The Missing Link: Emergency Management and Health Centers Mollie Melbourne, Director of Emergency Ma

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The Missing Link Emergency Management and
Health CentersMollie Melbourne, Director of
Emergency ManagementNational Association of
Community Health CentersJune 20, 2007
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Presentation Objectives

• Describe the principles of Emergency Management
• Outline the role of Health Centers
• Review the BPHC PIN Expectations in draft form
• Provide resources to support EM activities at
  Health Centers and PCAs

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Definition of Emergency

• Any unplanned event that can cause deaths or
  significant injuries to employees, customers, or
  the public or that can shut down a business,
  disrupt operations, or cause physical or
  environmental damage

Federal Emergency Management Agency, 1993
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Emergency Management Phases
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Mitigation

• Pre-event planning and actions which are
  intended to lessen the impact of a potential
  disaster
• Long-term effort
• Risk identification HVA
• Structural
• Reinforcing / strengthening / anchoring
• Non-structural
• Light fixtures / HazMat Containers

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Preparedness

• Actions taken before an emergency to prepare
  for response
• Develop EMPs
• Develop Communication Plan
• Drills and Exercises
• Stockpiling
• Equip an EOC
• MOAs and MAAs

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Response

• Activities to address immediate and short-term
  effects of a disaster
• Implement EM Plan
• Incident Command System Structure
• Activate Emergency Operations Center
• Save lives
• Protect property
• Meet basic human needs

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Recovery

• Restore health center essential functions and
  normal operation
• Starts with preparedness
• Develop BCP / COOP
• Adequate insurance coverage
• Back-up systems
• Cash reserve
• Assess damage / impact of disaster
• File insurance claims / assistance
• Address psychological needs of patients and staff
• Produce after action debriefing and report

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Importance of Planning

• HCs serve the most vulnerable patients
• Trusted members of their communities
• HCs are strong link to disenfranchised residents
  homeless, migrant, LEP, undocumented

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Importance of Planning

• Serve as advocates for medically underserved
• Mission driven organizations serve their
  communities
• Closely linked with hospitals and health
  departments
• Financially lean need fast recovery
• People go to the HCF they are most familiar with
  in emergencies
• HRSA Expectations

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Emergency Management Program Expectations

• Currently in draft form
• Extension of expectations set forth in PIN 98-23
• Applies to all health centers funded under the
  330 Health Center Program and Look-Alikes

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EM Expectations

• Emergency Management Plan
• All Hazards Command Structure
• Collaboration
• Data Collection and Reporting
• Business Plan

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I. Emergency Management Plan

• Based on Hazard Vulnerability Assessment (HVA)
• All hazards approach
• Addresses 4 phases of EM

• Include process for staff training
• Annual exercises, at a minimum

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Plans should address following

• Continuity of Operations
• Staffing
• Surge patients
• Medical and non-medical supplies
• Pharmaceuticals
• Evacuation

• Decontamination
• Isolation
• Power supply
• Transportation
• Water/sanitation
• Communications
• Medial records security and access

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II. All Hazards Command Structure

• Incident Command System (ICS)
• Chain of command
• Modular structure
• Scale-able to fit situation / organization
• NIMS compliance strongly encouraged
• Standard command structure (ICS)
• Common terminology
• Mutual aid and resource management
• Develop communication plan

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Incident Command System
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Incident Commander
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Command Staff
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Functional Areas
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III. Collaboration

• State and local agencies, other HCF, community
  organizations
• Integrate plans define role
• Attend/join community planning committees
• Play in community exercises and drills
• Understand EM system at state and local
  levels

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IV. Data Collection and Reporting

• Provide requested/required data to Federal,
  State, and local agencies
• Encouraged to have systems to collect/organize
  data

• Follow state surveillance reporting protocols
• Provide data to HRSA Project Officer

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V. Business Plan

• Address financial response to emergency
• Cash reserves
• Insurance coverage
• Business interruption
• Equipment / Facilities / Property loss
• Restoration of normal business functions
• Billing systems / Practice Mgt
• Back up facilities and equipment
• Back-up information technology systems
• Financial and medical records
• Billing track charges and sustain flow of
  reimbursement
• Patient tracking

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HC Roles in Emergency Management

• Provide services to HC patients
• Increase ED Surge Capacity on off site
• Triage patients
• Provide mental health services
• Disease or syndromic surveillance
• Patient/community education
• Outreach to hard to reach populations

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HC Roles in Emergency Management

• Dispatch mobile clinics
• Decontamination in rural areas
• Provide culturally competent, linguistically able
  provider/support staff for alternative care sites
• Distribute medications or vaccine to patients,
  staff, community members (PODs)

