Southern Minnesota Regional Trauma Advisory CommitteeFeb 02, 2020 · Page 1 of 4. Southern...

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Southern Minnesota Regional Trauma Advisory Committee

General Meeting February 11, 2020 | 1:00 p.m. – 3:00 p.m.

MCHS - Clinic, Rooms A/B/C – 2200 26th Street NW, Owatonna, MN

Meeting web cast access on www.smrtac.org | JOIN ZOOM

AGENDA

Time Agenda Item Presenter(s) Action

2 minutes Welcome, Call to Order Daniel Stephens, MD

3 minutes Roll Call (Establish if Quorum is Met) Daniel Stephens, MD

3 minutes Current Agenda and Minutes of November 12, 2019 Daniel Stephens, MD Approval

5 minutes

Consent Agenda:

• Subcommittee Minutes o Trauma Program Managers o Outreach Education Meeting Minutes

Daniel Stephens, MD Approval

5 minutes Chairperson’s Report:

• Fiscal Report • Injury Prevention - Subcommittee Chair/Committee


10 minutes Final SMRTAC MCI Plan Vicki Neidt Approval

10 Minutes Review of SMRTAC Pediatric Surge Annex Vicki Neidt Discussion

5 Minutes 2020 Meeting date alternate for May - May 19 meeting room available not May 5 Kristen Sailer Approval

15 Minutes PMG Updates from Chairs Status/Review/Approval: 1. No PMGs submitted for review

All Chairs Approval

10 minutes BREAK

10 Minutes

Level IV Criteria issues/concerns: Request for a guideline to be created regarding the care of minor SAH at a level 4 hospital. In addition to neuro checks, if they should be getting PT/OT, if there are restrictions to their activities and with whom they should follow up if general surgery does not feel comfortable managing them in

Dr. Stephens Discussion

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clinic.

5 Minutes PI Updates Dr. Kasal Discussion

5 Minutes Stop the Bleed School Program Ideas Dr. Stephens Discussion

5 Minutes Funding for RTTDC training Winona March 16 Funding for TNCC training July 21 St. Paul Dr. Stephens Discussion/

Approval

5 Minutes

SMRTAC Booth 2020 Conferences: Funding Requests for items to stock the booth items – tourniquets, pens, pamphlet, TTA, etc.

• SE EMS Conference March 20-21, 2020 – funding request $500 Vendor cost Apache Hotel Rochester

• Zumbro Valley ENA Conference April 14-15, 2020 Rochester International Event Center Free

• TZD Workshop May 6, 2020 Free with lunch provided to staff

• SC Emergency Management Conference May 14 Free with lunch provided to staff

Kristen Sailer Discussion/ Approval

5 minutes STAC Update • Dr. Klinkner All Informational

10 minutes Subcommittee Chair Reports All Chairs Informational

5 minutes Roundtable All Informational

Adjourn *Items with attachments are hyperlinked blue

Notation Items Member List Robert’s Rule

Future Topics

Dates to Note • 2020 SMRTAC Dates

NEW VENUE MCHS Owatonna 2200 26th Street NW – Owatonna, MN 55060 o 2/11/2020 o 5/19/2020 o 8/4/2020 o 11/10/2020

• 2020 STAC Meetings

o 3/3/2020 o 6/2/2020 o 9/15/2020

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o 12/8/2020

Voting Members Kathy Berns, RN Aero-Medical Representative

Jill Bondhus Dispatch Agency Representative

Bethany Corliss daRocha, MD Medical Director of Level III/IV Representative

Adam Grant EMS Agency Representative

Peggy Sue Garber, RN Injury Prevention Specialist

Don Hauge Regional EMS Representative

Mike Juntunen Regional Data Registry Specialist

Daniel Stephens, MD Level I Representative Chair, SMRTAC

Laurie Mc Levis, RN Pediatric Specialist

Vicki Neidt Disaster Planning Specialist

Angela Schrader Level IV Representative Secretary, SMRTAC

Elizabeth Fogelson MD Level IV Provider

Pam Williams, RN Hospital Administrator Vice-Chair SMRTAC

Administrative Staff

Kristen Sailer SMRTAC Co-Coordinator

Vicki Shea Administrative Assistant

Sub-Committee Chairs OPEN Regional Data Registry

Terri Elsbernd PI Co-Chair

Tim Malchow EMS

Jill Hunchis, RN, CNP Pediatrics

Chris Kasal, MD PI Co-Chair

Jessica Pastick, RN Education/Outreach

Gail Norris, RN Trauma Program Manager

OPEN Injury Prevention

Liaisons Chris Ballard MN Statewide Trauma System

Maria Flor SMRTF Foundation Executive Dir.

Marty Forseth State Designation Coordinator

Tim Held MN Statewide Trauma System, Rural Health

Dr. Denise Klinkner, M.D. STAC Liaison

OPEN SMRTF Foundation Treasurer

Tammy Peterson State Designation Coordinator

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Attendance of Voting Members

Kathleen (Kathy) Berns RN Vicki Neidt RN Jill Bondhus Angela M. Schrader RN Bethany Corliss daRocha MD Daniel Stephens, M.D. Karla Eppler ME-PD, NRP Elizabeth Fogelson, .M.D. Donovan (Don) A Hauge Pam Williams RN Michael Juntunen Laurie A. Mc Levis RN

X= attending; NA = not attending; P = participating remotely

Attendance of Subcommittee Members

OPEN Jessica Pastick RN Terri Elsbernd RN Gail L. Norris RN Peggy Sue Garber RN Tim Malchow Jill M Hunchis RN, CNP Christopher Kasal, MD Denise B. Klinkner MD, M.Ed


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General Meeting November 12, 2019 | 1:00 p.m. – 3:00 p.m.

MCHS - Clinic, Rooms A/B – 2200 26th Street NW, Owatonna, MN

Meeting web cast access on www.smrtac.org | JOIN ZOOM

AGENDA

Time

Agenda Item

Presenter(s)

Action

2 minutes Welcome, Call to Order Daniel Stephens, MD

3 minutes Roll Call (Establish if Quorum is Met) Daniel Stephens, MD

3 minutes

Current Agenda and Minutes of October 1, 2019 Dates grant approved 7000 Deb Anderson is retiring soon will need replacement if going to continue data group


Approved by Peggy Sue

Garber

seconded by

Angela Schrader

Dates grant approved

7000

2 minutes

Special Recognition of Carol Immermann Thank you to Carole with a certificate presented.

Daniel Stephens, MD

Recognition

5 minutes

Consent Agenda:

• Subcommittee Minutes o Trauma Program Managers o Outreach Education

Daniel Stephens, MD

Approval

5 minutes

Chairperson’s Report:

• Fiscal Report • MDH Grant • Injury Prevention - Subcommittee Chair/Committee

How are we going to spend money that is in the bank ideas (more STB kits for schools ect..education and outreach if have ides or topics send them to Kristen Sailer

Daniel Stephens, MD

Approval

10 minutes

Updates to the SMRTAC MCI Plan We no longer have a disaster committee it will now be on EMS subcommittee language change will be made voting

Vicki Neidt

Approval

Approved by Seconded by

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members and not the subcommittee Appendix 2 needs to be updated Kristin will add the new one. To document would need ems subcommittee to review then be added. Appendix 3 Minnesota duty officer needs more detailed as on website and will be include in the appendix Appendix 2 needs updated in 2020 will need to be revised Items will be updated subcommittee will review then sent out to voting members for electronic approval voting. ECC has changed name to emergency communications.

