Healthcare Coalition Development: Preparedness, Response, Validation

1. Paul L. Link, RN, MSHS CDR USPHS ASPR HPP Field Project Officer Healthcare Coalitions

2. Objectives • Healthcare Preparedness Guidance • Defining Healthcare Coalitions • Development of Healthcare Coalitions • HCC Preparedness • HCC Response • HCC Validation

3. Healthcare Preparedness Guidance • The Healthcare Preparedness Capabilities, National Guidance for Healthcare System Preparedness, was released in March, 2012 • This document provides direction for Healthcare Coalition development • Addressed in Capability 1 and collaborative planning for the healthcare system is the basis for healthcare coalitions

4. Definition The Healthcare Coalition • The Healthcare Coalition is a collaborative network of healthcare organizations and their respective public and private sector response partners • Serve as a multiagency coordinating group to assist with preparedness, response, recovery, and mitigation activities related to healthcare organization disaster operations • Priority objective of the Healthcare Coalition includes sub-state regional, healthcare system emergency preparedness activities involving the member organizations. This includes planning, organizing and equipping, training, exercises and evaluation • The response objective for Healthcare Coalitions includes representation of healthcare organizations by providing multi-agency coordination to advise decisions made by incident management regarding information and resource coordination for healthcare organizations. • Includes a response role as part of a multi-agency coordination group to assist incident management (area command/unified command) with decisions, • OR coordinated plans to guide decisions regarding healthcare organization support

5. DISASTER CYCLE Healthcare Coalitions: Assist HCOs within their region to return to normal healthcare delivery operations Healthcare Coalitions: Address areas in critical infrastructure and key resource allocation planning that decreases the vulnerability of the healthcare delivery system Recovery Mitigation Response Healthcare Coalitions: Integrate with ESF8 to coordinate healthcare organizations’ priorities and needs to assist incident management with resource and information management during response. Healthcare Coalitions: Follow the steps of the Preparedness Cycle to effectively mitigate, respond and recover from a disaster Preparedness Disaster Role in Disaster

6. Development Capability 1: Healthcare System Preparedness • Function 1: Develop, refine, or sustain Healthcare Coalitions • P1: Healthcare Coalition regional boundaries • P2: Healthcare Coalition primary members • P3: Healthcare Coalition essential partner memberships • P4: Additional Healthcare Coalition partnerships/memberships • P5: Healthcare Coalition organization and structure • P6: Multi-agency coordination during response P1 = Planning Element 1

7. Development Regional Development • Healthcare Coalitions can be developed around or within a functional service region/area such as • healthcare service catchment areas, • trauma regions, • Emergency Medical Service (EMS) regions, • Regional Coordinating Hospital regions, • Public Health regions/districts, • county jurisdictions, • Emergency Management Agency (EMA) regions, • or another type of functional service region. • Participation in emergency management preparedness and planning can be achieved by • The formation of Healthcare Coalitions as a component of a larger planning region (e.g., EMS or EMA regions) • OR around healthcare delivery areas (e.g., Regional Coordinating Hospital Region, etc) (this includes obtaining input for preparedness from relevant response organizations and stakeholders) Healthcare Coalition Regions = DHEC Public Health Regions

8. Staged Development Stage 1 Stage 2 Stage 3 • Maintain the Stage 1 requirements through sustainment and preparedness activities • Perform preparedness activities as outlined in Capability 1: Healthcare System Preparedness • Determine regional approach and boundaries • Establish awardee support and partnership • Determine governance structure • Establish the healthcare coalition for purposes of preparedness evidenced through appropriate documentation • Determine how healthcare coalitions will address multiagency coordination during response and perform ongoing regional exercises to test this capability. 

9. Sustainment Healthcare Coalition Governance Finance Legal/Policy Technology Business Operations Integration with ESF#8

10. Function 2: Coordinate healthcare planning to prepare the healthcare system for a disaster P1: Healthcare system situational assessments P2: Healthcare System disaster planning Function 3: Identify and prioritize essential healthcare assets and services P1: Identify and prioritize critical healthcare assets and essential services P2: Priority healthcare assets and essential services planning PLAN EVALUATE/ IMPROVE Function 3: Identify and prioritize essential healthcare assets and services E1: Equipment to assist healthcare organizations with the provision of critical services Function 4: Determine gaps in the healthcare preparedness and identify resources for mitigation of these gaps P1: Healthcare resource assessment P2: Healthcare resource coordination P3: Address healthcare information gaps Function 6: Improve healthcare response capabilities through coordinated exercise and evaluation P3: Evaluation and improvement plans P4: Best practice and lessons learned sharing S1: Exercise and evaluation training ORGANIZE/ EQUIP EXERCISE TRAIN Function 6: Improve healthcare response capabilities through coordinated exercise and evaluation P1: Exercise plans P2: Exercise implementation and coordination S1: Exercise and evaluation training Function 5: Coordinate training to assist healthcare responders to develop the necessary skills in order to respond P1: Healthcare organization - (NIMS) training S1: Training to address healthcare gaps and corrective actions Preparedness

