Disaster Planning, Management, and Healthcare CoordinationSeptember 1, 2016

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On Managing Expectations…

Before we begin… Some introductory material.

Why spend a semester on this stuff?

• Increased fragility• Increased likelihood of bad things happening• All disasters can touch healthcare (and most do)• It is the right thing to do• Regulatory compliance demands preparedness

and staff knowledge, skills, and abilities in disaster management

The Phases of Emergency Management

Let’s get some definitions out of the way…

• Disaster• When the anticipated or actual needs exceed the resources available.

• Emergency Management• The comprehensive approach for the mitigation of, preparedness for,

response to, and recovery from disasters.• Mitigation

• Reducing the impact of uncontrollable hazards or threats.• Hazard

• A source of potential harm• Threat

• Something/some action that has potential to cause harm• Risk

• The likelihood of being injured by a threat caused by a hazard• Vulnerability

• A weakness that may be exploited by a hazard

Disaster Impacts to Public Health/Healthcare

• Premature deaths, illnesses, injuries that may exceed capacity

• Destruction of the local health infrastructure

• Environmental imbalances

• Psychological• Blood shortages,

equipment shortages, supply shortages

• Mass population movement

Disasters and Public Health/Healthcare

PopulationIndividualAndrea Booher/FEMAJocelyn Augustino/FEMA

Disaster Impacts to Public Health/Healthcare

Public Health Impacts•Damage to the public health infrastructure•Widespread population displacement•Health service interruption•Population resource disruption•Inability to provide surveillance of population health

Healthcare Impacts•Facility damage•Staffing shortages•Psychological•Blood shortages, equipment shortages, supply shortages•Patient tracking/accountability•Delay in treatment

Public Health Functions in a Disaster

Promote health and hygiene, prevent epidemics and spread of disease

Provide supply of food, clean water, sanitation supplies

Conduct mass vaccination/prophylaxis Implement environmental controls

Enhance epidemiologic surveillance Ensure provision of health services

Inform professionals about health issues and emerging diseases

Enforce laws and regulations relating to health and disease

Implement and enforce isolation and quarantines

Provide emergency risk communication

Assist with community evacuation and sheltering operations

Manage incidents related to public health issues/epidemics

Collect health data and report to community, responders, and providers

Develop new policies and plans to aid in preparedness for next disaster

Regulations, Standards, Accreditation, Licensure, Codes, and …………….

• Centers for Medicare & Medicaid Services, Conditions of Participation

• The Joint Commission, Emergency Management Chapter

• DNV (Det Norske Veritas)• National Fire Protection Association 99, 101, 1600• Virginia Department of Health• Virginia Uniform Statewide Building Code• Fairfax County Fire Ordinances• Commonwealth of Virginia Trauma System• American College of Surgeons• HRSA/ASPR/HPP Grant Requirements• The Jeanne Clery Disclosure of Campus Security

Policy and Campus Crime Statistics Act (Clery Act), as amended

What will we be discussing?

• Essentials of Disaster Planning (Chapter 1)• Where do we start in Disaster Planning?• What are the typical challenges?• What is the difference between capability and capacity?• What is the typical planning process?• What is a Hazard Vulnerability Analysis? (int/ext)• What are mitigation strategies?• How do we prepare?• How do we evaluate the plan?

• Disaster Management (Chapter 11)• How does the community integrate during a disaster?• Incident Command System/Hospital Incident Command System• House Management versus Incident Management• Staff Competencies• Recovery

• Leadership & Coordination in Disaster Health Systems: The Federal Disaster Response Network (Chapter 2)

• What is the National Response Framework and the Emergency Support Functions?

Capacity versus Capability

Warning! These terms are not interchangeable!

•Medical surge capacity refers to the ability to evaluate and care for a markedly increased volume of patients—one that challenges or exceeds normal operating capacity.

•Medical surge capability refers to the ability to manage patients requiring unusual or very specialized medical evaluation and care.

Any questions before we get started?

Why do we need to plan for this?

Why do we need to plan for this?

Why do we need to plan for this?

What are the common themes?

