September 9 – 15, 2019




1. Regional Coalition Meeting

The Northwest Region Healthcare Coalition will hold its monthly meeting Thursday September 12 beginning at 10:30 am. The agenda, July meeting minutes, and dial-in information will be sent to the routine attendees Tuesday September 10. 

2. Surge & Evacuation Project

The Northwest Region Healthcare Coalition has begun the Regional Surge Capacity and Evacuation Plan project for the acute care, critical access, psychiatric, and rehabilitation hospitals in the region. This project has several goals such as determining space management, resources and assets to complement existing plans, enhance rapid assessment capabilities of transportation resources, and establish a process to ensure the patients are evacuated using the right patient/right place theory during a hospital evacuation. For more information, please click here.

3. Pediatric Surge Annex Project

The Northwest Region Healthcare Coalition has begun a Regional Pediatric Surge Annex project for the regional acute care, critical access, and psychiatric hospitals in the region and other hospitals in the state that can provide additional surge beds. At the conclusion of the project, the region will have an annex that will be part of the Regional Surge Capacity and Evacuation Plan. To ensure the annex is understand by the regional coalition members and partners, training on the annex will be provided and a Table Top Exercise will be conducted validating the annex and making any necessary changes to it.

4. Save the Dates

Upcoming regional training:

          a. The Coalition will conduct four training opportunities titled NIMS-in-a-Nutshell.

           NIMS and ICS – what do they mean and how do they apply to your facility or organization? This workshop will describe the purpose of the National Incident Management System (NIMS) and provide an overview of how the Incident Command System (ICS) can be applied to your facility. At the end of the workshop, the attendees will work through a facilitated table top exercise to apply what was learned and to implement your Emergency Operations Plan. The offerings are spread around the region to help limit travel time for attendees. The first offering is October 10th in Harrisonburg. The second offering is October 17th in Front Royal. The third offering is November 7th in Charlottesville. The fourth offering is November 14th in Winchester. You can register for any of the four offerings by clicking here. Please obtain the password to complete the registration process by contacting Becki Chester or Matt Cronin from the Contact Us page.

          b. The Coalition will host the MGT – 349 Pediatric Disaster Response and Emergency Preparedness course November 18 – 19, 2019 in Harrisonburg, VA. Questions regarding upcoming training, please contact our Exercise and Training Coordinator, Matt Cronin. Please see the link for more details.

5. Clinical Advisor

The Northwest Region Healthcare Coalition is seeking a part-time physician to serve as a clinical advisor. The job announcement can be found here. We ask healthcare organizational staff to please assist us by spreading the word about this open position. As part of our grant funding requirement, we must hire a physician before the next grant period begins.


6. Memorandum of Understanding

We are pleased to announce that the Northwest Region Healthcare Coalition continues to receive requests to sign a Memorandum of Understanding (MOU) between the coalition and non-hospital facilities. The MOU is designed for healthcare facilities that are not classified as an Acute Care or Critical Access hospital, and it is good for five (5) years before it will need to be renewed. If your organization resides within the Northwest Region and you have not signed the MOU, you can contact either the Regional Coordinator or the Medically Vulnerable Populations Coordinator to find out more details.

We are expanding our outreach to healthcare agencies within the region as a way of offering assistance to you and your organization. We ask for everyone’s help to spread the word by talking with your colleagues about the Northwest Region Healthcare Coalition. You can contact us by clicking the Contact Us tab on our website.


Click here to access our website. Don’t forget to visit the Events calendar for upcoming training and exercise events.


We have developed a one page document explaining the regional coalition’s mission, listing its partners, and contact information that can be shared between coalition partners. Please click here to view the regional “one-pager”.

Virginia Hospital & Healthcare Association Credit:

Virginia Department of Health



Health & Human Services

 Assistant Secretary for Preparedness and Response


Assistant Secretary for Preparedness and Response Technical Resource,                                                                                                           Assistance Center, and Information Exchange

Hospital Preparedness Program





Credit: Centers for Disease Control and Prevention

CDC Releases Two MMWR E-books on Severe Pulmonary Disease Associated with Electronic-Cigarette Use

CDC has released two e-books on severe pulmonary disease associated with electronic-cigarette use: 

“Severe Pulmonary Disease Associated with Electronic-Cigarette–Product Use — Interim Guidance”

Twenty-five states have reported more than 200 possible cases of severe pulmonary disease associated with the use of electronic cigarettes (e-cigarettes).

Based on available information, the disease is likely caused by an unknown chemical exposure; no single product or substance is conclusively linked to the disease. Until a definitive cause is known, persons should consider not using e-cigarettes. Those who use e-cigarettes should seek medical attention for any health concerns. Clinicians should report possible cases to their local or state health department.

