Alternate Care Site

ACS

Role of Medical Reserve Corps

Objectives What is an Alternate Care Site is

Why an Alternate Care Site may be necessary

Plans in the metro areas that have been developed to open an Alternate Care Site

Possible role of Medical Reserve Corps Volunteers at an Alternate Care Site

How an Alternate Care Site fits into the “big picture” response to a health emergency

8 Public Health Regions in Minnesota

Northwest

Northeast

West Central

Central

Metro

Southwest

South Central

Southeast

Metropolitan Hospital Compact 29 Hospitals

7 County Metro Area

Agreements

Multidisciplinary Group

Hospitals

EMS

Public Health (state and local)

Every Public Health Region in State has a compact

Hospital Compact Work Groups Alternate Care Site (ACS)

Clinic Coordination

Long Term Care (LTC)

Behavioral Health (BH)

Laboratory

Emergency Medical Systems (EMS)

Regional Hospital Resource Center (RHRC)

Exercise

Steering Committees

Metro Pharmaceutical Cache

MNTrac

Alternate Care Site Work Group

One of the first work groups formed

Led by Pat Hadfield - HCMC

Hospital regulatory compliance – Joint Commission

All hospitals working together

Kittson Roseau

Lake

of the

WoodsMarshall

Polk

Pennington

Red Lake

Clearw

ater

Norman Hu

bb

ard

Becker

Koochiching

Itasca St. Louis Lake

Cook

Aitkin

Carlton

Cass

Wad

ena

Todd

Morrison

Mille L

acs

Kanabec

Pine

Stearns

Benton

Isanti Chisago

Wright

Clay

Otter TailWilkin

Grant Douglas

Traverse

Stevens Sher-

burne

Pope

Anoka

Hennepin

Washington

Carver

Dakota

Meeker

Mc-

Leod

Le-

SueurNicollet

Brown

Blue

Earth

Wa-

secaWat-

onwan

Faribault

GoodhueRice

Wabasha

SteeleOlmsted

Winona

Free-

bornMower Fillmore

Houston

Big

StoneSwift Kandi-

yohiChippewa

Lac Qui

ParleRenville

LincolnLyon

Redwood

Pipe-

stoneMurray Cotton-

wood

Rock Nobles Jackson

Sibley

Crow

Wing

Ramsey

Martin

Beltrami

Mahnomen

Yellow MedicineScott

Dodge

Tribal Reservations

Indicates Current ACS Sites

Mission of the ACS

To establish patient care facilities during an emergency/disaster if hospitals are taxed beyond capacity. This may be required for triage, screening, initial treatment or for an austere patient care site

Provide effective care to the greatest number of people with limited resources

Hospital Surge Capacity How many extra patients can a hospital take beyond their

normal capacity

MCI – public health event

Hospital plans satisfy grant deliverables & Joint Commission – surge to X% beyond normal capacity – strategies include

Cancelling elective surgeries

Make single rooms into doubles

Convert classrooms to wards with cots

Altered standards of care

Early discharges

Staff shift changes – 12 hour shifts

Role of RHRC/Metropolitan Hospital Compact in Surge Capacity Planning

As hospitals meet their individual surge capacity the RHRC and Metropolitan Hospital Compact can monitor and facilitate moving patients to other hospitals

MNTrac

As the metro hospitals all reach their surge capacities an Alternate Care Facility may be opened

Not for short term or limited time event

Not for events that affect one or two hospitals

Considered when resources are stretched to the max

Requires 72 hours to open

Activation of Alternate Care Site Hospitals

contact RHRC leadership

RHRC activated

MDH notified by RHRC

RHRC representative

to SEOC

ACS work group

activated

Decision to Open Alternate Care Site RHRC with input from other facilities will assess the

community

Local and jurisdictional Emergency Managers, in collaboration with the Local Public Health and the State Health Department will approve the activation of an ACS and assist with the resource requests.

Request for the use of a facility (ACS) is made via the local and/or jurisdictional Emergency Management agency or Multi-jurisdictional Incident Command

MDH designates Hennepin County Medical Center (RHRC) to assign an ACS Incident Commander that will oversee site operations.

