November 18 – 24, 2019




1. Regional Coalition Meeting

The Northwest Region Healthcare Coalition will hold its monthly meeting Thursday December 12 beginning at 10:30 am. The agenda, the November meeting minutes, and the conference dial-in information will be sent to the routine attendees on the Tuesday prior to the meeting. The meeting will be held via our Ring Central conference call line.

2. Save the Dates

Upcoming training and conferences:

          The Coalition will host a Basic Disaster Life Support course December 10, 2019 in Harrisonburg, VA. Please contact our Exercise and Training Coordinator Matt Cronin to register.

Questions regarding upcoming training, please contact our Exercise and Training Coordinator, Matt Cronin. 

Crisis Standards of Care: Ten Years of Successes and Challenges

November 21 – 22, 2019

The National Academies is conducting a two-day public workshop in Washington, DC to explore the evolution and implementation of crisis standards of care (CSC) since the publication of the NASEM report Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report in 2009. Specific topics that will be discussed include:

  • The experiences, successes and challenges of planning for and implementing CSC plans at the local, state and federal level;
  • Shifts in planning assumptions as a result of specific operational experiences, changes to treatment protocols, availability of new or difference resources, and advances in technology;
  • Accepted issues and outstanding legal and ethical challenges; and
  • Potential opportunities for continued development and implementation of crisis standards of care plans for the next ten years.

The workshop will include plenary sessions, small breakout sessions, and a published proceedings. It is free and open to the public via in-person attendance or live webcast.

Register Now »

3. 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.

4. 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.

Virginia Hospital & Healthcare Association Credit:

Virginia Department of Health

Virginia Department of Health Weekly Influenza Activity Report

The Virginia Department of Health monitors the level of activity of influenza-like illness (ILI) each week from October through May. Those are the months when influenza (“flu”) is most likely to occur in Virginia, and that time period is referred to as the “flu season”.

Data Sources:
The Virginia Department of Health uses a number of different data sources to determine the level of flu activity that is occurring each week during flu season. The main data sources that are used to make the weekly flu activity level determination are:

  • laboratory reports
  • outbreak reports, and
  • data on visits to hospital emergency departments and urgent care centers for flu-like illness.

Flu Activity Levels:
Flu surveillance is not designed to count every person who has the disease. That would be nearly impossible because not all people with the disease are diagnosed by a physician and even fewer have their illness confirmed by a laboratory test.

Instead, VDH monitors changes in flu activity from week to week in each of the five health planning regions to look for increases compared to a baseline period. Activity is based on illness complaints that lead people to seek care in a hospital emergency department or urgent care center. Flu-like illness is defined as a fever along with a cough and/or a sore throat.

To view the weekly report, click here.


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




1. ASPR TRACIE The Last Stand: Evacuating a Hospital of a Wildfire

Read » the Q & A Session hosted by ASPR TRACIE

Editor’s Notes:
A true emergency evacuation of a healthcare facility is a daunting prospect. Making sure basic medications, patient care supplies, and key belongings are easy to organize and transport is important. Evacuation equipment education and training are important, but so is the education of command and unit staff about when and how to evacuate versus a true emergency evacuation shelter in place. Facility-specific templates can often be used to predict EMS needs, saving precious resources that would be dedicated to conducting a realtime assessment. EMRs often contribute to challenges during evacuation events; printing “face sheets” for patients at the first sign of danger (e.g., a tornado warning, communication with first responders) can help the evacuation (and patient tracking and relocation) run more smoothly. Using all transportation options available is key, as EMS resources may be committed to responding to the community. Medical personnel must be prepared to accompany patients in non-traditional vehicles. Finally, patients will often continue to present to “closed” facilities and families will call seeking information when they hear about the evacuation – make sure your plans address continuity of services as well as a process for reopening a closed campus.

2. The Healthcare and Public Health Sector Highlights

The HPH Sector Highlights – Healthcare Supply Chain Edition is a monthly email produced by the HHS ASPR Division of Critical Infrastructure Protection (CIP) on behalf of the HPH Sector Partnership. It includes updates with information related to the healthcare supply chain.

Healthcare Supply Chain Edition November 2019

  • FDA Holds Meeting on Ethylene Oxide Plant Closures
  • FDA Releases “Drug Shortages: Root Causes and Potential Solutions” Report
  • U.S. Companies Preparing for Long-Term ‘Confrontational Relationship’ With China
  • EU Accepts UK Brexit Extension Until Jan. 31, 2020
  • 4 Ways 5G is Set to Transform Supply Chains

The HPH Sector Highlights – Cybersecurity Edition is a weekly email produced by the HHS ASPR Division of Critical Infrastructure Protection (CIP) on behalf of the HPH Sector Partnership. It provides updates on threat information, resources, and situational awareness related to healthcare cybersecurity. 

