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©2017 Northwest Healthcare Response Network. NWHRN is a nonprofit corporation and 501(c)(3) organization.
7100 Fort Dent Way, Suite 210, Tukwila, WA 98188 | 425-988-2898 office | 206-707-9920 fax | [email protected] | nwhrn.org
Preparing for a surge in hospital patients
In late December 2016, Pierce County’s
two largest hospitals were operating at maximum
capacity. Emergency medical service providers were
struggling to find emergency departments with
available bed space, often forcing ambulances to
drive long distances to deliver patients to care.
Hospitals nearly always see an increase in patients
during winter flu season, but seldom to this degree.
In the third week of December within CHI Franciscan
Health, which operates nine hospitals in Western
Washington, between 65 and 100 percent of
emergency room beds were occupied by patients
who were waiting to be admitted to the hospital.
“We quickly realized that this was not just an
emergency department problem,” says Cindy Miron,
Program Manager of Emergency Preparedness at the
Tacoma-Pierce County Health Department (TPCHD).
Inpatient beds were full. Outpatient clinics were
seeing higher than normal capacity. Long-term care
facilities were reluctant to accept patients ready for
discharge out of concern for potential outbreaks
among their vulnerable residents.
Response Activation
Similar reports from King and Snohomish counties
lead the Washington State Department of Health
(DOH) to convene a call with local health officials in
early January. Four days later, the Northwest
Healthcare Response Network (the Network), the
healthcare coalition serving King and Pierce counties,
activated its Healthcare Emergency Coordination
Center to gather information that would help
regional and state authorities decide how to address
the problem.
“One of the challenges was figuring out what was
causing this and what, therefore, was the solution,”
says Nigel Turner, Director of Communicable Disease
Control at TPCHD. “What the Network brought to this
was a structure that could allow that type of analysis
to happen.”
In A DisasterThe work of the coalition allows our community to:
• Share information that supports crisis decision-making
• Analyze and report trends affecting healthcare delivery
• Create additional healthcare capacity when needed
• Work collectively to solve common problems
Over the next six weeks, the Network polled
healthcare organizations weekly regarding trends in flu
cases, bed capacity, staffing shortages and strategies
for addressing them. Results were compiled in
Healthcare Impact Reports that were shared with local
and state public health leadership and healthcare
stakeholders. Hospitals all along the Interstate 5
corridor had been struggling with a rising daily census
for more than two years. Since the reports indicated
this was not a particularly severe flu season, it was
determined that the ongoing capacity issues had
become so severe that some facilities now lacked the
space and resources to handle even minor surges in
patients without activating their disaster plans.
Situational Awareness
The Network’s reports assured providers that their
challenges were part of a larger problem that had the
attention of the state’s highest authorities. “These
communications were really helpful for me as a
leader,” says Margo Bykonen, Chief Nursing Officer for
Swedish Health Services. “It’s really hard for staff trying
to place all these patients and not having any bit of a
break. So to be able to see that we were not alone in
this, that this was a community-wide struggle, not just
within the Swedish system, was a big deal.”
IMPACT STORY: UNDERSTANDING REGIONAL HEALTHCARE CAPACITY CHALLENGES
©2017 Northwest Healthcare Response Network. NWHRN is a nonprofit corporation and 501(c)(3) organization.
7100 Fort Dent Way, Suite 210, Tukwila, WA 98188 | 425-988-2898 office | 206-707-9920 fax | [email protected] | nwhrn.org
The reports inspired some non-hospital facilities to take
measures to lighten the burden on emergency
departments. The Polyclinic, which includes nearly a
dozen outpatient centers in King County, stepped up its
standard flu season employee vaccination and
education campaigns, and encouraged providers to
minimize referrals to hospitals whenever safely possible.
“Knowing what was happening in the hospital sector
gave me the information I needed to make sure we
were ready if this became a bigger issue,” says Judy
Mitacek, the Polyclinic’s Business Continuity and
Compliance Coordinator for Disaster Preparedness.
“In an emergency, not everything can happen in the
hospital setting. Outpatient settings have to share
part of the burden of taking care of all of our patients
in King County.”
To be able to see that we were not alone in this, that this was a community-wide struggle…was a big deal.”
