advancements in hpp regional healthcare coalitions - The 2012 ...

Advancements in HPP Regional
Healthcare Coalitions---
Utah’s Experience
Kevin McCulley
Hospital Preparedness Program Manager
Utah Department of Health
Sara V. Sinclair
Northern Utah Regional Medical Surge Director
Bear River Health Department

Regional Coalitions in Utah
• 7 defined areas
– Good correlation with EMS
transport, facility transfer
patterns, in EMS statute
• 4 match LHD boundaries
• 3 combined LHDs
• LHD as host entity
– CDC PHEP in place
– Increased role of LHD in ESF8
and response
– Good fit with grant alignment

Northern Utah Healthcare Coalition
Jurisdiction: Six northernmost counties in UT
MEMBERS:
• Eight hospitals
• Three local health departments
• Six county emergency managers
• Six county EMS representatives
• Long term care representatives
• Primary care clinics (private and CHC)
• Ad hoc---dispatch, home health, hospice, regional liaison
from Division of Emergency Management, behavioral
health, UDOT, Highway Patrol, City Emergency Managers

Required Coalition Members
• 2011 Required
– One or more hospitals
– One or more local healthcare facilities (LTC, CHC, ASC)
– One or more political subdivisions
• 2012 “Essential” membership also includes
– EMS
– Emergency Management
– Behavioral Health Services
– Specialty and support (dialysis, pharmacy, home health)
– Tribal Health and others
– Plus “Additional” members (Law, Public Works, VOADs)

Organization of Coalition
• Executive committee---5 hospitals, 1 health officer, 1
clinic representative, 1 EMS representative, 1 county
emergency manager
– Meets bimonthly; officers (chair, vice-chair, immediate past
chair) are hospital representatives
• Full Coalition---meets bimonthly; meetings chaired by
chairman of coalition; attendance averages around 30
people
• Minutes for meetings within 48 hours or less; agendas
two weeks in advance, full year meeting schedule,
meet at member agencies and take tours

Organizational Requirements
• 2011
– LHD hosts, determines best FTE level for staff working on
HPP projects
– All hospitals must be included
– Hospitals retain voting majority
– Hospital representative as chair of Coalition
– Minimum full Coalition meeting quarterly
– Recommend to establish Executive Committee
• 2012
– Clarity on primary point of contact and liaison with ESF8
– Define roles and responsibilities for each member across
preparedness cycle
– Sustainability planning needed

Regional Medical Surge Director
• Employed fulltime by Bear River Health
Department (BRHD); BRHD administrates the
grant funds
• Acts as convener, facilitator, team
builder/relationship builder, communicator,
consensus builder, planner, problem solver
• Developed and updates regional medical surge
plan with assistance of task force made up of
coalition members
• Regular visits to members; regular communiqués

Coordinator Capabilities/Development
• Healthcare experience preferred over
emergency management
• Communication skills essential, coalition
building is about listening and sharing
• Willingness to get out into Region, into
facilities
• Clear understanding of Medical Surge Capacity
and Capability (MSCC) I & II and other ASPR
documents and research

Coordinator Capabilities/Development
• FEMA ICS Courses
– Required
• 100HCb (ICS), 200HCa (ICS), 700 (NIMS), 800b (NRF)
• 808 (ESF8) and 701a (MACS)
– Preferred
• 300 (Intermediate ICS) and 400 (Advanced ICS)
• 703a (Resource Mgmt) and 704 (Comms and Info Mgmt)
– Wish List
• FEMA Professional Development Series
This should help with 2012 HPP response goals
Multi-agency & EOC coordination during response.

Core Project Deliverables
• 2011 ASPR HPP
– Integrated Regional Medical Surge Plan
– Increase response capabilities in Region
– Address At-Risk (AFNP) populations
– Coordinate activity to minimize duplication
– Maintain continuity with local EMAs
– Develop MOU to share assets and information and test
through tabletop
– Unify ESF8 management
– Clarify MACC role, as contrasted with Command role

Core Project Deliverables
• Utah DOH HPP 2010 Targets (Beginner)
– Charter or formal formation documents*
– MOU/A*
– Regional Response Plan*
– Shared HVA*
– Training and Exercise Plan*
– Joint Coalition funds
– Regular meeting schedule

Core Project Deliverables
• UT DOH HPP 2011 (Intermediate)
– Recruitment and retention of non-hospital partners*
– Correlate training events with required exercises*
– Develop/refine Regional communications network*
– Test MOU/A through tabletop exercise*
– Assess response roles for Coordinator*
– Complete self-assessment and strategic planning session
– Identify and determine method to track sharable assets*
– Engage Medical Reserve Corps in events*
– Choose At-Risk population as focus for year*

Core Project Deliverables
• UT DOH HPP 2011 (Advanced)
– Assess minimum required health services*
– Alignment of facility disaster protocols
– Assess 24/7 access to Coalition team*
– Develop SME area to share with other Coalitions
– Engage in inter-Regional and collar state planning
– Establish plans for use of state assets (Blu-Med,
EMS Strike Teams, portable mass fatality
equipment)

Vital Components of our Coalition
In addition to the previous program elements:
• Mission and shared values; clear purpose
• Logo development project
• Bimonthly newsletter (goes to far more people than just the
coalition members)
• Web page – meetings, calendar, plans, newsletter, etc.
• “Can do” attitude, collaboration between members and with
the State Hospital Preparedness Program team, engaging all
members, follow through

Mission
Purpose
• Mission: To serve our communities through
collaboration, coordinated communication
and resource sharing for effective medical
surge management in a disaster.
• Purpose: Access to networking, relationship
building, training, education, discussion,
regional planning, resource sharing; we aren’t
a response unit.

