Pictured above is the Washoe County Health District (Nevada) and Inter-hospital Coordinating Council members upon receipt of the National Association of County and City Health Officials (NACCHO) award. (Provided photo)
Facing the threat of a disaster or managing the aftermath of such an incident, either natural or manmade, can be tragic. Natural disasters can be prepared for, but ultimately the outcome of such disasters can leave a community without their main lifelines (water/food, shelter and healthcare). Besides the financial burden of restoring order and structure to a community, immediate needs of the public safety and healthcare infrastructure are often times taxing to both local agencies and mutual aid responders alike. Additionally, the communication between government and non-government agencies, as well as local and national responders, directly relates to the success of mitigation efforts. Effective emergency preparedness plans should cross multiple disciplines and outline response efforts from the start of the incident, until the region is back to a steady state.
This year, the Washoe County Health District in Nevada was selected as a National Health Security Award winner in the “Building Regional Disaster Health Response Capabilities” category. The following information outlines the Inter-hospital Coordinating Council (IHCC), created and implemented in Washoe County due to an identified need for better interagency communication during a disaster.
On January 21, 1985, seventy people lost their lives when Galaxy Airlines Flight 203 crashed after takeoff in Reno, NV. In response to that incident and the lessons learned, the Washoe County Health District (WCHD) collaborated with the local private ambulance company, Regional Emergency Medical Services Authority (REMSA), and the two hospitals in 1986 to create a committee to address emergency response planning from a medical perspective. Through this partnership of four individuals, emergency planning for prehospital medical responses within Washoe County was discussed and the first prehospital medical response plans were developed. The MultiCasualty Incident Plan (MCIP) was first approved and adopted by the District Board of Health in August 1986. For the past 33 years, this partnership has flourished and the roles and responsibilities of the regional healthcare partners are more defined.
The WCHD was identified and tasked with the responsibility for patient tracking during an incident. This is a critical role for healthcare to ensure all patients are accounted for, from the incident scene through discharge at the hospital. The hospitals identified a baseline number of patients they would receive without needing the ambulance company to obtain approval. Small designations such as these have made large impacts during emergency responses and have allowed a continuity of emergency preparedness efforts over the years.
The WCHD has revised the MCIP nine times through the years, improving the response plan, creating communication plans and developing annexes to meet the expectations of the community. In addition to the original MCIP, there is now an annex outlining response to an MCI with more than 100 patients or a multiple location emergency. As well as an annex for the family services response to an incident, there is a secondary response to an emergency. This partnership has also culminated in the creation of the Mutual Aid Evacuation Annex (MAEA). The MAEA is a plan that outlines how the region would respond in the event of a healthcare system evacuation.
WCHD obtained federal grants to support preparedness efforts, beginning with the HRSA grant and now the ASPR grant. This partnership continued to expand to meet the expectations of the federal grant award. The committee officially became the Inter-Hospital Coordinating Council (IHCC) and several more initiatives have been achieved. Some of the deliverables include mass fatality planning for the healthcare facilities, redundant communication capabilities, development of a healthcare system response guide and the development of an Alternate Care Site annex to the MAEA.
Today, that partnership extends to over 122 partners comprising close to 40 agencies – and is growing. The IHCC meets on a monthly basis, has sub-committees as needed and is a resource for WCHD for plan development and revisions.
The benefit of the public-private partnership for medical emergency response planning is the unified plan for responses. The plans draw upon the strengths and capabilities of each regional partner, from EMS to the surgery centers. Each partner agency has a role to play in an emergency. The emergency plan provides the framework to ensure each organization is able to meet their charter as well as the needs of the community. Specific to emergency response, the community benefits by each agency operating under the same set of protocols. Each department personnel will be operating under the same response guideline, triage and tagging system and the same level of expectations. This will allow for seamless responses, reduced time for assistance to citizens and an overall more organized response to an emergency incident.
The partnership between WCHD began with three other agencies, the private ambulance provider Regional Emergency Medical Services Authority (REMSA), Renown Regional Medical Center (then named Washoe Medical Center) and Saint Mary’s Medical Center. Over the last 33 years, this partnership has grown to include newly built hospitals, three fire departments, sub-acute care healthcare facilities, emergency management, non-government organizations such as the American Red Cross, etc. What began as a four-person committee has grown to over a 120-person distribution list associated with 40 agencies. The partners’ involvement is attendance at a monthly meeting and the participation in emergency plan development and revisions, as it applies to their disciplines.
Additionally, subcommittees have been deployed to work on specific projects. Aside from plan revisions, some examples of subcommittee projects include supply cache rotation planning, CMS data processes and pharmacy cache planning.
Comprehensive List of Partner Disciplines Affiliated with the IHCC
- Acute care hospitals, to include behavioral health: 10
- Healthcare, non-hospital to include hospice, dialysis and home health: 16
- Non-government organizations: 4
- Government agencies: 4
- Other, to include power company and water authority: 6
The success of the partnership with WCHD and the region is measured by the continued growth and engagement of the partners. The value of the partnership has spanned 33 years, born out of a tragedy to help ensure future incidents do not follow the same path.
Any time one of the District Board of Health approved emergency response plans activate, WCHD conducts an after-action review (AAR) on the incident and the applicable plan. The AAR reviews all elements of the response to identify what went well, and opportunities for improvement. These reviews then influence subsequent emergency planning.
A mass casualty incident was declared in September 2011, when a plane crashed at the Reno Air Races. This incident highlighted the success of preplanning for emergency medical response. Part of the MCI declaration is the activation of mutual aid agreements. In response to the plane crash, 20 ambulances deployed into the 911 system for emergency response and routine 911 calls for service. The incident yielded 54 transports to four hospitals in 62 minutes. Additionally, a Family Assistance Center (FAC) was opened, led by WCHD. There were 19 organizations represented at the FAC, all operating under one objective and mission.
During the plane crash AAR, it was identified that the triage system did not function as expected during the patient response. Through discussions and analysis, it was determined that the triage system needed to be changed to accommodate large incidents, with an emphasis on quick triage directly translating to quicker transport to definitive care. The MCIP was approved in December 2013 with a new triaging system for Washoe County. Since that time other area jurisdictions across the state of Nevada have switched to the selected triage system.
While there are currently soft funds allocated and utilized for personnel affiliated with the regional partnerships for medical emergency response, the first WCHD employee affiliated with this program was funded locally. That position continues today, with local funds supporting the initiatives to ensure sustainability of the emergency response plans.
However, the sustainability of the partnership exists due to the relationships and collaboration that has been built over the last 33 years. The agencies are not paid to participate; they are a full partner because they believe in the vision and mission of WCHD emergency response planning. WCHD takes the lead with medical pre-hospital emergency response planning, beginning with the MCIP and now including several annexes. Additionally, the existing partnerships help WCHD achieve the federal required healthcare system response plans, identified in the ASPR grant.
Collaboration amongst all playing parties in an emergency response plan is by far the most important piece. Each entity within a system (even down to the power company) can have their own deployment plan, but unless there is an overarching system with proper communication and delegation, there will be chaos within the chaos.
Cindy Green oversees the Regional Emergency Medical Services Authority (REMSA) Center for Prehospital Education in Washoe County, Nevada. Her department educates, certifies and outreaches to 14,000 community members annually on topics including CPR, first-aid, bleeding control, car seat safety and safe sleep.