Margo Bykonen,Chief Nursing Officer, Swedish Health Services
Facilities across the region exercised relationships
they’d built through the Network to share best
practices for meeting the community’s healthcare
needs. Several important conversations revolved
around the work of the Network’s Disaster Clinical
Advisory Committee, funded almost entirely through
the HPP. This group of providers and health
department representatives meets quarterly to
develop regional strategies for clinically responsible
decision-making in times of crisis when the
community might face a shortage of important
resources ranging from staff to medicines. “Having
those ethically challenging conversations up front
about how we provide care when there are limited
clinical resources is so valuable,” says Bykonen, who
has served on the committee since 2012.
As the flu season waned in late February, hospital
censuses returned to their previous numbers, still
much higher than ideal. Armed with the knowledge
that daily capacity problems mean that a disaster
could overwhelm the healthcare system, state and
local health authorities, supported by the Network
and regional healthcare leaders, are convening a task
force to root out causes and seek long-term
remedies. Programs funded by the U.S. Office of the
Assistant Secretary for Preparedness and Response
and Network members are critical to that effort.
“Without them, you wouldn’t have the tools to
support healthcare in making tough decisions about
resource allocation or space allocation,” says Michael
Loehr, Chief of the DOH Office of Emergency
Preparedness and Response. “That would have to be
made up on the fly, and that’s not a good place to be
in a disaster.”
About the Network
We lead regional healthcare collaboration to effectively respond to and recover from emergencies and disasters in King, Pierce and Kitsap counties in Washington State. We serve the state’s medical epicenter, including 3.2 million residents, 140,000 healthcare workers, almost 50% of the state’s hospital beds, and nearly 2,000 healthcare organizations.
Planning Pays Off
In addition to situational awareness from the
Healthcare Impact Reports, healthcare organizations
benefited from previous efforts to plan for surge
situations. In recent years, the Network had hired
consultants to assist regional hospitals in identifying
ways to accommodate extra patients in the event of a
crisis. St. Joseph Medical Center, a CHI Franciscan
hospital in Tacoma, used that planning at the height
of this winter’s capacity challenges to add 20
temporary beds by converting single rooms in its
orthopedic wing to double occupancy and
implementing contingent staffing plans.
IMPACT STORY: UNDERSTANDING REGIONAL HEALTHCARE CAPACITY CHALLENGES
©2017 Northwest Healthcare Response Network. NWHRN is a nonprofit corporation and 501(c)(3) organization.
7100 Fort Dent Way, Suite 210, Tukwila, WA 98188 | 425-988-2898 office | 206-707-9920 fax | [email protected] | nwhrn.org
Getting the right patient to the right place during an evacuation
When a mock fire inside Swedish Medical
Center’s First Hill Campus in Seattle damaged the
primary electricity supply and generator on March
31, 2011, dozens of hospitals and emergency
response agencies worked together during a
disaster drill to evacuate 133 pediatric patients, 75
of whom required transfer to a Neonatal Intensive
Care Unit (NICU).
Healthcare for All Populations
“It is very daunting to think about all of the necessary
elements needed to ensure a safe and effective
evacuation,” says Cindy Miron, Emergency
Preparedness Program Manager at the Tacoma-Pierce
County Health Department. “Knowing that none of us
is alone and we can rely on partners is so important, as
is knowing what each other’s roles are.”
In the 2011 exercise, some patients were sent to
facilities that were not capable of providing the level
of care they needed, forcing the receiving hospitals to
stabilize and transfer them again, a risky and
avoidable extra step brought on by a lack of
understanding of which regional hospitals had certain
specialty services, recalls Eileen Newton, Emergency
Preparedness Manager for CHI Franciscan Health,
which participated in the exercise. “Swedish First Hill
cares for some of the sickest babies there are,” she
says. “You can’t just move them to any hospital. Most
hospitals don’t have a NICU, let alone a NICU that
provides as high of a level of care.”
As the regional healthcare coalition, the Northwest
Healthcare Response Network (the Network) has
created regional plans for evacuating and distributing
hospital patients, as well as exercises to test them
and identify gaps in preparedness.
The same is true for adult patients who need
specialty care. From heart-lung bypass machines and
continuous dialysis to behavioral healthcare for
patients who are incarcerated, there are many
services that are provided only at certain hospitals.
Yet at the time of the exercise, there was no index of
which hospitals provided which services. “If you don’t
have that information in advance, you slow down
your ability to respond appropriately, because you’re
having to get it on the spot, likely with compromised
communication systems,” says Barb Graff, Director of
the Seattle Office of Emergency Management.
