September 10, 2019 Workgroup Meeting- Spec Path, PHEP, Spec Pop

9-10-19 Special Pathogens, PHEP, Special Populations Workgroup Meeting


Reminder that the Closed POD workshop is September 26.  Formal registration is closed but Jennifer can still add a few attendees, email her for last minute registrations.

The plan for the next meeting includes an infectious disease go team presentation, human personnel assets (WEAVR, MRC, DMAT) presentation, Training and Exercise Planning Workshop, workgroups.  It wiill consume most of work day but we will provide lunch, partners are welcome to come and go.  Looking at November 20, somewhere in the Madison area.

We talked about hosting a communications workshop covering the topics of social media, media relations, Joint Information Systems operations, organizational internal communications (with staff/patients), message mapping.  Partners agreed this is a good topic.

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.  Suggested to add a 96-hour sustainability plan component.  This is distinct from the business continuity planning workshop offered in April, as we will be more formally exploring how an emergency disrupts healthcare delivery, how we assess essential services and how to prioritize restoring them, and how SCWIHERC can assist this effort.  Targeted audience includes all coalition disciplines.

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), and message mapping.  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.

Reminder that the Coalition Surge Test will also be an exercise this year.

SCWIHERC scholarship opportunity announcement coming soon.  Public health partners are asked to utilize PHEP funding instead, they will have funding comparable to last year for scholarships.

The goal for all workgroups is to define goals and objectives, nominate a leader, share lessons learned, and make progress on grant requirements relevant to the workgroup.

Special Pathogens Discussion

Grant guidance on this topic:

Educate stakeholders on current policies and practices regarding the type of PPE necessary for various infectious pathogens, and the availability of PPE resources, to include stockpiling considerations, vendor-managed inventories, and the potential for reuse of equipment.

During an infectious disease outbreak, ASPR and CDC require that recipients and HCCs coordinate the following activities to ensure the ability to surge to meet the demands during a highly infectious disease response: Establish a Medical Common Operating Picture, Develop or update plans accordingly, Establish key indicators and EEIs, Provide real-time information sharing, Coordinate public messaging.

Support and promote regional PPE procurement, Equip, train, and provide resources necessary to protect responders, employees, and their families from hazards during response and recovery operations. PPE, MCMs, workplace violence training, psychological first aid training, others.

We discussed the special capabilities of certain organizations in our region related to handling patients with high consequence infectious diseases (HCID).  Nomenclature note:  while these capabilities were built using support and guidance prescribed by the Ebola grant administered through ASPR/HPP, we have updated the preparedness and response activities to encompass all high consequence infectious diseases.

UW Hospital is a category 1 Ebola Treatment Facility.  Their activities and capabilities include the ability to treat up to 2 confirmed HCID/Ebola patients at a time.  They support this through their HCID team which includes representatives from infection control, infectious disease, emergency medicine, and others.  They do quarterly training and a required annual HCID drill with performance measures reported to the feds.

St. Mary’s Madison is a category 2 Assessment Facility. Under ideal circumstances, if public health is alerted to a potential HCID patient, they are directed to St. Mary’s rather than presenting at their preferred hospital or clinic.  Their activities and capabilities include being able to admit and treat a suspected HCID/Ebola patient for up to 72 hours, the window it could take to receive confirmed positive laboratory results for a patient.  If the patient is confirmed positive, they are transferred to a treatment facility, which could include UW Hospital or the regional treatment center, which is the University of Minnesota Medical Center West Bank.  St. Mary’s does quarterly training and a required annual HCID drill with performance measures reported to the feds.

The University of Minnesota Medical Center West Bank is the region’s treatment center (referring to HHS/FEMA regions, not HERC regions) and has greater capacity for HCID patients than UW Hospital.

It is protocol for a confirmed positive patient to be transferred to UMMC West Bank.  Situations that would alter this protocol include if the patient was not stable enough for transfer, terminally ill, or if UMMC West Bank’s HCID unit was full.

Transportation of a confirmed positive HCID patient must be done by agencies that are specially trained and have HCID plans and procedures.  Madison Fire has the capability to transfer within Dane County, and Baraboo EMS has the capability to transfer anywhere within Wisconsin and from anywhere in Wisconsin to UMMC West Bank.

Baraboo EMS has a cache of PPE, two ISO PODS, and procedures for transporting a HCID patient.  There is one medic donning a full PAPR who accompanies the patient (contained in an ISO POD), a driving medic that wears certain PPE, and the ambulance is followed by a chase vehicle with additional supplies that can offer support as needed.  Several medics are trained in these plans and there is a very specific procedure for disinfecting the rig after transport is complete.

We were able to share lessons learned from a recent event wherein a patient with a fever of unknown origin with a positive travel history was transported by ambulance to a local facility and held until HCID was ruled out.  Emphasis was placed on adhering to existing plans for these events, including prescribed communications channels.

The conversation evolved into discussion of how frontline healthcare facilities can be better prepared, and the wide assortment of PPE that is available.  It was suggested that this workgroup follow up in the future with a PPE show and tell, wherein regional partners can view the different types of PPE available and perhaps move toward a goal of having the same PPE throughout the region, potentially giving us power as a region to negotiate pricing.

