Mexico 2017

1. Mexico 2017

2. Disaster ExercisesHow to conduct a disaster exercise that prepares your staff &meets CMS disaster rule requirements Santa Barbara County Disaster Healthcare Partners Coalition Presents

3. Welcome Write down: 2 things you think your facility or agency should practice for an earthquake event • Scenario: EARTHQUAKE Post on the board!

4. Jan Koegler, MPH Program Manager Stacey Rosenberger, MPH Emergency Planner Santa Barbara County Public Health and Emergency Medical Services Agency

5. Mexico 2017

7. Agenda: Disaster Exercises • Benefits and requirements for disaster exercises • How to conduct a “tabletop” exercise • Required forms: Exercise plans and after action reports • How to conduct a full scale exercise • Practice: Let’s conduct a full scale exercise

8. Benefits and Requirements of Disaster Exercises Benefits Requirements • Prepares and protects your clients, facility, or agency • Educates your staff re: procedures • Team building • Meets accreditation or licensing requirements • Meets Centers for Medicare-Medicaid disaster rule requirements

9. Four coreelements of CMS rule • Training &Exercise Program • Develop training program • Initial and annual training on policies & procedures • Conduct drills and exercises • Tabletop annually • Full-Scale community based exercise annually • EmergencyPlan • Based on arisk assessment • Usean all- hazardsapproach to risk assessment • Updateplan • annually • Policies & Procedures • Develop based on risk assessmentand emergencyplan • Must address: subsistence ofstaff and patients, evacuation, sheltering in place, tracking patients andstaff • Review/Update annually • Communications Plan • Complies with Federal andState laws • Coordinatepatient care within facility, across providers, and with state and local public health and emergency management • Annual update

10. Annual Exercise requirements • Conduct one FULL SCALE EXERCISE annually • Must participate in a community based exercise if offered • The PHD annual medical and health exercise in November is a community based exercise • SNF/ICF’s have option to do PHD/ EMS Agency annual evacuation exercise as full scale • Conduct one additional exercise • Can be a tabletop exercise

11. Types of Disaster Exercises

12. Disaster Exercise Process

13. Tabletop “Talk-thru”Large OR Small

14. Step 1: Assemble planning group Who to Invite to a planning meeting: • Who is responsible for emergency operations during a real event? • Administrator, managers, supervisors • Who is responsible for writing emergency plans and procedures? • Safety officer, environmental services, other • Who is responsible for safety and facilities day to day? • Facilities personnel, office administrators

15. Step 2: Meet with Planning group • Present the hazard • “Earthquake that disrupts utilities and damages facilities” • Determine policies and procedures to test • Earthquake procedures • Utility outage procedures • Request a facilitator for the tabletop • Staff who is used to facilitating meetings • Hired or volunteer facilitator • Determine who to invite and date/time of exercise

16. Who will Facilitate?

17. Step 3: • Determine Objective (s) to “Test” • You can’t test everything in your policy/procedure • Prioritize and pick 1-3 objectives: • “Exercise our SNF facility plan to provide care with a loss of utilities for 36 hours after an earthquake” • Write a scenario that sets the scene • Develop questions to “test” your policies and procedures • Assign a Scribe: to capture answers/suggested improvements for your after action report

18. Tabletop Template

20. Tabletop Exercise Plan Template

21. Tabletop Exercise Plan Template Do you want to provide these plans, policies, or procedures in advance?

22. Sample Tabletop QuestionsIn the “Situation Manual Tabletop Template”

23. Tabletop in Action : Let’s Practice Staff and Supplies: • Facilitator • Scribe(s) • Whiteboard or Large Sticky Paper/Pens so that comments are seen by all • Evaluation Forms

24. Tabletop in Action: Let’s Practice • Scenario: Today at 5:00 pm a 7.4 earthquake occurs. Power is out and cell communication is sporadic. Power is not expected for 72 hours. It is 90 degrees. • Our facility appears to have suffered at least some damage and at least 5 injuries of staff and patients are reported. • Objectives for the Tabletop • Exercise facility ability to provide essential care after an earthquake with a 72 hour power outage • Exercise facility ability to communicate with staff during a disaster with limited cell service. • Other: What do you want to practice?

