STATE OF LOUISIANA. Health and Human Services Administration (HHS) HOSPITAL PREPAREDNESS PROGRAM

Transcription

1 STATE OF LOUISIANA Health and Human Services Administration (HHS) HOSPITAL PREPAREDNESS PROGRAM Needs Assessment Survey September 2009

2 TABLE OF CONTENTS Section Page Inventory Overview Introduction 3 Purpose 3 Survey Design & Distribution 3 Acknowledgements 3 Instructions 4 Timelines 4 Frequently Asked Questions 4-5 Inventory Sections Section A: Hospital Demographics 6 Section B: General Emergency Preparedness and Planning 7-12 Section C: Surge Capacity: Laboratory Section D: Surge Capacity: Surveillance Section E: Surge Capacity: Beds, Isolation, and Healthcare Personnel Capabilities Section F: Surge Capacity: Pandemic Influenza Section G: Surge Capacity: Pharmaceutical Caches Section H: Surge Capacity: Decontamination & Personal Protection Equipment Section I: Surge Capacity: Communications & Information Section J: Pediatric Trauma

3 INTRODUCTION Louisiana is requesting your hospital s cooperation and participation in an important survey to assess hospitals preparedness to respond to a large scale disaster such as a bioterrorism incident, hurricane or potential epidemic. PURPOSE The following survey is being conducted to meet the federal requirements of the Health and Human Services (HHS) Hospital Preparedness Grant Program. The survey will be used to assess hospital s current emergency management capabilities and to evaluate the readiness of the State of Louisiana. Completing this survey is a necessary part of the HHS grant and will positively impact your hospital s allocation. The responses of this survey will also be used to complete the end of year report for the HHS grant. Therefore, submitting a completed survey is strongly encouraged. Please be reassured that your responses will be held strictly confidential. SURVEY DESIGN & DISTRIBUTION The hospital survey has been designed so that it can be separated into sections for distribution to individual departments for completion. Please note that this survey is not intended to serve as a formal template for hospitals preparedness plans. Rather, the questions are intended to provide the opportunity for your hospital s input into the regional and state planning processes. The presence (or absence) of a question in this survey concerning any specific component of preparedness is not intended to imply that the element should or should not be part of any individual hospital s preparedness efforts. The questions contained in this survey are intended to assist Louisiana in assessing the state of preparedness of Louisiana hospitals. We urge you to complete this survey promptly to ensure that the needs of your hospital and the community it serves are represented in the planning and accompanying funding allocations. Each section of the survey should take approximately minutes to complete. We thank you in advance for your cooperation and assistance. ACKNOWLEDGEMENTS We wish to thank the following groups for assisting in the development of the Needs Assessment: HHS: Education and Training Subcommittee, Surge Subcommittee, Pharmacy Subcommittee, Surveillance Subcommittee, Laboratory Subcommittee, and Emergency Medical Services Subcommittee and Designated Regional Coordinators. Development of the Needs Assessment is also credited to the following individuals: Phillip McCrory, RPh; Allyn Whaley; Raoult Ratard, MD; Marcia Fries; Coletta Barrett, RN; Asha G. Smith, MPA; Rosanne Prats, MHA; ScD; Jimmy Guidry, MD; James Aiken, MD; Tom Arnold, MD; Mark Ryan, RPh; Doris Brown, RN; Knox Andress, RN; Anjanette Hebert; Stacy Hall; Evon Smith; Kendra Powell, MPA; Lauren Barleycorn; Henry Yennie; and Amina Assefa. 3

4 INSTRUCTIONS Individual sections of this survey may require different hospital staff to complete. To accomplish this task, we recommend the following steps and timeline: STEPS: 1. Identify one individual (it is recommended that this be the HHS Grant Coordinator or Emergency Manager) within the hospital who will be responsible for coordinating the completion of the survey and returning it to Louisiana Hospital Association, Research & Education Foundation. 2. Upon receipt of the survey, the coordinator should distribute the survey to the appropriate individuals within the hospital. The survey has been designed so that it can be broken down, copied and distributed to individual departments of the hospital. (Week 1) 3. The coordinator should check for completion and any discrepancies that should be resolved prior to submitting results. (Week 2) 4. The survey coordinator should log onto the Louisiana Hospital Association website at and click on HHS Needs Assessment Survey under the What s New? section of the homepage to submit your final responses. If you have any questions, please call and ask for HHS Emergency Preparedness Staff: Asha G. Smith, MPA (asmith@lhaonline.org); Kendra Powell, MPA (kpowell@lhaonline.org); or Lauren Barleycorn (lbarleycorn@lhaonline.org). (Week 3) TIMELINES Surveys will be distributed to hospitals on the week of September 7, Completed surveys must be returned to the LHA by October 9, This deadline can not be extended. All licensed facilities (acute care, long term care, psychiatric, rehabilitation, etc.) are requested to submit a completed survey on time to qualify for allocation points and to have their information included in the final regional and state planning processes. It is suggested that the survey coordinator require all sections to be completed by individual hospital departments no later than October 2, This will allow time for the coordinator to review answers, ensure completion and return final survey results. FREQUENTLY ASKED QUESTIONS What is the purpose of completing this survey? The information will be used to develop Statewide and Regional Hospital emergency management plans. The information will also help Louisiana obtain, allocate and distribute grant dollars. How will the information be used? The information will be used to perform a detailed gap analysis for hospital preparedness planning; to assist in budget funding allocations; and to identify potential gaps that require time and attention. 4