“Outbreak of Electronic-Cigarette–Associated Acute Lipoid Pneumonia — North Carolina, July–August 2019” 

During July and August 2019, five patients were identified at two hospitals in North Carolina with acute lung injury potentially associated with e-cigarette use. Patients were adults aged 18–35 years and all experienced several days of worsening dyspnea, nausea, vomiting, abdominal discomfort, and fever. All five patients shared a history of recent use of marijuana oils or concentrates in e-cigarettes, and all of the products used were electronic vaping pens/e-cigarettes that had refillable chambers or interchangeable cartridges with tetrahydrocannabinol vaping concentrates or oils, which were all purchased on the street. 

One potential explanation for acute lipoid pneumonia among these patients is that aerosolized oils inhaled from e-cigarettes deposited within their distal airways and alveoli, inciting a local inflammatory response that impaired vital gas exchange. Lipoid pneumonia has long been described from aspiration of oil into the lungs and has been associated with e-cigarette use in some case reports. Symptoms of lipoid pneumonia are often nonspecific with variable chest imaging, which can lead to delayed or missed diagnosis. 

These five cases highlight the importance of awareness of a potential association between use of marijuana oils or concentrates in e-cigarettes and lipoid pneumonia. 

Credit: U.S. Food & Drug

Tetrahydrocannabinol (THC)-containing Vaping Products: Vaping Illnesses

BACKGROUND: Consumers are likely aware of the recent reports of respiratory illnessesincluding some resulting in deaths – following the use of vaping products.The FDA is working closely with the U.S. Centers for Disease Control and Prevention, as well as state and local public health partners to investigate them as quickly as possible.

ISSUE: The FDA is providing consumers with some information to help protect themselves while the work by federal and state health officials to identify more information about the products used, where they were obtained and what substances they contain is ongoing.

In particular, many of the samples tested by the states or by the FDA as part of this ongoing investigation have been identified as vaping products containing tetrahydrocannabinol (or THC, a psychoactive component of the marijuana plant) and further, most of those samples with THC tested also contained significant amounts of Vitamin E acetate. Vitamin E acetate is a substance present in topical consumer products or dietary supplements, but data are limited about its effects after inhalation.

The FDA is analyzing samples submitted by a number of states for the presence of a broad range of chemicals, including nicotine, THC and other cannabinoids along with cutting agents/diluents and other additives, pesticides, opioids, poisons and toxins.

No one substance has been identified in all of the samples tested. Importantly, identifying any compounds that are present in the samples will be one piece of the puzzle but will not necessarily answer questions about causality.

The FDA is committed to taking appropriate actions as the facts emerge and keeping the public informed as we have more information to share.

RECOMMENDATION: While the FDA does not have enough data presently to conclude that Vitamin E acetate is the cause of the lung injury in these cases, the agency believes it is prudent to avoid inhaling this substance. Because consumers cannot be sure whether any THC vaping products may contain Vitamin E acetate, consumers are urged to avoid buying vaping products from the street, and to refrain from using THC oil or modifying/adding any substances to products purchased in stores. Additionally, no youth should be using any vaping product, regardless of the substance.

If you continue to use these THC-containing vaping products, monitor yourself for symptoms (e.g., cough, shortness of breath, chest pain) and promptly seek medical attention if you have concerns about your health.

If you are concerned about your health after using a vaping product, contact your health care provider, or you can also call your local poison control center at 1-800-222-1222. Health care providers also can contact their local poison control center.

Health care providers and consumers are encouraged to report adverse events or any problems related to these products to the Safety Reporting Portal.

Credit: Centers for Medicare and Medicaid Services


         U.S. Department of Homeland Security 

Federal Emergency Management Agency


Virginia Department of Emergency Management

Course Offerings

ICS 300 Intermediate ICS for Expanding Incidents course is scheduled for September 14-15, 2019. Please see flyer for additional details.

Course Announcement ICS 300 Shenandoah, VA

MGT-418 Readiness: Training Identification and Preparedness Planning (RTIPP) course is rescheduled for September 23-24, 2019. Please see the flyer for additional details.     

MGT418 Course Announcement – Spotsylvania VA

ICS 300 Intermediate ICS for Expanding Incidents course is scheduled for October 1-3, 2019. Please see flyer for additional details.

Course Announcement ICS 300 Stafford, VA

PER-335 Complex Coordinated Attacks (CCA) course is scheduled for October 15-16, 2019. Please see the flyer for additional details.

PER335 Course Announcement – Fredericksburg, VA

G205 Recovery from Disaster: The Local Community Role course is scheduled for October 29-30, 2019. Please see the flyer for additional details.

G205 Course Announcement Orange, VA

1. Health Sector Publishes Matrix of Cybersecurity Information Sharing Organization

Washington, D.C., September 9, 2019 – The Healthcare and Public Health Sector Coordinating Council (HSCC) today released its 4th cybersecurity resource for the health sector in 2019: the Health Industry Cybersecurity Matrix of Information Sharing Organizations (“HIC-MISO”).  This resource serves as an inventory of national information sharing organizations and key services related to cybersecurity for the health sector.  The HIC-MISO directly addresses “Imperative 6” of a 2017 report by the Health Care Industry Cybersecurity Task Force, which called on industry and the U.S. Department of Health and Human Services (HHS) to “improve information sharing of industry threats, risks and mitigations.”

