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Leadership Challenges In A Mass Casualty Incident

6/13/2012. 2. Welcome. Thank you for participating in this teleconference for Senior Leadership of Wisconsin HospitalsThank you for your participation in and commitment to Wisconsin's Hospital Emergency Preparedness Programs100% of all hospitals participating. 6/13/2012. 3. Thank You . The staff o

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Leadership Challenges In A Mass Casualty Incident

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    1. 6/13/2012 1 Leadership Challenges In A Mass Casualty Incident Wednesday, March 23, 2005 1:00 PM - 2:00PM

    2. 6/13/2012 2 Welcome Thank you for participating in this teleconference for Senior Leadership of Wisconsin Hospitals Thank you for your participation in and commitment to Wisconsin’s Hospital Emergency Preparedness Programs 100% of all hospitals participating

    3. 6/13/2012 3 Thank You The staff of your Emergency Management Committee Your staff serving in state leadership roles: Regional HRSA Boards State Expert Panels HRSA Leadership Group

    4. 6/13/2012 4 What Are We Doing and Why? The events of 9/11 and the anthrax event, that immediately followed, demonstrated our VULNERABILTY in our ability to respond to mass casualty traumatic (all hazards) incidents (MCI), intentional or unintentional mass casualty biological incidents, intentional or unintentional

    5. 6/13/2012 5 Health Resources and Services Administration (HRSA) Congress appropriated funds through HRSA for hospital preparedness: enhance our surge capacity response collaboration and integration of plans of all emergency response partners ability to maintain hospital services in a sustained event

    6. 6/13/2012 6 “It’s Not Just Bioterrorism” 9/11 and Anthrax were followed by SARS, Hurricanes, threat of Avian Flu Early in our preparedness efforts, decision was made to use funds for “dual use”

    7. 6/13/2012 7 What Are We Preparing For? “Preparing for the unthinkable also prepares us for the likely.”

    8. 6/13/2012 8 Leadership “To think that the worst will not happen at my hospital is natural… ...to lead in preparing for the worst at my hospital is a moral imperative.”

    9. 6/13/2012 9 Your Hospital Is Critical Despite all the preparations at the State or National level, Every disaster is LOCAL. What matters most to your community is not the state and national response... …what will save lives is the response of your hospital

    10. 6/13/2012 10 Preparedness Means... Your hospital is ready

    11. 6/13/2012 11 Role of CEO/Administrator and Senior Management Today we will focus on leadership challenges Next month (Wednesday, April 20) we will focus on the tools to help you as senior managers in your response all emergency responders use ICS (NIMS) hospitals have available HEICS

    12. 6/13/2012 12 No Answers Unfortunately, we cannot provide detailed guidance on how to lead in a MCI Today we will raise issues and situations that you will face as senior managers We will draw on “lessons learned” from 9/11, Anthrax, Israel, Spain, Oklahoma, Florida and others

    13. 6/13/2012 13 4 Leadership Responsibilities Mitigation Planning Response Recovery

    14. 6/13/2012 14 The Scenario To put these challenges into a real-life context, we will use a scenario that is most likely to occur An incident caused by “nature’s terrorist” PANDEMIC FLU

    15. 6/13/2012 15 Scenario Time Line Today: no indication of pandemic flu How are you leading your hospital in planning and preparation? Fall of 2005: outbreak of novel virus in Far East How will you lead your hospital “on the eve”? January 2006: pandemic flu is here What are the leadership challenges?

    16. 6/13/2012 16 January 2006 (this scenario is occurring at many hospitals) hospital has been full for weeks 40% of staff and key managers are sick staff is burned out and exhausted from OT staff is stressed due to worry, grief, fear some staff do not come to work caring for sick family members frightened of catching the flu

    17. 6/13/2012 17 January 2006 (this scenario is occurring at many hospitals) Some services are canceled due to sick and absent staff, including physicians increased patient complaints - patients are stressed and fearful supply chain is disrupted payments are delayed financial status is negative

    18. 6/13/2012 18 Challenge: Public Relations From the SARS event in Toronto complaints from public about mixed messages coming from different hospitals hospitals and physicians receiving many calls for information From 2001 anthrax attack need to communicate when information was not complete uncertain messages increased fear and anxiety

    19. 6/13/2012 19 Challenge: Community Reaction From the SARS event in Toronto spread of SARS was nosocomial versus community-acquired community ostracized hospital employees out of fear of “catching” SARS

