NCTTRAC 2017 - 2018 Annual Report - FINAL by mmparlington

2017 - 2018 ANNUAL REPORT

PREPARE. SUPPORT. RESPOND.

TABLE OF CONTENTS EXECUTIVE SUMMARY ............................................................................................................................................ 1 FY18 BOARD OF DIRECTORS ................................................................................................................................... 2 FINANCIAL OVERVIEW ............................................................................................................................................ 3 EMERGENCY & ACUTE HEALTHCARE SYSTEMS ...................................................................................................... 5 TRAUMA FACILITIES ................................................................................................................................................ 7 STROKE FACILITIES .................................................................................................................................................. 8 NEONATAL FACILITIES ............................................................................................................................................. 9 WORKGROUP UPDATES ........................................................................................................................................ 10 FY18 COMMITTEE CHAIRS ELECT .......................................................................................................................... 11 FY18 COMMITTEE HIGHLIGHTS ............................................................................................................................ 12 HOSPITAL PREPAREDNESS PROGRAM .................................................................................................................. 16 2018 NCTTRAC QUALITY ASSURANCE REVIEW ..................................................................................................... 19 CMS EMERGENCY PREPAREDNESS ....................................................................................................................... 19 EMERGENCY MEDICAL COORDINATION CENTER ................................................................................................. 21 CRISIS APPLICATIONS ............................................................................................................................................ 22 TRAINING & EXERCISES ......................................................................................................................................... 25 TSA - E REGIONAL HAZARD VULNERABLIITY ASSESSMENT .................................................................................. 26 EMERGENCY MEDICAL TASK FORCE ..................................................................................................................... 28 TRAINING, EXERCISES, & DRILLS ........................................................................................................................... 31 LOGISTICS .............................................................................................................................................................. 36 INFORMATION TECHNOLOGY SYSTEMS ............................................................................................................... 37 STAFF CONTACT INFORMATION ........................................................................................................................... 38 FY18 NCTTRAC MEMBER RECOGITION.................................................................................................................. 38 FY19 NCTTRAC INITIATIVES ................................................................................................................................... 39

EXECUTIVE SUMMARY We hope you find this eighth consecutive NCTTRAC annual report to be enjoyable, interesting, and insightful. This report reflects the activities of our members, partners and regional Health Care Coalition through the period of July 1, 2017 to August 31, 2018. While we are proud of what we accomplished in 2017, a year of unprecedented disaster response, 2018 provided “after-action” opportunities to further strengthen regional and statewide capabilities – we remain grateful and thankful to our partners, each of whom contributed significantly to the overall successful response to which our great state is being credited. In 2018, our Committees, Subcommittees and Workgroups continued their efforts as leaders and change agents for our region as evidenced by their support for national initiatives and commitment to the development of regional best practices. The “Stop the Bleed” program is just one example of a national initiative wholly and fully supported by NCTTRAC members and the Health Care Coalition to which significant funding was committed from the EMS Local Projects Grant and well as the Hospital Preparedness Program. The formation of two addition workgroups this year – Mental Health Workgroup and the Active Threat Workgroup again demonstrates the commitment of our partners to address the contemporary issues and growing needs within our region. Our NCTTRAC Healthcare Coalitions in TSA-C (Wichita Falls), TSA-D (Abilene), and TSA-E (DFW) continue their efforts to build representation reflective of their overall medical community and supporting partners.

The

creation of two new subcommittees in TSA-E – the HCC Planning Subcommittee and the EMTF Subcommittee both provide the needed opportunity to further develop and solidify disaster preparation, coordination and support to future local, regional and state-wide disasters and events. In the wake of Harvey, TX EMTF received funding from the Texas Department of State Health Services to help address a number of after-action items aimed at increasing response effectiveness and capabilities while also creating standardization measures across EMTF regions. This past year our NCTTRAC Offices received several new audio and visual enhancements to provide our members, partners, and regional Healthcare Coalition a more user-friendly venue to attend NCTTRAC meetings both in-person and virtually. Our office space underwent considerable renovation this year making more efficient use of the existing space to accommodate our meetings and provide the opportunity for future growth as needed. Lastly, I am very proud of our outstanding and continued relationship with the Dallas Fort Worth Hospital Council (DFWHC). Both organizations have shown tremendous commitment to on-going and future collaboration. NCTTRAC is now a standing item on the DFWHC’s meeting agenda allowing NCTTRAC leadership to provide updates on relevant issues and initiatives impacting either or both organizations. In turn, NCTTRAC has created two (2) Hospital Executive seats on the NCTTRAC Board of Directors. As we move into 2019, we look forward to working with our members, partners and Health Care Coalition to build and promote a health care community to effectively and collectively address the present-day and future issues – involving the patients and community it supports – today, tomorrow, together… 1

FY18 BOARD OF DIRECTORS Chair

Chair Elect

Jorie Klein

Ricky Reeves

Parkland Health & Hospital System

Lewisville Fire Department

Secretary Amy Atnip Medical City Plano

Treasurer Derrick Cuenca Lake Granbury Medical Center

FINANCIAL OVERVIEW EMS/Regional Advisory Councils (EMS/RAC) The purpose of these funds is to assist in the enhancement and delivery of patient care in the EMS and Trauma Service Care System. Administrative support functions are the principal activities supported by this contract with the intent to enhance and improve delivery of EMS and trauma patient care in TSA-E. Tobacco/RAC The purpose of these funds is to assist in maintaining and improving the Texas EMS and Trauma Service Care System to reduce morbidity and mortality due to injuries. These funds supported programmatic functions as well as provide educational programs and public education materials for members. EMS/County Assistance The purpose of these funds is similar to the EMS/RAC funds, to assist in the enhancement and delivery of patient care in the EMS and Trauma Service Care System. The most significant difference is that these funds are paid directly to qualifying EMS Providers to support supplies, education and training, communications equipment, and vehicles. Hospital Preparedness Program (HPP) The purpose of these Hospital Preparedness Program funds is to enhance the ability of participating hospitals and healthcare facilities to improve surge capacity and enhance community and hospital preparedness for public health emergencies. Local Projects Grant (LPG) The purpose of these funds is to complete projects related to Bleeding Control, injury prevention, educational programs or to purchase equipment for patient care or communication. Funds were used to purchase gunshot wound trainers that were distributed through the region.

HPP 3,432,132 69%

Tobacco 287,738 6%

EMS/RAC 296,359 6%

Other Unrestricted 36,851 1%

Membership Dues 482,505 9%

Local Projects Grant 48,588 1%

EMS/County 386,602 8%

STATEMENT OF ACTIVITIES

FINANCE COMMITTEE The Finance Committee focused on strategies to increase revenue and grow unrestricted reserve funds. NCTTRAC Staff initiated a review of the prior years financial performance. Based on recommendations from the FY18 Planning & Budgeting Session, the Finance Committee, with approval from the Board of Directors, elected to move $150,000 from the idle unrestricted fund to the investment account to ensure continued growth of the reserve funds. A change in staff within Merrill Lynch prompted a proposal by the financial service firm, Raymond James. Raymond James proposed a strategy that more closely matched the organizationâ&#x20AC;&#x2122;s goal of minimizing risk while actively growing the account. As part of the strategy to increase revenue, the Board of Directors Chair established a Revenue Sustainment Workgroup. The workgroup addressed the potential reduction in funding from state contracts. The workgroup developed a plan to increase membership dues annually at a rate equal to the increase in the Consumer Price Index (CPI). The Membership Dues increase passed with a 74% approval rate by NCTTRAC Voting Representatives and will begin in Fiscal Year 2020. The Finance Committee will continue to monitor the financial activity and maintain the financial viability of the North Central Texas Trauma Regional Advisory Council.

