Annual Report

Transcription

1 Annual Report PREPARE. SUPPORT. RESPOND Texas Department of State Health Services Outstanding RAC Award Recipient! 600 Six Flags Drive, Suite 160 Arlington, Texas (817)

2 1

3 TABLE OF CONTENTS Message from the Board Chair 1 Message from the Executive Director 2 Board of Directors 3 Executive Summary 5 Financial Overview 6 Emergency Healthcare System Grants 8 Programs Supported with the Tobacco Endowment EMS County Assistance Pass-through Funds 9 Funding Details 2011 EMS County Assistance Fund Expenditure by Type FY 2011 Uncompensated Trauma Care Fund Distribution for Hospitals 10 Background Information FY 2011 Uncompensated Trauma Care Disbursement Local Projects Grants 11 FY2011 LPG Recipients from TSA-E REG*E 12 REG*E EMS and Trauma Centers Data Progress Acute Care Facility Designation 13 Trauma Stroke Cardiac Hospital Preparedness Program 15 HPP Funding Funding Distribution HPP Expenditures by Activity NCTTRAC Programmatic Support

4 Use of Hospital Reimbursement Allocation Subrecipient Hospital Planning for Response Decontamination and Personal Protective Equipment (PPE) Training & Exercises 19 Hazard Vulnerability Analysis (HVA) Super Bowl XLV & Regional Exercise Jericho Packaged Exercises HPP Year 9 Exercise Recap Regional Training MMU Training & Maintenance Videos Data and Information Systems 24 In Support of TSA-E Support Requests Uptime Report Redundancy and Back-up Crisis Applications 26 E*TRACS WebEOC Integration WebEOC Emergency Medical Task Force 27 Team Development Emergency Medical Operations Center 29 Interoperable Communications TDVR/ESAR-VHP (Medical Reserve Corps) Partnership/Coalition Building For Additional Information! 30

5 Message from the Board Chair I am excited to be the new Chair of the North Central Texas Trauma Regional Advisory Council (NCTTRAC). Over the past twelve years, I have seen our RAC grow from a small cubicle at the Dallas-Fort Worth Hospital Council in Las Colinas to filling most of the ground floor of the Centerpoint I Building in Arlington. The RAC has always been driven to develop the best pre-hospital and hospital emergency healthcare system in the state. Since our creation, it has provided hospitals, EMS providers, first responders, and medical personnel a venue for communicating issues and concerns that impact this region. The RACs were first created to help organize and coordinate trauma activities in trauma service areas. Our trauma service area (Trauma Service Area-E) is the largest in the state with a population of over $6 million in our nineteen counties. We receive more funding from the state and the federal government than any of the 22 RACs located in Texas, and our RAC has more Level I and Level trauma designated hospitals and more ALS and MICU EMS providers as well. I am proud of what the RAC has accomplished over the years and look forward to improving the RAC s ability to advance patient care for our citizens. During my seven years as Program Director for NCTTRAC, the Board of Directors has always been comprised of volunteers who actively worked to move the RAC forward. This group of individuals worked long and hard to develop a trauma system that served not only North Texas but across the state. Over time, the Hospital Preparedness Program was moved to the RAC from the Dallas-Fort Worth Hospital Council and emphasis on stroke and cardiac care were also added as key components to regional emergency healthcare planning. While the funding for Hospital Preparedness took our organization from a $500,000 to over $7 million annual budget, the RAC grew exponentially with personnel and additional hospitals. Even though hospitals receiving preparedness funds were not required to be RAC members, many joined and began to participate in RAC activities. The RAC has transitioned from a trauma focus to a comprehensive emergency healthcare system including emergency preparedness, cardiac, stroke, and trauma. All RACs in Texas focus on these key components under the direction of the Texas Department of State Health Services. Today, the RAC Board of Directors and committees are still comprised of volunteers, and they continue to work diligently for the benefit of the patient. One example is an emphasis on a regional trauma registry program to provide patient information for data-driven decision making, allowing this RAC to focus on projects having the most impact on patient outcomes. I am excited and proud to be the Chair for this RAC for the next two years and see it as a chance for NCTTRAC to continue to move forward as a RAC leader in this state. I am acutely aware that it will take a lot of work from all RAC committees and members to make the RAC the best it can be. I encourage all of our RAC members to get involved in a committee of the RAC that interests you and start making a difference in the delivery of patient care in the pre-hospital and hospital setting. I look forward to meeting and working with you to move this RAC forward in the years to come. Thanks for all you do and, remember, the RAC is only a strong leader as long as you are willing to get involved! Jimmy Dunn Chair, North Central Texas Trauma Regional Advisory Council 1

6 Message from the Executive Director "You've come a long way, baby, " Many of us (definitely not all) are old enough to remember the advertisement from way back when, "You've come a long way, baby, to get where you got to today " Hey, let's not dwell on its having been a marketing ad of the times, but rather its catchy and appropriate parallel in describing NCTTRAC's dramatic changes over the past few years! Quite often our leadership and members have shared that "not enough people know what the RAC does" and have expressed frustration in knowing the good works of the membership, as a group, go somewhat unnoticed outside of the membership itself. In recent strategic planning efforts of the RAC's Board of Directors this was addressed, even through the means of investing its own unrestricted reserve funds toward the proposals and activities that did yield a degree of success, if not enough to be self-sustaining. With lessons learned and resources considered, we've come to produce the document you are now reading in an on-going commitment to "spread the word" about NCTTRAC's continued growth and success. It is intended to make an illustrated accounting of what's been accomplished by the RAC over the year that's passed a "yearbook" of sorts. Before continuing, our RAC's history reaches back, as our long-contributing Trauma / EMS leaders and equally dynamic supporting members can attest, many years before the crafting of this, our first comprehensive Annual Report. To them, we should be exceedingly grateful for the foundation of pure commitment to improving systems of care for the patients' sake alone. These committed professionals, and volunteers, gave of their time and expertise before there was regionally contracted money to spend on system development, before the State provided Tobacco money, before EMS "pass-through", before it provided Hospital Preparedness Program funds but rather, because it was the right thing to do to systematically improve patient care and outcomes. To each of you those no longer as well as those still actively involved a huge debt of thanks! Now turning to the pages ahead, you'll see a "home-grown" effort our first NCTTRAC Annual Report produced and published entirely by the NCTTRAC employee staff to outline and provide overview of programmatic projects undertaken and summarized value derived. Fruits of our labor, so to speak, spanning the past fiscal year in review from ad-hoc event coordination and relationships with community partners to the more formally expected deliverables of Department of State Health Services contracts. With this document, we want to not only account to you what your RAC has been engaged with, but we also hope to stimulate interest and engagement by you in your RAC's continued progress toward being an organization that makes a difference! A difference resulting in improved facility and agency preparedness a difference resulting in improved support to providers and receivers alike a difference resulting in improved response capabilities by the RAC itself and its members but simply and most importantly -- a difference resulting in fewer people becoming trauma and acute care patients and better outcomes for those who do! NCTTRAC's current and "official" mission statement and philosophies follow, but first let me please encourage you to contact me, directly, at or rantonisse@ncttrac.org with any questions, comments, criticisms or even compliments that you may have with regard to your RAC. Your awareness, your support, your leadership, and dynamic followership exemplified by your active participation are all essential to system development and improved patient outcomes. Thanks again to you, in advance, for your continued and future commitment to the regional emergency healthcare system of both this Trauma Service Area and the State of Texas! Hendrik J. (Rick) Antonisse Executive Director, North Central Texas Trauma Regional Advisory Council 2

