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<p><strong>You Are Here:</strong> <span class="crumb_link"><a href="/" class="crumb_link">AHRQ Archive Home</a> > <a href="/prep/" class="crumb_link">Public Health Preparedness Archive</a> > <a href="." class="crumb_link">Lessons Learned From the Field of Emergency Preparedness</a> > Transcript of Webcast (continued)</span></p>
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<td height="30px"><span class="title"><a name="h1" id="h1"></a>Lessons Learned From the Field of Emergency Preparedness</span>
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<td><div id="centerContent"><div class="headnote"> <p>
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This resource was developed by AHRQ as part of its Public Health Emergency Preparedness program, which was discontinued on June 30, 2011. Many of AHRQ's PHEP materials and activities will be supported by other Federal agencies. Notice of transfer to another agency will be posted on this site. </p>
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<p>This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: <a href="https://info.ahrq.gov/">https://info.ahrq.gov</a>. Let us know the nature of the problem, the Web address of what you want, and your contact information. </p>
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<p>Please go to <a href="https://www.ahrq.gov/">www.ahrq.gov</a> for current information.</p></div>
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<p><strong>Cindy DiBiasi</strong>: Now for your question. How do you accomplish patient tracking in an ACS [alternate care sites]? </p>
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<p><strong>Terri Gill</strong>: We actually came up with a tool to do that. That is also in our Surge Standards and Guidelines Alternate Care Site tool. It's something that's a challenge, so we brought a bunch of people together to come up with a sample tool that local government can modify to meet their needs. </p>
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<p><strong>Cindy DiBiasi</strong>: Nancie, in past disasters there have been problems communicating to providers. How will providers know when alternated standards have been turned on or off? </p>
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<p><strong>Nancie McAnaugh</strong>: Believe me, when the Governor issues the executive order, folks in the State will know. We've had this conversation with the health care system in Missouri late last week. The discussion was hospitals are going to know at the local level way before we know at the State level that they need to move to a scarce resource environment/altered standards environment, so how do we get that information up through the pipeline to the State in as quick a manner as possible? We do have an EM [Emergency Management] system in the State of Missouri that's been utilized in the past, but quite frankly, right now what we're talking about doing is having a direct line communication protocol that we set up between local hospitals and the State health department when we know we have a mass casualty event going on in the State. </p>
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<p><strong>Cindy DiBiasi</strong>: Chris, describe the level of detail of information you can store in EPRI [the Emergency Preparedness Resource Inventory]? Is it easy to keep track of how up-to-date the information is?</p>
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<p><strong>Chris Feller</strong>: It is very easy to keep track of how up-to-date the information is. Basically, with EPRI allowing you to enter in whatever field you like, you can certainly track, for instance, for an N95 mask, you can even track who the manufacturer of that mask is by typing it in. There's been what we called validation dates or validation screens that show the last time you updated that resource and how frequently you do update it. </p>
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<p><strong>Cindy DiBiasi</strong>: Terri, will California's ACS be able to handle normal childbirth and well baby care during a pandemic? </p>
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<p><strong>Terri Gill</strong>: Well, since I am not a doctor, and I am not sure what would be required to handle that, I'm assuming the answer to that would be yes because they plan for a variety of care, including critical, so I'm assuming that having a baby isn't worse than critical or ICU. I would assume, yes, they would be able to provide for that. </p>
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<p><strong>Cindy DiBiasi</strong>: You have said that the local government has the responsibility to set up and operate ACS; is this true in every State or just California? </p>
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<p><strong>Terri Gill</strong>: That's California's decision to make it for California. We can't dictate how other States will operate. </p>
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<p><strong>Cindy DiBiasi</strong>: Nancie, does the Ventilator Allocation Protocol have a SOFA [sequential organ failure assessment] score component? </p>
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<p><strong>Terri Gill</strong>: SOFA score is really the touchstone of our Ventilator Allocation Protocol right now. </p>
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<p><strong>Cindy DiBiasi</strong>: Here's an interesting question. Have any of you networked with tribal entities and if so, do you have any tips for doing so? </p>
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<p><strong>Nancie McAnaugh</strong>: We don't have any recognized tribes in the State of Missouri; I defer to my other two colleagues here. </p>
