csc indicators and triggers for a large, urban health...
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January 15, 2013
CSC Indicators and Triggers for a Large, Urban Health Department:
The Chicago Perspective
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Rahm Emanuel
Mayor
Bechara Choucair, MD
Commissioner
Suzet M. McKinney, DrPH, MPH
Deputy Commissioner
Chicago Department of Public Health
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Chicago Department of Public Health
� Established in 1835
� Public health authority for the 3rd largest city in the U.S.
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Rahm Emanuel
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Bechara Choucair, MD
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� 2nd largest municipal health department in the U.S.
� Charged with protecting the health of the city’s nearly 2.8
million residents, workers and visitors
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CDPH Approach to Emergency Response
� City/County, state and federal governments all
have a role in emergency planning and response,
but….
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Rahm Emanuel
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Bechara Choucair, MD
Commissioner
� “All events are local”
– Local public health agencies are expected to
develop capacity to respond
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CDPH Role in Emergency Response
� To lead the City’s response to all threats of public health
significance
� How do we do this?– Monitoring disease trends (surveillance);
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Rahm Emanuel
Mayor
Bechara Choucair, MD
Commissioner
– Training and preparing the workforce to respond to all-hazards disasters;
– Fostering partnerships with other city agencies, state and federal
governments, hospitals and other area public health/allied health partners;
– Leveraging resources (human, financial, etc);
– Working to affect improvements in education, training and communications
capability.
– Provide event-specific information, resources and guidance to our partners
during emergency events
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hChicago Healthcare System Coalition for Preparedness and
Response (CHSCPR)
� 36 Hospitals, full-service, specialty, and VA
� 125 Long Term Care Facilities
� Chicago Department of Public Health
� Chicago Fire Department/EMS
� Cook County Medical Examiner
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Rahm Emanuel
Mayor
Bechara Choucair, MD
Commissioner
� Cook County Medical Examiner
� American Red Cross
� Illinois Department of Public Health
� Metropolitan Chicago Healthcare Council
� Other not- for- profit organizations (CHUG, PPERS)
� New this year: Primary care, surgi centers, peds
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hChicago Healthcare System Coalition for
Preparedness and Response (CHSCPR)
� Built upon a model of collaboration among city hospitals
and healthcare organizations
– Facilitated by the Metropolitan Chicago Healthcare Council
(MCHC)
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Commissioner
� Governed by an Executive Committee made up of CDPH,
MCHC and co-chairs of working committees
― Reviews, analyzes work of the committees
― Makes decisions about future work, initiatives and policies
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Healthcare System Capabilities (pre-2012)
� NIMS
� At-risk populations
� Education and
Preparedness Training
� Exercises, Evaluation and
� HaVBED
� ESAR-VHP
� Fatality Management
� Alternate Care Sites
� Mobile Medical Assets
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� Exercises, Evaluation and
Corrective Action
� Interoperable
Communications
� Medical Evacuation/Shelter
in Place
� Mobile Medical Assets
� Pharmaceutical Caches
� Personal Protective Equipment
� Decontamination
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Healthcare System Capabilities (2012)
� Healthcare system preparedness
� Healthcare system recovery
� Emergency operations coordination
� Fatality management
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� Fatality management
� Information sharing
� Medical surge
� Responder safety and health
� Volunteer management
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CSC Planning and Activities� Pediatric Critical Care and Transport Stakeholder Summit (April
2010)
– Discussion of Peds scarce resources
– Scenario, discussion and action steps
� Peds Disaster Planning Workshop (April 2010)
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Commissioner
� Peds Disaster Planning Workshop (April 2010)
– Lessons learned, ED surge, vent management, ethical
dilemmas
� Public Health Scarce Resources TTX (April 2011)
� Pre-positioning of assets in hospitals and long-term care
facilities (ongoing)
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CSC Planning and Activities
� Hospital pandemic influenza exercise – crisis standards of
care module (2012)
― Identified preliminary CSC planning in hospitals
� Crisis Standards of Care project at Harvard NPLI (2012)
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Commissioner
� Crisis Standards of Care project at Harvard NPLI (2012)
― Developed planning tools to advance CSC planning
� Core planning group development (2013)
� Planning stakeholder engagement meetings (2013)
� CSC Stakeholder’s conference (Fall 2013)
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Situational Awareness
� CDPH facilitates situational awareness and information
flow across all response partners and healthcare orgs
� Public health �� Emergency management
― Facilitates situational awareness and information sharing with
city leadership (conference call)
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Commissioner
city leadership (conference call)
� Public health �� Hospitals
― HAN (alerts, treatment recommendations)
― Situational awareness conference calls
― HCRS radios
― WebEOC for hospitals (currently exploring)
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Data Sources
� Epidemiological Data
– ESSENCE
– I-NEDSS
� Hospital Data
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Commissioner
� Hospital Data
– Bed availability
– Syndromic surveillance
– S/A via survey (HAN) or phone conference
� EMS Data
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Other Data Sources
� BioWatch
� Intelligence information
– Law enforcement
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Mayor
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Commissioner
– Law enforcement
– Emergency management
� Media reports
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hOperational Changes
Conventional Contingency Crisis
Business as usual Situational awareness, as
needed (PH-> EM ->
healthcare)
Constant information flow
(HAN, conference calls)
Review plans and policies,
emergency plan activation
as needed
Activation of CSC plans,
COOP plans
Verify resource inventory Emergency cache
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Mayor
Bechara Choucair, MD
Commissioner
Verify resource inventory Emergency cache
activation (hospitals, LTCs)
Verify contracts and
purchasing vehicles
Emergency procurements,
MOUs and mutual aid
agreements
Activation of ESAR-VHP,
medical evacuation,
alternate care sites,
alternate power sources,
etc.
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Guidance on Triggers
� Surge capacity― Normal surge
― Proximity to extending beyond capacity
― Availability of other surge resources (ACS, LTCs)
� Supply chain/resources
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Commissioner
� Supply chain/resources― Ability to obtain additional resources
� Communication capability
―Compromised?
―Limited?
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Guidance on Triggers
� Epidemiology― Increased cases of unusual clusters of disease,
― Demand for care (EDs overrun, hospitals on bypass)
� Emergency response systems
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� Emergency response systems
―Compromised capacity
� Staffing levels
– Availability of healthcare volunteers
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Questions?
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Rahm Emanuel
Mayor
Bechara Choucair, MD
Commissioner
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