Kenneth Alexander, MS, RRT Vice President of Quality and ...
Kenneth Alexander, MS, RRT Vice President of Quality and ...
Kenneth Alexander, MS, RRT Vice President of Quality and ...
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<strong>Kenneth</strong> <strong>Alex<strong>and</strong>er</strong>, <strong>MS</strong>, <strong>RRT</strong><br />
<strong>Vice</strong> <strong>President</strong> <strong>of</strong> <strong>Quality</strong> <strong>and</strong> Regulatory Activities<br />
Louisiana Hospital Association<br />
As vice president <strong>of</strong> quality <strong>and</strong> regulatory activities, Ken<br />
<strong>Alex<strong>and</strong>er</strong> is responsible for the Louisiana Hospital<br />
Association’s emergency preparedness activities. Ken is<br />
integrally involved in the planning, execution <strong>and</strong> support<br />
<strong>of</strong> Louisiana’s Medical Institution Evacuation Plan,<br />
Sheltering in Place plan, <strong>and</strong> state m<strong>and</strong>ated hospital<br />
reporting plan. During hurricanes Gustav, Ike <strong>and</strong> Isaac,<br />
Ken manned the state Emergency Operations Center.<br />
During hurricanes Katrina <strong>and</strong> Rita, Ken was a hospital<br />
CEO, maintaining routine hospital operations while<br />
sheltering in place <strong>and</strong> serving as a medical special needs<br />
shelter for 35 Katrina evacuees. Most <strong>of</strong> his 35+ year<br />
career has been spent in the hospital industry where he<br />
has served a variety <strong>of</strong> roles ranging from care delivery to<br />
executive management.
Disaster Planning,<br />
Response & Recovery:<br />
Louisiana Lessons Learned<br />
<strong>Kenneth</strong> <strong>Alex<strong>and</strong>er</strong>, <strong>MS</strong>, <strong>RRT</strong><br />
<strong>Vice</strong> <strong>President</strong> <strong>of</strong> <strong>Quality</strong> <strong>and</strong> Regulatory Activities<br />
Louisiana Hospital Association<br />
Ken <strong>Alex<strong>and</strong>er</strong>, <strong>MS</strong>, <strong>RRT</strong><br />
<strong>Vice</strong> <strong>President</strong> <strong>of</strong> <strong>Quality</strong> & Regulatory Activities<br />
Louisiana Hospital Association<br />
kalex<strong>and</strong>er@lhaonline.org<br />
www.lhaonline.org<br />
Medical Institution Evacuation Plan<br />
Sheltering In Place<br />
Power Management
What Are We Talking About?<br />
• Louisiana’s experiences through 5 major hurricanes in 7 years<br />
• Not even counting massive oil spills <strong>and</strong> river flooding, etc!!<br />
• And a little about our last year’s visitor Isaac<br />
• Medical Institution Evacuation Planning<br />
• Pre-Event Planning helps develops Post-Event Recovery<br />
• Sheltering in Place<br />
• Planning <strong>and</strong> Decisions<br />
• Facility Recovery<br />
• Power Management Issues<br />
• Relationships between state & federal agencies <strong>and</strong> LHA<br />
6<br />
Louisiana - 2005-2012<br />
5 Major Hurricanes, Massive Oil Spill,<br />
<strong>and</strong> Record Level Flooding<br />
7<br />
Hurricane Katrina<br />
Hurricane Katrina hits the Gulf Coast on the<br />
morning <strong>of</strong> August 29, 2005
9<br />
New Orleans Superdome Before……<br />
Downtown Before…..<br />
10<br />
New Orleans Superdome After……<br />
University<br />
Hospital<br />
11
12<br />
13<br />
14
15<br />
16<br />
17
18<br />
19<br />
20
21<br />
Fast Forward Three Years….<br />
• Realistic Expectation developed: blend <strong>of</strong> both<br />
Medical Institution Evacuation Plan (MIEP) <strong>and</strong><br />
Shelter in Place (SIP)<br />
• Developed a comprehensive MIEP <strong>and</strong> SIP<br />
protocols<br />
• Patient Tracking Improvements<br />
• Hospital Needs/Requests Process Improvements<br />
• Communications Improvements<br />
• Post-Storm Recovery Improvements<br />
22<br />
And then…<br />
déjà vu all over again…<br />
but different!<br />
23
Background Information<br />
Gustav/Ike<br />
• GOHSEP Activation<br />