5 Minutes

2020 Meeting date alternates for May and August Dates will be May 5th

August 4th new dates were approved

All Chairs

Approval

Peggy Sue Garber

Jill Bondhus seconded

30 Minutes

PMG Updates Status/Review/Approval: 1. Adult Trauma Blunt Agonal Arrest – Tim

Malchow Clarification of age for pediatrics The algorithm speaks to BLS is not allowed due to certain procedures Will send out updates and have voting members approve remotely

2. Auto Launch Criteria – Tim Malchow Should be responding ems that cancels auto launch Tourniquets need data to support auto launch Less than 15 years old

3. Blunt Trauma Arrest Draft Guidance – Tim

Malchow

4. Initial Management of Potential Rib Fractures Level III/IV Trauma Centers –Gail Norris

Updating ATLS to 10th edition Should we add inpatient management to guidelines will try and attach these to the PMG

All Chairs

Approval

10 minutes

BREAK

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10 Minutes

2020 Outreach Education ideas/methods

Last outreach was cancelled due to low attendance. Need ideas for next year maybe just plan one event on a large scale speakers and skill stations? The challenge would be speakers time Would like to keep education sessions prior to SMRTAC meeting maybe record training maybe a video recorder that is not stationary Plan for 2020- locations? Need clarity on number of sessions. Would like more hands. Look to partner up with Maria Flor on trauma peer review that is held at SCC

Jessica Pastick

Discussion

Refer to notes under 2020 outreach education ideas/methods

5 minutes

SMRTAC 10 Year Anniversary Overview

Was a great time!!!

Dr. Daniel Stephens

Informational

10 minutes SALT Trauma Triage versus START Trauma Triage

for pre-hospital MCI events SALT triage CDC promoted becoming more common The use of colors in START triage confuses people in

relation to TTA criteria colors Should we move to SALT triage as a region? Is the EMSRB making recommendations for this? Should we bring to STAC executive committee is

there a preference between the two at STAC?

Mike Juntunen

Informational

5 minutes

STAC Update • Maria Flor, Peggy Sue Garber, Angela

Schrader, or Gail Norris Chris gave update EMS data the run sheet EMSRB no longer will supply data currently in negotiations to get this up and working again. There was a question regarding new level IV criteria. A new work group was formed and will be meeting November 22 by telephone. STAC terms expiring this year need applications by end of November so commissioner can appoint for these positions by the end of this year.

All

Informational

10 minutes Subcommittee Chair Reports Education nothing to add No updates

All Chairs Informational

5 minutes

Roundtable Add geriatric component to TTA criteria Revisit TTA criteria TZD workshops are coming up

All

Informational

Adjourn

*Items with attachments are hyperlinked blue

Notation Items

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Future Topics

Member List Robert’s Rule

Dates to Note

• 2019 SMRTAC Dates NEW VENUE MCHS Owatonna 2200 26th Street NW – Owatonna, MN 55060 o 2/12/2019 CXLD o 5/14/2019 o 8/13/2019 o 10/1/2019 o 11/12/2019

• 2019 STAC Meetings o 3/5/2019 o 6/4/2019 o 9/10/2019 o 12/10/2019

Voting Members Kathy Berns, RN Aero-Medical Representative

Jill Bondhus Dispatch Agency Representative

Bethany Corliss daRocha, MD Medical Director of Level III/IV Representative

Adam Grant EMS Agency Representative

Peggy Sue Garber, RN Injury Prevention Specialist

Don Hauge Regional EMS Representative

Mike Juntunen Regional Data Registry Specialist

Daniel Stephens, MD Level I Representative Chair, SMRTAC

Laurie Mc Levis, RN Pediatric Specialist

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Vicki Neidt Disaster Planning Specialist

Angela Schrader Level IV Representative Secretary, SMRTAC

Elizabeth Fogelson MD Level IV Provider

Pam Williams, RN Hospital Administrator Vice-Chair SMRTAC

Administrative Staff

Kristen Sailer SMRTAC Co-Coordinator

Elle Stangl Administrative Assistant

Sub-Committee Chairs Deb Anderson, RN Regional Data Registry

Terri Elsbernd PI Co-Chair

Tim Malchow EMS

Jill Hunchis, RN, CNP Pediatrics

Chris Kasal, MD PI Co-Chair

Jessica Pastick, RN Education/Outreach

Gail Norris, RN Trauma Program Manager

OPEN Injury Prevention

Liaisons Chris Ballard MN Statewide Trauma System

Maria Flor SMRTF Foundation Executive Dir.

Marty Forseth State Designation Coordinator

Tim Held MN Statewide Trauma System, Rural Health

Carol Immermann, RN STAC Liaison

John Osborn SMRTF Foundation Treasurer

Tammy Peterson State Designation Coordinator

Dr. Denise Klinkner, M.D. STAC Liaison

Attendance of Voting Members

Kathleen (Kathy) Berns RN X Vicki Neidt RN X

Jill Bondhus X Angela M. Schrader RN X

Bethany Corliss daRocha MD X Daniel Stephens, M.D. X

Karla Eppler ME-PD, NRP X Elizabeth Fogelson, .M.D. NA Donovan (Don) A Hauge X Pam Williams RN X Michael Juntunen X

Laurie A. Mc Levis RN X


Attendance of Subcommittee Members

Deb Anderson RN NA Jessica Pastick RN X

Terri Elsbernd RN NA Gail L. Norris RN X Peggy Sue Garber RN X Tim Malchow X Jill M Hunchis RN, CNP X Christopher Kasal, MD P Denise B. Klinkner MD, M.Ed X


Outreach Education Subcommittee Meeting Minutes:

Meeting date: 2/6/19 from 1400-1430

Members present: Jessica Pastick, Maria Flor, Todd Dorn, Jessica Schleck.

Pre-General Meeting Trauma Program Management Luncheon informally discussing

advice/tips from one program leader to another and advice on how to prepare for and smoothly get through a designation visit. Pizza Ranch is tentatively catering this

lunch SMRTAC members will need to RSVP for. 1200-1300 on Feb 11th Pediatric Trauma Considerations being organized as a one-hour lecture for one or two

facilities in 2020- I’ve been emailing Jill the NP from Mayo that is the peds chair who sounds willing to help provide this

Survey Monkey results/discussion about what the region wants and plans for this

coming year.

2/3 state they regularly come to smrtac

Methods: Most preferred was at their own facility/community, second was in Owatonna, 3rd was one

large annual conference, 4th was online, and lastly was on paper.

What education topics they want:

Pediatrics

Hemorrhagic shock, MTP, new blood product recommendations, ATLS guideline changes, head bleeds on anticoagulation -trauma surgeon.

Procedures including: Pediatric and US guided IVs, chest tubes, Chest thoracotomy, Bedside Ultrasound

BLS training including c-spine clearance, long board vs scoop stretcher, fall assessments

Todd Dorn -Don Hogge and Mark Griffith – regional meetings? Going to monthly meetings…

What we can do to make things better- Record presentations better, maybe demonstrate skills.

Offer education on-site at times that work best for them. Design training just for BLS providers.

Who would be able/willing to design training for BLS crews?

Hemorrhage management including those on anticoagulation presentation to include ATLS guidelines?

Pediatric Talk is being provided by Mayo- Klinker and Terri Elsbernd, I will ask them their willingness to provide more than one, otherwise we will try to get a high-quality recording.

Next meeting – PI committee? Talk about interfacility transfer issues- Dr Terri Elsberg, Dr. Castle.

May 6th- TZD conference- Print guidelines, Ask if anyone is willing to partner at a booth…otherwise we will just donate tourniquets on SMRTACs behalf. -Rochester, register as a participant and exhibit- request that Meghan be next to our booth-mayo one

Open Forum 1. Creative, interactive, team based challenges, ways to reach the unreached…

brainstorming Please email me at [email protected] with and agenda items you wish to

add/cover

Meeting adjourned at 1425.

