Latest / Becker’s Healthcare Podcast / Beyond Checklists: Readiness vs. Reality, Leading MCI Change with Ben Toombs & Nicholas Bell

Transcript

Beyond Checklists: Readiness vs. Reality, Leading MCI Change with Ben Toombs & Nicholas Bell · Becker’s Healthcare Podcast

• 0:01
  This is where health care leadership comes together.
• 0:04
  Becker's sixteenth annual meeting brings more than 3,500
• 0:07
  hospital and health system executives and nearly 800
• 0:10
  speakers to Chicago, April 13 through the sixteenth.
• 0:14
  This year's event includes keynote conversations with Dallas
• 0:17
  Cowboys legend Troy Aikman and former president George
• 0:20
  w Bush. For the agenda and event details,
• 0:22
  visit beckershospitalreview.com
• 0:25
  and click on the events tab in the
• 0:26
  upper right. We're looking forward to hosting you
• 0:29
  in Chicago.
• 0:31
  Hello, everyone, and welcome to a very special
• 0:34
  Becker's HealthCare podcast. I'm Scott King, thrilled today
• 0:37
  to be joined by two very special guests,
• 0:39
  Ben Toombs, the director of emergency programs with
• 0:42
  UW Health, and Nick Bell, manager of safety
• 0:45
  and emergency management with UW Health. And, we're
• 0:48
  gonna have a a really interesting and unique
• 0:51
  conversation today.
• 0:52
  We're gonna work with the title Beyond Checklist,
• 0:55
  Readiness versus Reality, Leading
• 0:57
  MCI Change. Gonna gonna cover a lot,
• 1:00
  with a mass casualty
• 1:02
  incidents and and how to prevent them and
• 1:04
  some really great in-depth stuff. And and Ben
• 1:06
  and Nick, thank you guys so much for
• 1:07
  doing this. I appreciate it. Yeah. Thank you,
• 1:09
  Scott.
• 1:10
  Of course.
• 1:11
  And then, you know, we'll we'll just we'll
• 1:13
  just jump right in here. You know, the
• 1:15
  first thing I wanted to ask you
• 1:17
  and, Ben, if you don't mind taking this
• 1:18
  one, what's the biggest misconception leaders have about
• 1:22
  what MCI readiness,
• 1:24
  really requires today?
• 1:26
  Yeah. Absolutely. Great question. So
• 1:29
  with MCI,
• 1:30
  when you're dealing with MCI preparedness, there are
• 1:33
  a lot of little traps out there that
• 1:35
  sometimes,
• 1:36
  create pitfalls for MCI
• 1:39
  readiness and and being prepared for it.
• 1:42
  Some of them can be as simple as
• 1:43
  saying that you have an MCI plan.
• 1:46
  The issue is sometimes
• 1:48
  saying you have an MCI plan
• 1:50
  can be that you have this false sense
• 1:51
  of security where you say, well, we've got
• 1:54
  this binder. We have these policies, and we
• 1:56
  have this annual drill. So, therefore, we're ready
• 1:59
  for an MCI.
• 2:01
  But, actually,
• 2:02
  most failures when it comes to an MCI
• 2:04
  isn't on the clinical side. It's actually looking
• 2:07
  at the organizational
• 2:08
  logistics side of how to deal with an
• 2:11
  MCI.
• 2:13
  The reality of an MCI and how to
• 2:15
  handle it,
• 2:16
  it's like an operational muscle. You have to
• 2:19
  constantly
• 2:19
  be using it and and testing it to
• 2:23
  really make it stronger and more robust.
• 2:26
  So
• 2:27
  with that, you also have to be comfortable
• 2:30
  with working with what you have and not
• 2:33
  becoming distracted
• 2:34
  or,
• 2:36
  again, creating that false narrative of saying, well,
• 2:39
  okay. If this happens,
• 2:41
  we're going to do this. Well,
• 2:44
  are you sure? Have you tested that? Are
• 2:46
  you aware that's actually what's gonna happen? And
• 2:49
  sometimes we fall into this other trap, which
• 2:51
  is believing something is gonna happen, but, actually,
• 2:54
  that isn't what is reality
• 2:56
  when an MCI occurs.
