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Knox Andress, RN, FAEN Designated Regional Coordinator Louisiana Region 7 Hospital Preparedness LSU Health –Shreveport Louisiana Poison Center “To know where you’re going you’ve got to know where you’ve been” author unknown Louisiana Hospital Preparedness Updates y Background y Regionalization y Hazards y Planning updates the LHA “Preparedness” Website y Hurricanes y Training/Education y Pandemic y Communications / Information Management Louisiana Hazards Impacting Hospitals y Hurricanes y Katrina and Rita ‐ 2005 y Gustav and Ike ‐ 2008 y Pandemic (H1N1) ‐ 2009 y Hazmat (B.P. Gulf Horizon) ‐ 2010 y Flooding (Mississippi River) ‐ 2011 5 6 Impact ‐ Canal Breeches London Avenue Canal Industrial Canal 7 A potential “soup‐bowl” Hospital Impact –New Orleans 9 2005 ‐ Katrina Dynamics y Hurricane Katrina – y Entered Gulf of Mexico –August 26, 20051 y Predictions: “Category 1” projected to become a “Category 5” y Hurricane warnings: Louisiana central coastline to Florida panhandle y Landfall: August 29, 2005; Burras, LA (Southeast Louisiana); “Category 3” w/ 125 mph winds y Storm surges: 10’ – 19’. y Levee breaches: = 53; 80% New Orleans & neighboring parishes flooded. y Louisiana fatalities: 986 storm‐related2 y Estimated 100 billion dollars in LA property damage/loss3 1 2 NOAA, 2005; Brunckard et al, Hurricane Katrina Deaths, 2008 10 2008 –Gustav: Predictions and History 11 2008 ‐ Gustav Dynamics y Hurricane Gustav – y Entered: Gulf of Mexico –August 31, 20081 y Predictions: “Category 1” projected to become a “Category 5” y Hurricane warnings: Cameron Parish to Ala/Fla border y Landfall: September 1, 2008; Cocodrie, LA – (Central coastal Louisiana); “Category 2” w/ 105 mph winds y Louisiana storm surges: 10 –14 feet. y Levee “topping” ‐ No (0) levee breaks y Louisiana Fatalities: 48 storm‐related2 y Estimated 4.3 billion in LA property damage/loss 1,2NOAA,Tropical Cyclone Report...Gustav, 2009 12 Louisiana Hospital Evacuations – Katrina (2005) vs. Gustav (2008)1 Hurricane Pre Post Total Hurricane Pre Post Total Katrina Storm Storm Gustav* Storm Storm Total 8 26 34 Total 38 7 45 Hospital Hospital Evacuation Evacuation Partial 5 5 Partial 25 3 28 Hospital Hospital Evacuation Evacuation Total 13 26 39 Total 63 10 73 *Gustav ‐ approximately 1000 patients evacuated pre‐storm; 223 patients were evacuated post‐storm. 1 Hurricane Gustav and Ike, Louisiana ESF-8, Health and Medical Response After-Action- 13 Report; Louisiana Department of Health and Hospitals; November 5, 2008. Impacting Hospitals ‐ Gustav: Nursing Home Evacuations6 Hurricane Gustav Pre Storm Post Storm Total Complete 94 2 96 Evacuation Partial 0 0 0 Evacuation Total 94 2 96 8,401 residents evacuated pre‐storm; 160 residents evacuated post‐storm 14 What is the potential throughput? Number of Parishes: 12 Number of Hospitals: 60+ Regions 4,5: 624 patients Regions 3,4: 343 patients Regions 1,3,9: 1063 patients Anticipated Planning Range: low - high 343 - 1063 (reasonable “worst case” planning scenarios) Louisiana Emergency Operations Center DHH/OPH – ESF‐8 Louisiana DHH/OPH Louisiana Pandemic Influenza Clinical Forum Pharmaceutical Subcommittee Ventilator Subcommittee Regional EOC / Regional Hospital‐Medical Coordination Center Crisis Standards Subcommittee Non‐clinical Advisory Group Regional Crisis Standards of Care Subcommittee (La. HHS‐LERN) Others Hospital Hospital Ethics/Critical Care Committee Hospital Triage Team “Black” ‐ planning mode “Red” ‐ response mode Patient B.P. Gulf Horizon Oil Spill Est. 92,340,117 gallons leaked April 20, 2010 (U.S.) Louisiana ESF-8 Dashboard June 8 – June 14 CONTENTS OF DASHBOARD LA Department of Health and Hospitals LOUISIANA DEPARTMENTS Background Seafood Safety Program Governor’s Office of Homeland Security and Emergency Preparedness Louisiana State Police Critical Events by Week Seafood Surveillance Data Louisiana Dept of Wildlife and Fisheries Louisiana Dept of Corrections MSC 252 – Impact Summary MSC 252 Oil Spill Surveillance Report Louisiana Dept of Health and Hospitals Louisiana Dept of Social Services BP Activities to Date Air Surveillance Data Louisiana Work Force Commission Louisiana Oil Spill Coordinator’s Office US EPA Monitoring Efforts Info for Response Workers and General Public Louisiana Dept of Natural Resources Louisiana National Guard Governor’s Office of Coastal Activities NOAA Health Threats for Responders Louisiana Dept of Environmental Quality Louisiana Attorney General’s Office LA Department of Wildlife and Fisheries Mental Health Louisiana Economic Development Louisiana Dept of Transportation and Parishes with State of Emergency Declaration Hotlines and Relief Centers Development Division of Administration Louisiana Dept of Agriculture & Forestry 8 Existing Fact Sheets 7 