7 Board of Directors FY 11 Board Position Name Organization FY 12 Board Position Chair Carrie Hecht JPS Health Network Name Organization Chair Jimmy Dunn PHI Air Medical Vice Chair Jimmy Dunn PHI Air Medical Vice Chair Dr. Rajesh Gandhi Secretary Robert Knappage Sachse Fire Rescue Treasurer Wes Dunham Methodist Health System Air Medical Committee Dr. Bob Simonson (in FY 11 part of Systems Development) Physician Emergency Care Association EMS Committee Jodie Harbert Collin County College Finance Committee Pediatric Committee Physician s Advisory Group Liaison Professional Development Committee Pub Ed/Injury Prevention Committee Regional Emergency Preparedness Committee JPS Health Network Secretary Amy Atnip Medical Center of Plano Treasurer Wes Dunham Methodist Health System Air Medical Committee Cardiac Committee Ricky Reeves Lewisville FD Finance Committee Lori Vinson Dr. Bob Simonson Courtney Edwards Mary Ann Contreras Donna Glenn (in FY 11 part of Systems Development) SPI Committee Systems Development Committee Dwayne Howerton Sharon Eberlein (in FY 11 part of Systems Development) Zones Representative Children s Med Center Dallas Physician Emergency Care Association Parkland JPS Health Network Texoma Medical Center Rick Thurman Karen Yates Medical Center of Plano Methodist Mansfield Med Center EMS Committee Jodie Harbert Collin County College Pediatric Committee Physician s Advisory Group Liaison Professional Development Committee Pub Ed/Injury Prevention Committee Regional Emergency Preparedness Committee Stroke Committee Ricky Reeves Lori Vinson Dr. Bob Simonson Courtney Edwards Mary Ann Contreras Donna Glenn Sharon Eberlein CareFlite SPI Committee Dwayne Howerton Plaza Med Center of Fort Worth Lewisville FD Children s Med Center Dallas Physician Emergency Care Association Parkland JPS Health Network Texoma Medical Center Plaza Med Center of Fort Worth CareFlite (for FY12 replaced by Cardiac, Stroke, and Trauma Committees ) Trauma Committee Scott Vetterick Frisco FD Zones Representative Jorie Klein Scott Vetterick Parkland Frisco FD 3

8 4

9 Executive Summary We are pleased to provide this annual report to our members and partners and the region at large. The North Central Texas Trauma Regional Advisory Council (NCTTRAC) is an organization designed to facilitate the development, implementation, and operation of a comprehensive trauma care system based on accepted standards of care to decrease morbidity and mortality. The Trauma Service Area (TSA-E) for NCTTRAC is comprised of 19 counties of North Central Texas that include: Collin, Cooke, Dallas, Denton, Ellis, Erath, Fannin, Grayson, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, and Wise. NCTTRAC is the largest Trauma Service Area in the state serving a population equal to 25% of the population of the State of Texas and approximately 2% of the population of the United States. During Fiscal Year 2011, NCTTRAC has been proactive in building awareness among regional partners in many ways. The regional emergency healthcare patient data collection registry (REG*E) moved into the implementation phase as hospitals throughout the region signed agreements and began actively submitting data to the trauma registry. During 2011, stroke and submersion applications were purchased to enhance the registry with implementation of data submission expected to begin in mid NCTTRAC served as the Hospital Preparedness Program (HPP) regional contractor for the 4 th year in With 135 TSA-E hospitals participating in the program, NCTTRAC and its subrecipient hospitals represent the largest Texas regional healthcare coalition. The 2010 World Series and Super Bowl XLV provided NCTTRAC and regional partners the opportunity to showcase healthcare delivery resources and support local, regional, state, and federal agencies. These activities are just the first steps toward building the healthcare coalition and refocusing HPP toward regional capacity building. Implementation of the Emergency Medical Task Force (EMTF) initiative in 2011 provided NCTTRAC the opportunity to partner with Trauma Service Areas C and D (Wichita Falls and Abilene, respectively) in the coordination of EMTF-2. The EMTF Steering Group, consisting of representatives from Abilene, Wichita Falls, and the NCTTRAC Regional Emergency Preparedness Committee, has been developed to guide the project. A number of significant emergency medical response assets were purchased in 2011 to improve both regional and state-wide disaster response. These assets, including the first two of four ambulance buses, refrigerated transport trailers, and a mobile medical unit were set up in a static display at the General Membership Meeting held in September 2011 for members and regional partners to experience firsthand. These assets will be transferred to members and jurisdictions throughout the region. Through deliberate planning and coalition development, NCTTRAC leadership continues to work toward the fulfillment of our mission to support and improve all emergency healthcare through prevention, education, advocacy, research, preparedness, and response. The NCTTRAC Board of Directors and staff are proud of the work accomplished in and dedicated to continue the organization s progress in 2012 and beyond. 5

10 Financial Overview The Statement of Activities for the Fiscal Year Ended August 31, 2011 reflects NCTTRAC s financial activity for the last fiscal year. NCTTRAC receives funding through contracts and grants from DSHS as well as revenue from unrestricted organizational activities that are not related to the DSHS contracts and grants. Contract and grant funding sources for the Fiscal Year ended August 31, 2011 include the following: EMS/Regional Advisory Councils (EMS/RAC) The purpose of these funds is to assist in the enhancement and delivery of patient care in the EMS and Trauma Service Care System. Administrative support functions are the principal activities supported by this contract with the intent to enhance and improve delivery of EMS and trauma patient care in the nineteen county region served by NCTTRAC. Tobacco/RAC The purpose of these funds is to assist in maintaining and improving the Texas EMS/Trauma System to reduce morbidity and mortality due to injuries. These funds support programmatic functions related to the NCTTRAC Regional Patient Registry (REG*E) as well as provide educational programs and materials for members. ASPR/HPP The purpose of these funds is to enhance the ability of particpating hospitals and healthcare facilities to improve surge capacity and enhance community and hospital preparedness for public health emergencies by conducting activities at the local and regional level related to areas designated by the Office of the Assistant Secretary of Preparedness and Response. Local Projects Grant (LPG) The purpose of these funds it to conduct EMS program activities to develop, upgrade, or expande emergency medical services systems. The funds received during Fiscal Year 2011 were used to purchase the submersion module for REG*E and to purchase life vests for regional partners to distribute at public education events related to water safety and drowning, EMS/County Assistance The of these funds is similar to the EMS/RAC funds, to assist in the enhancement and delivery of patient care in the EMS and rauma care system. The primary difference is that these funds are paid directly to qualifying EMS Providers to support supplies, education and training, communications equipment, and vehicles. Unrestricted funds are orginzational and are not related to the contracts described above. Sources of these funds include membership dues, donations and sponsorships, and interest on investments. The Board of Directors is responsible for oversight and direction of unrestricted funds. According to Board directed policy, all contractual programs contained in the annual operating budget are required to balance. As such, total anticipated contract revenue must equal budgeted expenditures for each contract. As a result, unrestricted funds are not used to offset expenditures related to DSHS contracts. All contracts require that any funds remaining unobligated or unspent at the end of the contract period be returned to DSHS. For the second consecutive year, NCTTRAC has utilized 100% of the funding available from DSHS contracts resulting in $0 being returned to DSHS at the end of the fiscal year. While we expect that future funding through DSHS contracts and grants may be affected by current economic conditions, the Board of Directors and staff continue to strive to manage all NCTTRAC financial resources meet our mission to support and improve the emergency healthcare system within TSA-E through prevention, education, preparedness and response. 6