• 2:58
  So
• 2:59
  beyond capability
• 3:01
  and logistics,
• 3:03
  what you really wanna be looking at is
• 3:05
  having conversations
• 3:06
  around,
• 3:07
  well, what is an MCI?
• 3:09
  We're very lucky. We're a level one treatment
• 3:11
  center for both pediatrics and adults. We're also
• 3:14
  a pediatric adult burn center. So that means
• 3:17
  we can handle a lot of different things
• 3:19
  coming through our doors.
• 3:20
  But when you talk about an MCI,
• 3:22
  is it a gunshot penetrating
• 3:24
  wound? Is it blunt trauma from a vehicle
• 3:27
  accident? Is it,
• 3:29
  burns from kids throwing petrol on a on
• 3:31
  a bonfire?
• 3:32
  But also, you know, when we look at
• 3:34
  MCI, we're talking about an organization
• 3:37
  that has
• 3:38
  reached its limit of capability
• 3:40
  with,
• 3:42
  a mass surge of patients coming in
• 3:45
  and how it can handle that. And so
• 3:48
  organizations
• 3:49
  need to be really honest with themselves about
• 3:51
  what their logistical challenges are and what their
• 3:53
  supply chains are,
• 3:55
  and how
• 3:57
  that is gonna interact with their MCI plan.
• 4:00
  A powerful word we talk about a lot
• 4:03
  is,
• 4:04
  what does that mean? So when we talk
• 4:06
  about our MCI planning, we always say, well,
• 4:08
  what does that mean? And we really dig
• 4:11
  deep into that conversation,
• 4:14
  whether it's
• 4:15
  talking about
• 4:17
  burn patients that can take multiple days and
• 4:20
  months to care for or
• 4:22
  penetrating control rooms and saying, well, what does
• 4:25
  that mean and how does that look like?
• 4:26
  Or when we talk about supply chains,
• 4:29
  well, what does it mean for a supply
• 4:32
  truck to arrive on a Monday
• 4:34
  versus a Saturday night during winter.
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  And those are the conversations you really need
• 4:39
  to be having.
• 4:41
  Ben, you have really, really interesting stuff. I
• 4:42
  just wanna ask you a quick follow-up. You
• 4:44
  you mentioned
• 4:46
  dealing with MCIs. Is I mean, safe to
• 4:50
  say this day and age, there there's just
• 4:51
  a lot more kind of distractions across the
• 4:54
  board. And I'm I'm curious which ones,
• 4:56
  you you may wanna emphasize there.
• 4:59
  Yeah. So for us,
• 5:02
  we have,
• 5:03
  really robust clinical skills here.
• 5:06
  And what we're really looking into now is,
• 5:10
  you know, what does the next day to
• 5:13
  look like? What does tomorrow look like? Because
• 5:15
  we can handle the MCI when it comes
• 5:17
  through our door. But if we use all
• 5:20
  our resources then, so what does tomorrow look
• 5:22
  like for our next patients? But, also, we're
• 5:24
  looking at,
• 5:26
  if there is an MCI,
• 5:28
  then what we how do we handle our
• 5:29
  stroke patients, our STEMI patients? How do we
• 5:31
  continue our normal care as well at the
• 5:33
  same time?
• 5:35
  Burn patients is a really interesting one because
• 5:38
  with a penetrating gunshot wound, I'm gonna simplify
• 5:41
  it. They come into the ED. They get
• 5:43
  stabilized. They go to the OR. They go
• 5:45
  to inpatient.
• 5:46
  That should be they might go back to
• 5:48
  the OR for another review or some more
• 5:50
  surgery. But with a burn patient, what you
• 5:52
  end up having there is if it's a
• 5:54
  real deep burn, They're gonna be in the
• 5:56
  OR multiple times over a number of months
• 5:59
  for for skin grafts or debridements or cleaning.
• 6:03
  And so now what you thought with your
• 6:05
  MCI plan was, well, okay, we can handle
• 6:07
  this within a couple of days Is now
• 6:09
  an MCI plan that could take months,
• 6:12
  with a huge supply chain, requirement behind it?
