How VPC created a record snowfall that combines public health and healthcare providers in one region-wide exercise

Challenges

Transforming the State Department of Health’s ideas for Healthcare Coalitions into reality

Indiana’s 10 District Healthcare Coalitions routinely practice scenarios that test their ability to communicate and respond to large emergency events appropriately. A flood that impacts three counties could require up to half a dozen police departments, an equal number of professional and volunteer fire departments, four health departments, and three or more hospitals and clinics of varying sizes. 

Billy Brewer is the former Director of Emergency Preparedness at the Indiana State Department of Health and is now working with VPC to develop these top-level trainings.

“In the past, most healthcare coalitions would typically go to one spot to coordinate the exercise, either in person or virtually. And most coalitions were running the exercises focusing on communication as a primary objective. The problem is hundreds of entities would show up or reach out directly to the coalition, in many cases bypassing local community partnerships.”

“In the middle of a disaster training, it’s overwhelming to have 100 phone calls and everyone needing their own things to do their jobs with no real sense of interconnection or collaboration among  local entities.” To that end, in some ways it sidesteps the entire NIMS process and functions of the local EOC and ESF-8 role of the local public health department.

The Indiana State Department of Health wanted to see coalitions:

• Coalesce with NIMS (a national response network)
• Use proper ESF8 protocols (measures that coordinate federal assistance to states)
• Train as a region in a believable, real-world situation (not 150 tornadoes in one small area)
• Include urban and rural counties effectively
• Flip the dynamics between healthcare providers and health departments around so everyone worked through their Emergency Operations Center as the first level of requests and coordination, and
• Operationalize the healthcare coalition as a stand alone entity capable of providing resource coordination, communication, and act as a sort of “regional mutual aid” to all the local entity members through a multi-jurisdictional approach

“Coming as a former Director, this was huge. The US Health and Human Services Assistant Secretary of Preparedness and Response (ASPR) who oversees the Hospital Preparedness Program (HPP) recently prioritized  the operationalization and integration of healthcare coalitions with the local ESF-8 structure and local EOC. We had been trying to push and get to this level of integration for some time. The challenge is that every coalition and every membership is so different and diverse, there was no real simple one size fits all solution and requires a district born solution to truly work. While many coalitions have been able to coordinate and communicate among hospitals, it’s cool to see an exercise that’s new, different, and manageable for first responders and Emergency Operation Centers (EOCs) all while integrating the district based healthcare coalition into multiple local ESF-8 through public health”.

Solution

An integrated team of health departments, healthcare providers, and first responders reacting in near real-time

The result would be a one-day exercise that included full-scale, functional, and tabletop exercises in Indiana District 5’s Healthcare Coalition. District 5 consists of the Indianapolis statistical metro area: Marion, Hamilton, Hancock, Shelby, Johnson, Hendricks, and Boone Counties.

“The scenario was heavy snow, then a layer of ice. That caused travel issues, power outages, and a cascading effect of failure from a record snowfall. The total time for the simulation was five days, with the majority of the exercise including county road closures and travel restrictions.”

As the exercise unfolded, Marion County’s DOC and MESH’s MedMAC had to coordinate with multiple hospitals and healthcare partners throughout the county and surrounding counties. Similarly, other participating health departments participated as the ESF-8 coordinator role working closely with hospitals and other healthcare partners. When resource request came to the health departments that were above the county capacity, that’s when the healthcare coalition came into play – either providing those specialized resources, or facilitating resource sharing across the district.  Plus, hospitals and healthcare providers never stop for the real-world patients coming in the door, even during an exercise. So teams worked in different styles during the event.

“The overall district was in a functional exercise, which typically means the necessary people are going to their EOC. Then, hospitals and health departments had the opportunity to branch off and take that exercise in their county, hospital, or office. The result was a mix of people in a full-scale operation pretending it’s real, doing the physical motions. Some did it functional, where they work through the coordination element in specific locations, like a hospital EOC or county health department DOC. Some did a tabletop, where they go to a conference room and talk about what they would do.”

This enabled some facilities to train even further, like asking themselves, “What happens if our generator fails?” 

Results

Finding gaps and breaking processes result in improved safety for residents and responders

The purpose of this first-of-its-kind exercise is to find gaps in coverage and break processes. That gives hospitals, clinics, governments, and other involved agencies clear instructions on what to plan for, think about, and do next.

“What’s great about this was we haven’t had training before where a trainer like VPC understood both sides of the public health and healthcare relationship No vendor has ever been so ingrained with both public health officials and hospitals than VPC.”

— Billy Brewer, former ISDH Director of Emergency Preparedness

“What’s great about this was we haven’t had training before where a trainer like VPC understood both sides of the public health and healthcare relationship No vendor has ever been so ingrained with both public health officials  and hospitals than VPC. On paper, you say public health and providers are going to work together, but they have different priorities and in the real world, it’s a challenge during a disaster. The CDC used to define public health in having a major role in med surge coordination,  when the reality is that public health is typically limited to an information sharing and resource support coordination role whereas EMS, dispatch, organizations like MESH, or healthcare coalitions are coordinating the actual surge event. The CDC clarified this role to reflect such in this recent year’s project period for the Public Health Emergency Preparedness (PHEP) program. Most of the current focus for public health’s role in healthcare emergency management is as the ESF-8 coordinator and liaison to the county EOC.”

People found things they could and couldn’t respond to and recognized where they had good plans in place. This exercise continued to build the disaster relationship between public health and healthcare. Health departments know their role is not to augment hospital service as they are not staffed with surgeons and patient providers, but instead are able to fulfill the role of resource coordination and facilitate emergency response as the ESF-8 for the county, working closely with hospitals and other healthcare providers in that aspect. Likewise, the district healthcare coalition was able to take a more manageable emergency management role, facilitating resource needs and information sharing with the local ESF-8, EOCs, and healthcare members. Everyone began to know their place.

“The sense I got throughout the district was this was a perfect balance of player engagement and scenario complexity. It’s difficult to balance all the players because they’re so diverse. District 5 includes network hospitals, urban vs. rural health departments, small healthcare providers, big hospitals, and through it all we found a middle ground to get some real planning done.”

The goal of this exercise was to change the approach of how exercises are done and follow the Homeland Security Exercise and Evaluation Program (HSEEP) guidelines. VPC designed this exercise with input from agency leaders and experienced leaders. Now VPC can repeat this exercise and planning process with other agencies and coalitions.

“This worked out better than we had hoped. I’ve seen exercises in the past that I thought were light or felt like reading from a script to check a box. This one was top-level, with issues and scenarios going out to players across the region. Hospitals were calling other hospitals, EOCs were evaluating and managing teams and assets as if they were real emergencies. That level of player-to-player cross-play is difficult when you consider hospitals as busy as they are.”

“Coming from the state, the big thing I saw and I wished I knew a long time ago was just how obvious and clear it was VPC took the time to understand not only what HSEEP is about, but the amount of research that occured to align the exercise objectives to the Hospital Preparedness Program and the ISDH priorities laid out for the 2019-2020 year – well above and beyond simply testing communication or checking a box. This exercise was specifically testing a shift in the way resource coordination occurs through the local ESF-8. It was very cool to see.”

Ready to transform your next exercise from a script into a reality? 

VPC has completed thousands of exercises over the years and has continued to improve processes with each exercise. One of those improvements is assigning a single Exercise Director that works with the client year-to-year.  

Joel Heavner is the Exercise Director for Indiana District 5, he notes:

“This VPC-only approach to planning, facilitating, and evaluating the exercises provides consistency year-to-year and eliminates the learning curve from different people or different vendors.”