The Joint Commission s Emergency Management Update

Transcription

1 The Joint Commission s Emergency Management Update William M. Wagner, ScD CHCM CHSP CHEP Vice President-Education, Research & Development Safety Management Services, Inc. September 22, 2009

2 Goals Discuss New EM Chapter Identify Planning Activities Develop a Response Process Evaluate Response Activities

3 Emergency Management 3

4 Three Groups of EM Standards Planning (EM.0.0.0) Identifying & planning for emergencies Implementation (EM ) Developing emergency response Evaluation (EM ) Testing & analysis of the Plan

5 Planning for Emergencies EM.0.0.0

6 Planning for Emergencies EM.0.0.0: Planning Activities EP: Involves leadership in planning; including medical staff Document with Emergency Preparedness Committee Meeting Minutes

7 Planning for Emergencies EM.0.0.0: Planning Activities EP 2: Conducts the HVA: identify hazards, threats & events; likelihood, & consequences EP 3: HVA: Prioritizes the emergencies with community EP 4: Communicates needs & vulnerability to the community

8 Hazard Vulnerability Analysis Ability and Consequences to Provide Services Consequences on External Services Scoring EVENT Communications Failure Patient Care Services 2 Support Services 3 Staffing 2 Structure Utility Services Public Services 2 Commercial Resources 3 Staff and Patient Family Member 2 Total 6 Pandemic Event Mass Casualty Event Electrical Failure 8 Generator Failure Hazmat Internal Hurricane Water Failure Severe Weather = 00% prepared or insignificant 2= 75% prepared or minor 3= 50% prepared or moderate 4= 25% prepared or serious 5= 0% prepared or very serious

9 Hazard Vulnerability Analysis (Likelihood) EVENT Likelihood of Occurrence Scoring of Capabilities and Consequences (Table 2) Total Score Communications Failure Pandemic Event 3 3 Mass Casualty Event Electrical Failure Hazmat Internal 0 0 Generator Failure 3 3 Hazmat Internal 0 0 Hurricane Water Failure Severe Weather Scoring Criteria = Minimal or slight probability 2= Moderate probability 3= High probability SMS, Inc, 2008

10 Hazard Vulnerability Analysis (Priority) EVENT Scoring Total (Column L-Table ) Priority Hurricane 36 2 Water Failure 26 4 HazMat Internal 0 9 Mass Casualty 24 5 Severe storms/wind 39 Generator Failure 3 7 Electrical Failure 20 6 Pandemic Event 3 8 Communications Failure 32 3

11 Planning for Emergencies EM.0.0.0: Planning Activities EP 5-6: Defines mitigation & preparedness for each emergency in HVA

12 Sample Emergency Response Plan Component Worksheet Emergency Mitigation Preparedness Response Recovery Service & Facility Tornado Emergency Response Plan Staff training Drills Move patient Notify authorities Evaluate response Staff debriefing Contaminate Victim Decontamination facility Utility covers Alarms (chemical & radiological) Emergency Response Plan Awareness Training Staff training Drills Obtain PPE Community-wide involvement Initiate Facility Lockdown Establish decon procedures Begin triage activities Evaluate response Staff debriefing Patient information update Economical assessment HazMat Spill Spill Response Plan Spill kits for specific materials Training for Spill Team Supplies Obtain PPE Isolate area Notify authorities Use PPE Evaluate response Staff debriefing Re-supply consumables Infant abduction Emergency Response Plan Surveillance cameras Access control system Awareness training Drills Secure exits Notify authorities Search areas Evaluate response Staff debriefing

13 Planning for Emergencies EM.0.0.0: Planning Activities EP 7: Use ICS same as community HICS System Inside NIMS System Outside

14 HICS Management Functions Incident Commander Public Information Officer Safety Officer Liaison Officer Medical/Technical Specialist Operations Section Chief Planning Section Chief Logistics Section Chief Finance/Admin Section Chief

15 OPERATIONS SECTION CHIEF STAGING MANAGER EQUIPT/SUPPLY STAGING MEDICATION STAGING MEDICAL CARE BRANCH DIRECTOR INFRASTRUCTURE BRANCH DIRECTOR HAZMAT BRANCH DIECTOR SECURITY BRANCH DIRECTOR BUSINESS CONTINUITY BRANCH DIRECTOR CASUALTY CARE POWER/LIGHTING DETECTION/ MONITORING ACCESS CONTROL IT INPATIENT OUTPATIENT MENTAL HEALTH WATER/SEWER HVAC BUILDING/GROUNDS DAMAGE VICTIM DECON CASUALTY CARE DECON CROWD CONTROL TRAFFIC CONTROL RECORDS PRESERVATION BUSINESS RELOCATION CLINICAL SUPPORT MEDICAL/ GAS PATIENT REGISTRATION MEDICAL DEVICES ENVIRONMENTAL SERVICES FOOD SERVICES

