Advisory 24-10-09 Baxter IV Solution Supply Disruption
The Department of Public Health issued the following advisory today:
“The Department is actively monitoring the disruption at Baxter International’s North Cove plant in North Carolina following the rain and storm surge from Hurricane Helene. This plant manufactures approximately 60% of the domestic supply of IV solutions, producing 1.5 million bags per day across several product lines.
As of Wednesday, 09 OCT 2024, Baxter has reported that it continues to scale production across its global locations and is working closely with FDA on temporary importation of products to increase available inventory. Baxter’s goal is to restart North Cove production in phases and return to 90% to 100% allocation of certain IV solution product codes by the end of 2024. Baxter stated that they are increasing the current U.S. allocation levels of their highest-demand IV fluids for direct customers from 40% to 60%, and for distributors from 10% to 60%, effective today. They have resumed shipments to hospitals and dialysis patients based on allocations. Information on products currently in shortage can be found here: https://www.fda.gov/drugs/updates-2024-hurricane-season/hurricane-helene-baxters-manufacturing-recovery-north-carolina
Additionally, Hurricane Milton has intensified to a Category 4 storm in the Gulf of Mexico, with anticipated landfall on Florida’s Gulf Coast in the early morning hours of Thursday 10 Oct 2024. Of particular concern is B. Braun’s manufacturing facility in Daytona Beach, Florida. B. Braun holds approximately 23% market share in the IV fluids industry and has been working to increase capacity in the wake of Baxter’s impacts.
Action Steps:
While the level of impact is still dynamic, these supply chain disruptions may be impactful for ambulance services. It is critical to manage and identify conservation strategies - which should include:
• Completing a thorough assessment and maintaining inventory of all types of IV fluids,
• Evaluating clinical needs to forecast how long these levels will last,
• Work with additional vendors/suppliers to identify alternate sources and be aware of any delays/allocation, and
• Messaging this situation and need for conservation strategies to your field staff.
In addition to being prudent in the management of internal inventories, the Department recommends ambulance services prioritize the use of IV fluids utilizing these guidelines:
1. Be thoughtful and judicious in the use of IV fluids.
a. For example, do not preemptively spike and hang bags at the beginning of a shift or before assessing if a patient needs intravenous fluid.
2. Consult medical control if you are unsure if a patient requires IV fluids.
Sharing Critical Shortages:
As our health care system continues to navigate this developing situation, it is important to maintain communication and situational awareness. We would ask that critical shortages and no ability to resupply, which may interrupt the ability to deliver patient care, be shared with your Health and Medical Coordinating Coalition (HMCC), who will also be the pathway to critical resource requests. The HMCCs are Department contracted to support cross-disciplinary planning and response including coordination of urgent and emergent resource requests – these groups will not replace your current vendors and supplies but will work across the health care continuum in a region to identify if other entities have any resources to share during times of emergencies. You can use the following resource to find out which HMCC covers your agency: https://www.mass.gov/info-details/learn-about-the-health-and-medical-coordinatingcoalitions.
The Department is maintaining communication with federal partners and the HMCCs. We will provide updates as more information becomes available. In the meantime, please ensure that your EMS agencies are communicating with supply officers and distributors to confirm the availability of IV fluids and explore alternative suppliers if necessary.
Thank you for taking proactive and prudent steps and being strong partners as we work through the situation.
”
Health and Medical Coordinating Coalition (HMCC) Meeting September 26, 2024
We have been asked to let you know that as part of National Preparedness Month, the Health and Medical Coordinating Coalition (HMCC) is hosting an in-person Stakeholder Meeting with a special presentation on preparedness planning for civil unrest and protest events. As registration is required for the meeting, please see attached and below for more details.
The link to register is https://forms.office.com/r/3M1dKvQaen.
Date: Thursday, September 26, 2024
Time: 10:00 AM – 12:00 PM
Location: Rosemary Recreation Center (178 Rosemary St, Needham, MA 02494)
Special Presentation: Civil Unrest & Protests: Hazard Review & Planning Discussion with Guest Speaker Suzanne Blake, Director MIT Emergency Management
Feel free to share this information regarding the meeting with your relevant coworkers/contacts and encourage them to register to attend.