5 Will the responses be kept confidential? Yes, the responses will be confidential. Specific hospital locations will be deleted from the database upon conclusion of the assessment. The only information provided to the state may be subject to the Freedom of Information Act. The Designated Regional Coordinator (DRC) and the HHS staff will have access to all detailed information for planning purposes and for response efforts that may utilize regional information during a disaster or an imminent event. There are several places in the survey where the respondent is asked if they would like to receive additional information (i.e. ESAR VHP, etc.) If the respondent indicates in the affirmative, that they would like to receive more information, we will forward the list of hospital names to the appropriate agency. 5

6 SECTION A: HOSPITAL DEMOGRAPHICS Hospital Name (formal name): Street Address: City: Parish: Region Telephone Number: Fax: Person responsible for Survey Coordination: Telephone Number of Survey Coordinator: Address of Survey Coordinator: Number of Licensed Beds: Number of Specialty Beds you currently have at your facility? (Please complete all that apply.) Adult Intensive Care Beds Medical/Surgical (Med Surge)/Telemetry Beds Burn Beds Pediatric Intensive Care Beds Pediatrics Beds Neonatal Intensive Care Beds Neonatal Beds Psychiatric Beds Operating Room Beds Negative Pressure Beds Rehabilitation Beds Emergency Department Beds Total Number of Specialty Beds (This number should equal the sum of the number of beds listed above) Type of Hospital (choose one) Critical Access Hospital General Medical Surgical Hospital with 24/7 Emergency Department Psychiatric Hospital Rehabilitation Hospital Long Term Acute Care Hospital Specialty Hospital with 24/7 Emergency Department Specialty Hospital without 24/7 Emergency Department Hospital Components (check all that apply) Heliport Location of Facility (choose one) Free Standing Facility Burn Center Facility within a Facility Total ER Visits from January 1 December 31, 2008: 6

7 SECTION B: GENERAL EMERGENCY PREPAREDNESS & PLANNING EXPLANATION AND DIRECTIONS Much work has been done to develop the emergency response system for Louisiana hospitals. Fundamental to this framework is the response of each individual hospital and those that are developed in cooperation with other hospitals in the region. The purpose of this section is to identify your individual facility s current planning capabilities and the relationship with the region. It is suggested that your emergency preparedness director complete this section. CURRENT CAPABILITIES 1. Has your facility developed an Emergency Operations Plan (EOP) (i.e. plans/protocols for triage and treatment of critical patients* beyond your hospital s normal capacity)? Yes No Don t Know 2. Does your Emergency Operation Plan address: Protocols for biological agents? Yes No Don t Know Protocols for chemical agents? Yes No Don t Know Protocols for nuclear agents? Yes No Don t Know Protocols for radiological agents? Yes No Don t Know Protocols for pandemic flu? Yes No Don t Know 3. Under what circumstances will the Emergency Operations Plan be activated (Choose one)? 2-5 critical patients* 6-10 critical patients* critical patients* 21 or more critical patients* Don t Know * Critical patients are defined as acute care patients requiring extensive treatment resources such as intensive care or other specialized care. 4. Does your Emergency Operations Plan actively engage key response partners to indicate expected roles in a response? Yes No Don t Know 5. How often is the Emergency Operations Plan evaluated and revised? Annually Every two years Other (please specify) 7

8 6. In your opinion, which of the following does your hospital Emergency Operations Plan adequately address (check all that apply): Surge Capability for the hospital to surge within walls for beds, equipment, supplies, and health care personnel. Isolation ability for the hospital to expand isolation capabilities for a surge of patients. Emergency Medical Services ability to triage and transport patients in the event of a mass casualty event. Situational Knowledge ability to implement regional plans with hospitals, increase awareness and communicate in the event of a mass casualty incident. Trauma - ability to take care of severely injured adult and pediatric patients. 7. Does your hospital know who the Designated Regional Coordinator (DRC) is for your Region? Yes No Don t Know 8. Please provide the name the Designated Regional Coordinator: 9. In your opinion, are hospitals well integrated in your community in planning and preparing for significant emergency events? Yes No Don t Know 10. In your opinion, are hospitals well integrated with other emergency response organizations in your community in planning and preparing for significant emergency events? Yes No Don t Know 11. Has your hospital assessed its workforce to determine their level of emergency preparedness and response within the past year? Yes No Don t Know 12. Do staff members and contract employees receive training in emergency preparedness during new employee orientation? Yes No Don t Know 13. Does your hospital provide annual continuing education for emergency preparedness and response? Yes No Don t Know 8

9 14. Does your hospital provide educational opportunities to the medical staff on implementation of your Emergency Operations Plan? Yes No Don t Know 15. Does your hospital staff need additional basic training for emergency preparedness? 16. COMMENTS: National Incident Management Systems 17. Has your hospital formally adopted the National Incident Management System (NIMS) principles and policies (or its equivalent) as part of its Emergency Operations Plan? Yes No In process 18. Please indicate the number of personnel within your facility that have been identified to take as well as those that have taken the following NIMS courses. (Please do not leave blank.) IS-100 Introduction to Incident Command System (ICS) IS-200 Incident Command System for Single Resources and Initial Action Incidents IS-300 Intermediate Incident Command System (ICS) IS-400 Advance Incident Command System (ICS) IS-700 NIMS, An Introduction IS-800 National Response Framework, An Introduction Number of personnel Identified Number of personnel that have taken course 18a. Does your hospital have a system for tracking National Incident Management System (NIMS) training for appropriate personnel? Yes No Don t Know 19. Does your hospital exercise the Incident Command Structure (ICS) component of their EOP during drills and exercises? Yes No Don t Know 19a. If yes, does your hospital emergency operations plan employ the Incident Command System by designating positions of: Incident Commander? Yes No Don t Know Operations Officer? Yes No Don t Know Logistics Officer? Yes No Don t Know Planning Officer? Yes No Don t Know Finance Officer? Yes No Don t Know Public Information Officer? Yes No Don t Know Safety Officer Yes No Don t Know 9