Contact Us 6 DISCLAIMER: The Dashboard was developed using available sitreps and web‐based links. The intent of this Dashboard was to 9 organize and share available information in a centralized 2 4 document for visibility of a multi‐agency response effort. Should 5 there be questions regarding an Agency’s response effort, the 3 1 Agency should be contacted directly. Each slide has been sourced 1 to access further details. Mississippi River – Louisiana Flood Inundation: Planning Model for Hospitals and Nursing Homes Red = 0–5 miles Orange = 5–10 miles Louisiana Hospital Association “Preparedness” Website – www.lhaonline.org y Reflections of: y Hurricane Planning y Meetings/Trainings y Pandemic Flu Planning y Communications / Information Management y Others “Hurricane Planning” y ESF‐8 State/Federal Plan y Louisiana Hospital Emergency Preparedness Planning Network y “H‐Hour” calculation y Hospital Aeromedical Transfer Form y Shelter‐in‐place recommendations y DRC/DRH organization “Education / Trainings” y Regional Hospital Hazmat Education y Hurricane Shelter Response Training y Oklahoma Shelter Response Team –Hirsch Coliseum, Shreveport, Louisiana y Earthquake – National Level Exercise (NLE) y Tracking Emergency Patients (TEP) Exercise Oklahoma ‐ Shelter Support, Shreveport, La. EOC ‐ Caddo‐Bossier OHSEP Coordinates… Mass Care ‐ Sheltering Public Health, Medical, (ESF‐6) Mental Health, (DSS, ARC) (ESF‐8) Bossier Civic *CenturyTel Jewella Westpark Riverview Hirsch LSU‐S Southern U Center 2000 Center 8810 Jewella 7455 600 Clyde Fant 3701 Hudson 1 University 3050 MLK 620 Benton Rd, Drive, Bossier Ave, Atkinson Dr, Pkwy, Street, Place, Drive, Bossier City City Shreveport Shreveport Shreveport Shreveport Shreveport Shreveport MSNS CTNS CTNS CTNS CTNS CTNS General General DSS/OPH Parish DSS DSS Parish Parish Parish Parish OPH/LSUHSC‐S Bossier City LSUHSC – S; LSUHSC ‐ S; LSUHSC ‐ S; Oklahoma ARC; ARC; Fire/EMS; David Raines David Raines LifeCare Team MRC; MRC; Promise Clinic; Clinic; Hospital; Volunteer Volunteer Hospital; MRC MRC MRC Pool Pool NSU Nursing; Volunteer Pool Advanced Advanced Advanced Advanced Oklahoma EMS *Point‐to‐Point EMS EMS EMS EMS Unit ARC – American Red Cross CBOHSEP – Caddo ‐ Bossier Office of Homeland Security and Emergency Preparedness CTNS – Critical Transportation Needs Shelter DSS – Department of Social Services EOC – Emergency Operations Center ESF – Emergency Support Function MRC‐ Medical Reserve Corps 8‐31‐2010 MSNS – Medical Special Needs Shelter OPH – Office of Public Health Pool – volunteer resources from hospitals, clinics, MRC, LAVA, ESAR‐VHP, etc “Communications / Information Management” y A Preparedness Priorities Survey y Louisiana DHH ESF‐8 Web Portal y Tracking Emergency Patients (TEP) exercise y “Virtual USA” ‐ via “Virtual Louisiana”/B.P. Gulf Horizon Preparedness Priorities1 (n=84) 1Andress, ENA Journal of Emergency Nursing 2011 Communication and Information Management –the Louisiana DHH “ESF‐8 Web Portal” y Needs and components: y Site and User Security y Resource Status and Capability y Incident Management y Communication – Messaging y Survey 2009 to 2010: The Basics A New Strategy for 2011 and Beyond y Acquire a module that could serve as a secure web portal for end users, with “single sign‐on” access to all the applications they need y Acquire a module that offered robust incident management and notification capabilities y Acquire a comprehensive resource management module that could expand as needed. y Develop more advanced analytics, connected to the databases in real‐time Result of the Initial Investments Security Layer Stage 1 Application Layer Analytical Layer “ESF 8” Will Complete the Plan Security Layer Stage 2 Application Layer Analytical Layer National Level Exercise (NLE) ‐ y Overview – y Simulated evacuated patient & TEP data from multiple states shared across disparate systems using the TEP draft standard (Tracking Emergency Patients). y To Louisiana – y Simulated patient data from Missouri Hospital evacuations shared to two Louisiana patient tracking systems and a faux “National Reunification Center” Virtual USA Participant Examples: " Oil Spill Exposures: “Virtual Louisiana” ‐ Hospitals and Public Health. 1. Event – B.P. DeepWater Horizon Explosion 2. Resulting actions – seeking medical advice/attention 3. Challenges for an overloaded resource. 4. Oil spill exposure occurrences a. Types i. Workers ii. Non‐workers b. Ages c. Major complaints 5. Surveillance systems in Louisiana a. Louisiana Poison Center b. Hospital surveillance systems c. Public Health “Hotline” d. Physician –clinic offices e. Collected by Louisiana DHH 6. vLouisiana DHH agency data layer 7. Challenges – Real‐time vs Delayed Reporting 8. Impacts on health care resources in Louisiana “Virtual Louisiana” ‐ By “Parish”