In A Disaster
The work of the coalition allows healthcare in our community to:
• Follow up-to-date, practiced regional evacuation plans for hospitals and long-term care facilities
• Place specialty patients in hospitals that can provide the level of care they need
• Track and reunify patients and families
• Share information and resources
• Work together to be self-sufficient
IMPACT STORY: BUILDING CAPABILITIES TO SUPPORT HOSPITAL EVACUATION
©2017 Northwest Healthcare Response Network. NWHRN is a nonprofit corporation and 501(c)(3) organization.
7100 Fort Dent Way, Suite 210, Tukwila, WA 98188 | 425-988-2898 office | 206-707-9920 fax | [email protected] | nwhrn.org
Developing a Solution
In Spring 2016, the Network created a list of 70
specialty services and hired consultants to conduct a
survey to determine which among 33 hospitals and
acute care facilities in King and Pierce counties could
provide them. When the project wraps up in 2017,
the information will help each county’s Disaster
Medical Control Center (DMCC)—the hospital
responsible for coordinating the distribution of
patients in the event of an evacuation—save time
when placing patients.
We have to be able to continue to provide care to patients under any condition. The Network is helping us accomplish that.”
Eileen Newton,Emergency Preparedness Manager, CHI Franciscan Health
Although the healthcare players in the exercise
recognized the enormous complexity of
evacuating the community’s sole hospital, its
plight was low on the list of federal and state
priorities. This signaled to Newton the important
role that coalition-based collaboration has in
creating regional healthcare resilience.
The Value of the Network
“Before the Network it felt like we were running from
one exercise to another and we knew we had all
these gaps, but we really didn’t have a strategic plan
for how we were going to address them,” she says.
“We have to be able to continue to provide care to
patients under any condition. The Network is helping
us accomplish that. They’re helping make healthcare
agencies stronger and more prepared to deal with all
types of disasters.”
Although healthcare agencies and their emergency
response partners agree that a hospital evacuation
would require community-wide coordination and
support, no government agency has the mandate or
resources to maintain a regional healthcare
evacuation plan. That work falls to the Network.
“Healthcare organizations are required to have plans
and procedures in place to respond to disasters and
emergencies and they do a really good job at that,”
says the Network’s Planning and Preparedness
Manager Aaron Resnick. “But without organizations
like the Network and other coalitions, there are no
mechanisms to plan for emergencies outside of the
walls of any individual healthcare institution.”
Preparing as a Community
Exercises have also revealed the need for the local
healthcare community to be prepared to help itself
during a disaster, rather than rely on outside
resources that may be in short supply. In the Cascadia
Rising exercise, sponsored by the Federal Emergency
Management Agency in June 2016, the entire region
simulated a 9.0 earthquake.
As part of the exercise, St. Clare Hospital, a 106-bed CHI
Franciscan facility in Lakewood, Washington, learned
that its local water district had installed earthquake
sensors as a safety measure that would automatically
shut off the water supply in the event of tremors. The
lack of water would make it impossible for St. Clare’s to
maintain its environment of care, forcing administrators
to evacuate the building.
IMPACT STORY: BUILDING CAPABILITIES TO SUPPORT HOSPITAL EVACUATION
About the Network
We lead regional healthcare collaboration to effectively respond to and recover from emergencies and disasters in King, Pierce and Kitsap counties in Washington State. We serve the state’s medical epicenter, including 3.2 million residents, 140,000 healthcare workers, almost 50% of the state’s hospital beds, and nearly 2,000 healthcare organizations.
©2017 Northwest Healthcare Response Network. NWHRN is a nonprofit corporation and 501(c)(3) organization.
7100 Fort Dent Way, Suite 210, Tukwila, WA 98188 | 425-988-2898 office | 206-707-9920 fax | [email protected] | nwhrn.org
Tracking loved ones during a disaster
On September 24, 2015, a Ride the Ducks
tour vehicle collided with a charter bus carrying 45
international students and staff from North Seattle
College on Seattle’s busy Aurora Bridge. Five people
were killed and 71 injured in the largest multi-
casualty incident Seattle had experienced. On what
was likely one of the worst days the victims’ families
had seen, emergency plans and tools facilitated the
exchange of critical information about the patients’
whereabouts and conditions.
