PowerPoint slide deck for a briefing on the origin, structure and operation of the DC, an ESF-8 tier 2 response organization in Washington, DC.

1. DC EHC
DC Emergency
Healthcare Coalition
(DC EHC)
a “Tier 2” Response Organization
DC EHC

2. Background
• DC Hospital Assn. (DCHA) / EM Committee (1995)
– Initial HMARS (hospital mutual aid radio system)
– Initial hospital mutual aid memorandum of understanding
• 2001-2006
– 9-11, Anthrax, Isabel, Katrina, pandemic planning
– “mass-effect” concerns added to “mass-casualty”
– Committee-based response coordination
• Hospitals only (and sometimes health department)
• Long conference calls
• Little coordination of strategies, informtion, & messaging
• 2007
– HHS Project: Mass Surge Capacity & Capability
DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

3. Mass Surge Capacity-Capability
DC EHC:
• Integrates Tier 2
• Coordinates with other
Tiers:
– 1: HCOs
– 3: Jurisdiction
– 4: States
Source:
• Medical Surge Capacity and
Capability Handbook (HHS,
2007)
• http://www.phe.gov/preparedne
ss/planning/mscc/
Subsequently:
• MSCC: The Healthcare
Coalition in Emergency
Response and Recovery
(HHS, 2009) DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

4. 2008 ASPR Grant
(HHS, Assistant Secretary for Preparedness & Response)
• Coalition Emergency Management Plan (EMP)
• Emergency Operations Plan (EOP)
– i.e. establish a “Tier 2 Response Organization”
• Hospital security assessments (x14)
• Hazard vulnerability assessment (HVA)
• Radio system expansion & upgrade
• Jurisdiction-wide automated patient ED tracking system
• Training
• 2 exercises
• Project evaluation
DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

5. EHC Preparedness vs. Response
• Preparedness elements
– Grant Steering Committee  Executive Council
– Emergency Management Committee (EMC)
– Work Groups / Committees
• Response elements
– Baseline
• Coalition Notification Center (CNC)
• Coalition Duty Officer (DO)
– Escalated Response
• Healthcare Coalition Response Team (HCRT)
• Senior Policy Group (SPG)
DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

6. Coalition EMP*
• Mission • During response, facilitate
– Situational awareness
• Philosophy – Information sharing
– Resource sharing
• Governance – Strategy coordination
• HVA* • During preparedness
• Guidance templates – Enhance preparedness
– Enhance resilience
* EMP = emergency management plan
HVA = hazard vulnerability assessment DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

7. Coalition EMP
• Mission • Voluntary participation
• Philosophy • Full autonomy
• Consensus
• Governance
• Member preparedness is
• HVA* still needed
• Guidance templates
* EMP = emergency management plan
* HVA = hazard vulnerability assessment DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

8. Coalition EMP
• Mission • Grant Steering Committee
– Strategic oversight
• Philosophy
– Spending approval
• Governance • Emergency Mgt. Committee
• HVA* – Sets directions, goals
• Guidance templates – Approves work products
– Meets monthly
• Work & Task Groups
– Where the work gets done
* EMP = emergency management plan
HVA = hazard vulnerability assessment DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

9. Work & Task Groups
• EOP* Development • Pubic Info. Officers
• HVA*
• Mass MCI & Telemedicine • Training/Education
• Mass fatality – Seminar Planning
• Intensive care surge • Mass fatality
• Facility evacuation • Mass casualty
• Communications • Burn mass casualty
• HIS* enhancement • Evacuation
• HMARS* expansion • Incident management
• Security Directors • Active shooter
• Notification Centers – Exercise Planning
• ED-IT Data Sharing • 2x / year
* EOP = emergency operations plan HIS = Healthcare Info. System
DC EHC
HVA = hazard vulnerability assessment HMARS = Healthcare Mutual Aid Radio Syst.
12.7.11 DC EHC: A Tier 2 Response Organization

10. Coalition EMP
• Mission
• Philosophy
• Governance • An annual assessment and
ranking of „healthcare system‟
• HVA vulnerabilities
• Guidance templates
* EMP = emergency management plan
HVA = hazard vulnerability assessment DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

11. Coalition EMP
• Mission
• Philosophy
• Governance • facility evacuation
• HVA* • active shooter
• Guidance templates • mass fatality
• burn casualty mgt.
* EMP = emergency management plan
HVA = hazard vulnerability assessment DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

