At last I received the document regarding the TMC’s preparedness response.
PANDEMIC FLU TMC PREPAREDNESS RESPONSE GUIDE
Mission TMC and its neighbor institutions will have coordinated response for potential pandemic flu outbreak. The plan will incorporate an integrated response from member institutions administration, medical staff, public health, city, county and state resources. TMC and member institutions will aid in the triage, medical management and distribution of patients while maintaining a safe environment for the healthcare community as well as allowing concurrent patient care to continue for non-flu patients. The overriding goal is prevention of and infection control during a pandemic.
Overview Management of a pandemic in a large urban setting requires careful attention to traffic and security in and around the TMC. Once patients and employees have accessed the medical center a solid communications plan must be in place to maintain throughput in the healthcare system. The healthcare community needs to be able to triage patients to the appropriate level of care and then respond with treatment centers to deliver supportive care. The response will be a tiered response, so as to mitigate the incident with appropriate levels of resources. Policies and procedures will be developed for uniformity.
Infection Control An active surveillance system will notify caregivers and decision makers of infection prevalence. Spread of disease can be controlled by the following: Proactive vaccination of all residents and particularly healthcare providers, Implementation of standard and droplet precautions for infected individuals, prophylactic antiviral medications, hygiene education and etiquette. Cross contamination preventions entails: triaging off-site, transportation plans, PPE use by caregivers, active cleansing and disinfection of non-disposable resources, waste disposal, discharging patients to a safe environment, and protocols for management of the deceased.
Security and Traffic Control TMC and member institutions have MOU (memorandum of understanding) with city and county entities to provide perimeter security for the TMC. Access to TMC will be carefully controlled so as to protect the integrity of the treating institutions. Security will control access to and from the TMC via a predetermined traffic plan. The plan will allow access for employees, essential personnel, and supplies, while allowing controlled access for patients and visitors. Hospitals need to append current hospital disaster plans to include the advent of a pandemic flu outbreak, addressing unique aspects of a pandemic flu outbreak, security and crowd control, cross contamination, segregation of patients, patient tracking, controlled access.
Communications Communication plan calls for all communications to and from the TMC to occur through a central command post to allow coordinated communications and to eliminate duplication. External communications should be coordinated via a public information officer to ensure consistency of messages to the community that will follow predetermined policies and procedures. Internal communications will utilize standard devices including web-based dissemination of the following: Policies and procedures, current pandemic status, personnel and facility assignments, TMC status, triage status, EMS status. Secure web based patient tracking and monitoring should be instituted with possible link to EMSystem. The web can be utilized by peripheral healthcare providers to notify of pre-triaged inbound patients. Public information can also be distributed via the web.
Medical Management and Surge Capacity Medical response will be tiered with increasing levels of care and resource utilization. The thresholds for upgrading the tiered response will be determined and consistent across the community. Community wide checklists will be developed to define the tier as well as triage. Triage of patients will occur offsite from the TMC. Triage will occur at pre-established triage facilities as well in community healthcare clinics and physician offices. Standardized triage protocols will be established for consistent assignment of level of care, these protocols will be distributed to all healthcare providers and pre-determined triage facilities. Once triaged, patients will be treated and managed according to the level of care needed: Patients requiring ICU or higher levels of support will be triaged to hospitals with appropriate resources, patients may be triaged to ward facilities (i.e. Astrodome or George R. Brown), patients may be triaged to home with follow-up. Surge capacity will be monitored by the TMC and public health. Protocols will be established for the handling and management of medical records, patient registration, patient and staff safety, cross contamination. If the need arises, a hospital, based on pre-determined criteria, may be assigned as a Pandemic Hospital, for the treatment and management of large populations of critically ill patients.
Policies and Procedures The document being produced will be a living document with intrinsic properties allowing for modification as the nature of the pandemic changes. The guidelines serve to allow institutions to develop their own specific policies and procedures, while promoting inter-institutional cooperation. The TMC command will assist an inter-institutional cooperation as well as integration of institution specific plans. The pandemic flu response needs to allow for business continuity for non-flu patients.
