Surge Capacity and Surge Capacity and Preparing the Preparing the WorkforceWorkforce

Michael Allswede, D.O. Michael Allswede, D.O. Associate Professor of Emergency Medicine Associate Professor of Emergency Medicine

Section Chief, Special Emergency Medical Section Chief, Special Emergency Medical ResponseResponse

Department of Emergency MedicineDepartment of Emergency Medicine

University of Pittsburgh Medical Center Health University of Pittsburgh Medical Center Health System System

Pittsburgh, PAPittsburgh, PA

Non-Contiguous Training Non-Contiguous Training OverviewOverview

The Non-Contiguous Training Concept is a The Non-Contiguous Training Concept is a method of planning and training the method of planning and training the acquisition of WMD related skillsacquisition of WMD related skills

The ability to train during down-time or other The ability to train during down-time or other hours will prove to: hours will prove to: Improve skill level of the staffImprove skill level of the staff Cost less than standard drillsCost less than standard drills

Tracking skill deficits in key personnel will Tracking skill deficits in key personnel will improve the safety of the system improve the safety of the system

Non-Contiguous ObjectivesNon-Contiguous Objectives Disseminate individual knowledge and skills Disseminate individual knowledge and skills

prior to the drillprior to the drill Train on objectives, not “time-based” CME/CEUTrain on objectives, not “time-based” CME/CEU Drill for integration and for “macro” organizationDrill for integration and for “macro” organization Leadership training: Leadership training:

Must be dynamic “war game”Must be dynamic “war game” Model on “Sim-City”Model on “Sim-City”

Disaster InteractionsDisaster Interactions WMD events cause “triage inversion”WMD events cause “triage inversion”

Least injured present firstLeast injured present first Most injured remain for extricationMost injured remain for extrication Contaminated victims precede scene informationContaminated victims precede scene information

WMD events contaminate hospitals unless WMD events contaminate hospitals unless hospitals are protected hospitals are protected Hospital personnel were among victims in Tokyo Hospital personnel were among victims in Tokyo

SarinSarin

Hospitals and providers are “non-renewable” in Hospitals and providers are “non-renewable” in the short termthe short term

Navy ATEAMSNavy ATEAMS

Afloat Training Exercise Afloat Training Exercise and Management and Management System (ATEAMS)System (ATEAMS)

Allows skill acquisition Allows skill acquisition and maintenance to be and maintenance to be on-goingon-going

Drills are for system Drills are for system evaluation, not skill evaluation, not skill acquisitionacquisition

Assigns skills by duty Assigns skills by duty stationstation

USS Carl Vinson

The Problem with Disaster The Problem with Disaster DrillsDrills

Hospitals cannot stop their normal Hospitals cannot stop their normal function to play in a drillfunction to play in a drill Disaster drills are pre-announced Disaster drills are pre-announced Community drills scheduled at the Community drills scheduled at the

convenience of community services…in the convenience of community services…in the morningmorning

Morning is busy time for hospitalsMorning is busy time for hospitals Disasters happen at night when staffing Disasters happen at night when staffing

levels are thinnest levels are thinnest

The Problem with Disaster The Problem with Disaster DrillsDrills

Shifting extra personnel is expensiveShifting extra personnel is expensive $3,000 per hour at UPMC for ED personnel$3,000 per hour at UPMC for ED personnel Extra non-clinical personnel?Extra non-clinical personnel? Extra administrative personnel?Extra administrative personnel? Victim Volunteers?Victim Volunteers? EMS-Medical Command-Civic Services?EMS-Medical Command-Civic Services?

$16 Million for TOPOFF II$16 Million for TOPOFF II

The Problem with Disaster The Problem with Disaster DrillsDrills

Training a shift at a time is Training a shift at a time is inefficientinefficient 1 shift equals: 1 shift equals:

8% of total nurses8% of total nurses 5% of total attendings5% of total attendings 0% of residents and house staff0% of residents and house staff

Experienced people AVOID disaster drillsExperienced people AVOID disaster drills Moulage is never the real thingMoulage is never the real thing

FamiliarizeFamiliarize

Classic classroom Classic classroom teachingteaching

Distance learningDistance learning Video interfaceVideo interface Memory Memory

enhancement toolsenhancement toolsRaPiD-T Training, City of Pittsburgh

EMS, 2002

Acquire SkillsAcquire Skills

Virtual interfaceVirtual interface Training roomTraining room Video Video

demonstrationdemonstration Self-learningSelf-learning

UPMC Disaster Drill 2002

Practice SkillsPractice Skills

Announced drillsAnnounced drills Group drillsGroup drills Segmented Segmented

testingtesting SimulationSimulation

TOPOFF II, Chemical Weapons Site,

Chicago IL

ValidationValidation

Large drillsLarge drills Actual eventsActual events

TOPOFF II Tech Rescue Site, Chicago IL

For More Information:For More Information:

Contact: Contact:

Lucy Savitz, Ph.D., M.B.A. at Lucy Savitz, Ph.D., M.B.A. at savitz@rti.orgsavitz@rti.org