Maine Ebola Response Plan. Jane Coolidge PhD, RN DHHS, Maine CDC, PHEP

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1 Maine Ebola Response Plan Jane Coolidge PhD, RN DHHS, Maine CDC, PHEP

Ebola 2014 2014 the world experienced the largest Ebola outbreak in history affecting the West African countries of Sierra Leone, Liberia, Guinea Cases: 28,616

2 Ebola the world experienced the largest Ebola outbreak in history affecting the West African countries of Sierra Leone, Liberia, Guinea Cases: 28,616 Deaths: 11,310 Case fatality rate (CFR): 40% The US experienced 2 imported cases, including one death and two locally acquired cases US CDC activated the CDC EOC in Atlanta

3 Ebola 2014 Maine CDC: Activated the PHEOC to a Level 2 (partial activation) in October 2014 Convened a group of stakeholders to develop the Maine Ebola Response Plan. Building the ship while sailing the ship Facilitated preparations for the possibility of an Ebola case occurring in Maine

4 Maine Ebola Response Plan 2014 As a result of an intense, comprehensive, collaborative planning initiative, the Maine CDC developed systems and processes that when implemented will enable public health, healthcare and other emergency responders to detect and respond efficiently, effectively and seamlessly should a case of Ebola occur in Maine. It is important to note that the systems and processes that were developed for this Ebola Response Plan are directly transferable to any Viral Hemorrhagic Fever (VHF) disease with direct contact transmission that may emerge and threaten the health of the people of Maine.

5 Maine Ebola Response Plan The Maine Ebola Response Plan is comprised of a Base Plan and 12 supporting Appendices The Base Plan includes Planning Assumptions Concept of Operations, Response Partners, Roles and Responsibilities and other standard components The Appendices delineate in more detail the response resources and processes to be implemented by the Maine CDC in collaboration with the various response partners

6 Ebola 2014 All Ebola planning and preparations were based upon recommendations and guidance from the US CDC as the documents became available Maine CDC participated in regular updates with the US CDC, as indicated Maine CDC provided regular updates to Maine response partners and stakeholders, as indicated

7 Regionalization/Specialization The Maine Ebola Response Plan is based upon the concepts of Regionalization and Specialization: The confining of transport and care of an Ebola patient to specially trained teams and designated facilities in each region Basic Premise: this model would be the most effective and efficient method for disease containment and the maximization of limited resources.

8 Regionalization/Specialization The use of highly trained, specialized teams of responders and HC workers, designated space and equipment, and pre-staged supplies to ensure: Proficient use of PPE Designated transport vehicles; stripped down for ease of decontamination; isopods Designated patient isolation space including an institutional transport route and adequate space for safe donning and doffing Established waste management and decontamination procedures

9 Three Tiered System Frontline HC facilities Acute care hospitals and other emergency and urgent care settings Assessment Hospitals: 4 in Maine Eastern Maine Medical Center, Bangor Maine General Medical Center, Augusta Central Maine Medical Center, Lewiston Maine Medical Center, Portland Treatment Hospital (RESPTC) None in Maine; closest is Mass General in Boston

10 Frontline HC Facilities Rapidly identify and triage (travel hx, symptoms) Quickly isolate the potential case Immediately implement PPE to protect facility staff Inform hospital Infection Control staff and Maine CDC Notify 911 for EMS transport Transfer person to an assessment hospital

11 Assessment Hospital Perform same capability as Frontline HC facilities Additional capability of providing care to a patient until the DX of Ebola is either confirmed or ruled out; potentially up to 4-5 days Coordinate Ebola testing; obtain and transfer specimens to HETL Provide an in-house Ebola team of experienced staff that is trained to proficiency according to US CDC guidelines Donning and doffing with recommended PPE using a buddy system Provide adequate isolation facilities Implement waste management and decontamination plans according to US CDC guidelines

12 Treatment Hospital Patients with confirmed Ebola will be transported to either the regional or other nationally designated Ebola treatment hospital (9) The treatment hospital will be continuously ready and available to care for and manage Ebola patient(s) (or patients with other severe, highly infectious diseases) for the duration of their illness Our Regional Ebola and Special Pathogens Treatment Center (RESPTC): Mass General Hospital (in partnership with the MA Department of Public Health)

13 Treatment Hospital The 9 designated regional Ebola treatment facilities are part of a national network of 55 treatment centers that are funded to have enhanced capabilities (funding: 3.25 M over 5 years) The other 46 treatment centers must remain ready and may be called upon to receive an Ebola patient

