Title: Preparing for a Pandemic Event
1Preparing for a Pandemic Event
- Developing a Continuity of Operations Plan (COOP)
Presented by Scott Aronson, MS 860-793-8600 /
www.phillipsllc.com
2Implementation Goals
- NOT Flu Pandemic Diagnosis/Treatment
- Why Dialysis, Nursing Home, Home Health?
- Detail Approaches for a COOP
- Communications Incident Management
- Staffing Plan/Education
- Supplies/Resources
- Transportation
- Facilities/Engineering
- Clinical Services / Strategies
- Utilizing Mutual Aid to Supplement Planning
- Review Effective Exercises
3The Emergency Managers Problem
- Are You Really Prepared for a Disaster?
4 Money
Regulation/Statutes
Fear
Ethics
5Why Dialysis, Home Health Nursing Homes
6Emergency Operations Plan (EOP) and Continuity of
Operations Plan (COOP)
- EOP actions are procedural and taking place as
the event unfolds (i.e. Bomb Threat, Building
Evacuation) - COOP is how you ensure the ability to operate
your organization throughout any disaster
special emphasis on Influenza Pandemic - Challenge Limited to No Incident Command System
training (Communication/Redundancy) - Challenge Emergency responders and State are a
resourcedo not make them your plan
7Stand Alone
- Currently Joint Commission, but NFPA to follow
with CMS - Stand Alone for 96 Hours in 6 critical area
- Communications
- Staff Responsibilities
- Resources Assets (supplies, staff)
- Safety Security of Residents
- Utilities Management (power, HVAC, fuel, water,
etc.) - Clinical Support Services
- If you cant meet it say it or fix it!
8Communications and Incident Management
9Communications
- Ongoing communications to
- Staff
- On-duty (briefing) and Off-duty (sit-stat)
- Phone Number to Call Into
- Website to View with Emergency Information
- Patients/Residents and Families (staff families)
- Preplanning Information
- How do you Inform them of the Situationand keep
them informed - See Next Page
- Message on website, e-mailed out, blast fax to
media, paged to staff, on main facility phones
(briefed internally for staff as well)
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11Communications
- FAILURE (immediately post-Katrina)
- 2005 Hurricane Rita (Texas/Louisiana)
- Same Hospital as Listed on the previous slide
- Message from the Governor and the Mayors Office
- All residents of the City of Corpus Christi MUST
evacuate immediately followed by the
instructions, etc. - Problem?
Influenza Pandemic Governor Declares State of
Emergency Social Distancing (i.e. stay at home)
is the recommended approach ?How do you get
staff to come to work?
12Communications
- Ongoing communications to
- External Authorities
- Fire, Police and Public Health Local EOC DPH
DEMHS - No set Frequency for Influenza Pandemic reporting
Emergency Line Created at Time of Emergency - Regular Communications Failure HAM/Amateur
Radio - Incoming Communications may come in form of
- Blast Fax
- Direct Phone Call
- Health Alert Network (HAN) when updated
- All Facilities Should Sign On IMPORTANT
- Rolling phone, fax, e-mail, pager, etc.
- If you are unable to reach DPH or other State
Agency - Use Ethical Judgment on actions
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14Communications
- Ongoing communications to
- Vendors
- 24/7 Phone Numbers
- If entering high-risk area (i.e. National Guard
controlling access) - Letter from Facility
- Directions if Necessary
- Carry their Own Company Badges/ID
- Inform Local EOC of shipment
- Use Incident Command System to run this
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16Incident Command Organizing the
Chaos!Manageable Span of Control 3 7
17Incident Command
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20CDC Checklists
- In the Incident Command System, what position
would handle these roles? - Home Health
- The Organization point person for external
communications (e.g. hospitals, nursing homes,
health departments, social services agencies) has
been assigned. (Insert name, title and contact
information) - Nursing Home
- A plan for cohorting symptomatic residents or
groups using one or more of the following - Confining symptomatic residents and their exposed
roommates to their room - Placing symptomatic residents together in one
area of the facility, or - Closing units where symptomatic and asymptomatic
residents (staff who are assigned to work on
affected units will not work on other units?
21Incident Command Education
- Free
- On-line
- Boring except to people like me ?
