Creative NIMS Compliance Building incident management teams to support long term operations

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Creative NIMS ComplianceBuilding incident
management teams to support long term operations
Greg Santa Maria Emergency Preparedness
Manager Sanford Health System Sioux Falls, SD
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The Sanford Health System

• 24 hospitals
• Mostly critical access
• 105 clinics
• 4 states
• RURAL SERVICE AREAS

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How it all began

• Medical Center main campus update - 2004
• HEICS Updates
• Tabletops
• Decon Training
• Random network hospital requests
• Emerging patterns

What the heck is a Critical Access Hospital?
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Starting out the initial projects

• HEICS training
• Simple scenarios
• Realistic events
• Webster
• Elevated awareness of local hazards
• Large gatherings
• HAZMATS

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The burning questions

• How does a critical access hospital with a
  limited number of employees and resources respond
  to a large incident in their community?
• How do they maintain operations over multiple
  operational periods?

How does this also apply to rural fire and EMS?
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First Things FirstEffective ICS Training

• Internet vs classroom
• Who is monitoring comprehension?
• Advanced ICS
• What about practical applications?
• If you needed surgery and your doctor was
  licensed through an online course, would you put
  your life in his hands?
• Why Incident Command?

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Walking the Talk

• ICS
• NIMS
• Five year NIMS training plan
• Exercises
• Planning

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A team is born

• Wouldnt it be cool if

Just like wildland fire fighting , we could
develop seasoned and confident incident managers
and use them to create incident management teams
for our Health System and then beyond.
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Sanford Health Incident Management Team Project
Nice Vest!!!

• Hospital use of ICS is limited
• ICS is still new to hospitals
• Still HCC Confusion on roles
• Standards are staggered
• Few have taken ICS 300 / 400

Job Description
Planning Section Chief
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Sanford Health Incident Management Team Project

• Disasters cost money
• Why?
• Long term operations stress staff
• Lack of replacement staff
• Other issues
• What about incident commanders
• Who replaces them?
• Decon teams?

Disaster
Business
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Now is the time

• Nationwide Emergency Management Expectations
• The Joint Commission EM Standards
• Hospital Ops may last longer than scene Ops

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Sanford Health Incident Management Team Project

• Scenario 1 Pre - IMT
• Disaster in Winner, SD
• Isolated location
• Finite staff
• Multi period event will stress local resources
• System plan activation
• Takes IC focus from local to system communication
• May delay local decision making and IAP

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Sanford Health Incident Management Team Project

• Scenario 2 - HIMT
• Disaster in Winner
• Disaster response begins
• Multi period disaster identified
• Local SH facilities deploy HIMT support staff
• On Call Team leader notified
• Initial Situation Assessment completed
• If applicable, system plan activated
• Team members act as liaisons to local as well as
  system resources
• Communications link with Local EM established

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Activation

• Pulling the Trigger
• What barriers to activation exist?
• Personal
• Administrative
• Policy
• Other
• The Orwell Syndrome

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Activation
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Levels of Activation
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Sanford Health Incident Management Team Project
Project Description

• Develop a system wide team of responders
• Deployable to any system location
• Trained to assess a disaster situation and coach
  a
• Command center EOC manager
• Decon team
• On call and on site team leaders that initiate
  the system response
• Trained to coordinate efforts with local
  emergency managers

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Sanford Health Incident Management Team Project

• The concept
• On location support
• Increases morale
• Reduces business losses
• Increases response effectiveness over multiple
  operational periods
• Does NOT relieve local commander of
  responsibility
• Manager role (not commander)

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Sanford Health Incident Management Team Project

• The concept
• Liaison between system and affected facility
• Enhances communication
• Creates ease of resource management
• Removes the distant responsibilities so IC can
  focus on local event
• Allows local staff to maintain continuity of
  operations

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Sanford Health Incident Management Team Project

• The concept
• Liaison between affected facility and local EM
• Establishes trained liaison
• Ensures appropriate use of local resource
• Reduces potential for duplication of services
• Knows who to call and when / where to call them

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Sanford Health Incident Management Team Project