EMERGENCY & ACUTE HEALTHCARE SYSTEMS EMS/COUNTY ASSISTANCE “PASS-THROUGH” FUNDS The EMS “Pass-Through” fund is distributed to eligible EMS Licensed Providers within Trauma Service Area E that have met all NCTTRAC

Expenditure Requests are limited to: •Supplies •Operational Expenses •Education and Training •Equipment •Vehicles •Communication Systems

membership and participation requirements. Funding is provided through the Emergency Medical Services and Trauma Care System Account (911 fund), the Emergency Medical Services, Trauma Facilities, and Trauma Care System Fund (1131 fund), and the Designated Trauma Facility and Emergency Medical Services fund (3588 fund). NCTTRAC received a total of $386,602 in “Pass-Through” funding which was distributed to seventy (56) EMS Agencies.

Other Operational Expenses, $40,525 Communication Systems, $14,784 Vehicles, $39,985

FY2018 EMS/CO Pass Through Funds Supplies, $100,741

Equipment, $166,567 Education & Training, $24,000

LOCAL PROJECTS GRANT The Texas Department of State Health Services (DSHS), Office of Emergency Medical Services Trauma Systems Coordination (OEMS/TS) provided Local Project Grant (LPG) funding directly to the Regional Advisory Councils for program administration. The North Central Texas Trauma Regional Advisory Council (NCTTRAC) was allocated $48,588 from the Permanent Fund for Emergency Medical Services and Trauma Care Account to provide support and enhancement of pre-hospital Emergency Medical Services (EMS) and trauma care systems in Texas. Based on the recommendations from the NCTTRAC EMS Committee, funding was designated to support the regional Stop the Bleed efforts by purchasing wound packing trainer kits. A total of 237 wound packing trainers were ordered, which will provide each agency two (2) wound packing trainer kits. NCTTRAC is in the process of distributing these kits to the EMS agencies in Trauma Service Area- E.

STOP THE BLEED In response to state and national initiatives, the NCTTRAC Board of Directors Chair formed a Stop the Bleed (STB) Workgroup on February 27, 2018 which has since been renamed the Stop the Bleed Coalition. NCTTRAC Chair, Jorie Klein, and Chair Elect, Ricky Reeves lead the Coalition. The purpose of the STB Coalition is to facilitate communication and identify opportunities for regional collaboration, which will expand the STB training and define targeted audiences. The STB Coalition aims to provide a forum for stakeholders and healthcare providers in Trauma Service Area - E to advance the STB training in our region with the mission of ensuring that all individuals in the TSA-E region seeking STB training have access to the training courses. Recently the Regional Emergency Preparedness Committee (REPC) allocated more than $125,000 of Hospital Preparedness Program funds to support this initiative. Those funds allowed for the purchase of 22 wound packing kits, more than 2,000 tourniquets, and close to 2,000 STB kits. The STB Coalition has since divided this equipment among the eight (8) NCTTRAC Zones to assist with training and awareness across the entire region. The goal of the STB Coalition is to train a minimum of 25,000 individuals in STB over the twelve months from July 2018 – June of 2019. On November 14, the STB Coalition met with legislative representatives from TSA-E hospitals. This advocacy meeting served as a brainstorming session to identify the audience for STB trainings. The STB Coalition is working on grass roots efforts for the upcoming Texas legislative session to drive funding and education for STB programs at the local, regional and state levels. The STB Coalition meets every third Wednesday at 1 P.M. at the NCTTRAC Offices. To learn more about attending or hosting a STB course please visit our website at www.NCTTRAC.org. A link to the Stop the Bleed page is located under the “Programs” tab. Additionally, visit our Zones page to find the Zone Representative for your area to receive information on how to get training supplies or tourniquets in support of a community event.

Stop the Bleed Total Individuals Trained - 13,411 Hospital Staff/ Physician Offices

706

Fire/ EMS/ First Responders Organizations

1971 1638 181

Law Enforcement School Districts/ School Nurses

106 664

1086 2131

Religious Organizations Government/ Legislative systems/ Municipalities Corporate Systems

TRAUMA FACILITIES Level I (Comprehensive)   

Baylor University Medical Center Children's Medical Center of Dallas John Peter Smith Hospital

  

Medical City Plano Methodist Dallas Medical Center Parkland Memorial Hospital

  

Texas Health Harris Methodist Fort Worth Texas Health Presbyterian Hospital Dallas Texas Health Presbyterian Hospital Plano

Level II (Major)   

Baylor Scott & White Medical Center – Grapevine Cook Children’s Medical Center Medical City Denton

Level III (Advanced)       

Baylor Scott & White All Saints Medical Center Baylor Scott & White – Centennial (IAP) Baylor Scott & White Medical Center – Lake Pointe Baylor Scott & White Medical Center – McKinney Medical Center Lewisville Medical City Arlington Methodist Mansfield Medical Center

     

Medical City McKinney Medical City North Hills Methodist Charlton Medical Center Texas Health Harris Methodist Hospital HEB Texoma Medical Center Wilson N. Jones Regional Medical Center

          

Palo Pinto General Hospital Texas Health Arlington Memorial Hospital Texas Health Harris Methodist Alliance Texas Health Harris Methodist Azle Texas Health Harris Methodist Cleburne Texas Health Harris Methodist Stephenville Texas Health Huguley Hospital Texas Health Presbyterian Hospital Allen Texas Health Presbyterian Hospital Kaufman TMC Bonham Hospital (IAP) Wise Health System

Level IV (Basic)           

Baylor Scott & White Medical Center – Waxahachie (IAP) Children’s Medical Center Plano Dallas Medical Center Dallas Regional Medical Center Ennis Regional Medical Center Hunt Regional Medical Center Greenville Lake Granbury Medical Center Medical City Dallas Hospital Medical City Weatherford Muenster Memorial Hospital Navarro Regional Hospital

STROKE FACILITIES Comprehensive (Level I)     

    

Baylor University Medical Center John Peter Smith Hospital Medical City Dallas Hospital Medical City Fort Worth Medical City Plano

Methodist Dallas Medical Center Parkland Memorial Hospital Texas Health Harris Methodist Fort Worth Texas Health Presbyterian Hospital Dallas UT Southwestern Zale Lipshy University Hospital

Primary (Level II)              

Baylor Scott & White All Saints Medical Center Baylor Scott & White Medical Center - Centennial Baylor Scott & White Medical Center – Grapevine Baylor Scott & White Medical Center – Irving Baylor Scott & White Medical Center – Lake Pointe Baylor Scott & White Medical Center – McKinney Baylor Scott & White Medical Center – Plano Baylor Scott & White Medical Center at Waxahachie Dallas Regional Medical Center Medical City Arlington Medical City Lewisville Medical City Denton Medical City Las Colinas Medical City McKinney

             

Medical City North Hills Methodist Charlton Medical Center Methodist Mansfield Medical Center Methodist Richardson Medical Center Texas Health Arlington Memorial Hospital Texas Health Harris Methodist Hospital HEB Texas Health Harris Methodist Southwest Texas Health Huguley Hospital Texas Health Presbyterian Hospital Denton Texas Health Presbyterian Hospital Plano Texoma Medical Center Weatherford Regional Medical Center Wilson N. Jones Regional Medical Center Wise Regional Health System

Support (Level III)  

Texas Health Harris Methodist Azle Texas Health Harris Methodist Stephenville

 

Texas Health Presbyterian Hospital of Kaufman TMC Bonham Hospital

NEONATAL FACILITIES Level IV (Advanced Intensive Care)  

Children's Medical Center of Dallas Cook Children’s Medical Center

 

Medical City Dallas Hospital Texas Health Presbyterian Hospital Plano

Level III (Intensive Care)         

Baylor Scott & White All Saints Medical Center Baylor Scott & White Medical Center - Grapevine Baylor Scott & White Medical Center - McKinney Baylor University Medical Center Hunt Regional Medical Center Greenville John Peter Smith Hospital Medical City Alliance Medical City Arlington Medical City Lewisville

       

Medical City Plano Methodist Dallas Medical Center Methodist Richardson Medical Center Parkland Memorial Hospital Texas Health Arlington Memorial Hospital Texas Health Harris Methodist Fort Worth Texas Health Presbyterian Hospital Dallas William P. Clements University Hospital

Level II (Special Care Nursery)        

Baylor Scott & White Medical Center - Centennial Baylor Scott & White Medical Center - Frisco Baylor Scott & White Medical Center - Irving Baylor Scott & White Medical Center - Lake Pointe City Hospital at White Rock Medical City Las Colinas Medical City McKinney Methodist Charlton Medical Center