- ICS 100, 200, 700
- IS-100.HC Introduction to the Incident Command
System for Healthcare/Hospitals - IS-200.HC Applying ICS to Healthcare
Organizations - IS-700 National Incident Management System
(NIMS), An Introduction - Yale EM103 NIMS (meets 100, 700)
- Yale EM140 NIMS (meets 200, 700)
22Communications Tool Internal / From Field / To
Corporate
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26Staffing Plan / Education
27Staff Responsibilities
Share through your association for all facilities
to have consistent education
- Education, Education, Education
- What is expected of you?
- Come to work in a disaster
- Need to say this dont assume
- What are their specific responsibilities?
- Protect themselves (no exception PPE use for
patient contact or non-patient contact), other
staff, patients/residents - Tasks will be outside of normal daily
responsibility
28Staffing Plan
- How are they Called Back?
- Red / Yellow / Green OR On / Resting / Off
- Impact of changing staff hours on their
family/dependants? - If Limited Transportation, what are the
Preplanned Pick-up Locations? - Must Have Facility IDs in the Event of Roadblocks
- Facilities with Strike Plans Should already
have Pick-up Locations - Facilities with Severe Weather (ice / snow /
flood) Plans Should already have Pick-up
Locations - Home Health Any challenges?
- Are there Plans for Housing Them
- Their Dependents? (elderly family, children,
disabled)
29In Need of Staff
- Where can you get them from if in trouble?
- Your Corporate Office if applicable
- Staffing Agencies Draw from Outside State
- Medical Reserve Corp (MRC)
- Community Emergency Response Teams (CERT)
- Families (Staff and Patient/Resident)
- Retired Staff (never burn bridges)
- Sister Facilities or Neighboring Facilities
30Staff Family Education/Support
- Education Staff/Patient/Resident Families
- Patient/Resident Upon Admit or a New Client /
Staff Upon Hire - Provide Info to Staff/Families/Responsible Party
on Expectations in a Disaster and Support that
May be Requested (ask the question) - Home Health
- Provide direct care for Priority 2 3 patients
(phone support) - Agency should increase verification process on
accuracy of info frequency determined by Agency - Nursing Home
- Family member may be requested to pick-up patient
for discharge and care for them - Family member may be asked to provide on-site
volunteer support to care for residents (staff or
resident families) - Dialysis
- Provide diet oversight for patient (phone
support) - Center should increase verification process on
accuracy of info frequency determined by Center
31Staff Staff Family Support
- Staff and Family Support Examples
- Child care, elder care, communication, etc.
- CCRC Better Ability to have Adult Day Care,
Child Care (modifications), Lodging for Family - Hotel, on premises, Sr. Independent Living or
Assisted Living Residence, etc. - Child Care Fears
- Are these Real?
- How to Combat them? Or should you?
- Mental Health and Other Family/Staff Support
- CONSIDER THEM These are not required, just need
to be thought through and planned as to if you
are or are not going to provide them
32Family Disaster Planning
- Yale-New Haven Office of Emergency Preparedness
- Pamphlet
- http//yalenewhavenhealth.org/emergency/progsvcs/c
ommprep.htmlpersonal - Red Cross Family Disaster Planning Guide
- http//www.redcross.org/services/disaster/0,1082,0
_601_,00.html - Focal Areas
- Who has dependents (elderly, special
needs/disability, child) - Caring for them in a disaster?
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35Supplies Resources
36Supplies/Resources
- Where can you get them from?
- Outside 90 mile agreements
- Dont do all the work, have someone do it for you
(networking with other state associations to
share supplier/vendor information) - Your Corporate Office if applicable
- Other State Facilities (if not directly impacted)
- Local Pharmacies
- Local Hospitals
- Strategic National Stockpiles (SNS)/Push Packs
- Rationing
37Stockpiling?
- Financial Burden
- PPE
- How much should you stockpile?
