Transcript Renee Clack - Council on Licensure, Enforcement and Regulation

Expect the Unexpected: Are We Clearly Prepared?
Hurricane Rita & Katrina
Lessons Learned
Renee Clack
Unit Manager
Regulatory Licensing Unit
Texas Department of State Health Services (DSHS)
Council on Licensure, Enforcement and Regulation
2006 Annual Conference
Alexandria, Virginia
REGULATORY LICENSING UNIT
• FACILITY LICENSING GROUP
• ARCHITECTURAL REVIEW GROUP
• EMS CERTIFICATION & LICENSING GROUP
• CHEMICAL & PRODUCT SAFETY LICENSING GROUP
• FOOD & DRUG LICENSING GROUP
• RADIATION SAFETY & LICENSING BRANCH
• ENVIRONMENTAL & SANITATION LICENSING
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Licensing Boards/Agencies
• DEVELOP VIABLE BUSINESS CONTINUITY
PLANS
• IMPORTANT TO HAVE BACKUP LICENSEE
DATA AT ALTERNATIVE LOCATION IN THE
EVENT OF POWER OUTAGES OR PRIMARY
SITE INACCESSIBILITY BY STAFF
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
EMS/EMTs PARMEDICS
• LICENSED LARGE VOLUME OF PARAMEDICS &
EMTs FROM OTHER STATES
• DEVELOPED AN EXPEDITED LICENSING
PROCESS
• SHORT & CONDENSED TEMPORARY
APPLICATION FORM
• 1 PAGE & AVAILABLE ON WEBSITE
• APPLICATION AVAILABLE AT TEMPORARY
SHELTERS ACROSS STATE
• WAIVED LICENSING FEES
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
EMTs/PARAMEDICS LICENSE
RENEWAL
• TEMPORARY LICENSE VALID FOR ONE YEAR
• OUT OF STATE LICENSEES MUST THEN
COMPLY WITH NORMAL RENEWAL
REQUIREMENTS, INCLUDING CEUs & PAYING
RENEWAL FEES
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
NEW DISASTER PLANS FOR EMS
• DEVELOP MOAs WITH LICENSED EMS PROVIDERS FOR
MUTUAL AID OF EMERGENCY MEDICAL SERVICES FOR
PUBLIC ASSISTANCE IN A PENDING OR ACTUAL
DISASTER
• STAFFED AMBULANCES WILL BE PLACED ON A LIST OF
AMBULANCE RESOURCES & WILL BE REQUIRED TO
RESPOND TO STATE FACILITIES FOR THE MISSION OF
EVACUATING STATE SCHOOLS OR HOSPITALS
• AMBULANCE FIRMS ONLY COMMIT IF LOCAL SERVICE
AREA WILL NOT EXPERIENCE DEGRADATIONOF SERVICE
OR EXCEED OTHER CONTRACTUAL OBLIGATIONS
DURING A DISASTER
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
NEW DISATER PLANS FOR EMS
• ONCE DSHS SENDS DEPLOYMENT LETTER TO EMS
PROVIDER, MUST HAVE STAFFED AMBULANCES AT
DESIGNATED MISSION WITHIN 3 HOURS
• EMS PROVIDER REQUIRED TO KEEP
∙PATIENT CARE RECORDS
∙PATIENT DEMOGRAPHICS, INCLUDING
INSURANCE
∙A TIME LOG RECORD FROM ACTIVITIES
• AFTER BILLING MEDICARE, MEDICAID, PRIVATE
INSURANCE/3rd PARTY PROVIDERS, WILL ACTUALLY BE
ABLE TO BILL DSHS HOURLY FROM $47.92 (BASIC LIFE
SUPPORT) - $57.92 (MOBILE INTENSIVE CARE UNIT)