Tracking Critical Information
Within minutes of the crash, the Seattle Fire
Department was on scene triaging injuries, while the
city’s Office of Emergency Management (OEM)
opened its Emergency Operations Center. Once
notified by OEM, the Northwest Healthcare Response
Network (the Network), which leads the regional
healthcare coalition, issued an alert through WATrac,
an online healthcare communication and resource
tracking system that hospitals use daily across the
state. Each Seattle hospital was prompted to update
its bed availability, facilitating the distribution of
nearly 60 accident victims to seven area hospitals and
one urgent care center.
The OEM coordinated among 15 separate city
departments and 11 partner agencies to manage
complexities ranging from the massive traffic impacts
to the notification of consulates representing the 14
foreign countries from which the accident victims
hailed. It relied on the Network for assistance in
tracking the location and condition of each of
the patients.
The Network held the master patient roster, with
staff members working as liaisons in the Emergency
Operations Center. Using their strong relationships
with emergency managers, they streamlined the
exchange of information and minimized the number
of phone calls so healthcare facilities could focus on
their top priority—providing quality, efficient medical
care to the accident victims.
“The very definition of a disaster is that there’s
chaotic, unconfirmed information,” says OEM
Director Barb Graff. “Trying to get your arms around
whether you got ahold of everybody is no small task.
But the Network made it so easy on us.”
Exercises conducted through the years had identified
a need for a standard way to track patients through
the healthcare system in a mass casualty incident. In
response to this gap, the Network began the
implementation of WATrac, a web-based application
that includes a patient tracking system. Within two
hours of the bus crash, the Network launched the
first disaster activation of WATrac, asking hospitals to
input basic demographic information about the
patients and update their status as they moved
through the continuum of care.
In A Disaster
The work of the coalition allows healthcare in our community to:
• Distribute patients to the appropriate hospitals
• Track patients’ location and conditions
• Use a single point of contact for healthcare information
• Anticipate medical facilities’ resource needs
IMPACT STORY: PATIENT TRACKING IN RESPONSE TO FATAL SEATTLE BUS CRASH
©2017 Northwest Healthcare Response Network. NWHRN is a nonprofit corporation and 501(c)(3) organization.
7100 Fort Dent Way, Suite 210, Tukwila, WA 98188 | 425-988-2898 office | 206-707-9920 fax | [email protected] | nwhrn.org
Family ReunificationThe patient tracking system also allowed Public
Health-Seattle & King County (PHSKC), the local
health department, to provide information to families
who called into its Family Reunification Hotline, which
received more than 70 calls in the two days following
the accident. “We could not have operated the call
center without the patient tracking piece,” says
Response Planning Program Manager Ashley
Kelmore. “We wouldn’t have had the information to
effectively respond to the callers.”
Trying to get your arms around whether you got ahold of everybody is no small task. But the Network made it so easy on us.”
Barb Graff,Director, Seattle Office of Emergency Management
availability of the components and what restocking might be needed,” he says.
PHSKC Preparedness Director Carina Elsenboss,
who has worked in healthcare preparedness in the
Puget Sound for more than 12 years, says the
patient tracking system made a “night and day”
difference compared to the many exercises she’s
participated in over the years in which there was
no central database of patient information.
Managing ResourcesThe patient tracking system also benefited non-hospital
healthcare organizations involved in regional
preparedness planning. Bloodworks Northwest, which
has been involved with the Network since its inception
as the King County Healthcare Coalition in 2005,
provides blood products and services to nearly 90
hospitals in Washington, Oregon and Alaska, had been
trained in the use of the WATrac patient tracking
system. After the accident, staff used the tool to
anticipate which healthcare facilities would likely need
blood products based on the listed patient conditions.
With this information, Bloodworks Northwest’s ability
to support the hospitals contrasted markedly with
the response to a shooting at Umpqua Community
College in Roseburg, Oregon, the following week,
says President and CEO Dr. Jim AuBuchon. “Even
though all the seriously injured patients in Roseburg
ended up at one facility that we serve, we had more
difficulty finding out the condition of the patients, the
likelihood of their need for transfusion, the
Addressing the GapsYet the incident also highlighted further work to be done, says the Network’s Western Washington Planning Support Coordinator Rebecca Lis. “It was an opportunity to test where we were, but also to reinforce what we can do,” Lis says. “It gave us momentum with the community and an understanding that this is something we all need to invest time in, and we’re on board with.” Since the accident, nearly all regional healthcare facilities have been trained in the use of WATrac’s patient tracking system.