• Start Date: Tuesday, August 26, 2008<br />
• End Date: Friday, September 19, 2008<br />
• Declaration <strong>of</strong> Emergency<br />
• State: Wednesday, August 27, 2008 at 1600 hours<br />
• Federal: Wednesday, August 27, 2008<br />
• L<strong>and</strong>fall Dates<br />
• Gustav: Monday, September 1, 2008<br />
• Ike: Saturday, September 13, 2008<br />
24<br />
Why Does Louisiana Evacuate?<br />
• Burning question for partnering states<br />
• Why use ND<strong>MS</strong>?<br />
• Why not just move South to North?<br />
• Capacity Limited in Northern Regions<br />
• Power outages, flooding impacts traditional<br />
sheltering areas<br />
• Current system level MOU’s for transfers<br />
• HCA, Christus, LifePoint, others<br />
25<br />
Abbreviated Timeline<br />
H-hour:<br />
• 120: Lean Forward! Email alerts, notifications distributed, communications check<br />
• 72: Flag goes up! All levels <strong>of</strong> government (local, state, federal) must watch this<br />
storm <strong>and</strong> be ready to mobilize an AMP. Form 1 is used to identify potential<br />
volume <strong>of</strong> patients so that number <strong>of</strong> aircraft can be estimated <strong>and</strong> organized for<br />
potential activation.<br />
• 72 – 54: Continuous updates to Form 1. Refinement <strong>of</strong> data as threat becomes<br />
more imminent. Based on the direction <strong>and</strong> threat <strong>of</strong> the storm, AMP(s) are<br />
activated.<br />
• 54: “No-kidding” numbers are ascertained.<br />
• 48: Wheels-up! The first load <strong>of</strong> patients should be en route to FCC.<br />
• 18: Clearing the Battlefield. A meter-check is determined to see how many<br />
patients still require evacuation. This is the last chance to make any corrective<br />
actions. SMART listing identified.<br />
• 12: AMPs CLOSED<br />
26
GUSTAV Medical Institution Evacuation: August 31, 2008<br />
• State/hospitals waited for almost two days before C-130s <strong>and</strong><br />
AE crews showed up at Region 5 AMP <strong>and</strong> Region 1 AMP.<br />
Region 5 AMP<br />
Chennault Airport<br />
124 ND<strong>MS</strong> patients Regions 4<br />
Acadiana Airport<br />
34 Homebound patients<br />
Regions 3<br />
Moved by ground/air<br />
ambulances the ND<strong>MS</strong><br />
patients <strong>and</strong> homebound<br />
patients to Region 1<br />
Regions 1 AMP<br />
Lakefront Airport<br />
302 ND<strong>MS</strong> patients<br />
81 Homebound pts.<br />
27<br />
Gustav/Ike: Transportation<br />
• Total Credentialed Ambulances <strong>and</strong> Para-transits<br />
• 464 Federal air, ground <strong>and</strong> para-transit seats<br />
• 88 Louisiana State<br />
• 94 EMAC ambulances from other States<br />
• These assets were used for evacuation, surge,<br />
transport, sheltering, medical support, search <strong>and</strong><br />
rescue as well as repatriation post-hurricane.<br />
28<br />
Evacuation <strong>and</strong> Sheltering<br />
• M<strong>and</strong>atory Evacuations Orders<br />
• Gustav: 17 parishes<br />
• Ike: 3 parishes<br />
• Number <strong>of</strong> People Sheltered<br />
(numbers are approximate <strong>and</strong> sourced from GOHSEP rolling sitreps)<br />
Gustav Ike<br />
Gen Pop 25,000 2,841<br />
CTNS 37,375 1,620<br />
<strong>MS</strong>NS/F<strong>MS</strong> 7,637 329<br />
29
Hurricane Gustav<br />
• 1.8 million people evacuated the coast<br />
• Over 400 spreadsheets generated for MIEP<br />
• Over 1000 patients evacuated from hospitals<br />
• Over 70 hospitals partially or fully evacuated<br />
• Pre <strong>and</strong> post storm<br />
• No electricity statewide – 98% <strong>of</strong> metered power<br />
• Labeled a “Power Event”– HVAC was issue<br />
• State leadership had insatiable desire for data<br />
30<br />
Hospital to Hospital Private<br />
Evacuation is Easiest to Manage<br />
31<br />
Patient Evacuation System Via ND<strong>MS</strong><br />
LOCAL<br />
HOSP<br />
State EOC/JPMT<br />
M<br />
S<br />
N<br />
Regional Coordinator/<br />
AE Liaison<br />
P<br />
M<br />
R<br />