10 20. Has your hospital identified a Point of Contact within the facility to be notified of a significant event in the community that may impact hospital operations? Yes No Don t Know 20a. If yes, are there measures in place to: Ensure their awareness? Yes No Don t Know Provide ongoing communications training? Yes No Don t Know Ensure coordination with local government and other key response partners? Yes No Don t Know Ensure coordination with health officials? Yes No Don t Know 21. Has your hospital identified a person most likely to serve as the Public Information Officer (PIO) that coordinates the dissemination of public health and clinical threat information with partner agency PIOs and the Joint Information Center? Yes No Don t Know CONTACT INFORMATION If yes, please provide your PIO s contact information below. 21a. Most Likely PIO 21b. Most likely Backup PIO Name Name Office Office Cell Cell Pager Pager Fax Fax 21c. If yes, are there measures in place to: Ensure their awareness? Yes No Don t Know Provide ongoing communications training? Yes No Don t Know Ensure coordination with local government and other key response partners? Yes No Don t Know Ensure coordination with health officials? Yes No Don t Know 22. Has your hospital participated in an exercises or actual incidents this year? Yes No Don t Know 10

11 22a. If yes, please complete the table below. Type of Event (Circle One) Tabletop/Desktop Exercise Functional Exercise Full-Scale Exercise Drill Actual Real Event Description of Event (Circle One) Chemical Biological Radiological Nuclear Explosive Natural Disaster Effective Month and Year of Drill or Actual Event (example: May 2009) After Action Filed (Circle One) Yes No Don t Know Developed Corrective Actions Plans? (Circle One) Yes No Don t Know Tabletop/Desktop Exercise Functional Exercise Full-Scale Exercise Drill Actual Real Event Chemical Biological Radiological Nuclear Explosive Natural Disaster Yes No Don t Know Yes No Don t Know Tabletop/Desktop Exercise Functional Exercise Full-Scale Exercise Drill Actual Real Event Chemical Biological Radiological Nuclear Explosive Natural Disaster Yes No Don t Know Yes No Don t Know 23. Does your hospital need additional training on the National Incident Management System (NIMS)? Yes No Don t Know 24. If there are questions concerning your response, who may we contact for clarification? Name: Title: Office Number: 11

12 Evacuation and Sheltering in Place Plans 25. Does your hospital have a medical evacuation plan? 25a. If so, has it been drilled or exercised? 26. Does your hospital have a sheltering in place plan? 26a. If so, has it been drilled or exercised? 12

13 SECTION C: SURGE CAPACITY: LABORATORY EXPLANATION AND DIRECTIONS One of the integral steps in developing a comprehensive laboratory plan for the region is to define the goal. The Health and Human Services (HHS) hospital preparedness grant has established the following mandated goals: Laboratory: Implement a hospital laboratory program that is coordinated with current laboratory capacity efforts, and which provide rapid and effective hospital laboratory services in response to terrorism and other public health emergencies The purpose of this section is to collect an updated assessment of laboratory capabilities that currently exists in each hospital. This information is helpful because it will allow us to target training to the hospitals needs. It will also allow information to be disseminated to all hospital laboratories during emergency situations. It is suggested that your laboratory department director complete this section. CURRENT CAPABILITIES 1. Does your hospital outsource laboratory services? Yes No Don t Know 1a. If yes, what is the name of the company that provides your laboratory services? Name: 2. Do you perform bacterial cultures? Yes No Don t Know 3. Do you perform viral testing? Yes No Don t Know 4. Is your hospital laboratory familiar with the Laboratory Response Network (LRN)? Yes No Don t Know If not, we encourage you to contact Kerri Gerage at the Office of Public Health, Laboratory Services at or Kerri.Gerage@la.gov. 4a. If you responded no, what relationship does your hospital have the with Office Public Health laboratory? 5. Does your hospital have an integrated laboratory Bioterrorism response plan? 13

14 Yes No (skip to question 7) Don t Know 6. If yes, does your laboratory plan contain a Bioterrorism Specimen transport plan (Guidelines for shipping and handling of infectious materials consistent with the Office of Public Health) Yes No Don t Know 7. Does your laboratory provide packaging and shipping training for lab staff? Yes No Don t Know 7a. If not, how does your staff receive training? 8. Do you have appropriate shipping containers (that meet guidelines per the Office of Public Health) for specimens? Yes No Don t Know 8a. If yes, how many 9. Does your hospital laboratory provide Bioterrorism training (i.e. biological, chemical, radiological, and nuclear) to its laboratory employees? Yes No Don t Know 9a. If yes, how many hours per year? 1-3 hours 4-6 hours 7-9 hours 10 or more 9b. If no, does your hospital require its laboratory employees to receive Bioterrorism training (i.e. biological, chemical, radiological, and nuclear)? Yes No Don t Know 10. Does your hospital provide Personal Protective Equipment (PPE) for the lab? Yes No Don t Know 11. Are your hospital laboratory employees trained in the protocols for referral of clinical samples and associated information in accordance with the Center for Disease Control (CDC) Focus Area and Critical Benchmarks associated with laboratories? Yes No Don t know 11a. If yes, how many employees? 12. Does your hospital laboratory have a certified Class II Biological Safety Cabinet? Yes No Don t know 14

