Transcript Transportation - Network of New England

Preparing for a Pandemic Event
Developing a Continuity of
Operations Plan (COOP)
Presented by: Scott Aronson, MS
860-793-8600 / www.phillipsllc.com
Implementation Goals
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NOT Flu Pandemic Diagnosis/Treatment
Why Dialysis, Nursing Home, Home Health?
Detail Approaches for a COOP
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Communications & Incident Management
Staffing Plan/Education
Supplies/Resources
Transportation
Facilities/Engineering
Clinical Services / Strategies
Utilizing Mutual Aid to Supplement Planning
Review Effective Exercises
The Emergency Managers Problem
 Are
You
Really
Prepared for
a Disaster?
$ Money $
Regulation/
Statutes
Fear
Ethics
Why Dialysis, Home Health & Nursing Homes
Higher Level of Flu
Reported in Connecticut
Hospitals See Patient
Surge – Increase
Discharges
Nursing Home
Beds Full and
Resident Acuity at
Higher Level
Home Health
Provide Short
Term Surg to
Assist Discharging
Hospital Patients
Staffing Impact
Increases and
Influenza
Pandemic Clearly
Identified
Dialysis
Higher Acuity on
Dialysis Patients
Now At Home /
Transportation
Failures
Emergency Operations Plan (EOP) and
Continuity of Operations Plan (COOP)

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EOP actions are procedural and taking place as
the event unfolds (i.e. Bomb Threat, Building
Evacuation)
COOP is how you ensure the ability to operate
your organization throughout any disaster –
special emphasis on Influenza Pandemic

Challenge: Limited to No Incident Command
System training (Communication/Redundancy)

Challenge: Emergency responders and State
are a resource…do not make them your plan
Stand Alone

Currently Joint Commission, but NFPA to
follow with CMS

Stand Alone for 96 Hours + in 6 critical area
Communications
 Staff Responsibilities
 Resources & Assets (supplies, staff)
 Safety & Security of Residents
 Utilities Management (power, HVAC, fuel, water,
etc.)
 Clinical & Support Services

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If you can’t meet it – say it or fix it!
Communications and
Incident Management
Communications

Ongoing communications to:

Staff
On-duty (briefing) and Off-duty (sit-stat)
 Phone Number to Call Into
 Website to View with Emergency Information
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Patients/Residents and Families (staff families)
Preplanning Information
 How do you Inform them of the Situation…and keep
them informed


See Next Page
 Message on website, e-mailed out, blast fax to media,
paged to staff, on main facility phones (briefed internally
for staff as well)
Communications

FAILURE (immediately post-Katrina)

