Quantitative Planning for Epidemic and Disaster Response: Logistics and Supply Chain Considerations Health System Emergency Response Logistics:

Today’s Agenda (date)

Chapter 11

Quantitative Planning for Epidemic and Disaster Response: Logistics and Supply Chain Considerations

Health System Emergency Response Logistics:

Principles for Improved Disaster Supply Chain MGMT.

• Improving operations = “lean” production and warehousing
• minimal on-site inventory & rapid demand fulfillment
• improved profitability
• Benefits – reduced internal workforce requirements & occasionally cost savings
• Cost – lose flexibility & control over logistics & resupply stocks

Principles for Improved Disaster Supply Chain MGMT.

• Disasters = sudden and irregular demands for services and supplies
• Facilities may try to optimize ability to care for patients and increase surge capacity by:
• maximizing stores of critical resources using preexisting or rapidly determined estimates need
• Easy to underestimate need
• Resource use is variable on a good day
• “Every hospital for itself” strategy will fail
• Suppliers tend to contract with many hospitals
• Leads to hoarding & crippling own system

• Need systematic command and control, & centralized authority for critical resource allocation and reallocation decisions

Chapter 12

Risk Communication and Media Relations

Risk Communication Lessons from Katrina

• Addressing the needs of vulnerable populations
• Unclear lines of authority
• Inadequate media strategy
• Failure to refute rumors

Risk Communication Theories

• Four prevailing theories :
• risk perception theory
• mental noise model
• trust determination theory
• theory of negative dominance

Theory 1: Risk Perception

• Cause identifiable victims
• Affect small children and pregnant women
• Catastrophic potential
• Involuntary
• Uncontrollable
• Unfamiliar
• Inequitable
• Unbeneficial

• Difficult to Understand
• Uncertainty
• Dreaded
• Originate from untrustworthy sources
• Cause irreversible and hidden damage
• Personal
• Ethical and Moral nature
• Human Origin

16 “outrage factors” influence public’s perception of risk.

Theory 2: Mental Noise

• When people’s values are threatened, their emotions and thought processes are affected.
• It addresses how people process information during a crisis.
• When people are alarmed, their ability to assimilate and use information is severely impaired.

Theory 3: Trust Determination

• Messengers must become trusted sources & keep trust
• Four factors have been shown empirically to determine the public’s trust for organizations:
• Perceptions of caring and empathy
• openness and honesty
• competence and expertise
• dedication and commitment

Theory 4: Negative Dominance

• If must release a negative message, a min of 3 positives are needed to counteract it

Social Amplification of Risk and Vicarious Rehearsal

• News spreads rapidly around the globe
• Given this media exposure, those distant from the emergency’s epicenter experience anxiety (social amplification)
• To cope with this anxiety, they mentally rehearse the courses of action recommended for disaster victims (vicarious rehearsal)

Psychological Principles

• Mental Models

Availability Heuristic

Serial Position Effect

Confirmatory Bias

Materials Development and Media Relations

• Important Considerations
• Health literacy and Numeracy
• Plain language
• Cultural competence
• Key Messages

Considerations in Media Relations

• Deadlines
• Conflict in Public Health and Media Perspectives
• Elements of Newsworthiness
• Developing Media Contacts
• Identify and Train a PIO or Spokesperson
• Correcting Media Errors
• Media Advisories
• Writing News Releases

Preparing for a Press Conference

• Reach out to reporters early
• Facilities
• Press kits
• Timing
• Assign roles
• Anticipate Questions

During a Press Conference

• Sign-in
• Moderate the conference
• Keep it brief and on-time

After a Press Conference

• Have staff on hand
• Follow up with the media
• Evaluate performance

Preparing for a Press Conference

Preparing for Interviews

• What is the subject or topic of the interview
• What are the reporters deadlines
• Who will be conducting the interview
• What is the interview format
• Practice
• Express empathy
• Use bridging statements
• Admit when you don’t know the answer
• Remember body language

Phases of a Public Health Emergency

• Phase 1: Pre-crisis phase
• Create Partnerships
• Develop a communications plan
• Organize Clearance
• Logistics
• Coordination with partners
• Communications audiences, channels, materials, and protocols.
• Exercise and evaluation strategies