25. Tabletop in Action: Questions to “test” yourpolicies and procedures Objective: Exercise facility ability to provide essential care after an earthquake with a 72 hour power outage • What actions are our staff supposed to take during an earthquake? • Is this stated in a policy or safety plan? Where is the procedure located? • Does our facility have a plan to assess and treat staff and patients/clients injured during an earthquake? If yes, where is it? • When were staff trained on this plan? Have we tested this procedure?

26. Tabletop in Action: Questions to “test” your policies and procedures Objective: Exercise facility ability to provide essential care after an earthquake with a 72 hour power outage • “What type of heating and cooling can we provide during the impact of the power outage?” • “Who is responsible for the HVAC? Where do they live? Who is the back up?” • “According to our procedure, how will you communicate with the next shift of staff?”

27. Tabletop in Action: Questions to “test” your policies and procedures “Power is out and cell communication is sporadic.” Objective: Exercise facility ability to communicate with staff during a disaster with limited cell service. “Do we have an emergency communication plan” “According to our procedure, how will you communicate with the next shift of staff?” “What is our facility’s plan to communicate with staff on shift? And off shift?” “Do we need to write a communication plan or procedure for disasters/outages?”

28. Tabletop Debrief “Hot Wash” For each question wrap up with a review and ask participants (noting responses): • What did you learn during the tabletop? • What went well? • What critical issues for improvement were noted? • What additional critical issues did you identify? • What do we need to do now? • Get participants’ commitment to next steps: • Add a back up generator maintenance role • Provide staff with generator training • Update procedure

29. Participants Evaluate Tabletop

30. After Action Report

31. What is a Full Scale Exercise? We will help you understand how to do a full-scale exercise!

32. Disaster Exercise Process

33. Training on Procedures

34. Tabletop “Talk-thru” DiscussionLarge OR Small

35. Full Scale Exercise – Do Procedure Forms you will need: • Full scale exercise plan • Schedule of exercise events and evaluation guide • Participant evaluation form • After action report

36. Full Scale Exercise Plan: Template

37. Template: Full Scale Exercise Plan

39. Template: Full Scale Exercise Plan

40. Template: Full Scale Exercise Plan- Safety

41. Template: Full Scale Exercise Plan-Schedule of Events AND Evaluation

42. Template: Full Scale Exercise Participant Feedback Form

43. Template: Full Scale Exercise After Action Report

44. Full Scale Exercise - Activities Earthquake/Evacuation of facility: • Accounting for patients/clients/public • Activating your response plan • Activating “Who is in charge” command structure • Triage and treatment of injured • Accessing and using your emergency supplies • Tracking patients/clients who are moved • Practicing Communication Plan • Assessing and reporting your status to PHD • Making a resource request • Conducting a building assessment

45. Evacuation-How will you exercise? • Move from one side of building to another • Move mock patients or real patients out of building • Collect personal belongings, medical records, medication etc. • Time test how long it will take • Make sure staff account for clients and follow all procedures for residential clients Reminder: Review your CMS and accreditation requirements-differs by facility type

46. Full Scale Evacuation of ICF

47. Full Scale: Accepting Evacuees

48. Full Scale: Mock Evacuees/Patients

49. Full Scale: Power Outage Activities Demonstrate and evaluate how your agency/facility would do in a power outage: • Staff access disaster plan, patient forms, and conduct a staff call back without power or only generator power • Turn off power and go to generator only. Have staff care for patients on generator only (or no power). • Staff demonstrate actions required in plan related to keeping patients safe if no HVAC • Administrator decides at what point evacuation from facility or home (home health) is necessary • Have staff demonstrate ability to access all lanterns, lights, fans, etc. and assess their functionality/capacity.

50. Full Scale: Sewage Outage Staff demonstrate what agency/facility would do in a sewage outage: • Set up emergency toilet supplies and determine how long they would last • Set up emergency handwashing supplies and determine how long they would last • Staff use plan/procedure that states what you will do if no sewage • Make requests for portapotties through vendor, public health, or city EOC.