Disaster Ready…or Not?Disaster Ready…or Not?

Stan Szpytek, AzHCA ConsultantLife Safety / Disaster Planning

Arizona Health Care AssociationArizona Health Care Association

• AZ’s largest LTC Association

• AHCA’s members facilities- 15,000 residents

• AZ’s Long-Term Population Stats– 150 licensed SNF / 16,346 beds– 1880 licensed ALF / 30,095 beds

• 250 are “centers” (10 beds are more)

CHALLENGES…CHALLENGES…• Power• Transportation • Communications• Dependence on Community• Self Reliance• Workforce• Acuity of the LTC Population• Lack of Disaster Planning• No Hazard Vulnerability Assessment • Poor Collaboration

Mesa Transformer Fire…Mesa Transformer Fire…

Wallow Fire…Wallow Fire…

Outside of Flagstaff- 10/6/10Outside of Flagstaff- 10/6/10

Plane CRASHES into School- 6/11/10Plane CRASHES into School- 6/11/10Eager, ArizonaEager, Arizona

SUNDAY, MAY 22, 2011 - 5:15 P.M.SUNDAY, MAY 22, 2011 - 5:15 P.M.JOPLIN, MISSOURIJOPLIN, MISSOURI

Joplin, MO (Greenbriar)…..Joplin, MO (Greenbriar)…..

Colorado Springs- June 2012…Colorado Springs- June 2012…

How Vulnerable?How Vulnerable?

OIG Report: 4/13/12OIG Report: 4/13/12

““Gaps Continue to Exist in Nursing Home Emergency Gaps Continue to Exist in Nursing Home Emergency Preparedness Response During Disasters”Preparedness Response During Disasters”

• 24 facilities, 7 states, 2007 – 2010 disasters• Staffing shortages• Resident Care esp. feeding tubes and ventilators• Resident ID and tracking• Shelter in Place supplies• Communication• 92% of all nursing homes in the country met federal

requirements for emergency plans• Most providers DO NOT use an emergency Most providers DO NOT use an emergency

management model like the Incident Command management model like the Incident Command SystemSystem

Are LTC Facilities in AZ Ready Are LTC Facilities in AZ Ready for Disaster ?for Disaster ?

WHAT KEEPS YOU UP AT WHAT KEEPS YOU UP AT NIGHT?NIGHT?

Bureau of Public Health Emergency Preparedness: 150 N. 18th Avenue, Suite 150

Phoenix, AZ 85007(602) 364-3289

(602) 542-2722 Fax

A program was born……A program was born……

Major DRA Program Elements......Major DRA Program Elements......

• Identify Needs

• Provide Training Opportunities

• Provide Resources

• Develop / Facilitate Relationships

IDENTIFY NEEDSIDENTIFY NEEDS

GapGapAnalysisAnalysisSurveySurvey

Identify Needs……Identify Needs……

FocusFocus……

• HHS Hospital Preparedness Program (HPP) Grant Guidance

– Section 1.5: Level 1 and Level Sub-Capabilities

** Essentially the desired levels of preparedness in all healthcare occupancies

Survey ProcessSurvey Process……

• Developed comprehensive survey based on grant guidance

– Thirty-eight (38) probes

• Utilized On-line “Survey Monkey”

• Robustly Promoted by AzHCA with BA Assistance

• Excellent Member Participation

SURVEY FINDINGS…SURVEY FINDINGS…

COMMUNICATIONSCOMMUNICATIONS

Limited Alternate Comm…Limited Alternate Comm…• Satellite phone- 2.2%• Access to ham radio operator- 1.1 %

Common Comm…Common Comm…

• Two-way radios- 68.5%• National Weather Service alert radio- 21.3 %• Battery-powered am/fm radio- 60.7%

FB During Disaster???FB During Disaster???

COLLABORATIONCOLLABORATION

WORKING WITH KEY WORKING WITH KEY PARTNERS PARTNERS

Participation…Participation…

Does your facility participate in any local, Does your facility participate in any local, county or state disaster planning / county or state disaster planning / emergency management initiatives?emergency management initiatives?

• YES- YES- 18%18%

• NO-NO- 73%73%

• UNSUREUNSURE 9%9%

HAZARD VULNERABILITYHAZARD VULNERABILITY

What’s beyond the fence?What’s beyond the fence?

Hazard Vulnerability Assessment…Hazard Vulnerability Assessment…

• YES-YES- 24.724.7• NO-NO- 58.458.4• UNSURE-UNSURE- 16.916.9

Medical SurgeMedical SurgeFacility ExpansionFacility Expansion

Bed TrackingBed Tracking

Surge…Surge…

• Bed Availability TrackingBed Availability Tracking– YES- YES- 59.6 %59.6 %– NO- NO- 40.4%40.4%

• Formalized Receiving PlanFormalized Receiving Plan– Yes- Yes- 58%58%– NO- NO- 42%42%

INCIDENT MANAGEMENTINCIDENT MANAGEMENT

Incident Command System…Incident Command System…

• YES- YES- 25.6%25.6%

• NO-NO- 46.5%46.5%

• UNSUREUNSURE 27.9%27.9%

FATALITY MANAGEMENTFATALITY MANAGEMENT

Handling the Deceased During Handling the Deceased During Disaster…Disaster…

• Safe handling procedures establishedSafe handling procedures established

– YES- YES- 20.2%20.2%– NO-NO- 79.8%79.8%

• Temporary morgue identifiedTemporary morgue identified

– YES-YES- 19.3%19.3%– NO- NO- 80.7%80.7%

IDENTIFY NEEDSIDENTIFY NEEDS

GapGapAnalysisAnalysisSurvey- Survey-

Follow-up Site VisitsFollow-up Site Visits

Meet with Key Staff…Meet with Key Staff…

TRAININGTRAINING

ProvideProvideTraining Training

OpportunitiesOpportunities

NHICS Workshops- June 2012NHICS Workshops- June 2012

• Tucson (Pima County Health Department)• Mesa (Southwest Ambulance H.Q.)