15 12a. If yes, how many? or more 13. What type of air pressure(s) does your hospital laboratory have? (Please check all that apply) Negative-pressure Positive-pressure Alternating-pressure Other: Explain 14. Please indicate the number of hospital-based laboratory employees in each category (If response is none or zero, please mark 0 ). Medical Technologist Lab assistants Other 1 (identify) Other 2 (identify) Other 3 (identify) 15. Are your hospital laboratory Information Technology capabilities Centralized? Yes No Don t know 15a. If yes, what system are you using? 16. Are your hospital laboratory Information Technology capabilities Stand-Alone? Yes No Don t know 16a. If yes, what system are you using? 17. Does your laboratory staff need additional laboratory training? 17a. If so, what type of training is needed? 18. Is your laboratory familiar with the proper procedures for shipping Influenza samples to the State Laboratory? 19. Do you know who to contact or where to obtain updated information about Influenza testing? If not, we encourage you to visit or contact Kerri Gerage at the Office of Public Health, Laboratory Services at or Kerri.Gerage@la.gov. 15

16 20. Please complete your Laboratory Manager s contact information. Name Pager Office Fax Cell 21. Please complete your Assistant Laboratory Manager s contact information. Name Pager Office Fax Cell 16

17 SECTION D SURGE CAPACITY: SURVEILLANCE EXPLANATION AND DIRECTIONS One of the integral steps in developing a comprehensive Surveillance plan for the Region is to define the goal. The Health and Human Services (HHS) hospital preparedness grant has established the following mandated goals: Surveillance: Enhance the capability of rural and urban hospitals, clinics, emergency medical service systems and poison control centers to report syndromic and diagnostic data that is suggestive of terrorism to their associated local and state health departments on a 24-hour a day, 7-days a week basis. The purpose of this section is to collect a baseline assessment of surveillance capabilities that currently exists in each hospital. It is suggested that your Infection Control department director complete this section. CURRENT CAPABILITIES 1. Does your hospital have the ability to report unusual and unexplained items that are suggestive of bioterrorism to the Office of Public Health? Yes No Don t know If not, we encourage you to contact Office of Public Health, Epidemiology at a. If yes, what form of reporting does your hospital use (Check all that apply)? Office of Public Health Electronic Surveillance Telephone Web-based system Fax Mail Other: Explain 1b. Does your hospital report at least once every 12 hours on a 24 hour-a-day basis? Yes No Don t know 1c. Does your hospital report 7 days a week? Yes No Don t know 2. Does your staff need additional surveillance training? Infection Control 3. If a list-serve for Infection Control Practitioners was developed, would you be interested in receiving information? Yes No Don t know 3a. If so, please provide your contact information below. Name: Address: 17 Office Number: Fax Number:

18 Sentinel Provider Network The influenza sentinel provider network conducts surveillance for influenza-like illness (ILI) in collaboration with the state health department and the Centers for Disease Control and Prevention. Data reported by sentinel providers, in combination with other influenza surveillance data, provide a national picture of influenza virus and ILI activity in the U.S. Sentinel providers report the total number of patient visits each week and number of patient visits for influenza-like illness by age group. This data is transmitted once a week via the Internet, a touch-tone telephone, or fax to a central data repository at CDC. 4. Is your hospital currently enrolled in the Sentinel Provider Network? 4a. If not, would you be interested in participating in the Sentinel Provider Network? COMMENTS: 18

19 SECTION E SURGE CAPACITY: BEDS, ISOLATION & HEALTHCARE PERSONNEL CAPABILITITES EXPLANATION AND DIRECTIONS The purpose of this section is to better assess the capability of your hospital to surge within walls for mass casualty events. It is likely in a mass casualty event that your hospital will need to plan to provide maximum surge capacity or surge within walls for a period of time prior to outside assistance arriving. This section includes questions regarding surge capabilities at your hospital particularly as it relates to inpatient beds, isolation beds, intensive care beds, mortuary capacity, hospital equipment and health care personnel. It is recommended that hospital staff such as Nursing Services, Infection Control, Facility Management, and Staffing is consulted when completing the following sections. Inpatient beds 1. What was the average number of staffed beds your hospital operated in 2008? Please provide your best estimate: 2. In the event of a mass casualty incident, hospitals may identify contingency plans to re-arrange facilities such as recovery rooms, same day surgery, outpatient areas, physical therapy treatment, and alter staffing to respond to the additional patient needs. What is maximum number of surge beds you can open above the current daily staffed capacity (i.e. by calling in staff) within a 24 hour period? (If response is none or zero, mark 0 in the space provided. Do not leave blank. Surge within WALLS beds Adult Intensive Care Surge Beds Medical/Surgical (Med Surge)/Telemetry Surge Beds Burn Surge Beds Pediatric Intensive Care Surge Beds Pediatrics Surge Beds Neonatal Intensive Care Surge Beds Neonatal Surge Beds Psychiatric Surge Beds Operating Room Surge Beds Negative Pressure Isolation Surge Beds Rehabilitation Surge Beds Emergency Department Beds Total Number of Surge Beds (This number should equal the sum of the number of beds listed above) Staffed Surge Beds (A) *Additional Surge Beds (B) *Additional Surge Beds: Beds that can be opened if additional staffing is provided or standards of care are altered. Total # of Surge Beds (A+B) 19

