Is your Facility Prepared for a Community Disaster?

1. Is your Facility Prepared for a Community Disaster? Amber Pitts Michigan Department of Community Health (MDCH) Office of Public Health Preparedness (OPHP)

2. Office of Public Health Preparedness Developed in 2002 to coordinate development and implementation of public and medical health management services for preparedness and response to acts of bioterrorism, infectious disease outbreak and other public health emergencies.

3. Key Priorities • To upgrade state and local jurisdiction preparedness for response to outbreaks of infectious disease, public health threats and emergencies. • To upgrade the preparedness of the healthcare systems and collaborating entities to respond to public health and medical emergencies.

4. 438 Skilled Nursing Facilities within Michigan and 180 Hospitals Pre-planning Community Relationship Building Incorporation into Surge Planning Overwhelming Medical Resources Self sustainability Client well being Why is LTC an Important Partner?

5. Lessons Learned • In 2005, Hurricanes Katrina and Rita demonstrated how the elderly and disabled are often the most negatively affected by the consequences of a major disaster. • The elderly population only accounted for 15% of the New Orleans population, but 70% of the deaths from Hurricane Katrina. Source: County of Dane, Emergency Management

6. Hurricane Katrina & Rita • Even facilities with solid plans were challenged by the loss of community infrastructure. Many struggled with the fact they would not receive outside support for the first 72 hours or longer. These disastrous storms highlighted the consequences of not integrating long term care facilities into community emergency response system plans. Source: County of Dane, Emergency Management

7. Crawford County Wildfire - May 2010 • Crawford County experienced a well executed evacuation plan, utilizing Region 7 medical assets such as cots. • This dynamic response showed a great relationship from the local, regional and state perspectives.

8. Oakwood Annapolis Hospital • Manor Wayne LTC Facility • INSERT FROM REGION 2 South

9. What is a Disaster? • “A non-routine event that exceeds the capacity of the affected area to respond to it in such a way as to save lives; to preserve property; and to maintain the social, ecological, economic, and political stability of the affected region.” (FEMA 2006b).

10. Questions for the Facilities • What type of disasters does your facility plan for? • How many facilities have a pandemic influenza plan? • How many facilities have plans to shelter in place? • How many facilities have plans to evacuate to an alternate care site? • Are mutual aid agreements in place?

11. Facility Evacuation • When the disaster is so extreme and it is necessary to relocate for the safety for the well being of the facilities clients, staff and visitors. • Preferred method if sheltering in place is not an option or has been exhausted.

12. Evacuation Plan Considerations

13. Evacuation Planning Checklist Facility Planning • Ensure evacuation routes internally and externally are known by staff members • Vendor Contact Information is readily available for medical, water, food, & transportation • Alternate Sites are notified and mutual aid agreements are signed ahead of time • Staffing needs at Alternate Care Sites, hospitals or other LTC facilities as identified

14. Client Needs • ID bracelets, medications (med cart), MAR (med chart) • Medical Records • Relocation sites are recorded for family members • Client Family Contact Information

15. NFPA Emergency Evacuation Planning Guide for People with Disabilities • Building an Evacuation Plan for: People with the following impairments: such as lack of Mobility, Visual, Hearing, Speech, & Cognitive.

16. Available Evacuation Plan Tools • NFPA Emergency Evacuation Planning Guide for People with Disabilities http://www.nfpa.org/assets/files/pdf/forms/evacuationguide.pdf

17. Sheltering in Place • Definition: to take immediate shelter - usually for just a few hours or for less than 24 hours. Local authorities may instruct facilities to "shelter-in-place" if there were a chemical or radiological contaminants released into the environment. • Shelter-in-place is the preferred option, unless the decision is made by the facility administrator or supervisor, usually in coordination with response agencies, to evacuate, consider the circumstances of the incident, internally or externally and what is best for clients, staff and visitors. Source: Centers for Disease Control and Prevention