16 PLANNING SECTION CHIEF RESOURCES SITUATION DOCUMENTATION DEMOBILIZATION PERSONNEL TRACKING MANAGER PATIENT TRACKING MANAGER PHYSICIAN TRACKING MANAGER BED TRACKING MANAGER STAFFING PERSONNEL TRACKING MGR MATERIAL TRACKING MANAGER

17 LOGISTICS SECTION CHIEF SERVICE BRANCH DIRECTOR SUPPORT BRANCH DIRECTOR COMMUNICATIONS EMPLOYEE HEALTH FAMILY CARE IT/IS ALTERNATE CARE SITE STAFF FOOD & SLEEP SUPPLY FACILITIES TRANSPORTATION LABOR POOL & CREDENTIALING

18 FINANCE SECTION CHIEF TIME PROCUREMENT COMPENSATION/ CLAIMS COST

19 Incident Management Hierarchy Federal Government Activates NICS State Government Activates State ICS City Government Activates City ICS NIMS Corporate or Local Transfer Operational Control Point Hospital Administration Activates HICS Departmental Directors - Activates departmental procedures Line Supervisors- Executes departmental procedures HICS Line Staff- Performs emergency procedures

20 Planning for Emergencies EM.0.0.0: Planning Activities EP 8: Keeps inventories of critical assets & resources PPE Water Fuel Medical & surgical supplies Medications

21 Developing a Response EM

22 Developing Emergency Response EM : Emergency Operations Plan (The EOP ) EP : Involves leadership in development; including medical staff EP 2: Written EOP Plan includes response procedures for curtaining services, obtaining resources, closing & evacuation

23 Plans to Respond to the Emergencies Emergency Response Plans & Procedures Emergency Contagious victim Contaminate d victim Influx Lockdown Staff shortage Supply shortage Surge Utility failure Snow Bomb Generator Workplace Violence Pandemic Mass Casualty Infant Abduction Security Incident Severe weather/ Ice/snow Storms Internal Hazamat spill Contaminate Victim Contagious Victim Terrorism Utility Failure Generator Failure Workplace Violence Epidemic/Pandemic Infant abduction Mass Casualty Patient Surge Patient Influx Structural Failure

24 Developing Emergency Response EM : Emergency Operations Plan (The EOP ) EP 3: Identifies capabilities for response when the hospital cannot be supported by local community for at least 96 hours

25 Resource Utilization Inventory (in-house & storage) Average Daily Census (previous year) Consumption Rate (daily average based on pervious year) Sustainability (hourly utilization needed) Gap Analysis (difference actual & need) Consumption Adjustment (modify usage)

26 Resource Utilization: Planning Inventory = 200 N95 respirators Average Daily Census = 250 occupied beds (300 bed facility) Consumption Rate = 20 respirators/hour Sustainability = 60 hours Gap Analysis = 36 hours

27 Transportation Disruption Inventory = 200 N95 respirators Current Census = 250 occupied beds (300 bed facility) Consumption Rate = 20 respirators/hour Sustainability = 60 hours Gap Analysis = 36 hours Consumption Adjustment (@36 th hour) = 8 respirators/hr

28 Transportation Disruption Consumption Adjustment in respirators th hour = 8 respirators/hr) Actions to take: Wear for more than one patient Provide only to staff at risk Any ideas?

29 Developing Emergency Response EM : Emergency Operations Plan (cont.) EP 4: Defines recovery for each emergency in HVA EP 5: Identifies initiating & terminating activities; activating phases EP 6: Authority for activating response & recovery

30 I Initiation Process Incident Community Data AOD Hospital Data Stand-by Alert Initiation No Alert Normal Initiate Emergency Operations Plan Activate Emergency Response Plans Severe Weather Plan Utilities Plan Mass Causality Plan Contaminated Victim Plan Civil Disturbance Plan Chemical Spill Plan Activate Departmental ERPs Engineering Environmental Services Security Emergency Room Human Resources Nursing Services

