PHYSICIAN ROLES AT THE HOSPITAL IN A DISASTER

1. PHYSICIAN ROLES AT THE HOSPITAL IN A DISASTER This material has been developed for training purposes. No part of this course or its materials shall be copied or utilized for monetary gain.

2. (Insert Facility Name) Objectives • Discuss the physician role in HICS • Discuss the principal concepts and features of the Hospital Incident Command System • Discuss how the hospital is part of the community response PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

3. (Insert Facility Name) Planning WHAT DO WE NEED TO PLAN FOR: What are the risks we face daily? What is on our Hazard Vulnerability Assessment list? PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

4. (Insert Facility Name) The Responsibility is… WHO IS RESPONSIBLE FOR EMERGENCY PREPAREDNESS AT (Insert Facility): Emergency Management Committee Environment of Care Committee (Insert specific methodology used) CMS requires all staff, physicians and contractors, and volunteers be trained annually

5. (Insert Facility Name) Emergency Response HOW IS AN EMERGENCY RESPONSE DIFFERENT FROM DAY-TO-DAY? Emergency Operations Plan Emergency Codes Hospital Incident Command System

6. (Insert Facility Name) HICS HOSPITAL INCIDENT COMMAND SYSTEM: Helps improve hospital response and coordination between hospitals and other responders using: Defined responsibilities Clear reporting channels A common nomenclature HICS does not replace or supplant daily hospital operations

7. BASIC INCIDENT COMMAND STRUCTURE Incident Commander Public Information Officer Safety Officer Medical/ Technical Specialist(s) Liaison Officer Planning Section Chief Finance/ Administration Section Chief Operations Section Chief Logistics Section Chief Modular Organization: Functional Sections Activated as Needed

8. (Insert Facility Name) HICS is Scalable FLEXIBLE The system is scalableso that more or fewer positions - depending on the emergency - may be implemented PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

9. (Insert Facility Name) Activation of the Emergency Operations Plan ACTIVATING THE PLAN: The hospital Emergency Operations Plan is activated by: (Insert method such as; administrator on call authorizing the hospital’s emergency codes) PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

10. (Insert Facility Name) Activation of the Emergency Operations Plan HOW DO YOU KNOW THE PLAN IS ACTIVATED?: The hospital communicates that the plan is activated by: Overhead Page Email/Alerts Pager System PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

11. (Insert Facility Name) HICS - Hospital Incident Command System MANAGEMENT ROLES IN AN ACTIVATION : Command and General Staff PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

12. COMMAND Incident Commander Public Information Officer Safety Officer Medical/ Technical Specialist(s) Liaison Officer • Chemical • Clinic Administration • Communicable Disease • Hospital Administration • Legal Affairs • Medical Ethicist • Medical Staff • Pediatric Care • Radiological • Risk Management

13. (Insert Facility Name) • COMMAND STAFF: Incident Commander: Gives overall strategic direction for the hospital Public Information Officer: Communicates with internal and external stakeholders including: staff, patients, visitors, and media Safety Officer:Ensures safety of staff, patients and visitors Liaison Officer: Hospital Command Center contact for supporting agencies and organizations Medical Technical Specialist(s): Subject matter experts that advise the Incident Commander and/or assigned section

14. Biological Infectious Disease Chemical Radiological Legal Affairs Risk Management MEDICAL/TECHNICAL SPECIALIST Examples Include: • Medical Staff • Pediatric Care • Medical Ethicist • Clinical Administration • Hospital Administration

15. GENERAL STAFF: SECTIONS Incident Commander Public Information Officer Safety Officer Medical/ Technical Specialist(s) Liaison Officer Finance / Administration Section Chief Operations Section Chief Planning Section Chief Logistics Section Chief

16. (Insert Facility Name) HICS Sections SECTIONS INCLUDE: Operations Planning Logistics Finance/ Administration PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

17. (Insert Facility Name) Operations Section OPERATIONS SECTION MISSION: Manage tactical operations Direct all tactical resources Carry out the mission and Incident Action Plan PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

18. (Insert Facility Name) Operations Some of the Operations Section Branches you may be assigned to: Medical Care Branch Patient Family Assistance Branch HazMat Branch PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

