Transcript Ice Storm - 96 Hour Sustainability

This exercise program was developed and made
available by the Missouri Hospital Association
through funds from the ASPR Hospital
Preparedness Program CFDA 93.889, through a
subcontract from the Missouri Department of
Health and Senior Services for the purposes of
individual hospital preparedness and exercise.
Sources used in the development of these materials
are noted in the Notes Section except where
general knowledge.
96 Hour Hospital
Sustainability
Can We Make It?
Presenters
 [Complete with presenter’s information]
Objectives
 Overview of TJC 96 hour rule
 Strategies to “go the distance”
 Potential for Ice-Storms and other Severe Winter
Weather in [your area]
 Strengths and weaknesses related to extended
period without external resources
 Strategies and next steps to “mitigate” this type
of event
“96 Hour Rule” EM.02.01.01,
EP3
 Not a rule but a principle
 It takes into account that the federal response in
large scale disaster will be 72 hours +++
 Does not mandate building of additional storage
capacity or maintaining additional supplies
 It is an attempt to have organizations do
realistic
planning and develop a means to make realistic
decisions in advance of an event
6 Critical Components
1.
2.
3.
4.
5.
6.
Communications EM.02.02.01
Resources EM.02.02.03
Safety and Security EM.02.02.05
Staff Responsibilities EM.02.02.07
Utilities EM.02.02.09
Clinical Activities EM.02.02.11
Disaster Traditional Impacts on
Hospitals
 Increased admissions
 Decreased discharges
 Traditional out patient services sought at the
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hospital
Chronically ill patients seeking support and
medications
Citizens seeking non-healthcare services and
shelter
Ever-increasing pressure put on limited
resources
The question of “shelter in place” or
“evacuation”
Common Characteristics of
Significant Disasters
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Sustained (lasts multiple days)
Affects multiple communities
Impacted or debilitated public services
Overwhelmed federal response
Threatened healthcare infrastructure
Impact on Health Care
Home Care closed
Long Term Care closed
Physician Offices closed
Outpatient Pharmacies closed
Dialysis Centers closed
Outpatient Cancer Centers closed
Special medical needs patients can not be
supported at home
 Discharged patients won’t/can’t leave the
hospital
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Strategies to Consider
 Resource conservation
 Curtailment of services
 Obtaining additional resources from the
community
 Obtaining additional resources from outside the
community
 Closing the hospital to new patients
 Staged or total evacuation
Conservation of Resources
Know your current capabilities
Plan for interruption of supplies and services
Identify patients that can be discharged
Limit use of resources that cannot be replenished
(fuel, water, supplies)
 Plan for alternative methods to meet common
needs (gas generators, waste management)
 Identify what utilities can be rationed and how
(power, air conditioning, waste water, linens)
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Curtailment of Services
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Cancel elective surgeries
Shut down all non-essential services
Close selected clinics
Limit selected diagnostic testing as agreed to by
medical staff leadership (in advance of an event
where possible)
Consolidation of Resources
 Know your inventory and usage rate
 Construct estimates of usage rates during
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emergencies
Ensure your critical equipment is compatible
with your planning partners
Know the realistic response of your vendors
Ensure that supplies and medications are
available from distant and disparate sources
Consider self-reliance strategies
Staged or Limited Evacuation
 Identify criteria by which decisions will be made
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(less than 12 hours of fuel, 70% of resources
consumed, etc.)
Determine these through exercises
Designate staff to accompany patients and
protect medical information
Identify transportation requirements to
accepting
organization
Communicate decisions to staff and family
Full Evacuation
 Cannot be done on the fly or out of desperation
 Must have pre-determined criteria to activate
this plan that all staff are aware of
 If evacuation is necessitated by an abrupt event,
have principles in place to guide staff
 Must not lose track of patients or staff
 Be prepared for the fallout that such an event
will generate (media, liability, insurance
coverage, loss of revenue, impact on staff)
Evacuation Considerations
Background
 All of Missouri experiences freezing temperatures
every year. In winter there is an average of about
110 days with temperature below 32°
 Freezing Rain is super-cooled on its descent and
freezes after contact with freezing or below temp.
objects on the ground.
