Module 5: Emergency Management Standards for Health Care Systems

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Module 5Emergency Management Standards for
Health Care Systems
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Module Objectives
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Unit 5.1Overview ofNFPA JCAHO Emergency
Management Standards
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Unit Objectives
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National Fire Protection Association
(NFPA)Emergency ManagementStandards
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NFPA

• Mission To reduce the worldwide burden of fire
  and other hazards on the quality of life by
  providing and advocating scientifically-based
  consensus codes and standards, research, training
  and education.
• Organized in 1896
• Membership 68,000 individuals and 80 national
  trade and professional hroups.

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NFPA Activities

• Technical Development, publication and
  dissemination of timely consensus codes and
  standards intended to minimize the possibility
  and effects of fire.
• 225 Technical Committees composed of 6,500
  representatives serving on an unpaid basis.
• Educational Teaching these codes and standards
  and the importance of fire safety as a way of
  life.

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NFPA Format

• Standard
• Appendix A Explanatory Material
• Appendix B Referenced Publications
• Appendix C Additional Information
• General Considerations
• Personnel Notification and Recall
• Special Considerations

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NFPAEmergency Management Standards

• NFPA 99, Chapter 11 Health Care Emergency
  Management
• Pre-dates Joint Commissions attention to
  emergency preparedness.
• NFPA 1600 Recommended Practice for Emergency
  Management
• Public-private, international consensus

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2001NFPA 99, Chapter 11Health Care Emergency
Management
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NFPA 99, Chapter 11

• Scope Establishes minimum criteria for an
  effective health care facility emergency
  management plan.
• Applicability Any health care facility that
  intends to provide medical treatment to the
  victims of a disaster.

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NFPA 99/11Plan Criteria

• Identification of Emergency Response Personnel
• Continuity of Essential Building Systems
• Staff Management
• Patient Management
• Logistics

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NFPA 99/11Plan Criteria (cont)

• Security
• Public Affairs
• Staff Education
• Drills
• Operational Recovery

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2000 NFPA 1600Recommended Practice for
Emergency Management
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NFPA 1600

• Purpose To provide those with a responsibility
  for emergency management the criteria to assess
  current programs, or to develop,implement and
  maintain a program to mitigate, prepare for,
  response to, or recover from disasters and
  emergencies.

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NFPA 1600Program Elements

• Laws Authorities
• Hazard Identification Risk Assessment
• Hazard Management
• Resource Management
• Planning

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NFPA 1600Program Elements (cont)

• Direction, Control Coordination
• Communications Warning
• Operations Procedures
• Logistics Facilities
• Training

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NFPA 1600Program Elements (cont)

• Exercises, Evaluations Corrective Actions
• Public Education Information
• Finance Administration

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2001 Joint Commission on the Accreditation of
Healthcare Organizations (JCAHO)Environment of
Care (EC) 1.4 Emergency ManagementStandards
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Environment of Care

• The goal of the Environment of Care (EC) is to
  provide a safe, functional, supportive and
  effective environment for patients, staff members
  and other individuals to the health care
  facility.

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Environment of Care Areas

• Safety
• Life Safety
• Security
• Hazardous Materials and Wastes
• Utility Systems
• Medical Devices
• Emergency Management

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Emergency Management

• The goal of emergency management (EM) is to
  create and maintain an effective organization to
  prevent, prepare for, respond to and recover from
  major threats to lives and livelihoods.

