Emergency Management Strategies: Lessons Learned in Developing Specifications, Procuring, Housing and Maintaining a 100-Bed Mobile Hospital

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Emergency Management Strategies Lessons Learned
in Developing Specifications, Procuring, Housing
and Maintaining a 100-Bed Mobile Hospital

• Jenny Atas MD
• Associate Professor
• Wayne State University
• Medical Director
• Region 2 South Medical
• Bio-Defense Network

Mark Sparks Logistics/Planning Officer Region 2
South Medical Bio-Defense Network
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Presentation Overview

• Project Background
• Acquisition Process and Specifications
• Durable and Non-Durable Equipment Acquisition
  Process
• Storage Deployment Considerations

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PROJECTBACKGROUND Organization
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Project Background Organization Pre 9-11
District Organization

• 8 Emergency Management Districts covering 83
  Counties
• 45 Public Health Departments
• 65 Medical Control Authorities (oversight of
  pre-hospital system) with no seat at the table

5
Project Background OrganizationPost 9-11 New
Paradigm of Planning
Emergency Management
Health Care
Public Health
6
Project Background OrganizationPost 9-11 HHS
Grant Programs
HRSA (now HHS ASPR)

CDC
Medical Control Authorities Hospital/Pre-hospital
Local Health Departments Other Local/Regional
Partners
Coordinated State/Local/Regional Planning
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Project Background - Organization Post 9-11
Regional Organization

• 8 Medical Bio-Defense Regions
• Mirror of 8 E.M. Districts
• Incorporates 65 MCAs
• Bioterrorism Coordinator
• Medical Director
• Emergency Preparedness Coordinator (Local Health
  Department)
• Epidemiologist
• SNS Technical Advisor
• Seat at the table

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Project Background OrganizationRegion 2 South
(R2S) Overview

• 3 Counties 97 local political jurisdictions 2.6
  million people
• 14 P.A. 390 Emergency Management/Homeland
  Security Programs (4 with Public Health
  authority)
• 6 Public safety mutual
  aid
  organizations
• 4 Public Health Authorities
• 4 Medical Control Authorities
• 37 Hospitals
• 69 Fire/EMS agencies
• 11 Private/EMS agencies

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Project Background OrganizationLessons Learned

• Regional Partnership with Emergency Management is
  Critical
• Development of surge plans, procedures and
  resources must involve all disciplines
• Take full advantage in the ability to leverage
  other federal funding streams (restrictions /
  allowances)
• Allows you to mitigate duplication of effort on
  all fronts

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PROJECTBACKGROUND Foundation DHHS NBHPP
Program Guidance for Fiscal 2006 dictates that
states have the ability to surge outside
hospitals and healthcare systems
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Project Background FoundationSituation

• Hospitals in Michigan have incorporated the
  ability to surge 20 above the average daily
  census.
• Even with these additional 7,000 beds there still
  exists insufficient surge response capability to
  address the needs that a medium level pandemic
• MEMS remains the primary method of addressing
• Medical Surge Capacity and Capability (MSCC)
• Hurricane Katrina demonstrated the utility of
  surge facilities

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Project Background FoundationSituation

• Pandemic Flu
• Outbreak of a moderately severe pandemic flu
  would exhaust surge capacity within the first two
  weeks
• Natural and Man-Made Disasters
• Trauma victims immediately exhaust surge capacity
• Non-urgent health problems are exacerbated and
  further increase healthcare demands
• Local Healthcare Emergencies
• International air-traveler quarantine
• 2003 SARS 3,017,496 international passengers
  thru DTW
• All hazards response capability

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Project Background FoundationSituation

• In light of these factors a decision was made to
  utilize HRSA/ASPR funding to develop two
  self-contained all-weather mobile field hospitals
  or surge facilities
• Initially develop and equip a 100-bed unit
• Lay the groundwork
• Based on available funding, develop a 50-bed unit
• Extension of 100-bed unit
• Rapid acquisition rely on established
  specifications

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Project Background Foundation Patient and
Staff Planning Assumptions

