Hospital Emergency Operations Plan Workshop

Updating the Hospital and Rural Medical Center EOP for the Use of Volunteers in Medical Surge

AGENCY LOGO

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 Authority’s 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.

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.

Why is this an issue today?

• 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

I knew this would

happen!

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)

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

Haven’t we done this before?

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

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

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-CoP’s and

Joint Commission Standards?

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?

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.

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

Incident implications

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

Incident implications

• Incidents restrict and overwhelm resources, communications, transportation and utilities.

• Individuals and communities are cut off from the outside support.

What is your goal in an incident?

• RESPONSE – manage victims (treat, triage, transfer, disposition).

• RECOVERY – operational, financial, and return to “normal” operations.

All Hazards approach to planning

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

Who is involved in All Hazard response efforts?

• Federal• Tribal• State• Local• Emergency

Management• Public Works• Fire/Rescue• EMS• Hospitals• Public Health

All Hazard steps• Planning• Training• Exercising• Policies &

procedures• Resource

requirements• Resource upgrade

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

Emergency Operations Plan

• Introduction• Procedures &

Operations• HICS Job Action

Sheets• Specific

Departmental Tools

• Forms/Resources

Emergency Operations Plan-Part 1

• Introduction– General overview of <Hospital Name> and

facilities/support.

• Purpose/Policy– Provide continuous quality improvement.– Provide coordination and integration.

• Scope– Addresses Joint Commission and CMS

Conditions of Participation (CoPs.)

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.

Mitigation

• Hospital Hazard Vulnerability Analysis (HVA)

• Multiple Tools Available

Mitigation

• Hazard identification

• Hazard Assessment (HVA)

• Structural code compliance

• Equipment and maintenance

Preparedness• Plan development

• Training courses

• Exercises

• Employee education and competencies

• Public education

Response• Alerting• Assessment• Mobilizing- Healthcare

partners and ESF8• Implementing plan• Activate systems

(HICS, EOC)• Control, Set priorities-

Infection etc.• Communication and

situational awareness

Recovery

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

Recovery

• Return to “normal”• Detailed damage

assessment• Care and shelter

continues• Funding

assistance• Remove debris

Part 2- Specific procedures & operations

• Patient Flow– Triage– Treatment Areas

• Security Activities– Entry & Egress– Visitors Access

Procedures & operations

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

Procedures & operations

• Patient admissions, triage, disaster tags, registration process– Elective

procedures– Discharge of

patients

Procedures & operations

• News Media– Public

Information Officer (PIO)

– Strategic location

– Joint Information Center (JIC)

Procedures & operations

• Hotline

• Family of victims, visitors, outpatients

Procedures & operations

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

Procedures & operations

• Morgue– DOAs

– Others that expire

Procedures & operations

• Evacuation– Authority– Transportation– Location– Evacuation

routes– Practice/Test

Procedures & operations

• Continuing and/or reestablishing operations

• Off – site care (Alternate Care Sites, or ACS)

Procedures & operations

• Essential utility alternatives– Electrical– Water– Medical gas– Waste

disposal– Fuel

Procedures & operations

• Isolation & decontamination– Plan &

procedure– Equipment– Training

Procedures & operations

• Orientation & education

• Annual plan evaluation

Emergency Operations PlanPart 3- HICS Job Action

Sheets

HICS Job Action sheets

• Incident Command

• Operations

• Logistics

• Finance and Administration

• Planning

• Others

HICS Job Action sheets

• One for each position.

• Embodies title, mission/function and duties.

• Adjusted to meet hospital needs.

Emergency Operations PlanPart 4

Specific department tools

Specific departmental plans

• Emergency Department

• Security

• Maintenance

• Nursing floors

• Admission policy & registration

• Emergency triage

• Evacuation

• Communications

• Emergency Operations Center

Emergency Operations PlanPart 5-forms/resources

Forms/Resources• Help drive

positions• Documentation

aid• Financial

recovery• Decreases

liability• Enhances &

tracks communication

Emergency Management

A successful interface needs:•Planning•Training•Exercising

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/

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.

Emergency Operations Plan

• Plan Structure

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]

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.

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.

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.

Use of volunteers in medical surge

• 18 Elements of Performance (EP’s) 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?

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

Use of volunteers

• What can they do?• What can’t they do, unless supervised?• What shouldn’t 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?

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

Where do I start?• <Hospital Name>

has:– Emergency

Operations Plan

(a base plan to start with).

– Departmental Plans (ED, Triage, Admissions, Evacuation, Security.

– Email <hospital point of contact> to receive the plans electronically.

Center for HICS Education & Training- www.hicscenter.org

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

(14) Scenarios

<Presenter POC information>