At Seattle OEM, Graff has partnered with the Network for years in exercises and responses to infectious disease outbreaks and weather hazards. She says the city has come to rely on the Network and its tools like WATrac to be the voice for and liaison to the regional healthcare system in emergencies, a role no city department has the expertise or relationships to fill. “On our worst day, this is one thing we’ve taken care of that won’t go wrong for us,” she says. “The week that we were activated for the bus crash verified why it was vital to have that kind of a network and have a good working relationship with it. I think they proved their value in that activation.”
IMPACT STORY: PATIENT TRACKING IN RESPONSE TO FATAL SEATTLE BUS CRASH
About the Network
We lead regional healthcare collaboration to effectively respond to and recover from emergencies and disasters in King, Pierce and Kitsap counties in Washington State. We serve the state’s medical epicenter, including 3.2 million residents, 140,000 healthcare workers, almost 50% of the state’s hospital beds, and nearly 2,000 healthcare organizations.
©2017 Northwest Healthcare Response Network. NWHRN is a nonprofit corporation and 501(c)(3) organization.
7100 Fort Dent Way, Suite 210, Tukwila, WA 98188 | 425-988-2898 office | 206-707-9920 fax | [email protected] | nwhrn.org
Preparing to care for children in a disaster
Children are particularly vulnerable during disasters and have different medical and
emotional needs than adults. Yet a 2006 study by the
Institute of Medicine (IOM) determined that most
hospitals in the United States were not prepared to
provide nuanced care for children in an emergency.
“People think they can go to any hospital and kids will
get the same care, and that’s just not true,” says
Carolyn Blayney, Program Manager for Pediatrics and
Burns at Seattle’s Harborview Medical Center. “Kids
are not small adults. They come in all different shapes
and sizes, which means equipment has to be
different, medications are different, and how you talk
to them has to be different.”
Addressing a Gap in Service
In 2010, Mary King, the Director of Harborview’s
Pediatric Intensive Care Unit, and colleagues
partnered with the local healthcare coalition, now
known as the Northwest Healthcare Response
Network (the Network), to study the geographic
distribution of local pediatric resources. They found
that although about 78 percent of children in King
County live outside of the city of Seattle, more than
80 percent of pediatric healthcare resources—
hospital beds, doctors and nurses—are inside the
city. An earthquake of the magnitude Seattle is
predicted to experience in coming years would likely
damage the bridges that provide access to the city,
effectively cutting children off from the doctors and
facilities that are specifically trained to care for them.
“We have to think about how we’re going to get the
resources to those kids or the kids to the resources,
or at least better prepare everybody to take care of
kids, and feel they have a duty to do so,” King says.
In A DisasterThe work of the coalition allows healthcare in our community to:
• Access easy-to-use pediatric emergency medicine tools
• Utilize training on the nuances of caring for children
• Provide care for children at non-pediatric facilities
• Share best practices in pediatric preparedness and response to support other communities
Innovative Tools
To address this gap, the Network launched a Pediatric
Triage Task Force to develop tools and trainings to
prepare providers who typically see adults to care for
children. These resources are designed to build
capabilities that not only help during emergencies, but
also on a day-to-day basis since the IOM study
reported that 82 percent of pediatric visits to
emergency departments are to non-children’s
hospitals and departments. “Every hospital is going to
see children and every emergency room has to be
prepared for that,” says Dr. Vicki Sakata, the Network’s
Senior Medical Advisor and a physician at Mary Bridge
Children’s Hospital in Tacoma. “Preparedness practices
have to become part of everyday practice, not
something used only in a disaster.”
The Network’s Pediatric Disaster Toolkit encourages
non-children’s hospitals to identify pediatric champions
and provides resources like supply lists, strategies for
managing unaccompanied minors and job action sheets
to help staff understand their responsibilities in
disasters that affect children. They also include
templates of tools that Harborview has developed to
improve its own pediatric emergency care.
IMPACT STORY: TRAINING ALL PROVIDERS IN BASIC PEDIATRIC EMERGENCY CARE
©2017 Northwest Healthcare Response Network. NWHRN is a nonprofit corporation and 501(c)(3) organization.
