Hospital Emergency Operations Plan Workshop Updating the Hospital and Rural Medical Center EOP for the Use of Volunteers in Medical Surge

1
Hospital Emergency Operations Plan
WorkshopUpdating the Hospital and Rural Medical
Center EOP for the Use of Volunteers in Medical
Surge



AGENCY LOGO
2
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
• 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 Authoritys
  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.

3
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.

4
Why is this an issue today?
I knew this would happen!

• Terrorism
• Disasters
• Other
• 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
5
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)
6
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

7
Havent we done this before?

• Pre-1950s Civil Defense Era.
• Fire Protection Era (1960s-1970s)
• Disaster Planning Era (1970s)
• 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.

8
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

9
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-CoPs and Joint Commission Standards?

10
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?

11
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.

12
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

13
Incident implications

• Transportation
• Electrical
• Telephone
• Water
• Fuel
• Structural
• Communications

14
Incident implications

• Incidents restrict and overwhelm resources,
  communications, transportation and utilities.
• Individuals and communities are cut off from the
  outside support.

15
What is your goal in an incident?

• RESPONSE manage victims (treat, triage,
  transfer, disposition).
• RECOVERY operational, financial, and return to
  normal operations.

16
All Hazards approach to planning

• A conceptual framework for organizing and
  managing emergency protection efforts.

17
Who is involved in All Hazard response efforts?

• Federal
• Tribal
• State
• Local
• Emergency Management
• Public Works
• Fire/Rescue
• EMS
• Hospitals
• Public Health

18
All Hazard steps

• Planning
• Training
• Exercising
• Policies procedures
• Resource requirements
• Resource upgrade

19
Major Incident Operations

• Disruption of normal process of health care
  delivery
• Displacement of day-to-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

20
Emergency Operations Plan

• Introduction
• Procedures Operations
• HICS Job Action Sheets
• Specific Departmental Tools
• Forms/Resources

21
Emergency Operations Plan-Part 1

• Introduction
• General overview of ltHospital Namegt and
  facilities/support.
• Purpose/Policy
• Provide continuous quality improvement.
• Provide coordination and integration.
• Scope
• Addresses Joint Commission and CMS Conditions of
  Participation (CoPs.)

22
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.

23
Mitigation

• Hospital Hazard Vulnerability Analysis (HVA)
• Multiple Tools Available

24
(No Transcript)
25
(No Transcript)
26
Mitigation

• Hazard identification
• Hazard Assessment (HVA)
• Structural code compliance
• Equipment and maintenance

27
Preparedness

• Plan development
• Training courses
• Exercises
• Employee education and competencies
• Public education

28
Response

• Alerting
• Assessment
• Mobilizing- Healthcare partners and ESF8
• Implementing plan
• Activate systems (HICS, EOC)
• Control, Set priorities-Infection etc.
• Communication and situational awareness

29
Recovery

• Those activities undertaken by a hospital after
  an emergency or disaster occurs to restore
  minimum services and move towards long-term
  restoration.

30
Recovery

• Return to normal
• Detailed damage assessment
• Care and shelter continues
• Funding assistance
• Remove debris

31
Part 2- Specific procedures operations

• Patient Flow
• Triage
• Treatment Areas
• Security Activities
• Entry Egress
• Visitors Access

32
Procedures operations

• Communications
• Telephone
• Back-up systems
• Radio (VHF/800)
• Satellite phone
• Walkie Talkies
• HAM radio
• Fax

33
Procedures operations

• Patient admissions, triage, disaster tags,
  registration process
• Elective procedures
• Discharge of patients

34
Procedures operations

• News Media
• Public Information Officer (PIO)
• Strategic location
• Joint Information Center (JIC)

35
Procedures operations

• Hotline
• Family of victims, visitors, outpatients

36
Procedures operations

• Supplies equipment
• Essential supplies
• Pharmaceuticals
• Medical supplies
• Equipment
• Food
• Water
• Linen
• Utilities

37
Procedures operations

• Morgue
• DOAs
• Others that expire

38
Procedures operations

• Evacuation
• Authority
• Transportation
• Location
• Evacuation routes
• Practice/Test

39
Procedures operations

• Continuing and/or reestablishing operations
• Off site care (Alternate Care Sites, or ACS)

40
Procedures operations

• Essential utility alternatives
• Electrical
• Water
• Medical gas
• Waste disposal
• Fuel

41
Procedures operations

• Isolation decontamination
• Plan procedure
• Equipment
• Training

42
Procedures operations

• Orientation education
• Annual plan evaluation

43
Emergency Operations PlanPart 3- HICS Job Action
Sheets
44
HICS Job Action sheets

• Incident Command
• Operations
• Logistics
• Finance and Administration
• Planning
• Others

45
HICS Job Action sheets

• One for each position.
• Embodies title, mission/function and duties.
• Adjusted to meet hospital needs.

46
Emergency Operations PlanPart 4 Specific
department tools
47
Specific departmental plans

• Emergency Department
• Security
• Maintenance
• Nursing floors
• Admission policy registration

• Emergency triage
• Evacuation
• Communications
• Emergency Operations Center

48
Emergency Operations PlanPart 5-forms/resources
49
Forms/Resources

• Help drive positions
• Documentation aid
• Financial recovery
• Decreases liability
• Enhances tracks communication

50
Emergency Management

• A successful interface needs
• Planning
• Training
• Exercising

51
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/
52
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.

53
Emergency Operations Plan

• Plan Structure

54
Emergency Operations Plan

• Addresses Twelve Critical Access Hospital Joint
  Commission Components
• Planning EM.01.01.01
• The EOP EM.02.01.01
• Communication EM.02.02.01
• Resources Assets EM.02.02.03
• Safety Security EM.02.02.05
• Staff responsibilities EM.02.02.07
• Utilities Management EM.02.02.09
• Patient, clinical support activities EM.02.02.
  11
• Volunteer Management EM.02.02.13
• Volunteer Credentialing EM.02.02.15
• HVA and Evaluation EM.03.01.01
• Plan Evaluation EM.03.01.03

55
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.

56
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.

57
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.

58
Use of volunteers in medical surge

• 18 Elements of Performance (EPs) of Joint
  Commission Standards address use of volunteers.
• Medical Surge exercises that are HSEEP-compliant
  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?

59
For Volunteer Licensed Independent Practitioners
and Volunteer Practitioners

• Section 1 Disaster Privileges
• Section 2 Credentials Verification
• Section 3 Volunteer Oversight
• Section 4 Cessation of Volunteers

60
Use of volunteers

• What can they do?
• What cant they do, unless supervised?
• What shouldnt 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?

61
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

62
Where do I start?

• ltHospital Namegt
• has
• Emergency
• Operations Plan
• (a base plan to start with).
• Departmental Plans (ED, Triage, Admissions,
  Evacuation, Security.
• Email lthospital point of contactgt to receive the
  plans electronically.

63
(No Transcript)
64
Center for HICS Education Training-
www.hicscenter.org

• Guidebook
• Training Resources
• Job Action Sheets
• Forms
• Internal (13) External (14) Scenarios

65
ltPresenter POC informationgt