Disaster Preparedness and Risk Mitigation: An Approach for Government Operations

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Disaster Preparedness and Risk Mitigation An
Approach for Government Operations Business
Continuity Joxel Garcia, MD, MBA Senior Vice
President Senior Medical Advisor joxelgarcia_at_maxim
us.com
National Emergency Management Summit March 6, 2007
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Possible Threats

• Pandemic Flu
• Natural disasters
• Terrorism
• Bioterrorism, Chemical, Nuclear, Etc.
• Dual Usage Technology
• Cybernetic

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Disasters

• Natural
• Technological
• Biological
• Chemical
• Radiological
• Complex

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Landslides
Earthquakes
Natural Disasters
Floods
Others
Hurricanes
Volcanic Eruptions
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Radiation Accidents
Aircraft Accidents
TECHNOLOGICAL, BIOLOGICAL, CHEMICAL and
RADIOLOGICAL DISASTERS
Fires
Others
Explosions
Chemical Accidents
Bioterrorism
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COMPLEX DISASTERS
Armed Conflict
Civil Strife
Refugees
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Avian Flu

• H5N1 detected in different countries Japan,
  South Korea, Vietnam, Indonesia, Thailand, Egypt
  and Nigeria
• As of January 15, 2007 267 Human Cases have been
  reported by 10 countries.
• 167 deaths since 2003

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Influenza Pandemics in the 20th Century
Credit US National Museum of Health and Medicine
1918 Spanish Flu
1957 Asian Flu
1968 Hong Kong Flu
A(H1N1)
A(H2N2)
A(H3N2)
50-100 million deaths
1-4 million deaths
1-4 million deaths
?
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Modelling Studies on Influenza PandemicGlobal
Health Implications

• Disease (attack rate 15 -35)
• 500 1.253 million ill (ill, no medical care)
• 875 1.601 require medical care (outpatients)
• 6.4 - 28.1 require hospitalization
• Deaths (case fatality rate 0.6)
• 2 - 7.4 million deaths
• 1918 mortality - 2.2
• Occurring in few weeks
• Several waves

Source CDC
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Severe Pandemic ( like in 1918) in the USA
Illness 90 million
Outpatient Medical Care 45 million (half of the affected)
Hospitalization 10 million
ICU Care 1.5 million
Mechanical Ventilation 750,000
Deaths 2 million
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Economic Impact of Selected Infectious Diseases
SARS, Ch, HK, SGP, Can 30-50 billion
Estimated Cost
Foot Mouth Disease, UK 25-30 billion
Avian Flu, Asia 8-12 bn
BSE, UK 10-13 billion
BSE, Jap 1.5 bn
FMD, Taiwan 5-8 billion
BSE, US 3-5 bn
BSE, Can 1.5 bn
Avian Flu, NL 500 m
HPAI, Italy 400 million
Nipah, May 350-400 million
Swine Fever, Nl, 2-3 bn
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02
94
98
2006
03
05
00
99
01
97
92
95
93
96
04
1990
Source Bio Economic Research Associates
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WHO Pandemic Phases

• Pandemic Alert Period
• Phase 3. Human infection with the new subtype but
  no human-to-human transmission
• Phase 4. Small clusters with limited human-to-
  human transmission.
• Phase 5. Larger clusters but human-to-human
  transmission still localized 

• Interpandemic Period
• Phase 1. No new human influenza subtype. Low risk
  of infection from circulating animal influenza
  virus
• Phase 2. No new human influenza subtype.
  Circulating new animal influenza virus poses risk
  to humans

• Pandemic Period
• Phase 6. Pandemic increased and sustained
  transmission in general population 

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Where are we?

• More important where should we be?

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Major Conclusions
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Gaps vs. Reality
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Extremely Limited Surge Capacity
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Hospital Preparedness
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US Hospitals by Bed Size
Bed Size Hospitals
lt100 2922 49
100-199 1426 24
200-499 1339 22
gt500 326 5
/- 6000
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GAO Report, 2004

• Hospital Preparedness ..Most urban hospitals
  haveplans but lackcapacities for bioterrorism
• www.ignet.gov/pande/ie/emergencypreparednessguide.
  pdf.

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Business Preparedness

• 77 of companies surveyed believe a pandemic flu
  represents a real threat to the U.S. (57 last
  year)
• 68 very concerned versus 43 last year
• 52 said their company has adequately planned
  ways to protect itself from the effects of a
  pandemic flu (14 last year)
• 45 feel confident their company is prepared
  compared to 18 last year
• Deloitte Center for Health Solutions and the
  ERISA Industry Committee.

