SETRAC Regional Ebola Plan - Texas Emergency Management

SETRAC
Regional Ebola Plan
Regional Ebola and Highly Infectious
Patient Transport Plan and Special
Considerations
WHO YOU GOING TO CALL?
PROJECT PARTNERS
RETA SERVICE AREA
DEVELOPMENT
• Early and frequent information with
healthcare at onset of EVD
• Community meetings with healthcare
executives, public health departments and PH
Medical Directors
• Large EMS Providers
– AMR
– BayStar
– Acadian
PURPOSE
• Regional approach for emergency medical
services, public health, and healthcare to
response in a coordinated fashion during an
Ebola outbreak or other highly infectious disease.
• The Plan serves as an annex to the existing
Catastrophic Medical Operations Center Basic
Plan.
• Details specific objectives, related tasks, and
agency/organization roles and responsibilities.
WHAT IT IS AND WHAT IT ISN’T
• The Regional Ebola Response Plan focuses exclusively
on regional support and coordination for screening,
isolation, identification, activation, notification, and
mobilization.
• It does not address local/facility/agency procedures
for:
– Incident Command (IC)
– Internal response activities
– Established mutual aid relationships and procedures at the
facility/agency level
– Joint information and messaging through the Joint
Information System (JIS)/Joint Information Center (JIC).
CRITICAL ASSUMPTIONS
• Local and regional health and medical plans will be
implemented.
• The Catastrophic Medical Operations Center (CMOC)
will raise its level of activation to meet the needs of the
occurring incident.
• The region will have pre-identified, specially trained
and equipped EMS agencies that are
familiar with
the region.
• Regional response assets (RETA – Regional Ebola
Transport Ambulance) will be available immediately,
but scene reporting times will vary depending upon
location.
CRITICAL ASSUMPTIONS
• Hospitals and other healthcare facilities will be responsible
for “Screening, Isolating, and Calling” their public health
official in accordance with the regional guidance for Ebola
triage.
• Hospitals and other healthcare facilities will be responsible
for laboratory sampling as outlined in the regional
guidance, and proper packaging and transportation of the
specimen to an approved LRN laboratory.
• State medical response and support may be available
within six hours after confirmed positive lab test.
• Federal medical emergency response support and
resources may be available approximately 72 hours after
confirmed positive lab test.
CRITICAL ASSUMPTIONS
• Only PCR confirmed patients will be transported to one of the State
designated Ebola Treatment Centers, or a federally identified
Treatment Center.
• A Standing Mission Task from the State to SETRAC to cover all costs
associated with:
– The care and transportation of a confirmed (State PCR) Ebola case to
an identified state facility
– The transportation of moderate or highly suspected individual from
home to area hospital (PH or 9-1-1 support)
– The transportation of moderate or highly suspected Ebola death from
home to ME/funeral home
– Resupply of PPE for regional ambulances and initial healthcare facility
– Decon/cleaning of ambulances and initial healthcare facility
– The disposal of waste identified as Class A associated with the care
and transportation of an Ebola patient
SCENARIOS
• Self-presentation to an acute care facility ER
• Self-presentation to a clinic, freestanding ER
or physician office
• 9-1-1 or Public Health call for assistance
CRITICAL STEPS
• Early notification to SETRAC (at decision to test)
• Primary and Secondary RETA will deploy each
time with a Supervisor vehicle
• DPS will provide 2 marked vehicles for escort
• Time and care will be taken to ensure safety
• Common radio frequency will be utilized
• Hand-offs will occur per regional guidance
• UTMB will support post-transfer decon and waste
disposal of RETA
PRESENTATION AND NOTIFICATION
ACTION
RESPONSIBLE PARTY
Screen, Isolate, Call Public Health for
consult
All healthcare, EMS, Dispatch Centers
Institute PPE for contact and droplet
precautions
All healthcare and EMS
Obtain, package and transport requested
blood sample
Acute care facilities and freestanding
ER/clinics
Request transport through public health
to CMOC to acute care facility
Clinics and physician offices, PH, and 9-11 assist calls
Request transport through public health
to CMOC for PCR confirmed cases to
designated Treatment Centers
Acute care facilities
POSITIVE LABORATORY
ACTION
RESPONSIBLE PARTY
Patient identified as moderate to high
suspicion based on screening criteria per
public health
All healthcare, EMS, Dispatch Centers,
public health
EVD testing approved – results positive
Public Health
Notification of RETA request made to
SETRAC/CMOC
Public Health, SETRAC, On-Call Service
SETRAC/CMOC notifies ON-CALL for RETA
transport and DPS for escort
RETA identified EMS
RETA prepares crew and identified vehicle
and provides ETA
RETA identified EMS
Transfer Process
ACTION
RESPONSIBLE PARTY
Compliance with all EMTALA
requirements for a transfer to a higher
level of care. Report will be called to the
accepting Treatment
Transferring Facility
Provide an ETA to the transferring facility
to facilitate a smooth transfer.
