Natural disasters continue to increase in frequency and severity on a global scale, limiting real-world opportunities for individual localities to train personnel, test plans, and apply lessons learned from previous disasters. Consequently, planning and drilling are critical activities, and realistic emergency preparedness drills and exercises can help ensure a more effective response when disaster strikes.
Studying lessons learned from other emergencies and practicing simulations is the best alternative to real-world experience because the ability to equivocally learn in a replicated environment strengthens readiness to respond during a disaster. In support of our Patient Unified Lookup System for Emergencies™ (PULSE Enterprise) and Emergency Census™ partners, Audacious Inquiry leads internal drills and participates in our partners’ state and local drills to prepare our staff and ensure that response protocols and software perform as planned.
As the saying goes, “if you can’t do it every day, you can’t do it on gameday.”
In this blog, two of our state partners, the Florida Agency for Health Care Administration (AHCA) and Texas Health Services Authority (THSA), discuss how conducting drills using PULSE Enterprise (known as E-PLUS in Florida) has helped them better prepare for emergencies and natural disasters.
How Emergency Preparedness Drills and Exercises Can Help
According to Suzanne Kirayoglu, PhD, ENS Program Coordinator for the Florida Center for Health Information and Transparency at AHCA, conducting drills is of the utmost importance because it allows AHCA to think of the possible situations that may occur in a real disaster and design the drill to see how different scenarios would play out. Drills allow partners to obtain lessons learned and incorporate them into their standard operating procedures. The drills are beneficial for both on-the-ground response personnel as well as the technical and programmatic teams that support them.
“Conducting drills gives the people supporting E-PLUS users in the field the ability to dive deep into the system and gain critical insights and understanding of how the system functions in ways that the technical team may understand, but others may not,” Kirayoglu noted. “This allows us to best support our field-based response teams.”
Eric Heflin, Chief Technology Officer and Chief Information Security Officer of THSA, notes that conducting realistic emergency preparedness drills and exercises serve several mission-critical functions, including:
- Confirming responsiveness and optimal configuration of the data sources that provide clinical and medication history data in PULSE
- Conducting end-user and administrative training that mimics a just-in-time scenario
- Validating connectivity to external programs, such as shelter vendors and other key operators who will leverage PULSE during emergency responses
- Enabling state partners to identify enhancement requests for user-led continuous product improvement
Florida Hurricane Drill: E-PLUS and Emergency Census Used by Local Health Departments
In January 2021, AHCA partnered with Audacious Inquiry and the Florida Department of Health to conduct a drill meant to test the ability to conduct just in time training and evaluate the user experience of minimally trained users. AHCA invited three Department of Health staff who had never heard of E-PLUS to participate in the drill. The staff were given 30 minutes of just-in-time training using standard E-PLUS training materials, and each was given a role (e.g., County Health Department Nurse, Reunification Coordinator).
Using a hurricane scenario that forced a Florida county to evacuate, the drill followed the patient journey of a male patient who required home health care and did not pre-register for a medical special needs shelter. His home health agency was unable to contact him and did not know where he was. When he was taken to a special needs shelter, he brought his medications but did not know how to administer them and could not remember the condition for which he needed oxygen.
Upon arrival to the shelter, the County Health Department Nurse was able to search for the patient’s medication and clinical history using E-PLUS, enabling her to better understand his condition, administer the medications appropriately, and inform the respiratory therapist of the patient’s condition and oxygen requirements. The Department of Health was also sent a list of missing patients by the patient’s home health agency. Using Emergency Census, the Reunification Coordinator was able to reconnect the patient with his routine home care services; they also identified that two other patients on the list were currently inpatients at a nearby hospital after a special needs shelter EMT determined their care required higher services than what was available.
By conducting the drill with Department of Health staff who had never heard of E-PLUS, AHCA was able to promote awareness of E-PLUS while simultaneously validating the just-in-time training mechanism. Kirayoglu noted that the 30-minute virtual training sessions were sufficient to enable end users to comfortably and successfully perform their assigned roles, and the user guides–particularly the QuickStart Guides which are two-page primers on how to successfully navigate E-PLUS quickly–were helpful for administrators to understand the system and answer any questions the end users had.
Texas Wildfire Drill: HIETexas PULSE Used by Shelter Operators
In April 2021, THSA conducted a virtual drill in partnership with Audacious Inquiry and BCFS, a state contractor that provides staff and operational support for medical shelters during disasters. The drill was observed by partners at Texas Health and Human Services Commission (Texas’ state Medicaid agency) and other staff at THSA.
Using a wildfire scenario that caused Texas residents to evacuate to the Austin Convention Center, the drill followed the patient journey of a woman who recently had back surgery and her neighbor with a seizure condition who arrive in the shelter together. Using HIETexas PULSE and Emergency Census, the evacuees were checked-in to the alternate care facility, assessed for clinical needs, offered appropriate treatments, and discharged from the shelter to their home locations.
To make the drill as realistic as possible, planners took inspiration from former disaster responses that leveraged PULSE. While serving as technical lead for the first deployment of PULSE during California wildfires in 2017, Heflin became aware of a man who recently had back surgery but was unable to obtain medication due to the pharmacy catching fire while the man was seeking to fill his prescription. As the man started evacuating, he checked in on a neighbor with diabetes who was unable to walk, and therefore required evacuation assistance. The pair went to a non-medical shelter and met a nurse who was able to use PULSE to identify that both the man and his neighbor were receiving critically important medications, including antibiotics, pain killers, and insulin. Ultimately, both individuals were referred to the appropriate follow-up care, avoiding the negative health consequences associated with medication interruption and preventing unnecessary hospitalization.
