Emergency Management

Emergency Management Disaster Planning Strategies Gary D. Slack, PE, CCE Healthcare Engineering Consultants Springfield, Ohio Healthcare Engineering Consultants

Approved Changes for 2009 • The organization of the standards : • EM.01.01.01: Plans for managing emergencies • EM.02.01.01: Develops an emergency operations plan • EM.02.02.01: Establishes emergency communication strategies • EM.02.02.03: Establishes strategies for managing resources/ assets • EM.02.02.05: Establishes strategies for managing safety and security • EM.02.02.07: Defines and manages staff roles and responsibilities • EM.02.02.09: Identifies an alternative means providing utilities • EM.02.02.11: Identifies strategies for patient activities • EM.02.02.13, 15: Emergency privileges to LIP’s andvolunteers • EM.03.01.01: Annual review of HVA, S-O-P-E of EOP, and inventory • EM.03.01.03: The organization conducts drills to evaluate the EOP Healthcare Engineering Consultants

Emergency Management • EM.01.01.01:The organization plans for managing the consequences of emergencies • Medical and clinical staff participate in planning • A Hazard Vulnerability Analysis (HVA) is performed and documented • The hazards are prioritized • Communication of emergency plan with community responders • Mitigation, Preparedness, Response, Recovery • Assets and resources are inventoried and documented • Asset and resource inventories are monitored during emergencies • The emergency management program is evaluated annually (S,O,P,E) Healthcare Engineering Consultants

Emergency Management • Tips for Compliance with EM.01.01.01: • Appoint a physician and administrative representativetoactivelyparticipate on the emergency management planning committee • Perform and document the Hazard Vulnerability Analysis (HVA) for all geographicallyseparate facilities – review annually! • Be ready to describe the Mitigation, Preparedness, Response and Recovery procedures in the EOP • Ensure that emergency resources are inventoried (PPE, utility and medical supplies and pharmaceuticals) and monitored • Verify that the hospital incident command system is integrated into and consistent with the community command structure (NIMS compliance?) Healthcare Engineering Consultants

Emergency Management • EM.02.01.01:The organization develops and maintains an Emergency Operations Plan (EOP) • Written EOP includes an “all hazards” command structure • An incident command structure (ICS) is established and is consistent with the community plan • The ICS identifies a reporting structure • Activation of ICS is identified • Activation of ICS phases is identified • The EOP identifies the organization response when community non-support may occur for up to 96 hours • Alternative care sites are identified Healthcare Engineering Consultants

Emergency Management • Tips for Compliance with EM.02.01.01 • Create a written emergency operations plan (EOP) that describes the incident command structure and process that is in use (HICS 4?) as well as how ICS integrates into the six critical core areas: 1. Emergency communications 2. Resources and assets 3. Safety and security 4. Staff roles and responsibilities 5. Management of utilities 6. Clinical and support activities • The EOP can either describe the ICS and core area integration in detail or reference existing documents Healthcare Engineering Consultants

Emergency Management HICS Organizational Chart Incident Commander Public Info Officer Safety Officer Liaison Officer Med/ Tech Specialist(s) Operations Section Chief Planning Section Chief Logistics Section Chief Finance/ Admin Section Chief Healthcare Engineering Consultants

Emergency Management • Tips for Compliance with EM.02.01.01 • Create two color-coded timeline charts the indicate how long utilities will be operational and how long consumable supplies will be available in the event of an emergency in which no re-supply is possible • Ensure that decisions are made to determine whether any utility or supply changes will be implemented to extend “green zones” • Create two 96-hour plans that assume the following scenarios: PLAN A:Supplies are available and are ordered and received PLAN B: Internal supply shortages or utility failures require partial or total patient evacuation PLAN C: Shortages and/ or utilities are not sufficient to continue normal patient care, although evacuation is not possible! Healthcare Engineering Consultants

Emergency Management • Critical Utilities and Supplies Timeline • Assume external help is not available • Create timeline for utilities and critical supplies, such as food and medications • Determine time-dependent status: - Green: Continue all services as usual - Yellow: Transition to conservation mode - Red: Discontinue patient treatment, evacuate Healthcare Engineering Consultants

Emergency Management Healthcare Engineering Consultants

Emergency Management • EM.02.02.01:The organization establishes emergency communications strategies • Staff notification procedures are created • Provisions for ongoing staff communication during the emergency • Process to notify external authorities • Communication with patients and their families • Communication with the community and media • Communication with vendors and suppliers • Sharing information with other health care providers • Providing information about patients to third-parties (FEMA, CDC, etc.) • Communication with alternative care sites • Establishment of back-up communication systems and technologies Healthcare Engineering Consultants