31 Developing Emergency Response EM : Emergency Operations Plan (cont.) EP 7: Identifies alternate care sites that meet patients needs EP 8: Implements response plans for care, treatment, & services

32 Six Critical Functions (EM ) Communication Management Resources & Assets Management Security & Safety Management Staff Role & Responsibility Utility Systems Management Patient Management

33 Six Critical Functions EM : Communication Notification & communication with staff Notification & communication with external authorities Communication with patients & families, including notification when relocation of patients occurs Communication with community & media Communication with purveyors of supplies, services & equipment

34 Six Critical Functions EM : Communication (cont.) Communication with other healthcare organizations; Names & roles of command structure Resources & assets Names of patients & deceased Communication of patient information to 3 rd party (e. g., police, state health department, FBI) Communication with alternate care sites Establishment of backup communication systems

35 Backup Communications Source of Service Equipment Required Supplies Required Backup System PBX System Plan-old-Telephone- System (POTS) Overhead announcement system Internal pagers Two-way radios Cellular telephones Runners

36 Six Critical Functions EM : Resources & Assets Obtaining & replenishing supplies; medical, medications & non-medical Sharing of resources with local & regional healthcare facilities Establishes method to monitor resources & assets during an emergency Transporting patients; medications, equipment, supplies, & staff to alternate care sites Transporting patient care information; clinical & medication to alternate care sites

37 Six Critical Functions EM : Security & Safety Establishes internal security & safety operations Identifies role of community security agencies Identities a process for managing hazardous materials & waste Provide for isolation & decontamination Controls access to healthcare facility Controls movement of individuals within the facility Controls traffic accessing the facility

38 Six Critical Functions EM : Staff Roles & Responsibilities Staff roles defined for all six critical functions Staff assigning & reporting in ICS Managing staff support activities (e.g. transport) Managing staff family support activities LIP informed of roles & command structure Staff, LIP & volunteers identified appropriately (e. g., ID badges, vests, hats)

39 Job Action Sheets (JAS) Information tool Radio contact title Purpose Reporting structure Critical action considerations Prompts actions related to their roles & responsibilities

40 Identification Section personnel should wear identification that identifies their role. SMS, Inc,

41 Six Critical Functions EM : Utility Systems Electricity Water needed for consumption & essential care activities Water needed for equipment & sanitary purposes Fuel needed for building operations, generators & essential transport services Medical Gas/vacuum systems Other essential utility needs (e. g., transport, ventilation, HVAC systems, steam)

42 Utility Systems Source of Service Equipment Required Supplies Required Backup System Electrical Generator ATS Fuel Portables Potable water Equipment and sanitation water Fuel: Generators Medical gas/vacuum Boilers HVAC

43 Six Critical Functions EM : Patient Management Patient activities; scheduling, triage, assessment, treatment, admission, transfer, & discharge Evacuating when environment cannot support care, treatment & services Clinical services for vulnerable population served by the organization (e. g., pediatrics, geriatric, disabled, chronic & addictions)

44 Six Critical Functions EM : Patient Management (cont.) Personal hygiene & sanitation needs of patients Mental health services Mortuary services Patient clinical information documentation & tracking

45 Evaluation of Planning Activities EM

46 Evaluation EM : Annual Review* Hazards Vulnerability Analysis (HVA) Objectives & scope of EOP Inventory & monitoring process *Document process and include changes in any revised EOP

47 Evaluation EM : Testing & Exercise Test the plan twice a year, actual or planned: One community-wide One with actual or simulated patients One has to escalate to non-support of community Exercise must be one of the HVA hazards Monitor(s) sole responsibility as evaluator Business occupancy - annually

48 Evaluation EM : Testing & Exercise Organization monitors at least the Six Critical Functions: Communication internal & external Resources mobilization & allocation Safety & security Staff roles & responsibility Utility systems Patient clinical & support activities

49 Critique of Critical Functions Critical Functions Good Fair Communication Resource Mobilization & Allocation Safety & Security Roles & Responsibilities Utility Systems Patient Management Opportunities for Improvement Comments Monitor(s)

50 Best Practices (Pandemic) Participate in HICS Assess available resources & assets Monitor consumption rate of resources Identify risks to employees Staff training on precautions & PPE Recognize impact on staff s family

51 Goals Revisited Discuss New EM Chapter Much enlarged & still growing Identify Planning Activities HVA & EOP are the key Develop a Response Process Integrate HICS into everyday operations Evaluate Response Activities Everyone should be involved

52 Emergency Management is Everyone s Responsibility!