11 NCTTRAC STATEMENT OF ACTITIES FOR THE TWELVE MONTHS ENDED AUGUST 31, 2011 EMS/RAC TOBACCO ASPR/HPP YR 9 * ASPR/HPP YR 10 ** LPG EMS/COUNTY ASSISTANCE UNRESTRICTED TOTAL Revenue State of TX - DSHS 246, ,781 5,954, ,734 36, ,960-7,843,586 HPP Obligated not Requested , ,900 Membership Dues ,077 46,077 Interest on Investments ,650 2,650 Other - 8, ,615 Public Relations & Development - Sponsorships ,306 2,306 Meetings & Events ,462 3,462 Awareness Campaigns Educational Registration In-Kind Donations Total Revenue 246, ,281 5,954,505 1,442,634 36, ,960 54,809 8,393,795 Expenditures Air Medical EMS - 8, , ,788 Executive 183, , , ,090 Finance 62,252 38, , ,983 Pediatric - 1, ,745 Professional Development - 24, ,397 Public Education - 21, , ,293 REPC - - 5,954, , ,269,826 System Development System PI - 42, , ,231 Total Expenditures 246, ,281 5,954, ,321 36, ,960 47,680 7,259,352 Pending Obligations , ,272 Total Expenditures and Obligations 246, ,281 5,954,505 1,263,593 36, ,960 47,680 8,207,624 Revenues Over/(Under) Expenditures and Obligations , , ,171 Beginning Unrestricted Net Assets , ,185 Ending Temp Restricted Net Assets , ,041 Ending Unrestricted Net Assets , ,314 Ending Net Assets , , ,355 * ASPR/HPP YR 9 - Twelve Months Ended June 30, 2011 ** ASPR/HPP YR 10 - Two Months Ended August 31,

12 Emergency Healthcare System Grants The Emergency Healthcare System of Trauma Service Area-E receives funding from the Texas Department of State Health Services (DSHS) through several funding streams including Red Light camera enforcement, the state s tobacco settlement endowment, 911 surcharges, and various dangerous driving fines. Programs Supported with the Tobacco Endowment Maintaining support for training and operations for the REG*E project (our regional patient registry). Consulting services fees for legal services as well as required independent audits. Maintaining the Regional Communication Center Trauma Hotline. Supporting member and partner endeavors with donations and marketing items for events such as Shattered Dreams and safety fairs. Items included bike helmets, safety drawstring sport packs, and items with prevention messages. Supporting educational programs such as the Association for the Advancement of Automotive Medicine (AAAM) Injury Scaling Course for trauma programs, hosting an EMS legal seminar, and for continuing education offerings at the General Membership Meetings. FUNDING NOTES LEGISLATE SOURCE The Tobacco Endowment Fund was established in the Texas Government Code to provide the means for the Department of State Health Services to assist RACs in maintaining and improving the Texas Emergency Medical Services (EMS)/Trauma System to reduce morbidity and mortality due to injuries. FY 2011 TOTAL FUNDING $283,781 Purchasing EMS patient backboards for a new pilot regional NCTTRAC backboard program. Continuing support of NCTTRAC Newsletter development and other means of communication with membership such as our website and social media. Meeting support for Board of Director, Committee, and General Membership quarterly RAC meetings. Support of travel to regional and state meetings for appropriate staff and Committee Chairs. Portions of the costs related to personnel, lease space, office expenses and equipment, training directly related to conducting RAC business, and internet support. 8

13 EMS County Assistance Pass-through Funds Funding Details NCTTRAC received $366,960 in EMS County Assistance funds for distribution to EMS Providers through a reimbursement process. Licensed EMS Providers must fill both DSHS requirements for data submission, as well as local RAC participation requirements to be able to submit eligible receipts for reimbursement. RAC participation includes a Board approved application and dues, a minimum number of attended meetings, and participation in system performance improvement activities, if requested. EMS Providers were verified to have active participation status for their September 2008 through August 2009 membership period. FUND USE RESTRICTIONS According to DSHS guidance, the funds in this program can only be used for the following: Supplies Operational Expenses Education and Training Equipment Vehicles Communication Systems Items range from EMS supplies such as medication, bandages, and airway equipment to some very unique items. Some of the more interesting expenditures include language translation devices or training for EMS personnel, a four-wheel vehicle for response in off-road situations, recognition awards for EMS personnel, and safety officer training and travel EMS County Assistance Fund Expenditure by Type The purpose of these funds, originating from the same base sources as the Tobacco Allocation funds, are to assist in the enhancement and delivery of patient care in the EMS and trauma care system. Vehicles, $23,029 Across 56 EMS Providers Comm Equip, $3,615 Supplies, $95,461 County No. Providers EMS COUNTY ASSISTANCE PASS-THROUGH FUNDS Amount Per Provider County No. Providers Amount Per Provider Collin 7 $ 3,278 Hunt 1 $ 12,378 Cooke 1 $ 10,118 Johnson 4 $ 2,560 Dallas 21 $ 6,733 Kaufman 2 $ 5,648 Denton 12 $ 2,051 Palo Pinto 4 $ 2,338 Ellis 2 $ 6,976 Parker 1 $ 10,460 Erath 4 $ 2,742 Rockwall 2 $ 1,167 Equip, $158,160 Op Expense, $39,603 Fannin 1 $ 8,767 Somervell 1 $ 1,864 Grayson 1 $ 12,475 Tarrant 18 $ 3,011 Ed & Trg, $47,092 Hood 2 $ 3,158 TSA-E Total $ 366,960 9

14 FY 2011 Uncompensated Trauma Care Fund Distribution for Hospitals The Texas Department of State Health Services (DSHS) Office of EMS & Trauma Systems Coordination announced an Uncompensated Trauma Care Fund distribution during the week of September 12th, $872,359 from the Designated Trauma Facility and Emergency Medical Services (DTF\EMS) Account (3588 Monies) was distributed to 268 eligible hospitals around Texas. The grand total distributed to eligible hospitals since the inception of this funding source is approximately $382,665,152. $848,862 from the Emergency Medical Services, Trauma Facilities, and Trauma Care Systems Account (1131 Monies), and $539,766 from the Emergency Medical Services and Trauma Care Systems Account (911 Monies) was distributed to 256 eligible hospitals. Background Information Texas Health and Safety Code directs DSHS to use 96% of funds in the DTF/EMS Account (3588 monies) to fund a portion of uncompensated trauma care provided at hospitals designated as state trauma facilities or a hospital meeting in active pursuit requirements. Texas Health and Safety Code directs DSHS to use 27% of funds in the Emergency Medical Services, Trauma Facilities, and Trauma Care Systems Account (1131 Monies) and 27% of funds in the Emergency Medical Services and Trauma Care Systems Account (911 Monies) to fund a portion of uncompensated trauma care provided at hospitals designated as state trauma facilities. FY 2011 Uncompensated Trauma Care Disbursement Uncompensated Trauma Fund Distribution Across 32 TSA-E Hospitals $3,187,923 $606,744 DISBURSEMENT METHODOLOGY Uncompensated Trauma Fund Distribution Across 256 State of Texas Hospitals $539,766 $17,755,191 $872, Monies Red Light Monies 911 Monies 3588 Monies 1131 Monies 911 Monies Uncompensated trauma care charges from 2009, as reported by eligible hospitals on the Fiscal Year (FY) 2011 Uncompensated Trauma Care Fund Application (Hospital Allocation), were used in the funding formula. Fifteen percent (15%) of the total amount of funds available was divided equally among all eligible applicants. The remaining eighty-five percent (85%) was distributed to eligible applicants based on the percentage of uncompensated trauma care a hospital provided in relation to the total amount. $848,862 10

