New England Society for Health Care Material Management

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New England Society for Health Care Material Management Preparing for Pandemic Surge March 22, 2006

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New England Society for Health Care Material Management Robert P. Paone, B.S., Pharm. D. Statewide Strategic National Stockpile Coordinator Center for Emergency Preparedness Massachusetts Department of Public Health (508) 820-2011 (work area) (617) 438-8249 (cell) Robert.paone@state.ma.us

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Objectives Review current effect projections of a Pandemic Flu in Massachusetts Describe Pandemic Response Plans at state and neighborhood levels Discuss surge arrangements

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Potential Impact of Next Pandemic In Massachusetts: Planning Assumptions Outbreaks will happen at the same time all through the US Up to 40% non-attendance in all segments at all levels Order and security upset for a while, not hours or days

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Pandemic v. Normal Surge Event Likely to happen crosswise over Commonwealth and influence all locales at the same time Expected to happen in no less than 2 influxes of roughly 8 weeks term each Projected numbers are spread over the wave, with a pinnacle happening mid-wave High assault rate among medicinal services laborers

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Example of an Epidemic Curve

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MDPH FLU SURGE ASSUMPTIONS Attack rate: 30% Hospitalization rate: 4% of sick Death rate: 1% of sick Duration of scourge wave: 8 weeks Avg. length of non-ICU remain for influenza related disease: 5 days Avg. length of ICU remain for influenza related ailment: 10 days Avg. length of vent use for influenza related disease: 10 days Flu affirmations requiring ICU mind: half Flu confirmations requiring mechanical ventilation: 15% Flu passings thought to be hospitalized: 70% Daily increment of cases contrasted with earlier day: 3%

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Surge Bed Definitions Level 1: Staffed and accessible Level 2: Licensed, Staffed Two sorts Beds made accessible through patient release and exchanges. These beds are NOT added substance – they are inside the Level 1 bed number, yet are abandoned and made accessible for surge. Beds made accessible through wiping out of elective surgery, for example, day surgery or endoscopies. Both the quaint little inns staff for those beds can be diverted for general healing facility patients. These beds ADD to general limit. (Diverted level 2 beds, or 2R) Level 3: Licensed however not staffed Generally prepared, including divider gasses Level 4: Overflow beds in non-conventional patient care ranges Cafeterias, entryways, and so on. Require buy of hardware (counting beds), supplies and needing staff

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Hospital Surge Capacity Level I 13,067 Current staffed beds Level II 2,000* Re-coordinated Level III 3,568 Un-staffed beds Level IV 5,071 Non-trad. space Total: 23,706* * Adjusted number reflects oversight of beds that had been twofold excludeed through exchanges to different healing facilities. This number will diminish after some time as the "elective" affirmations get to be non-elective. All beds are at last subject to accessible staffing, so greatest number may not generally be feasible.

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Comparison of Pandemic Planning Numbers *Based on 3X 1968 projections (Trust For America's wellbeing report: A Killer Flu, www.healthyamericans.org, June 2005)

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flare-up 30% assault rate

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Surge Bed Capacity versus Require * Requires Purchase of Beds & Supplies

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State: Need 23,560 out of 23,705 Beds

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128 Crescent (4AB): Need 562 a bigger number of beds than accessible

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Southeast (5): Need 994 more level 4 beds than accessible

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Gaps in Bed Capacity All 6 districts anticipated that would fill 100% of level 3 beds (authorized yet unstaffed) All districts should open some level 4 beds (flood ranges) Two areas will surpass their surge limit (Regions 4AB and 5) Staffing and supplies required for ALL level 3 and 4 beds Equipment, supplies, and staffing required for level 4 beds

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Hospital Surge Capacity Despite operational changes, doctor's facilities may get to be overpowered relying upon use in groups served Alternate care spaces should be distinguished to extend healing facility limit Pre-doctor's facility triage will be expected to diminish weight on clinic operations

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Alternate Care Sites (ACS) Hospitals: influenza patients requiring mechanical ventilation, or those with complex restorative administration needs ACS: Sickest influenza patients not meeting the criteria for doctor's facility affirmation but rather for whom home care is unrealistic Location and number to be dictated by neighborhood doctor's facility bed accessibility.