Prior to the drill, several participants had not yet been fully trained, but all participants noted that PULSE was easy to learn and they found value in using the technology. Without PULSE, many medical shelters lack electronic access to patient clinical and medication history and rely on the patient to describe their conditions and treatment plans. Using PULSE, clinicians are granted a comprehensive view of prior hospitalizations, ambulatory encounters, and recently filled medications, which can lead to better clinical care and patient health outcomes.
How Lessons Learned from Emergency Preparedness Drills and Exercises Were Applied During the 2021 Hurricane Season
Subsequent to their drills, both HIETexas PULSE and E-PLUS were used in disasters and were able to apply lessons-learned from the drills. AHCA was staged and ready to use E-PLUS in advance of Hurricane Elsa, but ultimately medical response using E-PLUS in shelters was not needed. Nonetheless, AHCA and Audacious Inquiry were able to quickly ready E-PLUS and rapidly identify users who received just-in-time training, which illustrated the effectiveness of advance planning activities.
THSA activated and utilized HIETexas PULSE to support Louisiana’s response to Hurricane Ida. BCFS, who had participated in the THSA drill earlier in the year, contacted THSA and Audacious Inquiry about using PULSE Enterprise in Louisiana shelters. With the support of the Louisiana Department of Health, BCFS Emergency Management Division (EMD) worked with THSA and Audacious Inquiry to rapidly address the legal, governance, and technology requirements to deploy Texas’ technology in Louisiana. Within days, a just-in-time implementation was available for deployment. Using the suite of available just-in-time training materials, BCFS EMD providers participated in self-directed training, leveraging knowledge obtained during the prior drill.
“The acute and chronic health needs of many Hurricane Ida evacuees required emergency personnel and shelter staff to act quickly,” said George Gooch, CEO of THSA. “We are proud to support our neighbors in Louisiana through our work with BCFS and Audacious Inquiry by bringing prompt, accurate medical and medication history information to clinical staff serving evacuee medical needs.”
Why Should Other States Prioritize Emergency Preparedness Drills that Test Technology Solutions?
Response personnel need to know the technology is vetted, reliable, and available. For AHCA, conducting a drill helped the Agency and partner agencies feel more confident in their readiness to respond if a disaster occurs. This confidence was also felt by E-PLUS end users who saw that they could quickly pick up the technology and feel assured that the system would perform when needed and fill critical care gaps experienced in the field.
Disaster response requires collaboration among many different partners and many of these relationships are built on trust that is acquired over time. THSA indicated that drills are a form of outreach among Texas’ response community partners and allows disparate agencies to work together using a very tangible and impactful solution to fill critical care gaps when treating evacuated and displaced persons.
Build Muscle Memory
Emergency responses are only as good as the planning that occurs before the emergency. While much of the response is reactive to the particular situation, pre-planning is integral to understanding what challenges may come up during any emergency situation, and how to quickly and flexibly implement solutions. Disaster preparedness literature suggests that participation in simulated drills can strengthen skills and capabilities to handle crises. The literature also indicates that detailed simulations can also increase knowledge and how to handle the complexity of real-world situations through simulations that provide equivocal learning experience that is comprehendible, usable and strengthens readiness to respond during a real emergency.
Anticipate the Unexpected
A crucial aspect of disaster preparedness is reducing the number of scenarios that you have never thought about or planned for. Emergency preparedness drills and exercises can help uncover unexpected user behaviors, and unexpected system behaviors that are better identified outside of a real-world response. For example, the night before AHCA’s disaster drill, there was a technical issue in the testing environment that made it difficult to locate missing persons as planned. Kirayoglu said that this situation actually helped the participants stay flexible by expanding the drill’s scope to test more functionalities than initially intended. Because of this, AHCA was able to think through its reaction during unexpected challenges and update their procedures to mitigate this from occurring again.
“Technical issues will happen in real emergency responses, too” says Lauren Knieser, Senior Director for Emergency Preparedness at Audacious Inquiry, “Being able to identify challenges and leverage solutions during a drill enables all parties to be better prepared for when something inevitably fails later. It also helps uncover the ‘gotchas’ in a controlled environment rather than being blind-sided during an actual emergency.”
PULSE Enterprise is available in any domestic geographic region for emergency management administrators to enable emergency healthcare professionals and first responders to better care for displaced individuals outside their normal care environment. In addition to supporting long-term planning and response for disasters and emergencies, Audacious Inquiry can quickly deploy PULSE Enterprise in coordination with our support services to best meet the needs of tribal, state, or community emergency responses.
About the Author
Eliana Donner-Klein is Senior Associate for Marketing at Audacious Inquiry, a national industry-shaping health IT company that developed the single most impactful platform for aligning better care across the healthcare continuum. At Audacious Inquiry, she works to support marketing and business development strategy through market research, case study and content creation, and product marketing. Eliana has been a patient advocate since 2015, working to raise awareness about living with chronic migraine and other invisible illnesses through writing, speaking engagements, consulting, and political advocacy.
Donner-Klein previously worked as an Associate at Sirona Strategies where she focused on a variety of health policy issues including Medicare and Medicaid, value-based care, health information technology and interoperability, telehealth, and the social determinants of health. In addition to her policy and regulatory work, she worked as the communications manager to redesign and run coalition websites, strategic communications campaigns, and thought leadership through events and newsletters.