The above is the overview section of the document. Each of the main topics are then spelled out in more detail. The document is 44 pages long.
Somes items of interest:
There are several appendices that were not provided.
Wow, Bluebonnet, thanks for sharing. There is a LOT packed into those words. I’m know each little phrase (ie - “protocols for management of the deceased”) has pages and pages of additional information underlying it. It’s encouraging to see active planning at that level of detail.
The one thing that really jumps out at me is the centralization of communication and standards among different parts of the med center, community health providers, and city/county officials. If they can really pull that off, I think it will go a long way to reducing chaos and, hopefully, some panic (at least the panic that would result from seeing the health grid go down). I think survival chances in your area have gone up.
Wonder if they’d send a copy of their plan up-state? ;o)
PJ - I have converted the file to a pdf but don’t know how to upload it onto the Wiki.
Mods - any suggestions?
The plan is not perfect by any means. They are relying on outlying hospitals and doctor’s offices to do most triage.
They only need to close 4 roads to seal off the Medical Center.
Another interesting thing that happened yesterday - we ran out of flu vaccine! We are currently in our seasonal flu vaccine mode and the response has been enormous among employees.
Also, another hospital here has told employees that if they don’t get the flu shot, they must fill out paperwork acknowledging that the shot was made available to them and that they refused. Never been done before.
Bluebonnet - I must have missed some earlier postings? What is TMC? By the way, I’m passing this along to others and also would like the PDF version when it’s available.
History Lover - The Texas Medical Center in Houston, TX. It consists of 8 hospitals and several medical schools.
Bluebonnet--- I can’t believe how this seems to have slipped under the fluwiki radar. This is among the world’s largest medical centers, with the most modern, and best equipped facilities!! Thank you!
Mission: of TMC & neighbor institutions (OK, that IS good news!) will have coordinated response… intergrated response… hmmmmm, “concurrent patient care for non-flu patients” (I hope they are right. But, I also worry that they aren’t even considering the potential of this thing… which is exactly what I am being told.)
Overview: sounds like quarantine of some kind
Infection control: triaging off site (I have heard some rumors here), PPE for caregivers (so, what is it?), they are putting alot of stock in “transportation” syestems
Security and traffic control: “perimeter security”, access to TMC carefully controlled, “predetermined traffic plan”, “crowd control”
Communications: public information officer and “web”
Surge capacity: “determined and consistent across the community”… hmmmmm, they do realise the size of Houston and the “community”… they have that many HCW’s they “know” won’t get sick?? *Astrodome and George Brown Center… triaged home for follow up. Pandemic Hospital assigned… again… crunch the numbers.
Policies and Procedures: “as the pandemic changes” … do they understand “tsunami”… I, II, III? “business continuity for non-flu patients”- gawd, I hope they are right. If not, just damn.
I am glad they are acknowledging this, however, I still think they are absolutely convinced there is no way it will be catastrophic. During “normal flu” outbreaks those TMC emergency rooms are packed like sardines. And good lord, what if there is a hurricane or tropical storm or something else… what a fricken nightmare.
Well, on another note: My husband just returned from NYC where he was part of a task force for emergency planning for the NE seaboard. Mayor of NYC and some other elected officials were there. There are some people very concerned about this, or even “something” like this, occuring and the impact it would have on the citizens in communities.
Thanks again Bluebonnet for posting this!!
You are most welcome, Enough!
From what I understand, most of the healthcare workers from the TMC will NOT be allowed in. They will be assigned to perimeter hospitals. I don’t too much about other large urban areas, but most of the hospitals in the Medical Center in Houston have affiliated hospitals in the suburbs. I’ve been told that nurses, techs, etc. will be assigned to those hospitals nearest to where they live.
Yes, they plan to block off the Medical Center and allow access at only 3 points - one for patients in the immediate area, one for heavily id’d HCWs, and one for ambulances.
I agree with you I just don’t think they have come to grips with how catastrophic this may be. My fear is that despite a good plan - they will be completely innundated at the very beginning.
