The Network: Supporting Healthcare Emergency Response

by Enhancing Partnerships

January 15, 2020 | WHCA Winter Conference

Aaron Resnick

“When a disaster hits, Americans rely on a fragmented healthcare system to miraculously mount a timely, cohesive, and effective recovery effort. Yet, the carefully orchestrated and sequenced medical responses to disasters lean on a disjointed health system.”

Closing the Seams: Developing an integrated

approach to health system disaster preparedness, Price Waterhouse Coopers, 2007

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Today’s Objectives

✓Explain who the Network is and what we do

✓Discuss regional healthcare preparedness and response operations

✓CMS Emergency Preparedness Rule

✓Focus on personal and facility / organizational preparedness

✓Discussion-based exercise (time permitting)

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We lead regional healthcare collaboration to effectively respond to and recover from emergencies and disasters.

What the Network does

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Serving the state’s medical epicenter

5.2 million residents

almost 70% of the state’s hospital beds

nearly 3,000 healthcare organizations

178,000 healthcare workers

public-private partnership

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Serving Our Community Before, During and After Emergencies and Disasters

✓Before disasters happen, we help prepare healthcare organizations and our response partners through planning, training and exercises, to build cutting-edge emergency response and recovery practices.

✓During a disaster, we coordinate information, resources and policy issues for the healthcare community and facilitate a collaborative response among healthcare and with other emergency response agencies.

✓After a disaster, we advocate for and support healthcare through the recovery process, while learning from our front-line experiences to develop and implement innovative life-saving response strategies.

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Power of the Whole: Who we are as a Coalition

Health care coalitions (HCCs) are groups of individual healthcare and response organizations – such as hospitals, EMS providers, emergency management organizations, public health agencies, and more – working in a defined geographic location to prepare for and respond to disasters and emergencies.

- HHS Assistant Secretary for Preparedness and Response

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NWHRN in Preparedness

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We build coordinated regional preparedness within the healthcare community by leading the development of and integration into regional and statewide plans and offering trainings, exercises, workshops to help build capabilities.

Before a disaster or emergency

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North District

West District

Region 4 HealthcarePreparedness Alliance

REDi Coalition

Northwest District

Central District

Tribal Nations

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District Model

NWHRN leads overall strategic direction and accountability

• Districts:

• Organize and coordinate work

• Honoring and fostering local and regional relationships while connecting communities

• Learning best practices through community engagement

• Does not replace local county level engagement and coordination

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Impact Areas

We commit our expertise and our resources to prepare and support a unified and coordinated

healthcare community that will:

Be Resilient: Learn and adapt to prevent, withstand and mitigate impacts of future emergencies

Sustain Care: Continue to provide patient care during an emergency

Surge Care: Manage a surge in demand for patient care during an emergency

Recover: Restore operations to meet patient care needs after an emergency

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Planning

To Support all Healthcare

• Healthcare Systems Coordination in a Response

• Situational Awareness

• Resource Coordination

• Patient Movement and Patient Tracking

• Crisis Standards of Care

• Acute Infectious Disease

• Hazard Vulnerability Assessment

• Medical Surge & Pediatric Planning

• Healthcare Supply Chain

Of Interest to ParticularPartners

• Long-term Care Advisory Group

• Supply Chain AdvisoryGroup

• Ambulatory Care Workgroups

• Community Surge and Alternate Care Systems

• Disaster Clinical Advisory Committees (By District)

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PLANNING Example

Community Surge Planning

All Coalition: Patient Movement, Patient Tracking, Healthcare Surge Planning, Community Alternate Care Systems planning

Local Implementation: Spurs local EMS, Emergency Management, and Healthcare discussions, mass casualty plans review, identifying community care centers, and reviewing surge capacity challenges

Outcome = Stronger and cohesive response capabilities and bolstered surge capacity

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Training and Exercise

Training• High Consequence Infectious

Disease (annually)

• Disaster Clinic Videos (online)

• Business Resiliency Workshop (in-person)

• Training and Exercise Workshop (in-person)

• Disaster Resiliency Training (in-person)

• Incident Command System for Healthcare (in-person)

Exercises

• Host two annual community exercises for all Coalition partners

• Coalition Surge Test

• High Consequence Infectious Disease

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Training Example

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Community Exercise Opportunities

Host 2 exercise opportunities per year:

• Communications and coordination focus

• Can participate from their facility

• Can create their own additional objectives

• Provide an opportunity for a community level exercise

Dates:

• December 11, 2019

• June 3, 2020

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Dec. 11, 2019 FallEx

Focus: Test coalition communications, provide an opportunity for partners to test their communication plans, and

support members updating their contact information.

147 Participants: 14 of 15 counties; 2 Tribal jurisdictions; 10+ communications

systems used

• 15 Hospitals

• 91 Non-hospital healthcare

• 3 Dialysis facilities

• 5 Emergency management agencies

• 4 Home health/hospice

• 7 Tribal clinics

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Mapped Connections

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Information Management and Response

Alerts Situational awareness

WATrac

WASecures Redundant Communications

Information Management and Response

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NWHRN Structure in Response

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During a disaster we support by providing:

• Community-sourced critical situational awareness briefs for healthcare

• Emergency alerts

• Emergency patient tracking

• Healthcare resource sharing and coordination

• Coordination of regional healthcare operational response and policy

Response | Regional disaster or emergency

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Healthcare Response

Healthcare Emergency Coordination Center (HECC)

The Network’s HECC serves as a single point of contact for coordination of the

healthcare system’s response to an emergency or disaster in our 15-county and 25 tribal nation service area. The

HECC is a means of coordination, rather than a physical place, and therefore can be activated in either a physical location or virtually, based on the needs of the

situation.