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Environment of Care (EC) Framework
EC 3.1 Collect information about deficiencies
EC 3.2 Corrective action
EC 1 Design
EC 3 Measurement
EC 1.4 Design management plan
EC 2.9 Drills are conducted
EC 2 Teach Implement
EC 2.5 Plan is implemented
EC 2.1 Staff can describe/demonstrate
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Relationship of EC to EM
EC 3.1 Collect information about deficiencies
EC 3.2 Corrective action
EC 1 Design
EC 3 Measurement
MITIGATION
EC 1.4 Design management plan
RESPONSE, RECOVERY
EC 2.9 Drills are conducted
PREPAREDNESS
EC 2 Teach Implement
EC 2.5 Plan is implemented
EC 2.1 Staff can describe/demonstrate
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JCAHO EC 1.4Whats New

• Comprehensive Emergency Management
• Hazards Vulnerability Analysis
• PICE Nomenclature

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JCAHO EC 1.4Whats New (cont)

• Plan Activation Criteria
• How, When, By Whom?
• Hospital-Community Linkage
• Who is in charge - when?
• Personnel Identification
• Preparing for Patient, Staff and Family Needs

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JCAHO EC 1.4Whats New (cont)

• Security
• Media Relations
• Back-up Communications
• Internal and External
• Facility Evacuation
• Horizontal and Vertical

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JCAHO EC 1.4Whats New (cont)

• Alternate Care Site
• Meet clinical needs of the patient
• Patient tracking
• Meds
• Medical records
• Transport patients, staff, equipment
• Interfacility communications

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JCAHO EC 1.4Whats New (cont)

• Planning for Restoration/Recovery
• Utility Systems
• Critical Supplies
• Continuity of Business Operations
• Incident Management System

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Unit 5.2Relationship Between the NFPA and JCAHO
EM Standards
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Unit Objectives
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Relationship99/11, 1600 EC 1.4

• Complementary consistent.
• NFPA 1600 provides an overall emergency
  management program structure.
• 13 functional areas/program elements specified
• JCAHO EC 1.4 provides detail on health system
  specifics.
• Align to functional areas/program elements
• NFPA 99/11 augments both.

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NFPA 1600-JCAHO 1.4
JCAHO
NFPA

• Program Management
• Policy
• Program Coordinator
• Program Committee
• Program Assessment q
• Program Elements
• General Intent
• Laws Authorities
• Hazard Ident./Risk Assessment a.

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NFPA 1600-JCAHO 1.4 (cont)
NFPA
JCAHO

• Program Elements (cont)
• Hazard Management
• Resource Management
• Planning c
• Direction, Control Coordination b, ( c ),
  f, g, h, o
• Communications Warning d, e, m.
• Operations Procedures (a),(h), i, j, k
• Logistics Facilities (h), I, n

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NFPA 1600-JCAHO 1.4 (cont)
NFPA
JCAHO

• Program Elements (cont)
• Training p
• Exercises, Evaluations
  Corrective Actions q, r, 2.9
• Public Education Information (h)
• Finance Administration

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Standard Program Description
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Program Review Tool
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Unit 5.3Approaches to the 2001JCAHO EM
Standards
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Unit Objectives
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EoC 1.4, Intent Statement

• The emergency management plan describes how the
  organization will establish and maintain a
  program to ensure effective response to disasters
  or emergencies affecting the environment of care.
  The plan should address four phases of emergency
  management activities mitigation, preparedness,
  response, and recovery.

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ComprehensiveEmergency Management4 Phases

• Mitigation
• Preparedness
• Response
• Recovery

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Mitigation Activities

• Hazards Analysis - Internal External
• Vulnerability Analysis
• Actions taken to reduce the impacts

- What types of natural, technological and
man-caused events threaten the Environment of
Care?
- For each threat, ask What will be the likely
impacts (considering both direct and indirect
effects) ?
- What can be done to ensure operating systems
remain functional? (And have back-ups...)
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Preparedness Activities

• Resources Listing
• Pre-arranged agreements
• Staff orientation and training on basic response
  actions
• Facility-wide rehearsals

- That provide the back-up for damage to the
plant, supplies, equipment, communications, and
people.
- Simple guidelines covering how you expect each
employee to behave during any emergency.
- That stress organizational mobilization
coordination, and communications
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Response Activities

• Take appropriate actions to protect life and
  conserve property
• Notify persons in charge
• Continue to organize and manage

