Medical%20Disaster%20Planning%20and%20Response%20Process:

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• Medical Disaster Planning and Response Process
• Pre-event Disaster Planning
• National Emergency Management Summit
• New Orleans
• March 5, 2007
• Barbara Bisset, PhD MPH MS RN EMTExecutive
  Director
• Emergency Services Institute

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Objectives

• Awareness of
• Key Considerations
• Disaster Phases
• Five Planning Tiers
• Contingency Business Plans
• Resources for Healthcare Planners

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Key ConsiderationsDefining Events

• Do NOT define events by the number of casualties
• Loss of mission critical systems is an event

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Key ConsiderationsInternal versus External
Events

• Three potential scenarios
• Hospital only
• Community only
• Hospital and the community

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Key ConsiderationsShort term versus Long Term
Events

• Event may last from hours to months

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Key ConsiderationsEvents Do Not Have Boundaries
Events may or may not be contained within one
geographic location

• Events can easily cross over county and/or state
  lines

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Key Considerations Hospitals Are First
Receivers

• Literature documents that greater than 85 of the
  population will likely bypass community emergency
  response systems and will report to the hospital
  that they normally go to for service

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Key Considerations Capacity versus Capability

• Capacity (Volumes of Patients)
• Most hospitals are already at full capacity
• Rapid versus gradual influx of patients
• Expansion / surge spaces

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Key Considerations Capacity versus Capability

• Capability (Types of Patients)
• Specialized populations
• Burn victims
• Pediatric populations
• Need for isolation rooms
• Decontamination procedures required
• Requires specialized equipment, supplies and
  staff

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Key ConsiderationsCovert versus Overt

• May or may not be an identifiable scene
• Patients may already be in the hospital system
  before there is an identified event

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Key ConsiderationsWarning versus No Warning
Events

• Notification Systems
• Advisory
• Alert
• Activation
• Updates

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Key ConsiderationsType of Casualties

• For every one physical casualty, you can expect
  four to twenty mental health casualties

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Key Considerations Special Needs Populations

• Special needs populations
• Often are those who are left behind
• Many times cannot afford the expense of taking
  personal actions
• Medical needs will be accelerated in emergency
  events

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Key Considerations Ethical Considerations

• Limited resources
• Level of care
• Sufficient versus normal

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Key Considerations Communications

• All communication systems that you use on a daily
  basis will rapidly become overloaded and/or will
  fail
• Hospitals can expect thousands of calls (if the
  normal communication systems are working)

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Key Considerations Communications

• Information may most likely be
• Inaccurate and/or incomplete
• Delayed
• Rumors can run rampant
• Intelligent community
• Event may involve risk communications

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Key Considerations Campus Security

• You cannot treat patients if you do not have a
  safe environment
• The crowds will come

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Key Considerations Staffing

• Employees and/or their families may be victims of
  the event
• May have fear of responding
• May need to alter duties
• Staff may be needed from resources outside the
  facility

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Key ConsiderationsDecision Making

• If event requires a rapid activation, the steps
  taken in the first ten minutes will affect
  patient outcome and success of response
• Normal decision makers may be unavailable

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Key ConsiderationsAvailability of Vendors

• Multiple agencies may have agreements with the
  same vendors
• Vendors contact may need to be 24/7

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Key ConsiderationsFinancial Cost

• Cost of event can rapidly escalate
• Details and documentation are needed for
  insurance and other potential sources of
  reimbursement

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Key Considerations Regulatory Agencies

• Regulatory standards apply during emergency and
  disaster events. Recognize in catastrophic event
  life saving measures will be a priority.
• Division of Facility Services
• Occupational Safety and Health Administration
  (OSHA)
• Emergency Medical Treatment and Active Labor Act
  (EMTALA)
• Fire Marshall Having Jurisdiction
• Environmental Protection Agency
• Health Insurance Portability and Accountability
  Act (HIPAA)
• Medical and Nursing and Allied Health Practice
  Boards

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Key Considerations Documentation

• Documentation of response to event is often
  uncoordinated and is generally the weakest link
• Many decisions may go undocumented

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Disaster Phases
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Mitigation Phase

• Critical systems on emergency power
• Redundant systems
• Construction and designs of space

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Preparedness Phase

• Employee Training
• 1. Awareness Level
• Quick Response Guides
• 2. Active Participant Level
• Quick Response Guides
• Standing orders / Protocols
• Other duties as assigned
• 3. Expert Level
• Knowledge of details of plans
• Job Action Sheets
• Key Assumptions
• Crisis Management

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Preparedness Phase

• Equipment and Supplies
• Just-in-time inventories versus preparedness for
  greater than 72 hours
• Specialty equipment for capability events
• Mobility of equipment

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Preparedness Phase

• Staff Assignments
• Active and Reserve Teams
• All employees are essential
• Systems for rapid activation and deployment
• Task Forces
• Strike Teams

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Response Phase

• Incident Recognition
• Notification
• Mobilization
• Incident Operations
• Demobilization
• Transition to Recovery

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Response Phase

• Authority to activate emergency operations plans
• Consider immediate threats
• Time to respond e.g. setting up decontamination
  operations
• Implement incident command for all events
• Develop focused action plan
• Better to over commit than to under commit