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<p><strong>Chris Feller</strong>: Nor do we, in the State of Ohio. </p>
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<p><strong>Terri Gill</strong>: Well, in California we have 109 recognized Federal tribes and so working with tribal entities is a critical part of our emergency planning efforts. In our State Emergency Plan there are recommendations to involve tribal entities and, since they are sovereign entities, you can't force them to come to the table, but you can explain to them the benefits of coming to the table. For example, in the 2007 fire storms, one of the local reservations was impacted, and they needed assistance. Because they were plugged into the local emergency management community and had been part of the planning effort, we were able to provide assistance to them. So there's no cookie cutter approach to this; you have to personally invite them and encourage them to participate at the table. They have an incredible amount of resources available to them that they bring to the table, as well. So really emphasizing the mutual benefit of everybody being at the table has helped us to move that forward, but there are challenges and it's not something we've completely overcome. We handle it on a case-by-case basis, and we work with them on a local level.</p>
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<p><strong>Cindy DiBiasi</strong>: Chris, is EPRI compatible with Web EOC or other incident management software? </p>
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<p><strong>Chris Feller</strong>: EPRI is a standalone tool right now. During our evaluation process, we did look at other tools, such as Web EOC [Emergency Operations Center ], but our region was strictly looking at resource management, and from a resource management standpoint, we thought EPRI did the best with that. With its open-ended architecture, you can tie into things such as mapping, various State resource tracking software, so I am confident that anyone with a software background such as Web EOC could make EPRI compatible with that. </p>
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<p><strong>Cindy DiBiasi</strong>: Terri and Chris, if each of you could comment on how you handle expiration of your stockpiled items? </p>
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<p><strong>Terri Gill</strong>: We have a set of rotation protocols for some of our stockpiled items, and we also have looked into the extension program that is available to use certain pharmaceuticals beyond their expiration date. </p>
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<p><strong>Chris Feller</strong>: We've done a couple of things to tackle the expiration process. We do rotate them in stock on a regular basis, but also, through our ASPR [Assistant Secretary for Preparedness and Response] funding, we look at when equipment or supplies expire and then we make sure that outlook is provided within future grant funding. So that if you have medications that expire in 2010, we'll already have that documented so that in our 2010 grant funding, we know that we need to look at replacement for that. </p>
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<p><strong>Cindy DiBiasi</strong>: Nancie, can you address unique issues for rural preparedness or any resources or information or experiences that you can share? </p>
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<p><strong>Nancie McAnaugh</strong>: Missouri has had a couple of pretty severe ice storms we dealt with the last couple of years, which I think have helped some of our rural hospitals accelerate some of the planning processes they've been doing for emergency preparedness. We have rural hospitals that are currently sitting on our Resource Allocation Group. It's critical to involve them in the process because it is going to be a different protocol in rural Missouri than in our metropolitan areas. So I just encourage you, as you move forward, to try and create your scarce allocation plan to make sure your rural hospitals are sitting at the table and keeping you honest because again, things are very different in rural Missouri than they are in the metro areas. </p>
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<p><strong>Cindy DiBiasi</strong>: I'm going to pose this question to any and all of you. In the event of a highly communicable disease outbreak, a large gathering of people for treatment is obviously undesirable. So, in addition to ACS, have any plans been put in place to treat individuals at home? </p>
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<p><strong>Nancie McAnaugh</strong>: We are fortunate in Missouri in that the Missouri Department of Health and Senior Services regulates home health providers in the State of Missouri, and it also is the agency that oversees our home- and community-based Medicaid programs for seniors and persons with disabilities. We have had preliminary discussions with two industry groups that represent those folks in trying to determine trigger points on providing care out in the local community during pandemics. I would say we're in the very early stages of those discussions. </p>
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<p><strong>Chris Feller</strong>: One of the things we identified in using EPRI and its importance was the tool being Internet-based. We realized that there may be times when we need to take health care to the patient or move the hospital to that patient. For that reason, EPRI being Internet-based has provided us the ability to take that tool with us and provide them with the resources they needed regardless of location. </p>