 As it is a liquid; it conforms to those objects before
freezing and creates “glaze.”
Missouri Winter History (pre-2000)
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1905-February 13, Warsaw records -40
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1924-Ice Storm-wintry mix fell from 16th-19th. Three-fourths of the state covered by a
sheet of ice the last half of the month.
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1940-January. Coldest month for the state with an average temp: 15.3
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1970’s-Three consecutive frigid winters (beginning with ‘76-77) had some
climatologists describing it as a “mini” ice age.
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1978-79-Coldest winter on record with average temp: 24.1
1911-November 11, 50 temperature fall over 3 hour period; 65-70over 18-24
hours
1951-Christmas Eve. Ice storms cripple the entire state transportation system.
1960-March. Coldest March for the state and several monthly snowfall records
established (some as much as 3 feet on the ground at one time).
1983-December. Coldest Dec. for the state.
1995-January. Winter Storm that dumped almost 15” in a 24hr period over portions
of the state.
Missouri Declared Disasters for Winter
Weather (2000-Present)
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2002-Feb:Ice Storm
2006-Dec:Severe Winter Storms
2007-Jan:Severe Winter Storms and Flooding
2007-Dec:Severe Winter Storms
2008-Mar:Severe Winter Storms and Flooding
2009-Feb:Severe Winter Storm
2011-Mar:Severe Winter Storm and Snow Storm
Ice Storm Effects
 Unlike snow, ice layers (glaze) provide no traction
and make driving dangerous if not impossible.
 Ice can add hundreds of pounds to power lines
causing many thousands to lose power for long
periods of time.
 Entire metropolitan areas can be shut down.
 Hospitals generally see a surge of patients at the
start of an ice storm as motorists attempt to
navigate the slippery roads.
 Most devastating ice
storms contain totals
of over one inch.
 These storms can
cause severe tree
and power line
damage.
 Outages can last for
days.
Severe Winter Storms Response Plan
 [Where is your plan located?]
 Other response plans to consider during an ice storm
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Structural Damage Response
Communications Loss Response
Electrical Power Failure Response
Others?
Provide a short review of your winter
response plan
Key elements:
 Storm monitoring
 Communication to staff
 Proactive measures - supplies, utilities, staff
 Shelter in place plans
 Staff supplemental transportation plans
96 Hour Sustainability
 Provide a brief summary of your facilities
Emergency Management Assets and Resources
Inventory Summary
Exercise Objectives
 Test the ability of the hospital to maintain
operations when the hospital can not be
supported by the local community in the
following areas:
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Communications
Resources and assets
Security and safety
Staff Responsibilities
Utilities
Clinical activities
IT
Exercise Participants
 [List your exercise participants]
Exercise Format
 Four segments of scenario that will progress
across 4 days
 [Choose your format – large group open
discussion or break out groups]
 Groups will be asked to discuss what their
response would be to the given scenario in the
form of questions
 Assign a recorder and someone to report back to
the group [if in small groups].
DAY 1
Advance Warning 0800
 A major ice storm is expected to hit Missouri tomorrow;
with expectations of 1-2” of accumulation.
 The Department of Transportation expects many road
closures. Major travel arteries will receive priority for
ice/snow removal.
 Missouri Highway Patrol is advising that they will have
limited patrol ability and will only respond to “priority”
dispatches. They are encouraging people to stay home
and off of the roadways.
 Schools are already cancelling sessions in advance of
this storm.
Day 1
Freezing Rain 2300
 Freezing rain begins to fall in the [your] area.
 Night-shift staff are concerned with their ability
to leave as well as the ability of replacement
staff to arrive in the morning.
 At this time, no power losses have been
reported and no roads have been closed.
Patient Census
[complete with likely census]
End of Day 1
Situation Report
 [your organization or facility] facilities have
power.
 No roads have been closed.
 Travel is becoming difficult.
 Only the front line of this storm has hit. Freezing
rain continues to fall at a steady rate.
Day 1 Questions
 How does the current situation effect the six
critical areas?
 Communications
 Resources
 Safety and Security
 Staff
 Utilities
 Clinical Activities (Patient Care)
Day 1 Questions
 How will the hospital coordinate it’s activities?
