medical disaster planning and response process: …medical disaster planning and response process:...
TRANSCRIPT
Medical Disaster Planning and Response Process:Pre-event Disaster Planning
National Emergency Management SummitNew OrleansMarch 5, 2007
Barbara Bisset, PhD MPH MS RN EMTExecutive Director Emergency Services Institute
Raleigh, North Carolina
WakeMed Health & Hospitals
ObjectivesObjectives
Awareness of
• Key Considerations
• Disaster Phases
• Five Planning Tiers
• Contingency Business Plans
• Resources for Healthcare Planners
Key Considerations:Key Considerations:Defining EventsDefining Events
• Do NOT define events by the number of casualties
• Loss of mission critical systems is an event
Key Considerations:Key Considerations:Internal versus External EventsInternal versus External Events
Three potential scenarios
• Hospital only
• Community only
• Hospital and the community
Key Considerations:Key Considerations:Short term versus Long Term EventsShort term versus Long Term Events
Event may last from hours to months
Key Considerations:Key Considerations:Events Do Not Have BoundariesEvents Do Not Have Boundaries
Events can easily cross over county and/or state lines
Events may or may not be contained within one geographic location
Key Considerations: Key Considerations: Hospitals Are First ReceiversHospitals 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
Key Considerations: Key Considerations: Capacity versus CapabilityCapacity versus Capability
Capacity (Volumes of Patients)
• Most hospitals are already at full capacity
• Rapid versus gradual influx of patients
• Expansion / surge spaces
Key Considerations: Key Considerations: Capacity versus CapabilityCapacity 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
Key Considerations:Key Considerations:Covert versus OvertCovert versus Overt
• May or may not be an identifiable “scene”
• Patients may already be in the hospital system before there is an identified event
Key ConsiderationsKey ConsiderationsWarning versus No Warning EventsWarning versus No Warning Events
Notification Systems
• Advisory
• Alert
• Activation
• Updates
Key Considerations:Key Considerations:Type of CasualtiesType of Casualties
For every one physical casualty, you can expect four to twenty mental health casualties
Key Considerations: Key Considerations: Special Needs PopulationsSpecial 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
Key Considerations: Key Considerations: Ethical Considerations Ethical Considerations
• Limited resources• Level of care
– Sufficient versus “normal”
Key Considerations: CommunicationsKey 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)
Key Considerations: Key Considerations: CommunicationsCommunications
• Information may most likely be:
– Inaccurate and/or incomplete
– Delayed
• Rumors can run rampant
• Intelligent community
• Event may involve risk communications
Key Considerations: Campus SecurityKey Considerations: Campus Security• You cannot treat patients if you do not have a safe
environment
• The crowds will come
Key Considerations: StaffingKey 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
Key Considerations:Key Considerations:Decision MakingDecision 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
Key Considerations:Key Considerations:Availability of VendorsAvailability of Vendors
• Multiple agencies may have agreements with the same vendors
• Vendors contact may need to be 24/7
Key Considerations:Key Considerations:Financial CostFinancial Cost
• Cost of event can rapidly escalate
• Details and documentation are needed for insurance and other potential sources of reimbursement
Key Considerations: Key Considerations: Regulatory AgenciesRegulatory 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
Key Considerations: DocumentationKey Considerations: Documentation
• Documentation of response to event is often uncoordinated and is generally the weakest link
• Many decisions may go undocumented
Disaster PhasesDisaster Phases
Mitigation PhaseMitigation Phase
• Critical systems on emergency power
• Redundant systems
• Construction and designs of space
Preparedness PhasePreparedness PhaseEmployee 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
Preparedness PhasePreparedness Phase
Equipment and Supplies
• Just-in-time inventories versus preparedness for greater than 72 hours
• Specialty equipment for capability events
• Mobility of equipment
Preparedness PhasePreparedness Phase
Staff Assignments
• Active and Reserve Teams– All employees are essential
• Systems for rapid activation and deployment
• Task Forces
• Strike Teams
Response PhaseResponse Phase
• Incident Recognition
• Notification
• Mobilization
• Incident Operations
• Demobilization
• Transition to Recovery
Response PhaseResponse 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
Recovery PhaseRecovery 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
Planning in Five TiersPlanning in Five Tiers
• Personal
• Department
• Organizational
• Participate in regional planning
• Participate in state and other organizations planning efforts
Tier One:Tier One:Personal and Family PreparednessPersonal 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
Tier Two:Tier Two:Department PlansDepartment Plans
• Every department is essential
• Each department needs to understand their preassigned role
Tier Three:Tier Three:OrganizationOrganization’’s Plans Plan
Details how the hospital responds as a system
• Hospital Command Center• Policies, Procedures, Emergency
Operations Plans
Tier Three: Tier Three: OrganizationOrganization’’s Plans Plan
• 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
In addition to the standard planning
Tier Four:Tier Four:Community and Regional PlanningCommunity 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
Tier Five:Tier Five:Planning with the State and Planning with the State and OrganizationsOrganizations
• 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
Business Continuity PlanningBusiness Continuity Planning
• Continued access to services
• Record preservation
• Business relocation plans
Planning ResourcesPlanning Resources
National Incident Management National Incident Management System (NIMS)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
NIMS:NIMS:Seventeen Implementation ActivitiesSeventeen 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
NIMS:NIMS:Seventeen Implementation Activities 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
NIMS:NIMS:Seventeen Implementation Activities 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
NIMS:NIMS:Seventeen Implementation Activities Seventeen Implementation Activities
# 13 All Hazard Exercise Program
# 14 Corrective Actions Reports
NIMS:NIMS:Seventeen Implementation Activities 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
National Incident Management National Incident Management Structure versus Hospital Incident Structure versus Hospital Incident Command StructureCommand Structure
• National committees collaborated• Reconciled discrepancies as HEICS (III) did not
– Include multi-agency cooperation
– Public information systems
– Proper incident command system language
Hospital Incident Command (HICS)Hospital Incident Command (HICS)(Version IV)(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
Hospital Incident Command (HICS)Hospital Incident Command (HICS)(Version IV)(Version IV)
• Seventeen internal and external events identified
– Incident Planning Guides
– Incident Response Guides
• Education Tools
• HICS Implementation Tools
The Joint Commission:The Joint Commission:Proposed Elements to Emergency Proposed Elements to Emergency Management StandardsManagement Standards
Need to think of critical capabilities beyond 72 hours
ResourcesResources
Agency for Healthcare Research and Quality• www.ahrq.gov
Best Practices for the Protection of Hospital Based First Receivers• www.osha.gov/dts/osta/bestpractices/firstreceivers
Emergency Management Principles and Practices for Healthcare Systems
• www.va.gov/emshq/page.cfm?pg=122
ResourcesResources
Hospital Incident Command (HICS IV)• www.emsa.ca.gov/hics
National Incident Management System• www.fema.gov/emergency/nims/index.shtm
SummarySummary
• Key challenges
• Phases of disaster
• Tier Planning
• Resources for Healthcare Planners
Raleigh, North Carolina
WakeMed Health & Hospitals