Planning and Practicing for a Disaster

Transcript of Webcast

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This is the transcript of a Webcast titled Planning and Practicing for a Disaster that took place on February 9, 2009.

Select to access the slide presentation (PowerPoint® file, 6 MB).

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Karen Migdail:  Welcome, and thank you for joining us today for this Webcast, Public Health Emergency Preparedness: Planning and Practicing for a Disaster.  I would like to acknowledge Sally Phillips, Director of the Public Health Emergency Preparedness Program at AHRQ [the Agency for Healthcare Research and Quality], for making this live event possible. 

AHRQ has produced a considerable number of research studies and related products, models, and tools to assist our Nation in preparing for possible mass casualty events, such as terrorist attacks, natural disasters, and other public health emergencies.   From the list of Webcast registrants, it is clear that most of you are emergency preparedness practitioners representing State and local agencies, emergency responders, and hospitals.  It is AHRQ's hope that through this Webcast, you will learn about its evidence-based tools as well as some valuable implementation strategies for your community's preparedness planning.

Today's Webcast has two parts.  The first part will focus on two of AHRQ's new and interactive computer models, the Hospital Surge Model and the Mass Evacuation Transportation Model.  Tool developer Tom Rich, from Abt Associates, will highlight their features.  This will be followed by a presentation from the Department of Defense's Christy Music, who will review a Federal multi-agency initiative that developed the Recommendations for a National Mass Patient and Evacuee Movement, Regulating, and Tracking System.  It includes a few of AHRQ's tools, including the Mass Evacuation Transportation Model.  After their presentations, they will take questions during a moderated Q&A [Questions and Answers] session.  The latter portion of the Webcast will focus on tool highlights and user perspectives of AHRQ's Tool for Evaluating Core Elements of Disaster Drills.  Following presentations by tool developer Mollie Jenckes, from Johns Hopkins University, and tool user Cindy Notobartolo, from Suburban Hospital, there will be a second moderated Q&A session. 

We encourage you to submit questions for our speakers by typing them into the Q&A panel.  This is intended to be an interactive forum, so please submit your questions throughout the presentation.  Please note that we will be taking questions for our first two presenters directly after their presentations, so if you have questions for them, do not wait until the end of the Webcast.  At the end, we will be taking questions for our last two speakers.  We will do our best to address as many questions as we can during the moderated Q&A sessions.

As our Webcast producer, Zac, mentioned earlier, sound for today's event is being brought to you via audio broadcast, which plays sound directly through your computer's speakers.  If you experience challenges with the Web audio broadcast and would like to listen via teleconference on your phone, you can leave the Web audio broadcast by clicking 'Communicate' at the top of your screen and then clicking 'Leave Audio Broadcast.'  Next, to obtain the teleconference information, click the 'Request Phone' button at the bottom of the 'Participants' panel at the right side of your screen.  Your teleconference information will then appear on the screen for you to call in.

Before I hand it over to our first presenter, I would like to give the audience some basic information regarding the AHRQ tools highlighted in Part I of the Webcast.  The Hospital Surge Model was released in 2008 and estimates the hospital resources needed to treat casualties resulting from chemical, biological, radiological, or nuclear attacks.  The user selects one of these scenarios and specifies various options describing the attack and its location. 

The Mass Evacuation Transportation Model was also released in 2008 and estimates the time required to evacuate patients from health care facilities and transport them to receiving facilities, while still taking into consideration the transportation requirements for different types of patients.  In conjunction with the Model, AHRQ and the Department of Defense [DoD] jointly led a Federal multi-agency initiative that developed recommendations for the design, development, and implementation of a National mass patient and evacuee movement, regulating, and tracking system.  

Now I have the pleasure of introducing our first presenter, Tom Rich.  Tom is a Project Director at Abt Associates who helped develop both the Hospital Surge Model and the Mass Evacuation Transportation Model.  Today he will give an overview of both of the tools, focusing on the real world applicability of each tool.  Tom?

Tom Rich:  Thank you very much, Karen.  I am very pleased to have the opportunity to talk about two of the tools we have built for AHRQ.  What these two tools have in common is that they both estimate resource requirements needed to respond to an emergency.  I am going to start with the Hospital Surge Model, which estimates hospital resource requirements needed to treat casualties from different weapons of mass destruction events or other attacks.  I would like to start by acknowledging our partners.  The model was a collaborative effort involving many people.  First and foremost, I would like to acknowledge Dr. Sally Phillips, our Project Officer.  Funding was also provided by the Office of the Assistant Secretary for Preparedness and Response [ASPR].  I especially want to acknowledge my principal investigators on the project, Dr. Rocco Casagrande from Gryphon Scientific, and Dr. Nathaniel Hupert from Weill Medical College of Cornell University; also, the 20 persons that served on our project steering committee.  

The Hospital Surge Model estimates resource requirements to treat casualties from the scenarios shown on the slide, which correspond to the various Department of Homeland Security [DHS] National Planning Scenarios.  You can see on the slide the three scenarios that are currently under development—food contamination, plague, and conventional explosive—and they will be included in the Hospital Surge Model in an upcoming release.  The Hospital Surge Model is a scaled down version of the Surge Model, which is a limited access, password-protected model that estimates casualties and resource requirements if the attack occurred in a particular metropolitan area.  In other words, in the password-protected version, you can specify where the attack happens.  If Federal or State agencies are interested in the password-protected version of the Surge Model, please contact us.  

To use the Hospital Surge Model, you have to specify the scenario as well as the number and/or type of casualties you want to assume your hospital or hospitals will have to treat.  For example, you can specify that 100 people will need to be treated in your hospital following the attack, or you can specify that 20 will arrive with severe symptoms, 40 with moderate, and 40 with mild symptoms.  I refer you to our User Manual for how we define the different patient conditions for each scenario.  For example, a person with a moderate case of flu would be admitted to the floor;  a person with a severe case would be admitted to the Intensive Care Unit [ICU].  It is important to realize that the number of casualties you specify could represent the number that a single hospital would be assumed to have to treat; or, you can use the Hospital Surge Model at the county, State, or regional level, in which case, the number of hospitalizations would be the total expected region-wide.  For most of the scenarios, all of the casualties are assumed to arrive at your hospital when the attack happens.  The model then calculates the number of patients in the hospital by day and by unit, which includes the Emergency Department, the Intensive Care Unit, and the floor.  Based on the number of patients in the hospital in the different units and the per-patient per-day resource requirements, the model outputs the resource requirements by day to treat all the patients.

Resource requirement estimates are provided for about 60 different resources that are grouped into the categories shown on this slide.  They include staff, supplies, and equipment.  We included what we viewed as the most important resources, but obviously, we do not have a complete list.  Only hospital resources are considered.  We do not consider resources needed to transport patients to the hospital or resources needed once patients are discharged.  What we recommend you do with this output is you compare the resource requirements, in particular, the peak demand for a resource to the supply of that resource, either at a specific hospital or county-wide or across your region.  The differences between the requirements and the supply can be used to assess preparedness and guide purchasing or hiring decisions.  

All planning models are based on a number of assumptions.  The Hospital Surge Model assumptions are all documented in our Model Description Report, which is on the AHRQ Web site.  I just wanted to highlight a couple of them.  The model assumes that a patient arrives at the hospital when their symptoms present.  In the case of an overt attack, like an explosion, the model assumes that everyone arrives immediately.  For a covert attack, which includes the anthrax scenario in one of the radiological attacks, symptoms in people will present over time.  You will see, for these scenarios in the model, that patients come to the hospital over a several-day period.  The assumptions on the length of time that patients spend in the different parts of the hospital and the likelihood that a percent will have to be treated in the Intensive Care Unit or other parts of the hospital are all based on documented cases of treated persons, if that information exists, or expert opinion, if there are no data on this.  Per-patient, per-day resource requirements are also based on documented cases or expert opinion.  

It is important to understand that the per-patient, per-day resource requirements assume an optimal level of care.  As a result, the Hospital Surge Model assumes there are not any capacity or resource constraints at your hospital.  In essence, the model estimates the resources that you will need to treat hospital-wide patients as opposed to how many patients you would be able to treat with your constrained resources.

The Hospital Surge Model has been implemented on an easy-to-use Web site where you can specify the scenario and how many casualties you want to assume your hospital will have to treat.  The outputs are presented in graphic and tabular form so that they can be pasted into a spreadsheet.  The graph shown here shows the number of patients in the hospital by unit by day for an anthrax attack in which approximately 1,000 patients requiring hospitalization.  The Web site also provides graphics on the resource requirements by day.  As I indicated earlier, what we recommend is you compare the resource requirements output by this model to the resources that you have in your area or hospital, so that the shortfalls can be estimated.

To use the Hospital Surge Model, you go to https://www.ahrq.gov/prep/hospsurgemodel/.  There is no user name or password required.  At that Web site there is also a User Manual and Model Description.  I encourage you to contact either Sally Phillips or myself if you have questions.  In particular, we welcome suggestions for improving the model.  

What I would like to do now is turn to the second of our planning tools, the Mass Evacuation Transportation Model.  Again, this is a tool for estimating the transportation resources needed to move patients from one or more evacuating hospitals to one or more receiving hospitals.  This was developed as part of a larger AHRQ Project that Christy Music will be speaking about in this Webcast a little bit later.  Again, I want to acknowledge our partners in developing the model, as with the Hospital Surge Model, Dr. Sally Phillips was our Project Officer.  Funding and additional leadership came from the Office of the Assistant Secretary for Preparedness and Response, the Health Resources and Services Administration [HRSA], FEMA [Federal Emergency Management Agency], and DoD.  I want to acknowledge our principal investigators from Partners Healthcare, Drs. Paul Biddinger and Richard Zane, as well as our Steering Committees, as well as the cities of New York and Los Angeles.  The New York City Department of Emergency Management and the Los Angeles Emergency Preparedness Department allowed us to pilot test these models in their cities.  New York City was interested in estimating the time required to evacuate coastal hospitals in the event of a major hurricane, and in Los Angeles, we participated in a tabletop exercise in which three hospitals were evacuated after an earthquake.

There are a substantial number of inputs to the model.  Overall, it will take you more time to set up and run this model, compared to the Hospital Surge Model.  The inputs to this model include the number of vehicles that are available to transport patients to the receiving hospitals.  We have four different types: buses, wheelchair vans, basic life-support ambulances, and advanced life-support ambulances.  In addition, you have to specify the number and type of patients to be evacuated and the available space, which includes surge capacity at the receiving hospitals.  By type of patients, we mean how many will require transport on those different types of vehicles that I indicated earlier.  There is no limit on how many evacuating and receiving hospitals you can specify.  Given all of these inputs, the model estimates the time required to move the patients to the receiving facilities.  By re-running the model with different inputs, you can also determine, for example, how many vehicles or what surge capacity you would have to have in order for all patients to be transported within a particular time constraint, say 24 hours.  As with the Surge Model, the Mass Evacuation Transportation Model has a number of assumptions, which again are highlighted in the Model Description Report.  I would like to highlight a couple.  I want to emphasize that this is a planning model for estimating transportation resource requirements; it is not an operational tool that produces a vehicle schedule or a roster of which patients will be taken to which hospitals.  Importantly, we do not model the physical constraints within a hospital that can affect how quickly patients can be moved from their room to a hospital exit, such as the number of working elevators.  Instead, you specify how much time it would take.  This is, clearly, a limitation of the model, particularly for no advanced warning evacuations.  We assume that the number and type of staff that need to go with the patients are available and this is a question I have gotten from other people using the model, you do have to specify the latitude and longitude of the evacuating and receiving hospitals.  In the User Guide, there are a couple of Web sites that you can go where you can specify an address and it will tell you what the latitude and longitude is.  

We have implemented the model, obviously, on the Web site.  This slide shows you a modified version of the input page.  The actual input page is organized a little bit differently.  It did not go on to one slide so we are showing you this alternate version.  You can see it in the upper left corner, there are cells for specifying information about your ambulances, wheelchair vans, what their capacity is, etc.  At the bottom of the screen, there is space for specifying characteristics of the different receiving and evacuating hospitals, including the geographic coordinates.  Then up in the upper right corner there is a "run scenario" button that you can click to run the model.  On the actual one on the Web site, that button appears at the bottom of the page.  

I wanted to offer a few words or some suggestions for how to use the model.  Rather than just running it once and getting the estimated evacuation time, a good way to use this is to run the model repeatedly, changing one of the inputs each time, so you can see the sensitivity of different inputs to the total evacuation time.  For many hospitals and jurisdictions, the key will be the number of ambulances, either advanced life-support [ALS] or basic life-support [BLS], that are assumed to be available to assist in the evacuation.  What percentage you assume is an important input.  In the New York City Pilot test, again, this was an advanced warning evacuation.  It was assumed that 40 percent of the city's ALS ambulances would be assigned to the evacuation.  In our Los Angeles Pilot test, which was, again, an earthquake, it was assumed that only 5 percent would be assigned to the evacuation.  So, in this slide, you can see, and this is information from our Los Angeles Pilot test, that the assumption on the percentage of the city's advanced life support fleet that will be dedicated to the evacuation has a significant effect on evacuation time, but that the effects are not linear.  There is a decrease on evacuation time if you can increase that from 10 to 20, but a much smaller effect if you increase the number available from, 40 to 50.  

So, again, to run the model, you go to the AHRQ Web site, http://massevacmodel.ahrq.gov.  There you will find a User Manual and Model Description Document.   As with the Hospital Surge Model there is no password or log in.  Again, we welcome comments and, in particular, suggestions for how to make this model more helpful to you.  Thank you, very much.

Karen Migdail:  Thank you, Tom.  In a moment you will see a quick poll question pop up to the right of your screen.  Please take a moment to fill out your response.

There will be three polls throughout this Webcast. Your responses will help AHRQ understand the audience and provide suggestions for tailoring these forums to stakeholders' needs.  The results will not be shared with others.

If you are unable to respond to the polls during this event, please E-mail your answers to emergencypreparedness@academyhealth.org. 

This first question asks: how would you characterize the organization in which you work?  Please choose only one response: hospital, clinic, or health care/medical treatment facility; home health care; nursing home; local or State public health agency; fire, rescue, emergency response; Federal Government; State government; community/local government; military; or other.

I would like to remind everyone again that if you have any questions for our panelists or experience any technical problems during this event, all you have to do is post a question in the Q&A panel on the right hand side of your screen.  Alternatively, please call 1-866-229-3239 for assistance.  Also, if you want to expand or decrease the size of any panel, such as the captioning panel on the right hand side of your screen, click the arrow shape in the upper-left corner of that panel. 

I would now like to introduce Christy Music. Christy is the Program Director for the Health/Medical Preparedness and Response Program at the Office of the Assistant Secretary of Defense for Homeland Defense & Americas' Security Affairs at the Department of Defense.  Today she will discuss the initiative that developed the Recommendations for a National Mass Patient and Evacuee Movement, Regulating, and Tracking System. Christy?  

F. Christy Music: Thanks Karen.  It is a pleasure to be here with you today and all the participants on the Webcast.  We know that through Hurricanes Katrina and Rita and large-scale and even catastrophic events that there is a requirement for general population evacuee and patient movement regulating and tracking.  We also have an issue within our country that there is not an interoperable National (meaning local, State, or Federal, tribal) system to be able to regulate, move, and track evacuees, either healthy general population evacuees or patients that need medical care or oversight.

To go over the terms: tracking, first of all, means to actually locate someone during movement either before the event, during the event, or after a mass-scale event and maintaining an audit trail of their movement from initial entry through other dispositions or intermediate locations through to their final destination.  Regulating and movement are actual operational processes, where regulating is the matching of transportation requirements of an evacuee or a patient, such as medical crews, equipment and supplies, ambulances, for instance, or a general population evacuee's need for regular transport through a train or bus, to a receiving location such as a shelter bed, or a patient that needs to be placed into a hospital bed for appropriate care.  Movement is defined as the availability, knowing that, as well as reserving, using, and releasing the appropriate transportation resource for either a general population member or a patient.  

The purpose of our initiative was to develop recommendations to build upon existing information systems and to develop a national system that is not only interoperable among the various jurisdictions (local, State, tribal, and Federal jurisdictions), but also shares data with the operational decisionmakers during the operational process.  What is important about this is that we want to build upon existing information systems, not develop a separate system. 

We have two major goals where first of all, the Federal sector, the Department of Defense, Health and Human Services [HHS], the Department of Homeland Security, along with FEMA, provide and develop a national system for all jurisdictions used, and our central goal is to use existing technology such as a central IT platform to bring together the existing systems to share data and then to identify the gaps that exist in that information system and build and insert those modules, for instance, for regulating.

The capabilities of the system include near real-time location and tracking, if needed, and an audit trail that tracks general population and patients, but also notices and tracks those evacuees that are healthy that become patients en route.  We know we need to locate and track someone from the first entry into the system through their final location or destination.  An entry point, for instance, can be a fixed facility, such as a hospital, nursing home, a collection point where a general population member would marshal or gather to get on transportation conveyances, such as buses, or patients at an aerial port of embarkation, a term used by the Department of Defense.  An entry point can also be a point of injury, someone who is found by a rescuer, a DMAT [Disaster Medical Assistance Team] within the National Disaster Medical System.  It can also be someone's home or someone found through search and rescue.  Eventually, it could also mean someone who has self-registered themselves and enters themselves into the system.  We know that we also need to incorporate regulating and movement information to perform the operations during an event.  So tracking, regulating, and movement all go hand in hand.

There are tremendous effects of this type of initiative and a system.  First of all, it will help to expand the Nation's capacity to transport, regulate, and track general population evacuees and patients.  It will support decisionmakers at the various jurisdictions for command and control decisions.  Very importantly, it will help to de-conflict the intended use of general population and patient movement resources such as ambulances, buses, trains, and also their final destinations.  We will be able to reserve hospital beds, nursing home beds, and shelter beds for incoming people who need appropriate management and care.  We will also help to coordinate general population and patient management at all levels throughout government vertically and horizontally.  We will also be able to locate the general population evacuees and patients, as I mentioned before, from first entry into the system through their intermediate locations, such as a hospital, and their final destination, such as going back home.  It will also help to provide near real-time updates, such as medical status of a patient or a general evacuee's specific needs.  It can also incorporate a patient's electronic medical records, so the receiving health care physician will be informed as to the requirements of their incoming patient.  It will also help to track general population evacuees as they become patients.  Currently, there are not systems, at the Federal sector, at least, that are interconnected to do so.  Also, it can be used by all jurisdictions by authorized users in a disaster and could potentially be available for those jurisdictions during routine use if they needed it.

It was proposed in 2004 by the Department of Defense and noted as a Department of Homeland Security priority throughout Secretary Ridge's Homeland Security Interagency Security Planning Effort as a long-term initiative, as well as a high-priority item.  It was funded by FEMA.  The focus of the first report that will be released soon is on the tracking and regulating and moving recommendations.

We asked the Agency for Healthcare Research and Quality, Dr. Sally Phillips, my co-partner in this project, to apply the funds to the existing HAvBED [National Hospital Available Beds for Emergencies and Disasters System] contract, which is a National hospital bed reporting system.  The project began in the late winter of 2005.  The draft report was completed in 2008, and the final report is expected to be published very soon.  It is also being supported now by the Department of Defense and the Health and Human Services Evacuee Patient Tracking Initiative, where we are working to interconnect our Emergency Tracking Accountability System, a general population evacuee system to the Armed Forces Health Longitudinal Technology Application-Mobile, otherwise known as AHLTA-Mobile, a hand-held clinical registration technology into HHS' Joint Patient Assessment and Tracking System, known as JPATS.  

Recommendations for this initiative were developed by a National Advisory Board comprised of Federal, State, and local representatives, along with New York City and California, as well as commercial representatives.  They developed recommendations for a system that could be used during a mass casualty evacuation to not only locate and track general population evacuees and patients, but also to improve decisionmaking regarding the evacuee and patient movement resource allocation and incident management.  They also built a planning tool, as mentioned by Tom in the previous presentation, for use before a mass casualty evacuation, which could estimate shortfalls in resources to transport patients and general population evacuees.  

There are many recommendations on the next two slides, and we will focus on the main ones that you will find in the report.  First, build on existing systems and incorporate data and architectural standards to ensure interoperability and that regulations and standards are followed, such as the Privacy Act and HIPAA [Health Insurance Portability and Accountability Act] regulations.  Activate the system in major multi-jurisdictional incidents, but offer the system optionally for routine use.  Begin with local, State, and tribal entry, then Federal entry last.  Track location and health status needs of any person encountering the system.  Enter data at touch points, such as collection points and hospitals.  Minimum data elements should be used to enter patient and general population data.  You should also build the system to accept more detailed demographic medical information later on to follow the patient.  The system should be accessible to emergency responders and planners.  We should not only incorporate feeder tracking systems but feeder institutional records systems from fixed facilities.  Eventually, we should include public, Web-based registration.  This supports Homeland Security Presidential Directive #21, which calls for the integration of vertical and horizontal levels of government but also expects that a national response should be deployed in a coordinated manner guided by constant and timely flow of relevant information during an event.

The initiative has been recognized repeatedly by senior Government officials, including the White House and Deputies Committee Council of the National Security Council and Homeland Security Council, March and April of 2008.  It also supports the Homeland Security Council Mass Evacuation Population Movement Policy Subcommittee and supports our current President's promise to create a National Family Locator System and to prepare effective emergency response plans including medical surge. 

The next step for this initiative is to develop the national system.  Our Department is proposing a partnership with AHRQ, the Department of Homeland Security, and FEMA with participation from stakeholder agencies and Federal departments, which are listed for you on this slide.

[The slide lists the American Red Cross, Department of Veterans Affairs, the Department of Justice, State, tribal, and local representatives, commercial industry, and professional association as participants in the development of a National System that the Department of Homeland Security and the Federal Emergency Management Agency would co-lead.]

Thank you very much.

Karen Migdail:  Thank you.  In a moment you will see the second poll question pop up on your screen.  This poll asks: what are your communities' current priorities for emergency preparedness?  Please choose all the answers that apply to your community: emergency health care;, primary health care/continuity of care; home health care services; palliative care; surge capacity; resource allocation; staffing; transportation; alternate care sites; disease surveillance; and communication.  Please take a moment to fill out your response.  

Now, we would like to start the first of two Q&A sessions.  We will take the questions you have regarding AHRQ's Hospital Surge Model, Mass Evacuation and Transportation Model, or Recommendations for a National Mass Patient and Evacuee Movement, Regulating, and Tracking System.  If you would like to pose a question to either Tom Rich or Christy Music, please type the question into the Q&A panel and then click on the send button. 

Tom, we will start with a question for you.  Did you use ICD-9 codes to develop your Surge Model?

Tom Rich: No, we did not.

Karen Migdail: There is another question for you.  The model uses an ED time of one day, yet most resources are only required for two to four hours.  Is two to four hours an accurate triage time, or are you including a 20-hour wait treatment lag?

Tom Rich:  We do not look at time chunks of under one day.  That is true. The accuracy could be improved by doing an hour by hour.  That is not where we are right now, but that is certainly a way to improve things.  That is a good suggestion, by the way, for whoever asked the question.

Karen Migdail:  The Hospital Surge Model has as a premise an understanding of how many patients will be coming.  Is it your sense that this information is readily available?

Tom Rich:  The model is essentially asking you to decide how many patients you want to assume your hospital will be treating.  That is, obviously, a difficult thing to do.  The model will not tell you how many to expect.  I did mention the password-protected Surge Model.  If the person asking that is from a State or Federal agency, that model will estimate how many casualties there will be from those attacks.  That is not a public Web site.

Karen Migdail:  Christy, one problem identified in the Gustav evacuation was the inability of the sending facility to get followup information with regard to the status and/or locations of the patients they sent.  Will the proposed system resolve this problem?

Christy Music:  Yes, actually, and I appreciate that question.  What we are proposing is that the fixed facilities who would enter the data on the evacuation of those patients would also be able to receive information and authorize users within that fixed facility, who would then be able to receive data and enter the system.

Karen Migdail:  Thank you. Tom, I will take the moderator's prerogative and combine two questions because they are very similar.  The first part is: by flu do you include pandemic H5N1 flu, and with regard to the Hospital Surge Model, does the output of the model, for example, bed and ventilator requirements, coordinate well with other models currently being used such as Flu Aid or Flu Surge?

Tom Rich:  The answer to the first question is yes.  We did use a different approach.  Our flu scenario is based on the model developed by the MIDAS group at the National Institutes of Health, I believe.  That is the one scenario that we did not build from scratch.  I do want to acknowledge that.  Thank you for asking that question.

Karen Migdail:  Christy, will this new system coordinate with TRAC2ES, and how?

Christy Music:  It is possible that the system will coordinate with TRAC2ES, which is a DoD transportation regulating system used by the U.S. Transportation Command at Scott Air Force Base in Illinois.  The regulating portion of TRAC2ES could potentially push data into this national information system.  There could be a push/pull system where the data could be bi-directional.

Karen Migdail:  Great.  Tom, can you discuss the process by which the travel time estimate is arrived?  In addition to distance, what other features are taken into consideration?

Tom Rich:  That is a great question.  That is a tough one.  We struggled with that because on the one hand we thought maybe we should just have people specify the travel time they want to use.  If you are running this model in a big city, evacuating 20 hospitals and sending them to 40 others, that is an awful lot of travel time to specify.  We did develop a sub-model within the model for estimating travel time.  It does take into account the latitude and longitude.  We obtained the drive time information from 40 or more metropolitan areas.  We do have a model in there, basically, the details of which I do not want to go into now; they are described in the Model Description Document.  I do want to add that there is an input for saying that the travel time is twice as fast or slow or twice as long so there is the ability to scale that in the model.

Karen Migdail:  Great. Thank you.  Christy, this question is a little off topic, but can you provide a brief update on the status of HAvBED?

Christy Music:  It has been finalized.  I understand that the Department of Health and Human Services has it, and it is functional.  It is used to roll up aggregate hospital data and also has the capability to open up and serve as a regulating tool, as I mentioned in the presentation, where it would have the national hospital beds available and could be visible to decisionmakers to reserve those beds for patients.  It can also be expanded for nursing homes and other fixed facilities.

Karen Migdail:  Thank you.  Tom, again about the Mass Evacuation Transportation Model, are the pre-loaded per-patient load times based on previous experience or observations in an exercise?

Tom Rich:  You have the ability to specify them.  So, if you did an exercise and know how long it takes, then you should, certainly, specify that.  In the User Guide, we did indicate what times were assumed in our pilot test in New York City and Los Angeles.  If you have an exercise, you could certainly use those values.

Karen Migdail:  Thank you.  Christy, does the tracking system interface with systems like the Salamander Intratracks?

Christy Music:  To whoever asked that question, I apologize, I am not familiar with that system, but it could be.  In the next phase of this initiative, there will be an overview of the existing systems.  We will take a look at those capabilities as well as the owners and users of those systems.  As long as those systems follow standards, national standards, we would be able to incorporate it into the national system.

Karen Migdail:  Great. Thank you. Tom, does the Hospital Surge Model include facility characteristics like morgue surge estimates?

Tom Rich:  I am not quite sure I understand the question.  That is one of the resources, the morgue resources needed.  There are assumptions on the per-patient per-day requirements for those people that need that.

Karen Migdail:  Christy, sorry if I missed it, but is there an estimated time of arrival [ETA] for when the tracking system will be operational?

Christy Music:  We are talking about the National Initiative Tracking System.  We are looking for an estimated three-year date of completion with phases to be able to complete certain tasks within a contract to be able to support, not only Federal, but local, State, and tribal jurisdictions.

Karen Migdail:  Thank you.  Another question for Tom: are there plans for incorporating staff and resource volume into the Hospital Surge Model and/or Mass Evacuation Transportation Model for a more realistic picture in a disaster situation?

Tom Rich:  There are a whole bunch of staff resources in the Hospital Surge Model; 10 or 20 different personnel resources.  

That is a great suggestion for the Mass Evacuation Transportation Model.  Right now, that is not in there.  Certainly, it is critical to have the appropriate persons on the ambulances and other places when patients are evacuated.  That would be a great way to enhance the model.

Karen Migdail:  Great.  Another one for Tom: what about multiple hospital evacuations in a region?  Can that be modeled in the Mass Evacuation Transportation Model?

Tom Rich:  Yes.  You can specify any number of evacuating hospitals and any number of receiving hospitals.

Karen Migdail:  Great.  We have time for one last question. Tom, can you discuss the time to overflow facility input?  I am unclear as to what is its purpose and how to use it?

Tom Rich:  Sure that is a good question.  Basically, through the inputs, you specify how much space is available in the receiving hospitals.  Part of that is surge capacity.  If there is still not room for the patients to be evacuated, they go to what is called the overflow facility.  In real life, that might correspond to an airport, where they may be transported out of town.  So, you specify how long it takes to get there.  Again, I would encourage you to go to the User Manual and the Model Description for more information.

Karen Migdail:  Great.  Thank you, Tom and Christy, and to our audience for the great questions.  I would like to remind everyone that there will be another Q&A session at the end of Part II of this Webcast.  

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