- Calculate of patients/residents
- Calculate of staff of shifts
- Delineate difference between clinical and
non-clinical - Review reuse strategies where safe to do so
- Home Health Storage in cars with specific PPE
that can be reused on the same patient
38Example
- Dialysis Center
- 40 patients per day (110 total for the Center)
- 10 direct patient contact staff (3 nurses/6
techs, Dialysis Asst) - 5 Admin/Support (Director, Social Worker,
Receptionist, Dietician, Word Clerk) - Approx. 30 N-95 Respirators (x 2 for staff
changes) / Glove Consumption Varies Based on
Patient Contact (saturated N-95 could change life
of respirator) - Up to 8 Week Timeframe Maximum of 1,200 N-95
Respirators for staff and potentially up to 1,600
respirators per patient (recommend patient reuse
which could reduce this to minimal numbers over
an 8 week period) - REALITY Reduction in Staff Reduction in of
Patient - 20 patients per day (110 still remains as )
- 5 direct patient contact staff (2 nurses/3 techs)
- 3 Admin/Support (Social Worker, Receptionist,
Dietician) - Approx. 16 N-95 Respirators (x 2 for staff
changes) and Glove Consumption Varies Based on
Patient Contact (saturated N-95 could change life
of respirator) - Up to 8 Week Timeframe Maximum of 640 N-95
Respirators for staff and potentially a total of
110 respirators for the patients (recommend
patient reuse) - Estimated Costs 11 per box with 20 per box 38
boxes at 11 418.00
39Stockpiling?
- Food MREs, non-perishables (sample multi-day
menus and feeding calculation document provided) - Rationing due to staffing or supply availability
could be necessary - Medications
- Home Health Eliminate vitamins and other
baseline meds as necessary - Nursing Home Elimination of non-essential meds
via an Influenza Pandemic Med List - Will you work to access vaccines and antiviral
meds? - Work with Corporate, State DPH, Associations,
Local Public Health and Other Providers to
address this during the disaster - Supplies (dialysers, lines, meds, saline,
chemicals)
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41Emergency Resources Contacts
- Emergency Agency Phone s (shown in
communications) - Emergency Alert System
- Emergency Bedding / Housing Plan
- Emergency Staffing Agency Phone Numbers by
Specialty - Materials Management / Nutrition / Pharmacy
Departments - Emergency Contractors/Vendor Phone Numbers
- Emergency Supply / Food / Liquid / Meds Sources /
Linens - Mutual Aid
- Stop-Over Site Agreements (Quarantine???)
- Nursing
- Emergency Contractors/Vendor Phone Numbers
- Transportation Resources Internal/External
- Utility Systems
- Emergency Contractors/Vendor Phone Numbers
-
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44Transportation
45Transportation
- Utilization of Staff Vehicles for Supply Movement
Who has 4-wheel drive or pick-up trucks to move
supplies? - Patient location analysis to eliminate
transportation redundancies - Dialysis Patients Centralized management of
transportation (pick-up other facilities
patients Private Transport Companies) - Pick-up Staff with the patients
- Leverage Facility Owned Vehicles (typically in
Long-term care) - Why cant a Nursing Home provide transportation
to a Dialysis Center?
46Transportation
- Home Health
- Centralized pick-up points for essential
administrative and support staff - Knowledge that gas supply chains could be
disrupted - Patient location analysis to streamline travel
times - i.e. elimination of visits to geographically
dispersed patients - Nursing Homes
- If you do not have, secure a facility shuttle for
staff pick-up points preplanned arrangement - If you do have, consider working in Mutual Aid
Agreements with other providers to support
transportation needs
47Utilities / Facilities
48System Failures
- Potential that repair teams will be rendered
incapable of supporting facility - Know what can shut down your operations
- Dialysis Patients If Reverse Osmosis water is
disabled can you use tap water? - Nursing Home If Generator is down due to power
loss and no extended fuel back-up, do you have
other means of redundancy? - All If your IT system fails and there are no
staff to repair it, - How will you bill?
- How will you ensure appropriate clinical data?
- How will you ensure appropriate
family/responsible party info?
49Clinical Services
50Clinical Services
- What are the strategies for providing a maximally
attainable, minimally acceptable level of care? - Exercise
- Dialysis Typically 3 nurses and 6 techs on a
shift - Down to 2 nurses and 3 techs for 8 weeks
- Strategy?