Charter/MOU
• Developed by task force of coalition members,
including the HPP Manager; approved by
coalition members
• Simple, concise---decided against developing
by-laws
• September, 2011---Tested the MOU and
regional medical surge plan via a table top;
careful follow up on plans of action to improve

Regional Medical Surge Plan
• Medical Surge Director wrote it with input
from task force of members; required
coalition member approval; appendices
updated at least quarterly
• Simple, concise, all hazard focus---basically
eight pages long; NIMS compliant, control is
local, IC and EOC are in charge; appendices are
detailed with names, phone numbers, etc.

Shared Hazards Assessment
• First one completed in 2010
• Will review and revise in 2013
• Used each hospital’s and each county’s HVA
• Written by regional medical surge director in
full collaboration with the 8 member
hospitals; approved by the executive
committee and the full coalition
• Came to an agreement with ease

Training and Exercise Plan
• Member input
• Grant deliverables help determine
• After Action Reports and Improvement Plans
affect it
• Strategic plan
• Updated throughout the year

Communication
• Major focus for coalition---most common
challenge in a disaster
• Exercises have focused on 800 MHz, HAM,
commercial radio, satellite phone
communication---involved hospitals, but also
skilled nursing facilities and clinics
• Developed 800 MHz radio protocol for hospitals
in concert with Department of Health and Utah
Communication Agency Networks (UCAN)
• Every hospital has at least three 800 MHz radios

Joint Coalition Funds
• $40,000 ($5,000 per hospital)
• Water purifiers, filling stations, and generators
for purifiers for all hospitals
• Critical Employee Emergency Planning
conference for all members, all regional
coordinators, ad hoc members---October,
2011
• Focus in future will be on training, exercises

Maintaining Membership
• Important to fully engage hospitals and nonhospital
members
• Strong effort to enlist and maintain active
participation of every hospital, every county
emergency manager, every EMS
representative, every clinic, every skilled
nursing facility
• Subgrantee participants are “encouraged”
through language in their contracts

Strategic Planning/Self-Assessment
• Both are vital components of an engaged
coalition membership
• Done annually
• 2012 coalition self-assessment very positive,
but there is a lot of work to be done---the
passion is there.
• Use self-assessment results to do the annual
strategic plan

Assets Shared Regionally
• Members know where the medical assets are
throughout the region and how to access
them---UDOH assets, but also assets at
member agencies—discussed at meetings,
maps, listed in surge plan appendices
• Blu-Med
• Water purifiers---protocol in place for any
member to borrow if needed
• MRC involvement

At Risk Populations
• Focus this year on MOUs between skilled nursing
facilities and hospitals---one locally, one
somewhere in UT but not close by, and one out of
state.
• Skilled nursing facilities are excellent alternate
care sites! Occupancy of SNFs in UT less than
65%.
• Presentations to professionals caring for seniors
& RSVP groups by regional medical surge director
• Brochure for Pregnant Women in a Disaster
• Pandemic flu brochure

PEOPLE FOCUS---A MUST!
• Know each other by face, by name—KEY
ASSET
• Work together
• Respect each other; trust each other
• Share perspectives and opinions
• Build relationships as members of the
coalition; meet new people in different
disciplines; break down any silos
• Marketing opportunities such as newsletter

The Future
• Refining response role for regional medical
surge coordinator
• Burn surge plan---develop, train, implement
• Meta-leadership training with all members
• NIMS training for all members, not just
hospitals
• Even more focus on EXERCISES, TRAINING
• Mass fatalities, mass casualties, alternate care
sites, recovery---all areas of ongoing focus
WE DEFINITELY CAN, AND WE WILL!!

Core Project Deliverables
• UT DOH HPP 2012 will include
– Increased SME and non-health partner input
– Enhance rapid situational assessment and
communications in support of common operating
picture
– Address recovery and COOP processes
– Clarify EOC role
– Mass Fatality management
– Address Immediate Bed Availability (20%) with LTC
partners and others

Challenges
• Communication gaps, within Regions and by
type of Entity
• Rural/Frontier challenges such as travel
distances and nontraditional groupings
• LHD and Coalition project walking over
existing groups – LEPC, ESF8 Workgroups
• Framing meetings to address all participant
types

THANK YOU FOR YOUR TIME!
Kevin McCulley
Hospital Preparedness Program Manager
Utah Department of Health
kmcculley@utah.gov
801-273-6669
Sara V. Sinclair
Northern Utah Regional Medical Surge Director
Bear River Health Department
ssinclair@brhd.org
435-695-2062