Continuity of Operations Planning for Public Health and Medical Services Greg Morgan Contingency...

Continuity of Operations Planning for Public

Health and Medical Services

Greg MorganContingency Planner

Stacy A. Robarge-SilkinerSNS Coordinator

KDHE Center for Public Health Preparedness

Purpose of COOP

Ensure the continued operation of organizations through a disaster (manmade, natural, technological) or a biological event (pan flu, anthrax, etc) Facilitate the preparation of, site or activity specific plans and procedures that help ensure the safety of personnel Allow organizational elements to continue essential operations in the event of an emergency or threat emergency.

Health System leadership will ensure that personnel are aware of their assigned COOP responsibilities via devolution of staffing concepts and just in time training.

www.ksn.com/weather/weathergallery/wxphotos

Hazard Vulnerability Assessment

Probability of an event occurring and the impact the event would have on departmental and system wide operations

Clara Barton Hospital Hoisington, Kswww.redcross.org

Hazard Vulnerability Tool

Allows individual health agencies to identify and rank various risk and mitigating factorsCoordinate with local law enforcement and emergency management HVA Tool

Hazard Vulnerability Gap Analysis

Priority projects related to health agency emergency preparedness.

Interprets results of HVA into useable format

HVA Gap Analysis

Assumptions and Considerations

COOP doesn’t apply to temporary disruptions of service

COOP plans will be operational within 12 hours

Maintain essential operations up to and beyond 30 days

Key Elements of COOP

Planning

Essential Functions

Delegation of Authority

Order of Succession

Alternate Facilities

Interoperable Communications

Public Information

Vital Records

Human Capital

Security

Logistics

Training and Exercising

Planning

Essential functions are listed and prioritizedStaffing requirements for each essential function are identifiedResource requirements for each essential function are identifiedCritical data and data systems for each essential function are identified

Planning cont.

Support activities are addressed as part of essential functionsPlans exist for attaining operational capability within 12 hoursProcesses and procedures exist to acquire resources necessary to continue essential functions and sustain operations for up to 30 days

Procedures for employee advisories, alerts and COOP/COG plan activation.Provisions for personnel accountability.Procedures exist for an annual review and revision of the COOP plan

Procedures

Alert and Notification ProceduresAlert ProceduresCOOP activation under any condition With Warning:

few hours warning deployment of key personnel to a pre-determined

location. Notification methods

Without Warning: Terrorist/bio-terror attack Act of war Natural disaster

Notification Procedures Notify proper authorities of COOP activation Notify the PT members

Cell phone, pagers, blackberry, land-line, radio, etc

Essential FunctionsIdentification and prioritization of essential functions necessary for agency continuity of operations. Essential functions include services that are:

Loss of lifePublic health and safetyFood and Shelter24/7 Direct Care and Critical Ancillary Providers

Economic impactSymbolic value

Essential Functions agency specific

Define the agency mission and goals

Identify the functions that are needed to accomplish the mission

Identify the tasks to accomplish those functions

Identify the resources needed to support those tasks

Essential Function Prioritization

Essential Function Prioritization rankingCritical- function cannot be delayed

Important- function can be delayed but should be resumed as soon as possible

Non-essential- function can be delayed until normal business operations resume

Public Health Essential Functions

Communicable Disease ContainmentImmunizationWomen, Infants, and Children (WIC) and Commodity Supplemental Food Program (CSFP)Family PlanningMaternal and Child Health (MCH)Child Care Licensing and RegistrationVital StatisticsFood ProtectionBioterrorism and Public Health ResponseHuman ResourcesFiscal ManagementPublic Information Officer (PIO)Public EducationHome Health/Hospice/In-Home Care ProgramInformation System SupportEnvironmental Health

Hospital Essential Functions

Patient Care including triage and treatment for inpatient and outpatient recipientsPatient movement to care centers with appropriate levels of care for patientsPostmortem care and disposition with appropriate community partnersPatient tracking including medical screeningsLong term care of elderly and other fragile populationsLab capabilities consistent with facility needMedical billing for procedures performedPatient decontamination and stabilizationFacility and personnel security for patients and employeesMeeting standards of care as required by State regulation or accrediting organization

Train successors and delegates identified for essential functions

Update contact information for all staff

24/7 facilities must include a plan for: Staffing Medication and food supply Medical assessment Infection control Communications

Execution

Provide devolution of essential functions for operation Identify:

Critical systems Capabilities to perform essential functions due

to staff depletion Logistical support Services and infrastructure alternatives Communications Related computer/software issues

Execution

Order of Succession vs Delegation of Authority

Order of Succession-list of individuals who would sequentially assume responsibility if the primary staff person is no longer able to carry out their functions

Delegation of Authority-positions in which the primary staff person has the authority to complete a particular task

Order of succession should be established for the highest positions of authority.

i.e. Public Health Director, Hospital Administrator, Director of EMS

Line of succession should be established for the other leadership positions.

i.e. Infection Control Nurse, ER Head,

Limitations on delegate authority should be listed

Order of Succession

Order of Succession

Rosters of trained/qualified personnel with the authority to perform essential functions and activities are maintained

Rules and procedures for implementing order of succession should be established

initiating conditions

notification methods

terminating conditions

Order of succession for essential functions

Three deep

Should include Name and title Point of contact information for 24/7

Same successor may be named for different positions but avoid listing the same person as the first successor to several key positions

