Episode 7

This podcast is part of our series of real-time discussions centering around the COVID-19 response in jurisdictions throughout the United States. This session will focus on the Health Care perspective in response to this COVID-19 pandemic. We will take a look at how Health Care Agencies have adapted to cope with this unique crisis; and discuss what their role is in the overall response to city and state efforts.

TRANSCRIPTION

Narrator: Welcome to the Disaster Management Podcast series each episode features subject matter professionals discussing strategies and techniques for emergency managers and policy makers to consider as they prepare for, respond to and recover from disasters. This series is brought to you by Texas A&M Engineering Extension Service and the National Emergency Response and Recovery Training Center.

Heather Crites: Howdy and welcome to the next podcast in are COVID-19 response series. Today’s podcast is hosted by Kris Murphy and Heather Crites. My name is Heather Crites. I am a training specialist with the Texas A&M Engineering Extension Service and am primarily responsible for our enhanced all hazards incident management unified command course also known as MGT 314. For those of you listening who are not familiar with MGT 314 this course centers on applying the essential incident command processes required for managing a large-scale, all-hazards incident. Participants exercise as part of an incident management team using the all hazards planning process to manage the response to four different simulation based scenarios. And I’m Kris Murphy many of you will recognize me from the MGT 314 program as well. I have been a project coordinator with TEEX for about eight years now and have interacted with many of you listening during your time here in College Station. Also joining us today is Chris Kyer from the Kettering Health Network in Ohio and Ryan LeNorman who is a full-time instructor here with TEEX.Today’s podcast is going to focus on the healthcare perspective of this COVID- 19 response. It’s gonna be a little bit different than the podcast we’ve done to this point so we hope for some great information coming out. Chris why don’t we start with you, why don’t you introduce yourself.

Chris Kyer: I’m Chris kyer I work for Kettering Health Network as Kris said. I’ve been with Kettering Health Network for about five years now. When I came on I was a career firefighter paramedic on the area Dayton Ohio. I came in as an EMS coordinator and quickly moved into some disaster preparedness elements specifically with hazmat training and preparation for all of our emergency room staff and kind of moved into general disaster preparedness management.

Ryan LeNorman: Kris thanks again for having us this morning. Chris Kyer thanks for stepping out there with me and being able to bounce some ideas off. My name’s Ryan LeNorman from TEEX. I am the agency instructor for medical management of chemical biological radiological nuclear and explosive events. I have a former history as a flight medic in Houston Texas with Memorial Hermann Life Flight. I was trained for the last ten years under that umbrella and for the first five years of that training I got to train under Dr. Red Duke, famous Texas A&M grad and probably the one who kind of shaped more over how I think about medicine and the simplicity that I used to explain things because that’s one man that could take a complex situation and turn it into a simple situation.

Heather Crites: Ryan you’ve been deployed as part of the state of Texas support efforts and have been working with Army Reserve National Guard and the State Guard share some of what that has entailed.

Ryan LeNorman: Absolutely. So early April we got a call that Texas Department of Emergency Management was requesting some assistance in their regions, and the state of Texas is actually broken up into eight regions. We essentially got pushed out to assist with the distribution supplies of personal protection equipment as well as some of the distribution for the HPP’s, which for those of you that are not familiar with the public health initiatives, much of that is correlated through the hospital preparedness programs. A lot of what we were doing up there was helping to coordinate that delivery of that PPE supplies as well as storage of that supplies. So the idea was we’re going to put these regional areas together and we’re going to push supplies out to these regions so that they’re closer to the centers, closer to the end-user if you will, and be able to provide them with quick access to this personal protective equipment. We quickly realized that we should probably set up a communication center or an emergency operation center if you will and it really provided us with a very good overview and a very good 30,000 foot view of what was going on.

Heather Crites: Chris do you find yourself in a similar situation in the Ohio Valley?

Chris Kyer: Absolutely. Governor DeWine and Dr. Amy Actin were very quick to deploy our Ohio National Guard as well. Kettering Health Network has received some of those supplies most of what we received were items that we had requested based on setting up an alternate care site should we have surge levels that required that. Thank goodness we did not end up having the numbers that justified opening a local alternate care site but certainly in my warehouse I still have thingsthat were delivered by Ohio National Guard.

Kris Murphy: So Chris I understand Kettering health network is comprised of a series of I think up to eight hospitals and around 120 outpatient facilities. Tell us a bit more about how the network operations have been impacted by the COVID-19 crisis. How have you had to change daily operations.