• 6:17
  And, Nick, what has fundamentally changed about MCI
• 6:21
  planning in the last five years and what
• 6:23
  hasn't changed, you know, nearly enough or, as
• 6:26
  much as it should?
• 6:27
  Yeah. Thanks. I think, you know, thinking from
• 6:30
  an industry perspective,
• 6:32
  I think over time, despite the complexity of
• 6:34
  the topic,
• 6:36
  we've increasingly got a better understanding of how
• 6:38
  to do MCI preparedness well, and I think
• 6:40
  there's many useful resources out there for health
• 6:43
  care organizations to use to do this well.
• 6:45
  And I think also kind of hand in
• 6:47
  hand with that, over time, we've increasingly seen
• 6:49
  improved technologies and communication tools,
• 6:53
  that are at our disposal that we can
• 6:55
  incorporate into our response strategies. And I think
• 6:57
  another thing that's changed,
• 7:00
  a positive positive thing today,
• 7:03
  is that there's been an increased focus on
• 7:04
  staff mental health and well-being and recognizing that
• 7:07
  these situations can be traumatic,
• 7:09
  and staff need to receive
• 7:11
  the the support that they need as part
• 7:13
  of our crisis response. But,
• 7:15
  I think another thing to talk about with
• 7:17
  this sort of, like, the shifting landscape of
• 7:19
  hazards,
• 7:21
  with respect to MCI and kind of what
• 7:23
  keeps us up at night.
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  Obviously, that's shifted over the last twenty five
• 7:28
  years,
• 7:29
  maybe a little bit less so over the
• 7:30
  last five years. But
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  I think with the story with MCI preparedness,
• 7:34
  you know, it's been kind of an increasingly
• 7:36
  broad scope,
• 7:38
  lens when it comes to those hazards. Right?
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  Like, I think twenty five years ago after
• 7:42
  nine eleven, the focus was on terrorism and
• 7:44
  bioterrorism.
• 7:46
  After hurricane Katrina, you know, like, that came,
• 7:49
  there came a more broad all hazards view
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  of preparedness generally. And, obviously, we're living in
• 7:55
  a post COVID world, and infectious disease surges
• 7:58
  are probably part of your planning process if
• 8:00
  they they weren't already.
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  You know, even though there's even not necessarily
• 8:03
  full overlap with your MCI plans and training
• 8:06
  trainings and exercises with,
• 8:08
  with infectious disease surge. But,
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  maybe one of the newer things that we
• 8:13
  think about more today than ever before
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  is cybersecurity and cybersecurity incidents, which
• 8:19
  you may not think of something that's related
• 8:21
  to NCI, but we think about the possibility
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  of, you know, like a cyberattack or cybersecurity
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  breach
• 8:28
  of a public or large infrastructure system that
• 8:30
  could have some really significant impacts that leads
• 8:32
  to a patient surge event.
• 8:34
  So like Ben was talking about previously, you
• 8:36
  know, MCIs can be caused by many different
• 8:39
  hazards. Right? There's be severe weather or natural
• 8:42
  disaster,
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  could be civil unrest, a crowd crush, a
• 8:46
  vehicle accident,
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  hazardous material incident.
• 8:49
  And the injuries from that can be blunt
• 8:51
  or penetrating or burn or chemical,
• 8:54
  radiological,
• 8:55
  and we really need to be ready for
• 8:57
  all of those things.
• 8:58
  I think having said that, though, I think
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  while,
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  MCIs can be caused by a lot of
• 9:03
  different things,
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  the one that when, you know, you discuss
• 9:06
  this topic with people today,
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  the one that has them worried, and I
• 9:10
  think rightfully so, is a large scale active
• 9:12
  shooter incident, like a Las Vegas style mass
• 9:15
  shooting or an Orlando style mass shooting,
• 9:18
  school shootings that you see that occur across
• 9:21
  our country, things like that.
• 9:23
  And in particular, that sort of potential situation
• 9:25
  where your resources are truly rapidly overwhelmed in
• 9:29
  the face of a massive surge of patients,
• 9:31
  like 5,100,
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  or more.
