ARE YOU PREPARED? A Disaster-Preparedness Workshop for Food and Nutrition Professionals October 12, 2006 UMDNJ-Scotch Plains, NJ

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ARE YOU PREPARED?A Disaster-Preparedness
Workshop for Food and Nutrition
ProfessionalsOctober 12, 2006UMDNJ-Scotch
Plains, NJ

• ALL HAZARDS EMERGENCY/DISASTER PREPAREDNESS
  ACROSS NJS HEALTHCARE CONTINUUM
• Gary J. Schnerr
• Director, Emergency Preparedness
• Health Care Association of New Jersey
• Hamilton, NJ 08691
• 609.890.8700
• www.hcanj.org

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Emergency Management The new normal

• Pre 9/11/01
• Focus on naturally occurring and accidental
  events i.e. fire, flood, hurricane/tornado,
  hazardous material spill, etc.
• Post 9/11/01
• Expanded to include human-caused deliberate
  events i.e. chemical dispersal, biological agent,
  nuclear/radiological release, bomb, etc.
• integrated, all hazards

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Primer on Emergency Management collaborative
alliances

• Life Cycle of all hazards EM Process

Preparedness
Hazards Vulnerability Analysis
Response
Mitigation
4 Phases Of EM
Recovery
Collaborative alliances strengthen and expand
the resources available in an Emergency
situation
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Not an Island.

• Organize/Leverage External Resources
• Collaborative alliances- define
  responsibilities of participants
• Municipal, county, state, private resources
• DHSS/Health Infrastructure Preparedness
  Response, Police, Fire, EMS, OEM, CERT, MRC
• Suppliers (goods and services)

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Healthcare ContinuumPartners in Preparedness

• Preparedness For
• all hazards including natural and man-caused
• fire, flood, food-borne pathogen, biological
  event, etc.
• single facility, local, regional, state,
  multi-state

Partners

• Acute Care Hospitals- 83
• Primary Care Centers (FQHC)- 19
• Long Term Care- 800licensed facilities
• SNF, ALF, CPCH, RHCF, ADS, Senior Housing
• Home Care-600 certified agencies
• Facilitated through Professional Trade
  Associations

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Role of the Professional Trade Associations

• Provide Advocacy Representation of respective
  constituency members at state level
• Provide active liaison for Disaster/Emergency
  Preparedness at local, municipal, regional, and
  state levels
• Provide targeted training and education
  applicable to membership needs
• Provide Disaster/Emergency planning guidance in
  form of tools, coaching, exercise review, etc.
• Meet as a group, Healthcare Associations
  Emergency Preparedness Alliance, monthly to
  ensure that healthcare continuum
  Disaster/Emergency Preparedness is coordinated
  for maximum efficiency and effectiveness.

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Preparedness Planning..

• Facilities required to have comprehensive
  Disaster/Emergency plans
• Acute Care Hospitals
• Long Term Care Facilities
• Federally Qualified Health Centers
• Home Care Agencies

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Sample TOC for Residential Health Care Facility

• Draft RHCF 1
• 843-12.2 Emergency Preparedness Plan
• Scope of Plan/General Statement
• Chain of command
• Emergency phone list
• Description of facility including
• Type of construction, number of floors, and
  number of beds
• Fire/smoke detection systems
• Fire suppression systems
• List names, addresses, telephone numbers of
  companies
• maintaining fire/smoke detection fire
  suppression systems
• 4. Facility floor plans including 843-12.2(b)
• Emergency exits
• Fire pull alarms
• Fire annunciator panels
• Fire extinguishers
• Fire sprinkler shut off
• Fire department connection/standpipes

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Sample TOC for Residential Health Care Facility

• NJDHSS Regulation for emergency preparedness
• Potential hazards for an evacuation
• Fire/smoke 843-12.3
• Explosion
• Weather related emergency 843-15.5
• Cold 843-15.5(a)
• Heat 843-15.5(b)
• Snow 843-4.8(a)1
• Hurricane/severe storm 843-4.8(a)1
• Flood 843-4.8(a)1
• Tornado 843-4.8(a)1
• Earthquake 843-4.8(a)1
• Disruption of utilities 843-4.8(a)1
• Water 843-15.6(a)
• Gas 843-4.8(a)1
• Electric 843-4.8(a)1
• Sewage 843-15.6(f)
• Communication 843-4.8(a)1

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Sample TOC for Residential Health Care Facility

• Nuclear or radiological incident
• Hazardous chemical incident
• Biological incident
• Terrorist incident
• Bomb threat
• Labor disputes/work stoppage
• Civil disturbance
• Structural damage
• Evacuation and relocation 843-12.1(b)
• Memorandum of understanding (MOU) with other
  facilities for relocation
• Temporary holding facility for relocation (if
  necessary, i.e. school)
• Partial evacuation to another area of facility
• Transportation for relocation 843-12.1(b)
• Agreement with transport provider
• Agreement with local and surrounding rescue
  departments
• Resident identification for relocation 843-12.1(b
  )
• Medication, records, equipment, supplies for
  relocation 843-12.1(b)
• Emergency staffing

