Emergency Management Strategies:
Jenny Atas MD
Associate Professor
Wayne State University
Medical Director
Region 2 South Medical
Bio-Defense Network
Mark Sparks
Logistics/Planning Officer
Region 2 South Medical
Bio-Defense Network
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Presentation Overview
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Project Background
Acquisition Process and Specifications
Durable and Non-Durable Equipment
Acquisition Process
Storage & Deployment Considerations
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Project Background ~ Organization
Pre 9-11: District Organization
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8 Emergency Management
Districts covering 83
Counties
45 Public Health
Departments
65 Medical Control
Authorities (oversight of pre-hospital system) with no seat at the table
4

Project Background ~ Organization
Post 9-11: New Paradigm of Planning
Emergency
Management
Public
Health
Health
Care
5

Project Background ~ Organization
Post 9-11: HHS Grant Programs
HRSA
(now HHS
ASPR)
CDC
Medical Control Authorities
Hospital/Pre-hospital
Local Health Departments
Other Local/Regional
Partners
Coordinated State/Local/Regional Planning
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Project Background - Organization
Post 9-11: Regional Organization
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8 Medical Bio-Defense Regions
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Mirror of 8 E.M. Districts
Incorporates 65 MCAs
Bioterrorism Coordinator
Medical Director
Emergency Preparedness Coordinator
(Local Health Department)
Epidemiologist
SNS Technical Advisor
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Project Background ~ Organization
Region 2 South (R2S) Overview
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3 Counties; 97 local political jurisdictions; 2.6 million people
14 P.A. 390 Emergency Management/Homeland Security
Programs ( 4 with Public Health authority)
6 Public safety mutual aid organizations
4 Public Health Authorities
4 Medical Control Authorities
37 Hospitals
69 Fire/EMS agencies
11 Private/EMS agencies
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Project Background ~ Organization
Lessons Learned
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Regional Partnership with Emergency
Management is Critical
Development of surge plans, procedures and resources must involve all disciplines
Take full advantage in the ability to leverage other federal funding streams (restrictions / allowances)
Allows you to mitigate duplication of effort on all fronts
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PROJECT
BACKGROUND
DHHS NBHPP Program Guidance for Fiscal 2006 dictates that states have the ability to surge outside hospitals and healthcare systems
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Project Background ~ Foundation
Situation
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Hospitals in Michigan have incorporated the ability to surge 20% above the average daily census.
Even with these additional 7,000 beds there still exists insufficient surge response capability to address the needs that a medium level pandemic
MEMS remains the primary method of addressing
Medical Surge Capacity and Capability (MSCC)
Hurricane Katrina demonstrated the utility of surge facilities
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Project Background ~ Foundation
Pandemic Flu
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Outbreak of a moderately severe pandemic flu would exhaust surge capacity within the first two weeks
Natural and Man-Made Disasters
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Trauma victims immediately exhaust surge capacity
Non-urgent health problems are exacerbated and further increase healthcare demands
Local Healthcare Emergencies
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International air-traveler quarantine
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2003 SARS: 3,017,496 international passengers thru DTW
“All hazards” response capability
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Project Background ~ Foundation
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In light of these factors a decision was made to utilize HRSA/ASPR funding to develop two self-contained all-weather mobile field hospitals or “surge facilities”
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Initially develop and equip a 100-bed unit
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Lay the groundwork
Based on available funding, develop a 50-bed unit
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Extension of 100-bed unit
Rapid acquisition; rely on established specifications
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Project Background ~ Foundation
Patient and Staff Planning Assumptions
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The Mobile Field Hospital would be designed…
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For patients suffering from COPD, asthma, congestive heart failure (no C-PAP or vent), chronic pain syndrome, and behavioral conditions, and needing IV hydration and IV antibiotic therapy
With a 4:1 ratio of adult to pediatric patients
With a planned admission/discharge rate of 23 hours
To be operated by a core team of medical professionals augmented by volunteers (Michigan Volunteer Registry)
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Project Background ~ Foundation
Lessons Learned
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Don’t recreate the wheel
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Patient profile from the Katrina disaster experience
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Patient demographics from Michigan Census
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Staff profile from existing Michigan plans for
Alternate Care Facilities/MEMS Model
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TESA Project ~ Facility Acquisition Process
Grant Application
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Region 2 South was selected to develop the 100-Bed
TESA Unit
The project was outlined in Region 2 South’s FY 06-07
HRSA Grant Application
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Statewide resource ; housed in S.E. Michigan and operated by “strike teams” from across the state
Complete project within the grant year
Establish a Task Force to:
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Research the different platforms and associated planning, operational, administrative and logistical considerations
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Recommend how to best configure and develop the facility within budgetary constraints
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TESA Project ~ Facility Acquisition Process
Grant Approval / Initial Steps
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Project was approved; $1,000,000 budget
Task Force formed in October 2006.