If you have any questions or concerns, please contact Teri Clover MPH, Region 4AB HMCC Planning & Operations Coordinator, MRPC Duty Officer tclover@challiance.org.
Carney Hospital Permanent Code Black Notification
Carney Hospital is officially permanent Code Black for all transfers as of 7:00 AM today, August 30, 2024. Carney Hospital will be officially permanent Code Black for all other services at 7:00 AM Saturday, August 31, 2024. This is the official closure of the facility.
All services should have already determined alternate transport destinations. If you have any questions, go to https://www.mass.gov/info-details/carney-hospital-closure-plan which has the entire hospital closure plan or contact Stephen Davis, Division Director Stephen.Davis@mass.gov
Dedication Ceremony
The Massachusetts State Police is holding a dedication ceremony for Trooper Tamar Bucci on Monday, July 29, 2024, starting at 11AM. The Marble Street bridge traveling towards Winchester is going to be closed on Marble Street at Park Street. Traffic will be allowed to travel from Winchester into Stoneham over the bridge. The travel lane into Stoneham is going to be shifted over to the opposite side of the bridge during the ceremony. Traffic is expected to be significantly affected in the area. It is anticipated that the road closures and traffic shift will begin at approximately 9AM.
White Powder Symposium
SAVE THE DATE
Deadly White Powder - A Symposium on Illicit Narcotics
When: Friday, November 15
Where: Gillette Stadium
1 Patriot Place
Foxborough, MA 02035
Experts will provide guidance on current threats including fentanyl and xylazine, as well as guidance for testing and developing the Community Response Emergency Drug Overdose Teams (CReDO).
This event is free of charge to any Massachusetts law enforcement, fire, EMTs, paramedics, health departments and community service providers.
UPDATE: TUFTS MEDICAL CENTER OFF CODE BLACK - Wednesday, May 22nd, 2024
UPDATE: 11:43 AM: Tufts Medical Center is OFF Code Black and power has been restored.
Attention: Tufts Medical Center is currently on Code Black due to a power outage. Updates will follow as more information becomes available
Clinical Laboratory Program (CLIA) Testing Requirements for Ambulance Services
The Department’s Office of Emergency Services and Clinical Laboratory Program is issuing the attached memo to provide information to licensed ambulance services of the federal and state requirements relative to performing laboratory testing. Frequently Asked Questions regarding the federal CLIA certificate process as well as general testing questions is also being provided.
Ambulance services will be afforded one year from February 28, 2024, after which, possession of an active CLIA certificate and clinical laboratory license (where applicable) will be added to the annual OEMS inspection process for licensed ambulance services. Licensed ambulance services must submit, as needed, appropriate application materials and obtain necessary CLIA certificates and, if applicable, clinical laboratory licensure, before February 28, 2025 to ensure compliance with federal and state laboratory requirements.
Please contact the OEMS Ambulance Regulation Program at OEMS.Ambulance@mass.gov with questions.
Coverdell Learning Session in January
Even if you missed Session 1 in December, there’s still time to register for Session @
Session 2: Stroke Quality Improvement in Practice: Using Case Study Training and Review to Inform Clinical Decision Making in the Field.
When: Jan 11, 2024 02:00 PM Eastern Time (US and Canada)
Register in advance for this meeting:
https://us06web.zoom.us/meeting/register/tZ0kf-CtpzMqGtaPL43G-Jmobqng24ZgTCLU
After registering, you will receive a confirmation email containing information about joining the meeting.
Advisory 23-11-01 Mortality and Morbidity (M&M) Rounds Required for All EMS Personnel
From our friends at OEMS:
The Massachusetts Department of Public Health’s Office of Emergency Medical Services (Department) is issuing the below Advisory, to clarify for all ambulance services that the requirement for M&M rounds under affiliation agreements applies to EMS personnel at all levels of certification, including EMT-Basics.
Subject: Weather Related Waiver for Alternate Transport to Emergency Shelters
Please see the attached weather related waiver for Licensed Ambulance Services operating in EMS Regions 3, 4, 5.
Ambulance Traffic Update Lahey Burlington Starting May 12, 2023
Please be advised, starting May 12, 2023 at 16:00 through May 14, 2023 at 19:00 the normal route from Mall Road to the ambulance entrance for the emergency department at Lahey Hospital will NOT be accessible to ambulance traffic. The hospital has a crane scheduled for that weekend and due to the size of the crane the road will not be passable.
