Patient Reception Area Operations

1
Patient Reception AreaOperations Exercises

• Michael S. Peters
• VA EMSHG Area Emergency Manager
• VA Central Iowa Health Care System
• Des Moines, Iowa
• NDMS Conference
• May 2, 2005
• Orlando, FL

2
Overview

• Concept of operations for local, community-based
  patient reception area
• Types of resources needed to perform patient
  reception operations
• Quake Response 2004 exercise

3
Concept of OperationsExcerpts from the FCC
Guidebook

• Patient Reception Area defined
• A geographic locale containing one or more
  airfields adequate patient staging facilities
  and adequate local patient transport assets to
  support patient reception and transport to local
  voluntary, pre-identified, non-Federal, acute
  care hospitals capable of providing definitive
  care for victims of a domestic disaster,
  emergency, or military contingency.
• NDMS Federal Coordinating Center Guide
• Draft January 20, 2005

4
Concept of OperationsExcerpts from the FCC
Guidebook

• FCC Activation Stages
• FCC Alerted. PRA could be among the next to
  receive patient however patients are currently
  not regulated to the PRA. FCC could expect at
  least 24-hour notice of patient arrival.
• FCC Activated. Patients are to be regulated, or
  have been regulated to a PRA. Patients can be
  expected to arrive within 12-24 hours.
• NDMS Federal Coordinating Center Guide
• Draft January 20, 2005

5
Concept of OperationsExcerpts from the FCC
Guidebook

• Patient Regulating and Evacuation Operations
• DHS Mission Assignment has been issued
• GPMRC bed-reporting instructions to activated
  FCCs
• GPMRC receives medical information about victims
• GPMRC coordinates movement to the PRA airport
• GPMRC communicates ground and aeromedical mission
  information to the PRA
• NDMS Federal Coordinating Center Guide
• Draft January 20, 2005

6
Concept of OperationsLocal Patient Reception
Area Operations

• Community support and active participation is
  essential for successful patient reception
  operations!
• Civilian airport and/or military base authorities
• Participating NDMS hospitals
• Local EMS and private transport services
• Local Red Cross and Salvation Army chapters
• Local Amateur Radio operators
• Local, county and state emergency management
• County and state public health departments
• Other appropriate volunteer organizations

7
Concept of OperationsLocal Patient Reception
Area Operations

• Local FCC/PRA Operations Planning
• Communication alert notifications systems
• Cascade calling system, e-mail groups, blast fax,
  etc.
• Hospital bed availability reporting processes
• Patient reception site operations
• Incident command system
• Identification of resource requirements and
  tasking
• Personnel / Manpower , Transportation, etc.
• Communications
• Patient tracking systems

8
Concept of OperationsLocal Patient Reception
Area Operations
Assembled upon PRA alert
9
Concept of OperationsLocal Patient Reception
Area Operations

• FCC Emergency Operations Center
• Pre-arrival planning and preparation
• Monitors hospital bed availability reports
• Identifies potential reception resource
  requirements
• Places available EMS and support organizations in
  stand-by mode pending patient regulating
  decisions
• Identifies primary/alternate patient reception
  location
• Pre-assigns available individuals to appropriate
  patient reception incident command positions

10
Concept of OperationsLocal Patient Reception
Area Operations

• FCC Emergency Operations Center
• Patient regulating message received
• Review latest bed availability report and
  pre-identify number of patients by category to
  each hospital
• Task pre-identified EMS and private transport
  services
• Confirm support organization personnel
  availability
• Assemble all personnel and support resources at
  the reception site NLT 2 hours prior to aircraft
  arrival

11
Concept of OperationsLocal Patient Reception
Area Operations
12
QUAKE RESPONSE 2004Des Moines FCC Casualty
Reception ExerciseNov 3-5, 2004

• Scope
• Full-scale exercise over 3 days raising level of
  activities from an initial alert notification, to
  casualty reception preparation, to casualty
  reception execution, to casualty post-hospital
  admission tracking.
• NDMS hospitals, EMS, emergency support
  organizations identified and tasked to support
  aircraft arrival and casualty reception
  operations
• Execute casualty reception on a Fall week-day
  evening to assess the effects of darkness and
  cool temperatures on casualty reception

13
QUAKE RESPONSE 2004Des Moines FCC Casualty
Reception ExerciseNov 3-5, 2004

• Community Participants
• 11 NDMS hospitals (bed reporting)
• 6 NDMS hospitals (patient reception)
• 11 EMS Services
• Red Cross
• Salvation Army
• Amateur radio
• 62 high school volunteer casualties

• County/State Organizations
• Emergency Mgmt
• Public Health
• IA DMAT AC
• Military Organizations
• 132 FW, IA ANG
• 934 AES, AFRES
• GPMRC