Agencies represented:
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Region 2 South Medical Bio-Defense Network
Michigan Department of Community Health, Office of
Public Health Preparedness
Michigan Department of State Police, Emergency
Management/Homeland Security Division
Michigan-1 Disaster Medical Assistance Team
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TESA Project - Facility Acquisition Process
Task Force Determinations
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The recommended basic platform for the facility would be a “soft-walled” shelter structure.
To account for cost uncertainties, the platform
(and invitation to submit proposals) would be designed around:
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A core 50-bed facility (to include areas for triage, supply, admin, and staff support)
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25-bed add-on patient wards .
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TESA Project - Facility Acquisition Process
Task Force Requirements
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Basic Requirements for the 50-Bed Core
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Separate staff and patient entrances
Separate areas for facility administration, facility supplies, staff lounge and staff hygiene, and patient care wards a. Staff hygiene must have a changing area, sink, shower and toilet, cold and hot water, an on-board potable water supply with a water distribution system and a gray water containment system
Each patient ward must be equipped with a private field toilet (the Brief Relief TM system, or equivalent)
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TESA Project – Facility Acquisition Process
Task Force Requirements
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Basic Requirements for the Entire Shelter System
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Completely self-contained
Trailer-mounted generators
Maximum component size (98”w, 50”d, 50”h)
Man-portable components (maximum 75lb per worker)
Rapidly erected without the use of tools or equipment
Must provide all-weather climate controlled environment
Materials must meet NFPA Standards
Must be interoperable with existing FEMA-NDMS assets
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TESA Project - Facility Acquisition Process
Task Force Determinations
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Proposal/Bid Quotation Requirements
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Must provide a comprehensive description of:
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Proposed system components
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Warranties, manuals, parts availability guarantees
Where requirements are met or exceeded
Where requirements are not met and why a variance should be considered
How it will be packaged w/container dimensions
Must include diagrams (50-bed core, 75-bed and 100bed configurations)
Must identify single POC for notices and inquires
Must be submitted by e-mail (formatted in MS Word and Adobe PDF.
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TESA Project - Facility Acquisition Process
Task Force Determinations
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Parameters established to select potential shelter sources:
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Identify potential sources known by the Task Force to manufacture shelters that
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Generally met platform requirements
Were in common use as mobile medical facilities
To maximize practical competition, limit the minimum number of potential sources to 3
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To minimize the procurement process, limit the maximum number of potential sources to 6
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TESA Project - Facility Acquisition Process
Task Force Determinations
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Six potential platform sources were identified
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4 that generally met shelter requirements and had been used by members of the Task Force
1 that generally met shelter requirements but was unknown to members of the Task Force
1 that manufactured “hard-walled” shelters, was unknown to members of the Task Force but was a Michigan-based company
These 6 potential vendors were e-mailed the
Invitation to Submit a Combined Proposal/Bid
Quotation
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TESA Project - Facility Acquisition Process
The RFP/RFQ Package
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Task Force determinations were reduced to a
3-page invitation to submit a combined
Proposal/Bid
Quotation…
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…that would be e-mailed to preselected vendors.
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TESA Project - Facility Acquisition Process
The RFP/RFQ Package
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Task Force determinations were reduced to a
3-page invitation to submit a combined
Proposal/Bid
Quotation…
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…that would be e-mailed to preselected vendors.