Phase 2: Initial Phase

• If your organization is involved, break the story before someone else does
• shape the news coverage rather than playing catch up and correcting misinformation later
• Public responds best when organizations are quick to announce a problem

Phase 3: Crisis Maintenance Phase

• The media will want updates on the situation
• They also may experience casualties and be short–staffed
• Keep in mind that a report of no change is still worth sharing
• If the crisis is lengthy, schedule daily briefings
• Continue updating your organization’s Web site, hotline scripts, and FAQs

Phase 4: Recovery Phase

• As the crisis winds down, media and public begin to examine who is to blame and how effective the crisis response was
• Communication may also need to focus on addressing the media’s analysis of your organization’s response
• Your communication plan should be updated with lessons learned

Chapter 13

Security and Physical Infrastructure Protections

Hospital Planning

Major vulnerability is open access to the public

• Emergency Operations Plan

Communications

Resources and Assets

Security and Safety

Staff Responsibilities

Utilities Management

Patient Clinical and Support Activities

Disaster Volunteers

Security Structure within ICS

• The security structure of HICS falls under the operations section chief.
• The security branch director manages and coordinates the activities of the following unit leaders:
• Access Control Unit
• Crowd Control Unit
• Traffic Control Unit
• Search Unit
• Law Enforcement Interface Unit

Hospital Infrastructure Security Measures

• Issue Identity Badges
• Issue Visitor Passes
• Issue Vendor Badges and Passes

Deterrence Practices

• Surveillance Cameras
• Security Staff Training
• General Staff Training
• Facility Lockdown
• Interaction with Law Enforcement

Chapter 14

Hospital Decontamination and Worker Safety

Background

• Industrial accident vs. mass or intentional exposure
• Increasing incidents of unknown substances brought into hospitals
• White powders
• Radioisotopes
• Difficult to prepare for 1 vs. multiple contaminated victims

Basics of Hazardous Substances

• A hazardous substance can be defined as any substance that is capable of causing harm to life, health, or property.
• Toxic industrial chemicals
• Toxic industrial materials
• Weapons of mass destruction
• Exposure versus contamination
• Volatility versus persistency

Referral Patterns of Patients

• Self-referred versus EMS initiated transports
• Three categories:
• Symptomatic
• Non-symptomatic-exposed
• Non-exposed “Worried Well”
• Challenges of identifying sick versus not sick patients

Symptom Presentations

• Chemical
• Biological
• Radiological
• Acute versus gradual onset
• Common symptom clusters or “syndromes”

Building Capacity For Hospital Decontamination

• Internal versus external subject matter experts
• Executive-level “buy-in”
• Appropriate equipment
• Trained and available workforce
• Written and updated plans
• Regular drills and exercises

Regulations and Guidelines

• OSHA
• 29 CFR 1910
• Relevent Subparts
• Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances
• Principal Emergency Response and Preparedness: Requirements and Guidance
• Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers
• Guidance on Preparing Workplaces for an Influenza Pandemic
• Guidance Update on Protecting Employees from Avian Flu (Avian Influenza) Viruses
• Joint Commission
• Health Care at the Crossroads: Strategies for Creating and Sustaining Communitywide Emergency Preparedness Systems.
• Current EPs

Hospital Decon Planning Process

• Develop written plan
• Team member selection
• Equipment
• Training
• Drills and Exercises

Chapter 15

Pharmaceutical Systems Management in Disasters

Determining Pharmaceutical Needs

• Specific factors influencing pharmaceutical needs include:
• Type and phase of the disaster
• Epidemiological patterns of diseases of the region
• Conditions influencing or enhancing communicable diseases
• Consider HazMat; different treatments may be needed if specific hazards, such as chemical manufacturers or nuclear plants are in the region.
• Ideally, known antidotes, treatments, and protective agents should be stockpiled in advance.