14
QUAKE RESPONSE 2004Des Moines FCC Casualty
Reception ExerciseNov 3-5, 2004

• Pre-exercise planning coordination
• 934 AES, AFRES, Minneapolis
• C-130 participation load/off-loading training
• Unit Liaison pre-deployed to FCC
• GPMRC
• Mass casualty Patient Movement Requests (PMR)
  loaded into TRAC2ES exercise account using actual
  casualty volunteer names and hypothetical
  injuries description
• GPMRC Liaison exercise participation

15
QUAKE RESPONSE 2004Des Moines FCC Casualty
Reception ExerciseNov 3-5, 2004
Des Moines NDMS Federal Coordinating Center

• Scenario
• A 6.5 magnitude earthquake occurs along the New
  Madrid Fault 30 miles northwest of Memphis
• Subsequent Presidential Disaster Declaration and
  activation of the National Response Plan NDMS
• Midwest FCCs notified to submit bed availability
  reports and instructed to prepared for casualty
  reception within 24 hours

Earthquake Epicenter
16
QUAKE RESPONSE 2004Des Moines FCC Casualty
Reception ExerciseNov 3-5, 2004

• Wednesday, Nov 3. Day 1 Exercise Activities
• Morning Real-time alert notification to
  hospitals and support organizations hospital bed
  availability reporting support organization
  resource availability FCC/EOC participants
  identified.
• Afternoon Activation, casualty regulating
  message and information notification to hospitals
  and support organizations. Initial lift bed plan
  and patient manifest received from GPMRC via
  TRAC2ES. FCC/EOC pre-arrival planning meeting
  (pre-scheduled).

17
QUAKE RESPONSE 2004Des Moines FCC Casualty
Reception ExerciseNov 3-5, 2004

• Thursday, Nov 4. Day 2 Exercise Activities
• Morning Received updated lift bed plans and
  patient manifests from GPMRC.
• Afternoon Patient reception operations
  established at 132 Fighter Wing, IA ANG.
• Casualty volunteers moulaged with bandages,
  splints, IVs, etc.
• 1600 C-130 arrival, pre-exercise litter
  carrying, C-130 patient loading/off-loading
  training
• Evening Patient reception operations initiated
  at 1800 all patients processed and transported
  to hospitals by 1930 amateur radio
  communication with hospitals

18
QUAKE RESPONSE 2004Des Moines FCC Casualty
Reception ExerciseNov 3-5, 2004

• Friday, Nov 5. Day 3 Exercise Activities
• Morning 3 pre-selected hospitals contacted by
  FCC for post-admission patient status reporting,
  e.g. patient name, tracking number, diagnosis,
  attending physician, condition, projected length
  of stay, etc.

19
QUAKE RESPONSE 2004Des Moines FCC Casualty
Reception ExerciseNov 3-5, 2004
Exercise Participant Sign-In
Casualty Volunteer Moulage
20
QUAKE RESPONSE 2004Des Moines FCC Casualty
Reception ExerciseNov 3-5, 2004
Litter Carrying Training
C-130 Patient Loading / Off-Loading
21
QUAKE RESPONSE 2004Des Moines FCC Casualty
Reception ExerciseNov 3-5, 2004
Ambulance Staging
Salvation Army Canteen
22
QUAKE RESPONSE 2004Des Moines FCC Casualty
Reception ExerciseNov 3-5, 2004
Manpower Ready To Off-Load Patients
Patient Off-Loading It gets dark pretty fast!
23
QUAKE RESPONSE 2004Des Moines FCC Casualty
Reception ExerciseNov 3-5, 2004
Applying Patient Tracking Wristband
Patient Holding Area Waiting Transport
24
QUAKE RESPONSE 2004Des Moines FCC Casualty
Reception ExerciseNov 3-5, 2004
Final Patient Tracking Prior To Ambulance Loading
Patient Care Awaiting Transport
25
QUAKE RESPONSE 2004Des Moines FCC Casualty
Reception ExerciseNov 3-5, 2004
Ambulance Loading
Amateur Radio Communications
26
QUAKE RESPONSE 2004Des Moines FCC Casualty
Reception ExerciseNov 3-5, 2004
27
QUAKE RESPONSE 2004Des Moines FCC Casualty
Reception ExerciseNov 3-5, 2004

• Lessons Learned
• Core list of EMS personnel familiar with NDMS
  and EMS roles
• Enhance pre-arrival incident command procedures
  and role descriptions
• Incorporate known patient information into
  pre-arrival briefings
• Secondary triage system within holding areas to
  easily identify and prioritize patients waiting
  transportation
• Availability of internet and TRAC2ES access at
  reception site for updates to lift plans and
  patient manifests

28
QUESTIONS
Michael S. PetersVA EMSHG Area Emergency
Manager VA Central Iowa Health Care System 3600
30th Street Des Moines, Iowa 50310 Office
515-699-5863 E-Mail michael.peters_at_med.va.gov