Emergency Management • Tips for Compliance with EM.02.02.01 • Create notification charts with phone numbers, email addresses, etc. • Include for staff, external authorities, community, media, vendors • Determine what information will be shared with other health care providers in the area • Ensure that liaisons are established with government agencies • Verify that MOU’s for alternative care sites are updated • Establish and check operation of back-up communication systems, such as the internet, cell phones, two-way radios, emergency land lines, and amateur radio operators Healthcare Engineering Consultants

Emergency Management • EM.02.02.03:The organization establishes strategies for managing resources and assets during emergencies • Plans for obtaining medications and non-clinical supplies • Replenishing medical supplies and equipment during the emergency • Replenishing pharmaceutical supplies • Replenishing non-medical supplies (food, water, fuel, linens, etc.) • Managing staff and family support activities • Sharing of resources with other health care organizations in and outside of the local community • Horizontal, vertical and total evacuation, including transportation of patients, medications, equipment, staff and medical record information Healthcare Engineering Consultants

Emergency Management • Tips for Complying with EM.02.02.03 • Plans should be in place to stockpile and reorder critical clinical and non-clinical supplies • Written procedures should describe how the needs of staff and families of staff will be met during an emergency • A plan to share community resources and assets should be in place • A practical patient evacuation plan that includes horizontal and vertical movement within the facility as well as partial or total evacuation outside of the facility is required • Logistics for evacuation should include: 1) transportation; 2) staffing; 3) medications; 4) equipment, and; 5) the medical record Healthcare Engineering Consultants

Emergency Management • EM.02.02.05:The organization establishes strategies for managing safety and security during emergencies • Internal safety and security measures are established • Role of community security agencies is established with the healthcare organization and means of coordination is identified • Processes for handling hazardous materials and waste are developed • Plans are developed for radioactive, biological, chemical decontamination • Patients susceptible to wandering are identified • Access into and out of the facility are controlled • Movement of staff and patients is controlled within the facility • Traffic accessing the facility is controlled Healthcare Engineering Consultants

Emergency Management • Tips for Complying with EM.02.02.05 • Security staffing plans during emergencies must be established • Expectations with outside police agencies should be identified • Plans to dispose of infectious and hazardous waste must be created • Procedures to treat contaminated patients must be written (radioactive, biological and chemical) • Methods to lock down the facility to prevent entry must be provided • Methods to minimize staff and patients from leaving the facility must be planned • Plans must be in place to control traffic accessing the facility Healthcare Engineering Consultants

Emergency Management • EM.02.02.07:The organization defines and manages staff roles and responsibilities • Staff roles and responsibilities are defined for the critical areas (communications, resources and assets, safety and security, utilities, clinical activities) • Management of staff support needs (housing, transportation, etc.) • Staff are trained relative to their responsibilities • Roles of LIP’s are specifically defined • Care providers and command center staff are identified (ID badges, vests, caps, etc.) Healthcare Engineering Consultants

Emergency Management • Tips for Complying with EM.02.02.07 • Review and update as necessary, the ICS organizational chart and job action sheets (check after each drill) • Ensure thathospital staff have participated in NIMS training • Discuss emergency expectations with the independent physicians who have privileges at the hospital • Select the primary and back-up command center locations • Have a method to identify incident command staff(ID badges, vests, caps, etc.) Healthcare Engineering Consultants

Emergency Management • EM.02.02.09:The organization establishes strategies for managing utilities during emergencies, such as: • Electricity • Potable and non-potable water • Fuel for building operations or transport vehicles • Other essential utility needs, such as: - HVAC equipment - Medical gas and vacuum systems - Fire systems - Sewer Healthcare Engineering Consultants

Emergency Management • Tips for Complying with EM.02.02.09 • Complete the utility 96-hour timeline chart • Determine which utilities require additional supplies, especially water and fuel • Determine the feasibility of redundant systems or supplies Examples: Water – on-site well, water tower or nearby lake Electricity – additional generators installed Boilers – portable boiler “on a truck” Medical gas – low pressure external connection, manifold Healthcare Engineering Consultants

Emergency Management • EM.02.02.11:The organization establishes strategies for managing patients during emergencies, including: • Patient scheduling, triage, assessment, treatment admission, transfer, discharge and evacuation • Clinical services for vulnerable patients, such as: pediatric, geriatric, disabled or serious chronic conditions or addictions • Personal hygiene and sanitation • Mental health needs • Mortuary services • Tracking and documenting patient information Healthcare Engineering Consultants