Identification of Pharmaceutical Agents

• Consider expiration & storage requirements
• Plan for pharmacy to be supported by nontraditional pharmacy staff
• The identification of medications in simple and easily understood ways
• Proper packaging will help ensure that the labels remain on the items and undamaged
• Identifying a medication and its usage is difficult & further compounded by untrained persons sorting and dispensing

Dispensing Pharmaceutical Agents

• Difficulties and Challenges
• Pharmacist’s Autonomy
• Relocation of Pharmacy to a Temporary Site
• Alternative Packaging and Labling

Staff Considerations

• Licensing requirements
• Stockpiles
• Hospital Staff Dispensing

County News Center TV

Alterations in Standard Practice

• Pharmaceutical agents may exceed the available supply
• transient while awaiting resupply or long-term shortage
• Requires planned monitoring
• May need to alter dispensing practices, change formulary, or impose new restrictions on the usage

Chapter 16

Laboratory Preparedness

Role of the Laboratory in Emergency Preparedness

• Public health laboratories, state and local, = first line of defense
• provide diagnostic and surveillance testing

Laboratory Response Network (LRN)

• Global network established by the Centers for Disease Control and Prevention (CDC) in 1999
• in response to the Homeland Security Presidential Decision Directive 39.
• To strengthen the preparedness of the U.S. to prevent and respond to threatened or actual domestic terrorist attacks, major disasters, and other public health emergencies
• The other founding members of the LRN are the Federal Bureau of Investigation (FBI) and the Association of Public Health Laboratories (APHL).

Role of the Laboratory Response Network

• Maintains an integrated network of state and local public health, federal, military, and international laboratories that can respond to bioterrorism and chemical terrorism as well as other public health emergencies.

Divisions of the LRN

• biological terrorism (BT), chemical terrorism (CT), radiation terrorism (RT).
• The main federal agency = CDC with the U.S. Army Medical Research Institute for Infectious Diseases (USAMRIID), and the Naval Medical Research Center (NMRC) as backup
• Facilities located in Australia, Canada, and the United Kingdom serve as back-up laboratories abroad.

Hospital-based Units

• Hospital-based units, are considered “sentinel laboratories” and play a key role in the early detection of biological infectious agents.
• These sentinel laboratories provide routine diagnostic services.

Chapter 17

Principles of Disaster Triage

Triage Categories

• The most common categories that are utilized are based upon those U.S. military.
• Casualties are divided into five categories:
• Immediate
• Delayed
• Minimal
• Expectant
• Dead

Immediate

• Need immediate medical attention because of an obvious threat to life or limb.
• Examples :
• unresponsive, an altered mental status, respiratory distress, uncontrolled hemorrhage, sucking chest wounds, unilateral absent breath sounds, or absent peripheral pulses.

Delayed

• In need of definitive medical care, but are unlikely to decompensate rapidly if care is delayed.
• Examples :
• deep lacerations with controlled bleeding and good distal circulation, open fractures, abdominal injuries with stable vital signs, amputated fingers, or hemodynamically stable head injuries with an intact airway.

Minimal

• Minor injuries that require medical attention, but this care can be delayed for days, if necessary, without an adverse effect.
• Examples :
• abrasions, contusions, and minor lacerations.

Expectant

• Little or no chance for survival despite maximum therapy.
• Examples:
• 95% total body surface area burns or multiple trauma with exposed brain matter.
• In systems with only four triage categories, the expectant category is not used and these patients are triaged as either immediate or dead.

Dead

• The final category is dead, which is used for those patients who are not breathing.
• Because of resource limitations, no CPR in a MCE
• Except a child: cardiac arrest most commonly = respiratory not cardiac.
• However, whether the patient is a child or an adult, the responder will need to provide only limited interventions before considering the patient to be dead;
• a full attempt at resuscitation is not recommended unless there are more resources at the scene than are needed.

Lifesaving Interventions

• No complex medical care
• intubation, chest tube insertion, or traction splinting
• Keep sight of their goal during triage, which is to prioritize patients for treatment and/or transport
• Otherwise may incorrectly apply resources
• However, there are some cases where simple rapid lifesaving procedures should be provided during the triage process.

Triage Tags

• May include commercial triage tags, marking the patient with some type of pen or marker, or placing the patient in a geographic area that has been designated for a specific triage category.

SALT Triage

• One system not better than the others
• However, proposed national standard for mass casualty triage is called SALT triage
• SALT stands for: Sort, Assess, Lifesaving interventions, Treatment and/or Transport

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