Emergency Preparedness Coordinating Council

1. Emergency Preparedness Coordinating Council February 13, 2018

2. Presentations • Got Gas? Planning For, and Challenges to a Planned Oxygen Shutdown, Jake Neufeld, Enterprise Resiliency Manager, Environmental Health and Safety, Emergency Management, Memorial Sloan Kettering Cancer Center • Montefiore’s Use of Technology for System-wide Situational Awareness, Jared Shapiro, Director, Environmental Health and Safety, Montefiore Health System • Takeaways from A Fact-finding Trip to Las Vegas to Learn about Their Response to the October 1st  2017 Mass Shooting

3. Fact-Finding Delegation Visit to Las Vegas • Purpose: Learn about Las Vegas’ response to the October 1st mass shooting • Organized in collaboration with the Nevada Hospital Association • Who participated: • Nine NYS health systems • Government response agencies including: FDNY, NYPD, OCME, DOHMH, NYCEM, NTSB, Department of State Diplomatic Services • Three Las Vegas hospitals, Las Vegas police and fire agencies, community ambulance companies, Public Health District, Nevada Hospital Association

4. Las Vegas Context • 18 hospitals in Southern Nevada – 1 Level One, 2 Level Twos and 1 Level 3 Trauma Center • Southern Nevada Health District supports healthcare coalition, oversees HPP funding • With Nevada Hospital Association and hospital emergency managers staffs the Medical Surge Area Command (part of ESF-8 – collects information, coordinates resources) • Accustomed to large planned events; weekend population routinely increases by 400K visitors • Route 91 not considered a large event; security and medical tents; contracted ambulances at event + municipal ambulances pre-staged • Many concert goers were from out of town • Many military and first responders in audience

5. October 1st Mass Shooting • Shooting began at approximately 10:05pm and lasted 15 minutes • Shooter fired more than 1,100 rounds into festival grounds approx. 490 yards away • Concert goers largely self evacuated • Many had no ID or lost ID while fleeing • Bystander actions saved lives – pulled injured to safety, applied tourniquets (military/first responder training) • Used technology to locate closest hospital; therefore not evenly dispersed • 80% of injured arrived in private vehicles (i.e. Uber, Lyft, private vehicle); many vehicles transported multiple victims at once to hospital • Began arriving at two closest hospitals while shooting still going on • Due to height of shooter, wounds distinct than previous mass shooting events – more head and chest wounds

6. Three Closest Hospitals

7. Hospitals Our Delegation Visited

8. Lessons for the Hospital Community • Arriving patients may be your notification • To victims, a hospital is a hospital • Triage (and re-triage) is EVERYTHING • At curbside, victims split into broad categories based on visual inspection (Alternate ED space, ED, trauma) • Trauma triage was organized by injury, prioritized by talking vs. not talking – focus on airway and hemorrhage control until specialists could take over • Must be prepared to quickly PULL most critical into the hospital to save lives and be ready to receive more victims • Sunrise – quickly created space within critical care units for critical patients; continuously re-triaged and prioritized for OR • Only conducted life-saving procedures in order to turn ORs

9. Lessons for the Hospital Community (con’t) • Creatively use the space you have • At Sunrise – endoscopy suite became temporary morgue, cafeteria became alternate ED, PACU became holding area for victims needing orthopedic intervention • The uninjured will seek shelter in the early hours of the incident • Clinical staff will spontaneously show up to help, including staff from other facilities • Patient tracking and family reunification is incredibly hard and high consequence • Requires institutional and regional planning

10. More about Sunrise Hospital Experience • Patient registration/charting was very challenging • Did not have protocol for disaster registration; used paper and delayed registration; took several hours before staff caught up • In initial hours, relied on resupply of items (i.e. chest tubes) from neighboring hospitals • Getting medications from Pyxis system was challenging; required pharmacist or other individual to distribute medications • Implemented forward flow and pulled patients out of ED to create space for incoming patients • 3 ICU areas with 40 patients made space for additional 70 by doubling/tripling up patients • Head/spine trauma went to Neurosurgical ICU • Chest trauma went to Cardiothoracic ICU • Abdominal trauma prioritized for OR/focus on damage control • Orthopedic trauma went to PACU where staged for later surgeries

11. Regional Follow Up Items • Patient tracking/family reunification • Planned NYCEM-GNYHA workgroup to begin meeting in late Spring • Areas of focus: disaster registration; standard Unidentified Patient naming convention; understanding and integrating hospital and citywide plans and capabilities • Engage TLC and car sharing services • Engage technology companies toward optimizing patient dispersion • Tactical medicine training for regional providers • Working on delegation proceedings document with NHA

12. Discussions & Updates

13. Coastal Storm Preparedness: Health and Medical Executive Advisory Group Priority for 2018 Workgroup 1: Improve Health Facility Data & Compliance (Leads: DOHMH & SDOH) • Pursue 100% facility compliance with accurate and timely completion of the NYSDOH Facility Profile application by 3/30/2018 through more intensive and coordinated partner outreach and streamlined facility guidance • NYSDOH completed 3 webinar trainings for HCFs on Facility Profile Application Compliance for 2018. Training was recorded and is posted on the NYSDOH Learning Management System. • Additional opportunities to present and offer training are being identified with our NYC partners, including associations.