12. Coalition EOP*
• Base Plan
• Annexes
– Communications
– Facility Evacuation
– Resource Sharing & Mutual Aid
– Public Information Coordination
– Mass Burn Casualty
• SOPs
– Coalition Notification Center (CNC)
– Duty Officer (DO)
– Healthcare Coalition Response Team (HCRT)
– NCR Information Sharing Procedure
* EOP = emergency operations plan
HVA = hazard vulnerability assessment DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

13. Coalition Members
• Children‟s Nat‟l. Medical • National Rehabilitation
Center Hospital
• George Washington Univ. • Specialty Hospitals of
Hospital Wash.
• Georgetown Univ. Hospital
– Capitol Hill
• United Regional Medical
Center – Hadley
• Howard Univ. Hospital • DC Primary Care Assn.
• Providence Hospital • Community Connections
• Sibley Memorial Hospital Mental Health Clinics
• Veterans Affairs Medical • Visiting Nurses Association
Center • DC Medical Society
• Wash. Hospital Center • DC Healthcare Association
• Psychiatric Institute of Wash. • Poison Control Center DC EHC

14. Operational Communications
Regional
Partners
Jurisdiction
DC DC DC DC DC DC
DOH HSEMA FEMS MPD OCME DMH
NoVA RHCC
HCRT* Duty Officer MD MEIMSS
activation
(response) (baseline)
MD Beltway
Coalition Notification Center (CNC) “hub” HCFs
Member HCOs
Primary Visiting Mental
14 Medical Poison LTC Funeral
Care Nurses Health
Hospitals Society Control Assn. Dirs. Assn.
Assn. Assn. Clinics
* HCRT = Healthcare Coalition Response Team DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

15. Communications Tools
• Coalition Notification Center (CNC)
• Radio Networks
– Healthcare Mutual Aid Radio Syst. (HMARS)
– DC DOH 800 mHz Radio
– Northern VA Regional Hospital Coord. Ctr.
– MD Medical Communications System
• DOH Health Alert Network (HAN)
• Teleconferencing
• Healthcare Information System (HIS)
– notifications, situation boards, info sharing DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

16. HIS
• MS SharePoint Sample content
• Notifications list
– Off-the-shelf software • Duty Officer contact &
– Readily edited schedule
• Available beds
• Multiple functions • Resource needs/offers
– Status/resource • Patient tracking
reporting grids • Facility status report
– Document sharing • Facility POCs
– Notifications via e-mail & • EOP & forms
• Documents on current
devices incident
– Streams HMARS radio
DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

17. DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

18. Baseline Operations
• Coalition Notification Centers (CNCs x3)
– 24-7-365 operation
– 3 volunteer comms/ops centers
– Monthly rotation
– Toll-free access number
– Authorized to alert for limited scenarios
• Duty Officer (DO)
– Weekly on call with backup
– Decision point for alerting & activation
DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

19. Response Operations
DC EHC
Senior Policy Group
HCRT
Manager
Healthcare Coalition HCRT HCRT
Response Team PIO Liaison
(HCRT)
HCRT Ops HCRT Logistics HCRT Planning
Section Chief Section Chief Section Chief
Notification Comms
Center Unit
Member HIS
Orgs. Support
DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

20. HCRT Activities
• Facilitating situational
– Getting, validating, and
awareness
sharing information
• Collating resource – Messaging to healthcare
availability organizations
• Facilitating mutual aid
• Coordinating strategies
• Facilitating teleconferences
• Incident management using
ICS
DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

21. HCRT Activities
• Facilitating situational
awareness
• Collating resource • Incident action planning
availability • Adapted ICS forms
• 201, 201, 205, 207, 209,
• Facilitating mutual aid 213, 214
• Coordinating strategies • Custom forms
• situation report
• Facilitating teleconferences
• evacuation
• Incident mgt. using ICS • resource needs
DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

22. In Summary…
• EHC is designed for both “preparedness” & “response”
• Duty Officer & CNC monitor routinely; initiate system
response if needed
• Activation of the HCRT provides augmented response
support
• Multiple information sharing technologies available
• EHC is the result of the partners working together rather
then alone
DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

23. Steve Mabley
Regional Emergency Manager, National Capital Region
VHA Office of Emergency Management
steve.mabley@va.gov
202.461.1011
DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization

24. HIS Demo
• https://www.heoc.org/dchis/default.aspx
DC EHC
12.7.11 DC EHC: A Tier 2 Response Organization