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Preparing for a Pandemic Event

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Title: Preparing for a Pandemic Event


1
Preparing for a Pandemic Event
  • Developing a Continuity of Operations Plan (COOP)

Presented by Scott Aronson, MS 860-793-8600 /
www.phillipsllc.com
2
Implementation 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

3
The Emergency Managers Problem
  • Are You Really Prepared for a Disaster?

4
Money
Regulation/Statutes
Fear
Ethics
5
Why Dialysis, Home Health Nursing Homes
6
Emergency 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

7
Stand 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!

8
Communications and Incident Management
9
Communications
  • 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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11
Communications
  • 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?
12
Communications
  • 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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14
Communications
  • 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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16
Incident Command Organizing the
Chaos!Manageable Span of Control 3 7
17
Incident Command
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20
CDC 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?

21
Incident 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)

22
Communications Tool Internal / From Field / To
Corporate
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26
Staffing Plan / Education
27
Staff 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

28
Staffing 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)

29
In 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

30
Staff 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

31
Staff 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

32
Family 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?

33
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35
Supplies Resources
36
Supplies/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

37
Stockpiling?
  • 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

38
Example
  • 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

39
Stockpiling?
  • 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)

40
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41
Emergency 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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44
Transportation
45
Transportation
  • 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?

46
Transportation
  • 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

47
Utilities / Facilities
48
System 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?

49
Clinical Services
50
Clinical 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?

51
Building 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)

52
What 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

53
Fill In the Plan Position / Department /
Facility
54
Department/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
55
Department/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

56
Department/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)

57
Department/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

58
Department/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)?

59
Leadership 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

60
Mutual Aid Plan (MAP)
61
MUTUAL 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
62
NEED 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

63
SUPPLIES
  • 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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66
QUESTIONS
Russell Phillips Associates, LLC New York /
Connecticut / California 860-793-8600 saronson_at_phi
llipsllc.com www.phillipsllc.com
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