CMOC/SETRAC/DPS/RETA Crew
Upon arrival of RETA, the hospital staff
will clear hallways and transport the
patient to the ambulance.
Transferring Facility
Provide an ETA to the Treatment Center.
This information will be relayed to the
Treatment Center by CMOC.
RETA Crew
Epidemiological surveillance of healthcare Public Health and the facility’s Infection
workers involved in care as well as
Control Professional
contacts of the patient.
ARRIVAL AT ETC
ACTION
RESPONSIBLE PARTY
Notification to ETC 10 minutes PTA
RETA Supervisor
RETA will transport to designated location
ETC Security
Patient will be off loaded at back of
ambulance
ETC Receiving Team
RETA will be taken to designated location
for decon of vehicle and staff
ETC Safety Department, RETA Crew
RETA will remain out of service for 24 hrs
post-decon
RETA Leadership
ADDITIONAL INFORMATION
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Regional Reporting
Ebola Hospital Screening Guidance
EMS Decision Tree Guidance
EMS-Hospital Hand-off
EMS Special Consideration
Hospital Special Considerations
Medical Waste Incinerators
Regional Reporting
17
Hospital Screening Guidance
EMS Decision Tree
EMS-Hospital Hand-Off
Full Scale Exercise
• February 12, 2015
• Participating Agencies
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Memorial Hermann Southwest
UTMB Galveston
SETRAC
AMR Ambulance
Bay Star EMS
Acadian EMS
Region 2 Texas Department of Public Safety
Galveston County Public Health
Objectives
• Healthcare System Preparedness
– Coordinate safe, effective transfer
– Identify gaps in Plan
• Emergency Operations Coordination
– Demonstrate notification and activation process
– Coordinate movement of HI patient
• Information Sharing
– Coordinate information sharing
Scenario
• Day 1
Mother and 15 yo daughter under PH surveillance.
Daughter develops fever, abdominal pain, nausea
and vomiting. Directed to local Ebola Assessment
Center for evaluation.
Hospital establishes IC and notifies public health
and SETRAC for briefing and liaison. DSHS and CDC
notified and testing approved to be completed at
Houston LRN lab on February 11, 2015.
Test results returned positive at 2000 that day. RETA
activated to transport daughter to hospital.
Ebola Assessment Center
SETRAC Actions per Plan
• Conference call with RETA ambulance point of contact
• Coordination call with UTMB regarding preparation
time and arrival time.
• Notify SMOC of situation and request Mission
Assignment if test is positive.
• Notify DDC for “head’s-up” STAR request for escort
• Notify Rosslyn Warehouse for possible PPE cache
support to Assessment Facility
• Maintain contact with RETA Supervisor during
transport
• Document costs and identify issues/concerns
Transport and Hand-off
Transport Convoy
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•
•
•
•
•
DPS Trooper front and back – lights, no siren
Ambulance with patient
Back-up ambulance (wrapped and ready)
EMS Supervisor
Designated TAC channels
Pre-identified communication progress points
– Ie: leaving sending hospital, 10 min ETA to
receiving facility, decon completion, completion of
mission
Decon and Waste Removal
• RETA crew directed to decon location per
UTMB EH&S leadership
• UTMB provides guidance and oversight of
crew decon of self and ambulance
• Waste is bagged per UTMB protocol and
disposed by UTMB via incinerator
• Ambulance remains OOS x 24 hrs
Lessons Learned
• Early notification to SETRAC if possibility of
utilizing RETA and/or transfer to UTMB
• PPE and training for DPS escort
• SETRAC liaison at Assessment Hospital for
coordination
• Regular exercises between RETA and UTMB
• Include alternate location in event of weather
• Consistency in participants
Staff Selection/Staffing
• Agencies and Agency Staff are all preidentified (Core Teams)
• Specially Trained and Equipped
• EMTF MOA currently in effect with Lead RAC
• Standardized Training
– RETA Plan, Deployment, Donning/Doffing,
Transport, Decon/Demob, Testing, PRACTICE!