       

Methodist Mansfield Medical Center Texas Health Harris Methodist Hospital Alliance Texas Health Harris Methodist Southwest Texas Health Harris Methodist HEB Texas Health Presbyterian - Allen Texas Health Presbyterian - Denton Texas Health Presbyterian - Flower Mound Wise Health System

Level I (Well Nursery)       

Baylor Scott & White Medical Center - Waxahachie Dallas Regional Medical Center Lake Granbury Medical Center Medical City Weatherford Navarro Regional Hospital North Texas Medical Center Palo Pinto General Hospital

     

Texas Health Harris Methodist Cleburne Texas Health Harris Methodist Stephenville Texas Health Huguley Hospital Texas Health Presbyterian Hospital Rockwall Texoma Medical Center Wilson N. Jones Regional Medical Center

WORKGROUP UPDATES MENTAL HEALTH NCTTRAC Board of Directorsâ&#x20AC;&#x2122; Chair, Jorie Klein, recognized the need for routine, committed discussion aimed at mental health issues in our region. On February 27, 2018, the Mental Health Work Group was established. The work groupâ&#x20AC;&#x2122;s mission is to form a collaboration of mental health professionals working toward enhancement of mental health care in the 19 counties of Trauma Service Area (TSA)E. The work group identified that the most common need for improvement across the region is the process of obtaining an Order of Protective Custody (OPC) for mental health patients. After surveying the region to determine common OPC related problems, results revealed that the most problematic issue was the availability of a judge or magistrate to approve an OPC. Other common problems included long wait times for available inpatient treatment, Emergency Department (ED) congestion due to holding mental health patients, most importantly, the work group found that the process to obtain an OPC varies significantly from judge-to-judge and countyto-county. Therefore, the main focus will be working toward standardizing and developing guidelines for the OPC process in our region. The Mental Health Work Group is continuing to collaborate with Peace Officers, EMS agencies, EDs, and mental health facilities to improve the mental health care system. If you would like to participate in the Mental Health Work Group, please contact us at EHS2@NCTTRAC.org.

ACTIVE THREAT This year the NCTTRAC Board of Directors approved the formation of an Active Threat Workgroup to identify and make available resources that will assist individuals and agencies prepare for an Active Threat situation. NCTTRAC Staff is developing a web page to provide educational

resources

for

communities,

corporations and individuals. The web page will also hold available After-Action-Reports from historical incidents that may serve as reference material in preparedness efforts.

FY18 COMMITTEE CHAIRS ELECT

FY18 COMMITTEE HIGHLIGHTS Air Medical The Air Medical Committee created an Aircraft Utilization Guideline to be included as an appendix within the Regional NCTTRAC Trauma, Stroke, and Acute Coronary Syndrome Plans. The purpose of the guidelines is to assist EMS ground providers facilitate a request for the closest appropriate aircraft for the patient in need. The Committee collaborated with the EMResource Workgroup to develop a training video regarding Air Medical functions within EMResource. The training video and additional helpful information is available at www.NCTTRAC.org.

Cardiac The Cardiac Committee created an Education Taskforce to focus on educational needs and to help improve quality of patient care. Educational committee presentations included committee presentations, ‘Change Theory’ and ‘Process Improvement Tools’. The Taskforce is also planning to host a conference, “Improving Collaboration in Cardiac Care”, on February 7, 2019. Continuing their efforts in public education, members participated in a Hands Only CPR training event at the Texas Motor Speedway in April of 2018. The Heart Safe Community Workgroup continues to review applications. The workgroup was established with the likelihood of receiving multiple applicants from our region, but the enthusiasm for the program has exceeded the workgroup’s expectations. The following cities were recognized as Heart Safe Communities in Fiscal Year 18.

City of Cedar Hill

City of Granbury

City of Hutchins

City of Decatur

City of Weatherford

City of Plano

If you would like information on becoming a Heart Safe Community, visit www.NCTTRAC.org.

Emergency Department Operations (ED Ops) The ED Ops Committee held multiple discussions regarding Care of Sexual Assault Patients and the potential need for a Regional Sexual Assault Care Plan. The committee is also reviewing prevention efforts regarding workplace violence of healthcare professionals by identifying and managing violent patients within hospital Emergency Departments.

Emergency Medical Services (EMS) The Centers for Medicare & Medicaid Services (CMS) proposed changes that would greatly affect the Ambulance Fee Schedule (AFS). Throughout the year, the EMS Committee remained up to date on legislative discussions and changes, including Agenda 2050 and the Ambulance Supplemental Program, which would potentially affect regional and statewide EMS providers. The EMS Committee recommended the use of Local Projects Grant (LPG) funding to purchase hemorrhage control wound packing trainers for EMS agencies. The equipment will help initiate, or supplement existing, Stop the Bleed training programs in their communities.

Medical Directors The Medical Directors Committee is tasked with reviewing NCTTRAC Regional Plans and recommending a minimum standard of practice for providers within the region. The committee worked diligently reviewing and promoting the Texas Medical Orders for Scope of Treatment (MOST), Palliative Care Guidelines, and the Crisis Standards of Care to NCTTRAC Committees.

Pediatric The Pediatric Committee, in conjunction with the NCTTRAC Training and Exercise Workgroup, is creating a Pediatric Tabletop Exercise. This exercise is a collaboration between The American Academy of Pediatrics and the Centers for Disease Control and Prevention.

Perinatal The Perinatal Committee established two (2) SMART goals: Newborn First Temperature Research Initiative and Improved Breastfeeding Rate of Well-baby & NICU population. A Newborn First Temperature Research survey was developed by the committee, which collected data from over 60K births. The data was blinded and shown to the committee, that later resulted in an improvement in hypothermia rates within NICU babies. Now having evidenced-based data, the committee developed Newborn Temperature Guidelines for our region. The guidelines were ultimately approved by NCTTRAC Board of Directors and is available on the website. The committee also created a taskforce to formulate the best measurement for breastfeeding rates of well-baby and NICU babies.

Professional Development The Professional Development Committee hosted two very popular courses; the AAAM Abbreviated Injury Scale (AIS) and Emotional Trauma Life Support (ETLS). The committee is reviewing mental health challenges for first responders and discussing the potential of hosting Tactical Emergency Casualty Care (TECC) and Emergency Neurological Life Support (ENLS) in the upcoming year.

Public Education / Injury Prevention (PEIP) The Public Education and Injury Prevention Committee discussed hospital based injury prevention.

The

committee also utilized data, provided by a third party vendor, to create an infographic regarding bicycle safety and awareness. The Falls Prevention Coalition Workgroup reviewed evidence based practices provided by programs designed to manage falls and increase activity levels. The workgroup hosted a Falls Prevention Awareness day at NCTTRAC with a target population of ages 60+. Representatives from hospitals provided information about medications, exercise/balance programs, and a â&#x20AC;&#x153;Fall Roomâ&#x20AC;? was created to resemble a living area so visitors could recognize potential fall risks. NCTTRAC night-lights and pillboxes were given to those who participated.

Stroke The Stroke Committee created a regional data collection survey to obtain quality metrics including Door to Groin, Door to Needle, and Door In/Door Out times. The committee is collaborating with the North Central Texas Stroke Coordinators to plan and support regional stroke awareness functions and events.

Systems Performance Improvement (SPI) Committee The SPI committee worked in depth with NCTTRAC staff to enhance and improve the electronic referral process within the NCTTRAC website. The committee tracked and responded to several SPI Referral Cases throughout the year. The SPI Committee, along with other NCTTRAC committees, are reviewing the potential for additional functionalities of the Regional Communications Center (RCC).

Trauma The Trauma Committee recommended the use of a third party vendor to collect trauma related data within the region. The cloud based data service has collected data from all levels of trauma centers and includes over 72K records from 34 trauma-designated hospitals. The committee is utilizing this data for performance improvement efforts in our regional trauma system of care.