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
END STAGE RENAL DISEASE
FACILITIES (ESRDs)
• EXPEDITED TEMPORARY REQUESTS FOR
ESTABLISHMENT OF ADDITIONAL STATIONS THAT HAD
NECESSARY EQUIPMENT & STAFF AVAILABLE TO
FUNCTION (30 – 90 DAY PERIOD)
• WAIVED FEES
• ALLOWED ESRDs TO RELOCATE TO ALTERNATE SITES
IF A FACILITY WAS LOCATED IN AN AFFECTED AREA
AND PROVIDER WAS ABLE TO STAFF/PROVIDE
SERVICES ELSEWHERE
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
NEW DISASTER PLANS FOR ESRDS
• DESIGNATING SHELTERS ACROSS THE STATE
SPECIFICALLY FOR DIALYSIS PATIENTS
• DSHS ENTERED A MOA WITH THE ESRD NETWORK FOR
THE ESTABLISHMENT OF A STATEWIDE COMMAND
CENTER TO BE OPERATED 24/7 IN THE EVENT OF A
DISASTER
• TOLL FREE NUMBER WILL BE POSTED THROUGHOUT
THE STATE VIA MEDIA SOURCES FOR DIALYLSIS
PATIENTS TO CALL AND BE PROVIDED IMMEDIATE
ACCESS TO SERVICE IN THE AREA
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
HOSPITALS
• EXPEDITED REQUESTS FOR ADDING
ADDITIONAL BEDS TO HOSPITAL LICENSE
• WAVIED FEES FOR ADDITIONAL BEDS UP TO 6
MONTHS
• AFTER 6 MONTH PERIOD, HOSPITAL HAD TO
PAY FOR ADDITIONAL BEDS
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
NEW DISASTER PLANS FOR
HOSPITALS
• DEVELOPING LICENSING RULES TO
ADDRESS DISASTER PREPARDNESS
OF HOSPITALS
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
NEW DISASTER PLANS FOR
HOSPITALS
• DISASTER PLANS SHALL INCLUDE:
∙
NAMES & CONTACT NUMBERS OF CITY &
COUNTY EMERGENCY MANAGEMENT OFFICERS
∙
SCHEDULE FOR EXERCISING DISASTER
PREPAREDNESS ANNUALLY & IN CONJUNCTION
WITH STATE & LOCAL EXERCISES
∙
METHODOLOGY FOR NOTIFYING THE
HOSPITAL PERSONNEL & THE LOCAL
DISASTER MANAGEMENT AUTHORITY OF
AN EVENT THAT WILL SIGNIFICANTLY IMPACT
HOSPITAL OPERATIONS
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
NEW DISASTER PLANS FOR
HOSPITALS
∙
∙
EVIDENCE THAT THE HOSPITAL HAS
COMMUNICATED PROSPECTIVELY WITH THE
LOCAL UTILITY & PHONE COMPANIES
re: NEED FOR THE HOSPITAL TO BE GIVEN
PRIORITY FOR THE RESTORATION OF SERVICE
PROCESS FOR UPDATING DSHS OF BED
AVALABILITY; EMERGENCY, BURN, ADULT ICU,
MEDICAL/SURGICAL, NEGATIVE PRESSURE/
ISOLATION, ETC
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
NEW DISASTER PLANS FOR
HOSPITALS
∙
∙
∙
∙
A COMPONENT FOR THE RECEPTION,
TREATMENT & DISPOSITION OF CASUALTIES
A PROCESS TO ALLOW ESSENTIAL HEALTHCARE
WORKERS & PERSONNEL TO SAFELY ACCESS THEIR
DELIVERY CARE SITES
PROVISION FOR USE OF PERSONAL PROTECTION
EQUIPMENT FOR STAFF IN ADDITION TO
IMMUNIZATION OF STAFF, VOLUNTEERS, STAFF
FAMILIES, ETC.