Jessica Pastick

Southern Minnesota Regional Trauma Foundation- Financial Report

Feb. 2020

Expenses:

Website Domain 155.80

Gas/Gift cards for Education Speakers 60.00

RTTDC Books (17) 1133.00

TOPIC Scholarships 595.41

Anniversary Event

Food 524.11

Decorations 58.90

Zoom annual fee 162.08

Total 2689.30

Current Balance:

Feb. 3, 2020 42.835.35


Serving South Central and South East Regions of Minnesota

Regional Mass Casualty Incident (MCI) Plan

November 2019

SMRTAC MCI Plan November 2019

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TABLE OF CONTENTS

INTRODUCTION ............................................................................................................................................. 1

SMRTAC MESSAGE ........................................................................................................................................... 1 SMRTAC MISSION .............................................................................................................................................. 1 SMRTAC PRIORITIES ............................................................................................................................................ 1 SMRTAC AS AN AGENCY RESOURCE ........................................................................................................................ 1 PURPOSE ............................................................................................................................................................ 2 PLAN DEVELOPMENT ............................................................................................................................................. 2 MAINTENANCE ..................................................................................................................................................... 2 IMPLEMENTATION ................................................................................................................................................ 3

SITUATIONS AND ASSUMPTIONS ................................................................................................................... 3

SITUATIONS ......................................................................................................................................................... 3 ASSUMPTIONS ..................................................................................................................................................... 3

CONCEPTS OF OPERATION ............................................................................................................................. 4

GENERAL SCOPE OF THE MCI PLAN.......................................................................................................................... 4 SMRTAC MCI FIELD GUIDE .................................................................................................................................. 4 TYPES OF MULTIPLE CASUALTY EVENTS ..................................................................................................................... 4 INCIDENT PRIORITIES ............................................................................................................................................. 4 CRITICAL INCIDENT STRESS MANAGEMENT ................................................................................................................ 5 PROTOCOL FOR TRANSPORT.................................................................................................................................... 5

ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES ............................................................................. 5

LOCAL EMERGENCY PLANS ..................................................................................................................................... 5 INITIAL RESPONSE TO AN INCIDENT........................................................................................................................... 5 ACTIVATING THE REGIONAL MCI PLAN ..................................................................................................................... 6 RESPONSIBILITIES .................................................................................................................................................. 6

Hospitals and Healthcare Facilities ............................................................................................................. 6 Pre-hospital ................................................................................................................................................. 6

FATALITIES AND MASS FATALITIES INCIDENTS ............................................................................................................. 7 MEDICAL DIRECTION/PROTOCOLS ........................................................................................................................... 7 STANDARD PRECAUTIONS ....................................................................................................................................... 7

DIRECTION AND CONTROL ............................................................................................................................. 7

EMERGENCY COMMUNICATIONS ............................................................................................................................. 7 FUNCTIONS OF REGIONAL SOUTHEAST & SOUTH CENTRAL HEALTHCARE MULTI-AGENCY COORDINATION CENTER (H-MACC) . 8 TECHNICAL RESCUE OPERATIONS/SPECIALIZED RESOURCES .......................................................................................... 8 HAZARDOUS MATERIALS ........................................................................................................................................ 8 CBRNE (CHEMICAL, BIOLOGICAL, RADIOLOGICAL, NUCLEAR, EXPLOSIVES) INCIDENTS ......................................................... 8 BURN INCIDENTS .................................................................................................................................................. 9

APPENDIX # 1 - ACRONYMS ......................................................................................................................... 10

APPENDIX # 2 - MCI FIELD GUIDE ................................................................................................................. 12

APPENDIX # 3 - MN STATE DUTY OFFICER PROGRAM .................................................................................. 14

CONTACT THE DUTY OFFICER AT: ........................................................................................................................... 14 AVAILABLE AGENCY RESOURCES ............................................................................................................................ 14

State Agencies:.......................................................................................................................................... 14 AVAILABLE AGENCY RESOURCES ............................................................................................................................ 15

Other Resources: ....................................................................................................................................... 15


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The following information (if available) will be requested by the Minnesota Duty Officer: ..................... 16

APPENDIX # 4 - SMRTAC COUNTIES IN SOUTH CENTRAL AND SOUTH EAST REGIONS .................................. 17

APPENDIX # 5 - EMS BOARD CONTACT LIST ................................................................................................. 18

APPENDIX #6 - BURN SURGE ANNEX TO MCI PLAN ..........................................................................................

PURPOSE ....................................................................................................................................................... 1

ASSUMPTIONS ............................................................................................................................................... 1

CONCEPT OF OPERATIONS ............................................................................................................................. 1

MEMBER AND PARTNER ROLES AND RESPONSIBILITIES ................................................................................ 2

FIRST RESPONDERS AND EMERGENCY MEDICAL SERVICES (EMS) .................................................................................. 2 FIRST RECEIVING HOSPITAL(S) ................................................................................................................................. 2 REGIONAL HEALTHCARE COALITION PARTNERS ........................................................................................................... 2 REGIONAL BURN SURGE FACILITY ............................................................................................................................ 2

TRAINING AND EXERCISE RECOMMENDATIONS ............................................................................................ 3

REVIEW 3

ATTACHMENT A ............................................................................................................................................. 4

BURN SURGE RESPONSE FLOWCHART ....................................................................................................................... 4


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INTRODUCTION

SMRTAC MESSAGE

The Southern Minnesota Regional Trauma Advisory Committee (SMRTAC) provides this plan to the agencies, facilities, counties, and state agencies within the boundaries of our SMRTAC Region with the understanding that it is considered a “living document”. Revisions of this plan are ongoing and will be implemented as new information and data is obtained. Appendices to this plan are continually “in process” as events and data inspired standards are set.

The SMRTAC Region also acknowledges that resources around our state are changing very quickly so the resource lists and other appendices are subject to change.

This plan is meant as a “systems” plan only, and should NOT be interpreted as a functional plan. This plan, along with the SMRTAC MCI Field Guide, should be used as templates to develop individual agency plans that work within our regional system.

SMRTAC MISSION

The mission of the SMRTAC Regional MCI plan is to enhance the existing regional medical and public health system sufficiently to assist with the management and mitigation of the health and major consequences of major Mass Casualty Incidents (MCI) resulting from deliberate or accidental occurrences.

SMRTAC PRIORITIES

• The primary priority is to minimize the morbidity and mortality associated with large-scale emergency patient care incidents.

• The intent of the MCI Plan is to ensure the provision of rapid and appropriate emergency medical care to the most possible patients through a coordinated response system based on incident management principles.

• Control the escalation of an event, both geographically and in the number of casualties through effective and efficient use of resources along with mitigation of potential predictable collateral effects of the event.

• Conduct all activities in a manner to ensure any investigation efforts and ultimate prosecution of responsible parties if they exist.

• Make the best use of personnel, equipment and facility resources. • Comply with any local, state, federal rules and regulations regarding patient care and

transport.

SMRTAC AS AN AGENCY RESOURCE

The Minnesota Legislature and the Governor approved the development of a voluntary State Trauma System in 2005 and established criteria for such with the State Statute 144.603. This statute has been further defined in successive years.


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The Commissioner of Health is charged to both seek the advice of the State Trauma Advisory Council (STAC) in implementing and updating the criteria and to adapt and modify the criteria as appropriate to accommodate Minnesota’s unique geography and the state’s hospital and health professional distribution. The latter requirement is aided by contributions of Regional Trauma Advisory Committees (RTAC).

The statutory function of RTACs are to advise, consult with, and make recommendations to the STAC modifications to the statewide trauma criteria that will improve patient care and accommodate specific regional needs.

PURPOSE

SMRTAC was created to develop a comprehensive and regional, emergency medical and trauma care system.

This SMRTAC Mass Casualty Incident (MCI) Plan establishes a basis for unified response to a Multiple Casualty or Mass Evacuation incident within our region. The region includes the following counties: Blue Earth, Brown, Dodge, Faribault, Fillmore, Freeborn, Goodhue, Houston, LeSueur, Martin, Mower, Nicollet, Olmsted, Rice, Sibley, Steele, Wabasha, Waseca, Watonwan, and Winona counties in Minnesota. It provides guidance for mutual aid response by EMS pre-hospital agencies and facilities.

The plan will be distributed to appropriate agencies in each region. County MCI plans may be tied to this plan, and agency MCI standard operating guidelines may be tied to respective county plans.