15 Local Projects Grants The Department of State Health Services Office of Emergency Medical Services Trauma Systems Coordination offers Local Project Grants (LPG) awards to eligible agencies for the funding of projects in support of EMS initiatives. For FY11, there were 85 applicants across Texas awarded funds totaling $1.3 million dollars. Of these, ten recipients from Trauma Service Area-E, including NCTTRAC, received a total of $130,283. This was the second straight year that NCTTRAC received a grant from this program. Continuing the theme of the previous year s award, NCTTRAC received $36,500 to partially fund an injury prevention initiative including life jackets for distribution by EMS agency members, as well as a submersion registry module for the regional patient care registry. FY2011 LPG Recipients from TSA-E AGENCY TOWN MEMBER STATUS AMOUNT Bonham FD Bonham Member $ 1,572 Bridgeport VFD Bridgeport *Non-Member $ 8,592 College Mound VFD Terrell *Non-Member $ 9,447 Cooke County EMS Gainesville Active Participant $ 22,500 Glenn Heights EMS Glenn Heights *Non-Member $ 1,600 Greenwood Rural VFD Weatherford Member $ 2,547 Keene Fire Rescue Keene Active Participant $ 7,500 Kennedale Fire Rescue Kennedale Member $ 35,000 Roanoke FD Roanoke Active Participant $ 5,025 *Membership is not required to receive LPG but qualifies the agency for additional points when applications are scored. 11

16 REG*E REG*E is the regional emergency healthcare patient data collection registry by the North Central Texas Trauma Regional Advisory Council (NCTTRAC) serving Trauma Service Area E (TSA-E); thus REG*E. The Board of Directors approved funding and grant requests to purchase REG*E with the purpose of collecting regional patient data using recognized national data sets. Robust reporting features then provide feedback to our participating stakeholders to help decrease morbidity and mortality for the populations of North Texas through professional and public education and system performance improvement. It is through the use of metrics we can drive best practices to reduce, and in some cases eliminate, trauma-related deaths. FY 2011 began with an implementation process which had stalled due to agreement concerns by some of our members. However, this was soon addressed through cooperative leadership on both sides and a strategy of helping hospital systems effect agreements for all of their system hospitals. This proved a successful strategy by the end of the fiscal year. Additionally, FY 2011 saw the acquisition of the stroke application add-on with Texas Department of State Health Services Tobacco Grant funds and the notification that NCTTRAC would be receiving funds to purchase the cardiac add-on, as well, with DSHS Local Projects Grants (LPG) funding. LPGs provided $13,500 in FY 2011 and $75,000 over three total years of matching grants, including the EMS and submersion injury components of REG*E. REG*E EMS and Trauma Centers Data Progress It has been an exciting year for the registry! NCTTRAC has witnessed substantial growth not only in participation as demonstrated by executed agreements to participate but with data submissions as well. Since April 2011, agreements signed by trauma centers have grown by 55 percent and EMS provider participation by 35 percent. Data submissions also increased significantly. In April, there were 10,437 data file submissions in REG*E. Since April that number has increased to 23,231 and is climbing. This is an extraordinary increase that will aide both EMS providers and hospital systems around the region to identify areas of greatest need for resources, education, and manpower allocation. The REG*E team continues the implementation phase for hospital and EMS patient registry modules. Several healthcare systems are working with NCTTRAC to sign one agreement which will allow all system facilities access to REG*E. While some agreements are pending for internal approval, there has been 100% success migrating data from all of the hospital trauma and EMS registry vendors in TSA- E. METRICS: SUBMISSIONS Quarterly data submissions from EMS Providers and Trauma Centers for Fiscal Year EMS providers and hospital personnel have access to several REG*E training classes each month. These are specifically designed to focus on the functionality of REG*E and the robust nature of the reporting system. REG*E staff is preparing for the roll-out of submersion, cardiac, and stroke components. Staff is also reporting monthly metrics on participation and data submissions to NCTTRAC s Board of Directors and as well as trauma specific related metrics to its stakeholders. The limits to this exciting regional capability are now only limited by the amount of data entered by the participants! 0 1,653 1,235 EMS 2,188 5,412 4,918 6,363 6,538 Trauma SEPT NOV 2010 DEC FEB 2011 MAR MAY 2011 JUN AUG

17 Acute Care Facility Designation As the largest Trauma Service Area in the state, NCTTRAC also has a high percentage of trauma and acute care designated hospitals. While this RAC does not designate or certify facilities, NCTTRAC staff plays a significant role in a facility s ability to meet designation requirements. All Texas Department of State Health Services (DSHS) designations require that the applicant show they are active participants in the system of care in which they seek designation. NCTTRAC staff not only keeps running totals of this participation, but also supports a structure where this participation is meaningful to regional patient outcomes. Facilities can meet criteria for participation through regional performance improvement opportunities, liaison activities with EMS Providers, public education and injury prevention activities, regional patient care data analysis, and other critical components of the designated facility s service to the region through NCTTRAC participation. Trauma Trauma designation, by level, has the longest history, with the trauma system in Texas turning twenty years old during Trauma facilities are designated by DSHS at four different levels: Level I Comprehensive Trauma Facility Level Major Trauma Facility Level I Advanced Trauma Facility Level Basic Trauma Facility All four levels are critical to the trauma system, with Level I and facilities serving as treatment and stabilization centers. Level I and hospitals not only have protocols for those responsibilities but also have efficient pathways to transfer the most critical patients to a Level I or trauma center. There is also a NCTTRAC Regional Trauma System Plan and regional guidelines, both adopted by NCTTRAC s general membership, which provide guidance for transporting directly to a Level I or trauma center when it is in the best interest for patient care. Level I and trauma centers are surveyed according to American College of Surgeons Committee on trauma criteria with nationally recognized teams. Level I and centers are surveyed by the Texas EMS Trauma and Acute Care Foundation (TETAF) according to DSHS standards. The current list of designated trauma facilities in Texas is available at: trahosp.shtm TRAUMA CENTERS BAYLOR UNERSITY MEDICAL CENTER CHILDRENS MEDICAL CENTER OF DALLAS JOHN PETER SMITH HOSPITAL PARKLAND MEMORIAL HOSPITAL COOK CHILDRENS MEDICAL CENTER MEDICAL CENTER OF PLANO METHODIST DALLAS MEDICAL CENTER TEXAS HEALTH HARRIS METHODIST FORT WORTH DENTON REGIONAL MEDICAL CENTER HUNT REGIONAL MEDICAL CENTER GREENVILLE TEXOMA MEDICAL CENTER TEXAS HEALTH HARRIS METHODIST HEB TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO DALLAS REGIONAL MEDICAL CENTER ENNIS REGIONAL MEDICAL CENTER GLEN ROSE MEDICAL CENTER LAKE GRANBURY MEDICAL CENTER LAKE POINTE MEDICAL CENTER MEDICAL CENTER OF ARLINGTON MUENSTER MEMORIAL HOSPITAL NAVARRO REGIONAL HOSPITAL NORTH TEXAS COMMUNITY HOSPITAL NORTH TEXAS MEDICAL CENTER PALO PINTO GENERAL HOSPITAL RED RER REGIONAL HOSPITAL TEXAS HEALTH HARRIS METHODIST CLEBURNE TEXAS HEALTH HARRIS METHODIST AZLE TEXAS HEALTH HARRIS METHODIST STEPHENVILLE TEXAS HEALTH PRESBYTERIAN ALLEN TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN WEATHERFORD REGIONAL MEDICAL CENTER WISE REGIONAL HEALTH SYSTEM LEVEL I I I I I I I I (IP) I 13

