As individuals, we create and test plans every day, usually without realizing it. Some plans are simple, like scheduling a meeting with a colleague. Other plans, such as organizing a potluck dinner party, are a bit more complicated. If the plan (in this case, an invitation) was adequately scoped, clearly written and communicated, you won’t end up with all desserts and no entrees.

And then there are far more complex plans. One way the Network helps bolster the disaster resiliency of the Puget Sound healthcare community is to create, test and maintain collaborative regional plans. Like the dinner party plan, these plans must be well scoped and clearly written to elicit the desired response. However, unlike our potluck scenario, the Network doesn’t wait for the event to test it. Instead, they approach plan creation and testing as a progressive, multi-year process, allowing for plan refinement and mastery at each level before moving to the next. Let’s take the Regional Acute Infectious Disease (AID) Response Plan as an example.

In late 2014, the threat of the Ebola virus was circling the globe. As Seattle is an international hub for travel, commerce and tourism, there was justified concern the virus could make its way to the Puget Sound region. The Network responded by activating its Healthcare Emergency Coordination Center to support coordination and information sharing within the healthcare community.

This activation was the catalyst to develop a regional response plan to address not only Ebola, but the broader category of acute infectious disease. Specifically, the plan would define roles and responsibilities of regional response agencies, including healthcare, public health and other regional and state partners for a coordinated regional response related to the potential consequences of an acute infectious disease outbreak.

By January 2016, the Network had conducted research and interviews with representatives from Public Health Epidemiology in King and Pierce counties, Washington State Department of Health Epidemiology, hospitals, outpatient care, and emergency medical services. A draft plan was created, input was gathered and gaps were addressed. Attention could now turn to testing the plan.

The Testing Cycle

For the Network, testing typically starts with a plan training, where key stakeholders are provided with the plan background and overview. Next, those same stakeholders participate in a tabletop exercise, which involves talking through a scenario with the goal of identifying gaps in the plan. Once those gaps are addressed, a functional exercise is conducted and a broader group of stakeholders play out a scenario, often focusing on key parts of the plan with a goal of resolving issues. Several functional exercises may occur, depending on the readiness of the plan and participating organizations. Lastly, if deemed appropriate and resources are available, a full exercise is conducted. In a full scale exercise, participants play out larger events as if they are actually happening and often include people role-playing as patients.

Preparing as a Community

The Network hosted its AID plan training webinar in February of 2016, followed by the discussion-based tabletop exercise in April. Fifty participants from four counties (King, Pierce, Snohomish, and Kitsap) and the state were given an evolving scenario to react to and discuss, resulting in collaborative conversations covering AID screening processes, precautions, notification coordination, operational protocol, laboratory protocol and how to transfer a suspected AID patient.

Drawing from lessons learned at the tabletop exercise, the Network created an improvement plan with the input of their Acute Infectious Disease Advisory Group, drove the development of curriculum, and hosted the webinar-based trainings to address gaps. The functional exercise took place in August of 2017, and focused on testing the decision-making and communications protocol. The plan is ready to be activated by public health or the Network when needed.

As there is great benefit in collaboratively planning for a regional response before a disaster strikes, the Network has created and maintains several other plans, including:

• Regional Healthcare Situational Awareness Procedure
• Regional Scarce Resource Management and Crisis Standards of Care Concept of Operations
• Regional Patient Tracking Concept of Operations
• King & Pierce County Long-term Care  Mutual Aid Plan (LTC-MAP) for Evacuation and Resource Sharing

The following plans are being updated:

• Regional Hospital Evacuation Plan
• Regional Healthcare System Emergency Response Plan

In a disaster, the work of the coalition allows our community to:

• Share information that supports crisis decision-making
• Address community-specific needs
• Quickly operationalize response plans
• Work collectively to solve common problems