Successful outcomes from the use of the Regional MCI Plan depend upon cooperation and shared organization and planning among county Emergency Managers, health care professionals, administrators in facilities, pre-hospital agencies, disaster related support agencies and government entities at all levels in the counties that comprise SMRTAC.

PLAN DEVELOPMENT

This MCI Plan, along with the SMRTAC MCI Field Guide (Appendix # 2) was originally written in 2012 through the SMRTAC Disaster and EMS sub-committees.

MAINTENANCE

• Yearly reviews and maintenance of the MCI plan is the responsibility of specific designated voting members(s). Yearly review of the SMRTAC MCI Field Guide is the responsibility of the EMS sub-committee. Other revisions can be made at any time that national, state, and federal standards change, upon approval of the committee and the SMRTAC Board.

• Proposed revisions, amendments and other changes shall be referred to the full SMRTAC committee.


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IMPLEMENTATION

Revisions and/or amendments shall be acted upon by SMRTAC not longer than 60 days after all members have been notified of the proposed changes and have had the opportunity to respond to any voting member or the EMS sub-committee.

SITUATIONS AND ASSUMPTIONS

Each Agency will define what constitutes a MCI for their jurisdiction.

SITUATIONS

Potential MCIs in the SMRTAC Region could include:

• Major vehicular accidents with multiple victims • Urban, residential and wildland fires • Severe winter storms or other severe weather or natural disaster related situations • Public transportation accidents (aircraft, train, bus, chairlift) • Construction and/or industrial and farm accidents, including hazardous materials,

or building collapses with multiple victims • River and/or localized flooding, dam failures, impassable highways, roads and

bridges • Healthcare facility or other evacuations • Acts of terrorism, bio-terrorism, and /or civil disobedience • Military/Federally related incidents • CBRNE (chemical, biological, radiological, nuclear, explosives) incidents • Any other incident that overwhelms the capabilities of local emergency response

agencies without additional resources

ASSUMPTIONS

• When considering activation of the Regional MCI Plan, all emergency response agencies are expected to maintain their own capabilities at predetermined levels to continue meeting local needs.

• Personnel, agencies and/or jurisdictions shall operate during an incident or evacuation under the National Incident Management System (NIMS) endorsed by SMRTAC and taught within the region

• Facilities and pre-hospital agencies will participate in periodic coordinated trainings and exercises of the MCI plan.

• Each pre-hospital agency should have an MCI Plan in coordination with the SMRTAC plan

• Each pre-hospital agency will be provided resources for templates for their MCI Plan upon request.


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CONCEPTS OF OPERATION

GENERAL SCOPE OF THE MCI PLAN

• Upon activation of this plan, the Southeast/South Central Regional Healthcare Multi-Agency Coordination Center (H-MACC) may be notified by the local hospital and assist in resource allocation.

• Emergency operations on scene shall be conducted as outlined in accordance with NIMS and local protocol and in accordance with legislation, local plans, medical protocol and mutual aid agreements.

• The Plan assumes and includes mutual aid agreements/MOUs between local EMS, hospital/healthcare facilities and other pre-hospital agencies.

• All MCIs within the SMRTAC Region shall be handled in cooperation with, and under, direction of the agency or individual having jurisdiction in accordance with National Incident Management Systems (NIMS).

SMRTAC MCI FIELD GUIDE (Appendix #2)

• Will be distributed to all pre-hospital agencies. • Provides a standardized guide to assist in coordination and/or management of any

response to an MCI within the SMRTAC Region. • Effectively utilizes various resources for MCI management in the SMRTAC

Region. • Can assist in evacuation and care for a significant number of patients from any

health care facility when the care and transportation of those patients exceeds the capabilities of the locality, facility, or jurisdiction.

• Will help ensure the largest number of survivors in mass casualty situations or healthcare facilities evacuations.

TYPES OF MULTIPLE CASUALTY EVENTS

The IC, based upon the needs of the scene and available resources, shall determine the classification of the incident. Situational awareness will be posted on MNTRAC.

• LOCAL: Required resources available within the county or immediately available through normal mutual aid.

• REGIONAL: Required resources exceed county and immediately available mutual aid.

• STATEWIDE: When regional resources are overwhelmed, a statewide incident may be declared. Statewide mutual aid or a county disaster declaration must be activated through the County Emergency Management System.

• FEDERAL: Activation of Federal resources requires a State declaration by the Minnesota Office of Emergency Management and the Governor’s office.

INCIDENT PRIORITIES

• Life Safety


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• Incident Stabilization • Conservation of Property and Evidence • Facility or agency provider safety, accountability and welfare

CRITICAL INCIDENT STRESS MANAGEMENT

• CISM team can be activated through the local Public Safety Answering Points (PSAP).

PROTOCOL FOR TRANSPORT

• Local MCI event is coordinated with the local facility. If that facility becomes overwhelmed, the first receiving facility may coordinate with the next closest appropriate facility and then coordinate with EMS.

• Large EMS services will co-ordinate through their dispatch centers. Other services will co-ordinate with their local dispatch.

• Regional medical surge event may be coordinated through the Southeast/South Central Regional Healthcare Multi-Agency Coordination Center (H-MACC).

ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES

The regional response to an MCI or evacuation may involve the following:

• EMS providers with Emergency Response agencies • Healthcare facilities • Trained First Responders • Local, State, and Federal government agencies • Non-transport support such as Fire organizations, CISM teams, American Red

Cross, public utilities, amateur radio and any local volunteer organizations involved in disaster recovery.

LOCAL EMERGENCY PLANS

• It is recognized that some localities and each county have a local emergency operations plan.

• This Regional MCI Plan shall be transparent to, and support any local jurisdictional plan.

• The SMRTAC voting members or EMS sub-committee will provide guidance to Emergency Managers to assist them in preparation and maintenance of their MCI plan.

INITIAL RESPONSE TO AN INCIDENT

• The MCI Plan uses NIMS nomenclature and a standardized ICS approach to all incidents.

• Requests for additional resources shall originate from the IC and be routed through the appropriate Communication Centers or PSAP.


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ACTIVATING THE REGIONAL MCI PLAN

• The agency with jurisdictional responsibility can activate the Regional MCI Plan from the scene by calling the Mayo Emergency Communication’s (EC) at 1-800-237-6822 or 1-507-255-2808.

• The person activating the Plan will first identify him or herself, and give a report on the incident with type, location, number of patients and a callback number.

RESPONSIBILITIES

Hospitals and Healthcare Facilities

• The local hospital will follow their usual transfer patterns, make those contacts for transfer and will notify local EMS when at capacity through standard communication.

• Regional medical surge event may be coordinated through the Southeast/South Central Regional Healthcare Multi-Agency Coordination Center (H-MACC).

• Facilities shall activate their own MCI plans for additional staffing based on anticipated patient counts from the scene

Pre-hospital

• Responding providers, including those responding in privately owned vehicles, shall report to their respective agencies, then report to staging and SHALL NOT self-dispatch to scene of the incident.

• To maintain security, all personnel responding to a MCI or facility evacuation shall be required to carry self-identification and proof of affiliation with their agency.

• At the discretion of the IC, responding units may be directed to the staging area of the Ambulance Loading Zone. They shall not be allowed direct access to the MCI site.

• All pre-hospital providers responding to a MCI in the region agree to operate under the ICS utilizing the START program.

• Localities affected by an MCI shall be responsible for activating mutual aid in the region through their own Communication Centers or PSAP. Use of the available statewide mutual aid resources through the State Duty Officer shall be activated by a County Sheriff or County Emergency Manager’s request to the State of Minnesota.

• Pre-hospital emergency response agencies agree to respond with personnel and equipment when the Regional MCI Plan is activated, but should not reduce the local capabilities below acceptable levels.

• Personnel from responding agencies shall be responsible for all of their medical patient care forms and incident documentation. Disaster documentation shall follow each responding agencies medical and incident documentation requirements.