NIMS and the Incident Command System (ICS)

One of the most important 'best practices' that has been incorporated into the NIMS

is the Incident Command System (ICS), a standard, on-scene, all-hazards incident

management system already in use by firefighters, hazardous materials teams, rescuers and

emergency medical teams.

The ICS has been established by the NIMS as the standardized incident organizational structure for the management of all incidents.

www.fema.gov/txt/nims/nims_ics_position_paper.txt

What is the Incident Command System?

Standardized approach to all hazards response and recovery

Used across all disciplines Promotes efficiency and effectiveness in

response Not a plan but a framework to overlay on

existing plans Used to manage all types of events- big or

small

How do you manage CHAOS ???

By

OBJECTIVESOBJECTIVES

San Bruno, CA….San Bruno, CA….

V.I.P. Visits…V.I.P. Visits…

Incident Action Planning Management By Objectives

Flexible, Measurable & Attainable Objectives Identified Time-Frames (Operational Period)

Feature of ICS

Common terminology Modular span of control Resource management Information management

Modular Organization Incident Action Planning/Objectives Command structure

The actions that must be covered:

OPERATIONSDirects Tactical Actions

Reports to the Incident Commander

LOGISTICSFacilitiesServicesMaterials

Communications

COMMAND

HAS OVERALL RESPONSIBILITY

IS IN CHARGE OF ALL FUNCTIONS

PLANNINGPrepares Action Plan

Maintains Resource and Situation Reporting

FINANCEADMINISTRATION

Tracks Cost

Evaluates Fiscal Considerations, Personal

Issues

The Power of the VEST…The Power of the VEST…

““All Hazards” All Hazards” Emergency ManagementEmergency Management

• Communications

• Resources and Assets

• Safety and Security

• Staff Responsibilities

• Utilities

• Patient Clinical and Support Activities

HAZARD VULNERABILITY HAZARD VULNERABILITY ASSESSMENT ASSESSMENT

HVAHVA

WHAT potential threats and perils may impact the community and

your facility?

HVA Factors…..(RISK)HVA Factors…..(RISK)EVENT TYPE (Specific)

• Probability– Likelihood of Occurrence

• Severity = Impact– Human– Property– Business

• Mitigation = Preparedness + Response– Preparedness– Internal Response– External Response

Hazard Vulnerability Hazard Vulnerability Assessment (HVA)Assessment (HVA)

RESOURCESRESOURCES

ProvideProvide

Members with Members with ResourcesResources

RESOURCESRESOURCES

ToolsToolsandand

InsertsInserts

http://azhca.org/disaster-preparedness-home

DRA WebsiteDRA Website

DRA WebsiteDRA Website

• HomeHome

• EventsEvents

• NHICSNHICS

• Useful LinksUseful Links

• ResourcesResources

ResourcesResources

• CMS Checklist (click to open)

• Resource Document Title: • Post-Incident Damage Assessment Checklist

• Description: This document provides a template to perform a Basic Damage Assessment following an adverse event like a fire, flood, severe weather, crime, act of violence or similar event where a facility has been damaged. It is recommended that this document is inserted into the facility's Emergency Operations Plan (disaster manual) upon completion.

• Download it here (or click the title above) 

ResourcesResources

• Resource Document Title: Fatality Management Guidance

• Description: This document provides guidance to facilities on the safe and proper handling of fatalities following an incident where people have died at the facility and traditional resources like the office of the medical examiner, funeral homes and mortuaries are not available to provide assistance due to the overall scope and severity of an adverse event. It is recommended that this document is inserted into the facility's Emergency Operations Plan (disaster manual) upon completion.

• Download it here (or click the title above) 

Sample IRG for Natural Disaster: Major Earthquake

COLLABORATIONCOLLABORATION

Develop and Develop and Facilitate Facilitate

RelationshipsRelationships

Association Level…Association Level…

Local Level…Local Level…

Provider Level…Provider Level…

Next Steps…Next Steps…

COALITIONSCOALITIONS

Full Scale Drills (Community)…Full Scale Drills (Community)…

http://training.fema.gov/IS/NIMS.asp

http://training.fema.gov/IS/NIMS.asp

Disaster Ready ArizonaDisaster Ready Arizona

Applying NHICS in YOUR Applying NHICS in YOUR FacilityFacility

Free On-line FEMA Training- IS 100-HCb / IS-700.AFree On-line FEMA Training- IS 100-HCb / IS-700.A

http://training.fema.gov/EMIWeb/IS/is100HCb.asphttp://training.fema.gov/EMIWeb/IS/is100HCb.asp

http://training.fema.gov/EMIWeb/is/is700a.asphttp://training.fema.gov/EMIWeb/is/is700a.asp

Request Training Assistance from Local Request Training Assistance from Local ResourcesResources

Integrate NHICS into Fire DrillsIntegrate NHICS into Fire Drills

Disaster Ready…or Not?Disaster Ready…or Not?

Stan Szpytek, AzHCA ConsultantLife Safety / Disaster Planning

stan@azhca.org708.707.6363