<strong>MS</strong>N<br />
PMR<br />
Mission<br />
Built<br />
GPMRC<br />
P<br />
M<br />
R<br />
AMC<br />
(TACC)<br />
M<br />
S<br />
N<br />
Crews<br />
Alerted<br />
Mission Specifics<br />
(<strong>MS</strong>N #, Times, Etc.)<br />
APOE/AMP<br />
Ambulance<br />
Control/Staging<br />
TRANSCOM<br />
CRE<br />
Airfield<br />
Incident<br />
Comm<strong>and</strong>er/<br />
AE CDR Element<br />
AELT<br />
MASF<br />
CCATT<br />
ND<strong>MS</strong> HOSPITALS<br />
APOD/FCC<br />
32
The Realities <strong>of</strong> Air Evacuation!<br />
33<br />
Repatriation <strong>of</strong> ND<strong>MS</strong> <strong>and</strong> <strong>MS</strong>NS patients<br />
State<br />
Number <strong>of</strong> Patients<br />
Total Number<br />
Received<br />
Total Patients<br />
Deceased<br />
Total Patients Left to<br />
be Received<br />
Total Patients in CareFlite<br />
Que<br />
Alabama 9 9 0 0 0<br />
Arkansas 325 304 21 0 0<br />
Kentucky 3 3 0 0 0<br />
Mississippi 98 98 0 0 0<br />
North Carolina 1 1 0 0 0<br />
Oklahoma 30 29 1 0 0<br />
Tennessee 8 8 0 0 0<br />
Texas 86 84 2 0 0<br />
Total 560 536 24 0 0<br />
Source: DHH Repatriation Cell, October 2, 2008 (Kathy Kliebert)<br />
34<br />
Shelter in Place<br />
Issues <strong>and</strong> Planning<br />
35
Shelter in Place Concerns:<br />
Pre-Storm Planning HUGE factor in<br />
Post-Storm Recovery Success<br />
• Facility Hardening<br />
• Staffing to support continued operations<br />
• Generators to support HVAC systems<br />
• Fuel for generators<br />
• Oxygen for Hospitals <strong>and</strong> Shelter<br />
• Homebound without power for concentrators<br />
• 7 Days Supplies<br />
• Security<br />
• Communication with Regulators<br />
36<br />
Shelter in Place Staffing<br />
Immediate Post Storm Recovery Issues<br />
• Sufficient staff?<br />
• Did Staff evacuate?<br />
• Areas <strong>of</strong> possible short-falls?<br />
[Categories: physicians, nurses, respiratory<br />
therapists, lab, X-ray technicians, pharmacists,<br />
facilities support, perimeter security, interior<br />
security, etc.]<br />
• Sheltering for staff? Families? Pets?<br />
• Civil/Criminal Immunity Provisions?<br />
• In Louisiana, referred to as the “Anna Pou”<br />
factor.<br />
37<br />
Shelter in Place Supplies – 7 Days<br />
• Food for patients <strong>and</strong> staff<br />
• Potable water for patients <strong>and</strong> staff<br />
• Oxygen-Bulk <strong>and</strong> tank<br />
• Extra tanks (“E” & “H”) w/ regulators as back up if<br />
bulk system fails<br />
• Linen for patients <strong>and</strong> staff<br />
• General Medical Supplies<br />
• Pharmaceuticals<br />
• Blood<br />
• Sanitation Supplies & Equipment<br />
• Decontamination Facilities & Equipment<br />
• Fuel for Generator<br />
38
MIEP/Shelter in Place Planning<br />
• Facility checklist reviewed annually at a minimum<br />
• Know resource requirements<br />
• Have a post event evacuation plan<br />
• Recommend 7 days <strong>of</strong> supplies – maybe longer<br />
• Rumors abound – verify, verify <strong>and</strong> confirm<br />
• Communications Required – 800MHz Radios or??<br />
• Added Security<br />
• ELECTRICITY IS KING – Maintain Generator!!!!<br />
39<br />
Shelter in Place<br />
Power Related Issues<br />
40<br />
41
42<br />
Gustav/Ike: Hospital Power Outages<br />
Post Event Greatly Impacted Recovery<br />
Region Gustav Ike Total<br />
Region 1 1 0 1<br />
Region 2 12 0 12<br />
Region 3 5 2 7<br />
Region 4 9 3 12<br />
Region 5 0 1 1<br />
Region 6 2 1 3<br />
Region 7 0 4 4<br />
Region 8 0 1 1<br />
Region 9 1 0 1<br />
TOTAL 30 12 42<br />
43<br />
What Does Your Generator Power?<br />
• HVAC<br />
• Chillers<br />
• Life support equipment<br />
• Surgery <strong>and</strong> sterile surgical equipment<br />
• Patient isolation rooms<br />
• Pharmacy <strong>and</strong> materials refrigeration<br />
• MRI <strong>and</strong> CT scans<br />
• Food service equipment<br />
• Water pumps<br />
• Elevators<br />
• Automated security lock-down<br />
• What is the one thing every generator needs?<br />
44