PRACTICE! PRACTICE!
• Standardized Equipment
RETA NOTIFICATION
• The Public Health individual contacting the CMOC
to request Regional Ebola Transport Ambulance
(RETA) should be prepared to provide the
following information:
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–
–
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Pick Up Location
Number of Patients
General Physiological Status of patient(s)
Complicating Factors – i.e., extensive diarrhea,
vomiting, bleeding, other body fluids
– Additional Precautionary Requirements
• Having this information will allow CMOC and
SETRAC staff to determine which asset to deploy,
determine what level of response is required, and
identify appropriate receiving location for the
patient.
• The RETA is dispatched via SETRAC Regional
Communications Center (RCC) that operates
24/365. Upon receiving request for activation,
the RCC will notify the RETA on call
Summary of Critical Tasks for RETA
Notification
Tasks
Agency
Patient identified as some to high
suspicion based on screening per public
health
All Healthcare, EMS, Dispatch Centers,
Public Health
Notification of RETA request made to
SETRAC/CMOC
Public Health
SETRAC/CMOC notifies RCC for RETA
Transport
SETRAC, RCC Dispatch
RCC Dispatch notifies on-call RETA of
transport request
RCC
RETA prepares crew and identified vehicle
and provides ETA
RETA Identified EMS
RETA Activation SOP
1.
2.
3.
4.
Upon notification of suspected case, notify supervisor
Arrange Conference Call to include the three (3) RETA services and
Supervisor(s)
Ensure “First-Up” Ambulance Service is on standby with wrapped
unit. Ensure “back up” ambulance service can be ready to
transport
Notify SMOC of situation and request State Mission for transport
if test is positive.
1.
2.
3.
4.
5.
Mission To Include: Cost of wrapping, staffing (3 personnel), PPE,
transport fee, supplies, equipment
Cost of Chase vehicle with personnel
Cost of Decontamination of Ambulance(s)
Cost of Waste incineration
Request for DPS escort
Cont’d
5.
6.
Notify DDC for “heads up” of STAR request coming via WebEoc.
Notify warehouse of possibility of need for PPE cache to initial
hospital for support.
7. Maintain communications with sending and receiving facilities as
well public health official in jurisdiction
8. If test is negative, notify all previously mentioned (SMOC, DDC,
Supervisor, Warehouse,RETA) of stand down
9. If test is positive, coordinate with sending and receiving facility for
transfer time (provide for on-call RETA a 4 hour prep time and
calculated travel time). Notify on-call 24/7 Dispatch Number.
10. Sending Facility is responsible for obtaining transfer approval from
UTMB, completing MOT, report and providing copies of medical
records. All forms for transfer should be placed in a watertight
sealed clear plastic bag for transport.