7100 Fort Dent Way, Suite 210, Tukwila, WA 98188 | 425-988-2898 office | 206-707-9920 fax | [email protected] | nwhrn.org
“We are an adult hospital that takes care of kids,”
Blayney says. “Even though we’re a Level 1 Trauma
Center, they’re a small part of our population—we
admit 800 kids a year, but thousands of adults. It’s a
lot harder to stay good and keep interested in
pediatrics when you’re caring for adults all the time.”
Every hospital is going to see children and every emergency room has to be prepared for that.”
Dr. Vicki Sakata,Physician, Mary Bridge Children’s Hospital
Preparing the Region and Beyond
Since 2011, the Network has also conducted Pediatric
Disaster Response Workshops, providing
opportunities for more than 800 non-pediatric
clinicians and EMS personnel across Washington to
develop the skills and self-assurance to provide
better pediatric care. Lessons include use of the
Broselow® Tape, management of pediatric pain and
recognition of mental health challenges. “If you get
people up and start practicing things, it builds
confidence,” Sakata says.
Mason General Hospital in Shelton, Washington, saw
the value immediately. The weekend following a
Pediatric Disaster Workshop there in May 2016, a
pediatric patient came in to the emergency
department and the providers on shift used the
techniques they had just learned to quickly stabilize
and prepare the child for transfer to Mary Bridge. A
year later, Monitor Technician Mariah Pede says the
staff has continued to reap benefits from the training.
“We loved the tips regarding the Broselow® Tape and
exact dosing for medications,” she says. “It has made
for faster, more efficient pediatric care.”
The Pediatric Triage Task Force’s work has caught the
attention of others around the country, and the Network
has helped physicians in Oregon and California launch
their own workshops to make sure regional providers are
prepared to care for children in emergencies.
Representatives from the Network and Harborview have
presented their work nationally and contributed to the
development of the National Pediatric Disaster Coalition
and other initiatives dedicated to advancing care for
children in emergencies.
Harborview has developed a suite of easy-to-use
resources based on the internationally respected
Broselow® Tape, a color-coded system that measures
a child’s height and weight to determine size-
appropriate medication dosages and equipment.
Each child who comes into Harborview is tagged with
a bracelet printed in his or her Broselow ® color.
Since all pediatric supplies and medications stocked
in the hospital are labeled with color-coded stickers,
providers can quickly identify the right item for a
patient and use color-coded medication sheets to
determine appropriate dosing.
These innovative tools have spread beyond the
hospital. In summer 2016, the six King County
emergency medical service (EMS) agencies began
using cards with standard color-coded pediatric
dosing instructions and formularies that King helped
them develop to standardize care and eliminate the
need for risky on-the-spot calculations. “It takes out
10 steps and 10 chances for error to try to make it so
that when we resuscitate a child, we do it the same
way every time, and we do it the same way we do for
adults,” King says. After six months, the percentage
of paramedics who reported that they were
comfortable performing pediatric resuscitation had
increased from 24 to 33 percent.
IMPACT STORY: TRAINING ALL PROVIDERS IN BASIC PEDIATRIC EMERGENCY CARE
About the Network
We lead regional healthcare collaboration to effectively respond to and recover from emergencies and disasters in King, Pierce and Kitsap counties in Washington State. We serve the state’s medical epicenter, including 3.2 million residents, 140,000 healthcare workers, almost 50% of the state’s hospital beds, and nearly 2,000 healthcare organizations.
©2017 Northwest Healthcare Response Network. NWHRN is a nonprofit corporation and 501(c)(3) organization.
7100 Fort Dent Way, Suite 210, Tukwila, WA 98188 | 425-988-2898 office | 206-707-9920 fax | [email protected] | nwhrn.org
Planning a communitywide response to acute infectious disease
As individuals, we create and test plans every day, usually without realizing it. Some
plans are simple, like scheduling a meeting with a
colleague. Other plans, such as organizing a potluck
dinner party, are a bit more complicated. If the
plan (in this case, an invitation) was adequately
scoped, clearly written and communicated, you
won’t end up with all desserts and no entrees.
And then there are far more complex plans. One
way the Network helps bolster the disaster
resiliency of the Puget Sound healthcare
community is to create, test and maintain
collaborative regional plans. Like the dinner party
plan, these plans must be well scoped and clearly
written to elicit the desired response. However,
unlike our potluck scenario, the Network doesn’t
wait for the event to test it. Instead, they approach
plan creation and testing as a progressive, multi-
year process, allowing for plan refinement and
mastery at each level before moving to the next.