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<p><strong>Terri Gill</strong>: What we've done in California is developed risk communication messages that are ready to roll at a moments notice to tell people what to look for in terms of symptoms, to tell them whether or not it's necessary to present at a health care facility so we can relieve that burden on the health care system. We've also done planning around providing medications through a variety of mechanisms and having them delivered to a patient's home rather than having them present at a medical facility. </p>
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<p><strong>Cindy DiBiasi</strong>: There's been a lot of praise today for AHRQ's tools, but a question on whether you had any difficulties or what some of those difficulties may have been as you were trying to use the AHRQ planning tools or modify them to your individual States and situations? </p>
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<p><strong>Chris Feller</strong>: We've had no difficulty whatsoever in using any of AHRQ's tools. The EPRI tool, for example, we contacted ally Phillips immediately when we wanted to roll this out at a regional level. She put us in contact with the various agencies that she works with, and it's been nothing but a very seamless hands-on process. </p>
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<p><strong>Nancie McAnaugh</strong>: I think that's the beauty of the AHRQ tools, really, is they're not prescriptive. It is not like you need to follow step one through ten; they are very flexible, so there's a lot of adaptability in them for each State to utilize as they move through their own planning processes. I wouldn't say, as a State, we've had any difficulties implementing the tools. </p>
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<p><strong>Terri Gill</strong>: I have to second everything that's been said by my colleagues and say that actually the AHRQ tools saved us a lot of work. Since we were able to use it as a starting point for our planning efforts, we started that much further ahead in the process and were able to move that much further with the resources we had to devote to the project.</p>
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<p><strong>Cindy DiBiasi</strong>: Do you have any specific suggestions for other States that may be thinking about using the AHRQ tools in their planning process? </p>
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<p><strong>Chris Feller</strong>: Probably my first suggestion would be: don't try to reinvent the wheel. The AHRQ tools are free and so is the knowledge of those in States surrounding you. Make sure you reach out to them and use some of the lessons learned that they've developed over time to enhance your experience. </p>
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<p><strong>Nancie McAnaugh</strong>: I would echo what Chris said about contacting other States that have utilized AHRQ tools. It's great to call folks up and ask: what sort of issues did you run into, and did you change the tool any when you were using it? I think that's a really excellent suggestion on utilizing other States that have gone through the process.</p>
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<p><strong>Terri Gill</strong>: I echo that, as well. As Nancie said, these tools are not prescriptive. They are based on evidence, so you know there's a lot of thought that has gone in to it, and it saves you a lot of work. Talk to people who have used them because that experience will help you discern which tool would be best applicable to you. There are a lot of resources there, and it can be overwhelming. Talk to folks who have been in your shoes, and find out what works for them, and modify them. Make them work in the legal environment that you live in and the realities that you live in. They're modifiable. There's nothing that's set in stone. </p>
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<p><strong>Cindy DiBiasi</strong>: Since AHRQ has done such a good job on this set of tools, are there any additional tools you would like them to work on? </p>
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<p><strong>Terri Gill</strong>: Can they complete the Crisis Standard Care tools please? </p>
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<p><strong>Cindy DiBiasi</strong>: Here is your opportunity. Anything else? No, we're good? What are some of the key lessons that you have learned from your emergency preparedness programs? </p>
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<p><strong>Terri Gill</strong>: I think one of the biggest lessons we learned in the Surge Standards and Guidelines project is that a lot of the protections, a lot of the information, a lot of the statutes already existed to make the modifications of how we deliver care in California in a surge environment, but nobody had brought them all together in one place so that they were easily accessible. I'd encourage you to do something along a similar vein to really look at what is available to you already before embarking upon a path of modification. The other thing we really learned is you have to involve everybody early and bring them into the process, otherwise you won't have the buy-in coming out, and the tools won't be used. Those are the two areas where we really felt we learned a lot on the Surge Standards and Guidelines project. </p>
