more of the populations described above.
-
Require adequate supplies of pharmaceuticals such as antibiotics,
antidotes and vaccines in dosages appropriate for children, the
elderly, pregnant women, individuals with disabilities.
-
Include pediatric health care facilities (children’s hospitals,
pediatricians’ offices, pediatric ERs, public health clinics) in all
aspects of preparation.
-
Use maternal and child health phone lines, Poison Control Centers and
other public health information resources in local and regional
planning efforts. Toll-free information lines provide updates on the
situation, access to emergency health services, information regarding
the status of children who have been relocated and other pertinent
information. During FY 03 DOH will determine appropriate role of
Poison Control Centers(PCC) in these areas. In collaboration with DOH,
the state PCC may be used as central clearinghouses for information on
toxicology, antidotes and treatment, and decontamination procedures.
-
Include obstetricians, pediatricians and others skilled at evaluating
and treating pregnant women and children as state, regional and local
disaster team members. Ensure that all standards and protocols
reflect the needs of pregnant women, children, and individuals with
disabilities and others with special needs.
-
Coordinate with the Office of the Superintendent of Public Schools to
prepare schools, childcare centers and after-school programs to assess
children and develop response plans including notifying parents,
providing or arranging care for children whose parents cannot reach
them, and rendering first aid.
-
Evaluate and update the protocols with the information as research
and development efforts continue with respect to appropriate and safe
uses, dosages and interaction of pharmaceuticals for children,
pregnant women, the elderly and individuals with disabilities.
With WSHA and key
member organizations, DOH will form a special advisory committee on
mental health and crisis communication issues with matrix partners,
the Community and Agency Communications Partner Matrix (CACPM). This
group will work to develop emergency communication planning
recommendations and strategies for the following initiatives:
- Helping staff required to
respond in a crisis to cope with the psychosocial consequences of
their involvement.
- Helping the general
public and special populations cope with the psychosocial
consequences of a crisis. This includes effectively addressing
psychosocial issues in related materials, and ensuring mental health
resources are available through DOH and other emergency hotlines.
(In support of hotline activities, participate in the planning of
related statewide initiatives such as the Access Washington State
Resource Directory—the health and human services database associated
with the state’s 211 initiative.)
- Ensuring the psychosocial consequences of crisis are
addressed in crisis and risk communication strategies
- Identifying training opportunities for emergency system
staff.
- Reviewing materials and best practice and making
recommendations for system use, including general public materials
from the American Red Cross, and staff materials from the CDC’s Crisis
and Risk Communication Guide. Distribute materials and recommendations
throughout the emergency partner system.
- Please see Cross-Cutting Activities F,
Populations with Special Needs.
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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.
DOH Division of
Community and Family Health with technical assistance from the
American Red Cross, the American Psychological Association (BT
guidelines have already been developed), Washington State Poison
Control Center, Washington State Psychological Association, Mental
Health Division, DSHS (each Regional Support Network has an identified
county mental health professional who is skilled in crisis
intervention), and the Washington State Mental Health Association.
Evaluation Metric: How will the agency determine
progress toward Washington State successful completion of the overall
recipient activity?
- Development of regional and local protocols
for management of special populations victims of bioterrorism.
- Appropriate equipment and supplies available.
- Evaluation feedback from pediatric health care
facilities and appropriate health care professionals regarding
implementation of developed protocols.
- Inclusion of poison control center as central
information clearinghouse for toxicology, antidotes, and treatments.
- Implementation of school and childcare center
plans to handle children’s issues.
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Summary of Priority Area 2-G
Communications and Information Technology
This Critical Benchmark addresses both the HRSA Hospital Bioterrorism
Preparedness Program and CDC Public Health communications and
information technology components (Focus Area E), as well as the
appropriate DHHS Cross-Cutting Benchmarks.
HRSA Critical Benchmark #2-10
Establish a secure and redundant communications system that ensures
connectivity during a terrorist incident between health care
facilities and state and local health departments.
Strategies: What overarching approach(es) will
be used to undertake this activity?
