Meeting: KET HC Monthly Meeting Location: Knox County Health Dept. 02/12/19 2:30-4:00 February 2019 Agenda

Please review before meeting: Crisis Standards of Care:

http://www.ketcoalition.org/wp-content/uploads/2019/01/Crisis- Standards-of-Care-2016.pdf

1. Minutes Review/Approval Wanda Roberts Motion: Approve:

2. Follow Up From Last Meeting

Stop The Bleed

Wanda Roberts Jenny Holden

Legal Action Update County Project Update

Bulex Fire Extinguisher Brennan Mitchell

3. Knox County RHC Position Larry Hutsell

4. HRTS Status Dashboard Tim Taylor/ John Brinkley RMCC EMS

5. Regional Exercise Wanda Roberts

6. Budget Update Wanda Roberts

7. Project Status

Mintie Units Phil McDaniel

HAM Radio/Winlink Jim Snyder

ICS Supplies Wanda Roberts

Isolation Carts Wanda Roberts

8. Equipment

Decon Tent/Training Supplies Tonya Shott

CPR Training Kits John Brinkley

Generator Wanda Roberts

Exercise Manikin Demonstration Drew Slemp

9. Crisis Standards of Care Dr. Benitez, Medical Director of Emergency Preparedness and Environmental Epidemiology, TN. Dept. of Health

10. Updates

CMS17 Groups

Group 1 Long Term Care Group 2 Home Health/Hospice Group 3 Ancillary/Outpatient Group 4 Dialysis

Regulatory/Compliance

Events/Exercises/Training Jan 24: Caring for Burn Patients Training Feb 6 Statewide Coalition Meeting Suspect Ebola Patient

11. Upcoming

DOT Initial and Refresher Update

Building Resiliency for the Long Game

Emergency Medical Management of Radiation Accident Victims (REAC/TS)

Stop The Bleed Train the Trainer

Vulnerable Populations Response and Treatment Training: 2 Speakers:

Sandy Hook Physician

Founder of Special Needs Awareness Program

CHEP Training

National Preparedness Summit

Not Scheduled February 13 8:00-4:00 February 27 1:00-5:00 March 5 (Various Times) March 12, 8:30-12:30 March 19-21 March 26-29 (St. Louis)

1 Presentation: Cause and Effect: The Evolution of the Coalition from Real World Events

Meeting: KET HC Monthly Meeting Location: Knox County Health Dept. 02/12/19 2:30-4:00 February 2019 Agenda

Emergency Medical Management of Radiation Accident Victims (REAC/TS)

Emergency Management Association of Georgia Conference

Las Vegas Shooting Training

March 27, 8:00-12:00 April 17-19 May 2

1 Poster Presentation

1 Presentation Submission: Teamwork Makes the Dream Work

12. Other

Meeting: KET HC Monthly Meeting Location: Knox County Health Dept. 02/12/19 2:30-4:00 February 2019 Minutes

Please review before meeting:

Crisis Standards of Care http://www.ketcoalition.org/wp-content/uploads/2019/01/Crisis- Standards-of-Care-2016.pdf

1. Follow Up From Last

Meeting • Stop The Bleed

Wanda Roberts: East Tennessee Regional Hospital Coordinator, East Tennessee Regional Health Office

Legal Action Update: Filing a civil complaint. Draft of Complaint should be finalized, filed and service attempted by the end of this week. Additionally, we will attempt to recover lawyer fees. We have allotted $5,000 for legal fees. (Not sure at this point how much it will total). T County Project Update Schools have to be rescheduled due to weather and sickness. Jenny Holden is rescheduling. Upcoming: Anderson County March 1 and Campbell County April 12. This will include the District II Homeland Security Active Shooter school presentation. Homeland Security has also distributed all training kits, so each county has 2 training kits available to check out. All STB kits have been distributed to the counties/schools.

• Bulex Fire Extinguisher Brennan Mitchell: Safety & Emergency Management Programs Officer, LeConte Medical Center

Information was distributed to group (attached). Cost: Screen with 2 fire extinguishers and an additional unit that projects water is $16,000 (includes pelican cases for transport). An outdoor propane model is also available that is about half the price. There are concerns with using that model because you will be training with a real fire. If we look into this further, we may want to see about purchasing discounts or grants.