All Staff

• Situation assessment
• Warning and notifications
• Setting objectives and priorities
• Facility-wide instructions
• Plan for what happens next
• Liaison with external systems

Mgmt.
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Recovery Activities

• Determine present level and extent of patient
  care capability
• Adjust patient care policies
• Set objectives and priorities for the
  re-establishment of operating systems that
  support the Environment of Care
• Make stress debriefing services available to
  patients and staff
• Schedule and conduct an incident critique
• Make improvements to the CEM program

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Structuring theManagement Plan

• NFPA 1600s 13 Program elements provide an
  outline for the emergency management program,
  within which JCAHO 1.4 fits.
• Management Plan components
• Laws Authorities
• Policy Mission statement(s)
• Responsibilities
• Goals, objectives and strategies
• Budget

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Hazards Vulnerability Assessment (HVA)

• A needs assessment for the emergency management
  program.
• Three components
• Hazard identification (what?)
• Risk assessment (how likely?)
• Appraisal of vulnerabilities (what will we lose
• Outputs/uses
• Resource identification and inventory.
• Mitigation program
• Education program

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IEMS
Maximum Capability Required
Optimally Integrated Plans
Continual Maintenance
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MITIGATION EFFORTS
CAPABILITY ASSESSMENT
EMERGENCY OPERATIONS PLANS
CAPABILITY MAINTENANCE
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EMERGENCY OPERATIONS
EVALUATION
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3
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HAZARDS ANALYSIS
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STATE/ LOCAL RESOURCES
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1
CAPABILITY SHORTFALL
MULTI-YEAR DEVELOPMENT PLAN
ANNUAL DEVELOPMENT INCREMENT
ANNUAL WORK INCREMENT
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FEDERAL RESOURCES
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9
10
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Hazard Identification

• Types of hazards in the local community
  natural, technological, man-caused.
• Sources of information State/Local Emergency
  Management Agency, Local Emergency Planning
  Committee
• Technical guidance NFPA 1600, engineering
  department.
• Output A list used by the facilitys emergency
  management planning committee.

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Risk Assessment

• Subjective prioritization of hazards identified
  (probability hazard will occur).
• Educational activity for facility emergency
  management planning committee.
• Think in terms of the facility, but also the
  entire community.
• Outputs Prioritized list of hazards, risk maps.

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Vulnerability Assessment

• Subjective analysis of the functional impact of
  the hazard occurring.
• Capability shortfall matrix
• Again, think in terms of the facility as well as
  the local community.
• Staff
• Home-based patients
• Suppliers
• Utilities

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Capability Shortfall Matrix
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Initiating the Emergency Plan

• An algorithm or decision tree that should reflect
  consideration of incident factors.
• The actions would include
• Initial and continuing assessment.
• Validation.
• Notifications, call-back and reporting.
• Assembling key staff.
• Establishing the operational period.
• Setting objectives.

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Defining Areas of Responsibility

• Defining the facilitys role in the communitys
  emergency management program
• Organizational mission
• Integrating the facilitys role
• Local Emergency management Agency
• Hospital Council
• Local Emergency Planning Committee
• Identification of who is in charge
• Expanded discussion as part of annual fire
  inspection.

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Personnel Identification

• Identification issues
• Staff
• Volunteers
• Personnel identification methods
• I.D. Badges
• Command vests

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Managing Staff Support

• Housing Transportation
• Situations approaches
• Stress debriefing
• Awareness by management of situations conducive
  to stress during disasters
• Critical incident
• Extended incident
• Separation
• Fear of loss
• All employees should be treated in a manner to
  reduce and/or alleviate stress reactions.

