ALAMEDA COUNTY DISASTER PREPAREDNESS HEALTH … · ALAMEDA COUNTY DISASTER PREPAREDNESS HEALTH COALITION Suzanne Ridel, Arnie Spanjers, Alameda County Disaster Preparedness Health

ALAMEDA COUNTY D I S A ST E R PR E P A R E DN E SS HE A L T H CO AL IT IO N

Suzanne Ridel, Arnie Spanjers,

Alameda County Disaster Preparedness Health Coalition

March 24, 2015 9:00am – 12:00pm Location : Emergency Medical Services

Attendees

In-Person: Gus Arroyo, Fred Claridge, Cynthia Frankel, Glen Goddard, Michelle Heckle, Zerlyn Ladua, Richard Luna, Erica Pan, Ron Seitz, Kathy Smedley, Caryn Thornburg, Dwight Williams, Nels Jenson, Donata Nilsen On the Phone: Steve Mier

Topic Discussion Action Item(s)

Updates

Trainings

Medical Surge Workshop on June 2 with Steve Mier

HICS/NHICS Training and Exercise in May/June

ReddiNet hands-on Training with LTCFs, Clinics and Hospitals in late May/June by Michelle Bruce

City of Hayward hosting Mass Casualty Incident Hands-on Skills Training and Exercise

Coalition members to please save the dates, as we would like to have as many Coalition Members present as possible

Medical Surge Project Update

Steve Mier introduced himself via the conference call line. Clinic, Hospital & Long-term Care Facilities Assessments

Wrapping up facility assessments o All but one of clinics, all but one of hospitals, and all but one of long-term

care facilities have been assessed

Reports for hospitals, clinics and long-term care facilities have been started.

A report will be sent to DCDCP-PHEP by April 1st of all hospitals, clinics and long-term care facilities that have been assessed.

o There is much information and data that will give a good feel of the findings o There is some missing data in these assessments that will be filled in with

follow-up calls/emails to the facilities o After the reports are done, the next step is developing a gap assessment for

the health care system as a whole Medical Surge Workshop

Need to put together objectives

Workshop looks at triggers for medical surge

Steve and Ann will continue to work with St. Rose on the assessment. Donata and Steve will work on a date for a webinar for the Medical Surge workgroup and Steering Committee. Steve will present data on the gap assessment and recommendations.


We want the gap assessment and roadmap completed by the time of the workshop

The workshop themes vary in terms of levels of participation

There has been a desire for additional training with the County

Understanding how to go further down the road with resource sharing in the hospital end is a concern

Feedback from the clinics include what they can do to relieve Medical Surge by helping the walking wounded

o There is a willingness to do, but there are still limitations due to working hours, etc.

Clinics have a robust capability to provide volunteer staffing in the form of mental/behavioral health & pediatric care

Another component is the capability to provide support for mass vaccination o Abilities with blood monitoring – there are robust phlebotomy capabilities

Some long-term care issues are o Discharge o Need for more clear procedures if conditions elevate (e.g. If there is a

pandemic, how would isolation be executed)

Lessons Learned from Small Emergency Events

Gus Arroyo from Washington Hospital described an incident at their hospital. Gus received a call from Dwight Williams about a bag found in the hospital. Gus’s question was “how did it get here?”. Was it an upset employee, a client, a family member upset about treatment of their loved one, or a lone-wolf terrorist event.

There were wires and batteries in the bag that did not look “right”

Gus called the Fremont Police Department and spoke with a liaison for Washington Hospital who spoke with bomb specialists, then, informed Gus that there were components of a bomb in the bag, minus the explosives. The liaison informs Gus and Dwight that should all of the items in the bag have been left in the bag, the bomb squad would have blown up the bag.

o It was later noted that an aerosol can in the bag is the explosive unit, as when connected to the components contained in the back, the aerosol can can be detonated and the metal casing acts as shrapnel

o Components of a home-made bomb can be found in Inspire Magazine,


Issue 13, with complete instructions on building the bomb.

o Instructions on extending cell battery life a bomb trigger, using a motorcycle battery, can be found online

Response to the bomb threat

Managers meeting was held

Sweep of campus (visible activity to calm things down)