PLAN TO PROVIDE FOOD & SHELTER FOR STAFF &
VOLUNTEERS
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
NEW DIASTER PLANS FOR
HOSPITALS
∙
EVACUATION COMPONENT – INCLUDING WHEN
WITHIN THE CONTROL OF THE HOSPITAL, PATIENT
EVACUATION DESTINATION, INCLUDING
PROTOCOL TO ENSURE THAT THE PATIENT
DESTINATION IS COMPATIBLE TO PATIENT ACUITY
& HEALTH CARE NEEDS, PLAN FOR THE ORDER OF
REMOVAL OF PATIENTS & PLANNED ROUTE OF
MOVEMENT, TRAIN & DRILL STAFF ON THE
TRAFFIC FLOW & MOVEMENT OF PATIENTS TO A
STAGING AREA, & ROOM EVACUATION PROTOCOL
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
NEW DIASTER PLANS FOR
HOSPITALS
∙
∙
∙
FAMILY/RESPONSIBLE PARTY NOTIFICATION
TRANSPORT OF RECORDS & SUPPLIES – INCLUDING
PATIENT’S MOST RECENT PHYSICAL ASSESSMENT,
MAR, ORDER SHEET, ETC.
ALL PATIENTS SHOULD HAVE A WEATHER-PROOF
PATIENT I.D. WRIST BAND
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Hospitals, Nursing Homes
Other Facilities
• HOSPITALS, NURSING HOMES & OTHER
FACILITIES SHOULD ALL HAVE REALISTIC
EVACUATION PLANS THAT INCLUDE PREESTABLISHED CONTRACTS FOR
TRANSPORTATION SERVICES TO RELOCATE
PATIENT/RESIDENTS.
• IMPORTANT TO ENSURE THAT ALL FACILITIES
AREN’T PLANNING/CONTRACTING WITH THE
SAME TRANSPORTATION COMPANY BECAUSE
IN THE EVENT OF A REAL EMERGENCY,
TIMELY ASSISTANCE CANNOT BE PROVIDED
TO MULTIPLE FACILITIES AT THE SAME TIME.
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Hospitals, Nursing Homes
Other Facilities
• AT LEAST ONE HOSPITAL, NURSING
HOME, OR FACILITY EMPLOYEE SHOULD
ACCOMPANY RESIDENTS/PATIENTS
DURING TRANSPORTATION FOR
RELOCATION PURPOSES TO ENSURE
SAFETY AND ALSO ENSURE THAT
PERTINENT MEDICAL RECORDS &
MEDICATIONS ACCOMPANY
RESIDENTS/PATIENTS TO THEIR NEW
LOCATION.
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Hospitals, Nursing Homes
Other Facilities
• RESIDENTS/PATIENTS SHOULD HAVE
IDENTIFICATION BRACELETS THAT
INCLUDE THEIR NAME, MEDICAL
DIAGNOSIS, & OTHER IMPORTANT
INFORMATION THAT CAN IDEALLY
BE SCANNED DURING EVACUATION
PURPOSES FOR EASY TRACKING.
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
LESSONS LEARNED…
BROKEN PROMISES
• MANY PROMISES ARE MADE DURING
EMERGENCY SITUATIONS THAT ARE
NOT LATER FULFILLED. FOR EXAMPLE,
MANY INDIVIDUALS WHO LACK THE
PROPER AUTHORITY SUCH AS DPS
OFFICERS DEPLOYED EMS PROVIDERS
WHO ARRIVED AT A DISASTER SITE TO
GO TO OTHER CITIES/LOCATIONS TO
ASSIST IN TRANSPORTING
PATIENTS/RESIDENTS.
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
LESSONS LEARNED….
UNIDENTIFIED POPULATION
• THERE IS A HUGE UNIDENTIFIED POPULATION
THAT IS NOT INSTITUTIONALIZED THAT
RECEIVE ASSISTANCE SUCH AS HOME HEALTH
SERVICES IN THE COMMUNITY, THAT MAY
NEED ASSISTANCE WITH EVACUATION.
• EFFORTS SHOULD BE UNDERTAKEN TO HELP
IDENTIFY THESE INDIVIDUALS PRIOR TO AN
EMERGENCY SITUATION SO THAT THEY CAN
GET THE ASSISTANCE THEY NEED IN
EVACUATING.