Activation of Staff Who to activate – facilities in what order

Large hospitals paired with smaller hospitals - quadrants of metro area

Schedule of hospitals pre planned

How staff will be identified

Length of shifts (7a-7p & 7p-7a)

Transport & Parking - Metro Transit

Coordination of ACS Pre-established M.O.U.’s with many vendors

Metro Transit

Laundry

Food and supply vendors

West Metro (Mpls.)– HCMC

Minneapolis Convention Center (MCC)

Target Center

East Metro (STP)– Regions Hospital

River Center

Working with other agencies (local, county, cities, state, PHD, federal) as needed

Care at Alternate Care Site Austere care

Altered Standards of Care – hospitals and ACS

Greatest good for the greatest number

Services Basic laboratory samples

Basic medications

Basic x-ray service

? Oxygen

Behavioral Health

Protocols and Standing Orders

ACS set up at Minneapolis Convention Center

•All plans made for “pods” of 50 patients

Staffing

ACS staffing for each 50 patient pod

1 physician

1 PA/NP or 2nd physician

5 nurses and/or LPN’s, paramedics (at least 3 RN’s)

5 nursing assistants/EMT-B personnel

1 social worker/case manager

1 environmental service staff

Additional Staff Additional Support Personnel

1 charge RN/250 pts

1-2 unit secretaries/100 pts

1 respiratory therapist/ 100 pts

1 patient admissions clerk/100 pts

1 chaplain/100 pts

1 pharmacist (if hospital > 200 beds)

1 – 2 lab personnel

Food service workers

Security

Patients/Staffing Patient care will consist of basic, austere care

Patient assignments will be greater than usual for all staff

Roles will be less distinctly delineated than during normal hospital functioning; all providers will be expected to fill any patient care need that they are licensed and credentialed to fill

Due to the limitations of the facility and number of care-givers, patient care needs may be prioritized

Admission to Alternate Care Site

Care Delivery Patients will receive ID band – admissions clerk

Basic paper admission sheet completed

Patient Care

Focused H&P within 4 hours of admission with medical plan of care

Standing orders – VS, I&O, nursing assessment - every 12 hours

Documentation on nursing flow sheet

Medical staff will assess patients as warranted

A patient log of admission time/date, location, disposition, and discharge time/date will be kept current by the admissions clerk/unit secretaries.

All providers will document significant events, changes in patient condition, and changes in plan of care on multidisciplinary progress notes.

Charting will be by exception

Admission Criteria Patients who have been decontaminated (as needed), triaged

and screened for admission by an existing healthcare facility, clinic, or ACS personnel and are

Patients requiring peripheral IV therapy for drug administration, rehydration, and/or palliative care – no IV pumps will be available

Patients requiring oxygen therapy delivered by nasal cannula, mask, or trach collar only (assuming O2 delivery is able to be set up)

Patients with communicable diseases who are able to cohort

The Metro Region RHRC is working with the state on a pediatric emergency plan that would be incorporated into the ACS

Ineligible Criteria Patients requiring mechanical ventilation, continuous ECG

monitoring, vasopressors, ACLS, ATLS, PALS, or NALS

Patients in active labor

Patients with existing diseases (cardiovascular disease, diabetes, cancer, etc) who are experiencing exacerbations of these diseases concomitant with injury or infection.

Patients requiring frequent and/or complex diagnostic testing (eg. Radiology, Lab Services, etc.)

Patients requiring blood transfusions

Patients requiring hemodialysis

Incident Command The ACS will operate

according the National Incident Management System/HICS

Command Staff

Incident Commander

PIO

Safety Officer

Liaison Officer

General Staff

Finance/ Administration

Logistics

Operations

Planning

Security Resources available to staff at site

Number of staff required

Entrances &/or sites to post

Vendor deliveries

All staff clearance process

at check-in

ID Badges

Vests

Armbands

Communications Primary and back up methods

Phones – lines and cell

Radios – 800 mHz and familiy – HAM radios

Speakers – Bullhorn

Computers

Will equipment work (site checks)?

Interpreter Services

Language Line

Equipment

Lab, X-ray, Pharmacy, Materials Management – protocols, forms, etc.

Plan for delivery, set up & maintenance

Long shelf life &/or rotation of items

Basic response list per 50 beds/cots Cot

IV pole as needed – no pumps

Clipboard for record

Lamp

Plastic tub for patient belongings

Supplies Some in storage with long

shelf life

Minneapolis Convention Center

River Centre

Allina Warehouse

Ask hospitals to contribute

Just in time ordering through MOUs with vendors

Pharmaceuticals Develop list of appropriate meds

Do any meds need refrigeration?

Distribution / method of delivery

Security issues

Patient Education / Teaching Sheets

Discharge needs

Lab Coordination of qualified staff will be done by the RHRC

with the Regional Laboratory Leads in the Metro area. Staff will complete lab testing

I-STAT and document results. A minimum number of tests will be able to be performed according to equipment available

A courier system with a nearby facility will need to be developed to assist additional tests if needed

Food Services

Patients and staff

Contract with vendors on site

MCC system

River Centre

Disposable plates, cups & utensils, etc.