 What are the hospital incident objectives at this
time?
 What strategies should be implemented to
continue operations?
Day 2
Day 2
 Accumulation totals average 1.5”
 Skies are overcast but no further precipitation is falling.
 Temperatures are very cold; averaging 20, the wind is
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blowing at 10-15 miles per hour
Highways [insert major roads] are closed due to
accidents
Most other roads are open, but travel is dangerous,
slow, and unreliable. Wrecked cars litter most roads.
The Highway Patrol and local law enforcement have
asked people to stay off the roads unless travel is
absolutely necessary.
The City/County activated its EOC during the night.
Day 2
Trash service is suspended.
Delivery of medical gases is suspended.
Staff members are unable to travel to work.
Supplies, linens, and pharmaceuticals will not be
delivered for at least 3 more days, depending on
the road conditions.
 Widespread power outages are starting to be
seen across [your area of] Missouri.
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Day 2 Situation Report
 A surge of patients is being seen from the multitude of
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accidents from the slick roads.
[list your organization or some of your facilities] are
without power, as are many of the homes and businesses
in the southern portions of [your town].
[one of your facilities] still has power.
There have been 35 people seeking shelter inside the
hospital but not requiring any other service.
Many of the staff members that were on duty have
stayed, and the staff that have been able to relieve them
expect to stay for the duration.
[list facilities] lose power at 23:00. The generators kick on,
causing many of the electronic and computer systems to
go temporarily off line.
Day 2 Questions
 How does the current situation effect the six
critical areas?
 Communications
 Resources
 Safety and Security
 Staff
 Utilities
 Clinical Activities (Patient Care)
Day 2 Questions
 How will the hospital coordinate it’s activities?
 What are the hospital incident objectives at this
time?
 What strategies should be implemented to
continue operations?
Day 3
 Temperatures for today are forecasted for high of 20
and low of 5 with winds at 15-20 mph.
 Temperatures are low and wind-chill levels are
dangerous.
 Power is out to the entire [your part of] Missouri area.
Fuel cannot be resupplied for another 3 days.
 The EOC is reporting that some shelters in the
community do not have emergency power, alternatives
are being sought. They would like to know if they can
send people to shelter at the hospital.
Day 3
 More community members are arriving seeking
shelter, some of them with special medical needs
such as oxygen and lack of medications.
 Dialysis patients are arriving as the community
center is closed.
 Many patients with flu-like symptoms are flooding
the emergency room. Many are very sick who
should have come for care 2 days earlier.
 Patients are arriving with injuries from falling on the
ice.
Day 3
 [Other facility] lost power at about 02:45. Their
generators are running.
 An outage of the IT network has occurred
causing VoIP phones to be inoperable.
 Power is out to the city wastewater treatment
plant.
Day 3
 The phones are out intermittently and radio
reception has been very staticky and hard to
hear.
 Cell phones are inoperable as the cell towers are
running on generators and can’t get fuel
resupply trucks to the towers.
 2 nursing homes with 120 total residents have
called to say they need to evacuate their
residents and would like to bring them to [your
hospital].
Day 3 Questions
 How does the current situation effect the six
critical areas?
 Communications
 Resources
 Safety and Security
 Staff
 Utilities
 Clinical Activities (Patient Care)
Day 3 Questions
 How will the hospital coordinate it’s activities?
 What are the hospital incident objectives at this
time?
 What strategies should be implemented to
continue operations?
Day 4
 Staff are starting to show signs of stress at the
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long hours, limited resources, lack of utilities,
and overcrowded condition of the hospital.
Additional patients are arriving with carbon
monoxide poisoning and hypothermia
symptoms.
Power, linens, and supply deliveries have still
not been restored.
They hope to have most utilities up and running
tomorrow.
Most roads and bridges in [your and adjacent
area] Missouri should be opening by tomorrow.
City/County EOC
 The City/County EOC informs you that
reimbursement for disaster expenses may be
possible, IF the expenses were tracked from the
beginning of the disaster
What have we learned?
 What went well?
 What did not go well?
 What do we need to do to ensure we are ready
should this happen in real life?
Questions?
Please complete your Participant
Evaluation Form
Thank you!