Many other resources were mentioned in the special pathogens discussion, listed here:

National Ebola Training and Education Center courses

EMS Infectious Disease Handbook

WI DHS MN DPH Joint Ebola Transport Exercise Video

CDC PPE Training videos

High Consequence Infectious Disease Toolbox

WI DHS Disease Fact Sheets

UW Health Special Pathogens Team Blog

Public Health Emergency Preparedness (PHEP)

We discussed the upcoming Closed POD workshop and how SCWIHERC and the contractor are lending support, but this event will be driven by local public health partners.  The event will start with a presentation on closed POD planning and logistics from Dan Michaels at Public Health Madison and Dane County, and then we will have a panel representing hospitals (Meriter), Universities (UW Madison), and private businesses (West Bend Mutual) as well as WI DHS medical countermeasures.  They have a list of talking points to address including the process for creating their own closed POD plan.  There will be time for Q&A from the audience.  We will then break for lunch and return for a tabletop exercise on an anthrax scenario in the afternoon.  Prior to the workshop, Jennifer will share the registration list, the closed POD template, and the TTX Situation Manual with public health partners for their awareness.  Printed closed POD templates will be available at the workshop for reference, but local public health representatives should be the gatekeepers of the electronic template, so planning is not occurring without local public health awareness.  The situation manual will be available to all partners after the exercise on the SCWIHERC shared drive, so they can use the exercise internally as they see fit.

We explored other opportunities for the PHEP workgroup to work collaboratively.  It was mentioned that local public health is waiting on the state to update the PHEP plan, and the state will look into this.  There was an idea to bring local public health partners together to share information and resources for completing the portions of the PHEP plan that require local customization.  We will bring this idea to Southern WALHDAB for feedback.

Special Populations Discussion

This topic was unfortunately cut short due to the great conversations taking place on the previous topics.

Grant guidance on this topic:

Support HCC members with situational awareness and information technology (IT) tools already in use that can help identify children, seniors, pregnant women, people with disabilities, and others with unique needs.  Support HCC member agencies in developing or augmenting existing response plans for these populations, including mechanisms for family reunification.  Identify potential health care delivery system support for these populations (pre- and post-event) that can prevent stress on hospitals during a medical surge event.  Assess needs and contribute to medical planning that may enable individuals to remain in their residences during certain emergencies. When that is not possible, coordinate with the jurisdiction’s ESF-8 lead agency to support the jurisdiction’s ESF-6 (Mass Care, Emergency Assistance, Housing, and Human Services) lead agency with access to medical care including at shelter sites.  Coordinate with the jurisdiction’s ESF-8 lead agency to assess medical transport needs for these populations.

Jennifer also offered a definition for those with access and functional needs according to FEMA: Children and adults with physical, mobility, sensory, intellectual, developmental, cognitive, or mental health disabilities.  Older adults. People with temporary or chronic health conditions (including taking daily medication).  Women in late stages of pregnancy.  People needing bariatric equipment.  People with limited English proficiency, low literacy, or additional communications needs.  People with very low incomes.  People without access to transportation.  People experiencing homelessness.

In planning for these populations, we talked about the need to engage more partners including home health agencies, aging and disability resource centers, family care organizations, primary care clinics, durable medical equipment companies, and 211.  In the absence of comprehensive planning and up to date information, 211 can be used for just in time resource sharing to identify these populations after an event to connect them with the resources needed.  Additionally, durable medical equipment companies have accurate and comprehensive lists of electricity dependent individuals, including those who have only private insurance, that can be used during emergencies.

Meeting Attendance:

Jeff Kindrai- Grant Co Health Dept

Gail Scott- Jefferson Co Health Dept

Donna Haugom- Jefferson Co EM

Alison Chouinard- Rock Co Health Dept


Sam LaMuro- Fort Healthcare

Brenda Klahn- St. Mary’s Janesville

Steve Haskell- UW Health

Sharon Rateike- St. Mary’s Janesville

Jony Marty- Green County Health Dept

Dave Larson- Madison VA

Anna Robb- Stoughton Hospital

Lynda Brereton- St. Mary’s Madison

Carol Quest- Watertown Health Dept

Kathy Noe- Mile Bluff Medical Ctr

John Rago- Baraboo EMS

Brad Armstrong- Meriter UPH

Nathan Bubenzer- Meriter UPH

Dan Michaels- PHMDC

Ben Eithun- UW Health AFCH

Tom Ellison- UW Health

Christal Foreyt- Gundersen Boscobel

Mike Stephens- UW Health

Juan Cullum- Mercyhealth Janesville

Mike Lohmeier- SCWIHERC/UW Health

Mary Crowley- Juneau Co Health Dept

Dave Kitkowski- St. Clare Baraboo

Alison Hanaman- Edgerton Hospital

Suzanne Schreiner- Adams Co Health Dept

Lisa Herritz- Ho Chunk Nation

John Longo- WI DHS OPEHC

Jennifer Behnke- SCWIHERC