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<p><strong>Nancie McAnaugh</strong>: I want to echo what Terri said. You can't be inclusive enough in bringing people to the table to really work through these processes. Even non-traditional partners, for example, the Trial Attorneys' Association, pulling them into the discussions we've had in the State on altered standards protocols because obviously, at the back end, they're going to be a really important partner for us. Involve as many folks you can think of who have a stake in what you're working on; ultimately, that's going to impact whether you are successful or not utilizing the tool. </p>
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<p><strong>Chris Feller</strong>: I hate to sound redundant, but I would only echo what my colleagues have said. One thing that has been consistent regardless of the AHRQ tool used is that some of the lessons learned and some of the communication has been key. If you can bring everybody to the table at the beginning, talk about what you want to do, and benchmark with other organizations, States, and entities, you would be much farther ahead than you would be otherwise. </p>
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<p><strong>Cindy DiBiasi</strong>: You have already provided us with some sort of a wrap-up, but I want to go around the group one more time just for some final thoughts. Anything you would like to emphasize or something we didn't cover that you'd like to bring up? Nancie, I'm going to start with you. </p>
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<p><strong>Nancie McAnaugh</strong>: Thank you, Cindy. One thing I think we do need to continue to work on as States is regional collaboration when it comes to scarce resource allocation. Missouri belongs to the Mid-America Alliance, so we do have ten other States that we currently do preparedness planning with. Illinois, Arkansas, Tennessee, and other States that surround us are not involved in the Mid-America Alliance, so I think the more consistency we can have nationwide when we have to move to a scarce resource allocation protocol should we have a pandemic, the better off we're going to be in the long run. Maybe that is something that AHRQ can help States work on is creating templates or providing additional ideas on how States can collaborate cross-border when we're trying to create these plans so we are as consistent as we can be. </p>
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<p><strong>Chris Feller</strong>: The biggest thing is bring everybody to the table. I think regardless of whether you're talking about scarce resources, altered standards of care, or even resource management, you need to get them to the table and get them involved. Disasters don't recognize political boundaries, and I think we need to respect the fact that we need to work collaboratively with other regions, other counties, and other States in our emergency planning. </p>
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<p><strong>Terri Gill</strong>: I think one of the things we continue to work on and struggle with are triggers. How do you move from business as usual to mass care and the changes that that brings with it. We're struggling with that now as a State. As we move into the Crisis Standard of Care program that we're embarking upon to establish come clinical protocols and what that would look like and what it is that moves you from business as usual to a different type of care, more population-based. That's something we still continue to work on and, again, something Sally is going to be involved with, and maybe AHRQ can lend us support and move us in the direction where we can establish some metrics triggers that will be applicable to everybody. The other thing I want to say in closing is: don't forget your politicians. Bring them into the process because they will enter your process whether you like it or not. It's better to involve them in the planning effort rather than in the response effort. We don't want to meet them for the first time in the middle of a response. </p>
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<p><strong>Cindy DiBiasi</strong>: Great advice, thank you. Well, our time is about up. Thank you for joining us for this event. I'd also like to thank our presenters, Terri Gill, Nancie McAnaugh, and Chris Feller again for sharing their experiences with us today.</p>
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<p>I also want to let you know that AHRQ will be hosting another Webcast in early winter. It will introduce you to more AHRQ emergency preparedness resources, including hospital and transportation planning tools. Please stay tuned to find out more about this next event.</p>
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<p>As we conclude this Webcast, let me remind you that the slides from today's event, and information about other emergency preparedness tools, are available at <a href="/prep/">www.ahrq.gov/prep</a>. </p>
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<p>Finally, when you close your screen, you will receive a pop-up feedback form. Please take a few minutes to complete this form. Your feedback is important for the development of future AHRQ emergency preparedness activities. </p>
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<p>Thank you, again, for joining us today!</p>
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<p class="size2"><a href="index.html#contents">Return to Contents</a></p>
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<p class="size2"><em>Current as of December 2008</em></p>
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<p class="size2"><strong>Internet Citation:</strong></p>
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<p class="size2"><em>AHRQ Lessons Learned From the Field of Emergency Preparedness</em>. Transcript of Webcast, November 6, 2008. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/prep/fieldemprep/fieldtrans.htm</p>
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