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Amtrak Train Derailment

• December 18th 2017, 7:33 a.m., Amtrak passenger train derailed as it was crossing Interstate 5 in Dupont, WA

• 3 passengers killed and 62 injured

• 8 additional people were injured in vehicles on I-5

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Some Key Takeaways

Takeaway Planning

Responding to a legislated transportation incident will be different.

• Many roles and responsibilities normally performed by local jurisdictions are the role of the carrier and/or NTSB

• Education and cross training with Amtrak and NTSB on response roles

Partners benefit from streamlining coordination and information sharing with Amtrak and NTSB

• Share key contacts • Anticipate what information may needed and when • Outline information sharing parameters in advance and

provide training • Recognize that information needs will go beyond family

reunification

Patient tracking will be a significant response element

• Multi-jurisdictional coordination• Dedicate appropriate human resources• People managing patient information will face incredible

demands and pressure for information: prepare and support them25

Support in Action

Nursing Home Water Outage Event

(June 2019)

Measles and IG Support

(May-June 2019)

Healthcare Capacity Situational Awareness

(March 2019)

Telecom Outage Situational

Awareness Support (March 2019)

Winter Storm Non-Medical Resource

Support

(February 2019)

Viaduct Closure Situational Awareness

(January 2019)

9-1-1 Communications

Outage

(Dec 2018)

Anchorage Earthquake/Potential

NW Impacts

(Nov 2018)

Canadian Natural Gas Disruption/NW

Impacts

(Oct 2018)

Kitsap Hospital Phone Outage

(June 2018)

Train Derailment

(Dec 2017)

Seattle Aurora Bus Crash

(Sept 2015)

Support in Action

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Questions?27

CMS Emergency Preparedness Rule Update & your facility / organization

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CMS Background

➢ 11/2017: Initial CMS ‘Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers Final Rule’ Covers most provider types

➢ 9/2019: CMS published updated Final Rule revising some of the emergency preparedness requirements.

➢ Applicable to all 17 provider/supplier types

➢ Effective November 2019

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CMS Focus Areas

➢ Emergency plan

➢ Communication plan

➢ Policies & procedures

➢ Staff training

➢ Facility testing

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CMS Changes

➢ Emergency plan: reviewed and updated at least every 2 years

➢ Policies and procedures based on emergency plan: reviewed and updated at least every 2 years ➢ Totally new: “If the emergency

preparedness policies and procedures are significantly updated, the [facility] must conduct training on the updated policies and procedures.”

➢ Comms plan: reviewed and updated at least every 2 years

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CMS Changes contd.

➢ Training: provide emergency preparedness training at least every 2 years (previously annually).➢ Maintain documentation of all emergency

preparedness training

➢ Testing: every 2 years ➢ Participate in a full-scale exercise that is

community-based every 2 years; or…

➢ Conduct an additional exercise at least every 2 years, opposite the year the full-scale or functional exercise

➢ Analyze the [facility's] response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the emergency plan, as needed.

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Your Role in Preparedness & Response

✓Offense starts with defense

✓It’s not the plan, it’s the planning

✓Do something…now

✓Speak up (early and often)

✓Communication…will be awful

✓Emergency preparedness = process improvement

✓Are YOU prepared?

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Facilitated Discussion

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Ground Rules

• Keep side conversations to a minimum

• Silence cell phone ringers and pagers

• Parking lot and documentation of themes and gaps

• Respect the facilitator and fellow participants

• Fight the problems and not the scenario

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It is Wednesday, January 15th. There has been a light dusting of snow all day with temperatures below 30 degrees. The National Weather Service detects a large cold front moving toward western Washington. Weather officials issue a winter storm warning for Western Washington and urge citizens to prepare for a long storm that will likely begin in the next 24 hours. Snow fall will mix with freezing rain and turn to ice, leading to ice accumulation between ½ to 1 inch. We are advised to expect widespread downed trees, power loss, and treacherous road conditions.

Scenario

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Discussion Questions

What key actions are you doing to plan ahead for the approaching storm?

• Yourself?

• Facility/organization/colleagues?

• Clinical?

• Patients/residents?

What other partners might you be reaching out to in advance of the storm?

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• By 6:00 a.m. Saturday, fallen wet snow has now turned into 3” ice accumulation causing downed trees and powerlines

• Gusts up to 40 mph winds are reported in the area

• Widespread power outages are reported including numerous healthcare facilities (hospitals, long-term care, dialysis, clinics, etc.) and private residences (impacting home health, etc.)

• Emergency vehicles are struggling to respond to calls

Situation Update

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Source: Q13 News

Discussion Questions

What are your current concerns and priorities?

• Yourself?

• Facility/organization/colleagues?

• Clinical?

• Patients/residents?

Who might you want to coordinate with across your area to support operations?

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• It has now been 12 hours without power, a total of 48 hours in severe weather conditions

• Due to the extent of damage throughout the area, power may not be restored for another 72 hours

• Fuel providers are inundated due to widespread impact

Source: piedtype.com/2016/03/16/i-hate-power-outages/

Situation Update

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Eventually the storm will end

Discussion Questions

What are your organization/agencies concerns about the prolonged weather situation? Are there specific resources you are most concerned about? How does the weather outlook change your response?

• Yourself?

• Facility/organization/colleagues?

• Clinical?

• Patients/residents?

What are your organizations/agencies plans for returning to normal operations following the storm?

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End of Exercise & Hot Wash

7brainstorming.blogspot.com

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Questions?

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CONTACT US:

PREPARE. RESPOND. RECOVER.

@TheNetworkNWHRN

www.nwhrn.org

Thank You!

Aaron Resnick

425.988.2898

Aaron.Resnick@nwhrn.org