Higher access control

Metal detector screening in Emergency Department was reinstated

Bag screening at main entry Investigation of the bomb threat

Backtracked and interviewed all who came in contact with the bag o There were many interesting answers from those who came into contact

with the bag, as if they had various motives to protect their jobs

Established a timeline

Reviewed video 30:30

It was found that the bag came in on the June 19th with a homeless male that was picked up in San Leandro and taken to the hospital. The bag wasn’t reported until July 2nd.

o The patient who came in with the bag had taken off from the ER and his bag was stored in the Emergency Department by a clerk, who labeled the bag with a name tag

o The bag was next taken from the Emergency Department and placed in a tower where it sat for ten days, but the transporter didn’t remember transporting it there.

Lessons Learned

Expect the unexpected

Contraband and dangerous weapons can easily be brought into the hospital on purpose and/or by unwitting parties

Safety and security is the responsibility of every employee

All bag, packages, and containers need to be opened and inspected before staff


takes possession and/or places them in storage

o EMS cannot check bags as they could get in trouble for rooting through patients things

Suspicious items and suspicious persons need to be reported to security immediately (if you see something, say something)

With a suspicious person you must “Let it RAIN”: o Recognize the threat o Avoid with defensive action o Isolate the threat o Notify the proper response authorities

An inventory log was created for found property for tracking the trail of each person that touches the logged item through their signatures, and no property will be accepted unless the form is completely filled out and the property must be inventoried item-by-item

o When it was found, where it was found and what was found o This also protects hospital from liability should someone indicate

fraudulently for gainful purposes that there was an item left in their belongings that really wasn’t there

Security is now in charge of all found items at the hospital Dwight reported further on this bomb threat with these thoughts:

The bag could have been just thrown away because someone called for a battery disposal, which lead to the discovery of the bomb components

Without formal direction on bomb threats, once the bomb components were discovered, one of three things could’ve happened: the bag could have been just thrown away; someone could’ve set off any potential explosives trying to disarm it themselves; or, an evacuation could have been called for the entire facility and the package could have been blown up by the bomb squad

All events such as this must reported to the state o Michelle noted that the code Children’s for a bomb threat is “Code 70737”

Michele Heckle Reported on a bomb incident at her facility (Children’s Hospital):

A suspicious caller called-in, and a top down search in the engineering areas were


searched

Clinical engineers checked if there was anything amiss with any medical equipment

The people that deliver mail/packages were sent to the areas they delivered to to see if they noticed anything suspicious

While checking medical equipment and delivery areas, a clinical bio engineer found an unusual box that wasn’t typical to it’s location (it says congratulations on the birth of your baby and there is no birthing center in the hospital)

o After questioning employees it was found the box was for a baby shower

The final sweep was coordinated with the Alameda County K-9 unit to reassure staff that this was being taken seriously and for the search

o Every floor was prepped to let every floor know there was a dog coming o Gus suggested that in doing a sweep, you really have to include all the

workers working in the areas being swept as only they can be certain of what looks out of place

The box was in Michelle’s office and happened to be from a bio-med vender

Michelle asked if we could work with law enforcement for lost and found so packages like this don’t get on rigs and Gus noted that Washington Hospital has made it a policy not to accept a large amount of personal property when picking up homeless individuals.

Questions from the Coalition

Erica asked if when sweeps are done, are there risk communication messages for people in the moment of the incident regarding preparation

o In Gus’ case, the CEO put out a notification that they had “found these items which were consistent with this based on the information from the police department and the FBI is telling us, and we are going to do this sweep to ensure…”. It was agreed that the Police Department would put out these notifications, in an effort to control the release of information, but there were still instances of people Tweeting.

o In Michelle’s case many messages were sent out, as it was about a three-hour process. The threat was deemed low, but ten days later the same thing happened to Alameda Health system

She noted it is very important we communicate these incidents


amongst colleagues as if a person is testing one facility with a bomb threat, it is likely that person will repeat the test at another facility

When sending out messages, they try not to send out more than five bullet points

There was a hotwash in addition to an open-door-policy to voice concerns

Michelle elaborated on another incident regarding the release of an unknown chemical in her facility:

On Friday, March 13 an unknown chemical was released

It was isolated to a back hallway just outside of a patients room

Staff immediately took actions to mitigate the chemical release

One EDS staff member was affected immediately with coughing, gagging, and tearing eyes at 11:57am

When the call at 12:02 was received by Michelle, the staff had already evacuated a portion of the ER and put on Max Air Clinical Pappers with Hepa Filters (although they are instructed to use only 3M breathe easy pappers, which provide both face and respiration protection), the back doors were already opened to allow fresh air

Based on the symptoms described, it seemed that the chemical was pepper spray

A buddy system was advised, in addition to wearing PPE

Fire was called in with their chemical sensors, but the sensors can’t recognize everything, including chemical agents that have dissipated in the environment

Called CVPH to call Environmental Response team to do toxicology screening

Michelle found a safety data sheet on pepper spray and sent it off to her Administrator On-Call and the Evening Manager

Compressors weren’t leaking and there was no tampering with the HVAC and there were no umes of smoke that got into ventilation, the chemical was not found to be in the ventilation system

Patients and families of patients were checked on and they were all okay

The exposed EDS staff member had removed her clothing, placed the clothing in a plastic bag to be sealed, and washed vigorously. Another staff member who was exposed did the same.

Videos were reviewed and staff interviews were done


CalStar informed Michelle that there were three EMTs that had checked in for the

same symptoms as the EDS staff worker affected by the chemical

Oakland Hazmat came in and used chemical sensors on the area and on the contaminated clothing the EDS worker was wearing, in addition to interviewing the EDS worker, and the conclusion was came to that they highly suggest there was a pepper spray release from spray in someone’s pocket or bag.

Michelle talked to CalOSHA to report what had happened and provide a CDPH report and was informed that someone had also informed CalOSHA of the incident.

o Normally reports are only called in to CalOSHA when a worker has been hospitalized for at least 24 hours, but Michelle was informed that in an incident such as this, it is ok and preferred CalOSHA be contacted immediately.

o CalOSHA visited and will be taking care of further review. Initially there were only 3 reports of affected employees, but

CalOSHA reported 9 (plus 3 CalStar people and one AMR driver)

Moving forward, UCSF Benioff Children’s Hospital Oakland has not changed any policies about back checking, but there is a weapons policy. Pocket knives are not allowed, but pepper spray is.

A representative of Contra-Costa Hazmat informed Michelle that there are pepper spray incidents all the time on public transit, and what was done at UCSF Benioff Children’s Hospital Oakland in this incident is all that can really be done, which is evacuate the area of the pepper spray release, have any exposed individuals remove their clothing (to be placed in plastic bags) and wash off with soap and water (self-decontamination), and air out the affected area.

Final conclusion: Upon review of the videos, it is apparent that the family housed in the room(s) were standing outside of the room(s) coughing and had told staff members they were in the hall because the room was too hot. They were discharged and no more than 30 seconds later did the EDS worker become exposed. It is unsure if something was sprayed directly into the room as the cameras are only set up in the main halls and not in exam rooms. All the families in the rooms in the area were called at 2:00am that same day to check on how they were feeling, but the family that caused the incident did not answer multiple calls. A welfare check was done to make sure they were okay and they indicated they were fine, and did


not mention anything on the pepper spray. There was no physical proof that they had the pepper spray in the exam rooms as well, but the garbage was taken out of the rooms affected for decontamination efforts

ReddiNet Update Donata discussed:

We have 22 licenses available

Long-term care facilities and clinics are being encouraged to sign up Michelle Voos’ Presentation

Michelle is the program manager for EMS for hospitals and providers for ReddiNet

Trying to get more long-term care clinics on board

Barabara Morita has been working on getting appropriate documents for clinics to come on board

Break-out session o It was helpful to have the MCIs ran in breakout tables to see how messages

are relayed o Goal is to have a large table-top (Maybe using EOC, Dublin Conference

Room) asking people to bring laptops but have a mixture of hospitals, clinics, and long-term care providers

Did two refreshers with the supervisors of Paramedics Plus, a provider. o Paramedics plus always has ReddiNET minimized on desktop in case of alert

In the process of signing on four fire providers o Berkeley o City of Alameda o Albany o Piedmont

