Preparedness & Response

1. Preparedness & Response

2. Session Objectives • Discuss the activities within this component and their relationship to the EC 1.4 standards. • Explain how the Emergency Operations Plan and the incident management system can be combined. • Identify some characteristics of emergencies & disasters that relates to how a response is implemented.

3. Objectives (con’t) • Explain the roles of responders and managers. • Demonstrate understanding of the use of the “Key Activity Management Tool.”

4. Preparedness and Response • Resource Management • Emergency operations planning (EOP) • Education and training • Exercises and real events • Evaluations & corrective actions

5. Inventory Critical Resources& Develop Agreements • Who can help respond? Identify partners: • Local, state and federal governments, private sector, NGOs, health sector networks • What can help? Identify needed resources: • physical, human, information • How to get help? Make arrangements now: • mutual aid, contracts, service agreements. • Meet & Greet - Make a New Friend Today

6. Purchase and MaintainEquipment & Supplies • What can’t you reliably borrow or improvise? • What are your supply chains like? • What about maintenance and mitigation? • What are the equipment needs of your recovery priorities? • ??

7. Build the Emergency Operations Plan • Through Emergency Management Committee: • Establish “domains” or roles of each Department, Service or Group. • Align Departments/Services’ roles under appropriate functional area. • Determine lead Department/Service. • Accomplish detailed planning activities.

8. Management Functions Key Activities Mgmt. Plan. Logs. Fin. Ops. Triage Labor Pool Communications Liaison Assessment Security Backup Utilities Cost Accounting Merging the EOP & IMS

9. General Training Goals • Hazard and Consequence awareness • Self and Family preparedness • Overall awareness of Facility EOP • Know specific role and responsibilities in Facility EOP - and how to fulfil them • Notification system (up and down)

10. Specific Training Goals • Supervisors • Departmental role in Facility EOP • Ability to direct the actions of others (delegation, span of control and unity of command) • Management • How to demonstrate leadership • How to communicate through and to the media • How to plan for what happens next

11. Training Strategies • New employee orientation • Annual safety fair • Mandatory training • Vary the format (time, style, presenter) • Invite other agencies !

12. Exercise Program • Learn: Attend an Exercise Design Course offered by the local or State EMA • Drills: teach specific tasks (e.g. decon) • Seminar: orientation on EOP roles • Tabletop: integration with community • Functional: test of backup systems • Full-scale: patient reception exercise

13. Focus on the Ability to Problem Solve! • Link disaster-relevant groups. • Maintain pre-existing authority & autonomy • Encourage regular inter-organizational contact. • Establish joint operating facilities. • Collect & share information, establish priorities & make decisions. • Engage in collective rehearsal activities. Dynes

14. Perform Evaluations & Corrective Actions Standards Compliance Continuity of Care JCAHO Requirements Local Program Goals FEMA Guidance Incident Management System “A continuous cycle of planning, training, evaluation and program improvement... Closely related to theories and practices of “Continuous Quality Improvement” Process Capability

15. Relationship to JCAHO Environment of Care StandardsEC 4.10

16. EC 4.10 Preparedness • Defining and integrating role of HCF in community-wide program • Cooperative planning among health care organizations • Defining an “all hazards” command structure that links to the community • Staff are trained in their roles • The HCF tests the response phase of its EOP twice a year • Radioactive, biological, and chemical isolation and decontamination

17. EC 4.10 Response • Initiating the response, notifications • Identifying and assigning staff • Evacuation, alternate care sites • safe transfer of • Logistics • Re-establishing critical systems • Support of staff and family • Patient tracking

18. Mitigation Preparedness Recovery Response Comprehensive emergency Management

19. Merging the EOP and ICS • Many “disaster plans” do not link with ICS. • A design principle was to focus on the functions common to both, then identify the “Key Activities” unique to health care systems: • HCF • Network

20. ICS Management Functions • Command or Management • Planning • Logistics • Finance/Administration • Operations

21. Command or Management • Command is responsible for the overall management of the incident. • Command also includes several staff functions: • Information Officer • Safety Officer • Liaison Officer vs. role of Agency Administrator

22. Planning Function Responsibilities: • The collection, evaluation and dissemination of tactical information about the incident • Maintaining information on the current and forecasted situation, and on the status of resources assigned to the incident • The preparation and documentation of incident action plans  thinking ahead

23. Logistics Function Responsibilities: • Providing all service and support needs to the incident, such as: • Facilities • Transportation • Supplies • Equipment maintenance and fueling • Feeding • Communications.

24. Finance Function Responsibilities: • The Finance Section is established on incidents when the agency(s) who are involved have a specific need for finance services. • In some cases, where only one specific function is required, like cost analysis, the position could be established as a Technical Specialist in the Plans Section.

