Bioterrorism Hospital Preparedness Program:  HRSA Work Plan

Priority Area 3: Emergency Medical Services

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• Optimizing EMS Preparedness and Response Capability
   
  • Critical Benchmark 3
    • Strategies
    • Tasks
    • Timeline
    • Responsible Parties
    • Evaluation Metric

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Summary of Priority Area 3

Optimizing EMS Preparedness and Response Capability

Washington State’s EMS Office has been active in emergency response system development since the early 1970s.

The use of local and regional councils has resulted in the improvement of grass roots efforts to improve response to community-perceived needs.  The councils and pre-hospital agencies have always been involved in assisting hospitals with their disaster exercises as well as the coordination of disaster response efforts through mutual aid agreements. 

Statutory requirements mandate hospitals, pre-hospital EMS/TC agencies, local elected officials, consumers, local law enforcement and local government agencies work cooperatively in designing and implementing local and regional EMS and trauma care plans and systems, through the DOH-approved regional EMS and trauma care plans.  Tribal government has been and continues to be involved in many of the local and regional councils’ planning efforts.  Other participants have been fire services, communication centers, injury prevention programs, medical program directors, physicians, helicopter services, forest service, national and state parks and more recently representatives of emergency management and local health jurisdictions.  Local health jurisdictions (LHJs) have been invited to become members. Many have declined but are represented at meetings by regional PHEPR coordinators in some cases. LHJs continue to be invited to the meetings and participate as issues come up that they perceive concern them. 

The above mentioned requirements also include direction to regional councils to plan for addressing inter-regional patient care responses, transport and transfer of patients to facilities outside the region and the EMS and trauma system response to mass casualty incidents at all levels.   Regional EMS and trauma care councils currently perform the following activities:  (1) assess and analyze regional EMS and trauma care needs;  (2) identify and implement specific activities necessary to meet state-wide standards and patient care outcomes;  (3) establish the number and levels of facilities to be designated as trauma facilities;  (4) identify the need for and recommend the distribution and level of care of pre-hospital services, to assure adequate availability and avoid inefficient duplication of services; and (5) advise DOH on all matters relating to EMS and trauma care delivery within the region. 

EMS and trauma care regions were originally established based on patient flow patterns in Washington State.  They are currently the focal point for EMS and trauma care service planning, implementation, and service provision statewide.  Regional hospital planning has built on this existing infrastructure through EMS/TC regional councils serving as the coordinating bodies for regional hospital bioterrorism preparedness plan development during FY 02-03.  Realignment of regional EMS/TC boundaries to match the public health jurisdiction regions is a practical solution to some confusing issues that have arisen over the last year.  The current plan is to change the Regional EMS and Trauma Care Regional boundaries to match the WA State Public Health, Homeland Security,  and Emergency Management regional boundaries within the next two year, and no later than  7/1/05.

Hospital and pre-hospital agencies in Washington are also collaborating in planning system changes supporting improved patient care at the scene, pre-hospital determination of patient facility destination, and facility requirements regarding the treatment of both emergent and trauma patients.  Existing tools including the Washington State Trauma Triage Tool (TTT) facilitate this work, MPD-approved regional Patient Care Procedures (PCPs), regional patient care protocols, and County Operating Procedures (COPs).

Training for responses to mass casualty incidents is provided under contract from DOH for both hospital and pre-hospital personnel.  Local emergency management personnel are included in the planning for both the local and regional EMS/TC systems, which determines the most appropriate methods of cooperation for all aspects of the patient care response system in Washington State.  In addition, local Mass Casualty Incident (MCI) planning conducted through local emergency management agencies regularly includes local EMS council (e.g., hospital and pre-hospital) participation.

The regional EMS and trauma care plans have been used in the past to identify regional activities relating to disaster management.  During FY03 the Regional Councils have been actively involved in the HRSA assessments, smallpox planning and Hospital Preparedness planning and have made great strides in getting all local and regional participants to take an active role in the statewide Hospital Bioterrorism Preparedness planning effort.  The increased involvement by emergency management, local health jurisdictions and hospital administration has improved the communications between and the working relationships of all involved agencies at the local and regional levels.

