Name, credentials Organization Date

1. David N. Gans, MSHA, FACMPE Vice President, Practice Management Resources Medical Group Management Association July 22, 2008 Preparing Your Office Practice for Disaster and Emergency Events Idaho Bioterrorism Awareness and Preparedness Program (IBAPP) Medical Group Management Association (MGMA) • Name, credentials • Organization • Date

2. About MGMA Our mission…To continually improve the performance of medical group practice professionals and the organizations they represent MGMA has • 22,000 members… • Who manage and lead 12,500 organizations • With 270,000 physicians

3. Program Objectives • Describe why a medical practice must be prepared for an infectious disease epidemic or bioterrorism attack • Describe how to protect your facility, physicians, staff, and patients in the event of a natural disaster, contagious disease outbreak, bioterrorist incident, or other emergency • Outline the key elements of a medical practice disaster plan and the resources available to assist a medical practice in the event of disaster or emergency

4. WhyPrepare for an Infectious Disease Epidemic or Bioterrorism? • Name, credentials • Organization • Date

5. WhyPrepare for an Infectious Disease Epidemic or Bio-Terrorism? • Counter uncertainty by physicians and employees regarding local, national, and international events • Preparations for infectious disease epidemic and bioterrorism are similar to preparations for many emergency situations • Preparations for an epidemic bioterrorism will assist physicians and employees deal with the emotional and practical disruptions created by other emergencies and disasters • Future probability of an event is high

7. The Bigger Picture: Disasters and Emergencies • Practice Emergency: Any event that can disrupt practice flow for more than 24 hours • Types of Disasters and Emergencies • Natural Events • Acts of Violence • Practice Emergencies • Public Health Outbreaks

11. Current Confirmed Human Cases of Avian Flu

12. Healthcare Workers Have Significant Risk from Contagious Disease and Biological Agents

13. Staff May Not Report to Work During a Pandemic Reuters Pandemic might keep some health staff away Updated: 4:38 p.m. MT May 22, 2007 NEW YORK - A survey of U.S. health care workers suggests that not all are willing to staff the front lines if there should be an outbreak of bird flu or other infectious disease. Some will opt to play it safe and stay home, according to the survey. About 50 percent of the hospital workers said “yes” they would report to work, while 42 percent said “maybe” and 8 percent said “no, even if I would lose my job.” Doctors (73 percent) were more likely than nurses (44 percent) or other hospital personnel (33 percent) to indicate that they would report to work in the event of bird flu pandemic.

14. Protecting your facility, physicians, staff, and patients in the event of a natural disaster, contagious disease outbreak, bioterrorist incident, or other emergency • Name, credentials • Organization • Date

15. How Can You Prepare? • Learn how to diagnose and treat patients affected with avian flue or who are exposed to biological agents and toxins • Train staff how to recognize potential cases • Establish medical practice disaster plan • Include pandemic and bioterrorism in the medical practice disaster plan • Develop a screening plan to identify and direct patients with high risk for contagious disease or biological agent exposure

16. Ten Step Response to Pandemic or Bioterrorism • Maintain an index of suspicion • Protect thyself • Assess the patient. • Decontaminate as appropriate • Establish a diagnosis • Render prompt treatment • Practice good infection control • Alert the proper authorities • Assist in the epidemiologic investigation • Maintain proficiency

17. Screening Patients with a High Risk for Contagious Disease or Biological Agent • If there is a risk of pandemic or biological attack, train receptionists to use a script that can identify patients at risk • Validate screening by triage nurse or physician • Direct patient to the appropriate health care services • Monitor symptoms for the scheduled appointment • Come immediately to the doctor’s office • Go directly to a designated health care facility • Call 911 for the Emergency Medical Response (EMR) system.

18. Sample Script for Receptionists to Use in Screening Patients Key questions • Symptoms • Travel • Military service • Mass transit • Public gatherings

19. Sample Script for Receptionists to Use in Screening Patients What symptoms do you have? (Score 1 point for each symptom) • Fever? • Fatigue? • Sore throat? • Difficulty swallowing? • Nausea? • Vomiting? • Coughing? • Headache? • Back pain? • Chest pain? • Abdominal pain? • Chills? • Sweats? How long have you had these symptoms? (Score: Less than week = 2 points, More than a week = 1 point)

20. Sample Script for Receptionists to Use in Screening Patients Have you traveled outside the United States recently? If yes, • When did you leave the US? • What countries were you in? (Score 1 point for each country) • When did you return? (Score: Less than a week=2 points, More than week=1 point)

21. Sample Script for Receptionists to Use in Screening Patients • Are you currently, or have you been in the military? If yes, • Were you stationed outside the US? (Score 1) • When were you discharged? (Score: Less than a month=2 points, More than a month but less than year=1 points)

22. Sample Script for Receptionists to Use in Screening Patients Have you recently utilized mass transportation? If yes, (Score: If used all the time or within the past weeks = 2 points, otherwise 1 point) • Subways? • Buses? • Trains? • Airplanes? Have you attended any large gatherings recently? If yes, (Score 1 point for each positive answer) • Where?