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• Pre-hospital agencies shall encourage their providers to participate in on-going training in ICS, START triage system, hazard awareness programs and other related MCI skills, along with periodic training exercises.

FATALITIES AND MASS FATALITIES INCIDENTS

• The Medical Examiner is responsible for implementation of County Mass Fatality Plan.

• Fatalities and any incident debris need to be left in place • Law Enforcement shall be responsible for scene and evidence security.

MEDICAL DIRECTION/PROTOCOLS

• Established medical direction will be maintained by each agency’s provider, even outside of the local agency’s jurisdiction.

• Patient care shall be rendered in accordance with the established pre-hospital care protocols of each responding agency.

STANDARD PRECAUTIONS

• All personnel involved in a response to any MCI or evacuation shall comply with standard precautions, to include universal precautions/body substance isolation, and all equipment and resources (PPE) for their own personal protection.

DIRECTION AND CONTROL

EMERGENCY COMMUNICATIONS

• The on scene EMS Operations/ designee contacts the primary hospital. • The Transportation Unit Leader shall report to the IC when all patients have been

transported from the scene. • On scene Incident Command may communicate with the Southeast/South Central

Healthcare Multi-Agency Coordination Center (H-MACC) EMS discipline. • Information will be posted to MNTRAC. • Only in cases of imminent life threats, shall ambulances make enroute changes to

hospital destination. Notification must be made to both the receiving facility and to the Communications Center.

• 800 MHz radios are available for emergency communications for hospitals, EMS, Fire, and Law Enforcement.

• Clear language shall be used in all MCI responses as per ICS standards. Currently, no cell systems have been exclusively dedicated to EMS. Therefore, the public access cellular system is likely to be very busy during an MCI. Once an open cell line has been established by the IC, it should be kept open for the duration of the MCI.

• Ongoing communication to healthcare about EMS activity during a surge incident will be provided by the on-scene IC.


8

FUNCTIONS OF REGIONAL SOUTHEAST & SOUTH CENTRAL HEALTHCARE MULTI-AGENCY COORDINATION CENTER (H-MACC)

• Facilitate and disseminate Southeast & South Central H-MACC standard operating procedures information as needed across partners

• Assist with coordination of requested regional health/medical resources • Assist with coordination of transport decisions in a medical surge incident. • Assist onsite EMS in distribution of patients to appropriate healthcare facilities. • On scene EMS IC/designee shall provide ongoing timely information to

receiving healthcare facilities. • Ensure equal access for the transfer of at risk patients and individuals with

special medical needs.

TECHNICAL RESCUE OPERATIONS/SPECIALIZED RESOURCES

• When needs exceed regional resources, additional assistance is available through Homeland Security Emergency Management.

HAZARDOUS MATERIALS

• A Hazmat activation and notification plan should exist locally for incidents involving hazardous materials.

• Early notification of receiving facilities should occur to ensure receiving facility is set up and ready to accept patients.

• Patients exposed to hazardous materials shall not be transported unless decontaminated.

• All healthcare facilities should have basic decontamination capabilities to treat patients exposed to hazardous materials.

• Patient self-transport should be anticipated by the facilities. Isolation and decontamination should be set up and available.

• Decontamination shall be conducted according to accepted national guidelines established by DOT, OSHA, EPA, NFPA and any local hazardous material response plans.

CBRNE (CHEMICAL, BIOLOGICAL, RADIOLOGICAL, NUCLEAR, EXPLOSIVES) INCIDENTS

• A CBRNE incident differs from a hazardous material incident in both effect scope and in intent.

• CBRNE incidents are responded to, based on the assumption, that they are deliberate, malicious acts with the intention to kill, sicken and/or disrupt society.

• Evidence preservation and perpetrator apprehension are of greater concern with CBRNE incidents that HAZMAT incidents.

• Decontamination efforts both pre-hospital and hospital will follow decontamination efforts similar to dealing with hazardous materials as above.

• After a CBRNE event, hospitals and emergency departments may have only enough resources available for patients who present relatively early after an


9

event. Resource-allocation decisions will need to be made until additional resources become available. This means that some patients will receive treatment and others will not. The only option is to make hard resource-allocation decisions with appropriate field triage.

• Effective scene management is required to control access to and from the incident scene, control movement of contaminated victims, provide safe working methods for responders, and contain the release of any substances. Once first responders approach and arrive at the scene, the following actions will need to be initiated:

1. approach scene with caution and upwind 2. carry out scene assessment 3. establish incident command (each responding agency) 4. recognize signs and indicators of CBRNE incidents 5. determine whether it is a CBRNE or hazardous material incident 6. estimate the number of casualties/victims 7. estimate resource requirements 8. carry out primary triage, decontamination, secondary triage, medical care,

and transport 9. consider specialist advice/resource requirements

• During the yearly review of the MCI plan, CBRNE and triage methodologies will be evaluated to ensure that they are the most accurate and up-to-date methodologies.

BURN INCIDENTS

• A burn incident requires specialized care for the affected patients and is resource intensive.

• Burn facilities in Minnesota include Regions Hospital in St. Paul, MN and Hennepin County Medical Center in Minneapolis, MN.

• Mayo Clinic Hospital in Rochester, MN has agreed to be the burn surge facility (BSF) for the SMRTAC region when there are no beds available at either of the verified burn facilities.

• See Appendix 6 for the SMRTAC Burn Surge Annex.

Appendix 1 SMRTAC MCI PLAN NOVEMBER 2019

10

APPENDIX # 1 - ACRONYMS

AHJ Agency Having Jurisdiction

BSF Burn Surge Facility

CBRNE Chemical, Biological, Radiologic, Nuclear, Explosives

CISM Critical Incident Stress Management

Communications Center Dispatch Center

DMAT Disaster Medical Assistance Team

DMORT Disaster Mortuary Team

DOT Department of Transportation

ECC Emergency Communications Center

EMS Emergency Medical Services

EMTS Emergency Medical and Trauma Services

EPA Environmental Protection Agency

ETA Estimated Time of Arrival

HazMat Hazardous Material

H-MACC (SEMN) Health Multi-Agency Coordination Center (South East Minnesota)

HSEM Homeland Security Emergency Management

IAP Incident Action Plan

IC Incident Commander

ICS Incident Command System

IMT Incident Management Team

MAC Multi-Agency Coordination

MCI Mass or Multiple Casualty Incident

MOU Memorandum of Understanding


11

MMRS Metropolitan Medical Response System

MNTrac Minnesota system for Tracking Resources, Alerts, and Communication

NFPA National Fire Protection Association

NIMS National Incident Management System

OSHA Occupational Safety and Health Administration

PPE Personal Protective Equipment

PSAP Public Safety Answering Point

H-MACC (SC) Regional Healthcare Multi-Agency Coordination Center (South Central)

RHPC Regional Healthcare Preparedness Coordinator

RTAC Regional Trauma Advisory Council

SMRTAC Southern Minnesota Regional Trauma Advisory Committee

SOP Standard Operating Procedure

STAC State Trauma Advisory Council

START Simple Triage and Rapid Treatment


12

APPENDIX # 2 - MCI FIELD GUIDE


13


14

APPENDIX # 3 - MN STATE DUTY OFFICER PROGRAM

CONTACT THE DUTY OFFICER AT: (651) 649-5451 1-800-422-0798 Fax: (651) 296-2300 About the Duty Officer The Minnesota Duty Officer Program provides a single answering point for local and state agencies to request state-level assistance for emergencies, serious accidents or incidents, or for reporting hazardous materials and petroleum spills. The duty officer is available 24 hours per day, seven days per week. If there is an immediate threat to life or property, call 911 first.