11. Hospital C Hospital B LTC MH/BH Hospital A HealthcareSupport HealthcareSupport EM MACC HC PH ESF 8 Healthcare Coalition EMS C B A Public Health Agencies A B C A C B Jurisdiction Emergency Management and Incident Management Capabilities CONCEPT of HCC Response EMS Agencies Response

12. Healthcare Coalition Validation • Occurs over the project period = 5 years (2012 – 2017) • Includes: • Joint HPP-PHEP application requirements • Capability requirements • Performance measure requirements • Validation is done using a combination of technical assistance and monitoring • Desk review of documents • Site visits (State level) • Coalition visits (regional level) • Exercise observation • Will incorporate best practices from regions

13. Healthcare Coalition Validation • Application requirements (HPP specific – awardee level) • Capability development • Coalition development • Training and exercise compliance • Interoperable communication compliance • HAvBED compliance • Integration of special populations • Application requirements: Found in the funding opportunity announcement at Grants.gov under funding opportunity number CDC-RFA-TP12-1201 at: http://www07.grants.gov/search/search.do;jsessionid=3h8KPRRSKTJ0Wvf6sHKFdMgGK2tsGwJ4qstqykMJW77XfdnnjGGh!1869518295

14. Healthcare Coalition Validation • Capability development (regional level) • Review of plans (desk review) • Validation of CONOPs (site visit/exercise observation) • Validation of information management processes (site visit/exercise observation) • Validation of resource management processes (site visit/exercise observation) • ASPR’s Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness available at: http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/capabilities.pdf.

15. Healthcare Coalition Validation • Performance measurement • 8 HPP measures • 3 Joint HPP/PHEP measures • HPP performance measurements are required to be met in the 5-year project period • There may be some adjustment to the measures this year • HPP Performance Measures found here: http://www.phe.gov/Preparedness/planning/evaluation/Documents/fY12-hpp-perf-measures.pdf

16. HPP Performance Measures(Provisional) • HPP 1.1: % of HCCs that have established formalized agreements and demonstrate their ability to function and execute the capabilities for healthcare preparedness, response, and recovery as defined in Healthcare Preparedness Capabilities • HPP 2.1: % of HCCs that have developed processes for short-term recovery of healthcare service delivery and continuity of business operations • HPP 3.1: % of HCCs that use an integrated ICS to coordinate operations and sharing of critical resources among HCC organizations during disasters • HPP 5.1: % of HCCs that have systems and processes in place to manage mass fatalities consistent with their defined roles and responsibilities. • HPP 6.1: % of HCCs that can continuously monitor Essential Elements of Information (EEIs) and demonstrate the ability to electronically send data to and receive data from coalition members to inform a Common Operating Picture • HPP 10.1: % of HCCs  that have a coordinated mechanism established that supports their members’ ability both to deliver appropriate levels of care to all patients (including pre-existing patients [both inpatient and outpatient], non-disaster-related patients, and disaster-specific patients), as well as to provide no less than 20% bed availability of staffed members’ beds, within 4 hours of a disaster • HPP 14.1: % of HCCs of that have systems and processes in place to preserve healthcare system functions and to protect all of the coalition member employees (including healthcare and non-healthcare employees) • HPP 15.1: % of HCCs that have plans, processes and procedures in place to manage volunteers supporting a public health or medical incident.

17. Before After Performance Measure HPP 10.1 • To ensure immediate bed availability in times of crisis, coalition partners must continuously monitor acuity of patients and maintain full ability for patient movement. Once a disaster happens, acute care facilities will need to prepare for an influx of new disaster patients. Through agreements with coalition partners, movement of lower acute patients begins from hospitals to other, appropriate facilities and care sites; thus making room for higher acuity patients. These same agreements ensure that receiving facilities are prepared to provide the appropriate level of care. See images below

18. Healthcare Coalition Validation First Steps: • Between July 1, 2012 and September 30, 2012 • Develop a draft 5 yr rotational schedule for HCC visits • May include regional meeting or regional exercise • Done with approval of HPP Coordinator and HCC • Request of initial assessment of regional level activity (i.e., tools developed by Region 5) • For remainder of BP1 – BP5 • Work with SC HPP as requested to provide HCC TA • Visit HCCs as available and requested to assist with development

19. QUESTIONS?

20. Contact Information Paul L. Link, RN, MSHS Commander, USPHS Field Project Officer, HHS Region IV Hospital Preparedness Program Office of the Assistant Secretary for Preparedness and Response BlackBerry: 404-989-4922 Cell Phone: 850-499-8563  paul.link@hhs.gov 61 Forsyth St. S.W., Suite 5B-95 Atlanta, GA 30303