Zones The Zones Liaison to the Board of Directors (Zones Liaison), Zone Representatives, and NCTTRAC staff are collaborating to enhance communication. Zone Representatives participate in a monthly conference call with the Zone Liaison and NCTTRAC staff regarding regional programs, initiatives, questions, concerns, participation, committee activities, etc. for discussion and updates. Additionally, the Hospital Preparedness Program funded the purchase of 248 Stop the Bleed kits, one wound packing trainer, and 20 tourniquets for each of the eight zones. The zones will distribute the Stop the Bleed kits and training supplies under the direction of an SOP developed by the Stop the Bleed Workgroup.

HOSPITAL PREPAREDNESS PROGRAM Hospital Preparedness Program (HPP) Year 16 marked the beginning of the fourth five-year block of the program. While NCTTRAC has historically served as the grantee for TSA-E, HPP Year 16 saw NCTTRAC’s contractual duties expand to cover TSA-C (Wichita Falls) and TSA-D (Abilene). When including the 19 counties within TSA-E, there are now 45 counties under NCTTRAC’s programmatic and administrative responsibility. NCTTRAC secured 140 HPP agreements from regional partners in all three Trauma Service Areas, indicating a high level of programmatic participation throughout each region. Additionally, the Assistant Secretary of Preparedness and Response (ASPR) revealed the new Coalition Assessment Tool (CAT), which provides a single location for each Healthcare Coalition (HCC) to assess and track progress toward achieving the 2017–2022 Health Care Preparedness and Response Capabilities, meeting the requirements of the 2017-2022 HPP Cooperative Agreement, and completing the 2017–2022 HPP Performance Measures. The CAT is a nationwide tool that also provides a more effective avenue for HCCs to request targeted technical assistance. The 2018 NCTTRAC Quality Assurance Review from DSHS provided NCTTRAC the opportunity to showcase some best practices in HCC development and expansion while seeking opportunities for improvement to better service the HCCs. With the advent of the Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness regulation implementation, NCTTRAC continued to provide tools and resources to help HCC members achieve the CMS standards. The table below provides a summary of regional activities including scope, training and exercise events, and asset acquisitions. Activity

TSA-C

TSA-D

TSA-E

Total

HPP Budget FY18

$164K

$2.9M

$3.22M

218,722

302,047

7,753,090

8,273,859

No. of Counties per HCC

HPP Support Staff

Hospital Letters of Agreement

119

149

Contract Deliverables (100% Complete)

Regional Sustainment Funds Distributed

$40K

$36K

$668K

$744K

20 / 1 / 3

12 / 1 / 3

65 / 6 / 16

97 / 8 / 22

N/A

$450K

A+

Population per HCC Region

Facility Visits / Asset Assessments Training / Exercises / Drills Distribution of Assets (NCTTRAC Warehouse) DSHS Quality Assurance Rating

TRAUMA SERVICE AREA - C TSA-C is located in the Wichita Falls area and meets the first Thursday of every even month. The key regional projects for this area included a regional decontamination training and a regional Stop the Bleed initiative. The coalition also updated their SOP/Governance Structure, Multi-Year Training and Exercise Plan (MYTEP), and completed the first Preparedness Strategy. The SOP was updated to include clearly defined roles and a procurement process section. The MYTEP was informed by the HVA and provided a guide for the yearly training and exercise events.

The

Preparedness Strategy outlined the short-term and long-term goals for the region and outlined key response elements. Each of these projects are scheduled to be updated annually.

TRAUMA SERVICE AREA - D TSA-D is located in the Abilene area and meets the second Thursday of every month. The key regional projects for this area included a regional Stop the Bleed initiative and firefighter rehab stations. The coalition also updated their SOP/Governance Structure, MYTEP, and completed their first Preparedness Strategy. The SOP was updated to include clearly defined roles and a procurement process section. The MYTEP was informed by the HVA and provided a guide for the yearly training and exercise events. The Preparedness Strategy outlined the short-term and long-term goals for the region and outlined key response elements. Each of these projects are scheduled to be updated annually.

TRAUMA SERVICE AREA - E & THE REGIONAL EMERGENCY PREPAREDNESS COMMITTEE The Regional Emergency Preparedness Committee (REPC) serves as the HCC lead for TSA-E. This committee meets the first Tuesday of every month. This year brought two asset request offerings, which helped to complete the budget items for Budget Period (BP) 1 and BP2. The key projects for this region included a regional Stop the Bleed initiative and MCI framework. The committee also updated their SOP/ Governance Structure, MYTEP, and completed their first Preparedness Strategy. The SOP was updated to include the following: the expansion of the Core Group from 31 to 49 slots, addition of the detailed Voter Eligibility section, addition of the Procurement Planning section, addition of the HCC Planning Workgroup, and the suspension of the Communications Workgroup. The MYTEP was informed by the HVA and provided a guide for the yearly training and exercise events. The Preparedness Strategy outlined the short-term and long-term goals for the region and outlined key response elements. Each of these projects are scheduled to be updated annually.

TRAUMA SERVICE AREA - E HPP YR 16 PERFORMANCE This year hospitals were expected to complete 11 performance measures throughout the July 1, 2017 - June 30, 2018 program year.

These performance measures included: Quarterly Communications Drill

Participation, Quarterly Participation in No Notice Bed Reporting, Hazard Vulnerability Assessment Submission, HPP Inventory Submission, and End of Year Assessment Submission. On average, facilities completed 5.8 performance elements out of the 11 available performance opportunities. There were 28 facilities which met the 80% or greater performance goal for the year. There were eight facilities who met all eleven of the performance measures and completed 100% of the performance measures. These 100% achievers are provided below:        

Children’s Medical Center Of Dallas Children’s Medical Center Plano Dallas Regional Medical Center John Peter Smith Hospital Medical City Arlington Reba McEntire Center For Rehabilitation Texas Health Presbyterian Hospital Dallas Texas Health Harris Methodist Hospital - HEB

The chart below provides a visual of the number of agencies which have completed the corresponding number of performance elements. There were 53 facilities who fell below the 50% achievement mark and are being provided with technical assistance to achieve a higher standard of preparedness. The performance measures are emailed quarterly to HCC members as a method to track progress throughout the program year. Number of Agencies

N=120

40 30 20 10 0

8 100

Percentage of Elements Complete

45 and below

HOSPITAL PREPAREDNESS PROGRAM CONTRACTOR PERFORMANCE The Hospital Preparedness Program Contractor Performance was reported through the Coalition Assessment Tool (CAT) for the first time this year. The CAT report is designed to showcase the contractor’s performance activities relating to HCC preparedness – specifically, these performance activities involve both enhancing the ability of participating hospitals and healthcare facilities to improve surge capacity and enhancing community and hospital preparedness for public health emergencies. The table below reflects the current status toward

cumulative deliverable completion for the contract period ending in 2022. Each capability is displayed along with the corresponding elements completed for the year, followed by a cumulative wrap-up of the percentage of total elements completed for each HCC. HPP Capability Capability 1: Foundation for Health Care and Medical Readiness Capability 2: Health Care and Medical Response Coordination Capability 3: Continuity of Health Care Service Delivery Capability 4: Medical Surge

TSA-C TSA-D TSA-E Total Number Completion Completion Completion of Elements Percentage Percentage Percentage 32

66%

72%

92%

60%

38%

40%

63%

39%

72%

42%

36%

67%

2018 NCTTRAC QUALITY ASSURANCE REVIEW The 2018 NCTTRAC Quality Assurance Review from DSHS also provided NCTTRAC the opportunity to showcase some best practices in HCC development and expansion while seeking opportunities for improvement to better service the HCCs. In May 2018, DSHS personnel met at the NCTTRAC offices to review progress towards completing the HPP deliverables. There were no deficiencies noted in the final report and NCTTRAC was awarded an A+ rating across all three HCCs. The next NCTTRAC Quality Assurance Review is expected to come within the next three years and we look forward to proving successful once again.