Attached is a map for EMS traffic to access the ED.
From Burlington Mall Rd all traffic will be diverted down South Bedford St to Kimball Ave.
From there all ambulance traffic can follow down Kimball Ave to Loop Rd and take a left.
Ambulances will still be able to come up the hill that they normally do at that point.
There will be signs directing ambulance traffic, as well as police details. We ask that emergency ambulances DO NOT use the main entrance, as this will cause confusion. Interfacility ambulance traffic can still access the main entrance during this time period.
We apologize for the inconvenience that this may cause your crews and appreciate everyone's cooperation with this.
Any questions, please contact Patrick McGovern, NRP, I/C, Coordinator of Emergency Services T: 781-744-5137 | C: 781-975-1493 Patrick.mcgovern@lahey.org
Work on Surrounding Streets - BID Needham
We have been asked to notify you that there will be 2 roadwork projects for you to be aware of at the BID Needham:
1. Thursday, 5/11/23 the town will be digging trenches on Chestnut Street, which will shut the secondary entrance into the OCC (the entrance at the lights will be open).
Another trench digging at the Ambulance Entrance will close that entrance so ambulances will have to enter on School Street.
A third micro-trench will be dug by the Ambulance bay entrance, but ambulances will be able to use the bay.
2. Sunday 5/14/23 from 7:00pm to 7:00am (Monday) the town will be removing the pavement on Chestnut Street (the street will remain open).
3. Monday and Tuesday 5/15 – 5/16/23 Chestnut Street will be repaved, but again the street will remain open.
Police details will be on site directing traffic.
Ambulance Traffic Lahey Burlington
Please be advised we have been informed that this Saturday May 6, 2023 05:00-17:00 there will be a crane in the loading dock area off of Loop Road when entering Lahey Campus in Burlington. This crane project WILL NOT impact EMS accessing the emergency room. Please continue to enter the normal way. There will be police details if needed, however the contractor states both lanes will be open during this project. Please advise crews to use caution when entering and exiting the Lahey Campus.
If you have any questions, please contact Patrick McGovern, NRP, I/C, Coordinator of Emergency Services, T: 781-744-5137 | C: 781-975-1493
Register Now - MRPC Regional Preparedness Conference
Since the establishment in 2017 of the MRPC the 4AB region has prepared for, responded to, and recovered from multiple emergencies and events such as: extreme weather, power outages, flooding, facility evacuations, technology disruptions, mass casualty incidents and probably the most challenging, the COVID 19 Public Health Emergency. These events have provided a wealth of information and opportunities for improvement across the region and in each discipline of the MRPC.
The MRPC Conference Planning Team is very excited to bring coalition members from across 4AB together and provide an opportunity to share experiences and lessons learned from recent events, network, and most importantly collaborate and plan for the future during the upcoming full day conference at the Four Points Sheraton in Norwood, MA on May 2nd.
The theme of this year’s conference “MRPC Regional Preparedness: Understanding the Importance of Collaboration” will emphasize the coalition's mission to enhance regional health and medical readiness for emergency events through collaborative, multidisciplinary planning necessary to foster a coordinated and effective regional response. Speakers from Massachusetts will provide information that is applicable to all discipline members.
In addition to the great presentations, please take advantage of the additional opportunity to showcase local or regional projects and let the region know about all the 4AB Health Care Heroes.
This conference is free to all members! The attached flyer outlines all the information regarding the conference and how to register. The conference is sponsored by the Metro Regional Preparedness Coalition through a contract with Cambridge Health Alliance and the Metropolitan Boston Emergency Medical Services Council, Inc. (MA EMS Region IV). Funding for this conference was made possible (in whole or in part) by the Center for Disease Control and Prevention and/or the Administration for Strategic Preparedness and Response and the Massachusetts Department of Public Health, Office of Preparedness and Emergency Management.
If you have any questions, contact hmcc@challiance.org - Subject line: “MRPC Regional Conference”.
Crane deployed in SSH ambulance bay starting at 6 a.m. on Sunday, November 13
On Sunday, November 13, a crane will be deployed in the ambulance bay from 6 a.m. to 3 p.m. The crane is required to remove a temporary air handling unit and equipment from the roof.