18 Stroke Stroke care facilities have been designated by various agencies over recent years, with the most common being The Joint Commission, which also accredits hospitals and other specialty areas of care. There are two recognized levels of stroke designations in Texas: Level Primary Stroke Facility Level I Support Stroke Facility Level facilities are certified by The Joint Commission and then designated by DSHS. There is no Level I certification process from Joint Commission, so DSHS has recently developed and is coordinating those surveys with TETAF according to DSHS standards as STROKE FACILITIES BAYLOR REGIONAL MEDICAL CENTER AT GRAPEVINE BAYLOR UNERSITY MEDICAL CENTER DOCTORS HOSPITAL AT WHITE ROCK JOHN PETER SMITH HOSPITAL MEDICAL CENTER OF ARLINGTON MEDICAL CENTER OF MCKINNEY MEDICAL CENTER OF PLANO LEVEL well. These designation levels are considered in the NCTTRAC Regional Stroke System Plan, adopted by the General Membership, to assist with the decision on the best facility to receive a pre-hospital patient suspected of having a stroke. The current list of designated stroke facilities in Texas is available at: etrastroke.shtm. MEDICAL CITY DALLAS HOSPITAL Cardiac METHODIST DALLAS MEDICAL CENTER METHODIST RICHARDSON MEDICAL CENTER METHODIST CHARLTON MEDICAL CENTER NORTH HILLS HOSPITAL PARKLAND MEMORIAL HOSPITAL PLAZA MEDICAL CENTER OF FORT WORTH TEXOMA MEDICAL CENTER TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL TEXAS HEALTH HARRIS METHODIST HEB TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS TEXAS HEALTH PRESBYTERIAN WILSON N. JONES UT SOUTHWESTERN UNERSITY HOSPITAL There are no current state designation requirements for cardiac hospitals, although TSA-E has many facilities that are recognized by the Society of Chest Pain Centers. The proposed NCTTRAC Regional Acute Coronary Syndrome Plan is in a final draft stage and considers these types of cardiac center capabilities for patient destination decisions. NCTTRAC staff and committee members are also actively participating with other regional cardiac initiatives such as the American Heart Association and the Caruth Grant project in Dallas. CHEST PAIN CENTERS BAYLOR MEDICAL CENTER AT CARROLLTON BAYLOR MEDICAL CENTER AT GARLAND BAYLOR MEDICAL CENTER AT IRVING BAYLOR REGIONAL MEDICAL CENTER AT GRAPEVINE CENTENNIAL MEDICAL CENTER DENTON REGIONAL MEDICAL CENTER DOCTORS HOSPITAL AT WHITE ROCK HEART HOSPITAL BAYLOR PLANO LAS COLINAS MEDICAL CENTER MEDICAL CENTER OF LEWISVILLE MEDICAL CENTER OF MCKINNEY MEDICAL CENTER OF PLANO MEDICAL CENTER DALLAS HOSPITAL METHODIST MANSFIELD MEDICAL CENTER METHODIST RICHARDSON MEDICAL CENTER NORTH HILLS HOSPITAL PLAZA MEDICAL CENTER OF FORT WORTH TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL TEXAS HEALTH HARRIS METHODIST HEB TEXAS HEALTH HARRIS METHODIST HOSPITAL AZLE TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH TEXAS HEALTH HARRIS METHODIST SOUTHWEST TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS TEXAS HEALTH PRESBYTERIAN HOSPITAL DENTON TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO TEXAS HEALTH PRESBYTERIAN WILSON N. JONES WISE REGIONAL HEALTH LEVEL I w/pci w/pci w/pci I I I w/pci w/pci w/pci I w/pci I w/pci I w/pci I w/pci I w/pci I I w/pci I w/pci I I w/pci I I w/pci w/pci I w/pci I w/pci I w/pci 14

19 Hospital Preparedness Program NCTTRAC continued its leadership role in pre-hospital and hospital preparedness efforts by again serving as the Hospital Preparedness Program (HPP) regional contractor for the Texas Department of State Health Services. Of the state s 664 hospitals, 135 of TSA-E s hospitals participated in the program making NCTTRAC, and its subrecipient hospitals, the largest Texas regional healthcare coalition. Demonstrating region-wide improvements in medical surge capacity, NCTTRAC, participating hospitals, and area EMS agencies showcased health care delivery preparedness while supporting local, regional, state, and federal agencies during both the 2010 World Series and Super Bowl XLV. These efforts became the springboard for enhancement of the healthcare coalition and future refocusing of the Hospital Preparedness Program toward regional capacity and capabilities building. HPP Funding HPP YEAR 9 OVERVIEW Contract Award NCTTRAC received $5,254,505 in baseline HPP funding for the period July 1, 2010 June 30, This represented 18.3% of the federal $28,701,403 award received by Texas. Supplemental funding for the development of an Emergency Medical Task Force ($250,000) and Public Health Emergency Response (PHER) improvement ($450,000) boosted program funding to $5,954,505. PHER $450,000 EMTF $250,000 HPP $5,254,505 Contract Period July 1, 2010 June 30, 2011 HPP Year 9 Award Total Funding: $5,954,505 HPP Award: $5,254,505 EMTF Award: $250,000 PHER Award: $450,000 Participating Hospitals Start: July 2010: 126 End: June 2011: 135 Funding Per Participating Hospitals: $5,500 Funding Distribution HPP expenditures promoted the growth of the healthcare coalition and hospital readiness during Year 9 through a prioritized spending approach of Overarching, Level 1, and Level 2 Sub-Capabilities. Per Capita Funding (Population 6,776,660): $ HPP CAPABILITY SPENT PROGRAM IMPLEMENTATION $1,355,315 OVERARCHING REQUIREMENTS $1,290,734 LEVEL 1 SUB-CAPABILITIES $1,130,896 31% 7% 22% PROGRAM OVERARCHING LEVEL 1 LEVEL 2 LEVEL 2 SUB- CAPABILITIES $1,727,560 PHER PROJECT $450,000 21% PHER TOTAL $5,954,505 19% 15

20 HPP Expenditures by Activity HPP CAPABILITY ACTITY EXPENDITURES OVERARCHING NATIONAL INCIDENT MANAGEMENT SYSTEM (NIMS) $1,121,698 EDUCATION AND PREPAREDNESS $115,949 EXERCISES, EVALUATIONS, AND CORRECTE ACTIONS $40,673 NEEDS OF AT RISK POPULATIONS $40,673 LEVEL 1 SUB-CAPABILITY INTEROPERABLE COMMUNICATIONS $959,103 FATALITY MANAGEMENT $483,952 MEDICAL EVACUATION / SHELTER IN PLACE $135,786 PARTNERSHIPS AND COALITIONS $2,054 BED TRACKING AND REPORTING $0 EMERGENCY SYSTEMS FOR ADVANCED REGISTRATION OF VOLUNTEER HEALTH PROFESSIONALS (ESAR-VHP) $0 LEVEL 2 SUB-CAPABILITY MOBILE MEDICAL ASSETS $1,275,345 PERSONAL PROTECTE EQUIPMENT (PPE) $282,246 DECONTAMINATION EQUIPMENT $65,651 CRITICAL INFRASTRUCTURE PROTECTION $32,745 ALTERNATE CARE SITES $3,215 PHARMACEUTICAL CACHES $387 MEDICAL RESERVE CORPS $0 NCTTRAC and hospital expenditures prioritized and supported 14 of 17 program activities in HPP Year 9. Work within the three remaining requirement areas was accomplished at no cost. NCTTRAC Programmatic Support NCTTRAC provided logistical support to regional preparedness and coalition building by implementing major procurement contracts. Primary regional projects included support of the LiveProcess hospital incident management system for all subrecipient hospitals, the provision of commercial and amateur band radios to hospitals, procurement of personal protective and decontamination equipment for new subrecipients, two ambulance buses, and ten refrigerated support trailers. PROJECT SUPPORTED SPENT LEPROCESS ALL SUBRECIPIENT HOSPITALS $1,105,962 AMBULANCE BUSES EMERGENCY MEDICAL TASK FORCE $1,048,371 REFRIGERATED SUPPORT TRAILERS REGIONAL HEALTHCARE COALITION $450,000 SUBRECIPIENT HOSPITAL RADIOS ALL SUBRECIPIENT HOSPITALS $116,080 PPE AND DECON EQUIPMENT ALL SUBRECIPIENT HOSPITALS $36,011 TOTAL $2,351,424 Use of Hospital Reimbursement Allocation NCTTRAC procured the LiveProcess hospital incident management system for all subrecipient hospitals, and implemented within that platform a system by which those hospitals were able to file an expenditure plan and appropriate documents supporting their expenses. Based upon a regionally-approved formula that gives more credit to hospitals that most contribute to regional healthcare delivery in a mass casualty situation, hospital allocations totaled $1,294,276, and ranged from $3,130 for the smallest non-acute care facility to $26,841 for the largest trauma centers. 16