19. MEDICAL CARE BRANCH DIRECTOR Supervises: • Inpatient Unit Leader (all inpatient units) • Outpatient Unit Leader (all outpatient services) • Casualty Care Unit Leader (Treatment Areas including: Immediate, Delayed, Minor, and Expectant/Deceased) • Behavioral/Mental Health Unit Leader • Clinical Support Unit Leader (Lab, Diagnostic Imaging, Pharmacy, Morgue, Blood Bank) • Patient Registration Unit Leader

20. (Insert Facility Name) Other Sections Logistics: Organizes and maintains the physical environment – providing human resources, material, and services to support the incident. Planning: Collects, evaluates, and disseminates information and develops the Incident Action Plan Finance/Administration: Monitors financial assets, accounting, and claims PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

21. (Insert Facility Name) How Do I Get My Assignment Depending on the facility’s Emergency Operations Plan, you can respond to the Labor Pool for assignment If you are not on staff and show up to help, the Medical Staff Office may handle the credentialing process (insert facility process for credentialing) (consider pre-registration as a medical volunteer) PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

22. (Insert Facility Name) After Action Reporting YOUR PART IN IMPROVING THE HOSPITAL’S RESPONSE: Hotwash and Debriefs PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

23. (Insert Facility Name) Incident Response Guides Active Shooter  Chemical Incident Earthquake  Evacuation, Shelter-in-Place, and Hospital Abandonment Explosive Incident Hostage or Barricade Infectious Disease  PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

24. (Insert Facility Name) Incident Response Guide Mass Casualty Incident Missing Person  Radiation Incident  Severe Weather Staff Shortage  Utility Failure  Wildland Fire  PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

25. (Insert Facility Name) Documentation How is documentation different in an emergency response: HICS Forms START Triage Tags How does the EMR Change in a Surge or IT Failure? Do we still follow HIPAA? PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

26. (Insert Facility Name) Community Response We are part of the national system: Individual Hospital Hospital System Community/County State Federal International PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

27. (Insert Facility Name) What if I Don’t Get A HICS Assignment? How do I handle current/new patients? Assist in clearing the ED for new patients Review/evaluate inpatients for early discharge Assist in transfer of appropriate patients to other service areas or other facilities PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

28. (Insert Facility Name) What if I Don’t Get A HICS Assignment? How do I handle current/new patients? Review cancelling elective surgery and procedures if necessary Prepare for patients transferred from an outside affected area such as another county or state Accept assignment to a treatment area Open up extra clinic appointments and/or staff Alternate Care Areas to “unload” the ED PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

29. (Insert Facility Name) What if I Don’t Get A HICS Assignment? Triage of Resources: Surgeons/Anesthesiologists: OR Availability and Priorities Radiologists: Imaging Priorities Pathologists: Lab Priorities Intensivists: Critical Care Priorities PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

30. (Insert Facility Name) Personal Plans Family/Pet Plans Department Plans PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

31. (Insert Facility Name) What Can I Do Pre-Disaster Educate Your Patients: Review and Evaluate DNR/POLST Extra Medications Disaster Supplies/Family and Reunification Plans Home Health and Special/Functional Needs Patients CERT Programs/First Aid PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

32. (Insert Facility Name) What Can I Do Pre-Disaster Personal/Departmental Preparedness: Office/Car Disaster Supplies Personal/Staff Disaster Supplies/Family, Pet and Reunification Plans Develop Departmental Disaster Plans Educate Your Staff Participate/Organize Disaster Exercises PHYSICIAN ROLES IN THE HOSPITAL IN A DISASTER

33. (Insert Facility Name) What Can I Do Pre-Disaster Society/Specialty Guidelines and Courses such as: National Disaster Life Support Foundation Disaster Management and Emergency Preparedness Course (DMEP; American College of Surgeons) American College of Emergency Physicians Society of Critical Care Medicine American Academy of Pediatrics American College of OB/GYN

34. (Insert Facility Name) What Can I Do Pre-Disaster Consider Crisis Standards of Care Consider Improvisations in Austere Environments

35. (Insert Facility Name) Crisis Standards of Care A Systems Framework for Catastrophic Disaster Response; Institute of Medicine; 2012. http://iom.nationalacademies.org/Reports/2012/Crisis-Standards-of-Care-A-Systems-Framework-for-Catastrophic-Disaster-Response.aspx California Department of Public Health Standards and Guidelines for Healthcare Surge During Emergencies at www.bepreparedcalifornia.ca.gov

36. QUESTIONS THANK YOU