The People, Process, & Progress Podcast - A Perspective on the COVID-19 Response from a Former Public Health Emergency Coordinator | PPP #14

Episode Date: March 29, 2020

In 'Early Lessons from the COVID-19 Pandemic, ' I share lessons learned from my perspective as a former Public Health Emergency Coordinator.

Hey everybody, thanks for coming back to the People Process Progress Podcast. I am your host, Kevin Pinnell. It is March 29th, 2020. We are all distancing socially and washing our hands and all the buzzwords that we hear about on the news. improvement based on some interactions I've had with folks either directly or that I've seen posted previously on LinkedIn, Facebook, and just I think ways to help us all through this. I know we're all stressed. We're homeschooling kids. We're working from home. We're dealing with surge capacity. We're figuring out how to keep our folks safe when they respond to calls. We can do it. Here are some suggestions and areas. I created a COVID-19 emergency and incident management knowledge sharing group on LinkedIn. I invited my connections that are in that business. If you didn't get an invite and we're connected or we're not connected, feel free to reach out to me on LinkedIn. Again, Kevin Pan messages and emails or shared templates and things like from the peopleprocessprogress. do with being efficient remotely or virtually as best we can in our emergency operation configurations,

on empowering our clinicians and patients' families to be able to communicate with each other still and making sure that we're preparing our people that we're assigning to the emergency operations center to be effective and and not set them up for failure but set them up for success as best we can again people process progress.com slash templates there's some templates there i'm going to keep adding stuff that i'm digging out of the old public health emergency coordinator trunk and that i know helped me when we were working H1N1, Ebola, different things, and whether it was real or practice, stuff that we worked through. And just remember that if you've practiced pandemic response or your mass vaccination clinics, you're doing similar things when you're setting up a remote testing site for the public health folks and public safety that are partnered with them.

And it should be partner, right? Remember that unified command I mentioned in previous podcasts? It should be public health and public safety, some variety of that, maybe even schools if you're at a school. I know our points of dispensing, pie in the sky, a cloud of anthrax is coming kind of thing, we always tested towards and exercised towards schools with the points of dispensing, right?

So they have bus loops, they have good drive-thrus. Make sure that you are working like you would be or like you did in your exercises. And again, just empower your folks. So let's jump through the first one. So we have folks all across the country, all across the world probably, that are running virtual emergency operations centers. So an emergency operations center, if you're listening and you're not in that business, is a place where either departments or differentday business style isn't working well or isn't as effective or just the scale of requests like, you know, personal protective equipment, the management of that for a lot of places now is well beyond just department level

stuff because everybody wants it. So you want to take that up to like logistics and the incident command system and have everything route through them. They can help prioritize and then the command can get involved if they need to, but it's just efficient. So when you're spinning up your virtual emergency operations center, picture in your head, you're still in a facility, but now you're all at each of your own facilities. How are you organized? Are you going to organize or is your emergency operations center based on your emergency operations plan set up to use the incident command system? And if so, then you're going to have those command and general staff positions right you're going to have you're going to have a unified command of whatever agencies then you're going to have public information and

public information is going to coordinate that joint information system and maybe a different joint information center but now it's really a virtual joint information system right so good to put that into play your safety officers officers, right? So in this instance, public health for sure should be involved in that. Your epidemiologist, your health director is advising on safety for first responders. Most public safety, particularly fire, have safety officers that are on call all the time or on duty. So a good option there. And then your liaison officers, right? So who's going to make sure that we're all communicating well, getting along, have each other's contacts, all that kind of stuff. And virtually, it's going to be kind of like being

a project manager. You're going to reach out to different agencies. Hey, how's it going? Is it going well? If it's not, let us know what we can change. Do we have the right contact? And then your general staff, if you're set up like the incident command system member that's planning. So who's going to facilitate our daily run through of the cycle, validating objectives with command and just keep everybody on track. Your operations folks, that's the folks all out in the field that you're supporting. And emergency operations center doesn't really have direct. I mean, they do via day to day command structure.

So if the fire chief or the police chief or their designees are in the emergency operations center, yes, by rank and by their departmental structure, they do have a direct report. But someone in operations in the emergency operations center is really helping coordinate the operations for the entire locality or department. So it's not necessarily discipline specific, but you definitely want fire people to advise other fire people, police, police, public health, public health, et cetera. So consider that. Logistics. Logistics right now and probably safety are two of the busiest emergency operations center in finance and admin, which we'll get to in a second. Probably the busiest. Logistics is trying to get more people, more medical reserve corps volunteers, more community emergency response team folks, those CERT people, more now we're looking at veterans, especially folks that have military medicine like myself,