21 Of the $1.294 million allocation, hospitals requested reimbursement for $615,189. A second reimbursement phase was implemented which provided another $553,438 to 29 hospitals. NCTTRAC applied the remaining unclaimed $125,649 to Reassigned to Regional Projects 10% Hospital Reimbursement Allocation Usage Initial Reimbursements 47% regional projects and, following a contract amendment, awarded a purchase order for two ambulance bus chassis for use by Emergency Medical Task Force-2. End of Year Reimbursements 43% Subrecipient Hospital Planning for Response The Hospital Preparedness Program sets benchmarks by which subrecipient hospital planning and readiness may be measured. These benchmarks include the development of plans for mass human fatalities, pandemic influenza response, medical evacuation and sheltering in place, pharmaceutical cache distribution, and medical evacuation / shelter in place planning. Subrecipient hospitals are also required to establish and maintain the capability to perform decontamination and use personal protective equipment. Mass Fatality Planning Each subrecipient hospital was expected to complete a final mass fatality plan that includes a process for handling deceased remains of up to 5% of their licensed bed capacity for 24-hours. NCTTRAC supported this goal by providing each hospital the BioSeal fatality response system. BioSeal is capable of supporting Biosafety Level 4 containment of deceased remains. Final 64 Draft 11 No Plan 2 Pandemic Influenza Response Plans Final 101 Draft 28 No Plan 4 Final Mass Fatality Plans Pandemic Influenza Response Planning Each subrecipient hospital was expected to have a final Pandemic Influenza Response Plan that addresses development and operation of Alternate Care Sites (ACS), triage of the ill, science-based triggers for action, use of personal protective equipment, just-in-time training of staff, education of the workforce, education of ill individuals and their caregivers, and equipment and supplies. These plans should continue to develop and improve ACS plans and concept of operations for providing supplemental surge capacity to the healthcare system. 17

22 Pharmaceutical Cache Planning Each subrecipient hospital was expected to complete a final pharmaceutical cache plan that provided for the distribution of broad spectrum prophylaxis for hospital staff and hospital-based EMS, and their families, for a period of 72 hours. Plans addressed the continued purchase, rotation, and maintenance of antibiotic and antiviral caches and vendor relationships in lieu of direct purchase. Final 76 Draft 17 No Plan 7 Final Pharmaceutical Cache Plans Final 98 Draft 24 No Plan 11 Final Medical Evacuation / Shelter in Place Plans Medical Evacuation / Shelter in Place Planning Subrecipient hospitals were expected to have the ability to receive emergent shelter-in-place notifications and institute appropriate shelter-inplace plans including notifications within the facility, communication internally and externally, and institute measures to preserve facility infrastructure and to sustain such operations for at least 48 hours. Supporting facility evacuation, all subrecipient hospitals were required to have a final plan detailing vertical and horizontal evacuation within the facility, out of the facility but within the local area, and out of the facility and out of the local area. Decontamination and Personal Protective Equipment (PPE) Hospitals must ensure that adequate amounts of appropriate personal 62 protective and decontamination equipment is in place to protect current and additional trained healthcare personnel expected in support of response to hazardous events. Acute care hospitals have a minimum 14 requirement of 12 sets of Level C 13 Level C PPE Achieved personal protective equipment. Nonacute care facilities are expected to have 6 Not Reported at least six sets of Level C PPE. NCTTRAC Level C Partially Achieved provides initial PPE and decontamination Acute Care equipment to hospitals joining the Non-acute Care program. Hospitals with existing stocks of PPE and decontamination equipment are expected to use the reimbursement system to maintain and sustain these minimum levels. The amount and type of PPE and decontamination equipment held by hospitals is dictated by the facility s Hazard Vulnerability Assessment. 18

23 Training & Exercises Throughout the Hospital Preparedness Program (HPP) contract year, NCTTRAC provides regional training courses, drills, and exercises designed and implemented in support of ESF- 8 (Emergency Support Function #8) Public Health and Medical Services. Training courses are identified through workgroups, regional recommendations, and exercise After Action Reports. Once identified for the upcoming program year, hands-on training, classroom-based informative sessions, and regional functional-level exercises are submitted to the Department of State Health Services (DSHS) within a cumulative document referred to as the Multi-year Training & Exercise Plan or MYTEP. The purpose of the MYTEP is to allow multiple organizations, within a trauma service area and across the state, to coordinate training courses and exercises in an effort to reduce or eliminate duplicated efforts. All NCTTRAC training and exercise efforts are consistent with identified regional and state priorities through a standardized implementation program, the Homeland Security Exercise and Evaluation Program. While the overarching sub-capabilities for training and exercises are directed from DSHS, regionally identified hazards and threats specific to North Central Texas are analyzed annually. Based on a systematic process for ranking hazards (i.e., tornados, hurricanes, terrorism), training courses and exercises are designed and implemented to address regional hazards. During HPP Year 9, a workgroup designated specifically for creating a regional Hazard Vulnerability Analysis (HVA) was established in order to both complete a required regional HVA for NCTTRAC and to guide in the development of future training and exercise needs for the region. Hazard Vulnerability Analysis (HVA) 53 HVA Results Reported Fall 2011 Miscellaneous Results Not Displayed: 41% Total of Completed Surveys: 69 Total Number of Hazards: 357 Tornado Severe Weather 36 Ice Storm 26 Electrical Failure IT Failure Mass Casualty Epidemic / Disease Outbreak Water Supply Failure Large-scale Terrorism Under the direction of the Regional Emergency Preparedness Committee (REPC), the HVA Workgroup was formed with the distinct purpose of creating a regional report that captured, through a survey assessment tool, hospital and public health hazards. Volunteers were solicited and quickly gathered momentum through REPC members participation. This workgroup included representation from several major trauma facilities within the metroplex with Chris Noah, from Parkland Hospital in Dallas, serving as workgroup lead. A standardized methodology for gathering hospital data was identified and the survey assessment tool was implemented region-wide. Hospitals accredited by The Joint Commission are required to conduct or review their respective HVA annually, and the workgroup recognized that a wide-array of HVA assessment tools would be in 19

