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Surge Capacity Management Plan Presentation to Ontarios Registered Respiratory Therapists Critical C


Established plans for the 5 elements of the surge capacity management ... Critical Care Gatekeeper. informs Senior Management. of minor event surge event ... – PowerPoint PPT presentation

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Title: Surge Capacity Management Plan Presentation to Ontarios Registered Respiratory Therapists Critical C

Surge Capacity Management Plan Presentation
to Ontarios Registered Respiratory
Therapists Critical Care Secretariat November
30, 2009
  • Overview of Surge Capacity Management Plan
  • Ventilator Procurement and Distribution
  • Moderate Surge Response-Ventilator Process
  • Provincial Ventilator Stockpile
  • Next Steps Ventilator Strategy

Surge Capacity Management Program
Surge Capacity Management Framework
Surge Capacity Management Elements
  • Foundation of the plan
  • Standardized practice for planning
  • Ensure a consistent application of the framework
    during surge response

Ontarios Plan of Action- HSAA Key Response
Minor Surge Plan
  • Hospital Teams
  • Established plans for the 5 elements of the surge
    capacity management
  • Ensure the surge response plan follows the
    outlined principles
  • Ensure the operations are scalable and flexible
    to 15 above the normal critical care capacity
  • Share information with the LHIN and partnering
    LHIN hospitals to develop inventory of resources
  • Utilize CritiCall to facilitate the transfer to
    another organization in the LHIN or across the

Moderate Surge
  • Defined as an increase in demand for critical
    care services that goes beyond individual
    hospitals and impacts on a Local Health
    Integration Network (LHIN)
  • A system-level approach applicable in all
  • Aimed at sustaining critical care services in a
    time where demand exists the capacity or
    capability of the hospital and regional resources
    are required
  • Hospital capacity 115 or patient safety

Moderate Surge Response Framework
Index Hospital Moderate Surge Escalation

Critical Care Gatekeeper informs Senior
Management of minor event surge event
  • Hospital CEO or delegate identifies
  • The current situation
  • The actions taken in the organization to mitigate
    the escalation ( minor surge response)
  • The actions required during the moderate surge
  • Specifically the services and resources necessary
    to sustain patient's) access to critical care in
    the organization and /or across the LHIN

Index hospital activates minor surge
plans Expand Capacity to 115
Index hospital critical care capacity is
exhausted or patient safety is compromised
Hospital CEO /Delegate notifies CritiCall
and triggers the LHIN Moderate Surge Response
Moderate Surge Response Framework
Partner Hospital Response
Details on required information will be provided
Ventilator Inventory
  • Ventilator Survey- August 2009
  • For the 131 hospitals with ventilator capacity
    the following information has been identified
  • Total number of invasive ventilators 1832
  • 1537 in use and 282 in storage
  • excludes HFO, operating room and portable
  • Total number of invasive ventilators including
    HFO, operating room and portable ventilators
  • 3215
  • Total HFO reported across the province - 74

Ventilator Procurement Distribution
  • The goal of the ventilator stockpile is to
    enhance critical care ventilator capacity across
    the province and provide hospitals with the
    ability to respond to unexpected increases in
    critical care patient volumes.
  • 216 ventilators were procured by the province to
    assist with Provincial Surge Capacity Management
  • Ventilators were allocated to each LHIN across
    the province
  • based on current ventilator capacity
  • analysis of specific variables from CCIS relating
    to capacity, location and services provided

Ventilator Procurement Distribution
  • The Ministry has procured the following three
    ventilator models to accommodate the needs of all
    patient populations
  • PB840 (Tyco Healthcare)
  • Avea (Viasys Health Care)
  • Evita XL (Drager Medical)
  • Each ventilator provides the capability to
    ventilate neonates, pediatrics and adults and
    provides basic and advanced modes such as Airway
    Pressure Release Ventilation (APRV). Specific
    details regarding ventilator capabilities will be
    provided directly by the vendor.
  • All ventilators are equipped with a N100
    expiratory filter system for infection control

Ventilator Procurement Distribution
  • Ventilators will be stored in host hospital in
    each LHIN to ensure that hospitals requiring
    additional ventilators receive them in a timely
  • Host hospitals will have an asset agreements
    with MOH outlining accountabilities
  • Ventilators will be made accessible to Ontario
    hospitals when all available resources within the
    LHIN have been considered
  • Any hospital in the province will have access to
    the provincial stockpile according to the process
    identified in Moderate Surge Planning
  • Receiving hospitals will receive an asset
    agreement prior to access to the stockpile
    outline accountabilities