• The Mobile Field Hospital would be designed
• For patients suffering from COPD, asthma,
  congestive heart failure (no C-PAP or vent),
  chronic pain syndrome, and behavioral conditions,
  and needing IV hydration and IV antibiotic
  therapy
• With a 41 ratio of adult to pediatric patients
• With a planned admission/discharge rate of 23
  hours
• To be operated by a core team of medical
  professionals augmented by volunteers (Michigan
  Volunteer Registry)

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Project Background FoundationLessons Learned

• Dont recreate the wheel
• Patient profile from the Katrina disaster
  experience
• Patient demographics from Michigan Census
• Staff profile from existing Michigan plans for
  Alternate Care Facilities/MEMS Model

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Transportable Emergency Surge Assistance Medical
Unit( TESA) Facility Acquisition Process
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TESA Project Facility Acquisition ProcessGrant
Application

• Region 2 South was selected to develop the
  100-Bed TESA Unit
• The project was outlined in Region 2 Souths FY
  06-07 HRSA Grant Application
• Statewide resource housed in S.E. Michigan and
  operated by strike teams from across the state
• Complete project within the grant year
• Establish a Task Force to
• Research the different platforms and associated
  planning, operational, administrative and
  logistical considerations
• Recommend how to best configure and develop the
  facility within budgetary constraints

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TESA Project Facility Acquisition Process
Grant Approval / Initial Steps

• Project was approved 1,000,000 budget
• Task Force formed in October 2006.
• Agencies represented
• Region 2 South Medical Bio-Defense Network
• Michigan Department of Community Health, Office
  of Public Health Preparedness
• Michigan Department of State Police, Emergency
  Management/Homeland Security Division
• Michigan-1 Disaster Medical Assistance Team

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TESA Project - Facility Acquisition Process Task
Force Determinations

• The recommended basic platform for the facility
  would be a soft-walled shelter structure.
• To account for cost uncertainties, the platform
  (and invitation to submit proposals) would be
  designed around
• A core 50-bed facility (to include areas for
  triage, supply, admin, and staff support)
• 25-bed add-on patient wards.

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TESA Project - Facility Acquisition Process Task
Force Requirements

• Basic Requirements for the 50-Bed Core
• Separate staff and patient entrances
• Separate areas for facility administration,
  facility supplies, staff lounge and staff
  hygiene, and patient care wards
• a. Staff hygiene must have a changing area, sink,
  shower and toilet, cold and hot water, an
  on-board potable water supply with a water
  distribution system and a gray water containment
  system
• Each patient ward must be equipped with a private
  field toilet (the Brief ReliefTM system, or
  equivalent)

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TESA Project Facility Acquisition ProcessTask
Force Requirements

• Basic Requirements for the Entire Shelter System
• Completely self-contained
• Trailer-mounted generators
• Maximum component size (98w, 50d, 50h)
• Man-portable components (maximum 75lb per worker)
• Rapidly erected without the use of tools or
  equipment
• Must provide all-weather climate controlled
  environment
• Materials must meet NFPA Standards
• Must be interoperable with existing FEMA-NDMS
  assets

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TESA Project - Facility Acquisition Process Task
Force Determinations

• Proposal/Bid Quotation Requirements
• Must provide a comprehensive description of
• Proposed system components
• Warranties, manuals, parts availability
  guarantees
• Where requirements are met or exceeded
• Where requirements are not met and why a variance
  should be considered
• How it will be packaged w/container dimensions
• Must include diagrams (50-bed core, 75-bed and
  100-bed configurations)
• Must identify single POC for notices and inquires
• Must be submitted by e-mail (formatted in MS Word
  and Adobe PDF.

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TESA Project - Facility Acquisition Process Task
Force Determinations

• Parameters established to select potential
  shelter sources
• Identify potential sources known by the Task
  Force to manufacture shelters that
• Generally met platform requirements
• Were in common use as mobile medical facilities
• To maximize practical competition, limit the
  minimum number of potential sources to 3
• To minimize the procurement process, limit the
  maximum number of potential sources to 6

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TESA Project - Facility Acquisition Process Task
Force Determinations

• Six potential platform sources were identified
• 4 that generally met shelter requirements and had
  been used by members of the Task Force
• 1 that generally met shelter requirements but was
  unknown to members of the Task Force
• 1 that manufactured hard-walled shelters, was
  unknown to members of the Task Force but was a
  Michigan-based company
• These 6 potential vendors were e-mailed the
  Invitation to Submit a Combined Proposal/Bid
  Quotation

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TESA Project - Facility Acquisition Process The
RFP/RFQ Package

• Task Force determinations were reduced to a
  3-page invitation to submit a combined
  Proposal/Bid Quotation

• that would be e-mailed to pre-selected vendors.