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Sample TOC for Residential Health Care Facility

• Emergency responsibilities 843-12.2(c)
• Administrator or designee
• RN/EMS health maintenance and monitoring
• Admission/office procedure
• Housekeeping/laundry
• Maintenance procedure
• Dietary procedure 843-8.3(a)13.
• Activities procedure
• Support personnel
• Incident Command System (ICS)
• Resident Care during relocation 843-12.2(c)
• Return of Resident 843-12.2(c)
• Emergency facility food and water
  supply 843-8.3(a)13.
• Memorandum of Understanding (MOU) for accepting
  residents from other facility (optional)
• Memorandum of Understanding (MOU) with emergency
  management officials (local, county, state)
  
• Disaster planners responsibilities
• Staff training 843-12.2(b)
• Evacuation drills 843-12.2(b)
• Crisis Communications

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Local Information Network Communication
System (LINCS)

• Statewide emergency/routine information
  dissemination
• Qualified agencies can subscribe, select type
  of info
• http//www.state.nj.us/health/lh/lincs/index.htm
• Internet-enabled
• 21 county LINCS Agencies
• Managed by DHSS Infrastructure Preparedness
  Response
• Directly connected to the Center for Disease
  Control (CDC) Health Alert Network (HAN) for
  national coverage
• Example-Recent e-coli spinach contamination

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NJ Office of Emergency Management
(OEM)---Nucleus of Disaster/Emergency Response

• A NJ State Police Agency
• Network of OEM Coordinators (OEMC)
• 21 County Coordinators-Full-time role
• www.state.nj.us/njoem- list/contact info
• 500 Regional/municipal/local Coordinators
• Some full-time, many part-time role
• List/contact info from County Coordinator
• Local Emergency Planning Committee (LEPC)
• 15 person every municipality county
• OEMC serves as chairperson

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NJ Office of Emergency Management (OEM) Regions
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NJ Office of Emergency Management
(OEM)---Nucleus of Disaster/Emergency Response

• State Emergency Operations Center (EOC)
• Staffed by key officials in disaster situations
• NJ Dept of Health Sr. Svcs. (DHSS) NJ
  Homeland Sec. etc.
• 800 MHZ radios maintain communications to all
  State Police locations independent of phones,
  Internet, etc.
• Fully self-sufficient
• Direct communications link to DHSS EOC
• Direct communications link to other states and
  Federal officials
• Full range of state-of-the-art situation status,
  asset tracking, other real-time software tools

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DHSS Emergency Operations Center

• Command Central for all public health and
  healthcare provider entities
• Activated (stood up) in emergency situations
• Inclusive of Emergency Medical Services, other
  first responders
• Staffed by DHSS Commissioner, other senior-level
  staff from DHSS and other agencies
• Real-time monitoring and decision making
• Status and Information Dissemination out to
  appropriate public and private partners
• Direct link to Health Auxiliary Command Ctr
  (HACC)
• Staffed by Professional Trade Associations
  representing the Preparedness Partners

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DHSS EOC-systems capabilities

• HIPPOCRATESan evolving real-time software
  package developed by DHSS
• Asset Resource management
• Epidemiological Surveillance
• Geographic Information System (GIS) enabled to
  track mobile assets
• Real-time hospital status, bed count, equipment,
  patient load, etc.

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HIPPOCRATESKey Features

• Integrated Application Suite allowing for
• One-Stop-Shopping for information for Health
  Emergency Preparedness and Response
• Mapping health locations from different sources
• Tracking real time changes on maps
• Performing analysis of critical health data on
  maps
• Accessing the Web based application anywhere,
  anytime
• Granting access based on user privileges so that
  users only see the information they need
• Follows Federal Geographic Data Committee (FGDC),
  Federal Emergency Management Agency (FEMA), and
  Homeland Security User Group (HSUG) guidelines
• Incorporating requirements beyond health
  emergencies
• Daily Monitoring
• Training and Exercise

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Collect Information in HOTS Health Operations
Tracking System

• Means for collecting and disseminating
  health-related information
• Incidents, and Events such as
• White powder
• Chemical, biological, radiological, nuclear
• Natural disasters
• Immediate Email notification of incident status
  to concerned personnel within multiple agencies
• Maintain logs by Command Center
• Morbidity/Mortality statistics
• Task Action Completion Sheet

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Map health locations and information
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Advanced Analysis

• Analysis
• Attribute Queries Locate all hospitals with
  surge capacity greater than 80
• Spatial Queries Locate the closest Point of
  Dispensing for each Biological/Outbreak incident
• Service Areas (Buffers) Find areas around
  incidents that are affected and access
  demographic statistics for the affected area
• Best route Find the shortest or fastest route
  from one point to another on the map

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Advanced Analysis

• Reports
• Thematic maps
• distribution of dynamic data, such as
• bed capacity, morbidity, mortality, and
• stockpile inventory.
• Summary Statistics
• Display summary statistics which can
• be used during emergencies to report
• on the state of affairs, such as
• total morbidity or total surge capacity across
• the state.