Cont’d
11. Maintain Communications with sending facility, receiving
facility, and chase vehicle regarding progress points
a) Leaving home base
b) Arrival at sending facility
c) Leaving Sending Facility
d) Progress enroute to receiving
e) Arrival to receiving facility
f) Decontamination of Personnel
g) Leaving receiving facility
h) Decontamination of Vehicle
i) Disposal of Waste
j) Completion of Mission
Cont’d
12. Document all costs associated with Mission
with RAC Finance and submit to SMOC for
reimbursement
13. Document issues, concerns, best practices
and convene post transport conference call
with RETA(s), sending and receiving facilities,
and public health official (if possible)
Transport of confirmed (State PCR)
from facility to State Ebola Facility
• Presumptive positive from State PCR reported to Commissioner of
Public Health
• Result reported from Commissioner to facility and local public
health (PHA)
• Commissioner identifies which state facility to receive patient and
notifies them of pending transfer
• Facility begins preparation for transfer
• PHA notifies Lead RAC of pending transfer and need for RETA
• Lead RAC through RCC sends notice to on-call RETA
• On-Call RETA determines ETA at transferring facility
• RETA coordinates transfer information/patient/status/equipment
needs with transferring facility
• Transfer of patient occurs
Transport of Moderate/High Suspect
from Home (9-1-1 support)
• Local 9-1-1 receives call
• Dispatch performs screening criteria on caller
• Dispatched ambulance arrives on scene, dons universal precautions and
surveys scene/patient status
• Calls medical control with assessment
• Medical Control confers with local public health on degree of suspicion
– Determined to be low risk of ebola – transport as per protocol
– Determined to be moderate/high risk or evidence of gross body fluids at scene
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9-1-1 service remains on scene to secure
Public health notifies Lead RAC of need for RETA
Lead RAC through RCC sends notice to an on call RETA
RETA provides ETA and coordinates transfer information with the on scene 9-1-1 service
RETA Ambulance coordinates with receiving facility of patient needs and ETA
Hand-Off of patient at receiving facility occurs at back of ambulance
Transport of Deceased Moderate/High
Suspected from Home
• Local 9-1-1 receives call
• Dispatch performs screening criteria on caller
• Dispatched ambulance arrives on scene, dons
universal precautions and surveys scene/patient
status
• Calls Medical Control with assessment
• Medical Control confers with local Public Health
on degree of suspicion
– Determined to be low risk of ebola – follow normal
scene death protocols
Cont’d
• Determined to be moderate/high risk or evidence
of gross bodily fluids at scene
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ME/JP notified and determination made if ME case
9-1-1 service remains on scene to secure
Public Health notifies Lead RAC of need for RETA
RETA ambulance provides ETA and coordinates
transfer information with on scene 9-1-1 service
– RETA ambulance coordinates with ME office or funeral
home the deceased precautionary needs and ETA
– Hand-Off of deceased occurs at ME office/Funeral
Home
Responding
Identify at risk patient and mitigate risk
– Appropriate PPE use
– Minimize extent & number of patient contacts
– Patient Treatment modifications
– No no-essential persons or escorts on board
Modify Care
• “Routine Care” per accepted practice
– Limit or Avoid
• Aersol-generating procedures
• Placing or removing advanced airway
– BiPap, King LT, LMA, ETT, etc
– Suctioning airway
– Nebulized or MDI medications
Limit Or Avoid
• Invasive Procedures
– Needle Thoracostomy
– Placing Lines, tubes, or drains
– CPR
SHARPS
-No “Routine” fingersticks, needles or catheters
• Exposure To Body Fluids or Secretions
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Put a mask on patient
Wear Impermeable PPE
Wrap the Patient in something / or POD
Empty Fluid containers PRIOR to transport
AFTER THE CALL
• Careful clean-up
• Disposal of PPE & Other items at receiving
hospital
• Vehicle Cleaning & Decontamination
• Provider Follow-Up & Monitoring
• Critical Incident Stress Debriefing
• Post-Exposure Management
Follow Up and Reporting Measures
after caring for Suspected or
Confirmed Ebola Patient
• EMS Personnel with exposure to blood, bodily fluids,
secretions, or excretions from a patient with suspected
or confirmed Ebola shall immediately:
– Stop Working and wash the affected area with large
amount of water or eyewash solution
– Contact the Supervisor for assessment and access to postexposure management services; and
– Receive medical evaluation and follow-up care, including
fever monitoring twice daily fever checks, based upon
recommendations from local, state, and federal public
health
Cont’d
• EMS Personnel who develop sudden onset of fever, intense
weakness or muscle pains, vomiting, diarrhea, or any signs of
hemorrhage after an unprotected exposure (i.e., not wearing
recommended PPE at time of patient contact or through direct
contact to blood or bodily fluids) to a patient with suspected or
confirmed Ebola should:
– Not report to work or immediately stop working and isolate
themselves.
– Notify their supervisor, who should notify local and state public health
– Contact Physician through Worker’s Compensation for assessment and
access to post-exposure management services; and
– Comply with work exclusions until they are deemed no longer
infectious to others.
CONTACT US
• FOR MORE INFORMATION YOU CAN CONTACT
US AT WWW.SETRAC.ORG
• OR VIA OUR SETRAC OFFICE 281-822-4444