Mass Fatality Management Guide for Healthcare Entities

1. Mass Fatality Management Guide for Healthcare Entities

2. AGENDA • Project Overview • History • Goal and Objectives • Methodology • Guide Review • Scope • Organization • Content • Next Steps • Implementation 3

3. 2008 MFI Guide Review • The 2008 goal was to develop a guidance document for hospitals to enhance the ability of Los Angeles County and its healthcare partners to manage a surge in the number of decedents as a result of pandemic flu outbreak • Developed by EMS, Coroner and DPH 4

4. 2011-2013 GOAL AND OBJECTIVES • Revise/Enhance Guide • Brings in best practices/lessons learned • Expanded throughout 2012 • Provides specific, tangible, and quantifiable recommendations • Tested during Statewide exercise • Provides an accompanying online toolkit • Expanded as part of vetting process • Addresses the nexus between healthcare entities, and other local agencies in the fatality management planning process • Tested during Statewide Medical and Health Exercise • Addresses the legal and regulatory issues 4

5. Relevance to other MASS FATALITY resources • The 2008 version was consistently recognized as one of the best resources available on mass fatality management at the time of its release. It is regularly referenced in other jurisdictional mass fatality plans • The new version is a benchmark in mass fatality planning efforts 4

6. METHODOLOGY • Identify Key Stakeholders • Project Oversight Group • Interviewees/SME • Reviewers • Timeline: September 2011 to January 2013 6

7. BASE • Acknowledgements • Overview • Background, Scope, Objectives • Guide Development Process • How to Use Guide • Plan Development • Writing the Plan • Training, Exercise • Special Considerations • Activation • Tiered Escalation Levels • Logistics, Staffing • Notify Stakeholders • JIT, Initial Briefing • Operation • NOK Notification • Decedent Identification, Processing, Transfer, Tracking • Demobilization

8. APPENDICES • Community-wide Response Matrix • Key contacts • HIPAA • Security • Internet Resources • Refrigeration Truck Storage • Mental and Behavioral Health Resources • Religiousand Cultural Resources • Fact Sheets • Glossary • Acronyms • ONLINE RESOURCES • Mass Fatality Management Guide for Healthcare Entities Forms • Triage Tag Training • Mass Fatality Management • Plan Template • Job Action Sheet • Guide Slide Presentation 8

9. KEY SECTION REVIEW • Plan Activation • Key Position Checklist • Physician-in-Charge Concept • Witness Form • Decedent Processing • Death Certificates & CA-EDRS • Decedent Tracking • Decedent Handling and Storage • Community-wide Response Matrix • Refrigeration Truck Storage • Religion and Culture • Fact Sheets

10. PLAN ACTIVATION • Identify triggers for plan activation & escalation • Plan activation likely in concert with ICS activation • Actions organized via six step process • Staffing Guidelines • Organized by facilities with/without morgues and escalation tier

11. KEY POSITION CHECKLIST • Decedent Affairs Group Supervisor • Based on HICS, can (and should!) be tailored • Developed as part of larger emergency response approach • Tasks in chronological order

12. PHYSICIAN-IN-CHARGE • Certain physicians are designated to sign death certificates • NOT for Coroner’s cases • Most MFIs involve Coroner cases • May pertain to widespread communicable disease events ADMIN STAFF • Gather as much information as possible regarding patient • Witness Form

13. DECEDENT PROCESSING • Organized in two steps • Step 1– Understand process • Step 2 – Identify ways to expedite • Flow chart provided DEATH CERTIFICATES AND CA-EDRS • Organized in two steps • Step 1– Understand & document death certificate parameters • Non-Coroner’s case process • Coroner’s case process • Step 2 – Identify ways to expedite • See Fact Sheets • Death Certificates • CA-EDRS • County Public Administrator

14. DECEDENT TRACKING • Organized in four steps • Step 1 –Understand tracking process for your facility • MCI Example • Step 2 – Document process • Hospitals w/ ReddiNet MCI module • Hospitals w/o ReddiNet MCI module • Medical Clinics • SNFs • Step 3 – Identify ways to direct decedents to mortuaries • Step 4 – Identify ways to accommodate NOK who cannot pay

15. DECEDENT HANDLING AND STORAGE • Organized in four steps • Step 1 – Determine your surge storage capacity • See Surge Storage Capacity Assessment • Step 2 – Ensure decedent handling processes are in place • Step 3 – Expand surge capacity • Primary morgue • Unused service areas • External morgues • Temporary burial (ONLY when directed by Coroner) • Step 4 – Ensure P&P

16. COMMUNITY-WIDE RESPONSE MATRIX • High-level roles/responsibilities matrix • Healthcare partners, and local, State, Federal partners • Tool for healthcare entity partners to enhance understanding of their role in a community-wide response

17. REFRIGERATION TRUCKS FOR STORAGE • Capacity • # of decedents that can be stored by truck size • NOT for transportation – storage only • Increase capacity with shelving • Procurement • Can procure own • Can request via NIMS/SEMS • Information to provide • Reimbursement • Requesting facility to pay • HPPs MAY qualify for reimbursement

18. RELIGION AND CULTURE • Organized in two steps • Step 1– Obtain and include information regarding death practices • Tailor for your population • Sample material included • Step 2 – Confer with cultural and religious organizations in your area FACT SHEETS • Death Certificates • CA-EDRS • Health risks • County Public Administrator • Recommendations • Considerations • Decomposition

19. NEXT STEPS • Guide implementation • See Plan Development Section • Review existing policy • Review Guide • Revise facility mass fatality plan based on Guide 9

20. Mass Fatality Management Guide for Healthcare Entities Thank you! Questions?