FUEL………….<br />
45<br />
<strong>MS</strong>TAT – At a Glance Status Review<br />
46<br />
Monitor Fuel Plus Other Critical<br />
“Utilities”<br />
The facility can define the utility account<br />
information for each utility (provider name <strong>and</strong><br />
account number)<br />
Assists utility providers to prioritize service<br />
restoration<br />
47
Region or State at a Glance<br />
48<br />
Relationships – Yes, Virginia, We Can<br />
Hold H<strong>and</strong>s <strong>and</strong> Sing Kumbaya!<br />
49<br />
Building Trust – Mars vs Venus<br />
• EVERYONE truly wants to help the patients – Work in progress<br />
underst<strong>and</strong>ing that hospitals are from Mars <strong>and</strong> the “Feds” are<br />
from Venus – <strong>and</strong> appreciating the differences<br />
• Hospitals trust the LHA – They don’t necessarily trust the<br />
government<br />
• The LHA underst<strong>and</strong>s the need for <strong>and</strong> value added by the<br />
various state <strong>and</strong> federal partners <strong>and</strong> vice versa<br />
• Hurricane Katrina forced ALL the players to work together during<br />
the acute stages <strong>of</strong> the crisis<br />
• LHA having a seat at the EOC helps accomplish mutual need<br />
• A guarded relationship emerged <strong>and</strong> has been fostered <strong>and</strong> grown<br />
50
Wrapping Up<br />
51<br />
Issues Requiring Advanced<br />
Thought/Planning<br />
“Coulda, Shoulda, Woulda”<br />
• FEMA Rules/Regulations – experience with reimbursement <strong>and</strong><br />
funding<br />
• Federal Language – experiences with communication <strong>of</strong> data –<br />
terminology, acronym soup!!!<br />
• Patient Tracking<br />
• Comprehensive patient database (At Risk Registry)<br />
• Tracking for evacuated patients – Who went where?!<br />
• Transportation<br />
• EMAC – statewide contract for ambulances<br />
• Private contracts<br />
• Politics<br />
• Local vs. Parish (county) vs. State vs. Federal<br />
• Message needs to be consistent<br />
52<br />
Issues Requiring Advanced<br />
Thought/Planning<br />
“Coulda, Shoulda, Woulda”<br />
• Consistent tracking <strong>and</strong> reporting <strong>of</strong> hospital requests<br />
(fuel, food, water) – La. Developed E<strong>MS</strong>TAT (now <strong>MS</strong>TAT)<br />
• Blessing <strong>and</strong> a Curse!<br />
• Power needs<br />
• Location <strong>of</strong> generator, damage resistance, transfer switch<br />
configuration <strong>and</strong> location<br />
• Is there a database <strong>of</strong> generator info at the State or CHA?<br />
• Oxygen, Fuel, Potable Water<br />
• Organization <strong>of</strong> volunteer vs. paid medical personnel<br />
• Civil <strong>and</strong> Criminal Immunity Issues (i.e., Anna Pou)<br />
53
Bottom Line – “Clif Notes”<br />
• Managing your Pre-Event plan effectively addresses many<br />
Post-Event Recovery Issues<br />
• Federal Partners – well-intentioned with some good people, but<br />
a bureaucracy is a bureaucracy….wheels can turn s.l.o.w.l.y.<br />
• C<strong>MS</strong> <strong>and</strong> State Regulators – waivers, re-occupy, etc.<br />
• Reimbursement – ‘Nuff Said………………..<br />
• Timelines can be deceptive – we planned for longer H-hour<br />
trigger points, <strong>and</strong> dealt with numerous delays<br />
• Staffing, Staffing, Staffing<br />
• Medical Malpractice protection for hospital personnel<br />
• Power, Fuel, Water, Oxygen, Food, Supplies<br />
• Work at working together – everyone wins<br />
54<br />
LHA Online Resources<br />
www.lhaonline.org<br />
55<br />
56
Thank You!<br />
<strong>Kenneth</strong> E. <strong>Alex<strong>and</strong>er</strong><br />
<strong>Vice</strong> <strong>President</strong> <strong>of</strong> <strong>Quality</strong> & Regulatory Activities<br />
E-mail: kalex<strong>and</strong>er@lhaonline.org<br />
Louisiana Hospital Association<br />
9521 Brookline Avenue ● Baton Rouge, LA 70809<br />
Phone: (225) 928-0026 Fax: (225) 923-1004<br />
57
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