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AD HOC INFRASTRUCTURE

[ENTER FACILITATOR’S NAME AND CONTACT INFORMATION]

Developed by Troutman Sanders LLPDeveloped for the Virginia Department of Health

Funded by Centers for Disease Control and Prevention

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Toolkit Presentations Instructions for Use

Toolkit Presentations are intended to be a companion to the Hospital Implementation Guide and should not be used in isolation.

The Presentations are intended to serve as a starting point for the facilitator. The facilitator should thoroughly review the Presentation prior to use in Implementation Team, CRAG or Subcommittee meetings and customize the Presentation to meet the unique needs of the meeting participants.

Pay particular to attention to the information provided in brackets ([ ]), which must be completed by the facilitator prior to use.

Included in the “Notes” section of each slide are the following types of information:

• Slide Type, which indicates whether the slide is for information or discussion, serves as a placeholder, or is some combination thereof

• Planning Guide Section(s), which will direct the facilitator to the corresponding sections of the Planning Guide and Hospital Implementation Guide for further information

• Special Instructions, which provides directions for the facilitator to customize the slide for the intended audience

• Speaker’s Notes, which provides more detailed information to supplement the material on the slide

Refer to the Hospital Implementation Guide for further guidance and helpful hints on effectively completing the process described in the Planning Guide.

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CRAG Members

[Enter names and departments of each CRAG member]

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Add slides from Altered Standards Overview and/or Chapter 1 presentation, as needed, to re-introduce the CRAG to the concept of altered standards and critical resource shortage response planning, especially if new members are involved.

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Introduction

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Why do we need an ad hoc infrastructure?

During an event, resources will become scarce for which you have no Protocol

Planning Unit will need to quickly develop Protocols in the midst of the event to respond to these shortages

Developing an infrastructure for this intra-event planning mechanism is crucial to an effective response

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Chapter Overview

Determine how the Planning Unit will decide when the development of an Ad Hoc Protocol is required

Develop the process by which an Ad Hoc Protocol will be created in the midst of a disaster

Develop a standard mechanism for communicating the creation, implementation, and operationalization of Ad Hoc Protocols

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WHEN IS DEVELOPMENT OF AN

AD HOC PROTOCOL REQUIRED?

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Development of a CRSE

Supply of the Resource

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Potential CRSE Alert

Supply of the Resource

Who will identify the declining supply of the resource?

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Ad Hoc Protocol Development

Supply of the Resource

Who will identify the need to develop an Ad Hoc Protocol?

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Identifying a Critical Resource Shortage

STATUS

Does demand exceed supply?

FORECAST

When will demand exceed supply if it doesn’t already?

DURATION

For how long will demand exceed

supply?

MAGNITUDE

To what extent does or will demand exceed supply?

MITIGATION

Options for obtaining additional supplies of

the resource.

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AD HOC PROTOCOL DEVELOPMENT

PROCESS

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Identifying Need for Ad Hoc Protocol

[____] reports a shortage to Incident Command

Incident Command activates/notifies Critical Resource Advisory Group (CRAG)

CRAG determines if an Ad Hoc Protocol is necessary by answering the following questions:

STATUS

Does demand exceed supply?

FORECASTWhen will

demand exceed supply if it

doesn’t already?

DURATION

For how long will demand exceed

supply?

MAGNITUDETo what extent

does/ will demand exceed

supply?

MITIGATIONOptions for obtaining

additional supply of the resource.

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Developing the Ad Hoc Protocol

Ad Hoc Protocol Development Subcommittee is formed

Subcommittee develops Protocol

Incident Commander activates Protocol when appropriate

Protocol is presented to CRAG/Incident Commander for review and approval

CRAG activates an Ad Hoc Protocol Development Subcommittee

Once the CRAG has determined that an Ad Hoc Protocol needs to be developed:

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Identifying Need for Ad Hoc ProtocolShortage is identified and assessed by

[_______]

[______] provides information to Incident Command

Incident Command determines there is no need to respond at this

time

STATUS

Does demand exceed supply?

FORECASTWhen will

demand exceed supply if it

doesn’t already?

DURATION

For how long will demand exceed

supply?

MAGNITUDETo what extent

does or will demand exceed

supply?

Incident Command provides simple directive for responding to CRSE

Incident Command activates a Subcommittee

to develop Ad Hoc Protocol

MITIGATIONOptions for obtaining

additional supply of the resource.

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Developing the Protocol

Subcommittee develops Ad Hoc Protocol

Incident Commander activates Ad Hoc Protocol when appropriate

Subcommittee presents Ad Hoc Protocol to Incident Command for review and approval

Incident Command provides instructions to Ad Hoc Protocol Development Subcommittee

Once Incident Command has activated a Subcommittee to develop an Ad Hoc Protocol the following process will occur:

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Ad Hoc Protocol Development Subcommittees

Liaison from Incident CommandPhysicians, nurses, and other clinical

personnel who are:• most knowledgeable about the resource• representative of the end user(s)

“Pre-trained” individualsFacilitatorEthics representative

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Instructions for Subcommittees

No more than X hours to develop algorithm Don’t forget your ethical frameworkDon’t forget your operational infrastructure – the

Protocol needs to be easy to implement Consider modifications to stretch resource firstConsider allocation criteria (inclusion, exclusion,

prioritization)

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Instructions for Subcommittees

Consider multiple tiers based on severity of shortage Consider “essential documentation” for the Protocol Identify any just-in-time training that will be required Develop process for revising Protocols Consider metrics for determining when the CRSE has

ended and the process for communicating this to the staff

Consider how to communicate all aspects of the final Protocol to various audiences

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DEVELOP AN EFFECTIVE WAY TO COMMUNICATE THE AD HOC

PROTOCOL

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Potential Audiences

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Possible Messages

Ad Hoc Protocol created

Ad Hoc Protocol content

Ad Hoc Protocol training required

Ad Hoc Protocol activated

Ad Hoc Protocol termina

ted

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Communication Methods

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What message(s) will you communicate to each audience and

how will you do this?

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Questions?Questions?