How Community Care Clinics can use the Standards and Guidelines

1. How Community Care Clinics can use the Standards and Guidelines for Healthcare Surge During Emergencies Volume

2. Provide an overview of the content within California Department of Public Health’s Standards and Guidelines for Healthcare Surge During Emergencies Volumes. Locate and utilize operational tools, training curriculum, regulatory information and other resources for planning and implementing a response to a healthcare surge within the Community Care Clinic Volume. Learning Objectives

3. Agenda • Introduction to the Standards & Guidelines for Healthcare Surge during Emergencies project • Overview of the Community Care Clinics Volume • Planning for Surge: Where to Start • Highlights from the Community Care Clinics Volume • Next Steps

4. Introduction to the Standards & Guidelines for Healthcare Surge during Emergencies project

5. Background • Healthcare Surge Standards and Guidelines Volumes are reference manuals identifying existing regulatory requirements and the ability to modify these requirements during an emergency, guidelines for planning for a surge, and procedures to use in implementing a surge plan. There are four published volumes: • Foundational Knowledge • Volume I: Hospitals • Volume II: Government-Authorized Alternate Care Sites • Volume III: Payers • Volume IV: Community Care Clinics (draft) • Volume V: Long Term-Care Facilities (draft) • Volume VI: Licensed Healthcare Professional (to be developed)

6. Key Healthcare Surge Planning Concepts The following concepts serve as the foundation for understanding the context and perspective for the information presented in the Standards and Guidelines for Healthcare Surge Volumes: • During a catastrophic emergency, healthcare providers will focus on saving the maximum number of lives possible. • The movement from individual-based care to population outcomes during an emergency challenges the professional, regulatory, and ethical paradigms of the healthcare delivery system. • There is a great deal of flexibility in current California state statutes and regulations to enable a move to a population-based healthcare response. • The coordination of activities during a healthcare surge entails significant responsibilities for local government, tribal governments as well as community healthcare professionals. • The proclamation of a healthcare surge may be accompanied by proclamations of emergency which activate legal immunities or allow the suspension of practice requirements that may impede the healthcare surge response.

7. Healthcare Surge Concepts Transitioning From Individual Care to Population-Based Care • Healthcare surge capacity planning must consider a departure from individual patient-based outcomes in favor of an approach that saves the most lives population-based care). • It is anticipated that certain legal requirements may be waived or suspended by state and/or federal government authorities during a healthcare surge in order to support a shift to population-based care. • To the fullest extent possible, this shift to population-based care should adhere to longstanding principles of ethical practice.

8. Healthcare Surge Concepts Healthcare surge A healthcare surge is proclaimed in a local health jurisdiction when an authorized local official, such as a local health officer or other appropriate designee, using professional judgment, determines, subsequent to a significant emergency or circumstances, that the healthcare delivery system has been impacted, resulting in an excess in demand over capacity in hospitals, long- term care facilities, community care clinics, public health departments, other primary and secondary care providers, resources, and/or emergency medical services.

9. Overview of the Community Care Clinics Volume

10. Overview of the Community Care Clinic Volume • Guidance for community care clinics related to increasing capacity and expanding existing workforce during a healthcare surge. • Addresses resources and assets under a clinic’s control that can be used to expand capacity and respond to a healthcare surge.

11. Overview of the Community Care Clinic VolumeOperational Tools Manual • Community Care Clinic Volume has a companion Operational Tools Manual. • The tools are sample templates, checklists, forms, and policies for organizations to use in implementing the Surge Standards and Guidelines. The tools can be modified and applied to meet each organization’s specific needs. • Each tool described in the Community Care Clinic Volume is also included in volume’s Operational Tools Manual. • Each tool is preceded by an introductory sentence, highlighted in red, that provides the name of the tool. Each tool within the Operational Tools Manual includes a cover page which contains: • the tool name • A brief description of the tool • Instructions for using the tool

12. Overview of the Community Care Clinic Volume -Training Curriculum Community Care Clinic Volume includes a Training Curriculum. • The training curriculum is designed to be used as a tool for developing training programs on surge plans. Emergency planners could use this training course as a starting point and customize it to include organization specific surge planning objectives. • The training curriculum is made up of the following two components: • Training PowerPoint: A presentation that provides an overview of each of the sections in the Community Care Clinic Volume. The slides are labeled with the corresponding section title and number of the manual to facilitate cross-referencing between materials. • Training Guide: A document that provides additional information context and reference information for the content on the PowerPoint slides. Each slide from the Training PowerPoint is included in the Training Guide, along with additional information on the content of that slide that you may find helpful in developing training materials.

13. Quick Tips to Locate Information Community Care Clinic Table of Contents 1. California Healthcare system response to healthcare surge • Provision of Care during a Healthcare Surge • General Emergency Response Planning • Clinic Emergency Management • Managing Facility Space & Operations During a Healthcare Surge • Expanding the Workforce • Augmenting Clinical Staff and other Staffing Strategies • Augmenting Non-clinical staff • Maintaining the Workforce • Pharmaceuticals, Supplies, and Equipment • Administration • Reimbursement

14. Community Surge Planning In a catastrophic event, healthcare facilities may lack the necessary resources and/or information to individually provide optimal patient care. Communities, therefore, must collaboratively develop community surge capacity and collaborate with the community, suppliers, and external response partners. Community Clinic Volume includes within its suggested guide of representatives Tribal entities, especially tribal health programs and health centers. Key considerations include: • Community based planning enables communities to better respond to an outbreak by defining the role of home health care and availability to support such care. • A critical component of community based surge capacity response is mutual aid—sharing personnel, facilities, equipment, or supplies.