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TESA Project - Facility Acquisition Process
Evaluating Proposals/Quotes
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All invitees responded
Hundreds of pages
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Each with unique format
Some highly detailed and well organized
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Some lacked detail and organization
All were printed, bound and distributed to each member of the Task
Force
Vendor 1
Vendor 2
Vendor 3
Vendor 4
Vendor 5

TESA Project - Facility Acquisition Process
Evaluating Proposals/Quotes
COMPARABLES
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Quote Duration
Cost
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Max Size Container
Assembly
# Basic Units
Access Doors
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Area (sq. ft.)
Furniture
Power
Lighting
Outlets
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HVAC
NDMS Interop?
Trailer Boot
Warranty
Framing
Fabric
Insulation
Hygiene Center
Flooring
Training
Vendor 1 Vendor 2 Vendor 3 Vendor 4 Vendor 5 Vendor 6
THE EVALUATION MATRIX
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TESA Project - Facility Acquisition Process
Awarding the Contract
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2 vendor’s RFP/RFQ met specs, the other 4 were eliminated from competition
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Task Force members to NDMS conference to inspect both shelter systems
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Gained experience - revised specifications
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Requested final quote on revised specifications
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Reviewed final quotes
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Unanimous agreement to award contract
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TESA Project - Facility Acquisition Process
Lessons Learned
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Need experienced and knowledgeable team to avoid pitfalls when expediting a complex project
Need comparison matrix to efficiently deal with variable specifications
No substitute for getting your hands dirty
(in-person inspection and assembly)
No substitute for face-to-face discussion with vendor representatives
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TESA
PROJECT
~
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TESA Project – Facility Specifications
Quick Specs
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10,000 Sq. Ft. Enclosed
Area
20,000 Sq. Ft. Footprint
(125’ x 158’)
5 Generators (4 @ 36kW and 1 @ 56 kW)
16 HVAC
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15 @ 42K BTU heat/3.5 ton cool/29K heat strip
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1 @ 60K BTU heat/cool/HEPA positive or negative pressure)
4 Hygiene Centers
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Each with sink, shower, toilet, hot H
2
O, 500-gallon fresh and gray water holding tanks
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16 Interconnected Shelters
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1 each for Administration,
Staff, Supply (w/boot) and
Intake/Triage/Treat
1 ten-bed Patient Ward
(isolation)
7 ten-bed Patient Wards
4 five-bed Patient Wards
Design
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4:1 ratio of adult to pediatric patients
Admit/Discharge Rate: 23 hours (= 100 patients per day)
Over
Pieces
1,000
Separate
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TESA Project – Facility Specifications
The Design
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TESA Project – Facility Specifications
Tactical Labeling
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The components of each individual shelter are:
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Color-coded & labeled
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Packaged together
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TESA Project - Facility Specifications
Tactical Storage
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TESA Project – Facility Specifications
As Built (40-Bed Unit)
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TESA Project – Facility Specifications
Lessons Learned
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Color-code and label individual shelter components
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Facilitates handling
Has limitations
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Only so many distinct colors
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Correlates only to complete 100-bed layout
Because it is a white vinyl tent labor intensive for cleaning before repackaging
Setup and tear down takes expertise
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Requires the development of specialized teams
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TESA
PROJECT
~ Equipment & Supply Acquisition~
38

TESA Project ~ Equipment/Supply Acquisition Process
Patient & Staff Profile
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The Mobile Field Hospital would be designed…




For patients suffering from COPD, asthma, congestive heart failure (no C-PAP or vent), chronic pain syndrome, and behavioral conditions, and needing IV hydration and IV antibiotic therapy
With a 4:1 ratio of adult to pediatric patients
With a planned admission/discharge rate of 23 hours
To be operated by a core team of medical professionals augmented by volunteers (Michigan Volunteer Registry)
39

TESA Project ~ Equipment/Supply Acquisition Process
Task Force Determinations
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The stakeholder Task Force determined to utilize solesource provider of medical supplies and equipment to outfit the facility
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Previously qualified source
Current source of ACC and NEHC facilities for MEMS components.
