Infrastructure Support Committee
Members
Mary Jo Beal
John Becker
*Doug DeVries
Barb Hiemstra
Steve Luther
Matt McConnon
Larry Walter
*Committee chair
Mid Michigan Medical Center – Clare
MMPC
City of Ionia
Kent County
The RAPID
Rockford Ambulance
Spectrum Health
Objectives

Draft a plan that outlines how technology (e.g., phones, media, and other systems such as 211)
supports this process.

Draft a plan that describes how technology will support data collection and reporting efforts.
Assumptions
1) Outpatient Care will be recording treatment on a paper system, not technology (i.e. computers,
databases, etc.).
2) Pre-ED Triage will be developing triage criteria to be used in the implementation of a phone
support system.
3) Hospitals will have technology in place and will maintain any networking system and data
collection between main campus and ACS.
4) The State of Michigan will allow their communications systems such as MDOS, UIA, DHS, and
Treasury to be used as a pandemic phone support system.
5) The existing 211 system will be utilized as the primary infrastructure to support pandemic flu phone
support system needs.
Background
The makeup of this committee fits with the tasks that were assigned. The committee was represented by a
large County IT department, independent medical IT department, a large medical facility IT department, a
large transportation department, an EMT, a hospital Emergency Operations Coordinator, and an
emergency manager. With the varied backgrounds and expertise of this group, the committee was able to
accomplish the plans designated for completion.
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This group looked at how records and record-taking would be done in an influenza pandemic-type incident.
The committee knew that there would be a call for data collection and maintenance. This data must be
documented, used, and stored. The use can be varied as it will depend on what data is collected.
There are several ways to collect data. The committee decided to address as many different ways as
possible as there are several different entities represented in this project.
During our research contact was made with the State of Michigan with regards to utilizing their phone
infrastructure. The State of Michigan was open to this idea and advised the committee to contact 211,
which is currently managed by the United Way. The committee learned that the existing 211 system was
capable of the following:

211 has the ability to route phone calls to outside agencies.

The phone call capacity is expandable based on the call volume experienced.