Bluebonnet – at 10:53 Having to sign a form saying the flu shot was offered is because of Joint Commission this year. It’s new. We have to do it here too. It’s to prove it was offered, you didn’t slip thru the cracks in not getting it. Covers the corp. so the employee can’t come back and say “you didn’t give it to me and now…” Also encourages getting it, to protect those around you.
Communications: public information officer and “web”….and if both are down???? I hear a lot of people shouting, “I don’t know….there’s no one to tell us what to do!”
mj - thanks for the info re: Joint Commission. Hadn’t heard about this before. But it definitely made some folks at TCH stop and think!
Workin’ - exactly! I also understand TPTB here are very, very concerned with the grid going down. So how in heck are they going to do a web site?
Some of it is good - some of it makes ya go, HUH?
I think having a plan is way above what most hospitals are doing (mine) but I still firmly believe Hospitals will be come completely overwhelmed very early on, and healthcare workers/hospitals the first to succumb to a panflu. I work in an ICU for many years now, and I know how many hosp. departments are in and out of each patients rooms in a 12 hour period. In a normal scenario….you have a patient who is admitted for chest pain, rule out MI. Lab comes in and draws blood, and continues to go about to all the other floors (tele, med/surg, maternal child health, etc.) for other blood draws (no PPE’s worn), next comes radiology, takes a chest film and continues on their way… Cardiopulmonary comes in and does an echo on pt. and continues on their way…housekeeping comes in and empties trash, and continues to other rooms/floors….family & friends visit, and then go on their way (again no PPE’s worn) lab comes in later in the day for the next blood draw….you get the picture! Final diagnosis : the man did not have a heart attack…but is in the first stages of H5N1..shedding virus but still asymptomatic. There is no way to isolate or contain H5N1 in a hospital!!! I know my hosp. only has PPE’s for maybe a week in any normal situation. JIT delivery will be the death of many of us!
TXNurse - It’s exactly that way at my hospital, too. I think they plan to do flu screening at physician’s offices. Riiiight!!!
Now that really makes me laugh…
I’ve “heard” the plan is to set up triage centers at neighborhood schools. Part of the plan is to be able to have the life flight helicopters land and take off. Like I said, it’s a rumor. (Hope there is fuel for those life flights.) Also have heard veternarians are being considered as fill-in for local areas, especially outliers.
Personally, I don’t think the medical community is taking this as much of a real threat. I sure hope they are right. All I know is, I have never seen such global hoopla about warning people to prepare in my entire life. Not even for the Cuban Missile Crisis… & I was smack in the middle of that one.
Bluebonnet – at 10:53
I, too, would like to have a copy of the document.
If you email it to DemFromCT and Dude… It might can be posted in the large file communication area.
i’ve been out of EMS for a long time. i don’t know how dark a scenario folks are planning for, but if petroleum products beome unavailable, local EMS may be able to continue using their med units for care. the units i used to work on had 2 12V batteries, and with the advent of LED lighting, folks could put a few solar panels on top of a type 3, and have a fairly useable exam facility. the gas trucks we used to run only got 4 mpg, and perhaps that has improved, but they’re not generally designed for fuel efficiency. they do have radios, inverters, exam lighting, suction, and a number of features that would prove more useful than setting up in a tent. they might also be useful for isolation facilities. the trucks we had, all had shorelines, so if AC power is available, the internal power capability would be considerably greater. i don’t know where old ambulances go - we always retrofitted ours - but old units could be used, as well.
Hospitals and the health care system cannot reasonably plan to provide care for every case in a pandemic. There are not enough HCW to provide care for 10% - or 20% or 80% - of the population, even if supplies and space existed and all HCW were available.
All they can do is plan for a maximum possible effort for as long as they can sustain it with the people and supplies available. At the end of that effort, the hospitals will have expended all their resources, and will completely cease to function.
They are hoping that they can outlast a pandemic. If not, they will go down fighting.
good points c3jmp, I wonder if citizens would chip in, once they understood the need for adding solar (and, a cache of backup supplies and drugs, for the EMTs?) to ambulances?