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Staff-Family Support

• Family preparedness
• General
• Special situations
• Family support
• Dependents
• Children
• Elderly
• Pets

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Managing Critical Supplies

• Management process
• Forecasting
• Sources
• Critical supplies
• Pharmaceuticals
• Medical equipment supplies
• Food
• Linen
• Water

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Security

• Roles of facility security
• Alerting/warning point
• Tactical activities
• Control over facility property
• Traffic
• Crowds
• Access

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News Organizations

• Public Information Officer
• Pre-planning
• Briefing location
• FAQs (welfare inquiries, volunteers, blood)
• Collecting/clearing information
• Types and needs of news media
• TV
• Radio
• Print

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Evacuating the Facility

• Types and uses of evacuation methods
• Decision to evacuate
• Alternatives
• Management process
• Alternative care sites

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Types of Facility Evacuations

• Horizontal
• An area becomes unusable
• Away from windows
• Vertical
• Away from water
• Total
• Damage to structure/infrastructure

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Decision to Evacuate

• Who makes the decision?
• The assessment process.
• What are the administrative and operational steps
  to initiate?
• Where do you go?
• How do you get there?
• What and who goes with them?

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Alternate Care Sites

• Expand existing space
• Short-term needs with intact infrastructure
• Horizontal evacuation or surge demand
• Use of remote space
• Site selection
• Logistics
• Patient management

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Implications of Using Alternate Care Sites

• Can it be accessed when we need it?
• Nights/weekends/holidays
• Who has the key(s)?
• Pre-existing MOA?
• Can it handle the patient problem?
• Isolation needed?
• Clinical capabilities
• Size and configuration
• Utilities?
• Security

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Some More Implications

• Cost
• Credentialling
• How are the logistics handled?
• Transportation (how, who, what goes too?)
• Staffing
• What about the patient management issues?
• Medicines
• Equipment/supplies
• Documentation/record-keeping
• Patient tracking

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Re-establishing Operations

• Pre-planning considerations
• Defining when it is safe to return
• What are you returning to?
• Damaged facility/equipment
• Staff availability

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Return Issues

• Getting the facility ready
• Getting the patients back
• Record-keeping
• Resuming operations
• Working around construction
• Putting everything back
• Staff morale
• Restoring public confidence

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Alternatives to Evacuations

• Reduce occupancy
• Employees
• Patients
• Discharge stable patients
• Re-schedule appointments
• Change admissions policy
• Shelter in-place
• Situations

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Alternate Sources of Utilities

• Pre-planning issues
• Resource identification inventory
• Pre-arranged contracts
• Loss of utilities
• Lessons from Y2K

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Incident Command System

• Alternate roles and responsibilities of
  personnel during emergencies, including who they
  report to within a command structure that is
  consistent with that used by the local community.

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Incident Command System

• Facility approaches
• No set procedures - rely on common sense
• Rely on SOPs in disaster plan
• Have adapted ICS/HEICS to Facility
• Which is it?
• ICS, HEICS, IMS ?
• What is important?
• 8 components
• 5 management functions

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Design Requirements

• Common standards in organization and procedures
• Adaptable to any type of emergency
• Useful for small to complex incidents
• Maintains autonomy of jurisdiction
• Stress total mobility concepts
• Adaptable to new technology

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ICS has 8 Components

• Common Terminology
• Integrated Communications
• Modular Organization
• Unified Command Structure
• Manageable Span of Control
• Consolidated Action Plans
• Comprehensive Resource Management
• Pre-Designated Incident Facilities

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ICS has 5 Functional Areas

• Command or Management
• Planning
• Logistics
• Finance
• Operations

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ICS for Dummies

• Command/management Pointers
• Plans Thinkers
• Logistics Getters
• Finance Counters
• Operations Doers

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Hospital Emergency Incident Command System (HEICS)

• Adaptation of ICS to health care facilities
• Job Action Sheets
• Wide acceptance

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Community - Health Care FacilityOperating
Linkages
Emergency Operations Center
Community Plan Tactical Response Procedures Ch
ecklists (SOPs)
Facility Plan Tactical Response Procedures Che
cklists (SOPs)
Incident Command Post
Staging Area
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Questions?