14 Treatment Hospital 9 Treatment Centers required to: Accept patient within 8 hours Have capacity for at least 2 Ebola patients Have capacity for respiratory infectious disease isolation for up to 10 patients Be able to treat pediatric patients Safely handle infectious contamination and waste Conduct quarterly training and exercises Receive an annual readiness assessment by the NETEC (National Ebola Training and Exercise Center) to ensure staff is adequately trained and prepared

15 Ebola Response Plan: Appendices A. Regional Ebola Assessment, Care and Transport Plan (REACT) B. Guidance for Maine HC Providers Caring for Possible or Known Ebola Patients C. CMS: Emergency Medical Treatment and Labor Act (EMTALA) for Ebola D. Ebola Virus Disease Investigation Protocol E. Active and Direct Active Monitoring Plan (AM/DAM) F. Health and Environmental Testing Laboratory (HETL) Ebola Plan

16 Appendices (Cont.) G. Hazardous Waste Transport and Disposal, and Environmental Decontamination H. Personal Protective Equipment (PPE) I. Public Communications J. Law Enforcement Response Capability in an Infectious Disease Outbreak K. Fatality Management Plan L. Disaster Behavioral Health Resources

17 REACT: EMS Transport If 911 gets a call for a patient with a Hx that is suspicious of Ebola, dispatch will contact the online medical control at the nearest hospital to assess risk. Based on the assessment, the patient may be transported either to a local hospital or to an assessment hospital for care. Transport will be provided by a specially trained, designated response team in specially prepared transport vehicles with barrier protection

18 Transport Maine has 4 designated, specially trained Ebola Response Transport Teams all associated with the designated assessment hospitals: Capital: EMMC Delta: Maine General United: CMMC Northeast: MMC

19 Regionalization/Specialization Hospitals: 4 assessment EMS: 4 transport teams Law Enforcement: designated response team For security and escort Funeral Directors: Designated a mortuary response team to recover and transport human remains of Ebola patients Designated crematorium assigned to cremate remains of Ebola patients

Guidance re: HC workers with direct patient contact Potential sources for employee exposure Low risk, some risk or high risk employees Hospital employee health monitoring

20 Guidance re: HC workers with direct patient contact Potential sources for employee exposure Low risk, some risk or high risk employees Hospital employee health monitoring All employees with potential (direct/indirect) exposure HC facility monitoring of exposure incidents Report incident to Maine CDC Environmental infection control in hospitals

21 Active Monitoring/Direct Active Monitoring (AM/DAM) Travelers from active outbreak countries are to be funneled into (5) pre-designated airports and screened Travelers are followed daily in their destination state by PH for the illness incubation period (21 days); for early detection and rapid isolation if symptoms appear Based on level of risk, travelers receive active or direct active monitoring Active: daily phone call; Direct active: daily direct observation (actual visit or could be via skype) Monitoring includes the reporting two temps a day with an associated check for the presence of symptoms

22 Health and Environmental Testing Laboratory (HETL) HETL will receive specimens and forward them to a regional laboratory or to the US CDC for testing All specimens must go through HETL to the US CDC or they will not be accepted for testing. Update: HETL has recently been approved to perform the Ebola test in-state and is currently developing the capability to perform the test; Ebola samples will be sent to HETL for testing therefore providing a quick turnaround of results.

23 Personal Protective Equipment PPE purchased is based on the recommendations of the US CDC Assets have been or will be forward-deployed to assessment hospitals, EMS and Law Enforcement by Maine CDC Assets will also be distributed to other partners as necessary if there is suspected risk

24 Waste Management Guidance is based on recommendations provided by the US CDC and WHO Stericycle is the predominant partner for waste transportation and disposal Stericycle has renewed their special permit to transport Ebola waste (valid through 3/31/17)

25 Decontamination Decontamination recommendations are based on US CDC and WHO guidelines Ebola waste is a biohazard Category A; recommend minimal handling When waste must be handled, should only be handled by personnel with full PPE There is no evidence that Ebola can be transmitted via sewerage (treated or untreated)

26 Decontamination Contract companies can be used for cleaning hazardous waste Contract companies must comply with OSHA Standards for blood borne pathogens, PPE, respiratory protection, and hazard communication

27 Disaster Behavioral Health Disaster Behavioral Health Resources identified for: res Children Adults Healthcare workers

28 Maine Ebola Response Plan The Ebola Response Plan has been officially approved and is now posted on the Maine CDC website: Training and exercising of the Maine Ebola Response Plan are currently in process

29 Regional Ebola Plan Region I (New England states) has recently formed a group of stakeholders to develop a regional CONOPS for the New England states to respond to a patient who is identified as having Ebola with a focus on transport of a patient to the Regional Ebola Treatment Center (RESPTC) at MGH in Boston.

