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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

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