Agency or Department Name Here (for pda/handhelds)

Accomplishments for Core Goal #9 Mass Casualty/Hospital Surge

Mass Casualty/Hospital Surge
The State’s Department of Health and Mental Hygiene (DHMH) and the Maryland Institute for Emergency Medicine Services Systems (MIEMSS) have focused on initiatives to better plan for and coordinate during surge events, to automate and combine various situational awareness and surveillance tools into single dashboard, and to provide additional human, medical, and transportation resources to public and private stakeholders.  Following are key projects and accomplishments:

• Developed an electronic dashboard that makes six separate hospital emergency room and health and medical resource systems available to health responders through a single online interface. With just a few mouse clicks, the Health and Medical Dashboard brings critical hospital resource status information directly to medical first responders in real-time, including hospital and emergency room status, resource availability within a hospital system, and the CDC’s health alert notification system, as well as traffic, weather, and emergency management applications.  Prior to MIEMSS’ and DHMH’s efforts to integrate and upgrade these medical resource systems, hospitals in Maryland relied on fax machines and call down lists to warn of a “code red” status (when an ER is overwhelmed and must divert patients to another hospital) or share information on critical medicines and supplies on-hand.  The Health and Medical Dashboard automates this information and makes it available in real-time to all hospitals, 911 centers, State and local EOCs, Local Health Departments, and EMS units in the State.  In the near future, MIEMSS will expand access to the dashboard to long-term care and psychiatric facilities.     

• Handheld, patient tracking devices that can produce pictures, video, and sound recordings will soon be available for every EMS transport unit in Montgomery and Prince George’s Counties and Baltimore City.  Patient trackers are handheld devices that can be used to enter patient encounter information and track a patient’s final hospital destination.  They are particularly useful in mass casualty incidents.  Upon arriving at a mass casualty scene, EMS may encounter patients who have lost their ID, are unconscious, or are otherwise unidentifiable.  With the use of a bar code and a camera, patient trackers can be used to identify these patients, record their vital statistics, and inform family members where they are being treated.  Previously, patient tracking was done by manually written and faxed lists or other non-automated and unreliable means.  The State has leveraged multiple federal grants to purchase patient tracker devices for every EMS transport unit in the NCR region (Montgomery and Prince George’s Counties) and Baltimore City and “disaster kits” containing four patient tracker units for 14 additional counties.  To prepare for the use of electronic patient trackers, the Health and Medical Dashboard has been uploaded with patient tracking software and is able to receive, store, and report patient tracking data.

• Replaced Maryland’s EMS patient care reporting system with a new, web-based application (EMEDS) that can generate reports for local and State EMS managers.  Many of the State’s jurisdictions continue to use scanned forms to manually report required EMS patient encounter information.  EMEDS, the state’s new online patient care reporting system, is now available to these jurisdictions.  It comes with full developer support, is able to generate reports based on reported symptoms, and allows EMS providers to share data through the Health and Medical Dashboard.  A pilot program was completed earlier this year with Cecil, Harford, and Queen Anne’s County.  By 2012, EMS providers in all but two jurisdictions are expected to adopt the EMEDS.  

• Installed multiple levels of backup communications capabilities throughout the health and medical community statewide.  MIEMSS began installing digital VOIP phones in 2007 in the State’s hospitals and local health departments.  These phones do not rely on publicly switched networks and operate on a dedicated Digital EMS Telephone (DEMSTel) system, which enables reliable communication when primary networks are down.  Approximately 64 percent of the state’s hospitals (including all hospitals in the Baltimore Metro region) are connected to the DEMSTel network, as well as 75 percent of Local Health Departments, Emergency Operation Centers, and 9-1-1 call centers.”

• Developed a Critical Care Unit Surge plan to assist hospitals in decision-making regarding the allocation of scarce resources during hospital surge events.  MIEMSS developed a scoring system with objective measures (i.e., number of oxygen supplies) and subjective clinical measures to determine the stress on individual hospitals and to suggest mitigation measures. This system was used during the 2009 H1N1 influenza pandemic to determine stress on the hospital system.

• Established a medical and strategic national stockpile (SNS) warehouse and distribution center for protection and storage of medical surge and mass casualty supplies.  The warehouse is secure, temperature controlled and has received, inventoried, stored and distributed tons of PPE including N-95 respirators, ventilators, antiviral medications, and other medical equipment and supplies to support hospital surge.  The SNS stockpile is managed by a web-based Inventory Resource Management System (IRMS), which all 24 Local Health Departments have access to.  The DHMH warehouse was critical to the protection of the SNS assets provided to Maryland during the spring 2009 outbreak of H1N1. 

• Completed the State Surge Plan that aids local jurisdictions in planning for a public health emergency.  All local health departments have completed plans for responding to public health emergencies in a collaborative manner.  These plans cover a range of programs and responses, including use of the Strategic National Stockpile, pandemic flu, and use of the Maryland Professional Volunteer Corps.  In June 2011 DHMH completed its draft of the State Mass Fatality Management Plan that clarifies and establishes the roles and responsibilities of state, local, and federal health responders in managing a mass fatality incident.  By May 2012, all Local Health Departments are expected to complete their own Mass Fatality Management Plans.   
  

• Established hospital Memorandums of Understanding (MOUs) to better share resources.  For many years, hospitals within jurisdictions that have multiple health care facilities have established agreements to share resources should an individual facility become overwhelmed, and Local Health Departments have cooperated on incident responses, but have lacked formal plans or agreements for this assistance.   Since 2007, the state has pushed efforts to expand regional and statewide MOUs.  DHMH has hired Regional Hospital Preparedness Coordinators to help enhance and expand regional mutual aid sharing agreements.  It has also directed federal grant funding to support more regional projects and helped establish four formal regional health care preparedness committees throughout the State.   

• Created a Disaster Medical Assistance Team for Maryland (DMAT Md1) under the direction of the National Disaster Medical System (NDMS) to be prepared to deploy mobile hospital services in the event of a catastrophic emergency.  The DMAT commanders are recruiting physicians, nurses, paramedics and logistic personnel to fill the 105 positions in the team under the direction of NDMS.  Currently, 60 members have been recruited and passed a federal background check.  Two members were recently deployed to help provide mass medical care as part of the region’s preparations for the July 4 events in the District of Columbia.