Hospital Emergency Operations Plan Workshop

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1 Hospital Emergency Operations Plan Workshop Updating the Hospital and Rural Medical Center EOP for the Use of Volunteers in Medical Surge AGENCY LOGO

2 Acknowledgements: This workshop was developed by the Mesa County Health Department as part of the National Association of City and County Health Officials (NACCHO) Advanced Practice Centers (APC) Program (Blueprint Project.) It takes into account new information in light of: Emergency Support Function 8 (ESF8) Planning; Homeland Security Exercise and Evaluation Program (HSEEP); Hospital Incident Command System (HICS); and National Health Security Strategy (NHSS). California Emergency Medical Services Authority s Clinic Emergency Preparedness Project is acknowledged for providing a framework from which a Hospital Emergency Operations Plan template could be created. Contributions of Family Health West Hospital, Fruita, Colorado in the review and revision of this information.

3 Objectives Participants will understand the importance and process needed for All Hazard emergency operations planning in Hospitals. Participants will understand the phases of Emergency Management. Participants will understand how an incident command leadership structure is an integrated component of the Hospital emergency operations planning. Participants will understand the major components needed to write an effective hospital emergency operations plan. Participants will understand why volunteer use in medical surge is critical to writing an effective plan for rural hospitals.

4 Why is this an issue today? Terrorism Disasters Other What keeps you awake at night? What often happens? What are you unprepared for? What can be done to plan for these situations? I knew this would happen! FEMA News Andrea Booher

5 How does terrorism/disasters affect the healthcare system? Produces mass casualties Murrah Building in Oklahoma City Suicide bombers in Middle East Olympic Park Bombing in Atlanta Twin Towers in New York Hurricane Katrina Virginia Tech School Shooting Mexican Hat, Utah Bus rollover (AP-Associated Press)

6 How does terrorism/disasters affect the healthcare system? Produces a redirection of resources and change in preparedness activities Smallpox planning for hospitals and health departments H1N1 Strategic National Stockpile (SNS) vaccines and drug caches, mass dispensing plans Surge capacity planning Agro-chemical/oil and gas chemical regulatory compliance issues

7 Haven t we done this before? Pre-1950 s Civil Defense Era. Fire Protection Era (1960 s-1970 s) Disaster Planning Era (1970 s) Emergency response for hospitals used to mean a disaster plan, fire plan, utility failure plan. Current (post- 9-11) all-hazards expectations (public/partners): community integration, address all aspects of patient care issues, records and data tracking/security, supply status tracking, surge resource tracking. Result: more complex planning due to a more complex response.

8 Hospital planning & preparedness County Mass Casualty Plan Surge capacity planning (H1N1) Aligns with EOP plans at city/county level NIMS/ICS compliance Homeland Security compliance funding HPP deliverables LPHA grants and deliverables

9 Hospital planning & preparedness State Hospital Associations: Emergency planning, HSEEP, state-level hospital coordination systems and heightened expectations for increased integration in surge capacity and response. Tendency towards credentialing and accreditation: Credentialing for surge staff/volunteers National trends toward accreditation: schools and health departments. What will be the future relationship between CMS-CoP s and Joint Commission Standards?

10 Chemical incidents planning considerations What measures must be planned in advance to safely evacuate/ treat patients contaminated with toxic chemicals? Does your hospital have the capability to decontaminate? What antidote medications might be important if a chemical terrorist attack occurred?

11 Definitions Capacity: amount or availability of resources and ability of staff, training, and depth. Capability: type of services in terms of emergencies, partnerships, and readiness. Vulnerability: susceptibility to failure due to inadequate resources, training, equipment, or planning. The goal is to decrease vulnerability. Readiness/Preparedness: a direct result of the adequacy of planning and the potential of those plans to create results in the area of training and resources.

12 What is an incident? Any event that overwhelms existing resources to deal with that event. Weather tornadoes, flooding, severe storms Terrorism Infrastructure failures affecting operations for a prolonged period Hazardous materials incident Large volume of patients Pandemic

13 Incident implications Transportation Electrical Telephone Water Fuel Structural Communications

14 Incident implications Incidents restrict and overwhelm resources, communications, transportation and utilities. Individuals and communities are cut off from the outside support.