24 use. Next steps included evaluation and use of a standardized HVA tool along with data analysis and assessment of the results. With NCTTRAC staff support, the HVA Workgroup surveyed hospitals within the North Central Texas region for their top HVA results using a standardized tool. Ranking of top priorities and hazards are shown above. Super Bowl XLV & Regional Exercise Jericho The North Central Texas region has successfully managed many large-scale planned and unplanned events in its past but none greater in scale than the planning and preparation for Super Bowl XLV (SBXLV). Advanced exercise planning began as early as March of 2009 during which NCTTRAC supplemented wage-offset costs for hospital staff who were actively involved in training and exercises in preparation for the February 2011 event. Throughout the months leading up to SBXLV, NCTTRAC staff was also heavily involved in regional planning efforts to support the readiness of public health and medical services through the facilitation of regional planning sessions and through staff attendance of regional meetings, as well. Leading up to the Super Bowl, NCTTRAC staff participated in planning committees, workgroups, specialized training, and various levels of response exercises. Under mobilization order by DSHS, NCTTRAC staff was assigned as an agency representative for medical services as one of the ESF-8 liaisons serving in support of the combined Disaster District Committees (DDCs) in our region from January 27 to February 6, The Trauma Service Area E Medical Operations Center (TSA-E MOC) was also activated during this time with staff support throughout the game. In preparation for the Super Bowl and the Regional Exercise (REGEX) Jericho, which was held in January in preparation for the SBXLV, NCTTRAC staff improved the use of a tracking tool through WebEOC to allow for the regional tracking of patients in a mass casualty incident (MCI). The final product, referred to as the MCI Toolkit, 20

25 was used by all hospital exercise participants during REGEX Jericho. Jericho was designed around a scenariosimulated act of terrorism at a major sporting event, resulting in a potential perfect storm for a mass casualty incident. REGEX Jericho was designed to test the regional strengths and weaknesses of response elements related to patient triage, transport, transfer, and tracking. The exercise was conducted during evening hours while also running concurrently with a real event, the 2011 ATA&T Cotton Bowl Classic. The atypical timing of a regional exercise during the evening hours along with the alignment during the Cotton Bowl game demonstrated regional planning, training, and exercise commitment by participants in support of SBXLV preparation. REGEX Jericho served as the first steps for regional testing of preparedness efforts in patient tracking and transfer in advance of Super Bowl XLV. Nearly one hundred organizations from within the North Central Texas region were involved which allowed for a significant proof of concept testing of the new MCI Toolkit. Prior to the exercise, discussion and planning sessions with local EMS agencies and hospitals were conducted to maximize the use of this computer-based tracking tool during field triage. With the nod of approval from our participating EMS partners that the tool could potentially serve to assist with a regional patient transfer / tracking system during a mass casualty incident, the first test of the system was conducted. For the hospitals and partnering agencies participating during the exercise, the MCI Toolkit was used for the transfer of over 2,000 simulated patients. These simulated patients were entered, tracked, and/or transferred throughout the region within the exercise duration of 4 hours. This bank of simulated patients included fictitious first and last names, dates of birth, gender, and triage categories. Simulated patients were received and transported within WebEOC in a system of waves, as shown above. With the exception of minor adjustments following the exercise, the MCI Toolkit showed great promise for its utilization as a successful resource for tracking patients during a large scale emergency. Packaged Exercises Over the course of three HPP program years, NCTTRAC has provided several regional functional-level exercises that meet requirements set forth by DSHS, the National Incident Management System (NIMS), the Homeland Security Exercise & Evaluation Program (HSEEP), and The Joint Commission. By providing regional exercises at the functional level, NCTTRAC assists hospitals with fulfilling their exercise requirements to test their Emergency Operations Plans, Hospital Incident Command System, and Hospital Command Centers. NCTTRAC now offers these past exercises as a packaged deal that allows hospitals to conduct one of the regional, NCTTRAC staff-developed exercises to assist hospitals with continuing to meeting their exercise requirements or serving as a re-test opportunity for any corrective action items that were identified during previous training or exercises. The packaged exercises being provided by NCTTRAC include all supporting and required HSEEP and DSHS exercise documentation including the After Action Report template, the Exercise Evaluation Guide, and the Master Scenario Events List. With the provision and support of our regional exercise packages, it is just one more way that NCTTRAC staff is continuing to support hospitals successful training and exercise activities! 21

26 HPP Year 9 Exercise Recap Exercise Scenario: The North Central Texas region was impacted by an act of terrorism with partial structural collapse of a major venue during a high-profile sporting event. As first responders coordinated patient triage and transportation, hospitals mass casualty plans were activated in preparation for overwhelming patient surge, patient discharge / transfers, and coordination activities. Exercise Scenario: The North Central Texas region was impacted by an act of terrorism involving an aerosolized biological weapon. This incident affected a significant portion of the population. Public health officials began efforts to minimize the outbreak by operating Points of Dispensing Sites for treating the general public within the region. Regional Exercise Red Cloud was conducted simultaneously and in collaboration with Operation Bluebonnet conducted by DSHS Health Service Region 2/3. Regional Training Each year, training courses are provided to address areas of concern from either vulnerabilities identified within the regional HVA, overarching sub-capabilities and requirements, hospital liaison recommendations, and deficiencies trending from exercise After Action Reports. During the time that NCTTRAC has managed the Hospital Preparedness Program for Trauma Service Area-E, training courses have ranged from the operational functionality of hospital decontamination team members to those in need of critical incident stress management for mental health situations. In HPP Year 9, NCTTRAC provided new courses for our region including a Healthcare Facility Evacuation Training Course, Internal HAZMAT Spill Course, and DECON Refresher training. 26% 5% 4% 4% 5% 56% Hospital Other Fire Public Health EMS County This year, training was again provided on hospital campuses across North Central Texas in a continued effort to bolster the readiness level of hospital decontamination teams. The capability for hospital emergency departments to provide mass patient decontamination is vital. The course of instruction covers the required precautionary measures as identified by the Occupational Safety and Health Administration (OSHA) for first receivers in healthcare facilities. The benefit of conducting training at hospital locations is allowing staff the familiarity of their provided equipment and the footprint of operations. A component of the on-site vendor training that hospitals receive is the added value of having a subject matter expert available to provide recommendations of practices that have worked best at other locations. As each hospital is unique in geographic location, access points, emergency department, and ambulance bay entrances, staging of equipment and the response process varies widely. Instructors share these lessons learned and best practice methods throughout the course of instruction. Trained team leaders and team members then 22

27 serve as a force multiplier throughout their own hospitals and the region as their expertise is shared from NCTTRAC supported training initiatives and beyond! MMU Training & Maintenance Videos During the eighth year of the Hospital Preparedness Program, funding was allocated for the creation of a training video that explained the deployment, operational functionality, nomenclature, and reconstitution of the Base X model Mobile Medical Units. The purpose of the training video was to provide a just in time tool for asset deployment while also being used as an introductory training aid. The availability of expedient training is vital to the operational direction NCTTRAC is heading toward with the development and implementation with the Emergency Medical Task Force. As several Base-X model MMUs have been forward placed in anticipation of an event, annual competency training is a must. Over the past year, a second video was created to provide training on the maintenance of the entire unit. This includes the main sections of the asset, as well as the ancillary equipment such as generators, inflator boxes, and HVAC units. Both videos are available for viewing on the NCTTRAC homepage. 1. HVA Page: 2. Packaged Exercises: 3. Regional Training: 4. MMU Training Video: 5. MMU Maintenance Videos: 23