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Getting Started

• Obtain buy-in from senior leaders, Board
• Establish Emergency Management Committee
• Appoint EM Coordinator

• Define Role of Coordinator
• Chair EM Committee
• Develop/revise EMP
• Attend local meetings
• Meet with key partners
• Coordinate staff training
• Facilitate/arrange exercises

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Next Step

• Contact PCA
• Background on State activities
• Training opportunities
• Technical assistance with HVA, EMP
• Exercise facilitation/support
• Federal updates
• Resources

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Hazard Vulnerability Analysis

• What are your risks?
• How likely are they to occur?
• How severely would they impact
• People staff, patients, community?
• Property?
• Business?
• How prepared are you for these risks?

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HVA Events

• Naturally Occurring
• Hurricane
• Tornado
• Flood
• Epidemic
• Technologic
• Electric failure
• Fuel shortage
• HVAC failure
• Supply shortage

• Human Related
• Terrorism
• Hostage situation
• Bomb threat
• Civil disturbance
• Hazardous Materials
• Chemical release
• Radiologic exposure
• Chemical terrorism

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Planning Process

• Determine the role of health center internal
  and external response
• Community plan
• Liability
• Capacity
• Resources
• Join local/regional planning efforts for public
  health and medical response (ESF-8)
• Meet with LHD, hospitals, community agencies to
  discuss role
• Train staff Basic EM, NIMS, Basic IC,
  Donning/doffing PPE, Gross Decontamination, Risk
  Communication, PERSONAL and FAMILY PREPAREDNESS
• Educate patients personal preparedness, what to
  do in an emergency, URE

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Create the EM Plan

• Consider it a living document
• Set realistic timeframe for completion
• Follow NIMS compliance principles
• Identify and execute needed MOAs/MAAs
• Test and revise
• SHARE with LHD, hospitals, PCA, other health
  centers
• Train staff on plan and their roles in it
• Incorporate role in emergency into job description

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Keep it Going

• Maintain regular meetings of EM committee
• Report to progress to Board quarterly
• Provide ongoing info to staff about EM activities
• Incorporate EM into annual trainings and
  orientation

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Show Me the Money

• HRSA National Hospital Bioterrorism Preparedness
  Program
• Health Care Facilities
• CDC Public Health Emergency Preparedness Program
• Public Health Departments
• 1.54 billion awarded nationwide through NHBPP
  and CDC for FY06

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PCA and HC Inclusion

• 58 of the states include PCAs and/or Health
  Centers
• 25 receive NHBPP only, 4 receive NHBPP and CDC, 1
  receives CDC only
• 10.6 million total awarded to PCAs and/or HCs
• Average amount of funding per state for PCAs
  and/or HCs is 353,408
• PCAs and/or HCs received 0.7 of FY06 NHBPP and
  CDC funds

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Tapping in

• Work with state, county, local health departments
• Educate them on HCs include patient and staff
  information
• Clearly define the role that your health center
  can play show them how you can help them
• Have a comprehensive EM Program
• Be present at the planning table develop the
  relationships

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NACHC Activities

• Training and technical assistance
• Increase awareness of HC role
• Partner with key national organizations to
  promote integration
• Promote funding inclusion / opps for HCs
• Expansion of NACHC Relief Fund
• Develop standing agreements for support during
  emergencies

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Pandemic Influenza

• The pandemic influenza clock is ticking. We
  just dont know what time it is.

Dr. Ed Marcuse, former member Advisory Committee
on Immunization Practices
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Presentation Objectives

• Provide overview of Influenza seasonal, avian,
  and pandemic
• Discuss planning considerations
• Summarize Pan Flu Plan components

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Bird Flu Hits Florida
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Influenza 101

• Highly contagious respiratory disease
• Symptoms
• Sudden onset
• High fever (100.4 or higher)
• Chills, cough, headache, sore throat, stuffy
  nose, muscle aches
• Weakness and/or exhaustion
• Diarrhea, vomiting, abdominal pain

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Influenza Cycle

• Day 0 Become Infected
• Day 1-4 Disease Incubation (2 day average)
• Day 1-6 Contagious (1 day before symptoms to
  5 days after symptom onset)
• Day 2-9 SICK (typically 2-5 days)
• Day 4-14 Fatigued (1 week)

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Spread of Influenza
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Seasonal, Avian or Pandemic?