The Regional EMS/TC Councils plan to work cooperatively with Washington State’s 502 licensed EMS and Trauma Care (EMS/TC) pre-hospital services and 82 designated hospital trauma services during FY 03 toward a goal of having a pre-hospital emergency medical and trauma care system capable of responding efficiently, appropriately, and proficiently to acts of bioterrorism, outbreaks of infectious disease, natural disasters, and other public health emergencies that may occur in Washington State.  DOH and the regional councils will also work with public health jurisdictions, emergency management and Homeland Security personnel to identify the areas of potential threat and develop plans to have regional EMS response teams to provide EMS coverage for at least 500 adult and pediatric patients per 1,000,000 population per day. The Councils will explore all available options in reviewing and establishing such response.

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Critical Benchmark 3

Develop a mutual aid plan for upgrading and deploying EMS units in jurisdictions they do not normally cover, in response to a mass casualty incident due to terrorism.  This plan must ensure the capability of providing EMS coverage for at least 500 adult and pediatric patients per 1,000,000 population per day.

Strategies:  What overarching approach(es) will be used to undertake this activity?

1. Evaluate the threat levels previously identified in previous assessments in each region to identify the areas that more likely will be potential targets in each region.
2. Consider any issues identified in those assessments relating to the ability to respond to terrorist incidents.
3. Assess the existing mutual aid agreements between EMS/TC agencies for EMS response unit deployment to terrorist incidents.
4. Assess the level of training needed by personnel working with first response agencies and EMS agencies with the Office of EMS & Trauma System licenses including those services operated by Indian Tribes.
5. Assess equipment needs of first response agencies and public safety agencies with EMS&TS licenses including those operated by Indian tribes.
6. Develop a mutual aid agreement that is capable of crossing over county and regional boundaries to allow the EMS/TC system to provide coverage for at least 500 patients per day for each 1 million in population in the state.
7. Test the mutual aid agreement.

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Tasks:  What key tasks will be conducted in carrying out each identified strategy?

1. Develop a work plan to utilize the information contained in the Progress Report.
2. Survey by EMS/TC regional councils to identify current agencies participating in such a mutual aid response system.
3. Use the information identified in the assessments to ensure coordinated EMS/TC system response in each region by providing the following training.

a.       Emergency Response to Terrorism

b.      Terrorism Awareness for Emergency Responders (Internet)

4. Use the information identified in the assessments to ensure coordinated EMS/TC response in each region by procuring specialized emergency EMS/TC system response in each region by including the following terrorism incident prevention and operational equipment in HRSA and non-HRSA grants available for such purposes.

a.    Personal Protective Equipment (PPE)

1)      Chemical Resistant Gloves

2)      Chemical/Biological Protective Undergarment

3)      Inner Gloves

4)      Chemical Resistant Outer Booties

b.      CBRNE Search & Rescue Equipment

1)      Hydraulic tools; hydraulic power unit

2)      Breaking devices (including spreaders, saws and hammers)

3)      Lifting devices (including air bag systems, hydraulic rams, jacks, ropes and block and tackle)

c.       Interoperable Communications Equipment

(Information omitted in accordance with R.C.W.42.17.310)(ww)

d.      Decontamination Equipment (interoperable)

e.       Medical Supplies

f.        Limited Types of Pharmaceuticals

5. Develop a mutual aid agreement in each region and ensure that there is adequate system response coverage across regions.

6. Conduct regional bioterrorism disaster exercises to test the mutual aid plan in each Region.  These will be coordinated with other ongoing public health and hospital preparedness exercises.

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Timeline:  What are the critical milestones and completion dates for each task?
Please see Appendix E, “HBPP FY 03 Workplan Timelines”.

Responsible Parties:  Identify the person(s) and/or entity assigned to complete each task.
Regional EMS/TC Councils will conduct each of the assessments and work with assigned DOH Office of EMS and Trauma System staff to complete all activities for each of the tasks.  Councils will collaborate with the COT to:

• Prevent duplication of equipment purchases;
• Ensure equipment interoperability; and
• Maximize use of all available federal and state funding resources.

Regional Councils and DOH staff will work to identify new funding sources, and work with regions on all other tasks associated with EMS system development.

Evaluation Metric:  How will the agency determine progress toward Washington State successful completion of the overall recipient activity?
The Office of EMS and Trauma System staff will coordinate the evaluation of the regional exercise of a bioterrorism incident to assess the effectiveness of the mutual aid agreement as well as the EMS/TC system response by 8/31/04.

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