20 3. In the event of mass casualty, some hospitals have the ability to open additional beds on-site (surge within campus), yet outside their normal operations (i.e. structures in the parking lot). During an emergency, does your hospital have additional surge capacity on-site that could be used for additional acute care patients? Yes No Don t know 3a. If yes, what is the maximum number of surge beds you can open on-site (outside the normal operations) within a 24 hour period? (If response is none or zero, mark 0 in space provided. Do not leave blank.) Surge within CAMPUS beds Adult Intensive Care Surge Beds Medical/Surgical (Med Surge)/Telemetry Surge Beds Burn Surge Beds Pediatric Intensive Care Surge Beds Pediatrics Surge Beds Neonatal Intensive Care Surge Beds Neonatal Surge Beds Psychiatric Surge Beds Operating Room Surge Beds Negative Pressure Isolation Surge Beds Rehabilitation Surge Beds Total Number of Surge Beds (Within campus) Staffed Surge Beds (A) *Additional Surge Beds (B) *Additional Surge Beds: Beds that can be opened if additional staffing is provided or standards of care are altered. 4. During an emergency, does your hospital have alternate (hospital owned/separate) care sites designated that could be used for additional acute care beds? Yes No Don t know Total # of Surge Beds (A+B) 4a. If yes, what are the locations of your alternative care site? Location Number of Patients that could be cared for at site? (1) (2) (3) Isolation Capabilities Please complete the following table according to your facility s surge isolation bed capacity. Provide the number of isolation beds your facility has according to three (3) locations: ER, ICU, and Patient Care Units. Complete all boxes in the table. If your facility does not use a particular type of isolation unit or does not have certain types of beds, mark zero (0) for that box. 20

21 TABLE 1: ISOLATION CAPABILITIES Negative Pressure Isolation Bed Capabilities* at Hospital Location Portable Fixed Total Emergency Room Intensive Care Unit Patient Care Units Other (i.e. onsite or other on campus alternatives) * Negative Pressure/Isolation: Beds provided with negative airflow, providing respiratory isolation. 5. Does your facility have portable isolation monitoring equipment? Yes No Don t know 5a. If yes, how many? Mortuary Capacity A mass casualty event will require rapid access to mortuary resources. 6. In normal operations, how many remains can your hospital hold in refrigerated storage? Please provide your best estimate: 7. Where is the normal operational storage capacity located? Hospital Morgue Contracted or leased space (i.e. local funeral home) Contracted or leased space other hospital Local Coroner s facility Other (Please specify) 8. If necessary, could your hospital expand storage capacity temporarily within the normal storage locations ( surge within walls )? Yes No Don t know 8a. If yes, what is your maximum number of additional remains that your hospital can hold in refrigerated storage? Please provide your best estimate: For a period of 1-5 days: Greater than 5 days: 8b. If no, do you have contractual arrangements to increase surge capacity (expanding outside walls)? Yes No Don t know 8c. If yes, please indicate your arrangements (Check all the apply): Contract or lease - refrigerated trucks Contract or lease - portable morgue unit 21

22 Contract or lease - other hospitals morgue Contract or lease - local funeral home facility Local coroner s facility Other (please specify) 8d. Using these other contractual arrangements, what is the maximum number of additional remains that your hospital can hold in refrigerated storage? Please provide your best estimate: For a period of 1-5 days: Greater than 5 days: 9. In the event of a pandemic flu outbreak resulting in mass fatalities, do you believe the hospital could extend the use of the expanded storage (internal or through contractual agreement) for up to 6 weeks to 2 months? Yes No Don t know 9a. If no, please describe the hospital s plans to address an extended need for surge capacity in the morgue area. 10. Have you participated in the development of a mass fatality plan for your region? Yes No Don t know 11. Would you be interested in participating in the development of a mass fatality plan for your region? Yes No Don t know 12. Due to the possible increase of deaths during a pandemic flu event, it is imperative that hospitals have a surge plan in place to handle the increase volume of deaths. Does your hospital have a mass fatality plan? Yes No Don t know 12a. If so, has it been drilled or exercised? Yes No Don t know Hospital Equipment The intent of the following section is to assess your current equipment capabilities. During an emergency, it may be possible to provide your facility with additional equipment. Directions: Please complete the following tables according to your facility s equipment resources. Place the number of equipment your facility possesses in the table provided. Fill in all the boxes. If your facility does not have a particular type of equipment, please mark zero (0) for the box. 22

23 13. How many portable monitoring defibrillators does your facility currently have in its possession? Portable Monitoring Defibrillators: 3 EKG lead Portable Monitoring Defibrillators: 12 EKG lead Fixed Transport Total 14. How many ventilators (portable and non-portable) does your facility currently have in its possession? Standard Electronic Intensive Care Unit (ICU) Ventilators Pneumatic Portable Ventilators Non-Invasive Ventilators Other (Ventilators with an internal gas source) Other (CPAP Only device) Other (EMS or Auto resuscitator)* Other (obsolete but working, possibly in deep storage) *Please include disposable ventilators in this category (e.g. Vortran) 15. What is the average number of ventilators in use on any given day? Standard Electronic Intensive Care Unit (ICU) Ventilators Pneumatic Ventilators Non-Invasive Ventilators Other (Ventilators with an internal gas source) Other (CPAP Only device) Other (EMS or Auto resuscitator)* Other (obsolete but working, possibly in deep storage) *Please include disposable ventilators in this category (e.g. Vortran) Adult Pediatric Neonatal Total Adult Pediatric Neonatal Total 16. Identify the manufacturer and model number of the ventilator(s) your facility uses. Manufacturer Model Number a. b. c. d. e. f. 23