15. Planning for Surge: Where to Start

16. Clinic Surge Preparedness Self Assessment Tool • This tool is designed to guide a clinic in assessing its current surge preparedness level and to assist planners in identifying ways to advance a clinic’s surge preparedness through the use of Standards and Guidelines. • The Clinic Surge Preparedness Self-Assessment Tool is shown below.

17. Hazard Vulnerability Analysis The Hazard Vulnerability Analysis is the needs assessment for a clinic’s emergency preparedness program and can help clinics to determine their particular areas of vulnerability. The National Association of Community Health Centers (NACHC) provides guidance for clinics on conducting a Hazard Vulnerability Analysis. This guidance is available at :http://www.nachc.com/client/documents/HVA%2012.16.08.pdf • 1Emergency Management Principles and Practices for Healthcare Systems. The Institute for Crisis, Disaster, and Risk Management (ICDRM) at the George Washington University (GWU); for the Veterans Health Administration (VHA)/US Department of Veterans Affairs (VA). Washington, D.C., June 2006. Available at http://www1.va.gov/emshg/.

18. Highlights from the Community Care Clinics Volume

19. Expanding the Workforce In order to support the delivery of care at the onset of a healthcare surge, it may be necessary for clinics to invoke pre-established Memoranda of Understanding with neighboring healthcare facilities (e.g., other clinics, hospitals, long-term care health facilities, physician practices). Staffing Component Considerations for Development of Mutual Aid/Mutual Assistance Memoranda of Understanding 1. Communication of Request: The request for the transfer of staff initially can be made verbally. Any request, however, must be followed up with written documentation. Ideally this should occur prior to the arrival of staff at the recipient healthcare facility. The recipient healthcare facility will identify to the donor healthcare facility the following: a. The type and number of requested staff b. An estimate of how quickly the request is needed c. The location to which staff are to report d. An estimate of how long the staff will be needed 2. Documentation: The arriving staff will be required to present their healthcare facility identification badge at the check-in site designated by the recipient healthcare facility’s command center. The recipient healthcare facility will be responsible for the following: a. Meeting the temporarily reassigned staff (usually performed by the recipient healthcare facility’s security department or designated employee). b. Providing adequate identification (e.g., “visiting staff” badge) to the arriving reassigned staff

20. Policy for Workforce Resilience during an Emergency This policy offers guidelines for optimizing workforce in the event of an emergency. It applies to all clinic staff (paid employees or volunteers) during a time of healthcare surge. A portion of the policy is below. • Staff Needs • Physical: • Rest areas for staff members are located in__ (list departments and areas) ___. • Provisions for showers are available in ____ (list locations) ___________. • Food will be served or provided __ (list location, frequency, and times) ___. • Healthcare in case of illness or injury will be provided ___ (list location and schedule) ___. • Transportation to and from work will be provided ___ (list schedule, vendor, etc.)___. • For pandemic: ___(describe what will happen if the employee is too sick to be at work)___ • Personal: • Phones for personal calls are located __ (list locations and rules) ___. • Televisions, radios, and internet access for keeping apprised of events are located _ (list • locations and rules) __. • Childcare is provided at ___ (list location, rules, providers, schedule, etc.)______.

21. Clinic Staff Family Emergency Plan • Family emergency plan templates can be found at • http://www.ready.gov ("Ready America" tab, then "Make a Plan" tab), • http:// www.pandemicflu.gov (in the "Resources“ section), • http://www.redcross.org ("Preparing and Getting Trained" tab), • http://bepreparedcalifornia.ca.gov/epo. • These websites provide detailed information about how families can prepare for emergencies. • For samples of these templates refer toCommunity Care Clinic Operational Tools Manual: • Sample Family Emergency Plan • Sample Family Emergency Supply List • Pandemic Flu Planning Checklist for Individuals and Families • Family Emergency Health Information Sheet

22. Patient Tracking

23. Next Steps

24. Next Steps—30 Day PUBLIC COMMENT • http://bepreparedcalifornia.ca.gov/epo/ • Input on final draft version needed. • Refer to “Healthcare Providers for the link to the public comment.

25. Where can I access the Volumes? http://www.bepreparedcalifornia.ca.gov/epo Hard Copy Can Be Ordered or Downloaded Interactive CD Can Be Requested

26. Community Care Clinic Volume Wrap Up • The Surge Standards and Guidelines materials are designed to be used in collaboration with each other. The Community Clinic Volume, Operational manuals and training curriculum are referenced throughout the volume. • The Foundational Knowledge Volume sets the stage for all the subsequent materials and provides foundational concepts regarding healthcare surge. It should be read by every audience member. • A Reference Volume contains over 600 pages of legal analysis and requirements that can be waived under a Declaration of Emergency. • The Community Care Clinic Volume defines the concept of healthcare surge planning as related to clinics and provides additional resources to guide you during planning.

27. Questions/Comments

28. Jeanne Machado-Derdowski Health Program Specialist II California Department of Public Health Emergency Preparedness Office (916) 650-0390 (916) 416-9434 (blackberry) Jeanne.machado-derdowski@cdph.ca.gov Who do I contact for questions?