Once fire providers are on board, all of transport providers (e.g. BLS private companies, ALS provider, Paramedics Plus) will be on ReddiNET and key is to get all of them at table-top discussion to have a networking day and to do MCIs

o Looking to do this and May and to have Linda Tripply facilitate o To be offered to those with no knowledge of ReddiNET to experience

workers

Doesn’t know status of contracts and MOUs because it is not something she is

Please fill out the Planning Request for Content Suggestions Form and return to Cynthia Frankel. Donata will send out form to coalition roster.


handling

Donata is sending email to long-term care facilities to meet on April 30 to turn in forms or complete forms then

Blanket fee for three-year period that covers 30 clinics and long-term care sites is taken care of.

Rules for sharing access to ReddiNET

Some clinics that are associated with hospitals, the problem is the receiving hospital has administrative rights over sending messages, updating status, going on different types of diversion (e.g. equipment failure), so if they were to give their log-on information to a clinic, that would give them the same rights as the hospital.

o Its under the umbrella of hospital>clinic>long-term care provider o Clinics have their own licenses that they have to manage appropriately o Each log-in is for only one entity, as they are sold by the license

Reddinet SmartPhone Update

Before one could update their status in terms of how busy they are in their ER using the Reddinet App, and that is function is no longer available – it only lets you change the ED diversion status

MedLine Email for Disaster Response

If it is a day-to-day event, it is no longer automatically being distributed so people may want to make sure that the duty officer has the information to notify MedLine

Michelle Voos will look into the ReddiNET App as to why the option is no longer available to update status in terms of how busy an ER is

Exercise Follow-up & Coalition Next Steps/Preparation for November 2015 Statewide Medical Health Exercise

Statewide EMSA exercise

The next Statewide EMSA exercise will involve the Pan Flu

Trying not to squeeze everything into a 3-4 hour exercise as the following must fit into schedule:

o Sit stat o resource requesting o communication drills o C&G Meeting o IAP


o Local call/regional call

discussed breaking it down to more smaller more meaningful components

there was an exercise in the past that was weekly titled Operation Red Dragon in which the airport, schools, hospitals, and child care facilities were involved

o This scenario was played out involving flu o The Oakland Airport had to close because there was no child care for the

workers o After Action Report (AAR) posted to EMS website and PHEP/HPP website o Tabletop recommendation was for priority for prophylaxis and clear

guidelines which will be provided for the exercise similar to what happened in the H1N1 exercise where there was a shortage initially in targeted populations, e.g. people who will get sickest or the worst consequences

There was also a recommendation of pre-planning for Point of Dispensing (POD) sites

o discussed RSS going out to PODs – had 400,000 doses of medicine from CDC go into warehouse and out to cities, but hospitals, clinics and long term care facilities need to be tested out as nothing was sent to them in the last exercise. We need to get the numbers and multiply by 2.77 (the census data for household) so with hospitals, that’s almost half a million doses, which would decrease the amount needed at PODs. Unsure how likely it is in a real event to push it out to small clinics and long-term care so we might consider having a hospital support small clinics and long-term care facilities.

o The EOC’s were activated, working with the OP area doing some call downs and finding out with critical staff how long it would take to activate, which came out to be about 80 minutes with the HCSA.

Working with the OES, Zerlyn was informed that they had done an exercise as well and a full activation would take up to three hours

We could try doing partial and full activations using a call-down list (6:19)

Exercise Committee

Right now we’re testing Medical Surge by doing messages on ReddiNet

In taking the Medical Surge Components into the hospitals:


o Maybe taking it to the next step, Rick said last time the exercise is more

involving the Emergency Rooms, so next time maybe we can use the discharge planners

Suggested to get BLS ambulance services involved o Suggestion for tabletop for the Command Center to really complete

discharge by making assumptions of an incident to push to get folks out and then identify gaps

Toy with events and exercises by toning them down and make them more manageable

Encouraging participation Understanding roles and responsibilities in the search component Anticipating the resource needs

Public Information and Guidance is always being tested o AAR revealed ReddiNET is in good state

Expanding to long term care next year, using ReddiNET more o Suggested getting long-term care facilities on ReddiNET to assist in sending

alerts and sit stats o Logistics need work as it took three hours to fulfill a resource request

