Medical Disaster Planning and Response Process: Pre-event Disaster Planning

1. WakeMed Health & Hospitals Raleigh, North Carolina Medical Disaster Planning and Response Process: Pre-event Disaster Planning National Emergency Management Summit New Orleans March 5, 2007 Barbara Bisset, PhD MPH MS RN EMTExecutive Director Emergency Services Institute

2. Objectives Awareness of • Key Considerations • Disaster Phases • Five Planning Tiers • Contingency Business Plans • Resources for Healthcare Planners

3. Key Considerations:Defining Events • Do NOT define events by the number of casualties • Loss of mission critical systems is an event

4. Key Considerations:Internal versus External Events Three potential scenarios • Hospital only • Community only • Hospital and the community

5. Key Considerations:Short term versus Long Term Events Event may last from hours to months

6. Key Considerations:Events Do Not Have Boundaries Events may or may not be contained within one geographic location Events can easily cross over county and/or state lines

7. Key Considerations: Hospitals Are First Receivers Literature documents that greater than 85% of the population will likely bypass community emergency response systems and will report to the hospital that they normally go to for service

8. Key Considerations: Capacity versus Capability Capacity (Volumes of Patients) • Most hospitals are already at full capacity • Rapid versus gradual influx of patients • Expansion / surge spaces

9. Key Considerations: Capacity versus Capability Capability (Types of Patients) • Specialized populations • Burn victims • Pediatric populations • Need for isolation rooms • Decontamination procedures required • Requires specialized equipment, supplies and staff

10. Key Considerations:Covert versus Overt • May or may not be an identifiable “scene” • Patients may already be in the hospital system before there is an identified event

11. Key ConsiderationsWarning versus No Warning Events Notification Systems • Advisory • Alert • Activation • Updates

12. Key Considerations:Type of Casualties For every one physical casualty, you can expect four to twenty mental health casualties

13. Key Considerations: Special Needs Populations Special needs populations • Often are those who are “left behind” • Many times cannot afford the expense of taking personal actions • Medical needs will be accelerated in emergency events

14. Key Considerations: Ethical Considerations • Limited resources • Level of care • Sufficient versus “normal”

15. Key Considerations: Communications • All communication systems that you use on a daily basis will rapidly become overloaded and/or will fail • Hospitals can expect thousands of calls (if the normal communication systems are working)

16. Key Considerations: Communications • Information may most likely be: • Inaccurate and/or incomplete • Delayed • Rumors can run rampant • Intelligent community • Event may involve risk communications

17. Key Considerations: Campus Security • You cannot treat patients if you do not have a safe environment • The crowds will come

18. Key Considerations: Staffing • Employees and/or their families may be victims of the event • May have fear of responding • May need to alter duties • Staff may be needed from resources outside the facility

19. Key Considerations:Decision Making • If event requires a rapid activation, the steps taken in the first ten minutes will affect patient outcome and success of response • Normal “decision makers” may be unavailable

20. Key Considerations:Availability of Vendors • Multiple agencies may have agreements with the same vendors • Vendors contact may need to be 24/7

21. Key Considerations:Financial Cost • Cost of event can rapidly escalate • Details and documentation are needed for insurance and other potential sources of reimbursement

22. Key Considerations: Regulatory Agencies • Regulatory standards apply during emergency and disaster events. Recognize in catastrophic event life saving measures will be a priority. • Division of Facility Services • Occupational Safety and Health Administration (OSHA) • Emergency Medical Treatment and Active Labor Act (EMTALA) • Fire Marshall Having Jurisdiction • Environmental Protection Agency • Health Insurance Portability and Accountability Act (HIPAA) • Medical and Nursing and Allied Health Practice Boards

23. Key Considerations: Documentation • Documentation of response to event is often uncoordinated and is generally the weakest link • Many decisions may go undocumented

24. Disaster Phases

25. Mitigation Phase • Critical systems on emergency power • Redundant systems • Construction and designs of space

26. Preparedness Phase Employee Training 1. Awareness Level • Quick Response Guides 2. Active Participant Level • Quick Response Guides • Standing orders / Protocols • Other duties as assigned 3. Expert Level • Knowledge of details of plans • Job Action Sheets • Key Assumptions • Crisis Management

27. Preparedness Phase Equipment and Supplies • Just-in-time inventories versus preparedness for greater than 72 hours • Specialty equipment for capability events • Mobility of equipment