and they're looking for stuff, right? I mentioned PPE, personal protective equipment. That's just, man, that's hard to find now, and I touched on it when I was still recording under the Between the Slides moniker that Decentralizing Ebola and Project Charters, which is actually the most popular episode. It's interesting when folks just kind of riff and have i guess they were pretty good thoughts um but now we're seeing a lot of folks that did wait and didn't already

kind of stock up and have enough and but again i've had a conversation on another podcast recently and and with other folks you know it's you can practice this a lot but just you can't truly scale to this level and perfectly prepare you you you can't truly scale to this level and perfectly prepare. You just can't. So that's another thing is, is just understand that everybody, you, you, we couldn't have perfectly prepared for this ever, right? So we can have the mechanisms in place, the, um, pathways, the ordering, all that kind of stuff. But you know, when, when it really hits, just like it is now what what's happening now it's just going to happen so we just got to push through it so logistics again super busy and then finance

and admin so they're of course looking for the best deals and and having to track you know we getting price gouged and and how much does this expert cost per day and just there'll be a lot of reimbursement after this i'm sure just like that stimulus package that's coming. But there will be no doubt because there are, after every disaster, boosts to grants and all that kind of stuff. So hopefully, it will be interesting to see that. So if you have an incident command system organized emergency operations center, then you're working under kind of the out-of-the-box ICS org chart. Another option, and again, your emergency operations center that's virtual or in person when we were doing that can be set up however you want. That's just something to consider is are you going to do that? Are you going to work under the emergency support functions? And these

are essentially, there's 15 or 16, I think, or 17, depending on your local state or federal configuration. There's a variation there, but basically it's the headers that um that um expertise is under so like seven is logistics so everything logistics goes through there eight esf8 which i fell under is public health and medical um and then there's other esfs for uh law enforcement fire or medical and just they break out that way so what i found and what i worked in the most was an incident command system slash esf hybrid so really what this means is your operation section changes quite a bit so like for me public health esf8 i we i was paired in like the response um group i think we were under under the operation section with like esf-4, which is firefighting, and they did the direct medical aid. It's public health and medical, but we've broken it that way.

We also were paired up with 13, which is law enforcement, and really the response-focused ESFs. So you could do that, and you could break that down on the ESF chart or just have pure ESFs. And then the other way that's pretty straightforward is just have every department, you know, public health, police department, fire department, public utilities, public works, finance, IT, et cetera, on down the line. So many different ways to configure your EOC.

So now how do you do that virtually? Really, you do it the same way. And if you're the EOC manager or the planning section chief, however you set that up, that's helping coordinate the process, is you do daily check-ins, just like you would do kind of a stand-up in the EOC, is you set daily meetings, Zoom, FaceTime, whatever you're using, Skype, and you go around whatever structure it is, work in the process. Hey, here's the objectives for the day. Are these still valid? Here's what we learned from yesterday. Here's the current status. And for now, of course, everybody's looking at number of cases, surge capacity, you know, in the different localities. And by now a lot of the health departments and healthcare organizations have really centralized probably their operations. So,

but there's still local support with that. You know, how can, how can locality help those organizations? And you just work the process. You just have to use tools that connect you. Radios as a backup. Do your folks that are working virtually, especially public health and the public safety folks, have those 800 megahertz or other radios in addition to their smartphones, in addition to their computers, in addition to network access?

Or if you use something like Office 365, you still need credentials, but you don't have to VPN into your organization's network. So that can really help out. And part of that is you just need to get your tempo going each day. And other than that, you know, that's really it. The challenge is you can't hand someone that, you know, ICS 213 general message or resource requests across the table or have a stack of those, but you can mimic that. So one thing I found and used that was helpful is take either an ICS form or the bullet points, like I've talked about that C-SALT acronym for resource ordering, and put that in an email and have people use that as a template for

the ICS forms. You can actually just copy them. They're really a table. You can copy and paste that directly into your email. Now I use Outlook, so it's another Microsoft product. So the formatting works well. How that works with Google and stuff or other products, it works pretty good. But really at some point, make sure you're capturing the same information or pare it down and just justify that. So virtual emergency operations, you just got to make sure you're doing your check-ins, your communication is on point, maybe keep a Zoom meeting open, people can jump in and out of. So it's kind of like a virtual space. Just consider those things. For healthcare, how can we reduce patient contacts, which means, you know, what that really means is how can, ones that we don't need to, ones that's just a saying hi or, you know, not interventions we need to do.

There's no way to get around that. particularly in sick areas like ICUs where a lot of these COVID-19 patients are, walk around and they stand outside the room and they talk about the patient. They look at the chart and then they'll go in and say hi and then maybe look at the wound or the vital signs or listen to the chest, you know, someone will or something like that. And then they go back out, wash their hands, of course, go back out, do the same thing outside the next room and on down. So how do we reduce the number of people going in rooms these days? How do we reduce the use of personal protective equipment, you know, so you don't have to don and doff?