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TESA Project - Facility Acquisition Process The
RFP/RFQ Package

• Task Force determinations were reduced to a
  3-page invitation to submit a combined
  Proposal/Bid Quotation

• that would be e-mailed to pre-selected vendors.

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TESA Project - Facility Acquisition Process
Evaluating Proposals/Quotes

• All invitees responded
• Hundreds of pages
• Each with unique format
• Some highly detailed and well organized
• Some lacked detail and organization
• All were printed, bound and distributed to each
  member of the Task Force

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TESA Project - Facility Acquisition Process
Evaluating Proposals/Quotes

• COMPARABLES
• Quote Duration
• Cost
• Max Size Container
• Assembly
• Basic Units
• Access Doors
• Area (sq. ft.)
• Furniture
• Power
• Lighting
• Outlets
• HVAC
• NDMS Interop?
• Trailer Boot
• Warranty
• Framing
• Fabric
• Insulation

THE EVALUATION MATRIX
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TESA Project - Facility Acquisition Process
Awarding the Contract

• 2 vendors RFP/RFQ met specs, the other 4 were
  eliminated from competition
• Task Force members to NDMS conference to inspect
  both shelter systems
• Gained experience - revised specifications
• Requested final quote on revised specifications
• Reviewed final quotes
• Unanimous agreement to award contract

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TESA Project - Facility Acquisition Process
Lessons Learned

• Need experienced and knowledgeable team to avoid
  pitfalls when expediting a complex project
• Need comparison matrix to efficiently deal with
  variable specifications
• No substitute for getting your hands dirty
  (in-person inspection and assembly)
• No substitute for face-to-face discussion with
  vendor representatives

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TESAPROJECT Facility Specifications
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TESA Project Facility SpecificationsQuick Specs

• 10,000 Sq. Ft. Enclosed Area
• 20,000 Sq. Ft. Footprint (125 x 158)
• 5 Generators (4 _at_ 36kW and 1 _at_ 56 kW)
• 16 HVAC
• 15 _at_ 42K BTU heat/3.5 ton cool/29K heat strip
• 1 _at_ 60K BTU heat/cool/HEPA positive or negative
  pressure)
• 4 Hygiene Centers
• Each with sink, shower, toilet, hot H2O,
  500-gallon fresh and gray water holding tanks

• 16 Interconnected Shelters
• 1 each for Administration, Staff, Supply (w/boot)
  and Intake/Triage/Treat
• 1 ten-bed Patient Ward (isolation)
• 7 ten-bed Patient Wards
• 4 five-bed Patient Wards
• Design
• 41 ratio of adult to pediatric patients
• Admit/Discharge Rate 23 hours ( 100 patients
  per day)
• Over 1,000 Separate Pieces

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TESA Project Facility SpecificationsThe Design
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TESA Project Facility SpecificationsTactical
Labeling

• The components of each individual shelter are
• Color-coded labeled
• Packaged together

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TESA Project - Facility SpecificationsTactical
Storage
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TESA Project Facility SpecificationsAs Built
(40-Bed Unit)
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TESA Project Facility Specifications Lessons
Learned

• Color-code and label individual shelter
  components
• Facilitates handling
• Has limitations
• Only so many distinct colors
• Correlates only to complete 100-bed layout
• Because it is a white vinyl tent labor intensive
  for cleaning before repackaging
• Setup and tear down takes expertise
• Requires the development of specialized teams

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TESAPROJECT Equipment Supply Acquisition
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TESA Project Equipment/Supply Acquisition
ProcessPatient Staff Profile

• The Mobile Field Hospital would be designed
• For patients suffering from COPD, asthma,
  congestive heart failure (no C-PAP or vent),
  chronic pain syndrome, and behavioral conditions,
  and needing IV hydration and IV antibiotic
  therapy
• With a 41 ratio of adult to pediatric patients
• With a planned admission/discharge rate of 23
  hours
• To be operated by a core team of medical
  professionals augmented by volunteers (Michigan
  Volunteer Registry)