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  That's the big one that people think about
• 9:35
  and talk about when we when we do
• 9:37
  MCI planning.
• 9:38
  And at UW Health,
• 9:40
  obviously, we experienced a a mass casualty incident
• 9:43
  in December 2024 when the Abundant Life Christian
• 9:46
  School shooting, took place.
• 9:48
  And, of course, we're we're really proud of
• 9:50
  the care that our patients received during that
• 9:52
  incident. But, you know, at UW Health and
• 9:54
  I think in in emergency management, generally, it's
• 9:57
  it's all about continuous improvement. Right? So how
• 10:00
  could we do this better? And,
• 10:02
  and so that was really a catalyzing incident
• 10:04
  for us. We we took that really seriously.
• 10:07
  And shortly after the incident, we formed an
• 10:09
  MCI preparedness steering committee and said,
• 10:12
  okay. We're gonna make sure that we're really
• 10:14
  prepared.
• 10:15
  And that process
• 10:18
  that we've gone through over the past year
• 10:18
  has involved many different org leaders across our
• 10:20
  organization, both physician leaders and operational leaders,
• 10:24
  and it involve creating this open,
• 10:27
  no fault learning environment and have some we
• 10:30
  had some very frank, open, and honest conversations.
• 10:34
  And I think it involved tearing down our
• 10:36
  assumptions about our readiness. You know, Ben was
• 10:38
  touching about on this. Like, really, what would
• 10:40
  happen,
• 10:41
  if we had MCI? You know? If we
• 10:43
  have assumptions about that, really question them.
• 10:46
  And we just took our plans. We took
• 10:48
  our assumptions, and we churned it all up.
• 10:50
  And the outcome of that was a completely
• 10:52
  revamped,
• 10:53
  MCI surge plan for us as well as
• 10:55
  a revamped labor pool and traffic control and
• 10:57
  family reunification plan.
• 11:00
  Yeah. Thanks, Nick. You know, I think it's
• 11:02
  the the focus on
• 11:05
  paying attention to and helping with a team
• 11:08
  member's mental health dealing with MCIs. I just
• 11:11
  I think that's so important. Is there any
• 11:12
  way you can kinda just dive into a
• 11:14
  little more maybe some things that
• 11:16
  UW Health does or or is planning to
• 11:18
  do along those lines?
• 11:20
  Yeah. Absolutely. So,
• 11:22
  we have an employee assistance program.
• 11:25
  We have resources
• 11:26
  that are in place that we can link,
• 11:30
  our employees to to make sure that they
• 11:32
  get that mental health support that they need.
• 11:35
  And a big part of that too is
• 11:36
  just, you know,
• 11:39
  when that sort of thing needs to be
• 11:40
  activated, that's gonna be something,
• 11:42
  that's activated through our hospital incident command system.
• 11:45
  So it's also about ensuring that the designated
• 11:48
  leaders at our organization
• 11:49
  who are gonna fill those roles,
• 11:51
  are aware of those resources and know,
• 11:54
  to activate them to get those, get staff
• 11:57
  those resources as quickly as possible.
• 12:00
  Wonderful.
• 12:01
  And, Ben, how do you balance detailed clinical
• 12:03
  protocols
• 12:05
  with execution under, you know, extreme stress in
• 12:08
  in these situations?
• 12:10
  Yeah. So, you know,
• 12:12
  we don't we don't really purely rely on
• 12:15
  just protocols when you're under stress. You you
• 12:17
  really
• 12:18
  rely on training patterns. You know, how many
• 12:21
  times I mean, when you really think about
• 12:22
  it, how many times during the day do
• 12:24
  you do something out of habit rather than
• 12:26
  thought? And so when you're in a stressful
• 12:29
  situation, you tend to go back to that
• 12:32
  safe known pattern.
• 12:34
  And so
• 12:35
  the way we're working that is people revert
• 12:37
  back to habits, not policies in some respects.