Chris Kyer: Sure. Kettering Health Network were a network of like you said about eight hospitals we’ve got 11 emergency departments that we currently have opened soon to be 12 and we stretch from essentially the edge of Cincinnati north of Dayton, not quite to the Toledo area. COVID-19 has impacted us significantly. I was down at the MGT 314 the week that COVID really started. While I was there in class I was you know on breaks doing a lot of phone calls and kind of deciding what we were gonna do to stand up to respond to things that were happening at the time. Initially what we decided to do was stand up an incident command team or incident management team comprised mostly of executives throughout our network and I think that this pandemic has really emphasized the need and the benefit of being a large system. Our incident command structure essentially unified from across the network. Instead of having an incident command system or a hospital incident command system set up at each one of our hospitals, we stood up one unified incident command system for the entire network and decisions were made by network executives with input from executives from each one of those hospitals or silos within. We have what we call a network operation command center or the NOC that typically deals with any patient movement through our systems. What our NOC started to do once this incident really got going was essentially anything that was stood up in response to COVID was approved through the incident commander here at the NOC and that system grew so rapidly. We ended up building out a 20,000 square foot area kind of overnight to accommodate the number of people that we had working an incident command and to try and maintain some kind of social distancing while we were working together. I don’t know that we anticipated supplies being so difficult to get because everybody’s dealing with the same thing. Typically most of standards are 72 to 96 hours worth of supply, the beginning of the response had a lot to do with figuring out PPE conservation methods and how can we safely conduct business and provide care for patients while reutilizing some of the PPE are restricting who was utilizing PPE.

Kris Murphy: How is Public Health interacted in this command post? In parts of the country Public Health is actually the lead agency.

Chris Kyer: Here in Ohio we have a healthcare coalition that is comprised of all the different areas of healthcare including Public Health, and certainly we use that model here. And Ohio Department of Health has been the lead response agency during the pandemic and has really set a lot of the tone and the policy that we’ve followed. But I think that a lot of those relationships from the healthcare coalition’s has been very beneficial. The healthcare coalition we partner with the county health department’s within that and it’s been interesting to some degree it’s not rolled out like I thought it would because we meet and plan as at a regional group but a lot of the response has been County based, but certainly the relationships that had been built with that coalition prior to the COVID pandemic are paying dividends today because of the person-to-person relationship.

Ryan LeNorman : And the Public Health Service itself side of these incident management teams have really struggled because it’s something that they haven’t seen before and a lot of the plans that were in place or the processes that they had in place couldn’t be followed because the supplies weren’t there. The reasons why Chris was talking about they really struggled with how to reuse things and how to sanitize things and a lot of that supplies was already spoken for.

Chris Kyer: You know Ryan, you’re right it’s interesting one of the things that we started going for very quickly was PPE realizing that even our cache of disaster supplies. I think I probably had a hundred and thirty hundred and fifty thousand of N95 masks, but we had immediately made a request to our local health collaborative to release some of what their cache was and I think we got ten thousand and N95’s from them realizing that that wasn’t gonna be enough with our burn rates etc. I put a request in to the state EMA that had stood up at the time and interestingly enough when they received my request essentially their answer was, we don’t have anything. So it was very interesting at the beginning even to see that what you had always drilled on and what your plan said to do was you know essentially you’ve got your cache and then you’ve got your local cache and then your state cache and really very early on in the response it was very evident that all of those channels had already been tapped and there just wasn’t anything out there available.

Ryan LeNorman: You talk about burn rate that’s a great term that we try to use a lot it’s a hospital preparedness setting what we’re trying to emphasize to these hospitals please calculate your burn rates and please be prepared for what you’re going to use because if we do see that surge in the fall where do you need to be. That’s been an interesting component to the whole thing is we’re really good at responding with isolated incidents but as widespread as this is it’s called such a backlog like you talked about Chris.

Kris Murphy: Chris do you have a public health representative on your incident management team?

Chris Kyer: Certainly we have our infection control group we call them infection control interventionist which essentially we assigned to the Safety Officer position for this incident within our incident command structure. And they have a group that meets regionally with the health collaborative and that relationships is how we’ve kind of liaised between the region and the hospital system to make sure that the public health request and so forth have been taken care of.

Heather Crites: And health care professionals deal with many widespread diseases from Ebola to H1N1 to Zika. We see repeatedly in the news that the corona virus is getting compared to the flu, what makes the response to this so different?

Chris Kyer: So I cannot say that I’m an infectious disease expert by any stretch of the imagination but what I can say is that the flu is similar. If you look at the 1918 pandemic here you have a flu in 1918 that’s brand-new nobody has any kind of immunity to it and it sweeps the world with infection and I think that COVID is very similar although it’s not an influenza it’s a different virus but I think it’s very similar in terms of how it’s been so widespread and how it’s affected so many areas worldwide.

