LESSONS LEARNED 2016 2017 Ebola Virus Disease Training
LESSONS LEARNED 2016 -2017 Ebola Virus Disease Training & Exercise Program 1
Presentation Objectives Detail the Ebola Virus Disease Training and Exercise program by: • Explain the background of this project. • Discuss the PADOH Novel Disease Plan: Ebola Virus Disease Concept of Operations. • Explain the development, implementation and outcomes of the training program. • Explain the development, implementation and outcomes of the exercise program. 2
Ebola Virus Disease • In 2014, the West African countries of Guinea, Liberia, Sierra Leone experienced the worst Ebola Virus Disease (EVD) outbreak in history. • 15, 227 laboratory confirmed cases with 11, 310 deaths. • The United States experienced four domestically acquired EVD cases. • 11 total EVD cases treated in the United States. 3
Project Background • The Pennsylvania Department of Health (PADOH), Bureau of Public Health Preparedness (BPHP) contracted for services: • Ebola Virus Disease Training • Ebola Virus Disease Exercises • Train and Exercise the PADOH Novel Disease Plan: Ebola Virus Disease Concept of Operations. • Both contracts were awarded to Delta Development Group, Inc. in May 2016. 4
Project Deliverables • Training • Three trainings delivered in each of the 9 Healthcare Coalition Regions for a total of 27 trainings • TTXs • Development of a 4 -hour Tabletop Exercise (TTX) • One TTX delivery in each of the 9 Healthcare Coalition Regions and one TTX delivery for each of the 10 county/municipal health departments for a total of 19 TTXs • One Full-scale Exercise Delivery 5
Project Numbers • Trainings • 25 trainings held • 389 participants • Exercises • 19 TTXs • 483 participants • Full-scale Exercise • Three UPMC hospitals • Emergy. Care and Pittsburgh EMS • State agencies 6
Novel Disease Plan: EVD CONOPS 7
The CONOPS • Focuses on the operations of PADOH’s internal programs and on PADOH’s partnerships with other responding state, federal, and non-governmental agencies. • Significant coordination is required to manage a Person Under Investigation (PUI) or patient confirmed with EVD. 8
Planning Assumptions • PADOH utilizes the lowest jurisdictional level possible to address PUI and EVD patients. • Two-tiered response system: • All Commonwealth hospitals are Frontline Healthcare Facilities (FHFs) - ability to identify, isolate EVDs potential patients. • Pre-identified several hospitals that will serve as a state Ebola Assessment/Treatment Facility (EA/TFs). • There are pre-identified, trained, and equipped EMS inter-facility transport teams for any potential PUI interfacility transport. 9
Training Program 10
Training Purpose • Give an awareness-level overview of EVD. • Introduce the PADOH Novel Disease Plan: Ebola Virus Disease Concept of Operations (Con. Ops). • Provide an understanding of what an EVD scenario may look like in Pennsylvania. 11
Training Topics • Public health implications • Epidemiology • Infection control • Hospital support – FHF and EA/TFs • EMS support • Waste handling • Fatality management 12
Positive Outcomes • Great cooperation from too many to mention to schedule the classes and locations. • Successful pilot rollout with constructive feedback from stakeholders. • Provided information on public health in PA and how it works. • Introduction of the PADOH Ebola/Novel Disease CONOPS Plan was well received. • Many group discussions generated with good input from stakeholders and participants from a variety of backgrounds. 13
Exercise Program 14
Ebola TTX Goals • Validate the PADOH EVD Con. Ops in conjunction with local plans. • Provided state agencies, local health departments, and healthcare facilities the opportunity to explore the EVD Con. Ops. 15
Ebola TTX Goals • Reveal planning strengths and weaknesses in the EVD Con. Ops. • Increase the general awareness and understanding of how state agencies, local health departments, and healthcare facilities will communicate and share information; and • Discuss the issues relevant to case management, responder protection, and the management of waste created in the treatment of patient with EVD. 16
TTX Overview • Nineteen total TTXs - Two versions • County/Municipal Health Department Version • Healthcare Coalition Region Version 17
Scenario • Two patients - a mother and her young daughter, who return from a funeral held in a region in Africa where EVD was once prominent. • Placed under active monitoring and are in contact with the local CMHD. • Both patients become symptomatic during the 21 -day monitoring period, thus requiring treatment. • The scenario is intended to prompt discussion on: • • Notification process between state, local, and private, Coordination of the transport from home to a FHF, The coordination of the transport from a FHF to an EA/TF, Protective actions (i. e. PPE, waste management, fatality management) taken by all parties to prevent the spread of a highly infectious disease (HID). 18