Note: Key
stakeholders for the coming grant year are defined as local and state
public health agencies, hospital emergency departments and emergency
management agencies. Priority stakeholders for following years are
infectious disease specialists and infection control practitioners,
large clinician practices, law enforcement agencies, first responders,
individual clinicians and pharmacists.
Strategies:
-
Assure 24/7 connectivity and communications between state health
department, local health agencies, emergency departments of hospitals
and emergency management agencies.
-
Assure at least three types of redundant communications capability
(Information
omitted in accordance with R.C.W.
42.17.310(1)(ww) are in place in state health department, local
health agencies and emergency departments of hospitals, and that these
connect with existing emergency management communications systems.
-
Establish Internet-based alerting mechanisms for key
stakeholders.
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Tasks: What key tasks will be
conducted in carrying out each identified strategy?
1a. In conjunction with Critical Benchmarks 7 and 9
develop policies for roles and responsibilities of duty officers for
each key stakeholder.
1b. Develop a communication plan for development and implementation
of 24/7 emergency alerting capacity in all local and state health
agencies, hospital emergency departments, and emergency management
agencies.
1c. For each key stakeholder organization (each local health
agency, hospital emergency department, state health department, and
emergency management agency) establish a 24/7 duty officer role,
define a roster of individuals responsible for carrying out that role,
and provide training as necessary in conjunction with Focus Area G.
1d. Assure that
organizations lacking necessary equipment for duty officer role (ie,
(Information omitted in accordance with
R.C.W.42.17.310 (1)(ww) are able to acquire such equipment.
Technology solution needs to be appropriate for each jurisdiction.
1e. Establish a process in each key stakeholder organization for
maintaining the duty officer role and for disseminating agency contact
information to other key stakeholders.
2a. Continue current program of assessing redundant communication
needs for hospitals and local health agencies.
2b. Identify gaps in redundant
communication needs and provide necessary technology to fill those
gaps.
2c. Continue with implementation of
the hospital communications technology plan.
3a. Define the types of alerts that
are routinely generated and identify the following items:
-- Type of message
-- Current delivery
format
-- Alert level (1 –
immediate, 2 – prompt, 3 – next business day)
-- Message
confirmation required
-- Amount of information
being delivered, pamphlet, one page, book, e-mail
-- What types of information should be disseminated via Internet-based
systems?
-- What limitations on access should there be to this information?
-- What processes should be used for posting this information to
Internet sites?
3c. Review current public health, emergency response and
healthcare-related Internet sites, and identify appropriate sites for
dissemination of alerts and other information to key stakeholders.
Decision on appropriate sites to include consideration of:
-- Type of system
-- System manager
-- Access/security
level (1 – confidential info, 2 – sensitive info, 3 – general release)
-- Support plan for
24/7 coverage/maintenance of web site
-- Use of web site
by target stakeholder audience
3d. Engage existing organizations that provide Internet-based
information to key stakeholders in agreements to post alerts as
necessary, following defined alerting mechanisms (i.e.,
Information omitted in accordance with R.C.W.42.17.310)(ww),
others as
appropriate).
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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(ies) assigned to complete each task.
1a. State and regional emergency
response coordinators.
1b. DOH Washington Electronic Disease
Surveillance System (WEDSS); state and regional emergency response
coordinators.
1c. Local health agencies, hospitals,
state DOH, Focus Area G.
1d. DOH WEDSS.
1e. Local health agencies, hospitals,
state DOH.
1f. DOH WEDSS; State and Regional Emergency Response Coordinators.
2 a, b, c. DOH Emergency Response Program.
3a. State and Regional Emergency
Response Coordinators.
3b. DOH WEDSS.
3c. DOH Communications Office.
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Evaluation Metric: How will the agency determine
overall progress toward Washington State successful completion of the
overall recipient activity?
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Percentage of local health agencies that have
identified duty officer and established 24/7 coverage.
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Percentage of local health agencies and hospitals that have received
wireless communication devices.
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Percentage of key stakeholders with access to Washington State SECURES
alerting system.
-
Percentage of key stakeholders receiving alerts via
identified Internet-based information systems.
Go to Priority Area 3:
Emergency Medical Services |