Ryan LeNorman: Chris you made some great points there and I echo your sentiments. I am not a disease person by any means. Three of the big things that we look at any pandemic communicability infectivity and mortality. We have to look at all three of those to decide how we proceed with the virus and when we look at those things and we listed a few of these about Ebola and h1n1. Ebola is very highly infectious very high mortality and very highly communicable. It’s easy to contact trace something like Ebola. The infectivity of it is so high and so rapid that we can easily ascertain someone that sick that had direct contact with someone. That allowed us that contact tracing ability. With this corona virus we struggle with contact tracing ability because this is very infective but it takes a long period of time we’re talking about an incubation period that’s been roughly estimated between two to 14 days. Initial reports for this disease we knew the three things we knew that there was a mortality that was associated with it we knew also that it was communicable that ability to transfer this infection from one person to another made this disease a completely different animal if you will, and then when we get into the infectivity that’s where they’re trying to figure out if you have no signs or symptoms are you still infected and can you still communicate that disease to someone else. All three of those elements that we talked about for a disease are all present. It’s got a high communicability it’s very infectious and then the mortality thing is still kind of up in the air. It’s been difficult to keep tabs on this disease process and how it made its move across the nation. Herd immunity is a big deal. For herd immunity we’re talking about eighty percent of the population being immune to the disease process. Research is going to help us out with that and basically what they found was out of the 3,000 patients that were already tested positive for COVID 19 and in the return of that for antibody testing only 14% of those patient tested positive for antibodies. That’s really raised a lot of eyebrows and a lot of question is are we able to develop the antibodies to fight against this to have that herd immunity we just don’t have the data yet to really push through.

Kris Murphy: This is a good time for me to ask what is the difference between isolation and Quarantine?

Ryan LeNorman : It’s a good question it’s very important that we notify both of them because we try to use isolation in most of our public health talks when we’re talking about dealing with a pathogen or disease we hate to use the Q word and for people that are in the public health sector stand that quarantine is a bad word. Quarantine literally in its definition is separating and restricting the movement of people who were exposed to a contagious disease to see if they become sick. Literally we’re taking people that have not shown any signs or symptoms and we’re telling them you need to stay here in this isolated area and we’re just gonna see if you get sick. Isolation is separating those sick people that have that disease already from the people who are not sick.

Heather Crites: Chris knowing what we know now what strategies can we employ to educate the public in preparation for the next pandemic.

Chris Kyer: There’s still so many unknowns about this novel coronavirus that it’s gonna probably be a long period of time before we really can come back and say what we understand about this disease. Even the debate between a mask and not wearing a mask are you putting yourself at more risk by wearing a mask versus less risk and I think some of those questions are going to have to be answered scientifically and we’re going to have to roll out public education that really educates public on scientific answers. There’s still a lot of controversy in terms of what prevention really should look like and what the best methods are so I think that we’ve got to get some of the academics behind this and show with science what really makes sense and probably create a an educational program to try and figure out best methods and how to deploy those.

Kris Murphy: Ryan what do you think?

Ryan LeNorman: One thing that we can start doing on our side of things to start preparing ourselves for the next pandemic like you talked about in terms of supply and what those supplies need to look like because we’ve never prepared ourselves we’ve talked about it we pay this is how we’re going to do these things and this is where it’s going to come from and that’s great when you’re dealing with an epidemic. It’s not so fantastic when you’re dealing with a pandemic. One big step in moving forward will be that planning process and how we do our after action. How did we respond to this and how effective was that how well did we prepare for this before this and what can we do to change it so we call that typically our after-action report.

Kris Murphy: You both mentioned information, how is the exchange of information taking place? Chris you worked for a private healthcare network, how is information coming to you how are you transferring it to other people?

Chris Kyer: You know Kris it’s interesting that you asked that. Not only do we have the local health collaborative that are asking for specific data they want to know how many events do we have available how many COVID patients are on ventilators. My executives within the system want to know that information the, state wants to know that information there are associations that we belong to that want to know that information and certainly the federal government wants to know it as well. So data collection and distribution has been a huge part of the incident command structure and how to best assemble that on a real-time basis. Within our planning section we’ve got the planning section chief and the situational unit leader that are working on a report twice a day that is used during a briefing with all of the executives and it goes down with the numbers of how many patients we’ve had that have been sick or that are currently sick and admitted with COVID, how many are pending testing certainly supplies have been a part of that how much supply do we have on hand. Assimilating a one page report essentially is what we’ve done and we distribute that to all of the agencies that are looking for those numbers and then internally we distribute that page and then a section report from each one of our sections. In addition we have a system here in the state of Ohio that’s called surge net. A system that you can go online and look at the number of beds that are available so if we had a local mass casualty we can quickly go in and fill those numbers out to figure out how we need to distribute patients equally across the system. We’ve started to utilize that during the COVID response to report outs the supplies the ventilators and that’s usually done by our nursing supervisors at each one of the hospitals. We’ve worked on a task force that is aligning hospital systems with the independent skilled nursing facilities to ensure that their processes are sound and they’ve got a system in place that if they start to see a surge within their system they have the ability to reach out to the partners that have been aligned with them

