HOSPITAL PREPAREDNESS PROGRAM (HPP)

1. HOSPITAL PREPAREDNESS PROGRAM (HPP) COUNTY OF LOS ANGELES HEALTH SERVICES EMERGENCY MEDICAL SERVICES AGENCY

2. EMS Agency HPP Staff • Kay Fruhwirth, RN, MSN – Assistant Director, HPP Coordinator Phone: (562) 347-1602 E-mail: kfruhwirth@dhs.lacounty.gov • RoelAmara, RN, BSN, MICN – Interim Chief, Disaster Services Phone: (562)347-1598 E-mail: ramara@dhs.lacounty.gov • Kathy Egan, RN, MSN, MICN – Pan Flu Coordinator, Site Audits Phone: (562) 347-1657 E-mail: kegan@dhs.lacounty.gov

3. EMS Agency HPP Staff • Jacqui Rifenburg, RN, MICN – DRC Program Manager, Trauma & Burn Surge Phone: (562) 347-1645 E-mail: jrifenburg@dhs.lacounty.gov • Gary Chambers, RN, BS – Audits, Training & Exercises Phone: (562)347-1644 E-mail: gchambers@dhs.lacounty.gov • Sandra Shields, LMFT, CTS – ESAR-VHP, Mental Health, Special Projects Phone: (562) 347-1648 E-mail: sanshields@dhs.lacounty.gov

4. EMS Agency HPP Staff • Terry Crammer, RN, BSN, MICN – Decon Training, HAvBED, CommandAware Phone: (562) 347-1647 E-mail: tcrammer@dhs.lacounty.gov • Ryan Burgess, RN, MSN – CHA Hospital Preparedness Coordinator Phone: (805)320-5809 E-mail:rburgess@calhospital.org

5. Overview of the HPP Grant • Program began in 2002. The FY 2009 award begins Year 8 of the program • Funding to date $91.6 million • FY 2009 Funding • HPP - $11,377,608 ($569,252 match by the County) • Pandemic Influenza - $2,940,946 • ESAR-VHP - $60,000

6. Mission of the HPP To ready hospitals and supporting health care systems to deliver coordinated and effective care to victims of disasters including natural and man-made events.

7. Hospital Readiness Levels of Capabilities Level One Sub-capabilities • Interoperable Communication Systems • Bed Tracking System • Emergency Systems for Advance Registration of Volunteer Health Professionals (ESAR-VHP) • Fatality Management Plans • Hospital Evacuation/Shelter in Place Plans

8. Hospital Readiness Levels of Capabilities Level Two Sub-capabilities • Alternate Cares Sites (ACS) • Mobile Medical Assets • Pharmaceutical Caches • Personal Protective Equipment • Decontamination

9. Hospital Readiness Levels of Capabilities Overarching Sub-capabilities • NIMS Compliance • Education and Preparedness Training • Exercises, Evaluation and Corrective Actions

10. Hospital Readiness Current Participation Basic • 31 Hospitals participating, anticipate 1 or 2 new participants this year Expanded • 52 Hospitals participating, anticipate 2 Basic becoming Expanded Disaster Resource Center • 13 Hospitals participating Trauma/Burn Surge • 13 designated Trauma Centers participating

11. New Basic ParticipantsHospital Receivables TOTAL FUNDING = $73,900 + PPE • Personal Protective Equipment (valued at $35,000) for decontamination procedures and infection control • Funding ($42,900) to off-set the cost of a designated disaster planner (at least 50% time dedicated to disaster activities) • Training of Decontamination Team • Funding ($5,000) to off-set the cost of staff training and staff time in planning and participating in disaster exercises

12. New Basic ParticipantsHospital Receivables (cont.) • Funding ($10,000) for Command Center communication/IT equipment • Funding ($1,000) for HAM radio equipment • Funding ($12,000) to purchase identified Disaster Management System (CommandAware) • Funding ($3,000) to purchase equipment used in evacuation of non-ambulatory patients

13. Existing Basic ParticipantsHospital Receivables TOTAL FUNDING = $52,673 • Funding ($42,900) to off-set the cost of a designated disaster planner (at least 50% time dedicated to disaster activities) • Funding ($5,000) to off-set the cost of staff training and staff time in planning and participating in disaster exercises

14. Existing Basic ParticipantsHospital Receivables (cont.) • Funding ($4,773) for ongoing subscription fee for Disaster Management System (CommandAware) • Funding ($800) to select hospitals for participation in the Telecommunications Service Priority (TSP) program • Training of Decontamination Team

15. Existing Expanded ParticipantsHospital Receivables TOTAL FUNDING = $56,373 (DRC and Trauma Centers receive $13,773) • Funding ($42,900) to off-set the cost of a designated disaster planner (at least 50% time dedicated to disaster activities) • Funding ($8,700) to off-set the cost of staff training and staff time in planning and participating in disaster exercises