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TESA Project Equipment/Supply Acquisition
ProcessTask Force Determinations

• The stakeholder Task Force determined to utilize
  sole-source provider of medical supplies and
  equipment to outfit the facility
• Previously qualified source
• Current source of ACC and NEHC facilities for
  MEMS components.
• Demonstrated ability
• Medical expertise to identify and meet needs
  (based on expected patients and healthcare staff)
• Professional packaging
• Competitive pricing

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TESA Project Equipment/Supply Acquisition
ProcessPatient Profile Questionnaire

• Comprehensive questionnaire was used to refine
  the patient profile and then determine what level
  of service would be provided over a given period
  of time

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TESA Project Equipment/Supply Acquisition
ProcessCapability Worksheet
Function (sample) Adult PEDS Infant
Airway X X X
Wound Treatment X X X
IV Therapy X X X
Ortho Care X X X
EENT X X X
Genitourinary X X X
Gastrointestinal X X X
Medication Admin X X X
Emergency Care X X X
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TESA Project Equipment/Supply Acquisition
Process Master Template

• Master Template was used to generate the type of
  treatment which could be offered and the type and
  quantity of equipment and supplies needed.

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TESA Project Equipment/Supply Acquisition
Process The Design
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TESA Project Equipment/Supply Acquisition
Process The Design
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TESA Project Equipment/Supply Acquisition
Process The Design
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TESA Project Equipment/Supply Acquisition
Process The Design
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TESA Project Equipment/Supply Acquisition
Process The Design
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TESA Project Equipment/Supply Acquisition
Process The Design
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TESA Project Equipment/Supply Acquisition
Process The Design
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TESA Project Equipment/Supply Acquisition
Process The Design
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TESA Project Equipment/Supply Acquisition
Process Lessons Learned

• Patient Profiles will define the treatment
  modalities necessary
• Establish a cache which is broadly used so that
  replenishment is easier and can be integrated
  into a local healthcare system
• Establish Augmentation Sets to supplement
  specialty areas
• OB-GYN
• PEDS
• Isolation
• O2 Therapy
• Nursery
• Establish and procure basic equipment lists which
  do not require long training sessions

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TESAPROJECT Storage Deployment
Considerations MAXIMIZEDEPLOYMENT AND
RECOVERY SPEED
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TESA Project Storage/Deployment Considerations
Tactical Containerization Labeling

• Color-coded labels
• Color-coded packages
• Color-coded containers and augmentation sets
• Modules which are color-coded and containerized

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TESA Project Storage/Deployment Considerations
Containers

• Storage
• Pallet size
• Weight
• Deployment
• On or off pallets?
• Storage of shipping materials
• Re-packing
• Sustainment

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TESA Project Storage/Deployment Considerations
Transporting Handling

• Transport Vehicle
• Semi-trailers
• Flat bed
• Dry box
• Box truck
• Material Handling Equipment
• Fork Lifts
• Pallet Jacks

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TESA Project Storage/Deployment Considerations
Trailer-Mounted Generators

• Shipping
• Flat Bed - loading unloading
• Need loading dock
• Need material handling equipment
• Individual
• Multi tow-vehicles and drivers

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TESA Project Storage/Deployment Considerations
Storage Space
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TESA Project Storage/Deployment Considerations
Storage Scheme
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TESA Project Storage/Deployment Considerations
Lessons Learned

• Color-coding simplifies storage, picking,
  shipping and sustainment planning and execution
• Consider the storage of shipping materials
  (pallets, containers, etc.) in deployment plans
• Know your material handling equipment needs
• Field (e.g. parking lot) vs. fixed facility (e.g.
  conference/exhibition center)

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Emergency Management Strategies Lessons Learned
in Developing Specifications, Procuring, Housing
and Maintaining a 100-Bed Mobile Hospital
Jenny Atas MD R2S Medical Director e-mail
jatas_at_2south.org Mark Sparks R2S Planning
Logistics Officer e-mail msparks_at_2south.org