Don means put on, doff means take off. Going in and out of the rooms, well, let's empower and use these devices everybody loves to look at every day, smartphones, right? It doesn't matter what kind, but have a device in the patient's room that stays in the patient's room and one that's outside that stays outside, whether nursing uses it or providers like the rounding team uses, and they can FaceTime, Zoom, whatever it is, message both voice and visual to the patient inside the room if it's really just a, how are you feeling today? We're here for you. Let us know anything you need, those kind of things,

and it's not a direct intervention like hanging med bags or something like that. There's, there's no getting around. You have to don your PPE and someone go in there and do that. But for just the consults and talking to someone, that's what this infrastructure we have set up in this, you know, really around the world, but in this country is all about. We have fantastic internet speeds, you know, organizations, networks are getting hammered now. There's more people probably remoting in. But think about that. So a smartphone dedicated in the room, it never leaves there. So you're not going to cross-contaminate from that device.

And there's a directory in all the phones that are outside that the staff uses. So they can have like room one, room two, room three, and on down the line and just call to that. And it's already preloaded. So work with your IT folks. Have them do that. map out the process, just make a nice picture. I'll share one as well, just so folks can get a visual. But it really keeps less people going out of the room. It keeps you connected to the patient. You can still see each other. And then as a bonus, if you've empowered that person with a phone or a tablet or some device inside the room, they can also be contacted by their family. Now, work out your IT policies, security policies, HIPAA, that kind of stuff.

But remember, we are kind of in a crisis standards of care mode where we're trying to do the most good for the most people. And HIPAA has relaxed a bit, right? That's why we're allowed to use Zoom and FaceTime and things like that to consult with patients because we're going to talk about protected health information or that PHI, right? But that's relaxed. And if it helps the situation now, you know, think about your policies, consider them. We don't want to, you know, open the vault doors and let everybody in.

But there are times if stuff's inside your network or there's not really, you know, secure information or patient information on a device or that people can kind of spill the beans about, then be innovative and empower your folks. So consider that smartphones or smart tablets, whether it's an iPhone, Amazon, or whatever it is, in the room that stays there and ones dedicated to the teams outside the room. You can do this in EDs, ICUs, general medicine. And then, again, you could also, if you have a bank of phones, even old ones you've just replaced, kind of repurpose them. So if there's non-COVID patients that come in, you could, through logistics, organize getting those checked out

from the different units that have family that want to call or something like that. So just consider that kind of a phone loaner program or assignment. And as a bonus for the devices you'd use for suspected or confirmed COVID patients, you can decontaminate those. There's a PubMed, and I'll share the link there, where the wipes that we use in the hospitals, you know, different colored tops, and I don't recall which color it is. Again, I'll post the link, are pretty good at disinfecting those. And so they can be reused between patients, just like an IV pump or another device just needs to be decontaminated. And then as a bonus, if you buy a bunch of new ones,

you can then reuse them down the road for future projects, right? And again, run all of this by your infection prevention because they're the sign off on it. It was an NIH PubMed though, so it's pretty legit. Again, I'll share the link. Or you could Google, you know, NIH iPhone disinfectant and you'll probably find it just as fast. Another EOC-related lesson learned or prompt that I would suggest is we're going to have a lot of people working in emergency operation centers that have never done that before. They've never

used the incident command system. That's not a big deal, but they're going to now be in charge of coordinating a process and people are going to call them and expect them to just be able to get to it. And again, we need to set them up for success. So make sure that you have before someone, before they're left alone by the phone or on call or whatever, that they get just-in-time training and have job aids for their position. It can be a generic job aid for what does logistics do? What does IT do here? What does operations do?

But give them an in-brief just like you would if you were starting a project or going in as an incident management team. If you were the emergency manager and they're coming in for the first time, let them know what they should be able to do. Here's a job aid. What concerns do you have? Here's all the contacts. Here's the schedule of rotation. Here's, you know, or if you have a coordinating plan, kind of like an incident action plan, but it's really for coordinating, not really incident focused, but you're still using similar forms to share that, make sure they understand that.

But really set them up for success. Don't just say, okay, here's your phone, see ya, and then let them figure it out, because it won't be as efficient. It's not fair to them, and it's huge pressure. There are tons of both incident command system and emergency support function-specific job aids out there. Just Google it.

Again, I'll try and share some more on peopleprocessproperties.com. You can have them go figure here's another shameless plug listen to some of the archived episodes of this the talk about incident command system stuff and public health but in particular give them something they can read now and again there's job aids for their positions the other thing when you help them is i would say and again they have to know who's doing what in your organization but to me the core incident command system principles are far more valuable than having to teach them the customized hospital information or incident command system or HICS. I have pretty extensive hospital experience, both with gloved up, gowned up, doing work in a

critical care setting, delivering patients there as an EMS provider and as an IT guy. And I'll tell you, I'm not a fan of HICS at all, right? It's a cool thing because it's very customized for hospital folks that don't use the incident command system a whole lot. It's got customized units within it that are specific to the hospital. My take on it is if you know the incident command system, or at least strongly the basic principles, you can use it for anything, not just the hospital. And that empowers people beyond the boxes that HICS puts people in. There's a reason that there's generic placeholder boxes for the incident command system. And then beyond that, call the group whatever you want to call the group.