CMS EMERGENCY PREPAREDNESS 2017 AHEPP CONFERENCE NCTTRAC Staff members Jessica Dupree and Jacob Seil presented at the 2017 Association of Healthcare Emergency Preparedness Professionals (AHEPP) conference on How to Develop a Communication Plan. This conference was held at the Omni Mandalay Hotel in Las Colinas on November 8-9, 2017. As a part of the CMS Boot camp series, this session provided an overview of the Healthcare Coalition framework and emergency preparedness efforts.

This discussion included

information about the revised National Healthcare Preparedness Capabilities and the impact of the Communications section of the CMS Emergency Preparedness Rule on Healthcare Organizations (HCO). The session further provided recommendations as to how these organizations can better integrate with HCCs through regular meetings, email distribution lists, conferences and symposiums, and social media. The presenters showcased current preparedness efforts related to redundant communications, reviewed the CMS Communications plan guidance, and provided examples of communication efforts during real-world events such as the 2014 Ebola incident, hospital evacuations, and Hurricane Harvey.

CMS WORKSHOP On March 20, 2018 NCTTRAC hosted the CMS Emergency Preparedness Workshop. There were 6 CMS provider types represented including ASCs, ESRD, HHA, Hospices, LTCs, and RHCs / FQHCs for a total of 25 participants. The workshop was led by three regional Instructors and included the topics of Emergency Operations Planning, Communications Planning, and Training and Testing. Participants received certificates of attendance at the end of the workshop and were invited to network with the HCC members.

CMS WEBPAGE In order to provide regional CMS providers with additional guidance relating to the CMS Preparedness Rule, NCTTRAC created a webpage to host CMS preparedness resources. This page showcased online learning management system (LMS) courses, which host relevant templates and tools to help HCC members achieve the CMS standards. These tools can be accessed by taking the “CMS Guidelines for Healthcare Agency Emergency Preparedness” course on the NCTTRAC LMS. Upon completion of the course, participants can click on their course library to view the resources available by CMS provider type. Another resource highlighted on the webpage included the CMS surveyors training course. The CMS Emergency Preparedness Training Online Course is available online 24/7 and provides guidance for incorporating the four core elements of emergency preparedness: Risk Assessment and Emergency Planning, Communication Plan, Policies and Procedures, and Training and Testing.

DISASTER HEALTH RESPONSE COOPERATIVE AGREEMENT North Central Texas Trauma Regional Advisory Council (NCTTRAC) supported a statewide collaboration to apply for a federal Partnership for Disaster Health Response Cooperative Agreement. This agreement was submitted under the name Texas Disaster Medical System 2 (TDMS-2) Partnership and represented a collaboration with University Health Systems as the project applicant, the South East Texas Regional Advisory Council as program lead, the Texas Department of State Health Services, the University of Texas Systems, and all eight Hospital Preparedness Program Coalition leads across the state. The aim of TDMS-2 was to build on a tiered regional framework that emphasizes the collaboration among local healthcare coalitions, trauma centers, public and private healthcare facilities, and emergency medical services to expand access to specialty care expertise and increase medical surge capacity. The goals of TDMS-2 included: 

Building a Partnership for Disaster Health Response



Aligning Plans, Policies, Processes, and Procedures Related to Clinical Excellence in Disasters



Increase Statewide and Regional Medical Surge Capacity



Improve Statewide and Regional Situational Awareness



Develop Readiness Metrics and Conduct an Exercise to Test Capabilities

In order to bring awareness to the Texas response programs and strengthen the application for funding, NCTTRAC sought letters of support to secure the statewide effort. Overall we received 20 letters of support from our three HCCs. The final document was submitted August 15, 2018. The notification of award was announced in September 2018. Nebraska Medicine in Omaha, Nebraska, and Massachusetts General Hospital in Boston, Massachusetts, received the grants from ASPR’s Hospital Preparedness Program to conduct pilot projects that show the potential effectiveness and viability of a Regional Disaster Health Response System. We would like to extend a sincere thank you to all of those who contributed to this statewide effort including:

Hospital Partners Crescent Medical Center Lancaster Dallas Regional Medical Center Ennis Regional Medical Center John Peter Smith Hospital Network Palo Pinto General Hospital Parkland Memorial Hospital Texoma Medical Center Texoma Medical Center Bonham

Healthcare Coalitions Healthcare Coalition - C Wichita Falls, Texas Healthcare Coalition - D Abilene, Texas Healthcare Coalition - E Dallas / Fort Worth, Texas Hospital Systems Baylor Scott & White Health Medical City Healthcare Methodist Health System Texas Health Resources Other Partners The DFW Hospital Council Frisco Fire Department MedStar Southern Methodist University

EMERGENCY MEDICAL COORDINATION CENTER The TSA-E Medical Coordination Center (EMCC) supports medical services delivery by hospitals and EMS agencies during emergencies. Response activities are scaled as appropriate for a given event, and may range from help desk support during working hours to 24/7 activation of the EMCC and the provision of liaison officers to work with various regional and state response agencies. The EMCC spent a large portion of the last year updating existing plans and procedures to develop the final TSA-E Medical Coordination Center Standard Operating Guidelines (EMCC SOG). The EMCC SOG serves as the guiding document behind EMCC activity and activations, focusing on the EMCC’s six (6) core functions:



Crisis Applications Facilitation and Support



Preparations for Patient Reception/Distribution



Medical Shelter Resource Support



DDC/EOC Liaison Support



Texas Emergency Medical Task Force



24/7 Duty Phone Monitoring

The EMCC also supported a wide variety of real life events. On Aug 26, 2017, the EMCC was activated by DSHS to support Hurricane Harvey operations. The EMCC also helped support TSA-E throughout the statewide IV Fluid shortage that lasted from November 2017 through March 2018. The EMCC created custom EMResource views and event templates to assist facilities suffering from IV fluid shortages, and TSA-E as a region reported on IV fluid availability to DSHS throughout early 2018. Beyond the large-scale events, the EMCC supported over a dozen local events throughout TSA-E, including multiple hospital power outages, a hospital water main breaks, and various surge-related events.

CRISIS APPLICATIONS The NCTTRAC Crisis Applications suite consists of three web-based software platforms that allow for regional communication and information sharing during both day-to-day operations and emergency situations. EMResource, WebEOC, and Everbridge are the central components of the NCTTRAC Crisis Applications Suite.

CRISIS APPLICATIONS TRAINING NCTTRAC continues to offer training on EMResource and WebEOC throughout the region. Training classes are held at the NCTTRAC offices once per month. If you would like for NCTTRAC to deliver a training at your facility or agency directly, contact Jacob Seil at JSeil@NCTTRAC.org or 817-607-7010. Crisis Applications Training Summary NCTTRAC Offices Partner Entities Number of Training Sessions 8 14 Number of Users Trained 48 100

Total 22 148

EMResource EMResource is a day-to-day system whose primary purpose is to provide a shared system where hospitals, EMS, public health, and jurisdictional emergency management agencies can provide and access regularly shared information relating to the emergency healthcare system in TSA-E. Its functionalities include daily updating of hospital Emergency Department statuses, event notifications, a status interface among regional air medical organizations and their individual Computer Aided Dispatch (CAD) systems, and Immediate Bed Availability reporting. In late 2017, the NCTTRAC Board of Directors created the EMResource Workgroup with a formal charge of improving EMResourceâ&#x20AC;&#x2122;s organization, utilization, and data system confidence. In support of that goal, the EMResource Workgroup spent the early part of 2018 reviewing the current state of EMResource in TSA-E and researching best practices being implemented across the nation. Then, in June, the EMResource Workgroup released a region-wide survey for EMResource users to provide feedback regarding future EMResource developments. Based on the information gathered in that survey, the EMResource Workgroup is developing

two products: a revamped EMResource, organized by county, with revised status type reporting, and a thorough EMResource Policy Document to guide users on regional EMResource policies and best practices. Additionally, the EMResource Workgroup oversaw the development of an EMResource Basic Orientation Video Series, which is available for new users on the NCTTRAC website. A large component of EMResource is the ability for users to create Events within the system which then notify other users about some type of issue or incident occurring within the region. When users create an Event, they assign it an Event Type – this allows other users to only receive notifications about certain types of events. 

Total Events Created: 137



Events Created By NCTTRAC: 23 (17%)



Events Created By Regional Partners: 114 (83%)



Real Events: 127 (92.7%)



Drill/Exercise Events: 10 (7.3%)

WebEOC WebEOC continues to be utilized as the primary information-sharing platform during major incidents. The NCTTRAC WebEOC server shares information with four other

NCTTRAC WebEOC Incidents

regional WebEOC servers as well as with the statewide LoneStar server. WebEOC saw its heaviest use during Hurricane Harvey

in August/September 2017 and during the TSA-E Coalition

Surge Test in March 2018.

The WebEOC-based NCTTRAC

Regional Patient Tracking Toolkit continues to develop after seeing use in multiple regional exercises and one real-life

September October November December January February March April May June July August Average

NCTTRAC WebEOC Unique Log-Ins 2014 - 2015 2015 - 2016 2016 - 2017 44 26 58 100 22 48 24 17 45 20 37 49 22 23 50 36 31 44 57 43 59 32 60 132 43 44 55 28 70 71 18 54 40 20 52 156 37.00 39.92 67.25

incident.

20 0

Local Incidents

Subscription Incidents

Real Incidents Training/Exercise 2017 - 2018 order to assist 83 with family reunification during and after a mass casualty 48 62 incident, NCTTRAC has added tools to the Regional Patient Tracking Toolkit to track the reunification process. 48 46 Additionally, NCTTRAC Staff has made many updates to the 65 Regional Patient Tracking Toolkit to make it easier to navigate 107 and use. 57 64 From September 2017 – August 2018, the NCTTRAC WebEOC 81 server saw 811 unique log-ins at an average of 67.58 per 67 83 month, a minor increase from 2016 – 2017’s 67.25. See the 67.58 table below for detailed numbers.

NCTTRAC NOTIFICATIONS NCTTRAC notifications allow partners to get alerts regarding regional emergencies and other important events.

This system enables

partners to receive critical information quickly in a variety of situations, such as severe weather, unexpected disasters, and evacuations. Through use of the Everbridge Member Portal partners, receive timesensitive messages wherever specified such as home, mobile or business phones, email address, text messages and more. NCTTRAC is beginning to support local Medical Operations Centers (MOC) by providing notification capability to members. Dallas Medical Operations Center (DMOC) is currently configured on the NCTTRAC Notifications system and staff is working with our vendor and partners for expanded use and integration across the region.

REDUNDANT COMMUNICATIONS & MERC RFP AWARD Request for Proposal Award - MERC-02 trailer transfer to Parker County Hospital District/Lifecare EMS.

The Mobile Emergency

Response Communications trailer (MERC) is a deployable asset that supports redundant communications during a communicationsrelated failure. The MERC trailer carries multiple VHF/UHF and 700/800 radios, an amateur radio, a VHF repeater, and a UHF repeater. It also has VSAT and MSAT capabilities, as well as the ability to set up six (6) VoIP phone lines.

Parker County Hospital

District/Lifecare EMS has developed and trained a team of communications professionals from multiple entities to deploy with the MERC. NCTTRAC is proud to be partnered with such a dedicated agency and looks forward to continued MERC capability development. NCTTRAC continues to host monthly redundant communications drills for HPP members. These drills take place on the last Friday of every month, and facilities/agencies can participate using jurisdictional radio systems, regional overlays (DFW CONNCT, DFW Wide), amateur radio, MSAT, satellite phone, or crisis applications. See the corresponding pie chat for a breakdown of the methods used to participate in HPP Program Year 16.

TRAINING & EXERCISES TSA-E Health Care Coalition Surge Test TSA-E Healthcare Coalition completed its first Coalition Surge Test (CST) on March 26, 2018. The Coalition Surge Test is an annual exercise requirement for the Hospital Preparedness Program (HPP). It is a Low/No â&#x20AC;&#x201C; Notice, peer assessment, tabletop exercise which helps the coalition identify gaps in surge planning. The exercise events included: activation of the EMCC, EMResource Immediate Bed Availability Reporting Drill, phone calls to the Evacuating and Receiving facilities to determine extend of play, monitoring WebEOC, and facilitating the CST discussion. At the conclusion of the simulated 90-minute exercise, 139 patients of the 321 licensed beds were evacuated. Many thanks to the facilities and agencies that participated in what will now become an annual event in our region. ESF-8 Agencies: Dallas County Health and Human Services Texas Department of State Health Services â&#x20AC;&#x201C; Public Health Region 2/3 Evacuating Facilities: Hunt Regional Medical Center iCare Rehabilitation Hospital Wise Health System Receiving Facilities: Baylor Medical Center at Uptown Crescent Medical Center Lancaster HealthSouth City View Rehabilitation Medical City Las Colinas Medical City Plano Medical City Frisco Navarro Regional Hospital Texoma Medical Center USMD Hospital at Arlington Vibra Specialty Hospital Vibra Hospital of Richardson Transportation Agencies: Benbrook Fire Department Texas EMS Medical City Alliance Texas Health Resources

2017-2018 TRAINING AND EXERCISE AT A GLANCE

65 training events provided; 8 of these training events were purchased with HPP funds.

More than 594 partners attended training

6 Exercises 16 Drills

TSA-E 2018 Regional Hazard Vulnerability Assessment The Regional Hazard Vulnerability Assessment (HVA) Report is a product of the TSA-E Healthcare Coalition, which includes The North Central Texas Trauma Regional Advisory Council, TSA-E regional hospitals, Emergency Medical Services, Centers for Medicare & Medicaid Services partners, Jurisdictional Emergency Managers, and Public Health. The Regional Hazard Vulnerability Assessment Report is a product created in Year 17 of the Hospital Preparedness Program and is a vital tool for the advancement of the Healthcare Coalition. Our region is exposed to many hazards, all of which have the potential to impact the community, causing casualties and damaging or destroying public / private property. With this in mind, it is critical that the Healthcare Coalition be aware of the potential impact. Throughout each program year, hospital representatives are asked to consider and submit their top individual hazard and vulnerability levels. The responsible member agencies prioritize their hazards and calculate risk, in collaboration with their leadership and staff. All HVA results are consolidated to show areas of concern based on the overall highest ten rated hazards and hazard vulnerabilities based on location within the region. The TSA-E Hazard Vulnerability Assessment is used to identify hazards that will have the highest impact on the regional healthcare system. These findings will be used to prioritize and provide planning, training, exercising, special project developments, and resource management in TSA-E. This regional report will be distributed to all coalition members and copies of this report will also be posted on the Training & Exercise Workgroup webpage for use by Coalition members. TRAINING AND EXERCISE GOALS: -

Identify regional healthcare hazards based upon review of existing healthcare facility HVAs.

Seek participation from regional EMS, Centers for Medicare & Medicaid Services partners, and Public Health to identify hazards that impact their Organization

Develop a Regional HCC Hazard Vulnerability Assessment

Share findings with local, regional and state partners.

TOP 10 HAZARDS Tornado Inclement Weather IT System Outage HVAC Failure Active Shooter Mass Casualty Incident Fire Epidemic Communications / Telephony Failure Temperature Extremes

TOP THREE HAZARD VULNERABILITY ANALYSIS RESULTS BY ZONE Zone 1

Zone 5

1. Tornado

1. IT System Outage 2. HVAC Failure 3. Tornado Zone 6

2. Inclement Weather 3. Communication/Telephony Failure Zone 2 1. Tornado 2. Inclement Weather 3. IT System Outage Zone 3

1. Fire

1. Tornado 2. Fire 3. Inclement Weather Zone 4

1. Tornado 2. Inclement Weather 3. Epidemic Zone 8

1. Tornado 2. Inclement Weather 3. Temperature Extremes

2. Tornado 3. Active Shooter Zone 7

1. Tornado 2. Fire 3. Mass Casualty Incident

EMERGENCY MEDICAL TASK FORCE Emergency Medical Task Force â&#x20AC;&#x201C; 2 (EMTF-2) remains vigilant in its response to regional and state events. The 2017-2018 year was one of tremendous growth for the EMTF Program both regionally and statewide. The year began with the coordinated medical response to Hurricane Harvey, continued with a significant funding opportunity, State Mission Assignments (SMA), community engagement, met contract deliverables, expanded state-level work groups and a series of training events that grew EMTFâ&#x20AC;&#x2122;s regional and statewide capability

HURRICANE HARVEY EMTF-2 played a significant role in the state response to Hurricane Harvey deploying 4 AMBUSes, 1 Task Force Leader, 35 Mobile Medical Unit (MMU) Personnel, 23 Medical Incident Support Team (MIST) Members, 6.5 Ambulance Strike Teams (33 Ambulances), and 26 Ambulance Staging Logistics Support Personnel. All told, 310 individuals from 62 different agencies responded to Hurricane Harvey from the EMTF-2 Region. Of which, 38 were jurisdictional Fire/EMS agencies, 15 hospital entities and 9 private agencies (i.e. Physician groups, EMS and consulting firms). The total cost reimbursements for EMTF-2 exceeded $3 Million. Each agency was reimbursed in accordance with established EMTF parameters and inside the authorized reimbursement window. NCTTRAC extends a special thanks to each agency and facility that deployed personnel and equipment to support those affected by Hurricane Harvey.

FUNDING OPPORTUNITY In months following the Hurricane Harvey response, the TX EMTF State Coordination Office (SCO) announced that the TX EMTF Program would be receiving carry-forward grant dollars from the Dept. of State Health Services. The funding amount exceeded $4 Million and provided an opportunity to established minimum equipment standards across each of the EMTF regions and bolster existing capability with the program’s Mobile Medical Units, AMBUS Program and Ambulance Staging. Regionally, each of the four AMBUS Host Agencies were allocated $22,500 to refurbish the items on the bus. The EMTF-2 MMU received new durable medical equipment, including iStat, cardiac monitors, and ventilators. The MMU will also be undergoing a cache realignment in order to standardize the medical supplies and arrangement of deployable medical inventory.

STATE MISSION ASSIGNMENTS The EMTF-2 Coordination Center received seven State Mission Assignments (SMA) during Hurricane Harvey. In addition, three other incidents occurred in which EMTF-2 received a mission assignment from the DSHS State Medical Operations Center. These events were: 

Exercise Key Resolve: April 18, 2018. A federal level repatriation exercise involving CDC, DOD and several other federal and state agencies. Assets deployed – Type VI MMU including a Group Supervisor, Physician’s Assistant, (2) RN, and (2) Paramedics. Supporting Agencies - Questcare and Medical City Healthcare.



Coryell County Hospital Explosion: June 26, 2018. A natural gas explosion at newly renovated section of the county hospital. This was an inter-regional response with EMTF-2 and EMTF-7. The incident yielded burn patients, minor trauma patients and caused an evacuation of a neighboring long-term care facility. MultiPatient Vehicle 2-02 hosted by Flower Mound Fire Dept. was on a return trip from a DPS training course and within the general vicinity at the time. Naturally and without pause, the unit detoured to the emergency to support the local response. The crew of the AMBUS assisted in ground operations before transferring eight long-term residence to an adjacent care facility. EMTF-2 Assets Deployed – MPV 2-02. Supporting Agency – Flower Mound Fire Department.

TEXAS FORESTRY SERVICE SUPPORT August 3-7, 2018. Medical mission in support of Texas Forestry Service (TFS) wildland fire operations across Central and West Texas. The EMTF-2 Coordination Center received a request to support EMTF-7 and TFS with a single MICU. The request was filled accordingly by MedStar Mobile Healthcare. The unit staged in McGregor, TX and later supported fire operations in Wise County. This assignment has prompted positive discussions among TX EMTF, DSHS and other state agencies on the integration of EMTF on large-scale wildland fire responses and on protecting firefighters. EMTF-2 Assets Deployed â&#x20AC;&#x201C; One MICU.

NEW MEMBER AGENCIES This year the EMTF-2 is proud to have gained 23 new member agencies. These agencies were EMS-Air, EMSGround, Hospitals, Physician Groups and Jurisdictions from each of the Trauma Service Areas that encompasses the EMTF-2 Region. Congratulations to the following agencies for joining EMTF-2: Addison FD

Duncanville FD

Plano Fire Rescue

Erath County EMS

Sachse Fire Rescue

Carrollton Fire Rescue

Farmers Branch FD

Somervell County FD

Citizens EMS

Heart of Texas EMS

Stonewall County Ambulance Service

City of Dublin EMS

Medical Air Rescue Company

Stonewall Memorial Hospital

City of Grand Prairie

Midlothian FD

Sweetwater FD

City of Lucas Fire-Rescue

Mineral Wells Fire/EMS

Texas Health Presbyterian Dallas

City of Roanoke

Mitchell County EMS

Beacon Emergency Services Team, P.A.

TRAININGS, EXERCISES & DRILLS NATIONAL EBOLA TRAINING AND EDUCATION CENTER (NETEC) On February 8-9, 2018 the EMTF-2 Infectious Disease Response Unit (IDRU) received “train-the-trainer” education from NETEC. Over a two days training the EMTF-2 IDRU developed donning and doffing procedure for the customized Personal Protective Equipment (PPE) ensemble developed specifically for the Hospital Augmentation IDRU team and the EMS IDRU Team. EMTF-2 sent five participates who are now members of the state-wide training team.

TX EMTF COURSES During this program year there were several EMTF Trainings conducted regionally. The TX EMTF SCO also hosted a series of DSHS Sponsored classes designed to develop and grow the EMTF Program across the state. Due to strong member agency engagement, EMTF-2 filed every allocated training seat and had representation in each of the following Texas EMTF Component areas.

EMTF-2 Training Summary 14 Classes; 173 EMTF-2 Members Trained

ASTL Courses (4) 48 Trained EMTF-2 MIST Workshop

EMTF-2 MMU Orientation/Logs

12 Trained

45 Trained

17 Trained MIST/ASMT Refresher

MIST Initial (2)

11 Trained

8 Trained AMBUS Drivers Course (3) 32 Trained

ASMT Initial (2)

REGIONAL AMBUS DRIVERS TRAINING During the week of April 16-19, 2018 EMTF-2 conducted a regional AMBUS Drivers Course for each of our AMBUS Host Agencies (Frisco FD, Flower Mound FD, Cedar Hill FD and MedStar/Ft. Worth). Each AMBUS Host Agency sent five drivers to receive education on advanced backing and close quarter maneuvering. NCTTRAC sponsored and facilitated the training provided by Smith System Driver Improvement Institute. These training and education opportunities advance the AMBUS program and offer unique experiences. Thank you to Ft Worth FD for graciously provided a location for the event at the Bob Bolen Training Complex.

REGIONAL AMBUS SUPPORT REQUESTS

MPV 2-01 Frisco Fire Department MPV 2-02 Flower Mound Fire Department MPV 2-03 Cedar Hill Fire Department MPV 2-04 MedStar / Fort Worth Fire Department

Event Regional Shelter Operations South Lake MCI Drill Texas Motor Speedway Gas Leak Cedar Hill Collegiate HS Quad Cities Safety Fair Dallas MCI Exercise Shattered Dreams Exercise, U.S. Congressman Burgess Preparedness Summit Mercury Rising FSE NRA Convention Head for the Hills Bike Rally CareFlite EMS Conference Midlothian Grass Fire, I-35 Grand Opening Rehab Missions Various Hospitals Train/Dump Truck Accident

AMBUS MPV 2-04

Date September 7

Location Tarrant County

MPV 2-02 MPV 2-04 MPV 2-03

September 15-28 Nov 5 Nov 15

Southlake Fort Worth Cedar Hill

MPV 2-01 MPV 2-03 MPV 2-02

March 9 March 28 April 20

Collin County Dallas Ponder

MPV2-02

April 28

Little Elm

MPV 2-02 MPV 2-03 MPV 2-03

May 4 May 5 May 19-21

Denton Dallas Cedar Hill

MPV 2-04

May 22-25

Arlington

MPV 2-03 MPV 2-04 MPV 2-04

June 22 July 19 July 20

Midlothian Fort Worth Fort Worth

MPV 2-04

August 25

Fort Worth

BATAAN MEMORIAL MARCH On March 25, 2018 EMTF-2 supported the Bataan Memorial Death March by providing medical assets and providing patient care to over 500 race participants. This marathon event takes place annually in New Mexico at the White Sands Missile Range. Each EMTF region from across the state sends teams to provide the main medical capability. This year EMTF-2 was able to send a logistics team and a clinical team comprised of nurses, paramedics and our medical director, Dr. Sharon Malone. Thank you to Medical City Healthcare and Baylor Scott & White Health for supporting this very special event.