2. Knox County RHC Position Larry Hutsell: Emergency Response Coordinator, Knox County Health Department Emergency Response Coordinator

Larry Hutsell Larry introduced the new RHC, John Brinkley. Larry is confident John will be an asset to both Knox County and the Coalition by bringing his areas of expertise to this position. John has many years experience with emergency preparedness in the healthcare community with both his military and EMS background. He has also been an active member in the coalition. The group welcomed John into his new role, which will begin on March 4, 2019.

3. Equipment Demonstration Drew Slemp Sales Manager/Educator, Engel Trauma Solutions.

Drew Slemp demonstrated th MCI inflatable, reusable, training manikin for training and drills. They are available in adult (5’7 tall), pediatric and (soon), a bleeding control manikin. Sandbags in the feet allow the manikin to stand on their own. Grommets on shoulder allow for tie-down and they inflate/deflate easily. Clear pocket on front allows for patient scenarios. They are compliant with JCAHO standards. Costs: Pediatric: 40.00, adult: 65.00, bleed control: 100.00

4. HRTS Status Dashboard Tim Taylor: Communications Center Supervisor, RMCC Manager John Brinkely: Operations Management, South Region AMR

• Tim Taylor (RMCC) – We have been using the new Healthcare Resource Tracking system (HRTS) dashboard for about 3 weeks now. This new dashboard allows hospitals to update and EMS to see real time status for EMS offload times, Behavioral Health and ED status. This pilot program is aimed at providing informational awareness to possibly assist with regional patient flow, decreasing patient treatment delays and long EMS offload times. Since initiation, there has been a decrease in EMS transports and hospital admissions. The system is being utilized regularly, by both hospitals and EMS. There was a problem with the original link not refreshing appropriately, but that has been since resolved, with a new link: file:///C:/Users/dc60i46/AppData/Local/Microsoft/Windows/INetCache/Content.Outlook/BH994REX/EastKnox.html

• John Brinkley (EMS) – He has not heard any issues form the EMS side. Local dispatch (AMR) is monitoring and sending out status updates twice a day. Until today we’ve had some slow weeks so there hasn’t been an issue with transports, but that will likely change soon. Current suggested update times: 6 AM, 12 PM, 6 PM, 12 AM.

• Other Issues: o Issues with color change on Psych status, has been resolved. o Continued confusion over wording “facility status” actually representing behavioral

health/psych status, especially as new staff begin to use the system. We’ve checked about this, but unfortunately the state cannot change the verbiage because it would change the verbiage for the entire state. It was suggested that a new box be added. Wanda will check and see if that can be done, in the meantime, we’ll just need to provide training.

Meeting: KET HC Monthly Meeting Location: Knox County Health Dept. 02/12/19 2:30-4:00 February 2019 Minutes

o Please make sure your facility is correctly representing their EMS offload status by EMS offload times and not wait room time.

o We are very proud of this system as it originated collectively by the administrators of the Knox area hospitals to address patient surge from recent hospital closures. The administrators continue to drive this project with their support as it evolves into a working program. Participation is voluntary, but our hospitals have been very supportive. This is being watched across the state to see how it works, and possibly be duplicated elsewhere. Thank you to everyone who has helped with this project from the administrators, trainers, and to the staff inputting the data.

5. Regional Exercise

Wanda Roberts: East Tennessee Regional Hospital Coordinator, East Tennessee Regional Health Office

• The group was presented with an option for this year’s evacuation exercise. It was suggested that we combine our evacuation exercise with our regional full scale exercise. Even during an evacuation, a facility could still surge, especially in the ED. If we do the exercises together, that would change our usual rotation and put our full scale exercises back to spring each year. It was also suggested we use Peninsula as one of our evacuating hospitals. Group agreed to move forward with this plan. If we evacuated both Penninsula and UT, we would exceed the percentage we need for the exercise requirements. (We have to surge approximately 550 beds and UT/Penninsula combined would be 750 beds), so we could have flexibility with evacuation numbers. This will also be a good exercise for our CMS17 partners, as an earthquake can affect every facility type. o If we plan on using students, school is out May 23. Other considerations: seniors are

dismissed earlier, student testing occurs at the end of the year as well. Wanda will check and see if any dates would work for the school system.

