Hazard Planning for Hospitals Large and Small

2. Hazard Planning for HospitalsLarge and Small Darrell Ruby, CEM Region 9 Coordinator

3. Today’s Discussion • Emergency Planning. • Hazard Vulnerability Analysis (HVA). What is it, who does it, why? • Why plan? • Planning references. • Federal, State, Local • Getting started. • HVA Tool.

4. Emergency Planning for Hospitals • 5 W’s plus…. • Who should be involved? • What are the requirements? • When should you do it? • Where do you begin? • Why and How often? • What resources do you use?

5. Whole Community – Unity of Effort • Preparedness is a shared responsibility. Everyone plays a role: • Individuals and families, including those with disabilities or others with access and functional needs • Businesses and nonprofits • Faith-based and community organizations • Schools and academia • Media outlets • All levels of government

6. Risk-Driven, Capabilities-Based • Natural hazards • Pandemic influenza • Technological and accidental hazards • Terrorist attacks • Cyber attacks

7. Hazard Vulnerability Analysis (HVA) Hospitals are required to conduct and annually review their Hazard Vulnerability Analysis (HVA). The HVA provides a systematic approach to recognizing hazards that may affect demand for the hospitals services or its ability to provide those services. The risks associated with each hazard are analyzed to prioritize planning, mitigation, response and recovery activities. The HVA serves as a needs assessment for the Emergency Management program. This process should involve community partners and be communicated to community emergency response agencies. It is important to note that cities and counties are also required to prepare HVAs; the hospital HVA should consider hazards identified in the community plans that may impact the hospital. In some communities the hospital and community HVAs are developed together. Also referred to as Hazard Identification and Vulnerability Analysis (HIVA) or Threat and Hazard Identification and Risk Analysis (THIRA) ~ New

8. PPD - 8 Presidential Policy Directive (PPD) 8: National Preparedness was released in March 2011 with the goal of strengthening the security and resilience of the United States through systematic preparation for the threats that pose the greatest risk to the security of the Nation. PPD-8 defines five mission areas—Prevention, Protection, Mitigation, Response, and Recovery—and mandates the development of a series of policy and planning documents to explain and guide the Nation’s approach to ensuring and enhancing national preparedness.

9. National Planning Frameworks http://www.fema.gov/medialibrary/mediarecords/11954

10. National Preparedness Goal • Prevention. Prevent, avoid or stop an imminent, threatened or actual act of terrorism. • Protection. Protect our citizens, residents, visitors, and assets against the greatest threats and hazards in a manner that allows our interests, aspirations, and way of life to thrive. • Mitigation. Reduce the loss of life and property by lessening the impact of future disasters. • Response. Respond quickly to save lives, protect property and the environment, and meet basic human needs in the aftermath of a catastrophic incident. • Recovery. Recover through a focus on the timely restoration, strengthening and revitalization of infrastructure, housing and a sustainable economy, as well as the health, social, cultural, historic and environmental fabric of communities affected by a catastrophic incident.

11. Mitigation Core Capabilities The National Preparedness Goal identified 31 core capabilities - these are the distinct critical elements needed to achieve the goal. Mitigation ~ Sustained actions taken to reduce or eliminate long-term risk to life and property from hazards.* 44 CFR §201.2 Mitigation Planning - Definitions

12. CPG – 101: Developing and Maintaining Emergency Operations Plans (EOP’s) • This Guide provides information and instruction on the fundamentals of planning and their application CPG – Comprehensive Preparedness Guide

13. CPG – 201: Developing and Maintaining Emergency Operations Plans (EOP’s) Threat and Hazard Identification and Risk Assessment (THIRA) guide provides a comprehensive approach for identifying and assessing risks and associated impacts. It expands on existing local, tribal, territorial, and state Hazard Identification and Risk Assessments (HIRAs) and other risk methodologies by broadening the factors considered in the process, incorporating the whole community throughout the entire process, and by accounting for important community-specific factors CPG – Comprehensive Preparedness Guide

14. CPG – 201: Threat and Hazard Identification and Risk Assessment (THIRA) Five Step Process • Identify the threats and hazards of concern - What could happen in my community? • Give the threats and hazards context - Describe how a threat or hazard could happen in my community, and when and where it could happen. • Examine the core capabilities using the threats and hazards - How would each threat or hazard affect the core capabilities identified in the National Preparedness Goal? • Set capability targets - Using the information above, set the level of capability a community needs to prevent, protect against, mitigate, respond to, and recover from its risks. • Apply the results - Use the capability targets to decide how to use resources from the Whole Community. CPG – Comprehensive Preparedness Guide

15. Handbook highlights case studies and tools for community officials providing practical guidance on how to incorporate risk reduction strategies into existing local plans, policies, codes, and programs that guide community development or redevelopment patterns. Local Mitigation Planning Handbook Task 5 – Conduct a Risk Assessment

16. Defining Risk Assessment Illustrates the concept of risk as the relationship, or overlap, between hazards and community assets. The smaller the overlap, the lower the risk.

17. Risk Assessment Terminology • Natural hazard – source of harm or difficulty created by a meteorological, environmental, or geological event. • Community assets – the people, structures, facilities, and systems that have value to the community. • Vulnerability – characteristics of community assets that make them susceptible to damage from a given hazard. • Impact – the consequences or effects of a hazard on the community and its assets

18. Risk Assessment Terminology(Continued) • Risk – the potential for damage, loss, or other impacts created by the interaction of natural hazards with community assets. • Risk assessment – product or process that collects information and assigns values to risks for the purpose of informing priorities, developing or comparing courses of action, and informing decision making. • Threat or human-caused incident – intentional actions of an adversary, such as a threatened or actual chemical or biological attack or cyber event.

19. References/Statutes ** • Revised Code of Washington, Chapters 38.10, 38.52, 43.21, 43.70 • Public Health Service Act • Public Law 93-288, as amended, "The Robert T. Stafford Disaster Relief and Emergency Assistance Act" • National Response Framework (NRF) • Public Law 107-188, Public Health Security Bioterrorism Preparedness and • Response Act 2002 • Public Law 107-296, Homeland Security Act 2002 • Federal Food, Drug and Cosmetic Act ** As identifed in the WA State CEMP, ESF 8 – Public Health and Medical Services

20. Joint Commission (aka JCAHCO) • Mission: To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.

21. So now that we are all on the same page…… Let’s look at a specific tool created for hospitals.

23. Where do you start?

24. Threats/Hazards by Category

25. Natural Hazards

26. Technology Hazards

27. Human Hazards

28. Hazardous Materials

29. Summary of Hazards

30. Best practices How do you plan? Who do you plan with? Just your hospital? Open Discussion How do you involve the community? Who should be involved? When do you do it? Lesson’s Learned What resources do you use? Where do you begin?

31. Links and Articles • California Hospital Association Website http://www.calhospitalprepare.org/hazard-vulnerability-analysis • Planning Resources for Hospitals - CDC http://www.cdc.gov/phpr/healthcare/hospitals.htm • Strengthening HVA: Results of Research in Maine http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056047/ • Cyber hazards and health care organizations, http://www.hitrustalliance.net/news/index.php?a=128

32. Thanks, for your time and participation. Contact info: Darrell Ruby druby@spokanecounty.org 509-477-3006

33. Back-ups

34. Natural Hazards

35. Technology Hazards

36. Human Hazards

37. Hazardous Materials

38. Summary of Hazards