Exercise Timeline • Development October-December 2016 • Delivery February through April 2017 • One-page summary document per exercise • Strengths • Areas of Improvement • New Ideas • TTX After-Action Report June 2017 19
Strengths • Diverse group of exercise participants, including hospitals, infection control officers, coroners, funeral home directors, police, fire, students, EMS, EMA, public health. • Agencies and organizations within specific regions and communities have worked with each other in the real-world, and have completed many trainings surrounding HIDs. • Communication and coordination between partners has been routinely tested. • Many hospitals, local health departments, and other local agencies will use a platform, like Knowledge Center or Web. EOC, to maintain situational awareness amongst response partners when there is a PUI in their area. 20
Strengths • Hospitals would use the Incident Command System (ICS) with a Unified Command that included the local CMHD and the local EMA when they have a PUI at their facility. • Most counties have an established process for notifying all public health/EMS/hospital partners, and it has been routinely tested and proven to work. • EA/TFs understand they have an important role in the EVD response process. They took on the immense system costs and staff took on added responsibility and training willingly. EA/TFs stress that they want to provide a well-built, safe place to treat a PUI or suspect-EVD patient. • EA/TFs understand the importance of having staff that is welltrained, confident, and competent. The money they’ve spent has as much to do with their want to protect their staff, as it is to provide competent treatment to any PUI. 21
Areas of Improvement • There is a need for increased lines of communication between PADOH and the various stakeholder groups within the state. • There needs to be more awareness of state level planning at the local level. • There are not enough ambulances and providers trained and equipped to transfer HID patients in the event of a large outbreak. • The current Con. Ops does not address the post-transport actions to be taken by the EMS units that bring a PUI to a FHF. 22
Areas of Improvement • The CMHDs are unsure of what is provided to a PUI under Active Monitoring/Direct Active Monitoring (AM/DAM) when they arrive back in the country. • Many small, rural hospitals voiced concern about all hospitals in the Commonwealth being mandated as an FHF. • Preparedness is not at the top of the list for some hospital administrations. Low preparedness budgets, lack of training. • There were concerns about potential PPE shortages. If PPE is scarce during an incident, providers would move to using crisis standards of care. 23
Gaps • The exercises also revealed a number of gaps and questions that will be addressed in continued planning efforts. These include: • What happens to the home where the PUI was picked up? • What kind of monitoring is done for providers who care and transport a PUI? • How are transfer decisions made? Which hospitals are the EA/TFs? How is the transfer coordinated between the FHF, EA/TF, and transport agency? How is decontamination managed? • How are children of a transported PUI managed? 24
Full-scale Exercise 25
Operation Keystone Convoy • Held June 15 – 16, 2017 • Exercise Goal • Identify a patient in a FHF and transport that patient to an EA/TF. 26
Players • University of Pittsburgh Medical Center (UPMC) • UPMC Horizon – Shenango Valley • UPMC Passavant – Cranberry • UPMC Montefiore • Emergy. Care EMS • Pittsburgh EMS • Department of Health • BPHP • BEMS • Bo. E 27
Exercise Objectives • Based upon the EVD Con. Ops • Command, Control, and Communication • All agencies involved in the decision process • Transport by EMS agencies from FHF to EA/TF with a patient handoff 28
Scenario – June 15 • A student from the Democratic Republic of the Congo, that attends Thiel, is picked up by his roommate at Pittsburgh Airport. Began feeling ill on the flight. • Car stops along road for the patient to become ill, passerby calls 911. • Public safety responds, patient becomes ill on some of the responders and warns them of the outbreak in his village. • Patient is transported to UPMC Horizon Shenango Campus. • Police and fire transported to UPMC Jamison. • UPMC System IP Manager contacts PA DOH. • PA DOH establishes the Department Operations Center. • Decision to transport the patient to the EA/TF. 29
Scenario – June 16 • Patient transport started by Emergy. Care EMS at UPMC Horizon Shenango Campus. 30
Scenario – June 16 • Emergy. Care completes the patient hand off at UPMC Passavant, Cranberry Campus to Pgh EMS. 31
Scenario – June 16 • Pgh EMS completes the handoff of the patient at UPMC Presbyterian/Montefiore. 32
Panel Discussion Moderator • Robert Ross – Delta Development Group, Inc. Participants • Eric Poach – University of Pittsburgh Medical Center • Harry Latta – Emergy. Care EMS • Mark Pinchalk – Pittsburgh EMS • Justin Sypolt – Pittsburgh EMS 33
Questions? 34
- Slides: 34