o Moving forward, we will plan exercise around student schedule, if they are available. If not, we will move forward and plan to use paper patients. Tonya Shott suggested manikins off Amazon starting around 6.00 each, if facilities wanted to use something more than paper patients.

o Wanda will send out an email this week or next week to see who would like to be on the planning committee. If you want to be on the planning committee, please let Wanda know. Etrhc.health@tn.gov

6. Budget Update Wanda Roberts: East Tennessee Regional Hospital Coordinator, East Tennessee Regional Health Office

We have completed several of our projects. As soon as we have our final purchases completed, we will purchase the Mintie Isolation units. Things we still need to complete for payment: Trainings (CHEP, Sandy Hook Training, Las Vegas Training, possible additional HICS class), lawyer fees, ICS supplies, Winlink, Evacuation exercise costs (buses, food for volunteers, facilitated discussion), Mintie Isolation Units. EVD funding contract goes through 2020. Budget summary attached.

7. Project Status Phil McDaniel, with his facility/engineering knowledge, was asked by Wanda Roberts to coordinate information with the Mintie company for our region before we purchase any units. The Mintee unit creates an isolation and anti-chamber for your facility. (see attached). The Mintie company is willing work with us however needed to make sure each facility has the correct unit needed. The current budget allows for 2 units for each hospital (5 for UT) and 4 for the storage unit. UTMC already knows which unit they would like to have. Janet said she has enough new maintenance personnel so she would like a full demonstration. Per grant requirements, we have 3 quotes for the units (both with and without the anti-chamber) and we will use the lowest vendor for purchasing. Phil said if you have a vendor that does your air pressurizations, you might want to bring them to the training. Phil has already invited the vendor that Covenant, Tennova and UT use. Phil will check with Mintie to see if they could do some CAD design. A conference call will be set up with the Mintie company, the vendor, Phil and Wanda to see about next steps. Whoever else wants to the on the call, let Wanda know. Phil will contact parties for dates for conference call.

• Mintie Units Phil McDaniel Regulatory Specialist, Covenant Health

• HAM Radio/Winlink Jim Snyder Amatuer Radio Subject Matter Expert/Regional

We only have 5 responses from the HAM Radio Assessments that were distributed (see attached). It was unclear when the form was sent out who was to complete: hospital or operator. It was intended for the Emergency Managers and the ham lead at the hospital to

Meeting: KET HC Monthly Meeting Location: Knox County Health Dept. 02/12/19 2:30-4:00 February 2019 Minutes

Consultant work together on this. Jim stated there are also antenna issues that may need to be checked on. The Forensic Center does not have any HAM equipment. We need to look into this.

• ICS Supplies Wanda Roberts: East Tennessee Regional Hospital Coordinator, East Tennessee Regional Health Office

We will be providing each of our members in the coalition with ICS bags. This will include a bag, phone charging cords for android and IOS, power banks, etc. Marcus will help picking out appropriate bags that will work and keep costs of project down.

• Isolation Carts Wanda Roberts: East Tennessee Regional Hospital Coordinator, East Tennessee Regional Health Office

Isolation carts have been purchased for each of our long term care facility members (56 facilities). Carts will be shipped to AMR and facilities will need to pick up that day.

8. Equipment Tonya has worked with staff from Physicians Regional Medical Center in regards to equipment with their hospital closure to see what can be provided for the coalition. • Tennova will provide a 3 line decon tent that can be used for training or exercises by

coalition members. Turkey Creek Medical Center will store it and will have a check out form that will need to be filled out before it is used. Transportation and transportation equipment will need to be provided by whoever is using the tent. This information will be listed on the website in the near future, with check out instructions. The tent remains Tennova’s property and can only be used by coalition members or those approved by Turkey Creek Medical Center.

• Tonya also secured decon equipment and bags for Decon training kits. We will post on website as soon as they are available with instructions for checking out.