25. Operations Function Responsibilities: • As the incident grows in size or complexity, the Incident Manager may designate an Operations Chief to assume tactical direction of resources organized into groups: • Business Continuity • Equipment, Plant & Utilities • Safety & Security • Health & Medical

26. Emergency Operations Plan (EOP) • Describes the situation, assumptions, concept of operations • Organizes all entities into groups • Designates incident facilities • Creates coordination processes

27. Structure of an“All-Hazards” EOP 1 Basic Plan An Overview Involved Groups’ Responsibilities 2 Functional Annexes 3 4 SOPs Checklists concerned with: concerned with: Guidance on how to accomplish a task Individual Roles, Lists, etc.

28. Federal Response Plan (FRP) • Basic Plan • “Emergency Support” Functions • ESF 1 Communications • ESF 2 Transportation • ESF 3 Public Works & Engineering • ESF 4 Firefighting • ESF 5 Information & Planning • ESF 6 Mass Care

29. FRP (con’t) • ESF 7 Resource Support • ESF 8 Health & Medical Services • ESF 9 Urban Search & Rescue • ESF 10 Hazardous Materials • ESF 11 Food • ESF 12 Energy • Support Annexes • Incident Annexes (Terrorism) • Appendices

30. Health Care System“Essential Functions” • Management & Planning • Logistics & Finance • Business Continuity • Equipment, Plant & Utilities • Safety & Security • Health & Medical

31. “Key Activities” • Tasks common to all emergencies and disasters. • Basis for the development of SOPs, position descriptions and checklists. • Activated/de-activated based upon the needs of the situation.

32. Direction & Control Liaison Legal / risk mgmt Public Affairs Safety Situation Status Resource Status Action Planning Documentation Reporting Management & PlanningKey Activities

33. Supply Facilities Personnel Transportation Communications Financial Mgmt Procurement Comp/Claims Time Cost Non-direct Patient Care Activities

34. Business ContinuityKey Activities HCF Network • IT Systems • Access to Service • Records Preservation • Business Resumption • IT Systems • Access to Service • Vital Records • Technical Assistance

35. Equipment, Plant & UtilitiesKey Activities HCF Network • Medical Devices • Medical Gas Systems • Power/Light Systems • Heating/Cooling Systems • Water/Sewer Systems • Buildings/Grounds/Roads • Technical Assistance

36. Safety & SecurityKey Activities HCF Network • Alerting/Warning • Hazmat Control • Fire Suppression • Search & Rescue • Security • Sheltering • Alerting/Warning • Technical Assistance

37. Health & MedicalKey Activities HCF Network • Patient Care • Patient Relocation • Home Health/Outreach • Mental Health • Environmental Health • Fatalities Management • Capability Assessment • Patient Distribution • Employee Health Surveillance • Technical Assistance

38. Characteristics of Emergencies

39. Disaster vs. Emergency vs. Incident • ?? • Resources are stretched or exceeded. • Non-routine tasks are created. • Expansion of normal roles. • New groups get involved.

40. Generic Activities Pre-Impact Initial Response Situation Assessment Fire Suppression Hazmat Control Search and Rescue Medical Services Public Information Debris Clearance Warning Protective Actions Mass Care Individual Assistance Essential Services Temporary Housing Debris Removal Service Restoration Business Restoration Permanent Housing Debris Disposal Initial Recovery Reconstruction CUSEC Journal

41. Characteristics • Magnitude - minor to severe • Frequency - common to rare • Speed of onset - possible warning period • Duration - of impact and consequences • Timing - time, day, season • Location - proximity and extent of damage • Spatial dispersion - concentration of damage

42. Sources of Information • Rapid, Reliable & Complete • Utility Service Control Centers: • Electric Power Outages • Interruption of Telephone Service • Loss of Pressure ~ Water & Natural Gas • Emergency Services / local OES • Less Rapid, Reliable or Complete, but most common • Media Reports • Public / Customer Reports

43. Who Implements the Response?

44. All employees should how know • To act on the warning: Protect yourself & others • To assess their areas • To determine immediate actions and priorities • How to activate the hospital / system response plan • Their role in the overall response

45. No Warning:Anyone starts the plan

46. Some Possible Steps • Someone Takes Charge • clear line of authority • Size-up / cene safety • Establish a Command Post • Establish Communications • Develop an “Initial Attack” Strategy • Resource Analysis • Continue to Organize and Manage

47. With Warning:Management starts the plan

48. Situation Assessment • Develop an Incident Briefing, based on the events characteristics, that includes: • Date/time incident began • Type of incident • Services involved / agencies effected • Current incident status • Current resource status • Current strategy/objectives • Communications systems being used • Special problems/issues

49. Incident Action Planning • Gather information through ongoing assessment. • Keep records on all resources. • Set overall objectives. • Determine activity areas. • Determine operational period • Specify control objectives/tactics for each area.

50. Incident Action Plan • Specify resources needed by each group. • Specify facilities and reporting locations. • Place personnel and resource order. • Develop communications and traffic plan. • Finalize, approve and implement the action plan. • Start planning for the next operational period.