Ebola TTX Hospital

Report
Wisconsin Department of Health Services
Ebola Virus
Table Top Exercise
Unknown Patient
INSERT DATE/LOCATION HERE
Ebola TTX
Division of Public Health, Public Health Preparedness
1
Wisconsin Department of Health Services
Purpose
To provide participants an opportunity to evaluate
current response concepts, plans and capabilities in
response to a possible outbreak of a viral disease
with high mortality.
Ebola TTX
Division of Public Health, Public Health Preparedness
2
Wisconsin Department of Health Services
Disclaimer
The current Ebola Viruses Disease outbreak continues
to evolve and guidance from the Centers for Disease
Control and Prevention (CDC) and the Department of
Health Services (DHS) frequently changes. The
information presented in this exercise may be quickly
outdated. Check the CDC and DHS websites for up-todate information.
Ebola TTX
Division of Public Health, Public Health Preparedness
3
Wisconsin Department of Health Services
Objectives
Critical Transport: Discuss how critical transportation
would occur in region/jurisdiction in the event of an
Ebola case.
1. Determine criteria and process for transport to local hospital
2. Determine criteria for inter-hospital transport
3. Discuss responder safety as it relates to: Personal Protective
Equipment (PPE), transport from one facility to another,
decontamination of ambulance, etc. . .
Ebola TTX
Division of Public Health, Public Health Preparedness
4
Wisconsin Department of Health Services
Objectives
Operational Communications (Information Sharing
and Emergency Public Information and Warning):
Ensure timely, accurate, internal and external
communication throughout response
1.
2.
3.
Ebola TTX
Identify internal communication and info sharing needs
Identify external communication needs
Develop risk communication strategy for public
Division of Public Health, Public Health Preparedness
5
Wisconsin Department of Health Services
Objectives
Medical Services: Determine the ability to provide
appropriate, safe care to an Ebola Virus Disease
patient.
1. Provide lifesaving medical treatment to an Ebola Virus
Disease patient
2. Ensure responder safety and health throughout the course
of providing treatment
Ebola TTX
Division of Public Health, Public Health Preparedness
6
Wisconsin Department of Health Services
Objectives
Public Health Functions:
1. Surveillance and Epi Investigation:
•
•
•
Investigate case and identify contacts to patient
Assemble appropriate screening tools/forms/resources to ensure
consistent data collection
Identify/activate local, regional, state and/or federal resources for
surge capacity in contact tracing
2. Quarantine (if needed):
•
•
Ebola TTX
Ensure the ability to appropriately quarantine those who may have
been exposed to Ebola in alignment with recommended guidance
Ensure isolation/quarantine plans are updated and ready to be
operationalized
Division of Public Health, Public Health Preparedness
7
Wisconsin Department of Health Services
Objectives
Fatality Management Services: Discuss the
coordination of fatality management services as it
pertains to a fatality caused by Ebola.
1. Ensure responder health and safety throughout processing of
the deceased
2. Ensure most current guidance is followed as it relates to
handling Ebola contaminated remains
3. Provide mental/behavioral health services for those impacted
by event
Ebola TTX
Division of Public Health, Public Health Preparedness
8
Wisconsin Department of Health Services
Exercise Instructions
This is an exercise based on a possible event.
Process the information just as you would in a real-life incident. Avoid the temptation
to “solve” the entire scenario.
There is no “hidden agenda” or any trick questions.
Participation is the key to making this exercise a success.
Feel free to make valid assumptions based on the information provided.
Respond based on your knowledge of current plans and capabilities (you may use only
existing assets).
Ebola TTX
Division of Public Health, Public Health Preparedness
9
Wisconsin Department of Health Services
Rules of Engagement
• This is an open, low-stress,
no-fault environment.
• Offer any suggestions or
recommended actions that
could improve response and
preparedness efforts.
• Be respectful of others, as
varying viewpoints, even
disagreements, may occur.
Ebola TTX
Division of Public Health, Public Health Preparedness
10
Wisconsin Department of Health Services
Scenario
• At 7 pm on Friday a 23-year-old male who is ill
presents at the local emergency department.
• Vitals/Symptoms:
•
•
•
•
Ebola TTX
Temp 101.5
Headache
Muscle pain
Abdominal cramps
Division of Public Health, Public Health Preparedness
11
Wisconsin Department of Health Services
Discussion
Emergency Department:
• How would ER registration handle
a patient that has flu-like
symptoms or says “I think I have
Ebola”?
• What symptom-related questions
would you ask this patient?
• What travel history questions
would you ask this patient? NOTE:
Patient NOT being actively
monitored.
How would this scenario change if
the patient had called 9-1-1?
Ebola TTX
15 minutes for discussion
Division of Public Health, Public Health Preparedness
12
Wisconsin Department of Health Services
Discussion
Patient was in Liberia 11 days
ago. Traveled from Africa to
Germany, where spent a few
days with friends. Upon
return to United States, he did
not end up on the Active
Monitoring list.