Ryan LeNorman: And Chris I’m actually on the other side of data that you’re providing and I’m looking at your request and I’m calculating to figure out exactly how much I need to get you. Most importantly for those of us that are in my locations is we’re looking at it to say do we have any outbreak, do we have any areas or of major concern and what do they need. When we talk about the nursing facilities a lot of those workers have more than one job so they wind up working in another skilled nursing facility. That’s where our contact tracing comes in. We also have decontamination team, a team essentially that’s trained and ready to go out to a skilled nursing facility to clean and disinfect those areas as best as possible with the appropriate supplies. A lot of that data that you’re putting out there is really paying dividends I just want to tell you that.

Heather Crites: And I think throughout this we’ve learned that pandemic preparedness involves more than just stockpiling pharmaceuticals and planning for surgeries of patients at hospitals that’s why we did this quarantine was to flatten the curve and try not to overrun the hospital’s. Chris what did you get right in terms of pandemic preparedness.

Chris Kyer: I’ve always had great support from the executives here at Kettering Health Network I can’t say enough about the support that we’ve had since the beginning of this incident. Again we were very quick to set up our incident command system and the efforts that have been put into that from all levels of our organization have just been overwhelming. The way that people have stepped up to the plate and played the roles with an incident command and figured out how to make this manageable. To really answer your question what we have done successfully is we’ve put that unified command structure together and figured out how to break everything down into bite-sized pieces. You figure out what the most important tasks are or the objectives of the day and you set your incident action plan up to take care of those at the end of the day you report out what you’ve got done and you sit down and figure out what the next operational period looks like. So I think that we’ve done very well and what excites me as an emergency management person is that I think that we have found that path of work so effective that I anticipate some of the things that we have put in place during this incident are things that will continue to be utilized in our everyday operations going forward.

Kris Murphy. Ryan any word of wisdom from you?

Ryan LeNorman: I 100% agree with him. I think you get the nail on the head. The MGT 314 class itself or the unified incident command course that we took, it’s provided us with a lot of knowledge and sub-base you perform on the level that we’ve had to do inside of this pandemic. I think is incident action plan is going to be a lot different from mine but it still provides you with the structure on how to respond to these incidents and when we first started I had a five-page incident action plan that was day one by day 22 my intent action plan was almost 30 pages. It gave us that subset it gave us that ability to respond to these incidents and it’s been a real helpful commodity to have walking into this. I hate say we got thrown into the fire but we did get thrown into the fire but you really couldn’t pick the better time I know that Chris was just recently in 314 classes as recent as I was and to have that fresh on our brains walking into this really helped things out and actually it kind of solidified what I do in my region. I’m actually the planning section chief having that 314 class just before that provided me with a great mindset to walk into this incident and help to better manage it.

Kris Murphy: Chris we had a gentleman on one of our calls from Santa Rosa and he mentioned that the two of you were on the flight together leaving College Station and you guys were already talking about all this.

Chris Kyer: Yeah we had quite a bit of time in the airport there was a lot of conversation around what this response was gonna look like. One of the things about the MGT 314 I think in the first in the first day they talked about everybody looks like a stranger now but before the week is out everybody’s gonna be best a friend that extended to when we were at the airport waiting to depart. There were a lot of good conversations. I was lucky enough to be in the fire emergency medicine world before I came into the healthcare side of the world and I don’t know that all of us realize that healthcare is really a part of that system, I think that we tend to think of public safety and emergency management and as a separate entity in healthcare and what I will say is at the 314 class there were world-renowned guys both instructors and people take in the class. Obvious experts from their area law enforcement firefighters, EMS guys Public Health people all of those people were obvious experts within their fields and in healthcare again sometimes I don’t know that it’s the recognition within that world that it deserves but what I will say is that seeing the executives and the people within this organization respond and quickly adapt to the incident command system truly solidifies for me just how important they are in terms of a response during any kind of major disaster. It’s very enlightening to see how all of this works together and that we’re all in this together.

Heather Crites: I really appreciate those comments. You know we hammer home unified command, silent partners that we don’t necessarily think about because you’re absolutely right we always think fire, law and EMS, nobody thinks about public health, public works and some of those unsung heroes that are behind the scenes that contribute to a respond. Gentlemen I want to thank you for taking the time to talk healthcare with us today we appreciate what each of you are doing to support the response to this pandemic. I would also like to thank all emergency personnel both behind the scenes and on the front lines for your continued dedication during these unprecedented time.

Narrator: Thank you for listening to the Disaster Management Podcast series brought to you by Texas A&M Engineering Extension Service and the National Emergency Response and Recovery

Training Center. If you have any questions or ideas for future episodes please contact NERRTC@teex.tamu.edu or visit teex.org for information about training near you.