2005: Hurricane Rita (Texas/Louisiana)
Same Hospital as Listed on the previous slide
 Message from the Governor and the Mayor’s Office
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“All residents of the City of Corpus Christi MUST evacuate
immediately” – followed by the instructions, etc.
Problem?
Influenza Pandemic – Governor Declares State
of Emergency: Social Distancing (i.e. stay at
home) is the recommended approach
How do you get staff to come to work?
Communications
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Ongoing communications to:
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External Authorities
 Fire, Police and Public Health; Local EOC; DPH;
DEMHS
 No set Frequency for Influenza Pandemic reporting –
Emergency Line Created at Time of Emergency
 Regular Communications Failure – HAM/Amateur
Radio
 Incoming Communications may come in form of:
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Blast Fax
Direct Phone Call
Health Alert Network (HAN) when updated
 All Facilities Should Sign On – IMPORTANT
 Rolling phone, fax, e-mail, pager, etc.
If you are unable to reach DPH or other State Agency:
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Use Ethical Judgment on actions
Communications
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Ongoing communications to:
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Vendors
24/7 Phone Numbers
 If entering high-risk area (i.e. National Guard
controlling access)
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Letter from Facility
Directions if Necessary
Carry their Own Company Badges/ID
Inform Local EOC of shipment
Use Incident Command System to run this
Incident Command
Organizing the Chaos!
Manageable Span of Control: 3 – 7
Incident Command
SOUTH HOSPITAL
INCIDENT COMMAND SYSTEM
Incident Commander
Documentation
Recorder
Medical Care Director
Safety/Security Officer
Public Information /
Liaison Officer
FUTURE POSITIONS
Site Safety Decon
Operations Officer
Logistics Section
Chief
Planning Section
Chief
Finance Section
Chief
Claims Unit Leader
Decon Setup Team
Member
Communications
Unit Leader
Psychological
Support
Team Leader
HVAC Shutdown
Officer
Facility Unit Leader
Staff Support/
Dependant Care
Unit Leader
Cost /Procurement
Unit Leader
Time Unit Leader
Security Decon
Operations Officer
Damage Assessment
and Control Unit Leader
Sanitation Systems /
Hazardous Waste Unit
Leader
Materials Supply/
Transportation
Unit Leader
Nutrition Supply
Unit Leader
Operations Section
Chief
Ancillary Services
Director
Cardiopulmonary
Unit Leader
Laboratory
Unit Leader
Labor Pool /
Medical Staff
Unit Leader
Medical Staff
Director
Inpatient Area
Supervisor
Critical Care
Unit Leader
General Nursing
Unit Leader
Pharmacy
Unit Leader
Situation-Status
(Sit-Stat)
Unit Leader
Triage Unit Leader
Haz-Mat Group
Supervisor
Decontamination
Unit Supervisor
Immediate
Treatment
Unit Leader
Standby Decon
Team Member
Delayed Treatment
Unit Leader
Decon Preparation
Team Member
Minor Treatment
Unit Leader
Decon Team
Member
Maternal/Child
Unit Leader
Volunteer
Unit Leader
Patient Information
Tracking
Unit Leader
Treatment Area
Supervisor
Radiology
Unit Leader
Surgical Services
Unit Leader
Rehabilitation
Unit Leader
Behavioral Health
Unit Leader
Potentially Injured /
Worried Well
Unit Leader
Radiation Safety
Officer
Discharge
Unit Leader
Technical
Reference
Specialist
Morgue
Unit Leader
Incident Commander
(building ops /
building evacuation
decisions)
Logistics Section
(bldg/
communications/
transp./food/supply)
Liaison Officer (other
HC facil/emergency
agency/monitoring
of public hlth
advisories)
Public Information
Officer (news
media/family)
Document Recorder
(command center
set-up/record
incident)
Safety & Security
Officer (building
security/traffic/
rescue)
Planning Section
(intel gathering/
overall ops plan/
staffing levels)
Finance Section
(provide
$’s/document cost)
Operations Section
(clinical services/
ancillary services)
CDC Checklists