• 12:40
  And so what we're doing is we're you
• 12:42
  know, we've got great clinical
• 12:44
  staff, and we're allowing our clinical staff to
• 12:46
  be the strong providers and nurses and support
• 12:48
  staff that they are. We're not messing with
• 12:50
  those relationships
• 12:51
  unnecessarily.
• 12:52
  But what we are doing is we're nudging
• 12:55
  habits down into the right pathway. So when
• 12:58
  those stressful episodes do happen,
• 13:01
  those patterns
• 13:02
  are already ingrained,
• 13:04
  into what needs to be done. Part of
• 13:06
  that is,
• 13:08
  developing on what we call job action sheets,
• 13:11
  setting role identification
• 13:14
  so that when people have a crisis, an
• 13:17
  MCI moment,
• 13:19
  then their normal reaction is to go to
• 13:21
  focus on clinical. Because that's what we all
• 13:23
  do as nurses and doctors, we focus on
• 13:25
  what we know.
• 13:26
  But what we want to do is nudge
• 13:28
  the leaders in those groups to say, okay,
• 13:30
  let the clinical people do the clinical, and
• 13:32
  you are now going to be doing the
• 13:33
  operational stuff and the command and control stuff
• 13:35
  in there. And interesting that we were talking
• 13:37
  about mental health a second ago because, you
• 13:39
  know, part of that journey with mental health
• 13:42
  is
• 13:43
  allowing people giving people those roles and saying,
• 13:46
  this is what you're responsible for, making a
• 13:49
  unsafe unknown environment to a safe unknown environment.
• 13:53
  And what does that truly mean? It it
• 13:56
  really means that
• 13:57
  by training people, by having definitive roles set
• 14:01
  out, by letting people do their jobs well,
• 14:04
  by giving them the tools and supplies,
• 14:07
  It allows people to function in that unknown
• 14:10
  environment
• 14:11
  in a safe manner,
• 14:14
  and that that really helps providers,
• 14:16
  achieve that that high level of care in
• 14:18
  those in those environments.
• 14:21
  Nick, where does MCI planning most often break
• 14:24
  down? Is it governance, communication,
• 14:26
  training, or execution?
• 14:29
  Yeah.
• 14:30
  Gosh. That's a really difficult question. And, like,
• 14:32
  you know, my initial reaction, I wanna say
• 14:34
  all of the above. But I think if
• 14:36
  I had to if I had to pick
• 14:38
  one or two, I'm inclined to say, you
• 14:41
  know, governance or communication.
• 14:43
  I think that's where we've had some issues
• 14:45
  in the past where where we've needed to
• 14:47
  make some of our big biggest improvements at
• 14:49
  UW Health.
• 14:51
  I think those things, governance and communication,
• 14:55
  fail before execution
• 14:57
  can really even begin. So, you know, execution
• 14:59
  is downstream from those things.
• 15:01
  So governance, right, I take that to mean,
• 15:04
  like, who has the authority to make decisions
• 15:06
  during an incident, who has the ability to
• 15:09
  declare that your NCI plan has been activated,
• 15:13
  who can make these decisions before, like, you're
• 15:15
  you know, if you've got administrators on call
• 15:17
  before they're notified. So, you know, once your
• 15:20
  once your command center is activated,
• 15:23
  you know, staffed by those leaders,
• 15:25
  you know, decision making authority and governance and
• 15:28
  who's responsible for managing the incident,
• 15:30
  it's probably super clear at that point. But
• 15:32
  there's there's a more uncertain period prior to
• 15:34
  that where
• 15:36
  delegation of authority and clarity of authority is
• 15:39
  really, really important.
• 15:40
  And our our county, Dane County in Wisconsin,
• 15:44
  define they define, an MCI as an any
• 15:47
  incident that
• 15:48
  involves five or more patients.
• 15:50
  And so we get notified anytime an incident
• 15:52
  like that takes place, but we don't necessarily
• 15:54
  wanna activate our full surge response plan anytime
• 15:57
  that happens. It's not necessary,
• 16:01
  result in alarm fatigue.
• 16:03
  So so you need that decision making process
• 16:07
  that you initiate when when you're notified of
• 16:09
  an MCI happening in the community
• 16:11
  where
• 16:12
  somebody
• 16:13
  looks at the incident.