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Recovery Phase

• Be prepared for extended operations
• Incident command in place until operations return
  to normal
• Opportunity for organizational learning
• Develop After Action Report (AAR)
• Follow identified actions through completion

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Planning in Five Tiers

• Personal
• Department
• Organizational
• Participate in regional planning
• Participate in state and other organizations
  planning efforts

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Tier OnePersonal and Family Preparedness

• Every employee needs to have a plan
• Includes
• Home inventories
• Evacuation routes
• Personal packs with self sustaining supplies,
  important papers
• Work Pack
• Emergency Car Kit
• Pet Plan

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Tier TwoDepartment Plans

• Every department is essential
• Each department needs to understand their
  preassigned role

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Tier ThreeOrganizations Plan

• Details how the hospital responds as a system

• Hospital Command Center
• Policies, Procedures, Emergency Operations Plans

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Tier Three Organizations Plan
In addition to the standard planning

• Crowd Control
• Restricted Access
• Lockdown
• Special Needs Populations
• Management of Communications from the Public
• Epidemiological Events
• Management of Staff
• Expectation of Employees
• Emergency Credentialing

• Capability Events
• Burns
• Mass decontamination
• Pediatrics
• Management of Donations
• Management of Volunteers
• Capacity Management

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Tier FourCommunity and Regional Planning

• Hospitals must take a leadership role with
  community and regional partners
• Cannot operate in a vacuum
• Public Information
• Joint Information Centers
• Multiple agency plans need to be coordinated
• Selection of Ambulatory Care Centers
• Mutual Aid Agreements

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Tier FivePlanning with the State and
Organizations

• Need to understand state plans and know
  individuals in key state and organizations
  agencies
• Public Health
• Office of Emergency Medical Services
• Hospital Association
• Law Enforcement
• Emergency Management

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Business Continuity Planning

• Continued access to services
• Record preservation
• Business relocation plans

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Planning Resources
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National Incident Management System (NIMS)

• Department of Health and Human Services in
  collaboration with the National Incident
  Management Systems (NIMS) Integration Center
• Seventeen elements for hospitals
• Compliance by August of 2008 if want to receive
  federal preparedness dollars

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NIMSSeventeen Implementation Activities

• 1 Organizational Adoption
• 2 Command and Management (ICS)
• 3 Multi-agency Coordination System
• 4 Public Information Systems
• Joint Information System (JIS) and Joint
  Information Center (JIC)
• 5 Implementation Tracking
• Annual Emergency Management report

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NIMSSeventeen Implementation Activities

• 6 Preparedness Funding
• 7 Revision and Updating of Response Plans
  annually
• 8 Mutual Aid Agreements
• 9 Training IS 700 NIMS
• All personnel who have a leadership role in
  emergency preparedness, incident management or
  incident response need to take the course

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NIMSSeventeen Implementation Activities

• 10 Training IS 800 National Response Plan
• Must be completed by individuals whose primary
  responsibility in a hospital is emergency
  management
• 11 Training ICS 100 and 200
• Must be completed by those who have a direct role
  in emergency preparedness, incident management or
  response
• 12 Training and Exercises
• Must include incident command structure

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NIMSSeventeen Implementation Activities

• 13 All Hazard Exercise Program
• 14 Corrective Actions Reports

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NIMSSeventeen Implementation Activities

• 15 Response Inventory
• NIMS Typing of resources
• 16 Resource Acquisition
• Relevant national standards and guidance are used
  to achieve equipment, communication and data
  interoperability.
• 17 Standard and Consistent Terminology
• Plain English communication standards across the
  public safety sector
• Common language between Emergency Management, Law
  Enforcement, EMS, fire public health and
  hospitals

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National Incident Management Structure versus
Hospital Incident Command Structure

• National committees collaborated
• Reconciled discrepancies as HEICS (III) did not
• Include multi-agency cooperation
• Public information systems
• Proper incident command system language

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Hospital Incident Command (HICS)(Version IV)

• Incident Command must be incorporated into the
  response to every events
• HICS is NIMS compliant
• HEICS III and HICS IV Position Crosswalk
• Job Action Sheets

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Hospital Incident Command (HICS)(Version IV)

• Seventeen internal and external events
  identified
• Incident Planning Guides
• Incident Response Guides
• Education Tools
• HICS Implementation Tools

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The Joint CommissionProposed Elements to
Emergency Management Standards

• Need to think of critical capabilities beyond 72
  hours

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Resources

• Agency for Healthcare Research and Quality
• www.ahrq.gov
• Best Practices for the Protection of Hospital
  Based First Receivers
• www.osha.gov/dts/osta/bestpractices/firstreceivers
  
• Emergency Management Principles and Practices
  for Healthcare Systems
• www.va.gov/emshq/page.cfm?pg122

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Resources

• Hospital Incident Command (HICS IV)
• www.emsa.ca.gov/hics
• National Incident Management System
• www.fema.gov/emergency/nims/index.shtm

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Summary

• Key challenges
• Phases of disaster
• Tier Planning
• Resources for Healthcare Planners

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WakeMed Health Hospitals
Raleigh, North Carolina
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