In the Incident Command System, what position would
handle these roles?
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Home Health
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The Organization point person for external communications (e.g.
hospitals, nursing homes, health departments, social services
agencies) has been assigned. (Insert name, title and contact
information)
Nursing Home
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A plan for cohorting symptomatic residents or groups using one
or more of the following:
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Confining symptomatic residents and their exposed roommates to
their room
Placing symptomatic residents together in one area of the facility,
or
Closing units where symptomatic and asymptomatic residents (staff
who are assigned to work on affected units will not work on other
units?
Incident Command Education
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Free
On-line
Boring – except to people like me 
ICS 100, 200, 700
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IS-100.HC Introduction to the Incident Command
System for Healthcare/Hospitals
IS-200.HC Applying ICS to Healthcare Organizations
IS-700 National Incident Management System
(NIMS), An Introduction
Yale: EM103 NIMS (meets 100, 700)
Yale: EM140 NIMS (meets 200, 700)
Communications Tool – Internal / From Field / To Corporate
Staffing Plan / Education
Staff Responsibilities
Share through your association for all
facilities to have consistent education
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Education, Education, Education:
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What is expected of you?
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Come to work in a disaster
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Need to say this; don’t assume
What are their specific responsibilities?
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Protect themselves (no exception – PPE use – for patient
contact or non-patient contact), other staff,
patients/residents
Tasks will be outside of normal daily responsibility
Staffing Plan
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How are they Called Back?
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Red / Yellow / Green OR On / Resting / Off
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If Limited Transportation, what are the Preplanned
Pick-up Locations?
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Impact of changing staff hours on their family/dependants?
Must Have Facility IDs in the Event of Roadblocks
Facilities with Strike Plans – Should already have Pick-up
Locations
Facilities with Severe Weather (ice / snow / flood) Plans
– Should already have Pick-up Locations
Home Health – Any challenges?
Are there Plans for Housing Them
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Their Dependents? (elderly family, children, disabled)
In Need of Staff
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Where can you get them from if in
trouble?
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Your Corporate Office – if applicable
Staffing Agencies – Draw from Outside State
Medical Reserve Corp (MRC)
Community Emergency Response Teams
(CERT)
Families (Staff and Patient/Resident)
Retired Staff (never burn bridges)
Sister Facilities or Neighboring Facilities
Staff & Family Education/Support
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Education: Staff/Patient/Resident Families
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Patient/Resident: Upon Admit or a New Client / Staff: Upon
Hire
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Provide Info to Staff/Families/Responsible Party on Expectations in a
Disaster and Support that May be Requested (ask the question)
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Home Health:
 Provide direct care for Priority 2 & 3 patients (phone support)
 Agency should increase verification process on accuracy of info –
frequency determined by Agency
Nursing Home:
 Family member may be requested to pick-up patient for discharge
and care for them
 Family member may be asked to provide on-site volunteer support
to care for residents (staff or resident families)
Dialysis:
 Provide diet oversight for patient (phone support)
 Center should increase verification process on accuracy of info –
frequency determined by Center
Staff & Staff Family Support
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Staff and Family Support Examples
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Child care, elder care, communication, etc.
CCRC – Better Ability to have Adult Day Care, Child Care
(modifications), Lodging for Family
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Child Care Fears –
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Hotel, on premises, Sr. Independent Living or Assisted Living
Residence, etc.
Are these Real?
How to Combat them? Or should you?
Mental Health and Other Family/Staff Support
CONSIDER THEM – These are not required, just
need to be thought through and planned as to if
you are or are not going to provide them
Family Disaster Planning
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Yale-New Haven Office of Emergency
Preparedness
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Red Cross – Family Disaster Planning Guide
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Pamphlet
http://yalenewhavenhealth.org/emergency/progsvcs/
commprep.html#personal
http://www.redcross.org/services/disaster/0,1082,0_6
01_,00.html
Focal Areas
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Who has dependents (elderly, special needs/disability,
child)
Caring for them in a disaster?
Supplies & Resources
Supplies/Resources
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Where can you get them from?
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Outside 90 mile agreements
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Don’t do all the work, have someone do it for you
(networking with other state associations to share
supplier/vendor information)