Takes the entire 3 hours to make a resource request, pull the product from warehouse, and deliver

Delivery time is impacted due to conditions of disaster Motions of doing plans are essential so plans need to be fully

implemented Suggested an exercise/simulation that is skewed out amongst

players and done in a two-week period where an hour a day is taken for sit stats

For the Pan-flu exercise, as duration of Pan Flu is over weeks to months, we can think of a 2-4 week time frame where mock Sit Stats are sent and anti-retrovirals/flu vaccines are sent out in

o Skew this out so not everyone is pushed at once o Focus on doing well twice instead of doing many times moderately well

Gaps in Hospitals


Establishing greater relationships with PIO

Creating drill scenarios

Workshop on fatality management with County Coroner and Funeral Homes

Evacuation drill

Integrating long-term care in local clinics

Involve staff departments for preparation in disaster response

Volunteer credentialing and utilization Gaps in EMS

Test the demobilization

Familiarize with the Alameda County fatality plan Gaps in Long-term Care

Volunteer credentialing Emergency Preparedness Kits

Gus showed interest in kits that are only being distributed to cities Gaps in Clinics

Reimbursement pathways and financial recovery

Training on county communication matrix

Training on mass fatality plan

Countywide patient tracking

Incorporate clinic plan into county medical surge plans

Reinforce annual fit testing o It was recommended that HPP funds not be used to reinforce fit testing, as

it is already a state mandate

On-site volunteer registration system Gaps at Berkeley Public Health

Maximize areas that overlap with our public health department

Updating plans

Zerlyn will look into getting kits for Gus


Testing plans during statewide medical health exercise

Collaborating more with mental health Cynthia and the Disaster Preparedness form

Would like everyone to look at what their needs are that could benefit the rest of the coalition when we get HPP money

CDPHC members to get form to Cynthia by the close of the day.

Member Updates

Ron

o Pursuing contractor to do site inspections for HPP purchased items and working on getting contract into place

Donata and Ron will be putting together an email to work within schedules of DPHC to set times up of four-hour blocks to look

at equipment, see if there’s any damage and make notes of replacement parts

If there are any items not related to an exercise that need to have evaluation or maintenance (e.g. generators, trailers) and

inspection can be performed

The contract should be complete by late April

Cynthia

o Urban Shield will be taking place September 12 and 13 this year

o September 11th there will be a “Yellow Command” exercise in which a terrorism exercise will be activated

o Pediatric rabies project site visits in Emergency Departments is coming up again to focus on gaps in the ER

o Children’s Annex tabletop in June

Erica

o Measles - No new cases in the state and activity has decreased so we are demobilizing

o Ebola - Within two hours of any treatment centers, most facilities can consider themselves front-lines

Kaiser Oakland is Alameda County’s treatment/assessment center. All other Alameda County facilities can consider themselves

front-line facilities except for Oakland Children’s Hospital, which will remain an assessment center for pediatrics.

Several travelers from West Africa are being monitored

2 some-risk travelers

And at least 3-7 travelers being monitored

On-going epidemic in Africa

Money-wise the state did provide some funding.

HPP will be with at the state level and the state will work with one hospital for a Region 9 bioagent.

Zerlyn


o For the MRC, we are working on First on Scene (FOS) classes.

Once a contract is in place classes can be planned at sites

We are working with Fast Response and ICE

Louise Diaz teaches triage class

An MCI putting all the skills together will be done on June 26 with Hayward

Working to ensure that we are teaching the same thing across the board

o Donata is working with vulnerable populations

As of 2010, it was found that CBOs that support them do not have personal preparedness for themselves, their staff and their

clients, they don’t have COOP plans and they don’t have ICS. We are working to address this.

Michelle F.

o Learn, Lead, Lift Training will be held March 25

The Alameda County Disaster Preparedness Health Coalition meeting is scheduled every other 4th Tuesday from 9am - 12pm (or as agreed to by coalition members).

Next General DPHC Meeting: March 24, May 26.

ALAMEDA COUNTY DISASTER PREPAREDNESS HEALTH … · ALAMEDA COUNTY DISASTER PREPAREDNESS HEALTH COALITION Suzanne Ridel, Arnie Spanjers, Alameda County Disaster Preparedness Health

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