16. Existing Expanded ParticipantsHospital Receivables (cont.) • Funding ($4,773) for the ongoing subscription for the Disaster Management System (CommandAware) • Funding ($800) to select hospitals for participation in the Telecommunications Service Priority (TSP) program • Training of Decontamination Team

17. Hospital Deliverables • Store, secure and maintain PPE • Maintain Hospital Decontamination Team and ensure quarterly training and an annual exercise/drill • Maintain designated disaster planner position to assist with overall disaster preparedness activities. Disaster Planner must be 50% dedicated (20 hours/week) to disaster activities and must attend 100% of regional DRC umbrella meetings

18. Hospital Deliverables • Ensure 14 elements of the NIMS compliance activities for hospitals and healthcare systems are implemented and complied with on an on-going basis • Ensure key/new staff assigned to hospital Command Center complete NIMS compliance trainings: • IS 700: National Incident Management System • IS 800: National Response Plan (NRP), an Introduction • IS 100: Introduction to the Incident Command System (ICS) • IS 200: ICS for Single Resources and Initial Action Incidents

19. Hospital Deliverables • Purchase/continue subscription to Disaster Management System (CommandAware) and continue training Hospital Command Center Staff • Participate in the FCC’s Telecommunications Service Priority Program (select hospitals) • Participate in exercises and drills in conjunction with County and community partners • Participate in hospital volume based surveillance program through ReddiNet (911 receiving facilities)

20. Hospital Deliverables • Participate in hospital bed tracking activities including reporting available bed count through ReddiNet, as requested by the County. Hospitals that do not have access ReddiNet shall subscribe • Enhance communication/information technology capabilities of hospital Command Center (new participants) • Maintain medical evacuation/shelter in place and mass fatality management plans that were approved by senior hospital management by August 8, 2009. New participants must develop plans by June 30, 2010.

21. Hospital Deliverables • Complete all surveys with in time frame, as requested by the County • Collaborate with County related to Pandemic Influenza planning and incorporate this planning into the hospital’s overall emergency management plan • Develop storage and distribution plan for the pre-positioned antibiotics for hospital staff prophylaxis (New participants)

22. Disaster Resource CentersHospital Receivables TOTAL FUNDING = $263,000 • Purchase racking system for decedent management • Replacement of outdated supplies and pharmaceuticals • Administrative and planning costs • Sustainment activities

23. Trauma CentersHospital Receivables Non DRC Trauma Centers TOTAL FUNDING = $95,000 • Trauma Surge Coordinator ($90,000) • Training activities ($5,000)

24. Trauma CentersHospital Receivables DRC Trauma Centers TOTAL FUNDING = $50,000 • Trauma Surge Coordinator ($45,000) • Training activities ($5,000)

25. Pandemic Influenza Healthcare Preparedness Improvements • $2,940,946 awarded July 30, 2009 • Key Activities • Healthcare Workforce Protection • Vaccination of healthcare workers • Pandemic Influenza Guidance documents • Infection Control training • PPE

26. Pandemic Influenza Healthcare Preparedness Improvements • Strategies for Optimization of Health Care • Expansion of hospital capacity – temporary sites • Antivirals • Pediatric suspension and Zanamivir • Other resources

27. Pandemic Influenza Healthcare Preparedness Improvements • Tiered Hospitals based on ED visits and/or Inpatient Beds. Also looked at number of personnel. • Tier 1 – ED visits > 60,000 and/or 300+ inpatient beds • Tier 2 – ED visits between 25,000 to 59,999 and/or 150-299 inpatient beds • Tier 3 – ED visits < 25,000 and/or <150 inpatient beds • Super Tier – Tier 1 plus > 5000 employees

28. Pandemic Influenza Healthcare Preparedness Improvements • Hospital Funding by Tier • Super Tier - $25,000 • Tier 1 - $20,000 • Tier 2 - $18,000 • Tier 3 - $16,000 Funding will be used for • administrative costs associated with planning and providing vaccination to healthcare workers • Expand capacity to care for surge of patients in alternate treatment areas (purchase tents, etc.)

29. Pandemic Influenza Healthcare Preparedness Improvements • Tiered Clinics based on number of visits and looked at number of personnel • Tier 1 - >50,000 visits and/or >100 staff • Tier 2 - <50,000 visits and/or <100 staff • Super Clinic – (Tier 1 and >300 employees)

30. Pandemic Influenza Healthcare Preparedness Improvements • Clinic Funding by Tier • Super Tier - $5,500 • Tier 1 - $4,600 • Tier 2 - $2,750 Funding will be used for • administrative costs associated with planning and providing vaccination to healthcare workers • Training and fit testing associated with N95 respirator use