• Decon Tent/Training Supplies Tonya Shott: Emergency Management Coordinator, Turkey Creek Medical Center

• CPR Training Kits John Brinkely: Operations Management, South Region AMR

• We now have 3 CPR training kits available for checkout. Each kit has enough equipment (adult and pediatric) to train 12. This equipment will satisfy new CPR requirements of interactive mannequins for training. This has already been used by one of our CMS17 dialysis partners. For smaller agencies, this is a fiscally sound alternative to buying expensive training equipment. The user agreement and checkout procedures will be added to website.

• Lung bags (which have to be used for each individual when training is done) cost about .70 each. We need to discuss how we would like to supply that. Trish Polfus suggested the coalition purchase 2 cases. Second – Janet, All approved.

• Generator Wanda Roberts: East Tennessee Regional Hospital Coordinator, East Tennessee Regional Health Office

Sweetwater was unable to get their generator hooked up, and they understand they will be paying 700/per day for it. As soon as it’s over it will be moved to Turkey Creek.

9. Crisis Standards of Care Dr. Benitez, Medical Director of Emergency Preparedness and Environmental Epidemiology, TN. Dept. of Health

Dr. Benitez, The purpose of the Crisis Standards of Care plan (Guidance for the Ethical Allocation of Scarce Resources during a Community-Wide Public Health Emergency as Declared by the Governor of Tennessee) is to provide government leaders and healthcare professionals with an ethical framework to guide and support decision making at the state, local, and facility level during both preparation for and response to a community- wide emergency. It is important that this document is shared with hospital administration, to encourage conversations to address this subject. This information is located on our website under coalition documents at: http://www.ketcoalition.org/documents/ THA have been in conversation with with the Department of Health regarding distribution of materials and Crisis Standards of Care.

Meeting: KET HC Monthly Meeting Location: Knox County Health Dept. 02/12/19 2:30-4:00 February 2019 Minutes

10. Updates • CMS17 Groups

Next Meeting March 14th.

• Regulatory/Compliance

Home Health had state visit. Her tabbed Emergency Plan notebook was am asset and had all the information the surveyor was looking for. All CMS17 facilities should keep their notebooks updated and readily available for any surveys.

• Events/ Exercises/ Training All

Jan 24: Caring for Burn Patients Training There was alot of positive feedback from this training facilitated by Vanderbilt University. The speaker was knowledgeable and relatable to participants and the group highly recommends another session. Feb 6 Statewide Coalition Meeting 4 Representative attended from our region: John Brinkley, Tonya Shott, and Marcus Sheppard, and Wanda Roberts. • We were unaware we would be formally presenting our projects/expenditures for this

fiscal year. We split up projects and presented: Tonya: Hospital closure/ Decon tent and kits; Wanda Roberts: Training events; Marcus Sheppard: Blount Memorial Hospital Patient Tracking Project; John Brinkley: HRTS dashboard, UTMC Ebola suspect patient event.

• We may have future discussions about using coalition funding to update older ventilators at AMR that could be used in an emergency.

Suspect Ebola Patient November 2019, in Blount County (Alcoa), there was a 911 call regarding a patient who complained with difficulty of breathing. EMS and hospital had difficulty with gathering information due to language barrier, which caused some initial confusion on patient origination location. Initial assessment was that patient arrived from the Democratic Republic of Congo, which EMS recognized as a county with active Ebola cases. EMS responded appropriated in gear and reporting to regional Assessment hospital (UTMC). Hospital had to prepare alternate isolation room for patient due to high census and concern that others may need isolation as well. Overall, the process went well and lessons learned from previous exercises helped facilitate a smooth process for both EMS and UTMC. There are areas of improvement that will be addressed.

11. Upcoming • DOT Initial and Refresher

Update Building Resiliency for the Long Game

• Emergency Medical Management of Radiation Accident Victims (REAC/TS)

• Stop The Bleed Train the Trainer

• Vulnerable Populations Response and Treatment Training: 2 Speakers: • Sandy Hook Physician • Founder of Special

Needs Awareness Program

• CHEP Training • National Preparedness

Summit • 1 90 minute presentation • 1 poster session

• Emergency Medical Management of Radiation Accident Victims (REAC/TS)

• Emergency Management Association of Georgia

There has not been enough response to justify a class. Wanda will resend to see if there are any other interested parties. Tonya Shott suggested checking with services from Stericycle, who provides this training for all Tennova facilities. February 13 8:00-4:00 February 27 1:00-5:00 March 5 (Various Times)

