Transcript APC Hospital Emergency Operations Plan Orientation Workshop

Hospital Emergency Operations Plan
Workshop
Updating the Hospital and Rural Medical Center
EOP for the Use of Volunteers in Medical Surge
AGENCY LOGO
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:
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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.
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.
Why is this an issue today?
• Terrorism
• Disasters
• Other
I knew this
would
happen!
– What keeps you awake at
night?
– What often happens?
– What are you unprepared
for?
– What can be done to plan
for these situations?
FEMA News – Andrea Booher
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)
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
Haven’t we done this before?
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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.
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
Hospital planning &
preparedness
• State Hospital Associations: Emergency planning,
HSEEP , state-level hospital coordination systems.
• “9-11” 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?
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?
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.
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
Incident implications
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Transportation
Electrical
Telephone
Water
Fuel
Structural
Communications
Incident implications
• Incidents restrict and overwhelm
resources, communications,
transportation and utilities.
• Individuals and communities are cut off
from the outside support.
What is your goal in an
incident?
• RESPONSE – manage victims (treat,
triage, transfer, disposition).
• RECOVERY – operational, financial, and
return to “normal” operations.
All Hazards approach to
planning
• A conceptual
framework for
organizing and
managing
emergency
protection efforts.
Who is involved in All Hazard
response efforts?
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Federal
Tribal
State
Local
Emergency
Management
Public Works
Fire/Rescue
EMS
Hospitals
Public Health
All Hazard steps
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Planning
Training
Exercising
Policies &
procedures
• Resource
requirements
• Resource upgrade
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
Emergency Operations Plan
• Introduction
• Procedures &
Operations
• HICS Job Action
Sheets
• Specific
Departmental
Tools
• Forms/Resources
Emergency Operations
Plan-Part 1
• Introduction
– 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.)
All Hazards Emergency
Operations
• Mitigation:
– 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.
Mitigation
• Hospital Hazard
Vulnerability
Analysis (HVA)
• Multiple Tools
Available
Mitigation
• Hazard
identification
• Hazard
Assessment
(HVA)
• Structural code
compliance
• Equipment and
maintenance
Preparedness
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Plan development
Training courses
Exercises
Employee
education and
competencies
• Public education
Response
• Alerting
• Assessment
• Mobilizing- Healthcare
partners and ESF8
• Implementing plan
• Activate systems
(HICS, EOC)
• Control, Set prioritiesInfection etc.
• Communication and
situational awareness
Recovery
• Those activities undertaken by a
hospital after an emergency or
disaster occurs to restore minimum
services and move towards longterm restoration.
Recovery
• Return to
“normal”
• Detailed damage
assessment
• Care and shelter
continues
• Funding
assistance
• Remove debris
Part 2- Specific procedures
& operations
• Patient Flow
– Triage
– Treatment Areas
• Security Activities
– Entry & Egress
– Visitors Access
Procedures & operations
• Communications
– Telephone
– Back-up systems
– Radio (VHF/800)
– Satellite phone
– Walkie – Talkies
– HAM radio
– Fax
Procedures & operations
• Patient
admissions,
triage, disaster
tags, registration
process
– Elective
procedures
– Discharge of
patients
Procedures & operations
• News Media
– Public
Information
Officer (PIO)
– Strategic
location
– Joint
Information
Center (JIC)
Procedures & operations
• Hotline
• Family of victims,
visitors, outpatients
Procedures & operations
• Supplies &
equipment
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Essential supplies
Pharmaceuticals
Medical supplies
Equipment
Food
Water
Linen
Utilities
Procedures & operations
• Morgue
– DOAs
– Others that
expire
Procedures & operations
• Evacuation
– Authority
– Transportation
– Location
– Evacuation
routes
– Practice/Test
Procedures & operations
• Continuing and/or
reestablishing
operations
• Off – site care
(Alternate Care
Sites, or ACS)
Procedures & operations
• Essential utility
alternatives
– Electrical
– Water
– Medical gas
– Waste
disposal
– Fuel
Procedures & operations
• Isolation &
decontamination
– Plan &
procedure
– Equipment
– Training
Procedures & operations
• Orientation &
education
• Annual plan
evaluation
Emergency Operations Plan
Part 3- HICS Job Action
Sheets
HICS Job Action sheets
• Incident
Command
• Operations
• Logistics
• Finance and
Administration
• Planning
• Others
HICS Job Action sheets
• One for each
position.