Impact:
· Alternate ambulance access established (see below).
· Limited ambulance bay parking will be available.
· All ambulance traffic will use alternate access to the South parking lot for patient drop-off and pick-up.
· Pedestrian and vehicle traffic will be modified in the work zone.
Mitigation:
· Weymouth Police and Public Safety details will be present to assist with access and direct ambulance traffic.
· Directional signage and traffic barriers will be installed.
· South parking lot designated area for patient drop-off and pick-up.
· A crane lift plan was established.
· An Interim Life Safety Measure Assessment and Pre-Construction Risk Assessment will be conducted.
· Work and fall zones will be identified and secured with safety cones and caution tape.
· Crane spotter will be assigned to the ground for safety and to direct crane activities.
Special Event with McLean Hospital
Alzheimer's Disease & Healthy Brain Aging
LIVE ZOOM PRESENTATION
THURSDAY, FEBRUARY 17 | 7 P.M.
With special guests from McLean Hospital
Did you know 35% of dementia risk may be preventable through certain activities and lifestyle choices?
Join Dr. Forester and Dr. Patrick for scientific updates on factors that can impact healthy cognitive aging in your daily life.
Chronic Disease & Condition Management
Activity Goals & Benefits for Adults 65+
Nutrition: Mind Diets
Cognitive Stimulation
Social Engagement for Brain & Body
Relaxation Techniques & Benefits
Dangers of Poor Sleeping Habits
Register For This Special Event
BRENT FORESTER, MD, MSC
Dr. Forester is the chief of the Center of Excellence in Geriatric Psychiatry at McLean Hospital, president of the American Association for Geriatric Psychiatry and a distinguished fellow of the American Psychiatric Association. His research focuses on novel treatment approaches to disabling behavioral complications of dementia, such as agitation and aggression.
REGAN PATRICK, PHD
Dr. Patrick holds a clinical and research position within the Center of Excellence in Geriatric Psychiatry and the Neuropsychology Department at McLean Hospital. His clinical work focuses on neuropsychological and psychodiagnostic assessment. His research uses cognitive and brain imaging techniques to better understand psychiatric and cognitive disorders.
Our Bridges® Locations:
Andover, MA | Hingham, MA | Lexington, MA | Mashpee, MA
Nashua, NH | Norwalk, CT | Pembroke, MA | Sudbury, MA
Trumbull, CT | Westford, MA | Westwood, MA
MA DPH Updated Comprehensive PPE Guidance
The Massachusetts Department of Public Health is releasing updated Comprehensive Personal Protective Equipment (PPE) Guidance. This guidance further updates the PPE standards for health care personnel. As part of this updated guidance, healthcare providers may implement policies to require HCP to use employer-issued PPE, and to preclude staff from using their own PPE absent appropriate safety and quality controls which may include but are not limited to fit-testing.
Memorandum
TO: Health Care Facility Chief Executive Officers and Administrators
Occupational Health Program Leaders
Emergency Medical Service Directors
FROM: Elizabeth Daake Kelley, MPH, MBA, Director
Bureau of Health Care Safety and Quality
SUBJECT: Comprehensive Personal Protective Equipment (PPE) Guidance
DATE: January 21, 2022
The Massachusetts Department of Public Health (DPH) continues to work with state, federal and local partners on the outbreak of Coronavirus Disease 2019 (COVID-19), caused by the virus SARS-CoV-2, and we continue to appreciate the essential role you have in responding to this evolving situation.
DPH has developed this comprehensive guidance, based upon the Centers for Disease Control and Prevention (CDC) recommendations, to clarify the PPE that health care personnel (HCP) use in clinical care areas and in other non-clinical areas in health care facilities. HCP refers to all paid and unpaid persons serving in healthcare settings and emergency medical services (EMS) who have the potential for direct or indirect exposure to patients or infectious materials including body substances; contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air.[1] Healthcare settings are not limited to health care facilities but may include community settings where home health workers or EMS personnel are providing care to patients. This guidance further updates the PPE standards that HCP must follow. Healthcare providers may implement policies to require HCP to use employer-issued PPE, and to preclude staff from using their own PPE absent appropriate safety and quality controls which may include but are not limited to fit-testing.
These changes may be implemented immediately.