TOPOFF3 Exercise Data
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Medical Coordination Centers (MCCs)-the
regionalization strategy

• Five regions across state using county boundaries
• Standard Operating Procedures (SOPs) defines
  basic rules and guidelines- top-level
  standardization
• Allows a degree of customization based on
  geography, other uniqueness
• All-inclusive council made up of locals who can
  objectively represent regional needs and
  challenges

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Medical Coordination Center Regions

• Northeast
• -Bergen, Hudson, Essex
• Northwest
• -Sussex, Warren, Morris, Passaic
• Central East
• -Union, Middlesex, Monmouth, Ocean
• Central West
• -Hunterdon, Somerset, Mercer
• South
• -Burlington, Camden, Gloucester, Salem,
  Cumberland, Atlantic, Cape May

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Medical Coordination Centers (MCCs)-the
regionalization strategy

• There are Five (5) Medical Coordination Centers
  (MCCs) programs that are housed in host
  hospitals.
• There are regions with more than one (1) Medical
  Coordination Center. In these regions, the
  designated host hospital will serve as the core
  for the MCC Program in the respective region.
• The MCCs are responsible for the development of
  regional planning, training, exercises and
  operations within the municipal, county and state
  Public Health, Healthcare and Emergency
  Management Systems.
• The MCC Program will provide statewide
  standardization as well as specialization.
• In addition, the MCCs will integrate/coordinate
  public health and healthcare systems both
  inter-intra state, based on the eight (8)
  national priorities.
• The MCC will/should have information on hospital
  diversion status, healthcare facility bed status,
  pharmaceutical availability, medical information,
  as well as, EMS system(s) status.

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MCC Regional Plans, Policy and OperationsThe
Regional MCC Advisory Council

• Responsible for development and administration
  of regional plans, policies and operations
• 5 MCC Regional Advisory Councils, (one council
  per region regardless of the number of MCCs per
  region)
• Similar to Health Emergency Preparedness Advisory
  Council (HEPAC)
• There will be a rotating Membership on each
  council
• Membership will represent cross-section of MCC
  participants
• Supervised by the DHSS
• Standardized MCC operational concepts (SOPs)
  tailored to specifics of the regional area

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MCC State Advisory Council Design

• DHSS
• EMS
• Hospitals
• Long Term Care
• Home Care
• OEM County/Region
• FQHCs
• Ambulatory Care
• Public Health/LINCSs

• Law Enforcement
• Fire Service
• Medical Reserve Corps
• Epidemiology
• Office of Domestic Preparedness (ODP)
• Urban Area Security Initiative (UASI)
• Subject matter experts

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Healthcare Auxiliary Command Center (HACC)the
6th MCC

• At NJ Hospital Association facility
• Associations emergency operations center
• Full power back-up via generator
• activated as required
• Direct communications with DHSS EOC
• Large screen video to present public and secured
  audio/video communications
• Healthcare Continuum partners have seat
• Phone, fax, computer, Internet
• Expandable as necessary
• Could be used as DHSS EOC if primary EOC is
  rendered inoperable or inaccessible

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HACC
HCC
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Some Preparedness Best Practice observations.

• All disasters are local but may have widespread
  impact
• Get involved and be informed whether as an
  individual, public sector employee, or private
  sector employee
• Consider Community Emergency Response Team (CERT)
  involvement
• www.citizencorps.gov
• Consider Medical Reserve Corps (MRC) involvement
• www.njmrc.nj.gov
• Relationship development with all stakeholders
  before the crisis is key to maximizing plan
  effectiveness and minimizing negative impact
• Public and private sectors as necessary and
  appropriate
• Take Personal Responsibility, be aware, plan
• Exercise your plan, analyze, use Continuous
  Improvement Quality management principles to
  minimize shortcomings

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Disaster Preparedness-the process continues

• Emergency/Disaster Planning that maximizes
  Preparedness does not just happen. It involves
  a well-understood and exercised plan and a
  partnership with all internal and external
  stakeholders coupled with walk the talk
  management support of a culture that promotes
  Preparedness.
• The following ageless cliché is appropriate
• An Ounce of Prevention is Worth a Pound of
  Cure

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Lets Discuss Further..

• Health Care Association of New Jersey
• 4 AAA Drive, Suite 203
• Hamilton, New Jersey 08691
• Gary J. Schnerr
• gary_at_hcanj.org
• www.hcanj.org
• Thank You!