14. Coastal Storm Preparedness: Health and Medical Executive Advisory Group Priority for 2018 Workgroup 2 (Lead: NYCEM) • Increase nursing home facility receiving capacity through targeted technical assistance to large out-of-zone providers. • Holding regular meetings • Aiming to identify and mitigate facility specific barriers such as space, supplies, staff, and financial reimbursement • By July 2nd 2018 complete surge plans for 10 facilities

15. Coastal Storm Preparedness: Health and Medical Executive Advisory Group Priority for 2018 Workgroup 3 (Lead: GNYHA) • Increase hospital receiving capacity to accept patients from evacuating hospitals as well as community members that cannot be accommodated at Special Medical Needs Shelters (SMNS). • Held first meeting on 2/7; spent much of our time reviewing shelter operations and homebound evacuation plans; need to better educate hospitals on how these operations will work • Workgroup focused on filling existing gap for community members who are too sick for SMNSs, but do not require hospital-level care • Discussion related to a few hospitals developing plans to accept large numbers vs. all hospitals being prepared to accept a few

16. Texas Hospital Association: Hurricane Harvey Analysis Major findings and opportunities for Texas hospitals to lead improvement initiatives: • Availability and medical readiness of shelter facilities • Inappropriate reliance on hospitals as shelters and evacuation sites • Availability of adequate security • Timely delivery of needed supplies • Access to dialysis services • Communication • Effective use of volunteers • Support services for hospital employees, including behavioral health and emotional support • Coordination of transfers and fatality management

17. Mass Casualty Response Planning • Draft of MCI Year 1 data summary for NYC 911-receveing hospitals • MCI Response Planning Toolkit for Hospitals under development • Began FDNY Dispatch Center Tours in December; prioritizing trauma centers and then will offer opportunity to all NYC 911-receiving hospitals • Upcoming Medical Preparedness and Response to Bombing Incidents Course; 2-day course will be offered 2x in March • Researching tactical medicine courses

18. CMS Final Rule on Emergency Preparedness Now in Effect • Compliance date of November 15th • NYS surveyors are integrating emergency preparedness regulations into full surveys following a complaint, and during validation surveys • Surveyors focusing on the presence of various protocols and processes as defined by CMS, but not the quality thereof • Commitment to ongoing dialogue as the survey process begins • Any issues thus far? • Number of resourced developed by GNYHA and others are available here: http://www.gnyha.org/whatwedo/emergency-preparedness/preparedness-communication/cms-final-rule

19. Sit Stat 2.0 Implementation • GOAL: Build on current Sit Stat platform + increased collaboration within health and medical community to create foundation for a shared situational awareness platform • APPROACH: Provide the Intermedix for Health software bundle (EMResource & eICS) to all NYS members to support daily operations and manage and document emergency incidents. • Emergency Preparedness Bulletin sent to wide range of roles December 21, 2017 • Memo sent to CEOs in January

20. Activities to Date & Upcoming • Kickoff meeting held January 9th • First Advisory Council meeting held January 23rd • Final Participation Agreement shared • Have produced number of request documents • IT Security call this Wednesday, Feb. 14th • Next Advisory Council meeting, February 27th • Will have demo dashboards and views for council member feedback • Implementation call being scheduled

21. Additional Resources Requested by Members • Document outlining IT and security considerations • Executive Briefing document that distills the benefits of the Sit Stat 2.0 system • Document that outlines notification capabilities within the EMResource and eICS modules vs. Intermedix’s mass notification module Alert • Document explaining discounted pricing for complementary Intermedix products Also working on interface/integration document

22. Upcoming Events • Preparing for Active Shooter Events in Health Care Settings, March 15th, 2-4pm; targeting healthcare clinical and security leadership • Discuss how different hospital systems within the region are approaching development of active shooter protocols and training of staff assigned to patient care areas, and collectively advance planning around this issue • Hospital Briefing and Information Exchange with Con Ed • March 28th, 9am-12pm; targeting facilities and engineering leadership • Cybersecurity • Building Hospital Cybersecurity Infrastructure with Cyber-insurance, February 28th, 3-4pm • Cybersecurity Tactical Simulation, May 9-10th

23. EPCC Survey Results • Sent out an EPCC survey seeking information about: • Protocol, process or resource that could be applicable to others • Drill or exercise that others could benefit from learning about • Involvement in national or regional workgroup • Plans to attend upcoming EM conference/symposium • Thanks for everyone who responded! • In the coming months we will all get to hear about these exciting innovations and initiatives. • EPCC is for all of us – please let us know about other presentation topics/opportunities.

24. Agency Updates • NYS Department of Health • NYC Department of Health and Mental Hygiene • NYC Emergency Management

25. 2018 EPCC Dates (through June) • Tuesday, February 13th • Thursday, March 22nd • Tuesday, April 17th • Thursday, May 17th • Tuesday, June 19th **All meetings will be held from 1:30-4:00pm