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
LESSONS LEARNED…
IDENTIFICATION BADGES
• STATE GOVERNMENT & CITY
OFFICIALS SHOULD HAVE I.D.
BADGES THAT INCLUDE A STATE
SEAL SUCH AS THE BADGES DPS
OR OTHER LAW ENFORCEMENT
OFFICERS CARRY IN ORDER TO
ENSURE THEY CAN GET PAST
BARRICADES TO PROVIDE
ASSISTANCE AT DISASTER SITE.
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
LESSONS LEARNED…
ACCOMMODATING EVACUEES
• TEXAS IS NOW WORKING OUT A PLAN WITH
ALL THE HEALTH SCIENCE CENTERS AT STATE
SUPPORTED UNIVERSITIES SO NURSING &
MEDICAL STUDENTS CAN STAFF LOCAL
SHELTERS THAT ARE TEMPORARILY SET UP
TO ACCOMMODATE EVACUEES.
• EACH OF THE HEALTH SCIENCE CENTERS WILL
ALSO BE SENT PRE-PACKAGED EMERGENCY
KITS IN BULK THAT INCLUDE BASIC MEDICAL
SUPPLIES LIKE STERILE BANDAGES, BOTTLED
WATER, ETC..
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
LESSONS LEARNED…
EVACUATION ROUTES
• TEXAS HAS DEVELOPED AN ORGANIZED PLAN FOR
EVACUATION OF CITIES ALONG ITS COASTLINE. FOR
EXAMPLE, PEOPLE IN BEAUMONT/PORT ARTHUR AREA
WILL GO TO TYLER; CORPUS CHRISTI WILL GO TO SAN
ANTONIO, HARLINGEN/BROWNSVILLE WILL GO TO
TEMPLE, WACO & EL PASO, ETC…
• COMFORT STATIONS WILL BE DEVELOPED ALONG
EVACUATION ROUTES TO PROVIDE MEDICAL
ASSISTANCE TO EVACUEES
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
LESSONS LEANED…
SPECIAL NEEDS POPULATION
• DURING SPRING OF THIS YEAR, PEOPLE ALONG
COASTLINE WERE ENCOURAGED TO CALL “211” TO
REGISTER & ALSO IDENTIFY IF NEED ASSISTANCE WITH
TRANSPORTATION.
• BASED ON EVACUATION NEEDS – PEOPLE ASSIGNED
LEVEL ONE (SELF – ECACUATE) TO LEVEL 5 (LEVEL 4/5 –
NEED ASSISTANCE & WILL EITHER BE TRANSPORTED
FROM HOSPITAL OR NURSING HOME TO ANOTHER
HOSPITAL OR NUSRING HOME).
• FACILITIES ARE RESPONSIBLE FOR ENTERING
AGREEMENT WITH DESTINATION FACILITIES &
SECURING TRANSPORTATION MODALITIES.
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
FINAL POINTS
• EVERY STATE SHOULD HAVE A PREESTABLISHED & STRUCTURED EMERGENCY
MANAGEMENT PLAN THAT INCLUDES HOW
INFORMATION/REQUESTS FOR ASSISTANCE,
RESOURCES & SUPPLIES WILL BE DIRECTED &
CLEARLY ESTABLISHES THE SINGLE
AUTHORITY EMPOWERED TO MAKE
DECISIONS/ISSUE DIRECTIONS/APPROVE
REQUESTS FOR ASSISTANCE, RESOURCES, ETC.
• EFFECTIVE COMMUNICATION OF
PREPARATION IS THE KEY TO SAVING LIVES
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Speaker Contact Information
Speaker Name: Renee Clack, Unit Manager
Organization: Regulatory Licensing Unit
Texas DSHS
Address: 8407 Wall Street
Austin, Texas
Phone: (512) 834-6744
E-mail: [email protected]
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia