Healthcare Emergency Response Coalition of Palm Beach County (HERC)

State: FL Type: Model Practice Year: 2004

The Healthcare Emergency Response Coalition of Palm Beach County (HERC) is a Coalition of representatives from the Health Department, Emergency Management, Fire Rescue, Sheriff, Red Cross, and area hospitals that have come together to work to prepare the community to respond to a public health emergency or disaster events including terrorist attacks. The target population for the model practice is the population of Palm Beach County. Based on the Coalition’s protocols, the group’s mission is intended to reach 100% of the target population. The mission of HERC is to develop and promote the healthcare emergency preparedness and response capabilities of Palm Beach County. Outcomes of the practice can be measured by the improved ability of the community to respond to a public health emergency or disaster event. To replicate the HERC model practice, communities would need to bring together representatives from the healthcare community including the Health Department, area hospitals, and other first responders from emergency management, fire rescue, and law enforcement. The Health Department in Palm Beach County has served as one of the leaders of the HERC model practice and would be a natural leader for a similar organization in other communities. The goals and objectives of HERC are to provide a forum for the healthcare community to interact with one another and other response agencies at a county, regional, and state level to promote emergency preparedness; to Coordinate and improve the delivery of healthcare emergency response services; to foster communication between local, regional, and state entities on community-wide emergency planning and response; to ensure overall readiness through coordination of community-wide training and exercises; and to promote preparedness in the healthcare community through standardized practices and integration with other response partners.
HERC came together in 2001 to begin to plan for a county-wide health and medical response to a terrorist attack or public health emergency. The Palm Healthcare Foundation, an independent community healthcare foundation, donated $250,000 to help local hospitals prepare for bioterrorism. The $250,000 grant was awarded with the intent of funding the purchase of bioterrorism preparedness equipment. Additionally, the grant’s intent was to secure a communication system that included dedicated communication devices in each of the 14 hospital emergency rooms in Palm Beach County. HERC’s practices directly responds to the public health need it was designed to address. HERC developed hospital protocols for preparing for and responding to any mass casualty incident including those that result from both terrorist attacks and naturally occurring public health emergencies. HERC’s policies and procedures provide step-by-step procedures for donning and doffing hazmat personal protective equipment (PPE) suits, decontaminating victims, controlling large numbers of potential victims, and triaging patients in a disaster scenario. Additionally, HERC addresses the loaning of staff and resources between the area hospitals, credentialing of volunteer health care providers, and communication protocols to be used during events both among hospitals and between hospitals and the emergency operation center. While other communities have come together to form a community-wide response apparatus, none rival the achievements or sustainability as exhibited by HERC. HERC’s effort is entering its third year in its current form and remains stronger than ever and continually engaged by all participants. HERC’s most innovative characteristic can be found in its ability to bring together several for-profit hospitals, not-for-profit hospitals, and public hospitals to work together and participate not only in the activities of the Coalition, but as participants in a Mutual Aid Agreement that addresses staff and resource assistance among all hospitals. Hospital representatives, along with representatives from the Department of Health and other county agencies, hold monthly planning meetings and engage in collaborative county-wide training and disaster drills.
Agency Community Roles The Palm Beach County Department of Health is an instrumental leader in bringing this group together and advancing its cause. The Health Department is the lead agency for the Emergency Services Function #8 – Health and Medical – in the County’s Comprehensive Emergency Management Plan and therefore a natural leader of the HERC Coalition. HERC strives to integrate its policies and practices with the County Plan so all emergency response partners are operating in conjunction with one another. In addition to the Department of Health, other members of the coalition include Palm Beach County Emergency Management, Fire Rescue, Sheriff’s Office, the Health Care District, and the Red Cross along with wide-spread participation by the 13 acute care hospitals in the county. In addition, the local Veterans Administration hospital and A.G. Holley state hospital are active participants. The Health Department helps to foster collaboration with all community stakeholders by assisting with community-wide planning, training, and exercise coordination. Public health alerts are disseminated throughout the Coalition Membership by the Department of Health to keep all community healthcare and emergency response participants informed and educated about emerging and potential public health threats. The Health Department has built a strong relationship with HERC Members which has enhanced the achievement of HERC’s model practice goals. Costs and Expenditures The costs for the first phase of the group’s activities were funded by a $250,000 grant from the Palm Healthcare Foundation, an independent community healthcare foundation. Additionally, all government agencies and each hospital provided in-kind contributions by providing a permanent representative to the group to participate in planning and development. Stakeholder commitment has remained high throughout the life of the Coalition. All stakeholders recognize the mutually beneficial outcomes from involvement in a community-wide emergency response entity. In regards to the cost of the program, the practice was clearly worth the resources invested. For $250,000 Palm Beach County is more prepared for an untoward event as a result of training, drills, and equipment. If a disaster occurred in Palm Beach County, hospitals would be capable of decontaminating patients while at the same time protecting staff and the hospital, communicating and coordinating assistance with the county emergency management, and sharing information and resources with other hospitals. Implementation HERC was the culmination of several years of work. After Hurricane Andrew in 1992, a group of interested emergency preparedness stakeholders came together to develop a response plan in the event another hurricane of Andrew’s magnitude struck Palm Beach County. The Health Department, along with County Emergency Management, Fire Rescue, Sheriff, and several area hospitals began meeting and planning. In early 2001, the group participated in a tabletop and full-scale drill using a terrorist attack scenario. The after-action critiques identified many areas for improvement and helped set the stage for future work. After September 11, 2001, the group’s work took on more urgency. Future drills were planned and the group grew to include representatives from all hospitals in Palm Beach County. The objective turned squarely to preparing the county for a health care and medical response to chemical, biological, and radiological terrorist events. To meet the objective, the group identified needs and procedures to achieve the needs. The needs included purchasing personal protective equipment (PPE) hazmat suits for all area hospitals, developing standardized training and disaster event protocols, and obtaining a communication system for all hospitals to be able to communicate with each other and with the county emergency operations center. Additionally, it was decided that there would be county-wide or regional drills each year and PPE / decontamination training sessions for hospital staff. The timeline to meet the groups first phase of needs was set at 2 years. This timeframe allowed for the purchase and delivery of 6 PPE sets for each hospital, the purchase and programming of one 800MHz radio for each hospital, and the detailed development of standardized training and disaster event protocols.
All of the major objectives have been met. Some ancillary items have still not been completed, but continue to be worked on. The major challenge to the practice lies in the fact that the Coalition is comprised of volunteer organizations and members. Each participant has a full-time job at their organizations and usually devotes additional time for HERC-related matters. This is where the Health Department and other county agencies provide services that help keep the process moving towards stated objectives. To date, HERC has accomplished the following: Developed countywide personal protective equipment (PPE) standards for Palm Beach County hospitals and coordinated the PPE equipment purchase. Implemented PPE donning and doffing training for all Palm Beach County hospitals free of charge, in collaboration with Palm Beach County and West Palm Beach Fire Rescue. 10 PPE / decontamination training exercises subsequently trained 293 healthcare professionals from 13 Palm Beach County hospitals. Coordinated with all hospitals emergency rooms to standardize and purchase secured communications equipment. Hospitals participate in weekly exercises to maintain competencies with these communication devices. Participated in a successful tabletop exercise and two local/regional drills that tested and evaluated HERC procedures in cooperation with the Region 7 Domestic Security Task Force and Palm Beach County Emergency Management. The two local disaster drills took place on May 21, 2003 and December 11, 2003. Developed a HERC webpage through the Palm Beach County Medical Society. Participated in a Needs Assessment and Strategic Planning Process. Shared program with the State of Florida and other counties within the state. Executed a Mutual Aid Memorandum of Understanding between 14 acute care hospitals in Palm Beach County, allowing for the sharing of resources and staff between hospitals.   Prior to HERC, there was no organization within the county working to bring together the major stakeholders to prepare for a public health emergency or disaster event. However, in two years, the county is clearly more prepared to handle such an event than it was previously. The outcomes of the Coalition are directly traceable to the practices of HERC. HERC brought all parties to the table to collaboratively plan a community-wide response to an emergency or disaster event.
Implementation Recognizing that the Coalition will require additionally funding to sustain its existence into the future, HERC has recently undertaken a strategic planning process to identify future needs and focus in on the most optimal way to raise funds to advance the Coalitions mission. Funding sources will primarily be focused on federal and state grants as well as foundation grants and self-financing activities. Lessons Learned Some lessons learned about procedures and tasks involved in implementing the practice are many. However, some primary ones include the need to share leadership of the Coalition between the hospital community and the government agencies. This sharing helps to assure that no one stakeholder drives the agenda. For example, the two leadership positions (Chair and Vice Chair) are filled by a representative from the hospital community and from the Health Department. Another lesson learned is that the items the Coalition works on must be of interest to all stakeholders to maintain interest. This has been challenging, as sometimes representatives from various disciplines may not have a topic on the agenda that directly relates to their agency or work. Staff turnover creates a challenge as well and a subsequent education process for the new representatives.