Emergency Management • Tips for Complying with EM.02.02.11 • Identify which patients in the hospital are considered “vulnerable” (neonatal intensive, pediatric, geriatric, dementia, behavioral health) • Plan for patient and staff hygiene and sanitation without water or sewer • Determine mortuary needs in the event of a pandemic • Evaluate back-up methods to track patient information in the event that the electronic information system fails Healthcare Engineering Consultants

Emergency Management • EM.02.02.13:During disasters, the organization may grant privileges to licensed independent practitioners • Privileges granted only when EOP has been activated • Medical staff bylaws indicate to who and how to grant privileges, and policies will indicate how performance will be evaluated • Minimum privileging requirements include: 1. Current picture ID and license to practice 2. Must be a member of a recognized disaster response group 3. Proof of government authority to provide services during a disaster • Hospital determines within 72 hours if privileges should continue Healthcare Engineering Consultants

Emergency Management • EM.02.02.15:During disasters, the organization may assign disaster responsibilities to volunteer practitioners • Hospital assigns responsibilitiesonly when EOP has been activated • Hospital identifies in writing who is eligible and how to assign disaster responsibilities to non-LIP’s • Minimum requirements to assist during disasters include: 1. Current picture ID and license to practice professional specialty 2. Must be a member of a recognized disaster response group 3. Confirmation by hospital staff the individual is qualified • Hospital determines a method to evaluate performance and decide within 72 hours if responsibilities should continue Healthcare Engineering Consultants

Emergency Management • EM.03.01.01:The organization evaluates the effectiveness of its emergency management planning activities • The Hazard Vulnerability Analysis (HVA) is evaluated annually to determine if revisions are necessary • The Emergency Operations Plan (EOP) is evaluated annually with regard to the Scope, Objectives, Performance and Effectiveness of the program • The hospital conducts an annual review of the inventory process with regard to emergency supplies, and documents the results Healthcare Engineering Consultants

Emergency Management • EM.03.01.03:The organization evaluates the effectiveness of the Emergency Operations Plan • Twice over 12 months, either as a drill or actual emergency, based on the HVA results • Once per year in a free-standing business occupancy • One “influx of patient” drill per year (cannot be tabletop) • One escalation per year to test community “non-support” (can be tabletop) • One “community-wide” drill per year (can be tabletop) • Drills are realistic and based on the HVA • A dedicated, trained individual must evaluate the drill Healthcare Engineering Consultants

Emergency Management • EM.03.01.03:The organization regularly tests its emergency operation plan (continued) • The six critical areas are monitored: 1) Communication; 2) Resource mobilization; 3) Safety and security; 4) Staff roles and responsibilities; 5) Utility systems, and; 6) Patient clinical and support activities • Exercises are critiqued with a multi-disciplinary group, including leadership, physician and support staff to evaluate deficiencies • The operations plan is revised based on the drill findings • Subsequent exercises evaluate the improvements to the EOP • Drill evaluations are reported to the hospital safety committee Healthcare Engineering Consultants

Emergency Management • Tips for Compliance with EM.03.01.03 • Two drills per rolling 12-month period should be performed, based on the HVA • At least one drill per 12 months in a business occupancy • At least one “influx” drill for a disaster receiving station • Community-wide and influx drills can be performed concurrently • The community 96-hour “non-support” drill can be a tabletop • Trained staff, including a physician and leadership, must evaluate the drill and must document the six core areas in the evaluation • Infant abduction (EC.2.10) and patient surge (IC.6.10) drills are highly recommended Healthcare Engineering Consultants

Emergency Management Simulating Plan A: “An internal or external disaster occurs, but adequate resources exist within the organization and community to provide for continuity of patient care and hospital operation” Exercise: A tornado that affects the community only Healthcare Engineering Consultants

Emergency Management Simulating Plan B: “An internal or external disaster occurs that requires movement of patients, either within or external to the hospital. Internal and external resources are available, but the healthcare facility is compromised so that partial or total patient movement and/ or evacuation is required” Exercise: A tornado that affects the community and the hospital facility Healthcare Engineering Consultants

Emergency Management Simulating Plan C: “A disaster of such magnitude occurs that partial or total evacuation from the facility is desired, but the surrounding community is unable to accommodate the patients. Also, physical movement of people and supplies to and from the facility is not possible for up to four days” Exercise: An avian flu pandemic Healthcare Engineering Consultants

Emergency Management Questions? Healthcare Engineering Consultants

Emergency Management