Behavioral Health Center (BHC)

Multidisciplinary - Chaplains, Social Workers, Counselors, Therapists

Psychological First Aid (PFA)

Patients

Families

Staff

Bedside consults

Interpreters/Language Line

Support from the Community

Support Center

Family & friends, yet maintain security

Patients under 14yo (minors) regarding care

On-site or at a nearby church?

Staffing & support

Temporary Morgue Resources within the

community

Procurement of refrigerated trucks

How to process the bodies (ID tags, bags)

Whom to notify for tracking purposes…..

Disaster Mortuary Team (DMORT)

Sanitation Environmental Services (Clean/Dirty)

Receiving items, containers

Vendor for disposal of dirty or contaminated materials

Laundry

Sharps

Medical waste

Training needed

Confidentiality

Infection control – handling of medical waste

Volunteers Medical Reserve Corps (MRC) – Licensed Personnel

Community Emergency Response Team (CERT)

non medical tasks – set up, security

Disaster Medical Assistance Team (DMAT)

Pre credentialed

Clearing site in community separate from facility

Liability Coverage

You are activated!

•Process

•Notification

•Reporting

•Assignment

Activation of Volunteer Staff at ACS

Need for staff is identified by Operations Chief at ACS

Logistics Chief at ACS will send request to the SEOC or the Minnesota Duty Officer who will contact the MN Responds MRC Coordinator

The local MRC Coordinator will be notified and will send a “call out” for volunteers

When you respond to the call, you will be directed where to report and other specific instructions as needed

Arrival at Alternate Care Site Bring your photo ID badge

with credentials

Sign in at registration table you will be given further instructions and an arm band for ID

Report to assigned area for Orientation and Just In Time Training (JITT)

Training Pre-event

This training

U of M online training @ http://cpheo.sph.umn.edu/

Psychological First Aid

Incident Command Training

All MRC training

JITT

Agent/Event specific information

Orientation to Alternate Care Site

Job specific information

Job Action Sheets

Topic Time Specifics

Welcome and Introductions

Determined by HICS – flush out for more specifics

5 mns Thank you for coming – pre-credentialed, skill set, & expectations,

Introduce ICS staff – explain vests point to command center

of ACS – (decrease pressure on hospitals)

Brief overview as large group and more specific small group

What is Alternate Care Site

Put together folders for MERET education (? Not too specific in details)

5 mns Provide austere care for patients

Hospitals full beyond capacity – exceeding surge capacity

Types of patients we will see

Basic services provided

o Basic cares

o Simple IV fluids

o Limited meds

o Limited lab

o O2?

o Psychological Care

Staff

- Remind hospitals that concept exists & script basic statement & process for their Emergency Response plan.

- Remind to utilize the on-line MERET education

- Expectations that core staffing is w/ hospitals and assistance w/ MRC & other volunteers

10 mns Shift times – specific assignments by direct supervisor

Check in – Hospital or Organizational Photo ID required

o ID badges given at check in returned at check out

o Reimbursement to “home” facility

o Shift times

o Communication (phone, radio, fax)

o Message Board – family contact

o Parking /transportation

o Legal – liability coverage, change in level of care/standards; Pre-education repeated annually at Compact

meeting

o Establish expectations with all compact hospitals.

o 1st option is for hospital staff to volunteer before assigning. The contract has no binding language if hospital

can’t or won’t participate.

o Get as much orientation done ahead of time w/ the concept & key elements as possible.

Virtual Tour (map on slide or drawing)/Floor Plan 10 mns Orient to map and point out each departmental area

o Main patient area (where they enter and are)

o Break room (valuables)

o Bathrooms

o Materials Management - supplies

o Lab

o Pharmacy

o Behavioral Health

o Medical Records

o Morgue

o Security posts/Safety

Infection Control 5 mns Basics (depending on event) details per specific role

o Hand washing – hand sanitizer

o PPE (gloves, masks, gowns, etc)

Behavioral Health 10 mns ? Show PFA video

Brief description of services available (patients, families, staff)

Alternate Care Site – Orientation/Operational Briefing General: (All staff at ACS) TOTAL OF 60 MINUTES

Questions?

Sheri Fox RN

Saint Paul – Ramsey County Public Health

90 West Plato Blvd – Suite 200

St. Paul, Mn 55107 – (651)266-2592

Sheri.fox@co.ramsey.mn.us

Pat Hadfield, RN, MS

Hennepin County Medical Center (HCMC)

715 Park Ave. So., Mpls, MN 55415 ; (612) 873-2668

Pat.Hadfield@hcmed.org