Rather than isolation, they might be needed to provide non-flu care to essential workers and first responders who get injured, have MIs, ect. (If there’s some mental health providers in the neighborhood, sounds like they’ll be needed too. If they’re ready.)(How can they be, they’re only human?)
What about women in labor that can’t get near a hospital? Would any doctors or midwives with low-tech expertise need an ambulance, or an old one under a tent, set up in their neighborhood, or, where the most need is, and, get volunteer security details (official ones or if they’re going to be busy, registered gun owners that live close by, to take turns)? (Smart gang members that want to protect the medical workers in their area??)
Just on my first cup of coffee; some units might help with unattended death pronouncement, id, and death certificates, if we could get the emergency legislation to ease laws during pandemic. (And start printing the forms out now…)Even if the EMT’s were doing care, a tent nearby could have the other person needed to do the paperwork, and sign off with the EMT, Dr. or hcw at the ambulance who could look at the bodies from a “10′pole distance”. The other person could be faith community leader, justice of the peace, some other municipal employee whose regular desk job is not happening…? Then other volunteers or family members could take the body to the nearest cemetery, by whatever methods are locally available.
TMC: Proactive vaccination of all residents and particularly healthcare providers with what? I heard what HHS Sec.Leavitt said about vaccine availability.
What are the details, and are the staff stocked up at home and ready, and is there fuel and security for “waste disposal, discharging patients to a safe environment”, and “let’s hear the detail of those “protocols for management of the deceased.”
(Is that the time?! Why did I make coffee? I thought it was a couple of hours later than this - oops…)
anonymous – at 03:38 but, I don’t want the pool of trained health care providers to cease to exist.
Let the public know what providing for living and dying at home may entail, and make sure some of the trained health care people are held in reserve for post-pandemic recovery; if some want to volunteer, ok, of course I honor them, but, if some need to stay SIP with their families, they will not have an easy road later either, and we need the skilled people without the building more than we need the physical structure of the hospital without and nurses or doctors, ect.
“They are hoping that they can outlast a pandemic”
Pandemics last more than two weeks; I don’t think it is reasonable to go through the motions of only preparing for a Cat.1 hurricane with a Cat.5 off the coast, just because some refuse to look at the weather report, or, to let it be broadcast to the public…
My understanding of the plan is that TMC will be used only for the most critical flu patients. Houston is ringed by outlying hospitals affiliated with the larger hospitals in the Texas Medical Center.
The current thinking is to “hold the line” at the TMC. This means that most folks will be referred to outlying hospitals and that only the sickest of the sick will be transported to the TMC.
The TMC will still be open (how long - who knows?) for heart surgeries, high risk OBGN deliveres, car accidents and other traumas.
Ben Taub Hospital is a Level 1 Trauma Center located in the heart of the TMC, one of only two in the Harris County area. This 650 licensed-bed acute care facility is one of the nation’s busiest trauma centers, caring for over 108,000 emergency patients each year. This Trauma Center must remain open.
The other alternative Trauma Center is at UTMB in Galveston.
My own institution is a specialized hospital. We will close our doors and accept ICU patients (non-flu) from the other hospitals in order to free up space there. My hospital will not and does not treat flu victims.
As anonymous put it - they are hoping to go down with a huge fight!
The plan is not perfect but at least it is a start. Right?
Bluebonnet – at 10:00 Out of curiosity, has your hospital stated what would happen if a patient was admitted but later became ill with the flu? Would that patient be discharged regardless of their condition? That patient will have contaminated the hospital staff that he/she came in contact with and the flu would begin to be transmitted to all of the other patients and staff.
IMHO, while it is a tempting thought to only admit non-symptomatic patients, I do not think it will be a practical way to keep a facility flu free.
Oops - that was me at 03:38.
They are not trying to gear up to care for every patient, because they know it will not be possible. They are preparing to do the most that they possibly can. The hospitals can only sustain a maximum effort for a finite time. They know it will probably not be enough - but they have to try.