Cybersecurity Edition Week of November 8, 2019

  • Now Available: Guide to Critical Infrastructure Security and Resilience
  • Upcoming 405(d) Spotlight Webinar on Ransomware
  • HC3 Intelligence Briefing “Supply Chain Risk Management”
  • The New Zealand National Cyber Security Centre Annual Report

3. The Exchange Issue 9

In this issue of The Exchange, we discuss planning, response, and lessons learned specific to chemical incidents. ASPR TRACIE interviewed subject matter experts from the federal government, a healthcare provider, and a fire chief to learn more about emerging threats and past and current challenges in chemical incident response. We hope that these real-life experiences shared by your colleagues across the nation help you plan (and adjust existing plans) for chemical incidents.

Read More »

Credit: Centers for Disease Control and Prevention

Evaluation [sic] of Bronchoalveolar Lavage Fluid Samples from Patients with E-cigarette, or Vaping, Product Use Associated Lung Injury (EVALI)

CDC, the U.S. Food and Drug Administration (FDA), state and local health departments, and multiple public health and clinical partners are investigating a national outbreak of e-cigarette, or vaping, product use–associated lung injury (EVALI). CDC developed laboratory methods to analyze chemicals of concern and active compounds in case-associated bronchoalveolar lavage (BAL) fluid samples (fluid samples collected from the lungs).

CDC has identified vitamin E acetate as a chemical of concern among people with e-cigarette, or vaping, product use associated lung injury (EVALI). Vitamin E acetate might be used as an additive, most notably as a thickening agent in THC-containing e-cigarette, or vaping, products.

Recent CDC laboratory testing of bronchoalveolar lavage (BAL) fluid samples from 29 patients with EVALI submitted to CDC from 10 states found vitamin E acetate in all of the samples. CDC a nalytic methods can identify vitamin E acetate, MCT oil (medium chain triglycerides), plant oils (long chain triglycerides), petroleum distillates (including mineral oil), diluent terpenes, cannabinoids, and nicotine in BAL fluid. For more information, visit Evaluation of Bronchoalveolar Lavage Fluid from Patients in an Outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury — 10 states, August–October 2019.

This is the first time we have detected a chemical of concern (vitamin E acetate) in biologic samples from patients with these lung injuries. These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lungs. These findings complement the ongoing work of FDA and some state public health laboratories to characterize e-liquid exposures and inform the ongoing multistate outbreak.

While it appears that vitamin E acetate is associated with EVALI, evidence is not yet sufficient to rule out contribution of other chemicals of concern to EVALI. Many different substances and product sources are still under investigation, and it may be that there is more than one cause of this outbreak. CDC will continue to update guidance, as appropriate, as new data become available from this outbreak investigation.

For more information, read the full MMWR.

Credit: U.S. Food & Drug


Credit: Centers for Medicare and Medicaid Services


         U.S. Department of Homeland Security 

Federal Emergency Management Agency


Virginia Department of Emergency Management

Course Offerings

L956 All Hazards Position Specific Liaison Officer course is scheduled for December 2-3, 2019. Please see the flyer for additional details.

L956 Course Announcement Alexandria

L0103 Planning: Emergency Operations course is scheduled for December 4-5, 2019. Please see the flyer for additional details.

L0103 Course Announcement Stafford County Public Safety Center

PER 211 Medical Management of Chemical, Biological, Radiological, Nuclear and Explosives, (CBRNE) Events course is scheduled for December 7-8, 2019. Please see the flyer for additional details.

PER 211 Medical Management of Chemical, Biological, Radiological, Nuclear and Explosives, (CBRNE) Events Course Stafford

NWS Basic SKYWARN course is scheduled for December 9, 2019. Please see the flyer for additional details.

SKYWARN Course Bowling Green

L954 All Hazards Position Specific Safety Officer course is scheduled for December 16-19, 2019. Please see the flyer for additional details.

L954 Course Announcement Manassas Park

G0205 Recovery from Disaster: The Local Community Role course is scheduled for February 10-11, 2020. Please see the flyer for additional details.

G205 Course Announcement Stafford 2020

1. Nurse staffing shortage expected to get worse

A survey of registered nurses found about 20% are planning to retire within the next five years indicating that staffing shortages could worsen. 