When to Call the Duty Officer

Examples of incidents the duty officer can assist with include but are not limited to:

Natural disasters (tornado, fire, flood, etc.) Requests for Civil Air Patrol

Requests for National Guard Radiological incidents

Hazardous materials incidents Aircraft accidents/incidents

Search and rescue assistance Pipeline leaks or breaks

AMBER Alerts Substances release into the air

AVAILABLE AGENCY RESOURCES State Agencies: Dept. of Agriculture Minnesota Pollution Control Agency

Dept. of Commerce Department of Public Safety

Dept. of Education Bureau of Criminal Apprehension

MINNESOTA DUTY OFFICER PROGRAM CONTINUED


15

AVAILABLE AGENCY RESOURCES State Agencies:

Dept. of Health Homeland Security and Emergency Management

Dept. of Human Services

Minnesota Joint Analysis Center

Dept. of Military Affairs

Minnesota State Patrol

Dept. of Natural Resources

Office of Pipeline Safety

Dept. of Transportation

State Fire Marshal

Minnesota IT Services

Other state agencies as needed

Other Resources: Minnesota Arson Hotline Local bomb squads

Chemical assessment teams Emergency response teams

Fire and rescue mutual aid Amateur radio (ARES/RACES)

Minnesota voluntary organizations Fire chiefs assistance teams

Search-and-rescue dogs Interagency Fire Center

U.S. Air Force Search and Rescue Center

Emergency Notification


16

If there is a spill of hazardous material or a petroleum product in Minnesota, you must call:

Local Authorities Call 911 first when there is a threat to life or property.

Minnesota Duty Officer

If there is a public safety or environmental threat and/or if state agency notification for reportable spills is required.

The National Response Center 1-800-424-8802

When federal notification is required.

The following information (if available) will be requested by the Minnesota Duty Officer:

• Name of caller • Date, time and location of the incident • Telephone number for call-backs at the scene or facility • Whether local officials (fire, police, sheriff) have been

notified of incident • Additional information will be requested in the following

special circumstances: Requesting state assistance for incidents:

• Type of assistance requested (informational specialized team assets, etc.)

• Name of requesting agency/facility • Materials, Quantity and personnel involved in the

incident • Whether all local, county and mutual aid resources have

been utilized

Making notification of spills/incidents: • Materials and quantity involved in the incident • Incident location (physical address, intersection, etc.) • Responsible party of incident (property/business owner) • Telephone number of responsible party • Any surface waters or sewers impacted • What has happened and present situation


17

APPENDIX # 4 - SMRTAC COUNTIES IN SOUTH CENTRAL AND SOUTH EAST REGIONS


18

APPENDIX # 5 - EMS BOARD CONTACT LIST

EMS Board Contact List Go to website

www.emsrb.state.mn.us

http://www.emsrb.state.mn.us/

APPENDICES SMRTAC MCI PLAN

SMRTAC BURN SURGE ANNEX

NOVEMBER 2019

APPENDIX #6 - BURN SURGE ANNEX TO MCI PLAN


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Table of Contents Purpose 1 Assumptions 1 Concept of Operations 1 Member and Partner Roles and Responsibilities 2 First Responders and Emergency Medical Services (EMS) 2 First Receiving Hospital(s) 2 Regional Healthcare Coalition Partners 2 Regional Burn Surge Facility 2 Training and Exercise Recommendations 3 Review 3 Attachment A A 4 Burn Surge Response Flowchart A 4


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PURPOSE

In the event of a mass casualty burn incident, the State Burn Surge Plan calls on each regional Healthcare Coalition to plan to initially treat and stabilize burn victims for up to 72 hours when transportation to MN Burn Centers is not feasible. This Burn Surge Annex provides a regional framework to support the Minnesota state-wide burn plan. This annex addresses the southeast and south central regional response to a mass casualty event involving severe or life-threatening burns.

ASSUMPTIONS

• Burn injuries are common in mass disasters and terrorist acts1. In general, in most large traumatic events, approximately 25% to 30% of the injured will require burn care treatment.

• Burn care facilities operate at high bed capacities most of the time. • Burn Centers have plans to manage a surge of burn patients by creating additional bed capacity by

converting existing and available intensive care unit (ICU) beds to burn patient care beds. • The Burn Surge response will comply with applicable NIMS requirements. • The event that triggers the activation of the this Burn Surge Annex, in most situations, will happen

with little or no warning requiring the immediate re-allocation of hospital resources in the area where the initial event has occurred.

• National burn bed capacity is limited. Current plans for transport of burn patients to out-of-state Burn Centers are likely to be limited or inadequate for the immediate response to a large-scale trauma and burn incident.

• Federal resources for transport, portable treatment facilities, burn team support and medical equipment (such as ventilators) could take anywhere from 12 hours to 7 days to arrive, if at all, depending upon demand for these resources in other areas of the country.

CONCEPT OF OPERATIONS

Minnesota currently has two verified Burn Centers in the metro region of the state. During a burn surge incident, the affected hospitals and regional partners will actively collaborate and communicate with the burn centers. Initially, this will follow routine communication and coordination protocols until routine processes become overwhelmed.

In a circumstance in which the number of burn patients and the severity of their injuries exceed or are expected to exceed the MN Burn Center resources, the state and regional burn surge plans will be activated in accordance with Attachment A and the State Burn Surge Plan. Mayo Clinic Rochester, as a burn surge facility, will provide additional capacity to manage burn patients needs and requirements for the Southern MN Trauma region until surge equilibrium is again reached. See Attachment A for a flowchart depicting the initial communication pathways.

1 Disaster Management and the ABA Plan, ABA Board of Trustees and the Committee on Organization and Delivery of Burn

Care, viewed at https://c.ymcdn.com/sites/ameriburn.site-ym.com/resource/resmgr/disastermanagementandtheabap.pdf on Nov 19, 2015

https://www.health.state.mn.us/communities/ep/surge/burn/burnsurgeplan.pdf




https://c.ymcdn.com/sites/ameriburn.site-ym.com/resource/resmgr/disastermanagementandtheabap.pdf


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MEMBER AND PARTNER ROLES AND RESPONSIBILITIES

FIRST RESPONDERS AND EMERGENCY MEDICAL SERVICES (EMS)

The initial care for burn patients will occur on scene and during transport by first responders and EMS providers. These providers should coordinate the transport of patients to the most appropriate hospital for care. During a large event this may not always be possible and transport to the closest hospital for stabilization may be necessary. If local resources are overwhelmed, local responders should activate Mutual Aid Agreements and if needed the Southeast/South Central Regional Healthcare Multi-Agency Coordination Center (H-MACC). (See SEMN DHC Healthcare Communications Guidelines for details on how to activate the H-MACC.)

FIRST RECEIVING HOSPITAL(S)

Community or first receiving hospitals provide initial stabilization and treatment to burned patients, as directed by their medical directors or medical advisers. Although burn patients should be transferred to the appropriate burn care facility as soon as possible, the extent of the incident and the availability of burn bed resources may exceed capacity or ability to receive additional patients in MN Burn Centers immediately. Thus, hospitals in the vicinity of the incident may be called upon, at least initially, to stabilize and treat these patients for up to 6 hours, until the transfer to a Burn Center or Regional Burn Surge Facility is possible. MN Burn Centers will provide advice and assistance remotely to these First Receiving Hospitals when communication is available. Hospitals should create internal plans to support this goal. Additional guidance regarding the triage of burn patients, burn surge response planning including supplies, and training, see the State Burn Surge Plan.

If the first receiving hospital is unable to directly transfer patients (meeting the burn transfer criteria) to a Burn Center and is not able to care for the patient(s) until a transfer is possible, it can contact the H-MACC to coordinate transfer of patients to the Regional Burn Surge Facility. The H-MACC will also provide additional resources and other assistance to the local hospital as necessary.

REGIONAL HEALTHCARE COALITION PARTNERS

Any coalition partner may activate this plan when informed that the Metro Region is not able to accept burn patients. Through the H-MACC, the Coalition’s partners will:

• Prior to an incident, work with healthcare facilities within the region to assess their capability and the resources needed to provide initial stabilization and treatment of patients and to temporarily hold the burn surge patients when the Metro Region in unable to immediately accept the burn patients.