Demonstrated ability
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Medical expertise to identify and meet needs (based on expected patients and healthcare staff)
Professional packaging
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Competitive pricing
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TESA Project ~ Equipment/Supply Acquisition Process
Patient Profile Questionnaire
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Comprehensive questionnaire was used to refine the patient profile and then determine what level of service would be provided over a given period of time
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TESA Project ~ Equipment/Supply Acquisition Process
Capability Worksheet
Function (sample)
Airway
Wound Treatment
IV Therapy
Ortho Care
EENT
Genitourinary
Gastrointestinal
Medication Admin
Emergency Care
X
X
X
X
X
Adult PEDS Infant
X X X
X X X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
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TESA Project ~ Equipment/Supply Acquisition Process
Master Template
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Master Template was used to generate the type of treatment which could be offered and the type and quantity of equipment and supplies needed.
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TESA Project – Equipment/Supply Acquisition Process
The Design
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TESA Project – Equipment/Supply Acquisition Process
The Design
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TESA Project – Equipment/Supply Acquisition Process
The Design
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TESA Project – Equipment/Supply Acquisition Process
The Design
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TESA Project – Equipment/Supply Acquisition Process
The Design
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TESA Project – Equipment/Supply Acquisition Process
The Design
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TESA Project – Equipment/Supply Acquisition Process
The Design
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TESA Project – Equipment/Supply Acquisition Process
The Design
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TESA Project ~ Equipment/Supply Acquisition Process
Lessons Learned
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Patient Profiles will define the treatment modalities necessary
Establish a cache which is broadly used so that replenishment is easier and can be integrated into a local healthcare system
Establish Augmentation Sets to supplement specialty areas
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OB-GYN
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PEDS
Isolation
O2 Therapy
Nursery
Establish and procure basic equipment lists which do not require long training sessions
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TESA
PROJECT
~ Storage & Deployment
Considerations ~
MAXIMIZE
DEPLOYMENT AND RECOVERY
SPEED
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TESA Project ~ Storage/Deployment Considerations
Tactical Containerization & Labeling
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Color-coded labels
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Color-coded packages
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Color-coded containers and augmentation sets
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Modules which are color-coded and containerized
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TESA Project ~ Storage/Deployment Considerations
Containers
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Storage
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Pallet size
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Weight
Deployment
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On or off pallets?
Storage of shipping materials
Re-packing
Sustainment
COT RACKS
HEPA HVAC
HVAC UNIT
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TESA Project ~ Storage/Deployment Considerations
Transporting & Handling
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Transport Vehicle
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Semi-trailers
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Flat bed
Dry box
Box truck
FLAT BED SEMI-TRAILER
Material Handling
Equipment
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Fork Lifts
CONSTRUCTION
HI-LO
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Pallet Jacks
BOX TRUCK
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TESA Project ~ Storage/Deployment Considerations
Trailer-Mounted Generators
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Shipping
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Flat Bed - loading & unloading
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Need loading dock
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Need material handling equipment
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Individual
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Multi tow-vehicles and drivers
SHIPPING GEN-SETS
GEN-SETS IN STORAGE
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TESA Project ~ Storage/Deployment Considerations
Storage Space
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TESA Project ~ Storage/Deployment Considerations
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TESA Project ~ Storage/Deployment Considerations
Lessons Learned
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Color-coding simplifies storage, “picking”, shipping and sustainment planning and execution
Consider the storage of shipping materials
(pallets, containers, etc.) in deployment plans
Know your material handling equipment needs
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Field (e.g. parking lot) vs. fixed facility (e.g. conference/exhibition center)
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Emergency Management Strategies:
Lessons Learned in Developing Specifications, Procuring,
Housing and Maintaining a 100-Bed Mobile Hospital
Jenny Atas MD
R2S Medical Director e-mail: jatas@2south.org
Mark Sparks
R2S Planning & Logistics Officer e-mail: msparks@2south.org
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