Hotter Nâ&#x20AC;&#x2122; Hell Hundred On Aug 24, 2018, EMTF-2 MMU mobilized for the fourth year in support of the Hotter N Hell Hundred (HHH). This year the task force stood up a Type II Mobile Medical Unit (MMU), an Ambulance Strike Team, four Medical Incident Support Teams and a Task Force Leader. The HHH is a large 100 mile bike ride that draws tens of thousands of participants. This yearâ&#x20AC;&#x2122;s focus was on integration of multiple EMTF components at one site. The Medical Incident Support Team interfaced with the local command team and liaised with the MMU on essential elements of information and the AST scouted the route and was dispatched to injured riders and transported to the MMU. EMTF-2 looks forward to supporting this multi-day event and uses it as an opportunity to exercise key components of the program.

LOGISTICS While at times unnoticed, Logistics remains a critical element to any organization’s operations; and NCTTRAC is no different. This past year, NCTTRAC Logistics implemented and maintained a proactive, forward thinking focus on meeting the needs of the region’s partners. This approach was extended to support two additional Trauma Service Areas (TSA-C & D). In 2018, NCTTRAC Logistics activities included:  Procurement of equipment, delivery and furnishing for TSA-C’s new office in Wichita Falls.  Submitted over $800K worth of purchase orders towards various sustainment in equipment, supplies, and services for the region’s partners. Some of these supplies and equipment included upgrades in radio equipment worth over $100K to Palo Pinto County, over 2,000 Stop the Bleed kits, tourniquets, training equipment for STB, evacuation equipment, and portable hand wash stations that will support shelter operations.  Acquired a 26’ heavy duty vehicle in support of the TX EMTF

$800k Sustainment Purchases

$300k Existing Inventory Transferred to Partners

$200k Butyl Hoods from DSHS

Infectious Disease Response Unit (IDRU) along with a cache of Personal Protective Equipment (PPE) to be stored at the warehouse and maintained in full readiness. 

Received 520 3M Butyl Hoods, worth $200,000, to

distribute throughout the TSA-C, D, E regions as part of the State’s Personal Protective Equipment sustainment initiative.  Issued equipment and supplies stored at the warehouse to region’s partners in excess of $300,000. Some of the items transferred/issued ranged from CBRNE filters to triage tags.  Conducted 17 facility/site visits throughout the region and assisting emergency managers with their HPP inventory accountability,  Received Collin County’s Mobile Medical Unit (MMU); unit was re-inventoried and is being considered for repurpose as a mobile shelter medical operations support unit.  Received, stored, serviced, and re-issued Mobile Emergency Response Communications trailer unit to Parker County Medical District.  Conducted a NCTTRAC capabilities briefing and warehouse orientation to Collin County’s Medical Examiner and supporting staff NCTTRAC Logistics now has its own webpage, once logged in, you can find forms and documents to help regional partners with GC-11 submission, property dispositions and regional inventory availability during unscheduled events and / or emergencies.

INFORMATION TECHNOLOGY SYSTEMS The NCTTRAC IT team has had a busy year of refurbishment of not only technology, but of change and updating of the NCTTRAC offices. Throughout December and January, we worked through a complete remodel of our office suites and our EMCC. We saw the updating and enhancement of WEBEOC and itsâ&#x20AC;&#x2122; servers, as well as the servers powering our infrastructure. This year the IT department also spent considerable time and resources on improving the audio and video quality and stability of the meeting rooms. During these projects, additional efficiencies were found to improve supportability of the systems as well as update the technology for better communication and overall experience.

Audio/Visual Enhancements Over the nearly 3-month remodeling process numerous vendors not only improved the in person experience, but the external dial in capabilities as well. Cisco and AMX controllers were upgraded along with displays, projectors, and speaker systems in the EMCC. Upgraded Panasonic projectors and 4K displays greatly improve image quality, as well as visual availability to any of the visitors in the room. Along with enhancing the capability of staff monitoring and communication during emergency events in the EMCC.

The NCTTRAC Website, and New Meeting Services To better ensure the performance of WebEOC in a time of need the servers were replaced and the redundant systems were upgraded. Last year saw the rise of the new NCTTRAC website. Throughout the year many hours and significant work has gone into expansion of the site as well as additional pages for committees, workgroups, and program expansions. The website has grown in usage and members and has seen over 30,000 unique users in the las 30 days alone. We encourage anyone who has yet to sign up to do so, and use the site often to explore its many benefits. Beginning November 1, 2018, NCTTRAC now uses GoToWebinar for our meeting and conference needs. The greater features allow for a better meeting experience and staff management. Please be aware that all WebEx meeting will be changed and new connection details will be emailed and posted to the website calendar.

NCTTRAC Staff Contact Information Title Executive Director Director, Healthcare Coalition Preparedness Program Accounting Coordinator Administrative Coordinator Communications & Information Manager Comptroller Crisis Communications Administrator Emergency & Acute Healthcare Systems Coordinator Emergency & Acute Healthcare Systems Manager Emergency & Acute Healthcare Systems Supervisor EMTF-2 Supervisor Healthcare Coalition Coordinator - TSA-C Healthcare Coalition Coordinator - TSA-D Healthcare Coalition Coordinator - TSA-E Healthcare Coalition Preparedness Manager Healthcare Coalition Preparedness Supervisor Information Technology Administrator Information Technology Engineer Logistics and Transportation Supervisor Manager of Information Technology Technical Solutions Engineer

Phone Number 817-607-7001 817-607-7017 817-607-7025 817-607-7012 817-607-7009 817-607-7019 817-607-7010 817-607-7014 817-607-7022 817-607-7011 817-607-7015 817-607-7028 817-607-7029 817-607-7018 817-607-7003 817-607-7024 817-607-7007 817-607-7004 817-607-7005 817-607-7006 817-607-7016

FY19 NCTTRAC INITIATIVES NCTTRAC Leadership •Increase essential subject matter participation by Members’ Program Managers & Medical Directors •Deliver forward-thinking Strategic Planning supported by Active Accountability •Innovate an Executives/Chiefs Dashboard that reflects at-a-glance Member Engagement Status •Renew Advocacy Work Group commitment to the 2019 Texas Legislative Session

Healthcare Coalition •Support the development and growth of Healthcare Coalitions in TSA C, D and E •Develop and support an effective regional MCI Framework and Response Strategy •Support the growth of TX EMTF in scope & capability at the state and regional levels. •Develop a robust training and exercise program throughout the region

Information Technology •Upgrade remaining aged out infrastructure •Simplify meeting systems & training to allow Committees more meeting flexibility •Expand website content for areas C and D •Align vendor contract terms to realize cost savings

Emergency Healthcare Systems •Increase hospital participation in the RAC Data Collaborative (RDC) •Support Regional, State, and Federal initiatives •Enhance and support data driven committee projects •Expand participation in our trauma Data and Reporting Service

Administration & Finance •Increase effectiveness of contact management tools to stimulate peer group coordination •Achieve wide distribution and accountable Member education of Regional Plans and Guidelines •Promote cost/benefit Information that recognizes unmistakable value to RAC Membership •Implement FY20 Indexed Renewals that are sensitive to the variety of Members’ Budget Cycles

North Central Texas Trauma Regional Advisory Council 600 Six Flags Drive, Suite 160, Arlington, TX 76011 Main 817-608-0390 â&#x201D;&#x201A; Fax 817-608-0399 www.NCTTRAC.org

600 Six Flags Drive, Suite 160 – Arlington, TX – (817) 608-0390 – www.NCTTRAC.org