August 27, 2019 Workgroup Meeting- Hospital, Surge, Evac, CMS

8-27-19 Hospital, Surge, Evacuation, CMS Partners Workgroup Meeting

Jennifer gave some reminders for upcoming events: SCWIHERC Closed POD Workshop September 26; Special Pathogens, Public Health Emergency Preparedness, and Special Populations Planning workgroup September 10.

We talked about the opportunity for a healthcare recovery/continuity of operations tabletop exercise, which is strongly suggested in the grant language: Supporting member organizations in defining what their “essential functions” that must be maintained after disruption of normal activities and determining priority for restoration if compromised and determining what the coalition might do to assess and support the maintenance of these functions. Admin/Finance operations, Supply Chain, Shelter in place, staff support and resilience including mental health support.  We talked about how there is some overlap with the business continuity planning workshop we offered in April.  We will pursue planning something like this and are looking for volunteers to participate on the exercise design team.

We also talked about the opportunity for a communications workshop and what our current gaps are that should be addressed by this.  We came up with social media, media relations, Joint Information Systems operations, organizational internal communications (with staff/patients).  There is a vendor used by another region that conducts customized workshops on these topics and this could be an opportunity, especially if we can invite members of the media for a meet and greet to build relationships before incidents happen.  A suggestion was made to include other media outlets (TV/radio/newspaper) outside the Madison market in addition to the Madison market.  We also talked about the Basic PIO course (G290) offered by Wisconsin Emergency Management.  If there is enough demand for this course that exceeds local emergency management agencies’ ability to fund this course, SCWIHERC could potentially fund a course, but partners are encouraged to take advantage of the offerings on the WEM Training Portal.

We had a discussion of the history of Medical Reserve Corps groups in our region, because there are none currently active.  It was suggested to have presenters come to talk about different opportunities and groups, including WEAVR, Medical Reserve Corps, and Disaster Medical Assistance Teams.  This is a potential future presentation topic.

Jennifer is working on a patient tracking project with the Office of Preparedness and Emergency Healthcare along with Robert Goodland, region 1 RTAC coordinator.  After an extensive review of previous pilots and current patient tracking procedures in Wisconsin, as well as best practices found in other states, there will be a patient tracking workgroup forming.  We are seeking one hospital and one EMS representative from each HERC region in the state to participate in this workgroup.  Jennifer will share more information about the degree of commitment involved soon.  Any interested parties should reach out to Jennifer.

We had a discussion about the idea of a hospital HazMat/Decon mutual aid team.  Many hospitals, especially on nights and weekends, have lean staffing that would not be able to support a complex decon operation.  Additionally, clinical staff would be needed for patient care and therefore would also be unavailable.  There was a mention of an initiative in another HERC region- the infectious disease mobile go team.  There team has members of multiple hospitals and can deploy to the hospital or into the community to care for a patient with a high consequence infectious disease.  We would like to hear more about this concept and then further discuss the possibility of a similar team trained in both HCID patient care and HazMat decon.

We discussed the SCWIHERC MCI Surge Functional Exercise held on June 19 and the AAR-IP draft that is out for review.  A few improvement items were suggested:

-All situational awareness updates from an incident be communicated by WI Trac update AND by WISCOM radio update.

-Hospital staff need training in triage to manage large numbers of patients that self-present after an incident.  SCWIHERC is currently developing training materials for the SALT Triage Ribbon Initiative, and we will invite local hospitals to participate in this training as well in an effort to unify EMS and hospitals in using the same triage practices.

-Hospitals need to think about perimeter control and patient access points during a mass casualty incident with large numbers of patients.  All EMS transports should come one place, all untriaged patients should come to another access point where they can be separated (incident casualties versus normal unrelated ED traffic), and then casualties can further be triaged and sorted.  Without a plan that addresses these issues, hospitals can very quickly deplete their staffing and resources on “green patients” (walking wounded) before they start receiving the most critically injured patients.

-Prior to a mass shooting in another area, that area cross-credentialed its clinical staff to enable them to work in other facilities.  Jennifer will look into this more as a future discussion/presentation topic.

We discussed the needs of our CMS partners and how better to engage them.  It was noted that they are critical in the continuum of healthcare service delivery, including helping patients to cope with emergencies and disasters so that they don’t decondition and require acute care, thereby surging local hospitals.  Additionally, they can provide assistance in caring for individuals who are expeditiously discharged from hospitals (like during an emergency evacuation).  There are 9 types of “CMS partners” found in Wisconsin (these are agencies affected by the CMS Emergency Preparedness Rule that was enforced starting November 15, 2017): home health agencies, skilled nursing facilities, ambulatory surgery centers, hospices, physical/occupational/speech therapy providers, end stage renal disease (dialysis) providers, federally qualified health centers, intermediate care facilities for individuals with intellectual disabilities, and critical access hospitals.  It was noted that these agencies are often looking for assistance to meet their annual community-based full-scale exercise requirement.  Jennifer noted that a workshop was held in Dane County last year to address this requirement, and we could potentially duplicate this effort for partners throughout the rest of the region.

Finally, we talked about planning logistics of the next workgroup meetings.  Meeting quarterly seems to be a good schedule, and keeping these workgroup topics together makes sense at this time.  We discussed continuing to hold meetings in a central location (Dane County) versus moving the meetings to alternating parts of the region.  Those in attendance at this meeting, including partners traveling from outside Dane County, agreed that holding meetings consistently in a central location was preferred over rotating meeting locations throughout the region.

Meeting Attendees:

Sam LaMuro- Fort Healthcare


Christal Foreyt- Gundersen Boscobel

Tina Strandlie- Stoughton Hospital

Juan Cullum- Mercy Janesville

Bob Swenarski- St. Mary’s Janesville

Cheryl Meyer- Marquardt Home Health

Jodi Moyer- Beloit Health System

Steve Haskell- UW Health

Mike Stephens- UW Health

Nathan Bubenzer- Meriter

Dave Larson- Madison VA

Dan Michaels- Public Health Madison Dane County

Ben Eithun- American Family Children’s Hospital, SCWIHERC Chair

Tom Ellison- UW Health

Alice Salli- Mendota Mental Health Institute, Central Wisconsin Center

Jeff Ethington- UW Organ Procurement Organization

Jennifer Behnke- SCWIHERC Coordinator

Sharon Rateike- St. Mary’s Janesville

Dave Kitkowski- St. Clare Baraboo

Dan Williams- South Central Regional Trauma Advisory Council

Kyle Schaeffer- UW Health

Bill Ritzer- Reedsburg Area Medical Center

Samantha Marcelain- Gundersen Moundview

Mary Crowley- Juneau County Health Department