15 What is your goal in an incident? RESPONSE manage victims (treat, triage, transfer, disposition). RECOVERY operational, financial, and return to normal operations.

16 All Hazards approach to planning A conceptual framework for organizing and managing emergency protection efforts.

17 Who is involved in All Hazard response efforts? Federal Tribal State Local Emergency Management Public Works Fire/Rescue EMS Hospitals Public Health

18 All Hazard steps Planning Training Exercising Policies & procedures Resource requirements Resource upgrade

19 Major Incident Operations Disruption of normal process of health care delivery Displacement of dayto-day patient management of casualties Distraction of health care providers from usual workflow Addition of mental health burden Disruption of supply chain Disruption of communication systems Fiscal disruption

20 Emergency Operations Plan Introduction Procedures & Operations HICS Job Action Sheets Specific Departmental Tools Forms/Resources

21 Emergency Operations Introduction Plan-Part 1 General overview of <Hospital Name> and facilities/support. Purpose/Policy Provide continuous quality improvement. Provide coordination and integration. Scope Addresses Joint Commission and CMS Conditions of Participation (CoPs.)

22 All Hazards Emergency Mitigation: Operations Removing/lessening the conditions that lead to incidents. Preparedness Readiness for the unavoidable. Response Decreasing the severity/intensity of an incident. Recovery Getting back to normal.

23 Mitigation Hospital Hazard Vulnerability Analysis (HVA) Multiple Tools Available

24

25

26 Mitigation Hazard identification Hazard Assessment (HVA) Structural code compliance Equipment and maintenance

27 Plan development Training courses Exercises Employee education and competencies Public education Preparedness

28 Response Alerting Assessment Mobilizing- Healthcare partners and ESF8 Implementing plan Activate systems (HICS, EOC) Control, Set priorities- Infection etc. Communication and situational awareness

29 Recovery Those activities undertaken by a hospital after an emergency or disaster occurs to restore minimum services and move towards longterm restoration.

30 Recovery Return to normal Detailed damage assessment Care and shelter continues Funding assistance Remove debris

31 Part 2- Specific procedures & operations Patient Flow Triage Treatment Areas Security Activities Entry & Egress Visitors Access

32 Procedures & operations Communications Telephone Back-up systems Radio (VHF/800) Satellite phone Walkie Talkies HAM radio Fax

33 Procedures & operations Patient admissions, triage, disaster tags, registration process Elective procedures Discharge of patients

34 Procedures & operations News Media Public Information Officer (PIO) Strategic location Joint Information Center (JIC)

35 Procedures & operations Hotline Family of victims, visitors, outpatients

36 Procedures & operations Supplies & equipment Essential supplies Pharmaceuticals Medical supplies Equipment Food Water Linen Utilities

37 Procedures & operations Morgue DOAs Others that expire

38 Procedures & operations Evacuation Authority Transportation Location Evacuation routes Practice/Test

39 Procedures & operations Continuing and/or reestablishing operations Off site care (Alternate Care Sites, or ACS)

40 Procedures & operations Essential utility alternatives Electrical Water Medical gas Waste disposal Fuel

41 Procedures & operations Isolation & decontamination Plan & procedure Equipment Training

42 Procedures & operations Orientation & education Annual plan evaluation

43 Emergency Operations Plan Part 3- HICS Job Action Sheets

44 HICS Job Action sheets Incident Command Operations Logistics Finance and Administration Planning Others

45 HICS Job Action sheets One for each position. Embodies title, mission/function and duties. Adjusted to meet hospital needs.