• We are going to need • Stuff• Staff• Space (maybe even special space)• A process to manage requests for stuff, staff, and space• Someone in-charge• A response structure or a system of command and authority• To communicate effectively, efficiently, quickly, and jointly with

response partners• To know everyone, every department’s responsibilities• To know when to start the response• To coordinate our response with community, regional, state, and

federal partners• Security

Oh, and we have to maintain operations to provide care of the “routine” patients…

The Planning Process (generally)

Types of Disasters

Hazard Identification, Vulnerability Analysis, and Risk Assessments

Hazard Identification and Risk Assessment

• Goals• Identify threats to the

organization• Prioritize the threats

based on:

• Determine mitigation and planning strategies

• POETE

Likelihood X Impact = Risk

The Hazard Vulnerability Analysis

The Hazard Vulnerability Analysis

The Results

Strategy Mapping

Strategy Mapping

So, we need a plan… What’s next?

Planning – The Right Goal

• Scenario – During the last snow storm, the hospital experienced a blood product shortage where there was trouble maintaining blood product stock levels due to impassable roads and three massive transfusion protocols (MTPs).

• What should be our goal(s)?

• We will have the right blood products in the right place 100% of the time.

• Pertinent staff will be aware of the current status of blood product availability.

Planning – The Right People

• Scenario – During the last snow storm, the hospital experienced a blood product shortage where there was trouble maintaining blood product stock levels due to impassable roads and three massive transfusion protocols (MTPs).

• Who needs to be involved in the planning? Why?

• Blood Bank, Surgery, Trauma, Emergency Department, OB, Leadership, Ethics, Laboratory, Anesthesia, Transfusion Services, Palliative Care, who else?

Planning – The Correct Process

• Scenario – During the last snow storm, the hospital experienced a blood product shortage where there was trouble maintaining blood product stock levels due to impassable roads and three massive transfusion protocols (MTPs).

• What is the process we are trying to define/refine?

All-Hazards Planning

What plan do we need to create for this?

All-Hazards Planning

What plan do we need to create for this?

All-Hazards Planning

• It is impossible to create plan for everything.• All-hazards planning addresses the impacts and anticipated impacts

regardless of the threat source.• Does all-hazards cover everything?

Essential Elements of a Disaster Plan

• Administration• Introduction• Concept of Operations

• Incident Activations• Incident Management (Hospital

Command Center)• Roles and Responsibilities• Local, State, Federal

Integration• Recovery

• Attachments• Functional Annexes

But…What is the major problem with developing a disaster plan like

this one?

Concept of Operations: Incident Recognition

Triggers, Patterns, Observations

An example of recognition

Concept of Operations: Hospital Incident Management Team

• Information Management (int/ext)

• Resource Management (ops/staff)

• External/Mutual Aid

• Incident Action Plan Management

Concept of Operations: Roles and Responsibilities

• Department Role

• Individual Role• The Disaster

Process

Preparing Based on the Plans

• P – Planning• O – Organization

• Do we need to organize our staff differently?• Do we need to organize our space differently?• Do we need to organize our stuff differently?

• E – Equipment/Supplies• Do we have the right stuff?

• T – Training• Does staff know their roles and responsibilities?• Does staff know how to use the equipment and supplies?• Do staff know the reporting structure?

• E – Exercises• Have we validated the policies and plans?• Have we validated the KSA’s of staff?

How does this tie into the clinician?

• If we are activating a plan, what is important for our clinicians to know?

• Knowledge of agency/organization role• Chain of command• Identify and locate the emergency

response plans• Emergency response functions• Use of equipment (including PPE)• Communication routes/methods• Media relations• Identifying the limits of individual

knowledge, skills, and authorities• Creative problem-solving skills• Recognition of deviations from the

norms and the appropriate actions• How to access continuing education• Evaluating drills and necessary

changes to plans

How does this tie into the clinician?

• If we are activating a plan, what is important for our clinicians to know?

• Knowledge of agency/organization role• Chain of command• Identify and locate the emergency

response plans• Emergency response functions• Use of equipment (including PPE)• Communication routes/methods• Media relations• Identifying the limits of individual

knowledge, skills, and authorities• Creative problem-solving skills• Recognition of deviations from the

norms and the appropriate actions• How to access continuing education• Evaluating drills and necessary

changes to plans

Realistically, what are the challenges Emergency Managers

(and Nurses) might face here?