28. Preparedness Phase Staff Assignments • Active and Reserve Teams • All employees are essential • Systems for rapid activation and deployment • Task Forces • Strike Teams

29. Response Phase • Incident Recognition • Notification • Mobilization • Incident Operations • Demobilization • Transition to Recovery

30. Response Phase • Authority to activate emergency operations plans • Consider immediate threats • Time to respond – e.g. setting up decontamination operations • Implement incident command for all events • Develop focused action plan • Better to over commit than to under commit

31. Recovery Phase • Be prepared for extended operations • Incident command in place until operations return to “normal” • Opportunity for organizational learning • Develop After Action Report (AAR) • Follow identified actions through completion

32. Planning in Five Tiers • Personal • Department • Organizational • Participate in regional planning • Participate in state and other organizations planning efforts

33. Tier One:Personal and Family Preparedness • Every employee needs to have a plan • Includes: • Home inventories • Evacuation routes • Personal packs with self sustaining supplies, important papers • Work Pack • Emergency Car Kit • Pet Plan

34. Tier Two:Department Plans • Every department is essential • Each department needs to understand their preassigned role

35. Tier Three:Organization’s Plan Details how the hospital responds as a system • Hospital Command Center • Policies, Procedures, Emergency Operations Plans

36. Crowd Control Restricted Access Lockdown Special Needs Populations Management of Communications from the Public Epidemiological Events Management of Staff Expectation of Employees Emergency Credentialing Capability Events Burns Mass decontamination Pediatrics Management of Donations Management of Volunteers Capacity Management Tier Three: Organization’s Plan In addition to the standard planning

37. Tier Four:Community and Regional Planning • Hospitals must take a leadership role with community and regional partners • Cannot operate in a vacuum • Public Information • Joint Information Centers • Multiple agency plans need to be coordinated • Selection of Ambulatory Care Centers • Mutual Aid Agreements

38. Tier Five:Planning with the State and Organizations • Need to understand state plans and know individuals in key state and organizations agencies • Public Health • Office of Emergency Medical Services • Hospital Association • Law Enforcement • Emergency Management

39. Business Continuity Planning • Continued access to services • Record preservation • Business relocation plans

40. Planning Resources

41. National Incident Management System (NIMS) • Department of Health and Human Services in collaboration with the National Incident Management Systems (NIMS) Integration Center • Seventeen elements for hospitals • Compliance by August of 2008 if want to receive federal preparedness dollars

42. NIMS:Seventeen Implementation Activities # 1 Organizational Adoption # 2 Command and Management (ICS) # 3 Multi-agency Coordination System # 4 Public Information Systems • Joint Information System (JIS) and Joint Information Center (JIC) # 5 Implementation Tracking • Annual Emergency Management report

43. NIMS:Seventeen Implementation Activities # 6 Preparedness Funding # 7 Revision and Updating of Response Plans annually #8 Mutual Aid Agreements # 9 Training IS 700 NIMS • All personnel who have a leadership role in emergency preparedness, incident management or incident response need to take the course

44. NIMS:Seventeen Implementation Activities # 10 Training IS 800 National Response Plan • Must be completed by individuals whose primary responsibility in a hospital is emergency management # 11 Training ICS 100 and 200 • Must be completed by those who have a direct role in emergency preparedness, incident management or response # 12 Training and Exercises • Must include incident command structure

45. NIMS:Seventeen Implementation Activities # 13 All Hazard Exercise Program # 14 Corrective Actions Reports

46. NIMS:Seventeen Implementation Activities # 15 Response Inventory • NIMS Typing of resources # 16 Resource Acquisition • Relevant national standards and guidance are used to achieve equipment, communication and data interoperability. # 17 Standard and Consistent Terminology • Plain English communication standards across the public safety sector • Common language between Emergency Management, Law Enforcement, EMS, fire public health and hospitals

47. National Incident Management Structure versus Hospital Incident Command Structure • National committees collaborated • Reconciled discrepancies as HEICS (III) did not • Include multi-agency cooperation • Public information systems • Proper incident command system language

48. Hospital Incident Command (HICS)(Version IV) • Incident Command must be incorporated into the response to every events • HICS is NIMS compliant • HEICS III and HICS IV Position Crosswalk • Job Action Sheets

49. Hospital Incident Command (HICS)(Version IV) • Seventeen internal and external events identified • Incident Planning Guides • Incident Response Guides • Education Tools • HICS Implementation Tools

50. The Joint Commission:Proposed Elements to Emergency Management Standards Need to think of critical capabilities beyond 72 hours