    20. 6/13/2012 20 Challenge: Community Reaction From 2001 anthrax attack (employees of America Media) employees shunned by community children were not permitted to go to school personal physicians refused to treat long-time patients (who were employees) “moonlighters” not allowed to work

    21. 6/13/2012 21 Challenge: Employee Compliance From the SARS event in Toronto hospital employees directed to sit one meter apart in cafeteria employees not permitted to congregate employees not to eat/sleep with family members employees put on “work quarantine” (go to work and then directly home)

    22. 6/13/2012 22 Challenge: Infrastructure Hospital will be effected by school and work closings disruption of critical utilities demands on law enforcement, fire departments, EMS, government services disruption in availability of business services disruption in supply chain and pricing

    23. 6/13/2012 23 Challenge: Ethics Ethics do not change in this scenario The application of ethical principles will be adjusted because of the mismatch between NEEDS and RESOURCES Triage decisions: “Who gets what first?” Ethical Principle: “The greatest good for the greatest number.”

    24. 6/13/2012 24 Challenge: Triage Decisions Today: “I am sorry, but we did everything possible for your mother.” Pandemic: “I am sorry, but we were not able to do anything for your mother.”

    25. 6/13/2012 25 Challenge: Triage Decisions Staff are accustomed to going the extra mile for a patient There will be patients for which we can do nothing or do less than usual because of limited resources This will be extremely difficult for staff who are caring and compassionate we have not had this “battlefield” experience

    26. 6/13/2012 26 Challenge: Triage Decisions How will you, as leaders, support your staff when they are required to limit their care? How do you prepare our staff for this? How do you deal with their emotions during the event? How do you help them to recover after the event?

    27. 6/13/2012 27 Challenge: Triage Decisions How do you prepare your patients and community for this? How do you deal with their emotions and reactions during the event? How do you help them to recover after the event? How do you maintain your image as a caring and compassionate organization?

    28. 6/13/2012 28 Challenge: Backlash Interim Pharmaceutical Stockpile is intended for prophylaxis/post-exposure treatment of key personnel purpose is to maintain the healthcare system There may be community reaction to a perceived “preferential treatment” policy

    29. 6/13/2012 29 Challenge: Recovery Hospital Assets Staff (physical, emotional and spiritual damage) Financial Losses Perception of hospital by community how well was the hospital prepared how did the hospital carry out its plan how did the hospital make decisions

    30. 6/13/2012 30 Challenge: Pandemic is a Sustained Event “I know I can handle the incident today. I am not sure how I will handle it tomorrow.” (Anonymous CEO) Most disasters are time-limited A pandemic will last for weeks and even for months

    31. 6/13/2012 31 Sustained Decision Making Tough decisions will need to be made not just once, but repeatedly staffing triage and treatment decisions taking care of the “normal sick and injured” “normal” business plans/decisions delayed financial and legal implications

    32. 6/13/2012 32 What Do We Know? Challenges bring out the best in you and your staff People in healthcare are driven by their Mission and Values Track record of hospitals for response is excellent We have plans and resources We have had exercises for years

    33. 6/13/2012 33 What We Do Not Know Many new questions and concerns - few answers and solutions Too many variables Lack of experience in mass casualty incident

    34. 6/13/2012 34 Next Steps Discuss these leadership challenges at your Management Council and Board meetings Exercise your plan, especially the role of senior managers Share with us the results of your discussions and exercises so we can learn from one another WHA will publish these periodically

    35. 6/13/2012 35 Importance of Exercise Competency in performance of your Emergency Management Plan can only be achieved through exercises Exercises build competency and confidence Involvement in these exercises by contracted staff, 2nd and 3rd shift and weekend workers Involve other emergency response partners

    36. 6/13/2012 36 State Preparedness Conference Monday and Tuesday, September 12 and 13 in Milwaukee Kobi Pegel, Director, National Center for Trauma and Emergency Medicine Research, Tel-Hashomer, Israel Presentation to be broadcast on the Web More information to follow

    37. 6/13/2012 37 Comments and Questions

    38. 6/13/2012 38 Contact Information Bill Bazan VP Metro Milwaukee Wisconsin Hospital Association 414-431-0105 bbazan@mailbag.com

    39. 6/13/2012 39 Contact Information Dennis J. Tomczyk Director, Hospital Bioterrorism Preparedness Wisconsin Division of Public Health 608-266-3128 tomczdj@dhfs.state.wi.us

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