24 17. Do you have a contract with a vendor to rent additional ventilators if needed? Yes No Don t know 17a. If yes, what is the name of the vendor supplying the ventilators? 18. How many Pulse Oximetry monitors do you have at your hospital? Fixed, bedside alternating current (AC) Models Portable, hand held, models Number of Units 19. How many days, on average, will your oxygen supply last before it needs refilling by your supplier? 20. Do you have a contractual arrangement for an alternative oxygen supplier in the event your primary supplier has unforeseen supply problem? Yes No Don t know Tier 2 Hospitals Tier 1 hospitals are defined as having acute care capabilities with 24- hour emergency care available. Tier 2 hospitals are generally defined as having non-acute care capabilities (without 24-hour emergency care available) such as rehabilitation, psychiatric, or long-term acute care facilities. Tier 1 Hospitals Skip down to the EMSystem/EMSTAT Section Directions for Tier 2 Hospitals Emergency management planning at the regional level increasingly requires Tier 1 hospitals to rely upon Tier 2 hospitals for their expertise and resources. When addressing surge capacity planning in areas such as increasing health care personnel, isolation capabilities, and bed space, Tier 2 hospitals will be asked to participate in the following planning areas. As a Tier 2 hospital, please respond to the following questions regarding your resource capabilities. Tier 2 Hospitals 21. If funding and appropriate Memorandum of Understandings were provided, would your facility be willing to support Tier 1 hospitals during a mass casualty event by: If yes, Yes No how many? Storing cots or temporary beds? Storing personal protection or decontamination equipment? Providing temporary staffing to Tier 1 hospitals? Receiving non-acute care transfer patients? Providing transportation for equipment resources? Providing transportation for staffing resources? Providing transportation for receiving patients? Comments: 24

25 EMSystem/EMSTAT In 2006, Louisiana hospitals adopted a web-based internet emergency preparedness tool, EMSystem. Hospitals participating in the EMSystem have been asked to report as needed status of operations (open, limited, or closed), availability of beds by category (M/S, ICU, ped, psych, etc); and other resources that may be needed by hospitals in an emergency (blood products, fuel, pharmaceuticals, personnel, etc.) and participate in drills. 22. Does your hospital participate in the drills, input data, etc for EMSystem/EMSTAT? Yes No Don t know 23. Who is your EMSystem/EMSTAT site manager? (Please identify below) Name: Phone: Title: Several hospitals provide information to the EMSystem/EMSTAT only during a declared state of emergency or planned drills. This limited use of the system may create problems as hospital users will also have limited experience with the EMSystem/EMSTAT. Would your hospital be willing to update the EMSystem/EMSTAT on a daily basis? Yes No Don t Know If you need more information regarding EMSystem/EMSTAT, please contact your DRC or the HHS Emergency Preparedness Staff: Asha Smith, Kendra Powell, or Lauren Barleycorn at Health Care Personnel 25. Do you have adopted policies, procedures, and protocols that allow you to increase the staff to patient ratio during an emergency or crisis? Yes No Don t Know 26. Do you have adopted policies, procedures, and protocols in place to credential and accept volunteer health care personnel to augment your staff? Yes No Don t Know 27. Does your facility have any special credential requirements (active clinical practice, etc.) for volunteer health professionals? Yes No Don t Know 28. Does your facility have adopted policies, procedures, and protocols in place to request additional staffing from the state? Yes No Don t Know 29. Please identify the number of critical care staff at your hospital. (Please do not double count.) Critical Care Physicians employed by your hospital Critical Care Physicians that use your hospital as their primary campus Critical Care Registered Nurses 25 Adult Pediatric Neonatal Total

26 30. Please identify the number of Respiratory Therapists at your hospital. Full-Time Part-Time Number of Respiratory Therapists 31. Do you have a training program to cross train employees to "float" into critical care departments? Yes No Don t know 31a. If yes, can we contact you? Yes No Don t know 31b. If yes, please complete your contact information below. Name: 26 Pager: Office: Fax: Cell: The HHS grant has provided for the development of an Emergency System for Advanced Registration of Volunteer Health Professionals (ESAR-VHP). ESAR-VHP is a state-based emergency medical database utilized during state and federal disasters to manage volunteers. Louisiana s ESAR-VHP program, Louisiana Volunteers in Action (LAVA) was launched in December 2007 and works to recruit, credential, train, manage and deploy medical as well as non-medical volunteers. Is your hospital familiar with the LAVA? Yes No Don t Know If not, we encourage you to visit or contact the Office of Public Health, ESAR VHP Coordinator, Mardrah Starks-Robinson, MPA at or Mardrah.Starks-Robinson@la.gov. COMMENTS: National Disaster Medical System (NDMS) The National Disaster Medical System (NDMS) was created to care for victims of any incident that exceeds the medical care capabilities of the affected state or region. One aspect of the NDMS response is the availability of inpatient beds across the United States. NDMS contracts with hospitals to provide inpatient care with all necessary treatment and administrative processing as may be required for the patients hospitalized Many out-of-state hospitals accepted patients as the result of Hurricanes Gustav and Ike through their NDMS contract. 33. Does your hospital have a current contract with NDMS to provide inpatient care? 34. Would your hospital be interested in reviewing, evaluating and potentially signing an NDMS contract to provide inpatient care?