28 Data and Information Systems NCTTRAC s Data and Information Systems Division has made extraordinary progress over the last 12 months. There are always further opportunities ahead in the coming year, which we look forward to tackling with dedication and optimism. This portion of the report provides you with a summary of the DIS Division s goals and objectives as well as our successes. The mission of the Data and Information Systems Division is to provide superior crisis application systems and customer service to support the mission of NCTTRAC and its partners. In Support of TSA-E Being consistent with our mission statement, a goal to build and provide a comprehensive online support system for our end users. That system was launched in late May The scope of the potential for end user support is demonstrated in the chart to the right. While many of the accounts are duplicated in the different systems, there are variations for a number of reasons. 519 Agency and User Counts Agencies Users The largest of these reasons is the agencies and users in E*TRACS for TSA-C and D in direct support of Emergency Medical Task Force-2. E*TRACS WebEOC EMResource Support Requests Since the deployment of the online support system, the DIS Division has responded to 1,600 support tickets and had 4 live support chats. That averages out to about 9 tickets a day with an initial response time of 4 hours. Our goal is to have a response time of less than 6 hours for any ticket. The following table outlines how the requests come to the support helpdesk. Level 1 Support handles all the tickets first for resolution. If resolution cannot occur, the ticket gets escalated to Level 2 Support. The RAC Internal Group is a section set up for internal staff to route tickets to the support helpdesk. Items in this group are website or distribution list updates. REG*E Support is a group specifically dedicated to the support of the regional patient registry. TICKET SOURCE GROUP TOTAL WEB LEVEL 1 SUPPORT LEVEL 2 SUPPORT RAC INTERNAL REG*E SUPPORT

29 Uptime Report The world of data management is measured in the time it is accessible to the end user. The expectation in the social world is that data systems are available and up at all times. This is all the more important in the world of emergency management. While and websites are important, to NCTTRAC and our partners, our crisis applications take precedence. The critical applications we host are: E*TRACS WebEOC REG*E Tandberg Video Conferencing and Listserv This chart shows the availability (uptime) of each of the above crisis or critical applications we host at the NCTTRAC. We maintain a % available status on all our major systems, including the network which is up % of the time. Uptime % % % % In perspective, this translates into being unavailable for about 5.3 minutes over the course of last 365 days. The causes of that unavailability were by updates to the system. In the past year, we did not encounter any unplanned outages % E*TRACS WebEOC REG*E Tandberg Redundancy and Back-up In the emergency management community, redundancy and back-up are terms that are applied to several theories. In the data management community these terms mean very specific things. Redundancy is having a real-time, ready to take over, duplicate of the system. In this past year, we established a contract with the Southwest Texas Regional Advisory Council (STRAC) to share and host a redundant system for our crisis applications. In return, we are hosting a backup copy of their critical data. That link was established four months ago, and we are working to improve the connection between us for a solid fail-over redundant solution. Back-up is a capture of data at a point in time and producing a copy in case of a failure. We back-up all data on a nightly schedule. This back-up is hosted locally. We are currently testing the Southwest Texas Regional Advisory Council and others for a secondary backup location. We expect the resolution of this project by the end of the calendar year

30 Crisis Applications E*TRACS E*TRACS is the acronym for TSA-E Tracking Resources, Alerting, and Capabilities System. It is a web-based database software that provides tools for coordinated preparedness and response by the health and medical sectors of our area. It was developed by ImageTrend (same developer for our patient registry software) specifically to track bed, inventory and resource availability from all designated agencies within the area as well as providing for allocation of these resources to support surge capacity needs. Agency diversion status, EMS resources, resource requests, and alert notifications are supported in real time. There has been substantial growth in the E*TRACS product in the past year. We started in March 2011 reporting bed information and using the notification system for alerts and advisories. We also started uploading the RAC specific documents into the Knowledgebase for easy access by facilities. WebEOC Integration A large advancement this past year has been the integration of WebEOC Medical Dashboard information into E*TRACS. We have integrated all the bed types to populate from WebEOC to E*TRACS and vice-versa. This advancement has given us the opportunity to allow for 75% more time for the hospitals to gather bed information and report it. The reason for this is because of the dynamic and quick reporting capabilities we have in E*TRACS versus what is available for reporting in WebEOC. Simulated MCI Patients during REGEX Jericho Red Yellow Green Black Red Yellow Green Black WebEOC WebEOC is a web-enabled, user-friendly, and locally-configurable incident and event management system. With access to the Internet, authorized emergency managers and first responders, regardless of location, can enter and view incident information in WebEOC status boards. NCTTRAC uses WebEOC to collaborate through situational awareness and a common operating picture with regional and state partners. As mentioned in the Training and Exercises section, a significant tool was added to the WebEOC arsenal in response to an identified need for patient tracking and transfer in support of the Super Bowl. In February 2011, we deployed a Mass Casualty Incident Toolkit. This toolkit was created to assist in patient tracking and management during no-notice emergency events. It allows for the tracking of a patient from the scene through EMS transfer to a facility. During the Regional Exercise Jericho, we simulated a large scale MCI event utilizing WebEOC. During the exercise window of 4 hours, we simulated moving 2077 patients from the scene to hospitals. In some cases, patients were transferred to two different hospitals after being seen at the initial facility. See chart above for break out of patient types. 26

31 Emergency Medical Task Force Team Development The Emergency Medical Task Force (EMTF) Project is an initiative started by the Texas Department of State Health Services (DSHS) and is designed to improve the medical response to disasters across the state. The project is funded, in part, with Hospital Preparedness Program funds from the Office of the Assistant Secretary of Preparedness and Response to develop, administer, equip, and train regionalized teams from across the state to respond to large-scale medical incidents with the development of four core medical teams. These teams include: Ambulance Strike Teams, Mobile Medical Units, Registered Nurse Strike Teams, Ambulance Bus Teams, and a Command and Control element that are designed to be rapidly mobilized for both regional and state-wide disaster response. ASTs AMBUSES Command & Control RNSTs MMUs In the spring of 2011, NCTTRAC entered into an agreement with DSHS to serve as one of eight lead Regional Advisory Councils (RACs) across the state of Texas to coordinate the development of these teams. This partnership includes working with neighboring Trauma Service Areas (TSA) C - Wichita Falls and TSA D - Abilene, for the formation of EMTF-2. 27

32 Since May 2011, an EMTF Steering Group has been developed to guide the formation of the project. This Steering Group consists of representatives from both Abilene, Wichita Falls, and from the NCTTRAC Regional Emergency Preparedness Committee (REPC). The development of Ambulance Strike Teams has been the initial focus of team development. These Ambulance Strike Teams will participate during state activations for a variety of missions, such as hospital evacuations during a hurricane event. However, in the spring of 2011, Ambulance Strike Teams were utilized as a potential resource to help support wildfire operations across the state. Each EMTF region has a requirement of identifying a minimum of 25 EMS agencies to participate on these teams. As of June 2011, 19 EMS agencies had agreed to participate on Ambulance Strike Teams. It is expected that EMTF-2 will easily achieve that requirement by the end of the contract year. The other EMS-related component of the EMTF Project is obtaining at least one ambulance bus (AMBUS) for each EMTF region. However, NCTTRAC has been able to identify funding mechanisms to purchase a total of four AMBUSES to be placed within Trauma Service Area E. The first two vehicles arrived for delivery in late summer to early fall of These vehicles will be used for both state-wide disaster responses, as well as be available for localized large -scale events. The other two teams to be developed are Registered Nurse Strike Teams, as well as the development of a Mobile Medical Unit. NCTTRAC is fortunate to already have four mobile medical units that are already placed within TSA- E. These assets are held in Collin, Hood, Navarro, and Tarrant counties. These assets are on permanent loan to these jurisdictions and are available for mutual aid requests. All of the structures were recently used for logistical operations related to Super Bowl XLV. In addition to these existing structures, NCTTRAC is expecting delivery of a rapidly deployable mobile medical shelter by late summer of 2011 with the and the accompanying equipment and supplies in the fall. Personnel recruitment is underway, including medical staff and support staff. 28