Universal Use of Facemasks
DPH has adopted a universal facemask use policy for all HCP. All HCP should don a facemask upon entry to the healthcare facility premises or care area (which includes ambulances); HCP working in community settings should don a facemask upon entry to the home or immediate area where they will be providing assessment and care. Facemasks are defined as surgical or procedure masks worn to protect the mouth/nose against infectious materials and have been shown to be highly effective at preventing transmission of COVID-19 when both individuals are masked. This policy will have two presumed benefits. The first benefit is to prevent pre-symptomatic spread of COVID-19 from HCP to patients, visitors and colleagues by reducing the transmission of droplets. The second benefit is to protect HCP by reducing transmission from their surroundings, including from other staff, visitors and patients who may be in a pre-symptomatic stage.
Extended use of facemasks is the practice of wearing the same facemask for repeated encounters with several different patients without removing the facemask between patient encounters. Due to improvement in the health care supply chain of facemasks, DPH is modifying earlier guidance and supports face mask use as follows:
As PPE to protect their nose and mouth from exposure to splashes, sprays, splatter, and respiratory secretions (e.g., for patients on Droplet Precautions). When used for this purpose, facemasks should be removed and discarded after each patient encounter.
As source control to cover one’s mouth and nose to prevent spread of respiratory secretions when they are talking, sneezing, or coughing. When used for this purpose, facemasks may be used for multiple patient encounters under the following conditions:
· The facemask should be removed and discarded if soiled, damaged, or hard to breathe through.
· HCP must take care not to touch their facemask. If they touch or adjust their facemask they must immediately perform hand hygiene.
· HCP should leave the clinical care area if they need to remove the facemask. (i.e., outside of the patient room)
· Facemasks should not be stored or put down on a surface; when removed, facemasks should be discarded and HCP should don a new facemask.
· If HCP remove their facemask to eat, drink or during a break they should perform hand hygiene with soap and water or an alcohol-based hand rub before and after touching their mask.
Homemade and cloth facemasks are not considered PPE and are not appropriate for use in the healthcare setting or by HCP.
As part of universal source control, if tolerated, patients/residents should wear a facemask issued by their provider when they leave their room or when staff are providing care to them.
PPE for patients with suspected or confirmed COVID-19, or confirmed exposures to COVID-19
DPH recommends that a fit-tested N95 filtering facepiece respirator or alternative, eye protection, isolation gown and gloves be used when caring for patients with suspected or confirmed COVID-19 or confirmed exposure to COVID-19.
Respirators:
Proper use of respiratory protection by HCP requires a comprehensive program (including medical clearance, training, and fit testing) that complies with OSHA’s Respiratory Protection Standard.
Facilities should eliminate the practice of reuse of N95 respirators with the exception of conditions outlined in Other Considerations. N95 respirators should always be discarded after doffing, such as when leaving a patient room, during a break or when eating or drinking. Respirators contaminated with blood, respiratory or nasal secretions, or other bodily fluids must be discarded immediately.
If reusable N95 respirator alternatives such as elastomeric respirators are used each facility must ensure appropriate cleaning and disinfection between uses and filter exchange according to manufacturer’s instructions. When used as source control, reusable N95 respirator alternatives may be worn between patients seen sequentially without cleaning and disinfection. If worn when seeing patients on transmission-based precautions, extended use may be performed if not contaminated.
Eye Protection:
At this time, when the risk of community transmission of COVID-19 in Massachusetts continues to be increased, HCP should wear eye protection for all patient encounters.
Disposable eye protection should be removed and discarded when it is removed for any reason; it should not be reused. Reusable eye protection should be cleaned and disinfected when visibly soiled and after removal/doffing of eye protection. Eye protection may be used for multiple patient encounters under the following conditions:
Eye protection should be removed and reprocessed if it becomes visibly soiled or difficult to see through.
Eye protection should be discarded if it becomes damaged (e.g., face shield can no longer fasten securely to the provider, if visibility is obscured and reprocessing does not restore visibility).
If reusable goggles or face shields are used each facility must ensure appropriate cleaning and disinfection between uses according to manufacturer’s instructions.
After cleaning and disinfection, reusable eye protection should be stored in a designated location.
HCP should not touch their eye protection while being worn. If they touch or adjust their eye protection hand hygiene must be performed.