27 SECTION F SURGE CAPACITY: PANDEMIC INFLUENZA PLANNING EXPLANATION AND DIRECTIONS An influenza pandemic will place a huge burden on Louisiana s healthcare system. Estimates based on extrapolation of the 1918, 1957 and 1968 pandemics suggest that in the State of Louisiana there could be 15, ,000 hospitalizations depending on the illness rate and case fatality ratio of infection during the pandemic, demanding inpatient and intensive-care unit (ICU) beds and assisted ventilation services. For the last 2 years, the Health and Human Services (HHS) hospital preparedness grant has provided funding to hospitals to increase their capabilities and to prepare them for a pandemic influenza event. The purpose of this section is to collect a baseline assessment of influenza plans that currently exists in each hospital. It is suggested that your Infection Control Director or Planning Chief complete this section. 1. Does your hospital have a pandemic influenza plan? 1a. If yes, has your plan been drilled or exercised? 1b. If yes, please identify the method of exercising the plan. Type of Event (Circle One) Effective Month and Year (example: May 2009) After Action Filed (Circle One) Developed Corrective Actions Plans? (Circle One) Tabletop/Desktop Exercise Functional Exercise Full-Scale Exercise Yes No Yes No Drill Don t Know Don t Know Actual Real Event Tabletop/Desktop Exercise Functional Exercise Full-Scale Exercise Yes No Yes No Drill Don t Know Don t Know Actual Real Event 27

28 Tabletop/Desktop Exercise Functional Exercise Full-Scale Exercise Drill Actual Real Event Yes No Don t Know Yes No Don t Know 1c. If real event, please explain: 2. Based on the after action report(s) (AARs), list what steps have been taken to improve the tested preparedness plans/policies. 3. Is the following information included in your hospital s pandemic flu plan? Yes No Don t Know Plans for employee family support? Policies and/or triggers for implementing procedures related to employee absenteeism/overtime, etc? Plans for respiratory isolation for influenza like illness (ILI) for Emergency Department patients? Training and guidance for the protection of staff? Policies for protection of Emergency Department waiting room patients? Plan to decompress or reduce overcrowding? Integrated risk messaging/signage throughout hospital. (This may include health risk messages for the public and healthcare stations within your hospital including masks, gloves, handwashing gel, etc.) 4. Does your hospital have an Altered Standards of Care Subcommittee? 28

29 4a. If yes, other than you regular hospital staff, what other type of staff members participate in the Altered Standards of Care subcommittee? Check ( ) all that apply. Ethicists Palliative Care Physician Clergy members Legal Representative Infection Control Nurse Patient Advocate Other (Please identify): 5. Does your hospital have plans for dispensing antivirals to your staff? 5a. If so, has your plan been drilled or exercised? 6. Does your hospital have plans for dispensing vaccines to your staff? 6a. If so, has your plan been drilled or exercised? EMERGENCY DEPARTMENT VISITS It has been anticipated that hospitals Emergency Department (ED) volumes will increase during the fall H1N1 resurgence. To help identify trigger points for activation of regional and state pandemic flu plans (i.e. triage hotline, altered of standards of care, mass fatality plans, etc), hospitals may be asked to provide a daily status update in EMSTAT. For comparison purposes, hospitals are asked to provide their average daily ED volumes during the last flu season. This information will be used to identify the threshold for your individual facility and region. We understand that the hospital volumes are usually collected on a monthly basis; however we ask that you provide the minimum, maximum and average number of daily ED visits during the months identified below. 7. What was your daily ED volume during November 2008 April 2009? Daily Emergency Department (ED) Visits Minimum Maximum Average November 2008 December 2008 January

30 February 2009 March 2009 April 2009 PPE FOR A PANDEMIC INFLUENZA EVENT In light of the recent H1N1 influenza outbreak, a few gaps have been identified in the state s current level of preparedness. One of the critical weaknesses is an inadequate supply of personal protective equipment (PPE). The Centers for Disease Control recommends that healthcare facilities stockpile a 6 to 8 week supply of PPE (as a back-up to normal volume of supplies) in preparation for a pandemic influenza event. Based on the HHS grant, hospitals are expected to have a 2 week supply of PPE this year. Your cache of PPE should include N95 masks, surgical masks, gowns, and gloves for your employees and inpatients and be used in accordance with CDC guidance during an event. Over the next 4 to 5 years, healthcare providers will be asked to increase their PPE cache by an additional week each year to reach the required 6 to 8 week supply. 8. Based on internal calculations, how much PPE does your hospital currently have on hand for a pandemic influenza or H1N1 event? 1 week 3 weeks 5 weeks 7 weeks 2 weeks 4 weeks 6 weeks 8 or more weeks EDUCATION AND TRAINING A second gap in the state s pandemic influenza preparedness is insufficient education/training on pandemic influenza. As part of the state s effort to address this issue, the Department of Health and Hospitals (DHH) has developed a web-based educational program for healthcare providers. The course can be found at Participants who complete the course can receive free CMEs or CEUs. 9. Has your hospital employees participated in following pandemic influenza educational/training programs? Participated in the DHH state sponsored web-based training course mentioned above? Yes No Don t Know Reviewed the State Hospital Pandemic Influenza Plan? Reviewed your Regional Hospital Pandemic Influenza Plan? Participated in regional Pandemic Influenza HHS Hospital Rounds meeting? Participated in regional Pandemic Influenza Desktop Drills? For additional information, you may contact the Hospital Pandemic Flu Coordinator, Karen Stassi, RN at Karen.Stassi@la.gov or visit the following websites:

31 SECTION G SURGE CAPACITY: PHARMACEUTICAL CACHES EXPLANATION AND DIRECTIONS An act of terrorism targeting US civilians will require rapid access to large quantities of pharmaceuticals and medical supplies. Such quantities of pharmaceuticals and medical supplies may not be readily available unless special stockpiles are created. Communities and their hospitals must have rapid access to pharmaceutical resources as first line of defense in the event of a bioterrorist event. The Health and Human Services (HHS) hospital preparedness grant has established the following mandated pharmaceutical cache goals for communities and hospitals: Pharmaceutical Caches: Establish regional plans that insure a sufficient supply of pharmaceuticals for 3 days for: o hospital personnel and their household contacts; and o all inpatients. The purpose of this section is to collect a baseline assessment of pharmaceutical caches that currently exists in each hospital. It is suggested that your Pharmacy department director complete this section. BIOLOGICAL TERRORISM Individual hospital planning must be prepared to respond to local emergencies without the aid of federal resources for a 72-hour period. Please help us help you by answering the following questions to better assess your current pharmaceutical capabilities. These plans must address the prophylaxing capabilities of a biological terrorism incident. Contingency plans for pharmaceuticals involving chemical incident will follow this section. Individual hospital planning must be prepared to respond to local emergencies without the aid of federal resources for a 72-hour period. Hospitals should plan to provide prophylaxis for three groups: 1) Hospital Personnel: defined as the average number of all full-time personnel, part-time personnel, contract personnel, and employees; 2) Household contacts: defined as at least 3.5 individuals/ hospital employee; and 3) Inpatients: The hospital s average daily census plus 10% or total number of licensed beds. Hospital Personnel 1. Approximately how many hospital personnel do you employ? (Hospital personnel is defined as the average number of all full-time personnel, part-time personnel, contract personnel, and employees) Please provide your best estimate: 31

32 1a.. Of that number, how many hospital personnel provide direct patient care? Please provide your best estimate: 2. Has your hospital identified protocols to dispense a 72- hour supply of prophylactic medication to hospital personnel within 12 hours of a disaster being declared? Yes No Don t Know 2a. If yes, do your hospital drills exercise the protocols to dispense medication to hospital personnel? Yes No Don t Know Household Contacts 3. What is the estimated number of household contacts you may have to provide prophylactic medication to for a 72 hour period? (Household contacts are defined as at least 3.5 individuals x hospital employee.) Please provide your best estimate: 4. Has your hospital identified protocols to dispense a 72-hour supply of prophylactic medication to household contacts? Yes No Don t Know 4a. If yes, do your hospital drills exercise the protocols to dispense medication to the household contacts? Yes No Don t Know Inpatients 5. What is the estimated number of inpatients you may have to provide prophylactic medication to for a 72 hour period? (Inpatient is defined as the hospital s average daily census plus 10% or total number of licensed beds. Your Average Daily Inpatient Census for 2008 plus 10% 6. Has your hospital identified protocols to dispense a 72 hour supply of prophylactic medication to inpatients? Yes No Don t Know 6a. If yes, do your hospital drills exercise the protocols to dispense medication to the inpatients? Yes No Don t Know 7. In a biological incident your hospital should have additional supplies and pharmaceuticals to treat a sudden influx of patients. Your hospital biological cache should consist of doxycyline or one of the quinolones such as cipro, levaquin and floxin for a 72 hour time period.. How many doses 32

33 of the following drugs do your hospital have available for the purpose of providing prophylaxis to inpatients, hospital personnel and their family members in the first 72 hours of an event? Type of Drug Doxycycline Gentamicin Ciprofloxacin Levaquin Floxin Silvadene (Silver Sulfadiazine) Cream Other (Please indicate) Other (Please indicate) Other (Please indicate) Other (Please indicate) Hospital Personnel Doses Currently Available Household Inpatients Contacts CHEMICAL INCIDENTS 8. In a chemical incident your hospital should have additional supplies of chemical antidotes to treat a sudden influx of patients. The following list of drugs is frequently offered as responses for chemical exposures. Please identify the number of doses currently available in your hospital cache. If your facility does not used a particular type of chemical antidote or does not have a certain type of antidotes please make zero (0) for that box. Type of Drug Nerve Agent Atropine Protopam Anticonvulsant Diazepam IJ Lorazepam IJ Midazolam IJ Other Albuterol or other Bronchodialator Calcium Chloride Calcium Gluconate Magnesium Sulfate Potassium Iodide Hospital Personnel Doses Currently Available Household Inpatients Contacts 33

34 ENHANCED PHARMACEUTICAL CACHE CAPABILITIES: Collaborative planning is encouraged with local partnerships such as the local hospitals, pharmaceutical wholesalers, the Department of Veteran s Affairs, Metropolitan Medical Response System (MMRS). 9. Who is your primary pharmaceutical wholesaler? Cardinal Health Morris & Dickson Other (Please list) 10. Does your hospital emergency plan include obtaining pharmaceuticals from other entities? Yes No Don t Know 10a. If yes, where does your hospital obtain pharmaceuticals in an emergency? Other Hospitals Independent or chain pharmacy Pharmaceutical wholesalers Other i.e. MMRS (indicate) STRATEGIC NATIONAL STOCKPILE The Strategic National Stockpile (SNS) is a federal pharmaceutical and medical supplies emergency resource that is available to Louisiana if our local and statewide resources are insufficient for response to a public health disaster. The SNS has been used for Hurricanes Katrina and Rita and in the recent spring H1N1 outbreak. The purpose of this section is to collect the appropriate hospital logistical and SNS planning information. 11. Please list persons authorized (i.e. DEA registrant, pharmacy staff, infection control nurse, ED physician) to request emergency medical material on behalf of your hospital: Primary Contact Second Contact Name Name Title: Title: Office phone # Office phone # Cell Cell Pager Pager Fax Fax 11a. Are these persons familiar with and trained on emergency medical materiel request procedures? Yes No Don t Know 11b. Have these request procedures been exercised with a corrective action plan to address discrepancies? Yes No Don t Know 11c. If yes, provide name and date of exercise. Name Date (example: 05/01/2009) 34