“Many health organizations are beginning to understand the importance of cybersecurity information sharing but don’t know where to start,” said Errol Weiss, Chief Security Officer of the Health Information Sharing and Analysis Center (H-ISAC) and co-chair of the HSCC task group that created the HIC-MISO toolkit. “With cyber-attacks against health organizations increasing in number and severity,” Weiss added, “one of the most important things an enterprise can do is build awareness and preparedness through community engagement.  The HIC-MISO points them in the right direction.”

The HIC-MISO identifies the most widely known information sharing organizations that are both health sector and cross-sector in scope.  The intent is to keep the HIC-MISO simple and manageable, at a national, rather than regional, level. 

“The target audience consists of health providers and companies that are not likely to have the resources or expertise to participate in more than one or two of these groups,” emphasized HSCC Information Sharing Task Group co-lead Bill Hagestad, who serves as Medtronic’s Senior Principal Product Security Engineer.  “In preparing this resource,” Hagestad noted, “the Task Group recognized the broad range of budgets and capabilities across the sector, and accordingly we will begin work to supplement the HIC-MISO with a guide for how organizations can establish an information sharing management structure appropriate to their enterprise size, resources and risk profile.”

To access and download a copy of HIC-MISO, go to or click here.

Previous HSCC Joint Cybersecurity Working Group resources published in 2019 include:

About the Healthcare and Public Health Sector Coordinating Council (HSCC) Joint Cybersecurity Working Group (JCWG).  The HSCC is an industry-driven public private partnership of health companies and providers developing collaborative solutions to mitigate threats to critical healthcare infrastructure.  It is one of 16 critical infrastructure sectors organized to partner with the government under Presidential Policy Directive 21 – Critical Infrastructure Security and Resilience.  The HSCC Joint Cybersecurity Working Group (JCWG) includes more than 200 medical device and health IT companies, direct patient care entities, plans and payers, labs, blood and pharmaceutical companies, and several government partners.  The JCWG industry chair is Terence (Terry) Rice, Vice President, IT Risk Management and Chief Information Security Officer for Merck & Co.

Source: Greg Garcia, HSCC Cybersecurity Working Group Executive Director

2. Nurse viewpoint: ‘Workarounds’ reveal the dysfunction of American hospitals

Workarounds, in which providers bypass burdensome rules to ensure their patients receive the care they need, are common throughout the American healthcare system and reveal its dysfunction, Theresa Brown, PhD, RN, a clinical faculty member at the University of Pittsburgh School of Nursing, wrote in an op-ed for The New York Times.

Staff use workarounds because they save time, Dr. Brown wrote. Hospital nurses are already stretched to the limit on their shifts, and inefficiencies in the system force them to find creative ways to deliver required care. Some nurses have resorted to hiding drugs, for example, because the hospital pharmacy is too slow and they don’t want to keep patients waiting. 

Dr. Brown had her own experience with workarounds when her hospital started requiring nurses to use bar code scanners for medications that did not work with electronic medical records. Checking off the drugs in both systems took up valuable time, and many nurses started ignoring the rules to provide better care.

One can argue the entire American healthcare system is built on workarounds, wrote Dr. Brown, and medical scribes are one example. Doctors are increasingly using medical scribes to keep up with paperwork, and in that sense medical scribes are workarounds for the design flaws of electronic medical records. 

Dr. Brown also wrote that the Affordable Care Act, which she supports, is a workaround. The ACA was not intended to ensure all Americans had affordable care, but rather to work around the nation’s failure to provide healthcare to all citizens. 

In sum, workarounds demonstrate how dysfunctional the American healthcare system has become, Dr. Brown wrote. Workarounds represent a “trade-off of values,” in which providers are forced to choose between onerous rules and patient safety.

Source: Anne-Marie Kommers of Becker’s Clinical Leadership & Infection Control

3. 5 vaping-related deaths spur CDC warning

The CDC is urging consumers to avoid using e-cigarette products amid an ongoing investigation into a cluster of mysterious lung illnesses linked to vaping, reports NBC News.

The CDC issued the warning Sept. 6, the same day health officials in California, Indiana and Minnesota each confirmed the death of a patient hospitalized with a vaping-related lung illness. 

Nationwide, five deaths have been linked to the lung illnesses. The agency is investigating 450 confirmed and suspected cases in 33 states. In many of these cases, patients said they used vaping products containing marijuana prior to their hospitalization.

The CDC and FDA are working with state health officials to identify the cause of the illnesses. Officials identified a common chemical — vitamin E acetate — in samples of patients’ vaping products. However, the CDC says it’s still too early to confirm this chemical as the definitive source of the illnesses.

Source: Mackenzie Bean of Becker’s Clinical Leadership & Infection Control