At the end of it all, win or lose, they need to be able to say, “We did everything we could.”
crfullmoon – at 03:54
sounds good. i was specifically looking at how a truck might be useful in the event there is no power, no fuel for the trucks, and no diesel for the hospitals’ generators - versus leaving it in a parking lot, or at the station. in terms of pre-hospital care in a pandemic, even with fuel, i doubt EMS will be able in most communities to meet the needs of the public in the manner the public has become accustomed to. that will be a considerable shock to many - one of several. advanced life support is a bit less advanced when you have no fluids, angiocaths, IV lines, drugs, oxygen, ET tubes, etc. and possibly no open facility to transport to. it seemed like it might give the hospitals an option - add panels, and you’ve got an exam room — you won’t be able to go anywhere without fuel, but you won’t be working in a dark ER, either - long after the generators run out of diesel. the thought on isolation is the concern with regard to the few number of real isolation rooms available (with separate ventilation) - put a couple units on shorelines and you’ve got that - a couple more than you had. even if you put older units in place - it beats a tent.
primary care facilities could use solar panels on the roof, or the top level of a parking deck for solar arrays, and deploy banks of batteries. there would need to be security for the decks to head off vandalism. that would buy a source of power independent of the generators. they’d need temporary wiring run to wherever care is provided, but with LED lighting, it would be possible to retain some exam capability. ventilation would be a tough issue to solve. as with all preps, if they wanted to go that route, they’d need to get the panels, batteries, wiring, and lighting now - before shipping shuts down.
Problem is, hospital officals don’t want to buy those things -the surrealism of having to act as if pandemic can happen at all, and, have a very high fatality rate, seem to have always been the disconnects.
They seem to be more concerned what will happen to their face/paycheck/bottom line if pandemic doesn’t materialize in the next month or year, than they are about what will happen to themselves and all the people in regions when it does. Or, they are ok with saying, it’s going to be so bad there’s nothing we can do but send hcw to die trying; don’t tell the public to stock up, and learn home nursing, nor discuss community’s mass fatality processing, just go along until something happens…
I imagine some EMTs would like to rig ambulances like you suggest, and I bet one or two individuals or businesses could afford to help them- if they knew; it is so hard to get information to people that would rather trust officials and the government, (and media) who reassure them everything is under control - they “have been planning”- so that the citizen would rather not check on the internet yet to see whether I was telling them the unpleasant truth… I hope the article about “pandemic could keep high fatality rate” gets around quickly, but, adjustment reactions and denial take time.
Solar panels and LEDs would certainly see use in limited regional emergencies now. I’ll try asking the fire chief (on the secret “emergency” all-hazards committee doncha know) what they plan to do with their ambulances, and what the county does with old ones…but, it is hard to get people on the page we’re on. (As a member of the public, I don’t seem to supposed to even know about the book - is that the conversation problem?)
i agree with you. the entities that really should be running in high gear to get ready, for the most part, still can’t seem to get out of neutral. too many horror movies perhaps - people’s natural reaction used to be fight/flight… now it’s become a couch potato response - sit, wait, see what happens - everyone is a spectator. doesn’t say much for the evolution of our species. pardon the cliche, but where we seem to be now, is analysis paralysis. perhaps the roaches will inherit the earth - it certainly won’t be the business analysts.
Bluebonnet – at 10:00
I hope they are as concerned about this pandemic as you seem to think they are. However, my experience with anybody I have spoken with affiliated with TMC &/or UTMB-Galv has been they are not worried about a pandemic. At least not on a large scale with the potential of totally overwhelming the entire system. I have spoken to 2 doctors who are seriously concerned, other than that, the others become increasingly condensending and abrupt. I have 2 adult children working in TMC hospitals who are being told this “flu” just isn’t going to be a problem. They are not taking any special precautions nor have they recieved any special training. This is pretty much the same story I am hearing from the surrounding areas… I am talking about in the directions of Beaumont, Livingston, etc.
Whether this hits this fall or winter, or next year, or the next… we can be sure it will hit. Being prepared is everything… it is what matters. Our local and state governments are not preparing realistically… and they sure as sam hill aren’t preparing the citizens.
And I am madder than a wet hen about it…