Validating Plans and KSAs - Exercising

Types of Exercises

Exercise Next Steps

• Importance of evaluations• Types of Key Positions

• Exercise Team• Players• Actors• Evaluators• Observers• VIPs

• Improvement Tracking – Who, What, When• Required by CMS, TJC, DNV, etc.

Major Barriers to Effective Preparedness Planning

• Financial Support• Time• Cash

• Organizational Priority ($ withstanding)

• Consensus (rarely)

Disaster Management and Healthcare Integration

Disaster Management

The Players (a sample)

• Healthcare• Hospitals• SNFs, ALFs, ILs, Rehab, Home Health, etc.• Dialysis Centers

• Municipal Agencies (County & City)• Public Safety (Fire, EMS, Law Enforcement, 911)• Office of Emergency Management• Transportation• Public Works (Water, Sewer, Waste, etc.)• Social Services

• Critical Infrastructure• Energy• High-Speed Internet• Telephone• Cable

• State • Public Health* (Office of the Chief Medical Examiner, Vector Control, Food Inspections, Epidemiology)• State Emergency Management• State National Guard• State Law Enforcement• State Transportation• Search and Rescue*• Regional Hospital Coordinating Centers

• Federal• Strategic National Stockpile, CHEMPACK Program• Disaster Medical Assistance Team (DMAT); Disaster Mortuary Assistance Team (DMORT), etc.• CDC Response Teams• Federal Law Enforcement (FBI, Secret Service, etc.)• Robert T. Stafford Disaster Relief and Emergency Assistance Act

How do we organize these teams? This team?

A few key points…

• All disasters are local (James Schwartz, ACFD Asst. Chief)

• There is a standard operating picture for everyone and everyone has a position to fill

• Information flow is deliberate yet free-flowing• The process for managing major incidents started

in 1973 with FIRESCOPE to combat California wildfires

• Has evolved over the years to be more inclusive

National Incident Management System (NIMS)

Significant Principles•Span of control 3-7 (5 is optimal)•IC is not always the highest ranking individual•Information flows up and over•Following an Incident Action Plan (IAP)•Critical documentation

National Incident Management System (NIMS)

Significant Principles•Standardized incident planning process•Routine briefings (operational picture)•Incident Action Plan is the product

A Sample Incident Action Plan

Community and State

Regional Healthcare Coordinating Center

County/CityEmergency

Operations Center

Statewide Healthcare Emergency

Coordinating Center

Statewide Emergency Operations Center

Joint Field Offices/ National Centers

Emergency Support Functions

ESF-8: Public Health and Medical

• Assessment of medical needs• Health surveillance• Medical personnel• Equipment and supplies• Evacuation• Acute care• Food/drug safety• Worker health and safety• CBRNE Consult• Mental health/behavioral health• Risk communications• Vector control• Drinking water• Medical examiner/decedent management• Veterinary services

The Importance of Disaster Declarations

• Remember the definition of a disaster• Access to the next-level-higher resources

and assistance• Access to federal financial support

(Robert T. Stafford Act)• Who has the authority to declare a

disaster? It depends on where you are in the “big picture”

Interesting Federal Resources

• Strategic National Stockpile

• CHEMPACK Program

• Disaster Medical Assistance Teams (DMATs)

Disaster Medical Assistance Team – National Disaster Medical System (NDMS)

Disaster Mortuary Operations Assistance Team (DMORT)

The Role of NGOs

• Non-Government Disaster Response Organizations

• American Red Cross• The Salvation Army• The American Radio Relay League

(ARRL)• The Catholic Charities USA Disaster

Response• Doctors Without Borders (international)• Private Industry

So What?

• Understanding the larger picture and how we fit into it is essential.

• You can be an asset during disaster.• Training is available

• FEMA Independent Study (100, 200, 700, 800)• DHS FEMA Sites (Anniston/CDP, etc.)

• More ready to take on a leadership role

Center for Domestic Preparedness – Anniston, Alabama

Questions?

L. Keith Dowler, MA, CEMEmergency Management Coordinator

Department of Public Safety and Emergency ManagementInova Fairfax Medical Campus

3300 Gallows RoadFalls Church, Virginia 22042

T 804-776-6418 |M 804-937-1921 |S 66418 |P ID 169032

Thanks!