Call the division whatever you want to call the division. Call this unit whatever or team, et cetera, and operations. And that there are specific unit names under planning and logistics. It's because what they do in every single box that was built out specifically for HICS can be built out or covered by the other boxes that already exist for the Incident Command System. So I get, it was nice innovation.

It was good, but I think it is too narrow focused and it doesn't empower our people to be able to use the incident command system broadly for whether it's this pandemic or mass casualty or anything else they might get involved in. You know, they may be part of the hospital team that supports a big event in the area and you're not using HICS now. Will they get some of the principles from HICS to be able to translate that to the incident command system for whatever big event or regional team? Yes. But will they understand it much better, be integrated better if they already know ICS generally? Absolutely, they will. So again, some things to consider as we get to this

next week. Set up your virtual emergency operations center operations so you're connected using all the tools. Set up a regular tempo, maybe one in the morning, one in the evening where you're all checking in with each other. You're coordinating constantly. You have chat up, something. Consider ways to empower clinicians and families and staff by using smart devices dedicated in rooms that don't leave there and then ones outside so they can still communicate. Just-in-time training. Before you put people in an emergency operations center,

whether it's a physical location and you're six feet apart or you're totally virtual, you've got to set people up for success. Make sure they have job aids, give them just-in-time training. They know what their position is supposed to do. Focus on the incident communication system principles, not just the HICS principles and setup. Because again, it's going to empower people well beyond hospital-based stuff and set them up for success further on down. Thank you all very much for listening, for reaching out on LinkedIn and other places, other platforms. Again, I'm Kevin Pinnell.

I'm on LinkedIn. I'm PinnellKG on Instagram. People Process Progress has a Facebook page. I'm trying to keep all these synced up and I'll keep the peopleprocessprogress.com website updated. I haven't posted a kind of blog post for a while. I posted an article on LinkedIn yesterday called Drown Proof Yourself for Adversity. I made it to the dive med tech

program when I was in the Navy. I didn't graduate from it, but I learned a ton. I really got through a lot of hard parts of it. I didn't pass my last base swim, but one thing I did get through was drown proofing. That's where your hands and feet are tied or held together and you bob up and down I got through a lot of hard parts of it. Didn't pass my last base swim. But one thing I did get through was drown-proofing, right? That's where your hands and feet are tied or held together, and you bob up and down in 12 feet of water, swim around a little bit, no mask, hands behind your back, drop your mask and snorkels. And how we can drown-proof ourself, the key to making that easy is calming down, taking a breath, relaxing.

You breathe out slowly. You descend to the bottom. You touch your feet. You push back up. You get a small breath. And to me, this is akin of if you're doing field operations, work, work, work. You got to give yourself a few minutes to step back, take a breath, then get back into it, right? If you're working remotely like I am doing project management or kind of project incident management, same thing.

Work, you know, 45, 50 minutes when you can. Stop. Take a breath. Stretch. Walk around. Come back to it, right? The way you can be successful with dealing with this, and I'm, you know, not perfect at it. I'm just things I've learned from not being good at sometimes, is you have to give yourself a break.

You can't do everything yourself at all levels. We are getting to or at the time when folks are going to be burned out. If you're in charge of something, let other people help you. You can't do everything at all levels for very long. And even when you do that, when this COVID-19 isn't happening, it's still not as effective. So my kind of final prompt as we close here is empower your people. Make sure they have what they need, like some of the tips we talked about. And then let them do it.

And then give yourself room to not have to do everything at all levels. It will help you do better, to help your team do better in so many different ways. And we can do a whole nother episode on, you know, like Jocko Willink's decentralized command, which as he says, isn't new. It's a concept of, you know, just letting your people, empowering your people and then, you know, letting them go forth. It's a huge benefit. So thanks for listening to this, taking some time. I hope you all are well. Follow the CDC again. That's our go-to. And here is a public service announcement from them to close us out. COVID-19, better known as coronavirus, has spread throughout the world. Symptoms of this respiratory disease may include fever,

cough, and shortness of breath. These symptoms may show up 2 to 14 days after exposure. If you are experiencing these symptoms and have come into contact or are in an area with an ongoing outbreak, please call a hotline and or consult with a physician. Clean and disinfect high-touch surfaces. For more information, please visit cdc.gov forward slash COVID-19. Thank you.