• Embodies title,
mission/function
and duties.
• Adjusted to meet
hospital needs.
Emergency Operations Plan
Part 4
Specific department tools
Specific departmental plans
• Emergency
Department
• Security
• Maintenance
• Nursing floors
• Admission policy
& registration
• Emergency
triage
• Evacuation
• Communications
• Emergency
Operations
Center
Emergency Operations Plan
Part 5-forms/resources
Forms/Resources
• Help drive
positions
• Documentation
aid
• Financial
recovery
• Decreases
liability
• Enhances &
tracks
communication
Emergency Management
A successful interface
needs:
• Planning
• Training
• Exercising
According to Joint
Commission1:
• 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 http://www.jointcommission.org/
Emergency Operations Plan
Emergency Operations Plan (EOP) describes
response procedures:
– Written plan
– Capabilities to self-sustain for up to 96 hours
[EM.02.01.01]
– 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.
Emergency Operations Plan
• Plan Structure
Emergency Operations Plan
• Addresses Twelve Critical Access Hospital Joint
Commission Components:
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Planning
The EOP
Communication
Resources & Assets
Safety & Security
Staff responsibilities
Utilities Management
Patient, clinical & support activities
Volunteer Management
Volunteer Credentialing
HVA and Evaluation
Plan Evaluation
[EM.01.01.01]
[EM.02.01.01]
[EM.02.02.01]
[EM.02.02.03]
[EM.02.02.05]
[EM.02.02.07]
[EM.02.02.09]
[EM.02.02.11]
[EM.02.02.13]
[EM.02.02.15]
[EM.03.01.01]
[EM.03.01.03]
Emergency Operations Plan
• EM.01.01.01 Planning (8 measures)
– The critical access hospital engages in planning activities prior
to developing its written Emergency Operations Plan.
• EM.02.01.01 The Plan (8 measures)
– The critical access hospital has an Emergency Operations
Plan.
• EM.02.02.01 Communication (15 measures)
– As part of its Emergency Operations Plan, the critical access
hospital prepares for how it will communicate during
emergencies.
• EM.02.02.03 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.
Emergency Operations Plan
• EM.02.02.05 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.02.02.07 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.02.02.09 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.02.02.11 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.
Emergency Operations Plan
• EM.02.02.13 Volunteer Management (9 measures)
– During disasters, the critical access hospital may grant
disaster privileges to volunteer licensed independent
practitioners.
• EM.02.02.15 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.03.01.01 Vulnerability Assessment and Evaluation (3
measures)
– The critical access hospital evaluates the effectiveness of its
emergency management planning activities.
• EM.03.01.03 Evaluating the Plan (17 measures)
– The critical access hospital evaluates the effectiveness of its
Emergency Operations Plan.
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?
For Volunteer Licensed
Independent Practitioners and
Volunteer Practitioners
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Section 1: Disaster Privileges
Section 2: Credentials Verification
Section 3: Volunteer Oversight
Section 4: Cessation of Volunteers
Use of volunteers
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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?
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
Where do I start?
• <Hospital Name>
has:
– Emergency
Operations Plan
(a base plan to
start with).
– Departmental Plans (ED, Triage, Admissions,
Evacuation, Security.
– Email <hospital point of contact> to receive
the plans electronically.
Center for HICS Education &
Training- www.hicscenter.org
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Guidebook
Training Resources
Job Action Sheets
Forms
Internal (13) & External
(14) Scenarios
<Presenter POC information>