Assumption: Substantial
patient history info needed
from the time period of return
to US.
Ebola TTX
NOTE: Patient worked for the
American Red Cross teaching
healthcare workers about infection
control practices. He was
considered low-risk.
Division of Public Health, Public Health Preparedness
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Wisconsin Department of Health Services
Discussion- Initial transport
A unified command teleconference is held between the local
hospital, state public health, local public health, and the CDC.
Based on policy and criteria, what would the likely
recommendation be for initial management?
• Should the patient remain where he
is or be transferred?
Ebola TTX
Division of Public Health, Public Health Preparedness
14
Wisconsin Department of Health Services
Discussion- Transport
Unified Command decision that patient should be seen at the
nearest Category II facility.
Ebola TTX
Division of Public Health, Public Health Preparedness
15
Wisconsin Department of Health Services
Update- Testing
• What testing should be performed in a rule-out
scenario?
• What lab capabilities and employee protections need
to be in place to perform this testing?
• Is the facility able to perform this testing (Category II)
or only screen and isolate the patient (Category III)?
• How about YOUR hospital?
Ebola TTX
Division of Public Health, Public Health Preparedness
16
Wisconsin Department of Health Services
Update- Testing
• Patient arrives at the nearest Category II facility for
monitoring/assessment/initial care.
• Discuss the process of specimen collection,
packaging, transport.
• Ensure permission is received to transport.
• Is there a written protocol?
• What technical support might be needed?
Ebola TTX
Division of Public Health, Public Health Preparedness
17
Wisconsin Department of Health Services
INJECT- Decon
• The EMS unit that transported the patient from
home to the Category II hospital is requesting
guidance on how to properly decon the rig.
• What is your guidance to them?
• Where would you turn for technical support?
Ebola TTX
Division of Public Health, Public Health Preparedness
18
Wisconsin Department of Health Services
Update- Patient Care and
Responder Safety and Health
• Please discuss your internal hospital response plan to
ensure the following:
•
•
•
•
Appropriate patient care
Appropriate isolation
Appropriate PPE to ensure Responder Safety and Health
Appropriate monitoring of healthcare workers and
coordination with public health
• NOTE- Include specific names of policies/procedures
where appropriate
Ebola TTX
Division of Public Health, Public Health Preparedness
19
Wisconsin Department of Health Services
INJECT- RISK COMMUNICATION
• Due to media and public interest, activate your Risk
Communication Plan.
• Do you have one? If so, describe it.
• How will the messaging be consistent between:
• Hospital
• Local public health
• Local government
• State government
• CDC
Ebola TTX
Division of Public Health, Public Health Preparedness
20
Wisconsin Department of Health Services
Update- Patient Deteriorates
• While at the hospital and awaiting test results, the
patient begins to deteriorate.
• A decision is made between Unified Command at all
levels to transport to a Category I facility.
• INJECT: INITIAL TEST FOR EBOLA POSITIVE
Ebola TTX
Division of Public Health, Public Health Preparedness
21
Wisconsin Department of Health Services
Inter-hospital Transport
• How would this process occur?
• Has the EMS that would be transporting already
been identified?
• If not, which EMS would transport the patient?
• Where would you turn for technical support?
• Once patient is transported:
• Who monitors staff?
• How is waste handled?
• How does hospital return to normal operations?
Ebola TTX
Division of Public Health, Public Health Preparedness
22
Wisconsin Department of Health Services
The investigation. . .
• How is contact tracing/investigation occurring?
• Who is the lead?
• Where can you get surge capacity for contact tracing?
• How are you handling the ‘worried well?’
• Is there a hotline/phone bank option?
Ebola TTX
Division of Public Health, Public Health Preparedness
23
Wisconsin Department of Health Services
Investigation Update:
• Extensive contact tracing has identified three close
contacts (girlfriend and two co-workers).
• There are other possible contacts that are being
investigated.
• How would you monitor these contacts? What
restrictions would you put on their movements?
• Who handles contact tracing and monitoring? Who
can assist?
Ebola TTX
Division of Public Health, Public Health Preparedness
24
Wisconsin Department of Health Services
OPTIONAL INJECT• Patient dies at your facility
• Activate fatality management plan for an Ebola
victim
• How are Ebola infected remains handled?
• What is the guidance?
• What is your recommendation to the Medical
Examiner/Funeral Home Director?
Ebola TTX
Division of Public Health, Public Health Preparedness
25
Wisconsin Department of Health Services
DHS Ebola Website
• Frequently updated by DHS Incident Command
structure to reflect the most current guidance:
• Go to:
http://www.dhs.wisconsin.gov/communicable/diseasepag
es/ebola.htm
• OR http://www.cdc.gov/vhf/ebola/index.html
• These are the two most current, up-to-date sites
Ebola TTX
Division of Public Health, Public Health Preparedness
26
Wisconsin Department of Health Services
Hotwash
Ebola TTX
Division of Public Health, Public Health Preparedness
27

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