51Building Lockdown/ Containment Strategy
- Pre-designate What Doors for Monitoring
- Stabbing in the Parking Lot
- Threat to Resident or Staff Life
- Labor Action / Strike
- Loss of Emergency Power
- Civil Unrest
- Pandemic Influenza
- Fever Testing at Entrance (customize off of DPH
Plan)
52What is Fever Testing
- Screening Process for Employees,
Family/Responsible Parties and Patients/Residents - Allow or Deny Access to the Facility
- gt101F Immediate Denial
- lt99F Access Granted
- gt99F and lt 101F Follow Series of Questions
- Determine appropriate infection control protocols
for isolation of or potentially to deny access
for patients with Influenza Pandemic - Policy/Procedure included on CD-Rom to customize
your facility specific plan for Fever Testing
53Fill In the Plan Position / Department /
Facility
54Department/Position -Specific Plans
Each department or position within our
organization should have the responsibility to
review and update critical functions in order for
us to continue operations in a disaster. The
plans should be formatted in the following manner
55Department/Position -Specific Plans
- Current staffing s / positions by shift
- Overall functions of the position/department
- Bullet List the Functions (i.e. Dietary in
Nursing Home) - Food preparation
- Gather menus from floors
- Prepare carts/trays (specific dietary needs)
- Prepare lines
- Deliver meals
- Staff kitchen, line and register
- Clean carts, trays, utensils, dishes, pots, pans
and equipment - Restock food and supplies (liquid consumables,
staples, meats, dairy, etc.) - Storage for food and supplies
- Reordering of food, liquids, equipment and
supplies
56Department/Position -Specific Plans
- Functions that must be maintained and that can be
suspended in a disaster situation - Dietary (sample list)
- Limit food prep to emerg. Menu
- Disposable products
- Consider moving to 2 meals/day plus snacks based
on patient or resident needs - Billing
- Need to bill, but what is the frequency?
- Minimal Staffing Operations
- Home Health Nursing / Aides
- Suspend Priority 3 Services Limit Priority 2
Services Manage Priority 1 Patients
Discontinue Hospice Care at Nursing Homes - Re-establish Geographic Borders to Maximize
Capabilities (work on alternative plans for
geographically dispersed patients) - Limit initial patient assessment for new patients
(rapid assessment)
57Department/Position -Specific Plans
- Minimal Staffing Operations
- Nursing Home Nursing / Pharmacy Billing
- Higher Acuity vs. Lower Acuity Residents
Reprioritize Service Capabilities - Utilize non-certified staff or resident/staff
families to provide direct resident care support
(CNA) - Eliminate non-essential meds for Residents based
on acuity - Billing 2 weeks late vs. getting meds to the
floor - Dialysis
- Extension of patients to spread out dialysis
treatments - Work to streamline physician orders Emergency
Physician Order Form - Streamline admissions paperwork
58Department/Position Other ?s
- Inability to provide services from the
department/area (relocate in the building to
consolidate staffing or relocate to another
physical location) - Information Systems down-time operations (i.e.
coders would go to the books and manually code
do you have all the necessary books?) - Inability to secure transportation for patients
(dialysis)? Inability to access your patients
(home health)?
59Leadership Considerations
- Priority of Services that MUST continue (cash
flow / clinical needs) - How to pay staff with no revenue coming in?
- Skeleton Crew Essential Staff (based on Dept.
Specific Plans) - When to determine if operations must cease?
- Insurance to support short term or long term
business interruption - Key relationships (if 2nd or 3rd in command need
to take over) - Fundraising
- Political Figures
- Financing Short-term Emergencies
- Banking Leaders
60Mutual Aid Plan (MAP)
61MUTUAL AID EVACUATION SUPPLY PLAN
Northeast Ice Storm 1998
Florida Hurricanes 2004
- Agreement among member facilities to provide
assistance to each other at the time of a
disaster
Plan as a group of providers, not as a stand
alone facility or corporation
62NEED SUPPLIES
- Coordination with the Mutual Aid Plan (MAP)
- 1) Standard Vendors first
- 2) Regional MAP Vendors second
- Continuous interaction with Local EOC for
non-medical needs - 3) Joint Region MAP Vendors
- Interaction with State EOC for non-medical and
medical needs - 4) State of Emergency Declaration
- Other facilities in your Regional MAP State of
Emergency Declaration - Other facilities in your Joint Region MAP
63SUPPLIES
- Request verbally followed by written
- Vendor MOU
- Transport may be offered by Donor facility
- Pharmaceuticals see next page
- Summary of Equipment and Supplies Aggregate of
all facilities - Facility Specific Info
- Plan will include
- Specifics that facilities will provide
- Medical Supply / Equipment Vendors
- General Supply Vendors (cleaning, waste removal,
mattresses, linens) - Personal Protective Equipment (PPE)
- Pharmaceuticals
- Portable HVAC
- Generators and Fuel
- Food and Liquids
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66QUESTIONS
Russell Phillips Associates, LLC New York /
Connecticut / California 860-793-8600 saronson_at_phi
llipsllc.com www.phillipsllc.com