46 Emergency Operations Plan Part 4 Specific department tools

47 Specific departmental plans Emergency Department Security Maintenance Nursing floors Admission policy & registration Emergency triage Evacuation Communications Emergency Operations Center

48 Emergency Operations Plan Part 5-forms/resources

49 Help drive positions Forms/Resources Documentation aid Financial recovery Decreases liability Enhances & tracks communication

50 Emergency Management A successful interface needs: Planning Training Exercising

51 According to Joint Commission 1 : Emergency Management is now its own accreditation manual chapter. All Standards and Elements of Performance from 2009 are incorporated into the 2010 Emergency Management chapter. This new chapter contains some standards that were in HR, EC and MS sections. Critical Access Hospital requirements are similar to other types of hospitals in most counties. 1

52 Emergency Operations Plan Emergency Operations Plan (EOP) describes response procedures: Written plan Capabilities to self-sustain for up to 96 hours [EM ] As well as Recovery strategies and surge capabilities. Initiation and termination of response and recovery phases. Defines authorities and community relationships Alternative care sites, alternate EOC. Actual implementation is documented.

53 Emergency Operations Plan Plan Structure

54 Emergency Operations Plan Addresses Twelve Critical Access Hospital Joint Commission Components: Planning [EM ] The EOP [EM ] Communication [EM ] Resources & Assets [EM ] Safety & Security [EM ] Staff responsibilities [EM ] Utilities Management [EM ] Patient, clinical & support activities [EM ] Volunteer Management [EM ] Volunteer Credentialing [EM ] HVA and Evaluation [EM ] Plan Evaluation [EM ]

55 Emergency Operations Plan EM Planning (8 measures) The critical access hospital engages in planning activities prior to developing its written Emergency Operations Plan. EM The Plan (8 measures) The critical access hospital has an Emergency Operations Plan. EM Communication (15 measures) As part of its Emergency Operations Plan, the critical access hospital prepares for how it will communicate during emergencies. EM Resources & Assets (9 measures) As part of its Emergency Operations Plan, the critical access hospital prepares for how it will manage resources and assets during emergencies.

56 Emergency Operations Plan EM Safety and Security (9 measures) As part of its Emergency Operations Plan, the critical access hospital prepares for how it will manage security and safety during an emergency. EM Staff Responsibilities (9 measures) As part of its Emergency Operations Plan, the critical access hospital prepares for how it will manage staff during an emergency. EM Utilities Management (7 measures) As part of its Emergency Operations Plan, the critical access hospital prepares for how it will manage utilities during an emergency. EM Patient, clinical & support activities (8 measures) As part of its Emergency Operations Plan, the critical access hospital prepares for how it will manage patients during emergencies.

57 Emergency Operations Plan EM Volunteer Management (9 measures) During disasters, the critical access hospital may grant disaster privileges to volunteer licensed independent practitioners. EM Volunteer Credentialing (9 measures) During disasters, the critical access hospital may assign disaster responsibilities to volunteer practitioners who are not licensed independent practitioners, but who are required by law and regulation to have a license, certification, or registration. EM Vulnerability Assessment and Evaluation (3 measures) The critical access hospital evaluates the effectiveness of its emergency management planning activities. EM Evaluating the Plan (17 measures) The critical access hospital evaluates the effectiveness of its Emergency Operations Plan.

58 Use of volunteers in medical surge 18 Elements of Performance (EP s) of Joint Commission Standards address use of volunteers. Medical Surge exercises that are HSEEPcompliant must address the use of volunteers in surge activities. How deep is your hospital in each staff skill area? By department? Supervisor? Facility? Occupation? Specialty?

59 For Volunteer Licensed Independent Practitioners and Volunteer Practitioners Section 1: Disaster Privileges Section 2: Credentials Verification Section 3: Volunteer Oversight Section 4: Cessation of Volunteers

60 Use of volunteers What can they do? What can t they do, unless supervised? What shouldn t they do? Who can they be? Can spontaneous unassigned volunteers ( SUVs ) be used? What are the most likely scenarios? Who can and cannot supervise volunteers?

61 Review: The Emergency Operations Plan Covers all of the All Hazards phases of Emergency Management Mitigation Planning Response Recovery As well as communications with ESF8 partners

62 Where do I start? <Hospital Name> has: Emergency Operations Plan (a base plan to start with). Departmental Plans (ED, Triage, Admissions, Evacuation, Security. <hospital point of contact> to receive the plans electronically.

63

64 Center for HICS Education & Training- Guidebook Training Resources Job Action Sheets Forms Internal (13) & External (14) Scenarios

65 <Presenter POC information>

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