10 Hospital System. LSU Hospitals LSU LSU LSU LSU LSU LSU LSU LSU LSU LSU LSU

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1 LSU Health System Emergency Preparedness / Gustav Evacuation Michael K. Butler, MD, MHA, CPE, FACPE Chief Executive Officer LSU Health Care Services Division

2 10 Hospital System LSU LSU LSU LSU LSU Hospitals LSU LSU LSU LSU LSU LSU LSU

3 Information Innovation Improvement Integrity Information Innovation Improvement Integrity Teaching Patient Our Vision Value Leader Our Values Our Mission Treat and Teach Our Values Excellence Excellence Equity Equity Execution Empathetic Explainable Execution Empathetic Explainable Tactics Empathetic Research Revenue Resources Access Quality Safety Service Satisfaction Medical Home Low Cost Integrated Info Systems Foundational Elements Disease Management High Quality Centers of Excellence Performance Improvement Distributed Services

4 What is a Disaster? Natural Hurricane Flood Tornado Storm Surge Technological Airplane Crash Levee Failure Hazmat Incident Nuclear Incident Offshore Oil Spill Human-Caused Civil Disorder Terrorist/Enemy Attack Cyber Terrorism Biological Animal Disease Pandemic Infectious Disease

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41 9/4/05, 2:00 PM

42 9/5/05, 9:00 AM

43 Katrina MCL Outcomes 1,300 staff and family evacuated over 5 days 380 patients evacuated 9 deaths 2 on roof awaiting helicopter evacuation 2 bodies left on stairwell Significant psychological impact

44 Katrina Toll - New Orleans > 1,800 died 1.5 million residents evacuated and repatriated 3,200 unaccounted for 200,000 homes damaged or destroyed >$100 billion in damages 80% of New Orleans flooded

45 Katrina Challenges Lack of coordinated community evacuation planning Many facility plans called for transporting patients to local hospitals Evolution of home health care increased # patients requiring special support Uncertain transportation assets companies engage in multiple MOUs No coordinated patient tracking systems Communication tools unreliable

46 Background Information - Louisiana

47 State Plan By order of the Governor, GOHSEP has developed a State Plan All state agencies are required to participate in the State Plan State agencies have primary and secondary responsibilities for specified Emergency Support Functions (ESFs) ESFs performed by agencies parallel their normal day-to to-day functions Day-to to-day operations not contributing directly to the emergency may be suspended or redirected Activation of the EOC constitutes implementation of the Plan HCSD is required to maintain 24-hour response capability at EOC (or other designated center) during Activation based on threat level

48 Emergency Action Levels LEVEL IV Normal operations are ongoing LEVEL III Potential or actual threat Crisis Action Team is activated State EOC may be activated with selected ESFs LEVEL II Events are in progress or have occurred EOC activated for 24-hour operation and may include selected staffing from agencies LEVEL I Events are in progress & require response activities EOC fully activated

49 Louisiana ESFs Emergency Support Functions ESF 1 ESF 2 ESF 3 ESF 4 ESF 5 ESF 6 ESF 7 Transportation Communications Public Works & Engr. Firefighting Emergency Mgt. Mass Care Resource Support ESF 8 Public Health & Medical ESF 9 Search & Rescue ESF 10 Hazardous Materials ESF 11 Agriculture ESF 12 Energy ESF 13 Public Safety & Security ESF 14 Community Recovery ESF 15 Public Information ESF 16 Military Support to Civilian Affairs DHH is the lead for this function and the LSU System is a supporting agency

50 ESF 8 Provides Public health and sanitation Emergency medical, dental, and hospital services Crisis counseling and mental health services Pre-hospital emergency services and medical transport (EMS, equipment and supplies) Coordination/Expertise concerning mass fatality

51 Immediate Lessons Learned During Katrina

52 HQ Command Center Depending on the severity of an event,, a Command Center may be established at HQ The Command Center will host video / conference calls daily, and / or on an as needed basis with the affected hospitals during the emergency event

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54 HCSD Command Center Why Does It Work? Assures communication Allows for information exchange and rapid decision making Allows for simultaneous/up-to to- the-minute updates to ICS

55 Communication Daily conference calls and video conferencing *** Fax Blackberry Text messaging 700/800 mhz radios

56 Activation Vendor Notification Med/Surg Supplies (MMS) Amerinet Amerisource Bergen

57 Why A Contract for Evacuation Services?

58 Something Different Had To Be Done

59 Response Systems Response Systems is our contracted vendor for evacuation services The purpose of contracting with such a vendor was to secure guaranteed transportation RS uses out-of of-state subcontracted transportation companies to perform evacuations HCSD is currently in the 3 rd year of the 5 year contract

60 An Event

61 Gustav

62 Katrina Evacuation

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64 In Preparation Hospital Emergency Activation Decompression of LSU Hospitals Prioritize Patient Evacuations Psych Infants ICU

65 10 Hospital System LSU LSU LSU LSU LSU Hospitals LSU LSU LSU LSU LSU LSU LSU

66 Timeline Quiet Moments Thursday 8/28 Friday 8/29 Saturday 8/30 Firming up patients, units and egress Contraflow / H-Hour H Hour moving up GOHSEP declares weakened storm is re-developing RS activates first units

67 Timeline Go Fast Go More Thursday 8/28 Friday 8/29 Saturday 8/30 Official Activation H-71! Plan 3 3 LSU HSCD hospitals must be fully evacuated Chabert Moss UMC All LSU Hospitals throughout the state must decompress 2 LSU HCSD hospitals must evacuate high risk patients University Hospitals (New Orleans) Bogalusa Medical Center

68 Timeline All Cylinders Firing Thursday 8/28 Friday 8/29 Saturday 8/30 EKL Hospital (Baton Rouge) nearing maximum inpatient census LSU Receiving Hospitals are stepping up Staff, Beds, Triage 2130hrs RS issues Phase Down H-36!! 2145hrs LSU Evacuations Completed 194 total patients evacuated Response Systems begins assisting the state in patient evacuations

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70 Not Much Down Time Repatriation is a complex issue It won t t be the only one Moss/Chabert/out of business MCLNO open but city closed UMC needs to get back in the game Baton Rouge in bad shape City Morgue has no power EKL on generator with limited shelf life

71 The Saga Continues 9/ hrs Prepare to Empty EKL 9/ EKL is urgent 9/ hrs RS Teams back in LA 9/ hrs RS/EKL prepares to triage 9/ hrs EKL Suspends Services 9/ hrs All EKL patients triaged 9/ hrs EKL Cleared 9/ hrs UMC repatriation begins 9/ hrs UMC repatriation finished 14 hours from first to last patient (65) at EKL 100+ EKL/UMC patients moved in 28 hrs!

72 Gustav Evacuation 4 out of 6 hospitals in potential hot zone complete evacuated 352 patient transfers 167 ALS 148 Coach 39 Med Flight 12 transport subs 52 units 35,000 miles All LSU hospitals affected

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74 Things to Work On Patient Triaging Medical Staff Coordination Tighter Standardized Forms Patient Tracking System Command and Control in Hospitals Command in Patient Decision Making Incident Management Team Capture Empirical Data / Processes for future

75 Tuesday 9/30/08 State Hospital Evacuation Glitches in evacuating thousands of people from nursing homes and hospitals remained a headache during Hurricane Gustav.

76 LSU Hospital Evacuation

77 LSU Health System Emergency Preparedness / Gustav Evacuation