March 12, 8:30-12:30 (approved for 5 contact hours through EMS) March 19-20 March 26-29 (St. Louis)

March 27, 8:00-12:00 April 17-19

Meeting: KET HC Monthly Meeting Location: Knox County Health Dept. 02/12/19 2:30-4:00 February 2019 Minutes

Conference • 1 presentation

submission • Las Vegas Shooting Training

May 2

12. Other

Paul Parsons discussed an Emergency Management Standard regarding patient tracking: Emergency Management Standard EM.02.02.11 EP 12 For hospitals that use Joint Commission accreditation for deemed status purposes: The hospital has a system to track the location of patients sheltered on site during an emergency. This system includes documentation of the name and location of the receiving facility or alternate site in the event a patient is relocated during the emergency. Note: The name and location of receiving facilities or alternate sites may be defined in the emergency management plan, formal transfer agreements, or other accessible documents.

He suggested we look at the document the state has and facilities may want to use that as a template or reference to meet this standard. (Attached).

Tonya Shott provided sleep safe baby books for anyone who would like them. John Brinkley will take any remaining books to distribute at the next Child Fatality Review meeting.

Base Funding $322,480.00EVD Funding $123,756.00 As of 02/15/19

Category Expenditure Projected Cost Actual Cost Difference OverDifference

Under Complete JustificationAdministrative/ Chempack Phones $3,500.00 $4,306.72 $806.72 XOverhead Storage $4,800.00 $4,320.00 $480.00 X

Website $4,000.00 $7,528.00 $3,528.00ETCH Payback $3,000.00 $3,065.07 $65.07 XRHC Discretionary $10,000.00 $2,267.17Forensic Center PAPR $4,000.00 $0.00 $4,000.00 X

$29,300.00

Wrap Up Projects Code Books $5,000.00 $3,633.30 $1,366.70 XComm HAM Radios $4,000.00 $596.90 $3,408.80 XComm HAM Training $300.00 $1,309.99 $1,009.99 XComm Winlink Completion $5,000.00Peds: Coloring Books Peds Surge Cart $2,500.00 $905.04 $1,594.96 X

Added SWAT T Tourniquets $24,680.21 $24,680.21 X$16,800.00 $29,067.49

Travel HPP Conference $12,000.00 $7,564.04 XSt Coalition Mtg. $214.04 XNational Preparedness ConferenceEMAG (Savannah)Totals $4,221.92

Training Coalition Evacuation Surge Exercise $2,000.00Region II EMS Dir. Asso. Conference $2,500.00 $1,000.00 $1,500.00 XABLS Training $15,000.00 $0.00 $15,000.00 XCHEP Training $3,000.00 $9,000.00 $6,000.00NIMS/HICS $2,000.00 $899.41NHICS $6,500.00 $3,667.10 $2,832.90 XDecon (Walter Idol) $5,000.00 $1,750.00 $3,250.00 XDecon (REAC/TS) $5,000.00 $2,300.00 $2,700.00 XReal Life Lessons Learned Series $15,000.00 $10,000.00 $5,000.00

Added: Chempack Training $236.00 $0.00 $236.00 X

Infectious Disease Regional Infectious Disease FSE $3,000.00 $1,908.02 $1,091.98 XRegional Infection Prevention Training $5,000.00 $0.00 $5,000.00 X

KETHC 2018/2019 Budget

Isolation Carts (CMS Partners) $15,000.00 $13,080.00 $1,920.00 X

Mintie Isolation Units $165,000.002 units per hospital. 4 units for cache

Other ICS Supplies $10,000.00 $1,395.91 Request from Coalition

Decon Training Supplies $10,000.00 $0.00 $10,000.00Circulation of supplies will save money

Added RMCC Equipment Purchase $8,797.29 $8,797.29 XGenerator Maintenance $700.00 $700.00 XGenerator Tires $900.00 $900.00 XGenerator Battery $396.81 XLawyer Fees $5,000.00EMS CPR Training Kits $8,276.09 $8,276.09 X

$60,396.18 $63,367.26

Black- Not CompletedPurple- EstimationRed- Over Allotted FundingGreen- Under Allotted FundingGray- Project/Funding Area Completed

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