• 16:15
  You look at how many patients there are,
• 16:17
  you know, whether they're adults or pediatrics or
• 16:19
  mix
• 16:20
  or is it their triage status, the the
• 16:22
  type of injuries they have. You look at
• 16:24
  your internal census, your staffing levels,
• 16:27
  and you make a call to say, yes.
• 16:29
  We are going to activate our response plan.
• 16:31
  So having
• 16:33
  that person or group of people that have
• 16:35
  that authority and know they have that authority
• 16:37
  and responsibility
• 16:39
  and and having them feel empowered,
• 16:41
  like Ben talked about earlier, to do what
• 16:43
  they feel is necessary is super important for
• 16:46
  everything else after that to work.
• 16:49
  And I just that's governance, but I I
• 16:51
  think I'd be remiss if I didn't mention
• 16:53
  communication.
• 16:54
  That's so important and so difficult to get
• 16:57
  right,
• 16:58
  during MCIs. I think, really,
• 17:01
  MCIs can be chaotic situations.
• 17:04
  Time is full of uncertainty.
• 17:06
  Information's
• 17:07
  flying around or misinformation's
• 17:09
  flying around. And,
• 17:10
  you know, execution can't happen
• 17:12
  unless you both make the decision that you're
• 17:15
  gonna activate your plan, but then also
• 17:17
  get that updated information
• 17:19
  to the people who need it in your
• 17:21
  organization in a timely manner.
• 17:22
  And, you know, I think there's there's with
• 17:24
  that, there's a couple of different things that
• 17:26
  we've grappled with.
• 17:28
  One's about, like, how to get that critical
• 17:30
  information in the hands of people who need
• 17:31
  it quickly,
• 17:33
  you know, because MCIs are incidents that progress.
• 17:35
  They evolve. They change over time really rapidly
• 17:39
  sometimes.
• 17:41
  So when you first huddle and make a
• 17:42
  decision,
• 17:43
  one way,
• 17:45
  you think there's a certain number of patients,
• 17:47
  coming
• 17:48
  at one minute. A minute later, it could
• 17:51
  be completely different.
• 17:52
  So you need to build mechanisms in your
• 17:54
  communications plan to quickly send timely updates out
• 17:56
  to everyone,
• 17:58
  and you need to build flexibility in your
• 18:00
  response plans to ensure you can you can
• 18:02
  quickly escalate the level of your response up
• 18:03
  or down when you need to. And then
• 18:05
  I think just lastly,
• 18:07
  at the same time,
• 18:10
  there needs to be a balance struck between
• 18:12
  over communication
• 18:13
  and under communication.
• 18:15
  You know, similar to what I said before,
• 18:17
  you you don't necessarily want or or need
• 18:19
  to notify everyone every time an MCI occurs
• 18:22
  in the community or or in your region.
• 18:25
  So one of the things we've developed was
• 18:27
  an escalating communication flow that had a number
• 18:29
  of concentric circles. You know, the number of
• 18:31
  people informed,
• 18:33
  would grow as the situation escalated. So the,
• 18:36
  you know, the first, it's our ED care
• 18:37
  team leader, then it's the huddle group, then
• 18:40
  it's all those who have a role in
• 18:41
  the plan, and then it's all staff.
• 18:43
  And you do that when you need to.
• 18:46
  And, also, for you, Nick, how should systems
• 18:48
  integrate MCI planning
• 18:50
  across hospitals,
• 18:51
  EMS, public health, and regional partners?
• 18:55
  Yeah. That's a good question. I think so
• 18:58
  maybe thinking about this first and foremost internally,
• 19:02
  like, within a system of hospitals,
• 19:05
  that to me is somewhat depends. Like, for
• 19:07
  us at UW Health, we have University Hospital
• 19:10
  in Downtown Madison.
• 19:12
  American Family Children's Hospital is a children's hospital
• 19:14
  attached to University Hospital.
