SETRAC Regional Ebola Plan

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1 SETRAC Regional Ebola Plan Regional Ebola and Highly Infectious Patient Transport Plan and Special Considerations WHO YOU GOING TO CALL?

2 PROJECT PARTNERS

3 RETA SERVICE AREA

4 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

5 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.

6 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).

7 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.

8 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.

9 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 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

10 SCENARIOS Self-presentation to an acute care facility ER Self-presentation to a clinic, freestanding ER or physician office or Public Health call for assistance

11 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

12 PRESENTATION AND NOTIFICATION ACTION Screen, Isolate, Call Public Health for consult Institute PPE for contact and droplet precautions RESPONSIBLE PARTY All healthcare, EMS, Dispatch Centers All healthcare and EMS Obtain, package and transport requested blood sample Request transport through public health to CMOC to acute care facility Request transport through public health to CMOC for PCR confirmed cases to designated Treatment Centers Acute care facilities and freestanding ER/clinics Clinics and physician offices, PH, and assist calls Acute care facilities

13 POSITIVE LABORATORY ACTION Patient identified as moderate to high suspicion based on screening criteria per public health EVD testing approved results positive Notification of RETA request made to SETRAC/CMOC RESPONSIBLE PARTY All healthcare, EMS, Dispatch Centers, public health Public Health 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

14 Transfer Process ACTION Compliance with all EMTALA requirements for a transfer to a higher level of care. Report will be called to the accepting Treatment Provide an ETA to the transferring facility to facilitate a smooth transfer. Upon arrival of RETA, the hospital staff will clear hallways and transport the patient to the ambulance. Provide an ETA to the Treatment Center. This information will be relayed to the Treatment Center by CMOC. Epidemiological surveillance of healthcare workers involved in care as well as contacts of the patient. RESPONSIBLE PARTY Transferring Facility CMOC/SETRAC/DPS/RETA Crew Transferring Facility RETA Crew Public Health and the facility s Infection Control Professional

15 ARRIVAL AT ETC ACTION Notification to ETC 10 minutes PTA RETA will transport to designated location Patient will be off loaded at back of ambulance RETA will be taken to designated location for decon of vehicle and staff RETA will remain out of service for 24 hrs post-decon RESPONSIBLE PARTY RETA Supervisor ETC Security ETC Receiving Team ETC Safety Department, RETA Crew RETA Leadership

16 ADDITIONAL INFORMATION Regional Reporting Ebola Hospital Screening Guidance EMS Decision Tree Guidance EMS-Hospital Hand-off EMS Special Consideration Hospital Special Considerations Medical Waste Incinerators

17 Regional Reporting 17

18 Hospital Screening Guidance

19 EMS Decision Tree

20 EMS-Hospital Hand-Off

21 Full Scale Exercise February 12, 2015 Participating Agencies Memorial Hermann Southwest UTMB Galveston SETRAC AMR Ambulance Bay Star EMS Acadian EMS Region 2 Texas Department of Public Safety Galveston County Public Health

22 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

23 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, Test results returned positive at 2000 that day. RETA activated to transport daughter to hospital.

24 Ebola Assessment Center

25 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

26 Transport and Hand-off

27 Transport Convoy 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

28 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

29 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

30 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

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34 RETA NOTIFICATION The Public Health individual contacting the CMOC to request Regional Ebola Transport Ambulance (RETA) should be prepared to provide the following information: 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

35 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

36 Summary of Critical Tasks for RETA Notification Tasks Patient identified as some to high suspicion based on screening per public health Notification of RETA request made to SETRAC/CMOC SETRAC/CMOC notifies RCC for RETA Transport RCC Dispatch notifies on-call RETA of transport request RETA prepares crew and identified vehicle and provides ETA Agency All Healthcare, EMS, Dispatch Centers, Public Health Public Health SETRAC, RCC Dispatch RCC RETA Identified EMS

37 RETA Activation SOP 1. Upon notification of suspected case, notify supervisor 2. Arrange Conference Call to include the three (3) RETA services and Supervisor(s) 3. Ensure First-Up Ambulance Service is on standby with wrapped unit. Ensure back up ambulance service can be ready to transport 4. Notify SMOC of situation and request State Mission for transport if test is positive. 1. Mission To Include: Cost of wrapping, staffing (3 personnel), PPE, transport fee, supplies, equipment 2. Cost of Chase vehicle with personnel 3. Cost of Decontamination of Ambulance(s) 4. Cost of Waste incineration 5. Request for DPS escort

38 Cont d 5. Notify DDC for heads up of STAR request coming via WebEoc. 6. 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.

39 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

40 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)

41 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

42 Transport of Moderate/High Suspect from Home (9-1-1 support) Local 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 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 service RETA Ambulance coordinates with receiving facility of patient needs and ETA Hand-Off of patient at receiving facility occurs at back of ambulance

43 Transport of Deceased Moderate/High Suspected from Home Local 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

44 Cont d Determined to be moderate/high risk or evidence of gross bodily fluids at scene ME/JP notified and determination made if ME case 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 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

45 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

46 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

47 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 Put a mask on patient Wear Impermeable PPE Wrap the Patient in something / or POD Empty Fluid containers PRIOR to transport

48 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

49 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

50 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.

51 CONTACT US FOR MORE INFORMATION YOU CAN CONTACT US AT OR VIA OUR SETRAC OFFICE

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