30 Regional Ebola CONOPS Plan Issues include: Making the Plan broad enough to address other infectious diseases Ensuring a strong communications system of the Unified Coordination group (UCG): MDPH and other state representatives in Region I including affected AHs, RESPTC, state EPIs, state DPHs, Region I Feds, state EMAs, EMS, LE) re: transport of a patient Defining where state plan ends and the regional plan begins; authority shifts

31 Regional Ebola CONOPS Plan Establishing a virtual, regional Joint Information Center (JIC); with JIC command (and PIOs) changing as the patient moves from AH in one state to the RETC in MA (including any traversed state) Media Consistent public messaging to reduce public panic, fear and anxiety Planning tactically orchestrated by the Region I Transportation Coordination Group (TCG)

32 Regional Ebola CONOPS Plan EMS ground transport issues: Standardization of processes; isopods Length of transport; time spent in PPE (2 hours) Exchange stations (likely AH) (2 vehicles/crews); 4 hour trip max Coordinated communications (interoperable/ redundant) for continuous situational awareness Crossing state lines; licensure reciprocity Police security and escort

33 Regional Ebola CONOPS Plan Ground transport contingencies: Patient becomes unstable; deteriorating condition Patient death during transport and return of remains; wil require coordination between state OME of death and state OME of origin PPE breach during transport Vehicular accident or mechanical failure in route Unexpected traffic delays (short- emergency warning devices vs long- alternate route) EMS destination: doff, rest and decontamination (MGH) Vehicle terminal decontamination (MA DEP) Waste management at destination (MGH or EMS provider)

34 Regional Ebola CONOPS Plan Air transport contingency from >200 miles (Bangor and Burlington) Phoenix Air: federally contracted medical team for aeromedical evacuation Maintains aircraft and crew readiness 24/7 communications capabilities Requires 5000 ft runway and able to accommodate Gulfstream G-III jet; 70,200 lbs ramp weight Transport requires an outdoor direct route for the transporting ambulance from the AH directly to the air ambulance Will fly from Bangor (BIA) to Logan

35 Regional Ebola CONOPS Plan HHS will reimburse for direct costs of care and transportation costs not covered by other means of reimbursement for an individual treated for Ebola in the United States at the discretion of the Secretary of DHHS. Public Law , Division G, Title VI, and section 311 (c) (1) of the PHSA, 42 U.S.C. 243, (c)(1). Narrative and supporting documentation Documentation required i.e., payroll records

36 Regional Ebola CONOPS Plan Eligible expenses include: (direct, uncompensated) All clinical care and interventions Increased staffing costs PPE Waste management, removal and disposal Increased laboratory costs including expenses of shipping of samples Patient transportation costs Law enforcement escort (anticipated) Decontamination costs (anticipated)

37 Regional Ebola CONOPS Plan Ineligible for reimbursement Costs already covered by other methods of reimbursement Training Facility modification Lost revenue Increased security Post exposure monitoring of staff

38 Regional Ebola CONOPS Plan All official documentation relating to transportation will fall under the ICS ICS forms and the Incident Action Plans (IAP). Important to create and retain documents EMTALA must be met if the patient is unstable HIPAA is not suspended during a PH emergency however the Secretary of HHS may waive certain provisions.

39 Regional Ebola CONOPS Plan The Regional Ebola Plan is currently a work in progress Version 1.2 was distributed August 24 for review and comment Feedback due date of September 7th

40 And finally Thank you!

Chicago Ebola Preparedness Update. Suzet McKinney, DrPH, MPH, Deputy Commissioner Stephanie Black, MD, MSc, Medical Director March 18, 2015

Chicago Ebola Preparedness Update Suzet McKinney, DrPH, MPH, Deputy Commissioner Stephanie Black, MD, MSc, Medical Director March 18, 2015 Agenda Ebola Overview Crisis in West Africa Symptoms and transmission