Let’s take the Regional Acute Infectious Disease
(AID) Response Plan as an example.
In late 2014, the threat of the Ebola virus was circling
the globe. As Seattle is an international hub for travel,
commerce and tourism, there was justified concern
the virus could make its way to the Puget Sound
region. The Network responded by activating its
Healthcare Emergency Coordination Center to
support coordination and information sharing within
the healthcare community.
By January 2016, the Network had conducted research
and interviews with representatives from Public Health
Epidemiology in King and Pierce counties, Washington
State Department of Health Epidemiology, hospitals,
outpatient care, and emergency medical services. A
draft plan was created, input was gathered and gaps
were addressed. Attention could now turn to testing
the plan.
This activation was the catalyst to develop a regional
response plan to address not only Ebola, but the
broader category of acute infectious disease.
Specifically, the plan would define roles and
responsibilities of regional response agencies,
including healthcare, public health and other regional
and state partners for a coordinated regional
response related to the potential consequences of
an acute infectious disease outbreak.
In A Disaster
The work of the coalition allows our community to:
• Share information that supports crisis decision-making
• Address community-specific needs
• Quickly operationalize response plans
• Work collectively to solve common problems
IMPACT STORY: UNDERSTANDING REGIONAL HEALTHCARE RESPONSE CHALLENGES
©2017 Northwest Healthcare Response Network. NWHRN is a nonprofit corporation and 501(c)(3) organization.
7100 Fort Dent Way, Suite 210, Tukwila, WA 98188 | 425-988-2898 office | 206-707-9920 fax | [email protected] | nwhrn.org
The Testing Cycle
For the Network, testing typically starts with a plan
training, where key stakeholders are provided with the
plan background and overview. Next, those same
stakeholders participate in a tabletop exercise, which
involves talking through a scenario with the goal of
identifying gaps in the plan. Once those gaps are
addressed, a functional exercise is conducted and a
broader group of stakeholders play out a scenario,
often focusing on key parts of the plan with a goal of
resolving issues. Several functional exercises may
occur, depending on the readiness of the plan and
participating organizations. Lastly, if deemed
appropriate and resources are available, a full exercise
is conducted. In a full scale exercise, participants play
out larger events as if they are actually happening and
often include people role-playing as patients.
“Plan testing is often seen as a ‘walk, jog, run’ process, building in complexity and capability….it’s also a cycle of plan, train, exercise the plan and fix gaps.”
Rebecca Lis,Western Washington Planning Support Coordinator, NWHRN
Drawing from lessons learned at the tabletop
exercise, the Network created an improvement
plan with the input of their Acute Infectious
Disease Advisory Group, drove the development
of curriculum, and hosted the webinar-based
trainings to address gaps. The functional exercise
took place in August of 2017, and focused on
testing the decision-making and communications
protocol. The plan is ready to be activated by
public health or the Network when needed.
As there is great benefit in collaboratively
planning for a regional response before a disaster
strikes, the Network has created and maintains
several other plans, including:
• Regional Healthcare Situational
Awareness Procedure
• Regional Scarce Resource Management and
Crisis Standards of Care Concept of Operations
• Regional Patient Tracking Concept of Operations
• King & Pierce County Long-term Care
Mutual Aid Plan (LTC-MAP) for Evacuation
and Resource Sharing
The following plans are being updated:
• Regional Hospital Evacuation Plan
• Regional Healthcare System Emergency
Response Plan
Preparing as a Community
The Network hosted its AID plan training webinar in
February of 2016, followed by the discussion-based
tabletop exercise in April. Fifty participants from four
counties (King, Pierce, Snohomish, and Kitsap) and the
state were given an evolving scenario to react to and
discuss, resulting in collaborative conversations covering
AID screening processes, precautions, notification
coordination, operational protocol, laboratory protocol
and how to transfer a suspected AID patient.
About the Network
We lead regional healthcare collaboration to effectively respond to and recover from emergencies and disasters in King, Pierce and Kitsap counties in Washington State. We serve the state’s medical epicenter, including 3.2 million residents, 140,000 healthcare workers, almost 50% of the state’s hospital beds, and nearly 2,000 healthcare organizations.
IMPACT STORY: UNDERSTANDING REGIONAL HEALTHCARE RESPONSE CHALLENGES