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Hospital Preparedness

• Preparedness is a process, not a goal
• Created within an all hazards framework
• Preparedness required at 3 levels
• Within the hospital itself
• With the communitys health system
• With the communitys essential infrastructure

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Population at Highest Risk

• Indigent
• Elderly
• Disabled
• Language Barriers
• Children

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The Vulnerable

• The Poor
• Over 35 million people (total)
• Over 13 million are children
• Approximately 1.5 million homeless

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The Vulnerable

• Disabled
• 23 million (total)
• 14 million physical disabilities
• 9 million mental disabilities
• Institutionalized
• Over 2.5 million (60 nursing homes 40 assisted
  living)
• Incarcerated
• Over 2.5 million across the Nation

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Functional Focus Areas

• Medical Management
• Hospital Coordination
• Health and Medical Resource Assessments
• Resource Acquisition and Mgt
• Major Decision/Policy Mgt
• Roles and Responsibilities

• Information and Communications
• Public Information/Media
• Surveillance and Epidemiology
• Prevention/Prophylaxis
• Systems Integration
• Fatality Management

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Health Actors

• Government
• Public Safety
• Public Health
• Social Services, Safety Nets
• Health Care System
• Hospitals
• Providers
• Systems
• Labs, Clinics, Outpatient Services

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Systems in Place

• Medicaid
• Medicare
• SCHIP
• School
• Insurance
• State, County, City, Tribal, Federal
• Other

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Business Continuity

• Worldwide members of the Corporate World, the G8
  Nations, Multinationals, and many others are
  making Business Continuity during and after a
  disaster a major component of their overall
  Business Strategy
• The Preparedness, Mitigation, Response and
  Recovery are an economic priority not only for
  the Industry or Company but for the State

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Business Continuity

• Priorities
• Continuity of Operations
• IT systems
• Continuity of business
• Personnel

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Business Continuity and the Healthcare System

• Priorities
• Staff
• Patients
• Information
• Facilities

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Health Care System Preparedness

• Research
• Evaluation
• Planning
• Education
• Training
• Communication
• Services

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Research and Evaluation

• Internal research and evaluation of the system
  and its components
• People, systems, components, supplies
• Benchmarking
• Do not reinvent the wheel
• External research and evaluation
• Community, County, State, Federal
• Other systems, partners, vendors, utilities,
  transportation, etc.

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Planning

• Internal System plans
• Local, State, Federal, Global
• Planning needs to be
• Dynamic and proactive
• Comprehensive but taking into consideration all
  its components
• Realistic and applicable
• Needs Accountability at all levels

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Education

• From Mahogany road to the parking attendant
• Internal, external and systematic
• Ever learning process
• Multi media
• Accountability

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Training

• Education is a component of the learning process
• Training makes it real
• Has to be realistic and applicable
• Accountability

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Communication

• Crisis communication is very different from every
  day communication
• People take, process and react to it differently
• Create a communication plan
• with pre- event, event and post event components
  (Internal External)
• Multimedia that is applicable to the communities

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Services

• Triage
• Inpatient, outpatient
• Residential care
• Clinics
• Immunization clinics
• Referrals

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Prevention
Measures designed to provide complete protection
from natural disasters by controlling effects of
natural phenomena
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Preparedness
Pre-disaster activities aimed at strengthening
the capacity for protecting staff and patients,
operations, and recovery
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Mitigation
Prevention in an imperfect world!Reduction of
the impact!
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Vulnerability Analysis
Disaster Mitigation in Hospitals

• Structural
• Nonstructural
• Functional
• Operational

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Training is the key to progress...
Workshops Short Courses University Training
From Vulnerability...
to Safety
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We Also Need...
Strengthening Institutions

• Mass media
• Military
• Industry/private sector
• NGOs and volunteers
• Government
• Public opinion, schools

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Some of the Pressures During an Event
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Preparedness Plans
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Some of the Needs

• Integration of data and systems
• Planning and Forecasting
• Tools
• Preparedness Mitigation
• Communication

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Goals

• To save lives by mitigating human and economic
  losses
• To keep the health and social systems working
• Protect the vulnerable populations

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Proposed model

• Entity to serve as an interface between
  government agencies and private sector
• Support the research, evaluation, planning,
  preparedness, mitigation and communication
  processes
• Support the decision makers
• Integrate the present systems

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Platform

• Interconnect the local needs and realities with
  the Federal and State processes
• Links the healthcare actors with the preparedness
  and response actors
• Support and connectivity

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Data

• Repositories of data
• Vulnerable people, children, etc
• Data management
• Use the data to connect the individuals with the
  system
• Supply management, surge capacity, etc
• Dynamic processes
• Pro active (before, during and after the event)

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Planning and Forecasting

• Integration of the multiple plans in a cohesive
  and user friendly plan
• Forecast needs, supplies, personnel and other
  variables
• Support in the management of staff, patients,
  vendors and suppliers

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Tools

• Management tools
• Staff, personnel, patients
• Tracking
• Supplies, medications, ancillary
• Control
• Quality, Quantity
• Security
• Identification, vehicles, staff, patients,
  property

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Mitigation

• Research
• Education of staff and community
• Training of all personnel
• Physical evaluation and mitigation plans and
  protocols

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Communication

• Internal and external
• Utilization of multiple technologies for
  continuous and real time communication
• Call Centers
• Training

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Final thoughts

• To support, connect and strengthen the systems in
  place
• Make them more effective (quality and outcomes)
  and more efficient (cost and expenses)
• No need to reinvent the wheel
• Provides accountability (objectives can be
  quantified and measured)

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Acknowledgements

• J. Jarrett Clinton MD, MPH
• Senior Medical Advisor MAXIMUS Federal Services
  Inc.
• Dr. Eric Noji MD, MPH
• The James A. Baker III Distinguished Fellow in
  Health Policy
• Center for Health Transformation

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Thanks Joxel Garcia, MD, MBA Senior Vice
President Senior Medical Advisor joxelgarcia_at_maxim
us.com
March 6, 2007