18. Facility Notification to Shelter in Place Facilities will be notified by: • Reverse 911 recorded message • Emergency Alert System (EAS) through the radio or television • Community Sirens • News media • Weather Radios such as NOAA Sources: American Red Cross & Centers for Disease Control and Prevention (CDC)

19. Shelter in Place Planning Considerations

20. Implement Lockdown Procedure for all doors and windows • Assess the need to turn off all facility mechanical systems such as: fans, heating and air conditioning systems • Advise Staff, Clients and Visitors of facility procedure • Conservation of resources • Assess Staffing Needs for next 24 hours • Assess location of Staff, Clients & Visitors, possible relocations within facility due to hazards to interior rooms

21. Shelter in Place Resources • Red Cross Fact Sheet • http://www.nationalterroralert.com/readyguide/shelterinplace.pdf

22. Are you Aware of the Following Available Resources?

23. Michigan Health Alert Network (Mi-HAN) Enhancing connectivity of Local Health Departments, Hospitals, EMS Agencies, Long Term Care, Rural, Migrant, Federally Qualified and Tribal Health Centers. Professional health organizations and other partners. Over 400 licensed users on the system.

24. Statewide Bed & Resource Tracking System

25. Pharmaceutical Caches • Local/Regional Caches Antibiotics, antivirals, nerve agent antidotes, burn surge supplies, etc. • Statewide Deployable Caches MEDDRUN/CHEMPACK Standardized caches of medications and medical supplies to treat from 100 – 1000 patients, focusing on nerve agent antidotes and other biological or radiological events. • Strategic National Stockpile (SNS) Comprised of pharmaceuticals, vaccines, medical supplies, and medical equipment to augment exhausted local and state resources.

26. Michigan Transportable Emergency Surge Assistance (MI-TESA) Medical Unit 40-bed MI-TESA Medical Unit 100-bed MI-TESA Medical Unit

27. Ventilator Capacity • There are currently state and regional cache stockpiled of the LTV 1200 portable ventilators.

28. Michigan Volunteer Registrywww.mivolunteerregistry.org

29. Past ASPR / CDC Cooperative Agreement Activities • In 2005 OPHP distributed $1,870 to LTC facilities to purchase computers, through Health Care Association of Michigan (HCAM). • These monies were awarded with the requirement that each long-term care facility would purchase a computer and printer for the purpose of receiving public health emergency alerts through the Michigan Health Alert Network (Mi-HAN). • Purchase of this equipment would enable the long-term care provider community to be an active partner in the 24/7 public health emergency alerting network.

30. Statewide Long Term Care (LTC) Workgroup First met in March 2007 Representatives from: • Health Care Association of Michigan (HCAM) • Michigan Association of Homes and Services for the Aging (MAHSA) • Michigan County Medical Care Council • Long-Term Care Commission • Michigan Office of Services to the Aging (OSA) • NADONA • TEACH • Region 2 South LTC Workgroup • MDCH/OPHP • MDCH Bureau of Health Systems, Division of Nursing Home Monitoring

31. Michigan LTC PreparednessToolkit • Continuity of Operations Plan (COOP) Planning Template • Local, Regional, & State Contact Information • Hazard Vulnerability Assessment • Sample MOAs • Guidelines for Employees • Pandemic Influenza Q & A • Pandemic Influenza Planning Checklist • Evacuation Checklist http://www.michigan.gov/documents/michiganprepares/LTCToolkit_225004_7.pdf

32. Michigan LTC - DVD Project • Facility Emergency Plan • Sheltering in Place • State Resources • Exercises • Emergency Kits for Residents • Community Health Emergency Coordination Center (CHECC) • Finalize and mailed to LTC - 10/1/08