The findings were published in the 2019 AMN Survey of Registered Nurses. It includes input from more than 20,000 RNs who work multiple settings, including post-acute and acute care.

The survey revealed 27% of nurses believe it’s unlikely they’ll remain at their current job in one year. 

Increasing wages and offering additional benefits could be key in how well providers retain nurses. Thirty-one percent said compensation and benefits are the biggest influences on whether they’ll stay at their current organization. 

Workplace violence is also a key concern for nurses, with 41% saying they have been victims of bullying, incivility or other forms of workplace violence. Another 27% said they have witnessed workplace violence. Sixty-three percent of respondents said their organization did not address the situation well at all, while just 10% said their organization addressed the situation extremely well or very well. 

Read More »

Source: Danielle Brown of McKnight’s Long-Term Care News

2. Feds challenge California to improve oversight of nursing home emergency preparedness compliance

California nursing homes could face tougher scrutiny on its emergency preparedness after a federal report detailed compliance issues in several facilities. 

An Office of Inspector General report found deficiencies in 19 facilities after it investigated their compliance with life safety and emergency preparedness regulations. 

In all, it uncovered 137 areas of noncompliance with life safety rules and 188 areas of noncompliance with emergency preparedness. Deficiencies included issues with fire detection and suppression systems, hazardous storage areas, plans for evacuation and sheltering in place, and emergency communication plans. 

The agency reviewed a sample of 20 facilities out of the state’s 1,202 nursing homes that participate in Medicare or Medicaid, and conducted unannounced site visits between September and December 2018. One facility was destroyed by a wildfire after the visit and findings were not included in the report.  

The OIG recommended that the state follow up with the 19 facilities and ensure corrective actions have been taken, conduct more frequent site surveys to follow-up on deficiencies, ensure surveyors consistently enforce federal requirements, and work with the government to develop life safety and training for nursing home staff members. 

California agreed with the first and third recommendations, but not the others. It said the state agency does not have the surveyor capacity to conduct more frequent site surveys to follow up on deficiencies. 

The state also said working with the federal government to develop life safety training for nursing home staff was beyond the state’s “power to operationalize,” but it would take actions within its authority to train surveyors and remind providers to view training and guidance.

Source: Danielle Brown of McKnight’s Long-Term Care News

3. Preparing an Emergency Preparedness Kit Overwhelms Some People
In a region at risk of disasters such as volcanic eruptions and major earthquakes, and where flooding and windstorms are commonplace, officials recommend individuals and families have emergency response plans and adequate supplies on hand to help them survive.

“It behooves everyone to be aware and be prepared … so they are equipped to ride out the event,” said Jason Miller, mayor of Concrete, which is in the danger zones of two volcanoes: Mount Baker and Glacier Peak.

While the general recommendation from emergency preparedness experts is to create kits with two weeks’ worth of supplies, some find that overwhelming and it keeps them from preparing at all.

Read More »

Source: Kimberly Cauvel of Skagit Valley Hearald

4. The Partnership for Public Health: Improving Hospital-Community Partnerships to Support Health Systems Transformation

Moving meaningfully towards healthy communities means that health care providers, public health agencies, and community-based organizations need to effectively coordinate their efforts together. Yet how can these efforts go beyond basic assessment to active collaboration? What are those key ingredients to begin successful cross-sector community health efforts?

As part of the Partnership for Public Health project, a joint effort between the Centers for Disease Control and Prevention (CDC), American Hospital Association (AHA), and the National Association of County and City Health Officials (NACCHO), this webinar will explore key insights, tips, advice, and leading practices from program participants on coming together as a cross-sector collaborative or consortia from both the hospital and public health perspectives. 

Register Here »

5. 2 people in China infected with plague, the disease tied to Black Death

Two patients in China were diagnosed with plague, the deadly and infectious disease tied to historic pandemics, local media reported.

The two people, from Inner Mongolia, were treated for pneumonic plague in Beijing’s Chaoyang district, local health officials said Tuesday, according to Caixin and state-media Xinhua

The news outlets reported the patients received “proper treatment,” and disease control measures and prevention methods have been taken. 

According to Caixin, the patients were treated at Chaoyang Hospital, which has since replaced all chairs in its emergency room.

The Chinese Center for Disease Control and Prevention said the patients were quickly isolated and health officials investigated everyone who could have been exposed to them, The New York Times reported. Chinese health officials also called the risk for further infections “extremely low.”

Read More »

Source: Ryan W. Miller of USA TODAY