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SNS Stakeholders Conference Federal Medical Station Type III (Basic) (FMS TIII) February 21, 2006

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FMS Goal Address the country's potential shortage on the whole peril mass setback mind occasions and make a government level possibility mind program as coordinated in HSPD 10. Convey a surge ability all through the Nation, pre-situated and designed to react quickly and adequately to a wide range of general wellbeing crises, from critical episodes to huge scale disastrous calamities

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FMS Types Standardized Capabilities Across Agencies Type I (Advanced): Has capacity to tend to extremely sick or harmed patients, identical to customary working room, ICU, and essential lab (Lead: DHS) (DHS utilizes "FMCS") Type II (Specialized): Configured for particular clinical situations, for example, respiratory detachment and blaze mind. Future models to be produced. (Lead: DHHS) Type III (Basic): Low to mid-level sharpness of care to give stage to DMAT groups, exceptional requirements covers, isolate work, exchange mind office to enlarge group clinic ability (Lead: DHHS) Type IV (FMS): Special Needs Shelter (Lead: DHHS)

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FMS TIII (Basic) Concept A Federal, deployable medicinal resource intended to bolster territorial, state, and nearby social insurance offices reacting to cataclysmic occasions. It gives two basic abilities: - Inpatient, non-intense treatment capacity for zones where clinic bed limit has been surpassed. - An isolate capacity to confine people associated with being presented to or influenced by an exceedingly infectious ailment. Highlights: -Consists of three center modules and bed development module -Very couple of recoverable things in the FMCS unit -Easily adjusted to meet a scope of mass medicinal care needs taking after debacle -Deploys with SNS specialized group to encourage FMCS set up and exchange to Federal Health Care Professionals

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Type III Basic Bed Aug (50) FMS TIII 250 Bed Module FMS TIII 250 Bed Module Configuration e Configuration Type III Basic Treatment Type III Basic Pharmaceutical Type III Basic Base Support With Quarantine Pharmaceutical Special Medications Prophylaxis Administration Support Feeding Quarantine Beds(50) Housekeeping First Aid Equipment Pediatric Care Adult Care Personal Protective Equipment Primary Care Non-intense Treatment Special Needs Non-intense Treatment Special Needs Beds Bedding Bedside Equipment Current Pack 634 things - 3 days supply 170 beds (uni-pacs and beds) 4 tractor trailer (53 ft) loads FMS

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Staffing Remains greatest test we confront Legal assurances are vital to enrolling work force Large number of non-clinical faculty likewise required Potential wellsprings of clinical surge staff: Internal Hospital Strategies MSAR volunteers Medical Reserve Corps that are excluded in doctor's facility staff Retired, inert wellbeing experts Students (therapeutic, nursing, drug store) Connect and Serve ( www.mass.gov )

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Health Care Professionals Professional capabilities must be checked and confirmed early Volunteers can't be doled out to deal with patients until their particular learning and aptitudes are comprehended It requires investment to do this – volunteers who have not been pre-enlisted and pre-credentialed might be postponed in getting a task

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Masks v. Respirators http://www.fda.gov/cdrh/ppe/masksrespirators.html* Viruses spread fundamentally by bead shower along these lines surgical cover is suitable insurance if working inside three feet of tainted patients. (After going into the patient's room) Respirators (i.e. N-95 covers, appropriately fitted*) ought to be worn by HCWs who are included with patients experiencing strategies in which aerosolized particles might be created. (endotracheal intubation, suctioning, nebulizer treatment, and so on.) WHO proposal November 2005, *FDA

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Oxygen Needs Model presumes that patients in Level IV and ACS who require oxygen will require oxygen treatment at 4-6 liters/minute (l.p.m.) stream. Level IV and ACS model depends on 50 patients being dealt with for 10 day time span. Supposition is that at any given time, 25 patients will require steady oxygen. Taken a toll gauges got from preparatory study of neighborhood sellers.

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Delivery Systems Oxygen Gaseous Cylinder Oxygen Concentrator Liquid Oxygen Stockpile/Cache Planning

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Gaseous Cylinder H tank barrel being utilized at 4-6 l.p.m. will last around 1 day for every patient. Accordingly, every ACS will require at least 250 H chambers worth of oxygen. Most oxygen sellers rent H barrels to end clients and reuse the discharges supplanting them with full tanks (like filtered water cooler set ups utilized as a part of workplaces)

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Oxygen Concentrators Different models can be utilized at 1 to 6 liters for each moment. Every patient would require their own concentrator. Fundamentally utilized for lower stream (1-2 l.p.m.) applications, however units do exist that do 6 l.p.m. what's more, more costly units could give oxygen up to 10 l.p.m. Concentrators deliver oxygen from room air and in this way don't require any vaporous or fluid oxygen to be provided.

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Liquid Oxygen Based on cryogenic innovation. Most healing facilities have fluid oxygen tanks on their premises used to supply oxygen all through office. Cost depends on pounds. It is assessed that at approx. 6 l.p.m., every patient would likely

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