33. Mather Lifeways - PREPARE PREPARE Learning Module Topics (Train-the-Trainer) Module 1 – Special Considerations of Older Adults in a Disaster Module 2 – Psychological Needs of Older Adults in a Disaster Module 3 – What Providers Need to Know About Biological/Chemical Agents Module 4 – Leading and Communicating in LTC During a Disaster Module 5 – Surveillance and Infection Control Module 6 – Tabletop Exercises Module 7 – Participating in Local, State-Wide, or Federal Response Module 8 – Effective Disaster Planning for LTC Funded project complete in Gaylord, Lansing & Troy During 2008 For more information, contact: http://www.matherlifeways.com/re_prepare.asp

34. Emergency Preparedness Grants Pilot Project • Funds could be used to purchased items such as: evacuation equipment, client go-kits, personal protective equipment (PPE), travel, training and exercises. Funding was awarded in amount up to $10,000. • Deadline for submission was April 3, 2009 • 133 facilities submitted applications and 130 were funded. • Funding was distributed to 100 facilities & spent by September 30, 2009 and the other 30 facilities spent by March 30, 2010.

35. How to Get Involved in Community Emergency Preparedness Planning? • Participate in the Regional Bio-Defense Network, monthly meetings • Take advantage of federal preparedness funds • Build relationships and partnerships ahead of time. • Knowing your available resources and plans. • Exercises and Trainings with community partners.

36. Cooperative Agreement (CA) Funding ASPR CA CDC CA Local Health Departments Regional Initiative Medical Control Authorities Other Local/Regional Partners Healthcare Partners Coordinate State/Local/Regional Planning

37. Keweenaw 44 % 8 • 8 Emergency Preparedness Regions • Emergency Management District Coordinators • Regional Epidemiologists • Regional Bioterrorism Coordinators • Regional Medical Directors 7 6 3 2N 1 5 2S

38. Regional BT. Coordinators Region 1:Region 5: Mark Malcuit Bob Dievendorf Region 1 BT. Coordinator Region 5 BT. Coordinator 5020 Northwind Dr. 1000 Oakland Dr. East Lansing, MI 48823 Kalamazoo, MI 49008 Office: 517-324-4404 Office: 269-337-6549 d1rmrc-mwmalcuit@sbcglobal.net dievendorf@kcms.msu.edu  Region 2N:Region 6: Rick Drummer Jamie Crouch Region 2N BT. Coordinator Region 6 BT. Coordinator 2032 E. Square Lake Road, Ste. 200 1675 Leachy St. Suite 308B Troy, MI 48085 Muskegon, MI 49448 Office: 248-828-0180 Office: 231-728-1967 Rickdrumrs@aol.com jcrouch@mcmca.org Region 2S:Region 7: Amy Shehu Mary Fox Region 2S BT. Coordinator Region 7 BT. Coordinator 6754 Brandt Street 2434 Silver Fox Trail, Suite A Romulus, MI 48174 Gaylord, MI 49735 Office: 734-728-7674 Office: 989-731-4975 AShehu@2South.Org region7btc@gmail.com Region 3:Region 8: Jim Brasseur Joshua Burt Region 3 BT. Coordinator Region 8 BT. Coordinator 1600 N. Michigan Ave. 420 West Magnetic Street Saginaw, MI 48602 Marquette, MI 48955 Office: 989-583-7938 Office: 906-225-7745 btdregion3@gmail.comJoshua.Burt@mghs.org 8 7 6 3 2N 1 5 2 S

39. Future Cooperative Agreement Activities for 2010 - 2011 • Expanding the use of Long Term Care facilities on the Michigan Health Alert Network (MI-HAN), currently 64% of facilities are on the HAN. • Statewide planning for resource tracking during an event. • Statewide and Regional conferences on Emergency Preparedness and specific topics pertaining to long term care. • Creation of statewide training and learning modules for long term care specific staff.

40. Additional Contact Information Local Emergency Management http://www.michigan.gov/documents/msp/LocalDir_external_320561_7.pdf Local Public Health, Emergency Preparedness Coordinators http://www.malph.org/page.cfm/108/

41. Questions? Amber Pitts pittsa@michigan.gov 517-335-8150