• Assist in the coordination of transporting burn and other injured patients to Mayo Clinic Rochester, the Regional Burn Surge Facility, when the capability and capacity of local resources is exceeded and this plan is activated.

• Identify hospital, EMS and other coalition partners’ needs and coordinate resource sharing within the region.

• Assist with coordination of healthcare resources inter-regionally and with state assets. • Investigate the best options for meeting burn patient supply needs for first responders, EMS and burn

surge patient receiving hospitals.

REGIONAL BURN SURGE FACILITY

Mayo Clinic Hospital – Rochester will assess the available capability to accept the burn patients and will implement surge plans if necessary. It will identify approximately how many burn patients can be accepted,

http://www.semndhc.org/wp-content/uploads/2014/01/SE-Region-Healthcare-Communications-Guidelines-061813.pdf



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and assure that burn patient supplies and staffing for those patients will be readily accessible. It should plan to care for the patients for at least six and up to 72 hours.

Mayo Clinic Hospital – Rochester will coordinate with the lead MN Burn Center (identified in the Metro/State Surge Burn Plan) move, as appropriate, the patient(s) to a definitive burn care facility. The Burn Center and state partners will be working towards finding definitive care options and communicating back to the hospitals holding the burn patients regarding the permanent disposition of the patients for care/treatment and follow up.

TRAINING AND EXERCISE RECOMMENDATIONS

It is essential first responders, EMS personnel, first receiving hospital and burn surge hospital personnel have appropriate education and training to increase their overall knowledge, skills, and abilities for the initial treatment and supportive care for the burn-injured patient and support appropriate initial patient disposition decisions to avoid unnecessary patient transfers. Kearns et al. (2014) concluded there was great value in extending ABLS curricula to first responders, EMS, and first receiving hospital personnel.

Each regional partner should assess the training needs of their personnel. The regional coalitions will assist in coordinating training when possible.

This regional plan should be exercised at least once in a three year period. Each partner should assess their risks/vulnerabilities and exercise their individual plans to assure staff competency and confidence responding to mass casualty incidents involving numerous burn victims.

REVIEW

This plan should be reviewed by the Southern Minnesota Trauma Advisory Committee at least every three years.


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Flowchart for Multiple/Mass Burn-related IncidentIn

itial

Res

pons

eSt

atew

ide

activ

atio

nBurn Center Region StateLocal Hospital

Burn Incident Occurs and Patient(s)

Arrive

Patient(s) meet burn transfer

criteria

Yes

Check with other Burn Centers for capacity to

accept Patient(s)No

Capacity to accept

Patient(s)

Activate Metro Region Burn Surge Plan

Accept Patient(s)& arrange transport

Yes

Activate HMACC and initiate

Regional Burge Surge Plan

Beds available

Center with capacityaccept Patient(s) & arrange transport

Yes

Assess ability to hold Patient(s)

until bed available at Burn Center

No

Hold Patient(s) until transfer to definitive care

Yes

On standbyNotify State

Notify

State 24/7 contact

Burn Surge Facility prepares to

receive Patient(s)

Accept Patient(s) & arrange transport to Burn Surge Facility

Contact Burn Center (with

Transfer Agreement)

Notify Local Hospital and

State

No

Notify State

Activate State Burn Plan

Send MNTrac Alert indicating

State Burge Surge Plan activation.

Capacityto accept Patient(s)

No

Initial Burn Center who will identify

definitive care site and coordinate transfer when

available.

Contact

Activate Burn Surge Plan for Region in which the

local hospital is a member.

ATTACHMENT A BURN SURGE RESPONSE FLOWCHART

February 4, 2020

1

SMRTAC PEDIATRIC SURGE

ANNEX

February 4, 2020

2

TABLE OF CONTENTS

Introduction ......................................................................................................................... 3

Purpose ............................................................................................................................ 3

Situations and Assumptions ............................................................................................ 3

Concepts of Operations ....................................................................................................... 3

Coordination/Information Gathering............................................................................... 3

First Responders and Emergency Medical Services (EMS) ........................................... 4

First Receiving Hospital(s).............................................................................................. 4

Regional Healthcare Coalition Partners .......................................................................... 4

Pediatric Trauma Hospitals ............................................................................................. 5

Training and Exercise Recommendations ....................................................................... 6

Review ................................................................................................................................ 6

Additional Resources .......................................................................................................... 6

Attachment A – Regional Demographics ........................................................................... 7

February 4, 2020

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INTRODUCTION

PURPOSE

This annex applies to a mass casualty, illness or influx event with a large number of pediatric patients. It is designed to support the SMRTAC MCI Plan by addressing the specific needs of children and the medical care of a pediatric patient. Each facility is expected to have their own pediatric surge plans.

SITUATIONS AND ASSUMPTIONS

Planning for pediatric surge should be based on the local demographics and risk assessment (South Central Regional HVA and SEMN Regional Risk Assessment results) completed by each of the two regions. See pediatric-specific details in Attachment A. Below are some of the planning assumptions for this document.

• Children have unique impacts during a disaster. (See MN Pediatric Surge Primer for details.)

• The region will only be asked to assist coordinate resources once facility and local community resources are expected to be exhausted.

• Non-pediatric facilities may receive children from mass casualty events. • Families should be kept together during all phases of care, whenever possible. • If the event involves more than one facility, regional coordination should occur

through the Healthcare Multi-Agency Coordination Center (HMACC). • For most hospitals who receive critical pediatric patients, their priority is to

transfer the most critical and then youngest patients (<8 years old) as early as possible to an appropriate definitive care site.

• In 2018, there were 603 traffic crashes in MN where at least one school bus was involved. In all, there were 609 school buses directly involved in these crashes http://www.dps.mn.gov. In the rural SMRTAC region, many students rely on bus transportation to get to and from school as well as to additional school events. Each year, there are many well-attended events in this region, from festivals and fairs to music performances as well as sporting events, where many pediatric populations are in attendance with or without a parent/guardian. Local hospitals and healthcare need to be aware of the specialty events occurring in their areas.

CONCEPTS OF OPERATIONS

COORDINATION/INFORMATION GATHERING

Local hospitals will follow their own emergency operations plans and initiate Trauma Team activation plans, when applicable. Hospitals communicate with Emergency Medical Services (EMS) and local law enforcement initially. Local Public Health may be contacted as needed. Hospitals are responsible for notifying a Regional Healthcare

http://www.semndhc.org/wp-content/uploads/2013/07/Report-SEMNRiskProfile010.13.17.pdf

https://www.health.state.mn.us/communities/ep/surge/pediatric/primer.pdf

http://www.dps.mn.gov/

February 4, 2020

4

Preparedness Coordinator (RHPC) in the SC region or the HMACC directly in the SE region when they need additional supportive or coordination assistance.

FIRST RESPONDERS AND EMERGENCY MEDICAL SERVICES (EMS)

The initial care for pediatric patients will occur on scene and during transport by first responders and EMS providers. These providers should coordinate the transport of patients to the most appropriate hospital for care. During a large event this may not always be possible and transport to the closest hospital for stabilization may be necessary. If local resources are overwhelmed, local responders should activate Mutual Aid Agreements and, if needed, the Southeast/South Central Regional Healthcare Multi-Agency Coordination Center (H-MACC). (See SEMN DHC Healthcare Communications Guidelines for details on how to activate the H-MACC.)

FIRST RECEIVING HOSPITAL(S)

Receiving hospitals should have a plan to surge internally with local resources to address a pediatric surge even if they are not a pediatric hospital. If the hospital does not have the expertise or the resources to manage the surge, they should reach out a pediatric hospital according to their normal referral patterns or the closest pediatric trauma hospital as appropriate.