By the summer of 2009, it is expected that 80 percent of Michigan will be serviced by 211 and the
remaining 20 percent will be serviced by a toll-free phone number.
The Process
Once this group was assigned these tasks, they looked into what infrastructure needs to be supported.
The committee made contact with several hospitals, EMS entities, and support locations to find out their
current infrastructure at their current locations as well as those planned for ACS (Acute Care Sites). The
committee created a survey that was distributed to determine what technology is used for communications,
power, supplies, etc. and what was crucial to be maintained during this type of an event.
Once this survey was returned, the committee evaluated the functions required to maintain necessary
levels of care.
This committee was in communication with the other committees in this process as well. The committee
needed to find out how we would be called to support the infrastructure of the other committees once an
event occurs and their groups were called upon to respond.
The Conclusion
These are the plans the committee has created for the two objectives that they were tasked with. The first
plan has several sections to it. It is broken down by function and then by level. This level is in connection
with the levels established by Pre-ED Triage and shows in their matrix. The first is as follows:
Draft a plan that outlines how technology (e.g., phones, media, and other systems such as 211) supports
this process.
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Communications
Prior to an outbreak of pandemic flu, the following steps are suggested for hospitals and emergency
responders with regards to communications:
First, a directory of contacts for all emergency management personnel and local emergency services
workers should be established. This list needs to include all key people in positions who deal with
emergency management, police, fire and EMS as well as local hospitals and the health department. This
list will be utilized in the initial stages of an outbreak and will be necessary to alert all personnel needed to
manage the situation. This list will be maintained by the Region 6 Bio-Defense Network Coalition
Coordinator.
The next step of the plan involves a Level A or B response levels of the pre-ED triage matrix (appendix 1)
and will not affect normal day-to-day communications. The Standard Operating Procedures should be
utilized during these stages of the incident as there is a high likelihood that the number of patients will not
increase substantially.
Thirdly, a triage and public information system should be established utilizing Interactive Voice Response
(IVR) technology. This system can use the current 211 system, which is readily available throughout most
of the state and has scalable capacity to handle the volume of calls that may come in the event of
pandemic flu. When the incident is classified as a Level A or B response levels of the pre-ED triage matrix,
this system should be activated and public education should begin. Whenever possible, local emergency
planners should establish the IVRs and have them tested to ensure they can be activated.
Lastly, prior to an outbreak, there should be Continuity of Operations Plans (COOP) drafted and tested to
ensure that the operations of all affected entities are familiar with their responsibilities during an outbreak.
Planning should be formalized in a written plan whenever possible and reviewed regularly to guarantee the
smooth transition from normal operations to emergency operations when needed.
Public Information
Pre Pandemic
It is assumed that to provide support for public information in Levels A-E response level of the pre-ED
triage matrix, pre-pandemic technology steps must be taken. These steps include establishing a
Memorandum Of Understanding (MOU) between the Emergency Management and the Statewide 211
Management. Incorporated in the MOUs will be:
1) The process for activating level-specific information through 211.
2) Establishing anticipated call volumes at each level.
3) The financial mechanism to reimburse the 211 centers for the increased capacity requirements.
211 will be available to 80 percent of the State of Michigan as of summer 2009. A toll free number will be
provided to the remaining population that is directed to a 211 Center. The 211 system currently has 36,000
resources such as the Red Cross, Salvation Army etc. to provide services.
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Technology to support public information at Level A and B response levels of the pre-ED triage matrix
would need to include ramping up and establishing the infrastructure for the Public Information Officer to
communicate a timely, consistent, and accurate message campaign. The infrastructure would include
standard public address media such as radio, television, and Internet, local medical facilities awareness as
well as the 211 Centers. In addition, at this level the committee would recommend the State 211 Director,
in conjunction with local EMS and health officials takes necessary Incident Command steps to activate the
pre-established Joint Information Centers/Systems. Delivery of the message from the Joint Information
Center will need to be provided in multiple formats and languages to accommodate the needs of all
populations.
At Level A and B response level of the pre-ED triage matrix the 211 resources would not include medical
personnel on call banks.
Technology to support public information at Level C-E response levels of the pre-ED triage matrix will
continue as in the earlier levels with the addition of an established call center of medical personnel to
provide Pre-ED Triage, and the infrastructure to maintain the added volume.
Transportation
Before a pandemic is declared, all entities should use standard operating procedures. At levels A and B
response levels of the pre-ED triage matrix, all entities should establish or review and update any MOUs
concerning emergency transportation. These can be established with local school districts, public
transportation or private providers. Resource management plans should be reviewed and updated if
necessary.
Emergency transportation-related MOUs should address the type of vehicle needed, the type of material or
personnel to be transported and the qualifications and availability of drivers. The location and availability of
any ancillary support, including fuel, fluids, vehicle maintenance, tire care, parts replacement and vehicle
storage should also be considered. Alternative storage facilities, in secure locations, should be established
during the early stages of a pandemic.
At levels C, D and E response levels of the pre-ED triage matrix entities will execute MOUs as necessary.
Alternative supply and storage locations will be activated as well as personnel assigned for
loading/unloading and security duties. Resource management plans for regional distribution will be