• 19:17
  And then on the East Side Of Madison,
• 19:18
  there's East Madison Hospital. And,
• 19:20
  you know, because of their proximity to each
• 19:22
  other and because of how we operate as
• 19:24
  a system of hospitals in Madison,
• 19:27
  when we activate our MCI surge plan, we
• 19:29
  activate at all three of our hospitals. It's
• 19:31
  not a building by building thing, though,
• 19:33
  you know, our response within each building may
• 19:35
  look a bit different depending on the incident.
• 19:38
  But But then also as an organization, we,
• 19:40
  you know, we have several hospitals in Northern
• 19:42
  Illinois,
• 19:43
  quite a distance away, and and we might
• 19:45
  align on how we do things as much
• 19:47
  as possible with Northern Illinois.
• 19:49
  You know, we may use the same terminology
• 19:52
  between regions and,
• 19:54
  use the same definitions.
• 19:56
  But I think our plans just out of
• 19:58
  necessity are they're gonna have to be different.
• 20:01
  There's gonna have to be differences, and it's
• 20:03
  not gonna be exactly the same playbook. There's
• 20:05
  there's just different capabilities, different realities across the
• 20:07
  state lines.
• 20:10
  And then externally,
• 20:12
  I'd say, you know, if you have a
• 20:13
  local, ideally, multi agency,
• 20:16
  multi organizational emergency preparedness committee or or council
• 20:20
  that you can participate in and and collaborate
• 20:22
  with those other entities at the local or
• 20:25
  municipal or county level.
• 20:27
  You know, that's fantastic. You should be involved
• 20:28
  in that.
• 20:29
  I think, of course, you know, there's your
• 20:31
  there's your regional health care readiness coalition as
• 20:34
  well. And I think both of those are
• 20:36
  potentially really critical venues,
• 20:39
  through through which you can, you know, conduct
• 20:41
  that
• 20:42
  collaboration and coordination
• 20:44
  and and integrated planning can take place with
• 20:46
  those entities.
• 20:48
  And then, you know,
• 20:50
  part of that collaboration, what that might look
• 20:51
  like,
• 20:52
  it could be just sharing of informations.
• 20:55
  Everyone understands,
• 20:58
  you know, what everyone else is doing. You
• 21:00
  develop that common operating picture. You share assumptions.
• 21:03
  Maybe share some language.
• 21:05
  One thing I wanna share that I think
• 21:08
  I wanna really highlight something I think we
• 21:10
  we do well in Dane County is the
• 21:12
  concept of base hospital or
• 21:15
  or area or regional medical coordination centers.
• 21:18
  The way it works, you know, for us
• 21:20
  at least, I'm sure there's there's it works
• 21:22
  differently
• 21:23
  where this is implemented elsewhere. But
• 21:25
  when an MCI occurs in our community responding
• 21:28
  EMS, they communicate with the base hospital emergency
• 21:31
  department. For for us, that's a university hospital
• 21:33
  emergency department,
• 21:35
  and they request activation of base hospital. And
• 21:38
  and then base hospital, what they do, they
• 21:40
  they send out an alert to all the
• 21:42
  area hospitals requesting information on capacity. Right? What's
• 21:45
  your what's your capability of taking triage red
• 21:47
  patients or yellow patients or green patients? How
• 21:49
  many can you take?
• 21:51
  And then base hospital, they receive that information.
• 21:53
  They relay it back to EMS in the
• 21:55
  field,
• 21:56
  and then they can make informed decisions on
• 21:58
  where best to distribute patients.
• 22:00
  And I think that, like, prehospital collaboration with
• 22:03
  area hospitals and EMS is really, really critical
• 22:06
  for us to to make it less likely
• 22:08
  that any one hospital in the areas
• 22:10
  surge during that MCI incident or if or,
• 22:12
  you know, if that's not possible because of
• 22:14
  the size of the incident, it can really
• 22:15
  help
• 22:16
  to flatten the curve of incoming patients at
• 22:19
  each facility. And and, ultimately, that helps us
• 22:21
  reduce the impact in our hospitals and improves
• 22:23
  the likelihood that we avoid unnecessary loss of
• 22:26
  life during an emergency. So
• 22:28
  Thanks so much, Nick.