The Minnesota Department of Health Pediatric Surge Plan addresses the response to a pediatric surge that exceeds the capability of local facilities to manage. The local hospital should contact an ACS designated pediatric trauma center to advise them of their situation and request assistance. The trauma center will provide guidance to the impacted facility via telephone or telemedicine regarding the stabilization of patients and will assist with coordinating transportation as appropriate. Just-in-time training may be given by the pediatric trauma center to local providers, when applicable. (Note: Each hospital in the SMRTAC region has a trauma level designation.)

Each hospital in the SMRTAC region has a trauma level designation. The Minnesota State Trauma system has a list of required supplies for each designation level. https://www.health.state.mn.us/facilities/traumasystem/hospresources/resource_manual.html#equipment Hospitals should ensure that those items are readily available. Hospitals should use their normal referral processes and locations as well as coordinate with the pediatric center contacted.

REGIONAL HEALTHCARE COALITION PARTNERS

The Regional Health Care Coalitions (HCCs) are responsible for assisting with the coordination of the regional health response. The first region to activate their response should activate the Minnesota Pediatric Surge Plan as appropriate. The Healthcare Multi-Agency Coordination Center will assist with identification of resources including beds and transportation assets, help manage resources between hospitals in the area and provide single point of contact for patient transfer coordination. The Regional Healthcare



https://www.health.state.mn.us/facilities/traumasystem/hospresources/resource_manual.html#equipment

https://www.health.state.mn.us/facilities/traumasystem/hospresources/resource_manual.html#equipment

February 4, 2020

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Preparedness Coordinator may also assist with information sharing and coordination of activities between coalition members and Minnesota Department of Health-Center for Emergency Preparedness and Response (MDH-CEPR).

When contacted, the HCCs may ask MDH-CEPR to request telemedicine support from the Great Lakes Healthcare Partnership (GHLP) when requested by a coalition hospital coping with a catastrophic incident and surge of pediatric patients or when state resources are overwhelmed.

PEDIATRIC TRAUMA HOSPITALS

When local hospitals notify a pediatric trauma center and advise them of their situation, the trauma center will provide guidance to the impacted facility via telephone or telemedicine regarding the stabilization of patients.

Just-in-time training may be given by the pediatric trauma center, when applicable.

The pediatric trauma center contacted will assume the role of the State Coordinating Pediatric Trauma Center (SCPC). (A listing of the pediatric hospitals can be found in the MDH Pediatric Surge Plan, Activation of the statewide Minnesota Pediatric Surge Plan is done as outlined in the Concept of Operations of that plan.

MN ACS DESIGNATED PEDIATRIC TRAUMA CENTERS:

LEVEL 1: Children’s of Minnesota, Minneapolis 612-813-6000

LEVEL 1: Hennepin County Children’s Hospital, Minneapolis 612-873-6963

LEVEL 1: Region’s Hospital/Gillette’s Hospital Specialty Healthcare, St. Paul

651-325-2200

LEVEL 1: Mayo Clinic Hospital Eugenio Litta Children’s Hospital, Rochester

507-255-5123

LEVEL 2: North Memorial Health Hospital, Robbinsdale 763-520-5200

LEVEL 2: Essentia Health St. Mary’s Medical Center, Duluth 218-786-4000

LEVEL 3: University of Minnesota Masonic Children’s Hospital 612-365-1000

LEVEL 4: Children’s of Minnesota, St. Paul 651-220-6000

ADJACENT STATES WITH LEVEL 1 PEDIATRIC HOSPITALS

Iowa:

University of Iowa Stead Family Children’s Hospital in Iowa City, 1-319-356-2233

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Iowa Wisconsin:

University of Wisconsin Health’s American Family Children’s Hospital in Madison, Wisconsin

1-608-890-5437

Children’s Hospital of Wisconsin in Milwaukee, Wisconsin 1-800-266-0366 for transfers and referrals

TRAINING AND EXERCISE RECOMMENDATIONS

It is essential that first responders, EMS personnel, first receiving hospital and pediatric Level 1 hospital personnel have appropriate education and training to increase their overall knowledge, skills, and abilities both for the initial treatment and supportive care for the pediatric patient and support appropriate initial patient disposition decisions to avoid unnecessary patient transfers.

Each regional partner should assess the training needs of their personnel. The regional coalitions will assist in coordinating training when possible.

This regional annex should be exercised at least once in a three-year period. All partners should assess their risks/vulnerabilities and exercise their individual plans to assure staff competency and confidence responding to mass casualty or medical incidents involving numerous pediatric victims.

REVIEW

The Southern Minnesota Trauma Advisory Committee should review this plan at least every three years.

ADDITIONAL RESOURCES

Reference materials are available in the Pediatric Surge Toolkit.

• Within the Toolkit, the Pediatric Surge Videos cover special consideration topics, as does the Pediatric Primer.

• Pediatric Surge Toolkit Handouts: Psychological First Aid; Disaster Mental Health for Children; Guide for Parents and Caregivers

Behavioral Health Homepage:

https://www.health.state.mn.us/communities/ep/behavioral/index.html

https://www.health.state.mn.us/communities/ep/surge/pediatric/index.html

https://www.health.state.mn.us/communities/ep/surge/pediatric/video.html

https://www.health.state.mn.us/communities/ep/surge/pediatric/primer.pdf

https://www.health.state.mn.us/communities/ep/surge/pediatric/pfa.pdf

https://www.health.state.mn.us/communities/ep/surge/pediatric/mental.pdf





https://www.health.state.mn.us/communities/ep/surge/pediatric/disaster.pdf

https://www.health.state.mn.us/communities/ep/behavioral/index.html

February 4, 2020

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ATTACHMENT A – REGIONAL DEMOGRAPHICS

Of the total population in the South Central region, 22.2% are under the age of 18, (64,902 persons). In the Southeast region, 23.3% (117,544 persons) are under the age of 18. http://www.mn.gov/admin/demography)

The following charts indicates the estimated numbers and types of disabilities in both the south central (SC) and the southeast (SE) coalitions pediatric populations:

South Central County

Disabilities (2017 estimates)

All 2017 estimates

Hearing Difficulty

Vision Difficulty

Cognitive Difficulty

Ambulatory Difficulty

Self-Care Difficulty

Under 5 years

5-17 years

Under 5 years

5-17 years

Under 5 years

5-17 years Under 18 Under 18 Under 18

Blue Earth 25 466 25 13 - 28 401 28 91 Brown - 159 - 43 - 16 94 17 29 Faribault - 155 - 10 - 23 119 21 20 Le Sueur 13 299 3 9 10 46 239 21 11 Martin - 320 - 49 - 35 259 19 28 McLeod - 314 - 30 - 57 227 17 121 Meeker 1 179 - 71 1 30 106 17 41 Nicollet - 276 - 22 - 18 254 34 54 Sibley 8 86 - 7 8 11 71 2 6 Waseca 6 187 6 21 - 36 156 9 48 Watonwan - 34 - 11 - 2 30 - 4 Totals 53 2,475 34 286 19 302 1,956 185 453

Southeast County

Disabilities (2017 estimates)

All 2017 estimates

Hearing Difficulty

Vision Difficulty

Cognitive Difficulty

Ambulatory Difficulty

Self-Care Difficulty

Under 5 years

5-17 years

Under 5 years

5-17 years

Under 5 years

5-17 years Under 18 Under 18 Under 18

Dodge 1 151 1 16 - 4 122 16 6 Fillmore 16 154 16 14 12 17 104 7 31 Freeborn 43 312 - 37 43 26 207 22 28 Goodhue 31 189 21 14 31 2 141 34 36 Houston 15 154 - 15 15 23 144 10 53 Mower 28 244 9 50 23 36 199 38 120 Olmsted 34 1,539 11 185 23 164 1,307 172 288 Rice 58 579 58 100 14 52 436 71 126 Steele 4 366 - 87 4 21 268 13 25 Wabasha 10 148 10 41 - 17 121 8 27 Winona 20 349 20 58 - 22 269 14 37 Totals 260 4,185 146 617 165 384 3,318 405 777

http://www.mn.gov/admin/demography

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