Your Corporate Office – if applicable
Other State Facilities (if not directly impacted)
Local Pharmacies
Local Hospitals
Strategic National Stockpiles (SNS)/Push Packs
*Rationing*
Stockpiling?
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Financial Burden
PPE
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How much should you stockpile?
Calculate # of patients/residents
 Calculate # of staff & # of shifts
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Delineate difference between clinical and non-clinical
Review reuse strategies where safe to do so
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Home Health – Storage in cars with specific PPE that
can be reused on the same patient
Example
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Dialysis Center
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40 patients per day (110 total for the Center)
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10 direct patient contact staff (3 nurses/6 techs, Dialysis Asst)
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5 Admin/Support
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(Director, Social Worker, Receptionist, Dietician, Word Clerk)
Approx. 30 N-95 Respirators (x 2 for staff changes) / Glove Consumption Varies
Based on Patient Contact (saturated N-95 could change life of respirator)
Up to 8 Week Timeframe: Maximum of 1,200 N-95 Respirators for staff and
potentially up to 1,600 respirators per patient (recommend patient reuse which
could reduce this to minimal numbers over an 8 week period)
REALITY: Reduction in Staff & Reduction in # of Patient
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20 patients per day (110 still remains as #)
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5 direct patient contact staff (2 nurses/3 techs)
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3 Admin/Support (Social Worker, Receptionist, Dietician)
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Approx. 16 N-95 Respirators (x 2 for staff changes) and Glove Consumption
Varies Based on Patient Contact (saturated N-95 could change life of respirator)
Up to 8 Week Timeframe: Maximum of 640 N-95 Respirators for staff and
potentially a total of 110 respirators for the patients (recommend patient reuse)
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Estimated Costs: $11 per box with 20 per box; 38 boxes at $11 = $418.00
Stockpiling?
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Food – MREs, non-perishables
(sample multi-day menus
and feeding calculation document provided)
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Rationing due to staffing or supply availability could be
necessary
Medications
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Home Health – Eliminate vitamins and other baseline
meds as necessary
Nursing Home – Elimination of non-essential meds via an
Influenza Pandemic Med List
Will you work to access vaccines and antiviral meds?
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Work with Corporate, State DPH, Associations, Local Public
Health and Other Providers to address this during the disaster
Supplies (dialysers, lines, meds, saline, chemicals)
Emergency Resources & Contacts
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Emergency Agency Phone #’s (shown in communications)
Emergency Alert System
Emergency Bedding / Housing Plan
Emergency Staffing Agency Phone Numbers by Specialty
Materials Management / Nutrition / Pharmacy Departments
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Mutual Aid
Stop-Over Site Agreements (Quarantine???)
Nursing
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Emergency Contractors/Vendor Phone Numbers
Emergency Supply / Food / Liquid / Meds Sources / Linens
Emergency Contractors/Vendor Phone Numbers
Transportation Resources Internal/External
Utility Systems
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Emergency Contractors/Vendor Phone Numbers
Transportation
Transportation
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Utilization of Staff Vehicles for Supply Movement –
Who has 4-wheel drive or pick-up trucks to move
supplies?
Patient location analysis to eliminate transportation
redundancies:
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Dialysis Patients: Centralized management of
transportation (pick-up other facilities patients: Private
Transport Companies)
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Pick-up Staff with the patients
Leverage Facility Owned Vehicles (typically in Longterm care)
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Why can’t a Nursing Home provide transportation to a
Dialysis Center?
Transportation
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Home Health
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Centralized pick-up points for essential administrative
and support staff
Knowledge that gas supply chains could be disrupted
Patient location analysis to streamline travel times
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i.e. elimination of visits to geographically dispersed patients
Nursing Homes
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If you do not have, secure a facility shuttle for staff pickup points – preplanned arrangement
If you do have, consider working in Mutual Aid
Agreements with other providers to support
transportation needs
Utilities / Facilities
System Failures
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Potential that repair teams will be rendered
incapable of supporting facility
Know what can shut down your operations
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Dialysis Patients: If Reverse Osmosis water is disabled –
can you use tap water?
Nursing Home: If Generator is down due to power loss
and no extended fuel back-up, do you have other means
of redundancy?
All: If your IT system fails and there are no staff to repair
it,
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How will you bill?
How will you ensure appropriate clinical data?
How will you ensure appropriate family/responsible party info?
Clinical Services
Clinical Services