Host Hospitals for Provincial Ventilator Stockpile
Moderate Surge Response Ventilator Process
Index hospital is approaching their maximum
ventilator capacity and has considered all
organizational vent capacity
Index hospital notifies CritiCall
CritiCall facilitates teleconference between CC
LHIN Lead Index hospital
Predetermined LHIN equipment sharing plan
actioned/ CC LHIN Lead identifies potential
resources within the LHIN
When all local equipment measures are exhausted
the CC LHIN Lead will notify CCS for ventilator
equipment options
Moderate Surge Response Ventilator Process
  • Each hospital will take measures to ensure there
    is an adequate four week supply of equipment and
    resources to sustain their critical care units as
  • Each hospital will ensure current supply of
    ventilators are maintained and the ventilator
    inventory is current
  • Each hospital will verify the functionality of
    all ventilators in storage and identify which
    ventilators from storage can be utilized during a
    time of increasing demand.
  • In addition to ventilators in operation the
    ventilators in storage would be checked and
    verified for functionality

Moderate Surge Response Ventilator Process
  • In addition to ventilators in operation the
    ventilators in storage would be checked and
    verified for functionality
  • Organizations would share equipment at a LHIN
    level prior to expanding to other LHINs or the
  • Equipment sharing agreement
  • Tracking tools

Provincial Ventilator Stockpile
  • Each ventilator will come equipped with
    supporting equipment such as a heated humidifier,
    temperature probe and humidifier cable, as well
    as disposable equipment such as circuits and
    humidifier pots.
  • The following tests are required prior to the
    ventilator being put into circulation for
    clinical use and results be must be documented by
    the hospital
  • Standard Biomedical Check (done by vendor or
    hospital Biomedical Engineering Department if
    accredited to perform)
  • Electrical Safety Testing by hospital Biomedical
    Engineering Department
  • Acceptance/Functionality Testing by Respiratory
    Therapy Department
  • Service manuals will be provided for all
    ventilators and humidifiers as well as
    information on equipment reprocessing.

Provincial Ventilator Stockpile-Maintenance
  • The host hospital is responsible to ensure
    ventilators and accompanying equipment is
    maintained according to the vendors maintenance
  • Ventilators are currently under warranty to the
    manufacturer and includes access to preventative
    maintenance servicing
  • Hospitals must notify the Critical Care
    Secretariat before doing any sort of preventative
    maintenance beyond what the manufacturer
  • Hospitals must notify the Critical Care
    Secretariat of any malfunctions or damage to the
    ventilators that occurs at any time. Proposed
    repairs will be assessed by the Critical Care
    Secretariat and coordinated with the vendor.

Provincial Ventilator Stockpile-Training
  • Each vendor will provide access to ventilator
    clinical training services, educational resources
    and on-line technical support for Respiratory
    Therapy staff and/or Biomedical Engineering staff
    at no additional charge 24 hours per day.
  • Hospitals are required to follow their internal
    policy guidelines and directives regarding
  • Access to clinical advice, protocols and support
    networks in circumstances such as ventilating
    unfamiliar patient populations or use of new
    ventilation modes should be addressed at the
    professional level.

Next Steps
  • MOHLTC will distribute instructions for host
  • to identify a contact person that will be
    available 24hours a day, 7 days a week that can
    be contacted to release a ventilator(s) from the
    provincial stockpile
  • to identify the training requirements for models
    unfamiliar to the organization from the stockpile
  • Priority will be given to host hospitals
  • Webinar will follow for all receiving hospital
    Respiratory therapy teams, Critical Care Units
    and Hospitals Administrators

Thank you!
  • Success always comes when preparation meets

Contact Information
  • Critical Care Secretariat
  • Julie Trpkovski
  • Phone 416-340-4800 ext 2767
  • BB 416-399-1173
  • Laura Pus
  • Phone 416-340-4800 ext 2766
  • Emergency Management Branch
  • Adam Miller
  • Phone 416-212-7062
  • Donna Dupont
  • Phone 416-212-4465