Double the Trouble: H5N1 Plus Cat 3 Complications

The state of North Carolina found itself facing a monumental – but, fortunately, imaginary – challenge on 12 June 2008. The scenario for the “Medical Evacuation Triage and Treatment Assessment” (METTA II) exercise was designed to evaluate the state’s ability to respond to a deadly pandemic influenza outbreak – complicated immensely by a hurricane-forced evacuation.

The exercise objectives incorporated a major test of the state’s Functional and Medical Support Shelter (FMSS) concept, which covers the evacuation of a long-term healthcare facility and, because of that requirement, thoroughly tested the ability of State Medical Assistance Teams (SMATs) to mobilize, transport, set up, and operate a portable medical station.

Within the METTA II scenario, a new strain of the H5N1 “bird flu” capable of rapid human-to-human transmission had emerged in New Guinea, and the World Health Organization (WHO) declared a Pandemic Alert Level 5 for what quickly became known as the “New Guinea flu.” A small cluster of cases was identified in the Charlotte, N.C., area, and North Carolina’s Division of Public Health undertook a massive effort to limit the spread.

Despite the fact that there had been only 10 confirmed cases, including two fatalities, the public’s well justified fear of the New Guinea flu resulted in a flood surge into area hospitals of “worried well” citizens that overwhelmed virtually all local medical facilities. In response to North Carolina’s requests for federal assistance, the U.S. Centers for Disease Control and Prevention (CDC) sent some of its own personnel to help, along with some material assets from the Strategic National Stockpile.

Unthinkable Trouble and Additional Complications

Then the unthinkable happened. The National Weather Service notified North Carolina officials that a major tropical storm was on track to make landfall somewhere on the state’s southern coast, most likely as a Category 3 hurricane. Local governments recommended that coastal residents take themselves and their families to safer areas of the state farther inland.

At a simulated command post, the North Carolina Office of EMS (NCOEMS), working in close cooperation with the state’s Division of Emergency Management, decided to activate and deploy a State Medical Assist Team II (SMAT II) unit. The hospital-based SMAT II units are staffed with the physical resources and the full complement of personnel required to establish and operate a 50-bed field hospital. The other seven of the state’s eight SMAT IIs provided additional personnel. The NCOEMS also deployed two of the new FMSS trailers, which carry the equipment needed to establish an 80-bed alternate-care facility.

In the past, activating that many teams of personnel might well have been an extremely difficult challenge. Prior to April of 2007, there was no central volunteer registry in North Carolina – several volunteer organizations maintained their own internal lists of volunteers, though, and each organization or team was in charge not only of recruiting its own personnel, but also of verifying their credentials and communicating with them during emergencies.

The Answer: A Multipurpose Web-Based Registry

But those tasks are not quite so difficult anymore. A new “ServNC” system was established in April 2007, under the leadership of Drexdal Pratt, chief of NCOEMS. The system was designed by a Pittsburgh (Pa.) firm specializing in web-based responder and incident-management solutions.

ServNC provides a single, web-based registry designed to manage both medical and non-medical volunteers. In North Carolina it serves as the state’s Emergency System for the Advance Registration of Volunteer Health Professionals (ESAR-VHP), which is administered and managed by NCOEMS and funded by HPP (Hospital Preparedness Program) grant funding administered by the U.S. Department of Health and Human Services’ assistant secretary for preparedness and response. The system has been enhanced to accommodate North Carolina’s own State Agriculture Emergency Programs and facilitate their use of the ServNC capabilities.

SMAT II teams and NCOEMS maintain a permanent marketing campaign to recruit volunteers to ServNC. Information about the program is distributed at local disaster-preparedness meetings and at regional and statewide conferences such as the annual Disaster Medical Preparedness and Emergency Medicine Today. ServNC is also working with the Association for Home & Hospice Care of N.C. Inc.

The way the system works is fairly straightforward: Individual participants log onto the website and register themselves, providing their contact information, their skills, and their availability to respond; more than 3,700 registrants had already done so as of late March of this year. The current roster includes doctors, nurses, and other allied health professionals as well as non-medical volunteers such as dispatchers, administrative assistants, firefighters, and law-enforcement personnel.

To facilitate the registration process, the system automatically verifies any professional licenses registrants claim to possess through electronic interfaces with: the state’s Nursing, Respiratory Care, and Pharmacy Boards; the North Carolina Medical Board; the North Carolina Office of EMS; and a number of national databases, including DEA Licensing. Finally, the system evaluates the individual volunteer’s experience and assigns that person an Emergency Credential Level rating – i.e., a numeric value which helps ensure that deployed volunteers possess the education, the license, the skills, and the current practical experience needed to support a response.

The personal data of every member of North Carolina’s SMATs is electronically stored within the ServNC database. During the METTA II exercise, Ann Marie Brown, an NCOEMS disaster medical specialist [and co-author of this article], used the system to quicklyentify all of the SMAT II members, alert them about the impending call-up, and give them the specifics of their own potential deployments – including, for example, information about how long they might be needed, where they would be expected to report, and what personal gear and/or equipment to bring with them. Each team member was easily able to use the system’s internal two-way communications capability to report his or her availability back to Brown at the command post.

To date, the system has been used primarily for notifying volunteers of training opportunities, conferences, and “exercise deployments” such as METTA II. Among the members of the state’s eight SMAT team deployed for the METTA II exercise were more than 275 well-trained and qualified responders.

Following the exercise, Brown commented that the ServNC system “worked very well.” She also noted that, “Administrators at all levels” must be trained and tested on a regular basis.  “ServNC is a great tool,” she said, “but if the core personnel are not familiar with the system it cannot be used to its fullest potential – exercises like this help to do that.”