executed. Any necessary equipment, like pallet jacks or forklifts, will be procured and assigned to
personnel.
Systems
At the A and B response levels of the pre-ED triage matrix of a pandemic event, communications should
follow the same Standard Operating Procedures already established. This includes all voice, phone, and
Internet. Other current systems such as patient tracking and record management systems should be used
as normal.
There should, however, be some additional uses of those current systems. Organizations need to ensure
trained and authorized staff is available to use EMresource, record management system, e-Team, patient
tracking, and any other system deemed critical.
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Organizations must review their Continuity of Operation Plan (COOP) and begin implementation steps as
needed. The steps should include verification of back-up systems. This should include the primary location
as well as secondary and tertiary sights.
Once the pandemic event elevates to levels C, D, or E response levels of the pre-ED triage matrix, the
committee recommends the following steps:
Utilize all voice on specified talk groups according to ICS 205. Use of your systems will be detailed later in
this document. This will assist you in communicating with all aspects of a response to this type of an event.
Utilize the pre-established pandemic IVRs throughout your region to communicate with patients and
provide them with the information that they need. These IVRs must be created in advance with medical
knowledge and expertise to make sure that a clear and consistent picture is sent across the area. These
IVRs will then be placed on 211 as well as their established 1-800 system for those not covered in the 211
areas.
Any and all alert and notification systems should be used. These include but are not limited to: City Watch,
Reverse 911, local print media, as well as local and non-local television media.
Now is the time to activate your COOP plan that you have created. This plan should include contingencies
for all of your critical areas that you provide service. This includes your systems utilized in your location.
ACS/NEHC
Under the guidelines of Public Act 390, an Acute Care Site (ACS) or Neighborhood Emergency Help
Center (NEHC) will operate under the policies and procedures of the affiliated local hospital. Based on this
premise the committee recommends the following:
The first thing that the committee recommends is that prior to any incident or event that would require
activation of ACS or NEHC, hospitals develop and test for effectiveness a communications plan for each
location determined in their pre-existing Emergency Operations Plans or Disaster Plans (using existing
infrastructure of existing locations if possible). If hospitals do not have pre-determined ACS or NEHC
locations or policies that govern these activations, it is our recommendation that they establish polices and
determine locations for both for future use. The committee recommends that any Memorandum of
Understandings (MOU) needed to establish or maintain either an ACS or NEHC are developed and
reviewed on an annual basis. All MOUs should be in writing.
While operating at A or B response levels of the pre-ED triage matrix of a pandemic event, the committee
recommends that agencies begin preparations for possible activation of an ACS or NEHC by reviewing
policies, procedures and plans. Agencies should begin testing their pandemic communications plans and
making any necessary preparations. MOUs should be verified for changes in commitments. At these levels
the committee also recommends that agencies begin the process of developing inventories of supplies on
hand as well as those needed to establish the ACS or NEHC. Communications should begin with Regional
Medical Coordination Centers (MCC) for supply augmenting.
While operating in Levels C, D, and E response levels of the pre-ED triage matrix the Infrastructure
Support Committee makes the following recommendations:
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All communications from the ACS or NEHC with hospitals and dispatch centers should be pre-established
according to the hospitals’ communications plans. These communications should be fully operational
based on preparations in the A and B response levels of the pre-ED triage matrix.
All record management should be done in accordance with established policy and procedures of the
agencies. If for any reason an electronic system cannot be used, a paper back-up system should be used
until the event is over. At that time records can be entered into the agency’s existing RMS. This process
should be followed for data collection and trending as well.
The second objective the committee was given to address is:
Draft a plan that describes how technology will support data collection and reporting
efforts.
The Infrastructure Support Committee had several discussions with other committees to assess the need
for data collection and reporting in a pandemic flu incident. The committee found the following areas to
address:
First, the committee looked at the day-to-day operations of hospitals, clinics, physician offices, health
departments, EMS entities and communications centers. Following discussions with each of these
disciplines, the committee decided that all would continue to utilize their current RMS (Records
Management Systems) for data collection in the event of a pandemic. All of these entities also have a
redundant paper back-up system in place should the electronic RMS fail. The committee is confident with
the continued use of the systems and back-ups in place.
The committee also evaluated the reporting infrastructure between hospitals, EMS and local health
departments. The committee is comfortable that the continued use of the reporting structure in place would
be sufficient for a pandemic flu incident.
The third area the Infrastructure Support Committee discussed is the Outpatient Care. The committee
debated the need for electronic RMS during the in-home patient visits. The Outpatient Care Committee
decided their plan would not include electronic patient tracking and that all patient contacts will be
documented on paper. The decision from the Outpatient Care Committee requires no additional support
from Infrastructure Support Committee.
The final area we evaluated was the ACS (Acute Care Sites) and NEHC (Neighborhood Emergency Help
Centers). The committee discussed the need for activation of either of these entities in a pandemic flu
incident. These entities are mandated by PA 390 and are under the direct supervision and management of
the local hospitals. Given this information, the committee decided to expand the hospitals’ RMS to cover
either of these entities when activated. The hospitals would follow their Standard Operating Procedures to
carry out the collection of data.
Supporting Documents
ICS 205
PA 390 (as amended)
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