• The concept
• Bring needed support staff to affected facility
• Decon
• EOC coach
• Incident managers

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Sanford Health Incident Management Team Project

• Incidents start locally
• This is not only about the big one
• Webster SD Lake Area Hospital HAZMAT
• Can be used for
• Ice Storms
• Blizzards
• Tornado
• Any incident that will result in multiple
  operational periods (8 hours)

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Sanford Health Incident Management Team Project

• Current outreach programs
• Preparedness evaluation
• ICS / NIMS classroom training
• Tabletops and functional exercises
• Decon training (OSHA 1910.120)
• Advanced ICS offerings

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Sanford Health Incident Management Team Project

• Coordination of multi agency exercises
• Winner
• Chamberlain

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Basic Steps

• ICS Training
• Simple tabletop
• Decon training
• Multi agency training
• Multi agency exercise
• Multi facility exercises
• Increasing complexities

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Sanford Health Incident Management Team Project

• Sanford HIMT Training
• Four levels
• HAZMAT operations technician
• HAZMAT group supervisor
• Hospital incident manager
• Hospital incident management specialist

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Level 1
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Level 2
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Level 3
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Level 4
http//www1.va.gov/emshg/page.cfm?pg122
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Training

• Can be modular
• Can be an immersion program
• Requires an internship at the highest level
• Is in development stages and requirements may
  increase or content may change

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Sanford Health Incident Management Team Project

• Team Leaders
• Become trainers
• Train their facility and other local regional
  facilities
• Develop HVA and preparedness assessments
• Initiate, script and facilitate local and
  multi-agency drills
• Are our disaster planning liaisons to
• Responder agencies
• Health systems
• Emergency management resources

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Sanford Health Incident Management Team Project

• Levels of Activation (not defined)
• Level 1
• 2 Managers and 1 Specialist
• Level 2
• 2 Managers and 1 Specialist with system EP plan
  activation and main campus liaison
• Level 3
• Management team with decon support
• Level 4
• Management team with area command activation

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What will we accomplish

• System wide consistent response
• Incident command
• Decontamination
• HVA Drill development
• NIMS Compliance
• The Joint Commission emergency management focus
• Enhanced Business Continuity
• Reduction of operational losses due to large
  events

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The good news..a value added service

• Team members exist in most locations
• Safety officers
• BT coordinators
• Volunteer Fire Chiefs and Officers
• Emergency Managers
• EMS Supervisors

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Identifying Team Members

• At least one from each facility required
• This is stated as expected participation
• At least one level 3 at each location
• Up to four active participants per facility
• This will be an active participation project
• Nobody just says they are participating

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Utilization in Exercises

• Area command concept
• Encourages communication between
• Affected facilities
• System command center
• Local emergency management

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Area Command Concept
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Command Center Tool

• eSponder
• ICS
• Resource Tool
• Communication Tool

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Preparedness is not just meeting a standard

• Its IS
• Achieving comfort levels
• Gaining knowledge and experience
• Denying complacency a place to grow
• Motivating the not so interested
• IT WILL NEVER HAPPEN HERE

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What's Next?

• Expansion outside of health system
• Stand alone facilities
• Other health systems
• Region
• State
• WHO ELSE?

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The future

• Assists implementation of Regional Plans
• Cross border / Jurisdictional response
• The next big exercises
• Worthington, MN
• Rock Rapids, IA

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Who else can benefit?

• Volunteer FD
• Large Municipal FD - FDNY is doing it as well
• EMS
• Emergency Management
• SD doing it!!!

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The Incident Management Team

• Achieves numerous elements
• Supports long term operations
• Provides EOC Support
• Provides TRAINED support personnel

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Thanks to the team
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Training Resources
Department of Veterans AffairsEmergency
Management (EM) Principles and Practices for
Healthcare Systems http//www1.va.gov/emshg/page.
cfm?pg122 FEMA EMI ICS 100 ICS 200 IS
700 Professional Development Series http//trainin
g.fema.gov/IS/crslist.asp California Hospital
Association http//www.calhealth.org/public/edu/ni
ms.html AHRQ EPRI http//www.ahrq.gov/research/
epri/
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Questions???