• Seasonal
• November through March in US
• 5-10 attack rate
• 30,000 50,000 deaths
• Avian or Bird
• Primarily affect birds
• Limited or no illness in humans
• Pandemic
• New influenza strain that causes illness in
  humans
• Little or no human immunity
• Higher than seasonal attack rates possibly 25
  - 35
• Pandemics typically last about 18 months
• Two to three distinct waves

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History of Pandemics

• Reports back to 412 BC
• Earliest recorded in 1580
• 10 pandemics recorded in past 300 years
• Average of 24 years between pandemics
• 20th Century
• 1918-1919 Spanish Flu (550,000)
• 1957-1958 Asian Flu (70,000)
• 1968-1969 Hong Kong Flu (34,000)

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World Health Organization Phases

• Phases 12 No new viruses subtypes detected in
  humans
• Phase 3 Human infection(s) with a new subtype
  but no or very limited human to human spread
• Phase 4 Small clusters with limited human to
  human transmission
• Phase 5 Larger clusters but human to human
  spread is still localized
• Phase 6 Efficient and sustained human to human
  transmission

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Pandemic Severity Index
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H5N1
Current Situation June 15, 2007 Total 313
cases / 191 deaths 61 CFR

• Azerbaijan 8/5 (62.5)
• Cambodia 7/7 (100)
• China 25/16 (64)
• Djibouti 1/0 (0)
• Egypt 36/15 (41.2)
• Indonesia 100/80 (80)

• Iraq 3/2 (66.7)
• Laos 2/2 (100)
• Nigeria 1/1 (100)
• Thailand 25/17 (63.6)
• Turkey 12/4 (33.3)
• Viet Nam 93/42 (45.2)

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Why worry about H5N1?

• High CFR
• Novel Strain people have no immunity
• Out of Control in bird populations in some
  areas - Indonesia, Egypt, China?

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Planning Considerations

• High absenteeism 30 or more
• Healthcare system will be stressed broken??
• Social distancing measures may be initiated
• Will likely have less than 6 weeks of warning
  before pandemic hits US after being announced
• No vaccine for at least 6 months antivirals will
  be in short supply antibiotics may be largely
  unavailable (secondary bacterial infections)
• 39 years since last pandemic (15 yrs gt average)
• WHO Phase 1-3 are for planning 4-6 are for plan
  execution
• Its a matter of WHEN, not IF

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Health Center Planning

• Surveillance
• Communications
• Staff Education and Training
• Patient Information
• Triage
• Infection Control

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Surveillance

• Develop system for monitoring public health
  advisories and tracking current situation
• Monitor influenza-like illness (ILI) in both
  patients and staff. Create system for tracking
  and trending
• Work with local health to define reporting
  protocol

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Communications

• Get contact lists together with multiple ways
  of reaching each person local health/other
  healthcare facilities/CHCs
• Create resource contact lists medical supplies,
  equipment, utilities
• Assign one person to for official communications
  (media, elected officials, etc.)
• Create patient contact database
• Enroll in Health Alert Network
• Set up redundancy HC phone, cell phone, email,
  text messaging, etc.

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Education and Training

• All staff should be trained on Incident Command
  System (ICS), infection control, pandemic flu,
  etc.
• Staff should be trained and tested (drills and
  exercises) in their roles
• Include in new staff orientation
• Maintain record of staff education and training

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Patient Information

• Seasonal and pandemic influenza patient education
  material in a manner that best suites your
  patients
• Develop way to educate patients with low literacy
• Incorporate personal family preparedness into
  patient education materials and process
• Plan for development, printing and stocking of
  materials for waiting areas

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Triage/Management of Patients

• Establish system for phone triage (to limit
  patient visits to HC)
• Participate in alternative care planning with
  local health, hospitals (hospitalize, home
  health care, family care, etc.)

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Triage/Management of Patients (cont)

• Develop plans for managing patients at peak
  periods of pandemic
• Temporarily cancel non-essential visits
• Separate waiting areas for influenza patients
• Separate appt times for influenza and
  non-influenza essential visits

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Infection Control Preventive Measures

• Establish
• Specific waiting room/exam room or area for
  symptomatic patients
• Signage (language appropriate) to notify
  receptionist if patient has symptoms
• Signage on handwashing, respiratory and cough
  etiquette.
• Mask distribution (patients and staff).
• Standard and droplet precaution policies (if
  dont already have in place).

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Social Distancing
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In Conclusion

• Emergencies happen
• Health centers will be involved in EM response
  might as well be prepared
• EM process is time-consuming be patient, ask
  for help, seek resources
• Knowledge is power

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Questions?

• Mollie Melbourne, MPH, MEP
• Director of Emergency Management
• National Association of Community Health Centers
• mmelbourne_at_NACHC.com
• www. NACHC.com
• [phone] Direct