HCP should leave the clinical care area if they need to remove their eye protection using recommended protocols for removing, cleaning, and disinfecting, and reprocessing.
Isolation Gowns:
Nonsterile, disposable patient isolation gowns, which are used for routine patient care in healthcare settings, are appropriate for use by HCP when caring for patients with suspected or confirmed COVID-19 or confirmed exposure. HCP may also use reusable (i.e., washable) gowns made of polyester or polyester-cotton fabrics; they can be safely laundered according to routine procedures and reused. Reusable gowns should be replaced when thin or ripped, and per the manufacturer’s instructions. Gowns should be disposed of or laundered after each patient encounter.
Any gown that becomes visibly soiled during patient care should be disposed of or laundered, as appropriate.
Gloves:
HCP should perform hand hygiene prior to donning and after doffing gloves.
Other Considerations:
For performing aerosol generating procedures, such as nebulizer treatments or intubations, HCP should don a fit-tested N95 filtering facepiece respirator or acceptable alternate product except in the following circumstances when Standard Precautions may be used:
The patient has recovered from COVID-19 within the previous 90 days;
The patient is asymptomatic, and a COVID-19 test obtained within the past three days is negative.
Health care organizations and providers that are caring for high numbers of patients with suspected or confirmed COVID-19, or confirmed exposures to COVID-19 during high rates of community transmission may choose to adopt any of the following principles when caring for patients in the same cohort (i.e. all confirmed COVID-19 cases):
Utilize the same N95 respirator or other acceptable alternate product between multiple patient encounters provided that the N95 respirator or acceptable alternative is always discarded after doffing, during a break, when eating or drinking or when contaminated with blood, respiratory or nasal secretions, or other bodily fluids.
Reuse the same N95 respirator or acceptable alternate product over the course of an entire shift; N95 respirators or acceptable alternative must be discarded if non-intact or contaminated with blood, respiratory or nasal secretions, or other bodily fluids.
Utilize the same eye protection between multiple patient encounters provided that the eye protection is clean and disinfected after doffing, or when contaminated with blood, respiratory or nasal secretions, or other bodily fluids.
Resources:
Health care organizations and providers that require additional PPE in order to meet the use standards described in this guidance and are not able to obtain through their usual supply chain resources may request support from DPH as a bridge until health care organizations increase their ordering and receipt of gloves, eye protection, facemasks, gowns and N95 respirators. DPH will review requests and provide additional PPE on a monthly basis for the months of January, February and March as a bridge supply for health care organizations and providers that have an immediate and insufficient supply for HCP caring for individuals with suspected or confirmed COVID-19 or exposures to COVID-19. Every health care organization must immediately adjust their supply order to ensure that going forward they have sufficient supplies to meet this guidance. A health care organization or provider who has insufficient supply should fill out and download the PPE request form and submit it via email to Covid19.resource.request@mass.gov.
The form may be found on DPH’s website:
https://www.mass.gov/info-details/personal-protective-equipment-ppe-during-covid-19. Please visit
DPH’s website that provides up-to-date information and guidance documents on COVID-19 for healthcare providers and organizations in Massachusetts:
Isolation and Quarantine Guidance for Health Care Personnel
Dear Colleagues,
The Massachusetts Department of Public Health is sharing updated isolation guidance for healthcare personnel. The updated isolation guidance applies to healthcare settings as defined by the CDC. The updated guidance reduces the amount of time healthcare personnel must isolate due to testing positive for COVID-19 under a set of conditions as described in the updated guidance. Please see the attached document or the below link for details: https://www.mass.gov/doc/isolation-and-quarantine-guidance-for-health-care-personnel/download
Thank you for your continued care of your patients, staff and communities during this unprecedented time.
The Department of Public Health
Thanksgiving ALERT UPDATE: Emerson Hospital off Code Black
UPDATE: Emerson Hospital is off of code black
ALERT: Emerson Hospital currently on Code Black. The facility is currently operating on generator power until full power restoration. Please adjust your EMS entry accordingly. We will advise when facility has reopened.
UPDATE: Emerson Hospital
12:30 PM: Emerson Hospital is off of Code Black. Normal EMS entry for facility
7 AM: Emerson Hospital currently on Code Black. Please adjust your EMS entry accordingly. Will advise when facility has reopened.