• 22:29
  And, Ben, if you can please help us
• 22:31
  close out close out our conversation here. How
• 22:34
  do you keep MCI preparedness from becoming a
• 22:36
  check the box exercise, you know, like something
• 22:38
  the system has to do? How do you
• 22:39
  keep it top of mind? Yeah. Don't put
• 22:41
  it on the shelf. It's the it's it's
• 22:44
  really easy for it to become a checkbox
• 22:46
  exercise,
• 22:47
  and to say, yes. We've got an MCI
• 22:48
  plan. Thank you very much. Put it away
• 22:50
  till we need it or maybe that annual
• 22:52
  review.
• 22:53
  You know, a thought exercise we sometimes play
• 22:56
  with each other and we talk about,
• 22:59
  within our steering committee is the, as I
• 23:01
  said, was the what does that mean? So
• 23:03
  everyone listening, I want you to kind of
• 23:04
  think about okay. So you have an MCI,
• 23:08
  and you say to yourself, okay. We need
• 23:10
  some more bedsheets. Well, in our plan, our
• 23:12
  policy says,
• 23:13
  supply chain will bring more bedsheets.
• 23:15
  Well, what does that mean? Because what if
• 23:17
  your supply chain is two people? And one
• 23:20
  of them is currently getting blood products, and
• 23:21
  the other one is trying to find,
• 23:24
  IV kits for other people. So who is
• 23:26
  getting the bedsheets?
• 23:28
  And bedsheets are a really small, low level
• 23:30
  thing that we're talking about, but those can
• 23:33
  be those are the kind of things that
• 23:35
  layer up every other time.
• 23:37
  When you think of it just as a
• 23:39
  checkbox exercise, you really need to go into
• 23:41
  the minutiae and really look at every single
• 23:43
  aspect and say, okay. So our policy says
• 23:46
  this. Well, who's actually gonna be doing that
• 23:48
  role? And do we have someone doing that?
• 23:50
  And who where is it overlapping?
• 23:53
  And so one of the joys of the
• 23:54
  process is, you know, I come from a
• 23:56
  nursing background. Nick comes from an operational,
• 23:59
  emergency management background. But our steering committee has
• 24:02
  providers and nurses and emergency management groups and
• 24:04
  operational leaders,
• 24:06
  and we're we all
• 24:08
  have that safe environment to poke holes at
• 24:10
  everything, question everything.
• 24:12
  And, you know, we say to ourselves, if
• 24:14
  we're making everybody feel uncomfortable during a drill,
• 24:16
  we're doing it right, because that
• 24:18
  uncomfortable feeling
• 24:20
  is you questioning,
• 24:21
  and you taking part of that continuous improvement
• 24:25
  culture,
• 24:26
  and asking what does that mean,
• 24:29
  which is part of creating a robust MCI
• 24:32
  drill road map.
• 24:34
  You know, it really comes down to looking
• 24:36
  at logistics and operations
• 24:38
  and then self validating. And and,
• 24:41
  again, Nick and I always say that if
• 24:43
  the answer at the end of a drill
• 24:44
  or the answer at the end of anything
• 24:46
  is
• 24:47
  it went really well,
• 24:48
  we always wanna hear a but. We wanna
• 24:50
  know it really well. It went well,
• 24:52
  but we could have done this, this, this,
• 24:55
  and this because there's always something that could
• 24:57
  be learned from anything. And that's, something that
• 25:00
  we want everyone to walk away with is
• 25:02
  ask yourselves,
• 25:03
  what does that mean?
• 25:05
  Yeah. I I think it's a great point.
• 25:06
  You you do wanna hear a button there
• 25:08
  for something important because then you know there's
• 25:09
  something you you have to work on that
• 25:11
  to make it go seamlessly.
• 25:13
  Ben, Nick, thank you both so much for
• 25:14
  just a great conversation on MCI readiness, and
• 25:17
  it was wonderful to hear how UW UW
• 25:20
  Health is, you know, leading a a much
• 25:22
  needed,
• 25:23
  change, with MCI. So thank you both so
• 25:26
  much.
• 25:27
  Thank you very much.