23. Sample Script for Receptionists to Use in Screening Patients A score in the range of eight (8) or more might indicate that a patient may be at risk of exposure to a contagious disease or biological agent and should be referred to a physician or triage nurse who can better assess the situation and direct the patient to come immediately to the doctor’s office, to a designated health care facility, or to instruct the patient to call 911 and notify the Emergency Medical Response (EMR) system. If the patient is asked to come to the physician’s office, upon arrival they should be isolated immediately. Walk-in patients also should be asked the appointment triage questions at the front desk and isolated from public areas based on the scoring.

24. Designing a disaster plan for your medical office • Name, credentials • Organization • Date

25. Sections of a Medical Practice Disaster Plan • Preparation – What you do before disaster strikes • Survival – Immediate actions • Recovery – Coming back after the smoke clears

26. Reverse Planning Helps Keep the Task in Perspective • Visualize what a successful recovery would look like • Break a large problem into manageable tasks • Evaluate each task in terms of how much closer it brings you to the goal

27. What do you need to get back in business? Who can help? What resources are available? Prepare for the worst - hope for the best Patient care delivery – who, what, where Communications - telephone, fax, e-mail, etc. Supplies Information processing and medical records recovery Staff availability Financial resources Stress management Recovery

28. Rapid actions – prioritize because there is never enough time to get it all done Patient and staff protection is first priority Practice makes perfect - have a “fire” drill Communication must be concise and clear Activity is reassuring in fearful situations Account for everyone Rely on checklists instead of memory Train and drill yearly Survival

29. Assess vulnerability Develop a emergency plan that fits each scenario – one size does not fit all Consider both isolated and community wide events What systems are needed for ongoing operations? Information Technology Financial Human resources Who do you need to coordinate with? Hospital Other physicians Suppliers, etc. Preparation

30. Will it result in: Injury or loss of life Business interruption Reduce staffing or patients Impact financial process Are there fines or penalties? Work the most serious and probable problems first What can you cover with insurance? What are your existing resources? Develop a plan to fill the gaps Assessing the Potential Impact of an Event

31. Steps for Developing a Disaster Plan • Keep the plan simple • Obtain copies of disaster plans from hospital(s) and other physicians • Obtain copies of community disaster plans • Model the practice’s plan on hospital and community plans • Let the plan reflect uniqueness of practice staff and resources available • Distribute draft to physicians, nurses, and key staff member for input • Review plan with appropriate hospital/community entities, defining role of the practice within framework of community disaster plans

32. Steps for Developing a Disaster Plan (continued) • Finalize plan, including group governance approval • Implement emergency response plan • Develop training modules • Conduct initial and on-going physician/staff training program, including testing and simulation • Re-evaluate and update emergency response plan annually 

33. If an Emergency or Disaster Happens, Learn from It • Debrief all involved parties and look how to improve the plan • Recognize the circumstances are never exactly the same • Stay vigilant for symptoms of stress in the staff, physicians, and you

34. Federal and Community Agencies Providing Emergency Assistance • Name, credentials • Organization • Date

35. Federal and Community Agencies Providing Emergency Assistance • The emergency preparedness system is fragmented with overlapping responsibilities at federal, state, and local government level as well as multiple private organizations having stakeholder interests • Tip O’Neal described, “All politics are local.” The same is true for emergency assistance

36. FEDERAL GUIDANCE TO IMPROVE STATE-LEVEL PANDEMIC INFLUENZA OPERATING PLANS • Presented to the American States, Territories and District of Columbia • By • U. S. GOVERNMENT • March 11, 2008

37. State Guidance States should plan and develop pandemic influenza plans with local, regional, State, and federal partners. Planning should include, but is not limited to the following: Form community-wide coalitions to include hospitals, urgent care facilities, other ambulatory care facilities, public health, long term care facilities, nursing homes, home health care agencies, community health centers, primary care offices, mental health and substance abuse treatment facilities, EMS, and other first responders to accommodate surge in patients expected from pandemic influenza.

38. Idaho Bureau of Homeland Secruityhttp://www.bhs.idaho.gov/index.htm

39. Federal Emergency Management Agency (FEMA)(http://www.fema.gov/)

40. Centers for Disease Control and Prevention (CDC)(http://emergency.cdc.gov/)

41. American Red Cross Disaster Services(http://www.redcross.org/services/disaster/)

42. Small Business AdministrationDisaster Assistance(http://www.sba.gov/services/disasterassistance/index.html)

43. IBHS Information for Business(http://www.ibhs.org/ibhs2)

44. Employer Support of the Guard and Reserve (ESGR)(http://www.esgr.org)

45. Questions? David N. Gans, FACMPE Vice President, Practice Management Resources Medical Group Management Association 104 Inverness Terrace East, Englewood, CO 80112 877.275.6462 ext. 1270 dng@mgma.com