What are the strategies for providing a
maximally attainable, minimally acceptable
level of care?

Exercise
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Dialysis: Typically 3 nurses and 6 techs on a shift
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Down to 2 nurses and 3 techs for 8 weeks
Strategy?
Building Lockdown/
Containment Strategy
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Pre-designate What Doors for Monitoring
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Stabbing in the Parking Lot
Threat to Resident or Staff Life
Labor Action / Strike
Loss of Emergency Power
Civil Unrest
Pandemic Influenza
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Fever Testing at Entrance (customize off of DPH Plan)
What is Fever Testing
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Screening Process for Employees,
Family/Responsible Parties and
Patients/Residents
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Allow or Deny Access to the Facility
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>101°F: Immediate Denial
<99°F: Access Granted
>99°F and < 101°F: Follow Series of Questions
Determine appropriate infection control protocols for
isolation of or potentially to deny access for patients with
Influenza Pandemic
Policy/Procedure included on CD-Rom to customize
your facility specific plan for Fever Testing
Fill In the Plan – Position /
Department / Facility
Department/Position -Specific Plans
Each department or position within our
organization should have the responsibility
to review and update critical functions in
order for us to continue operations in a
disaster. The plans should be formatted in
the following manner:
Department/Position -Specific Plans
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Current staffing #’s / positions by shift
Overall functions of the position/department
 Bullet List the Functions (i.e. Dietary in Nursing Home)
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Food preparation
Gather menus from floors
Prepare carts/trays (specific dietary needs)
Prepare lines
Deliver meals
Staff kitchen, line and register
Clean carts, trays, utensils, dishes, pots, pans and equipment
Restock food and supplies (liquid consumables, staples, meats,
dairy, etc.)
Storage for food and supplies
Reordering of food, liquids, equipment and supplies
Department/Position -Specific Plans
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Functions that must be maintained and that can be
suspended in a disaster situation
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Dietary (sample list)
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Billing
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Limit food prep to emerg. Menu
Disposable products
Consider moving to 2 meals/day plus snacks based on patient or
resident needs
Need to bill, but what is the frequency?
Minimal Staffing Operations
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Home Health: Nursing / Aides
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Suspend Priority 3 Services; Limit Priority 2 Services; Manage
Priority 1 Patients – Discontinue Hospice Care at Nursing Homes
Re-establish Geographic Borders to Maximize Capabilities (work
on alternative plans for geographically dispersed patients)
Limit initial patient assessment for new patients (rapid
assessment)
Department/Position -Specific Plans
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Minimal Staffing Operations
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Nursing Home: Nursing / Pharmacy & Billing
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Higher Acuity vs. Lower Acuity Residents: Reprioritize Service
Capabilities
Utilize non-certified staff or resident/staff families to provide
direct resident care support (CNA)
Eliminate non-essential meds for Residents based on acuity
Billing 2 weeks late vs. getting meds to the floor
Dialysis
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Extension of patients to spread out dialysis treatments
Work to streamline physician orders – Emergency Physician
Order Form
Streamline admissions paperwork
Department/Position – Other ?’s
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Inability to provide services from the
department/area (relocate in the building to
consolidate staffing or relocate to another physical
location)
Information Systems down-time operations (i.e.:
coders would go to the books and manually code –
do you have all the necessary books?)
Inability to secure transportation for patients
(dialysis)? Inability to access your patients (home
health)?
Leadership Considerations
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Priority of Services that MUST continue (cash flow /
clinical needs)
How to pay staff with no revenue coming in?
Skeleton Crew – Essential Staff (based on Dept.
Specific Plans)
When to determine if operations must cease?
Insurance to support short term or long term
business interruption
Key relationships (if 2nd or 3rd in command need to
take over)

Fundraising
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Political Figures
Financing Short-term Emergencies

Banking Leaders
Mutual Aid Plan (MAP)
MUTUAL AID EVACUATION & SUPPLY PLAN
Northeast Ice Storm
1998
Florida Hurricanes
2004
Agreement among member facilities to
Plan provide
as a group
of
providers,
not
as
assistance to each other at the
standtime
alone
facility or corporation
of a disaster

a
NEED SUPPLIES

Coordination with the Mutual Aid Plan (MAP)
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1) Standard Vendors first
2) Regional MAP Vendors second
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3) Joint Region MAP Vendors

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Continuous interaction with Local EOC for non-medical needs
Interaction with State EOC for non-medical and medical needs
4) State of Emergency Declaration


Other facilities in your Regional MAP State of Emergency
Declaration
Other facilities in your Joint Region MAP
SUPPLIES

Request verbally; followed by written

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Vendor MOU
Transport – may be offered by Donor facility
Pharmaceuticals – see next page
Summary of Equipment and Supplies – Aggregate of all
facilities
Facility Specific Info

Plan will include:
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Specifics that facilities will provide
Medical Supply / Equipment Vendors
General Supply Vendors (cleaning, waste removal, mattresses,
linens)
Personal Protective Equipment (PPE)
Pharmaceuticals
Portable HVAC
Generators and Fuel
Food and Liquids
Russell Phillips & Associates, LLC
New York / Connecticut / California
860-793-8600
[email protected]
www.phillipsllc.com