Courtesy of Doug Williams, St. Catherine Hospital, Garden City, Ks

Delegation of Authority

Delegation of Authority for each essential function should include:

Name and title of delegate

Position title and/or source of authority being delegated

Point of contact information (phone, cell, pager, email…)

Limitations (if any) or exceptions to the authority being delegated

Date or event that triggers delegation (Activation of COOP plan)

Date of termination or revocation (i.e. 30 day)

Name, title and signature of the official empowered to delegate the authority specified

Delegation of Authority to sign for Schedule Drugs

POWER OF ATTORNEY FOR DEA ORDER FORMS I, Howard Rodenberg, being authorized to sign the current application for registration under the Controlled Substances Act or the Controlled Substances Import and Export Act, by these presents, do make, constitute, and appoint Michael McNulty and/or Barry Autrey, acting jointly or severally, as my true and lawful attorney in fact to act for and in my name only in such manner as I could act as a registrant under the Controlled Substances Act or the Controlled Substances Import and Export Act, with respect to receiving and transferring the Strategic National Stockpile. In this connection, my attorney in fact is specifically authorized to execute applications for books of official order forms and to sign such order forms in requisition for Scheduled II and IV controlled substances, in accordance with Section 308 of the Controlled Substances Act (21 U.S.C. 828) and part 1305 of Title 21 of the Code of Federal Regulations. I hereby ratify and confirm all that said attorney shall lawfully do or cause to be done by virtue hereof until notice of revocation in writing. Dated this _____ day of _______________, 2006. ________________________________________ Howard Rodenberg, M.D. Director of Health and Registrant pursuant to the Controlled Substances Act or the Controlled Substances Import and Export Act State of Kansas ) )ss County of Shawnee ) This instrument was acknowledged before me on the ______ day of _____________, 2006 by Howard Rodenberg, M.D., of the Kansas Department of Health and Environment, in his capacity as Director of Health and Registrant pursuant to the Controlled Substances Act or the Controlled Substances Import and Export Act. ____________________________ Notary Public My appointment expires: ____________________________

Command and ControlAll response agencies are required to use Incident Command System (ICS) and follow National Incident Management System (NIMS) requirements (Hospitals use HICS)Command staff provides overall coordination of the response and is the central communications pointOperations Section responsible for clinical duties including triage and treatment and directs all patient care resourcesLogistics Section responsible for providing facilities, services (food, billeting, communications) and materialsPlanning Section determines and provides for the achievement of each medical objective and manages human resourcesFinance/Administrative Section responsible for maintaining accounting records, issuing purchase orders, and stressing facility wide documentation

Command and ControlForm an Operations Team (OT) for your COOP

Responsible for relocation activitiesEnsure all necessary and pre-planned communications systems are established and functioning properly Serve as the first shift operations at the alternate site

Provide cross training to personnel Utilize Job Action Sheets (JAS) and Just in Time (JIT) training Employ call-down roster

Advise staff where to reportWhat to bring

Alternate facilities may be needed in the event that the health care facility is damaged, destroyed or overwhelmedIn hospital terms: Alternate Care Site (ACS)

Site for hospital administrationSite for hospital patient care functions

Define ACSLocation for the delivery of medical care that occurs outside the acute hospital setting for patients who, under normal circumstances, would be treated as inpatients. Site may provide delivery of chronic care, the distribution of vaccines or medical countermeasures, or the quarantine, cohorting, or sequestration of potentially infected patients in the context of an easily transmissible infections disease

In Health Department terms this could be a POD


Mass Medical Care with Scarce Resources: A Community Planning Guide, Health Systems Research Inc.

Consider: level and scope of care to be deliveredfoot print or size neededstaffing requirementsequipment and suppliesICS structure needed to integrate this facility with other health facilities in the eventSecurityStaffingCommunicationsEMS and other transportation issuesrules/policies for operation

FMS, EMEDS, NDMS, Field Hospitals


Alternate FacilitiesPlan should identify:

Logistical considerations (utility services, food, water, etc.)Pre-positioning of resources Hot site- pre-wiredCold site- needs installationProvisions for establishing interoperable communications with all identified essential internal and external organizations, critical customers and the public

Provisions to sustain operations for a period of up to 30 days24/7 OperationsConsiderations for the health and safety of relocated employeesPhysical security and access controlsCo-location and duel useFormal agreements (MOU, MOA)

Alternate FacilitiesLessons Learned from Katrina:

Consider pre-planning and relationship building among agenciesUse of ICSPublic health (shower, toilets, amenities, hygiene)SecurityTransportation (EMS, self transported)

Supplies (medical, pharmaceutical, food, water)CredentialingStaffingPatient tracking and documentationCommunicationPatient screeningPediatrics, geriatrics and psychiatric patientsAccessibility to the publicSpecial populations


How to determine appropriate facilities

Alternate Care Site Selection ToolBased on the Rocky Mountain Regional Care Model for BT Events

Kansafied

Do a Hazard Vulnerability Analysis

Determine population to be cared for at the designated site

Train and Exercise


Challenges: lack of regional/state planning with clear delineation of responsibility and authorityrequirement that multiple entities work together who normally don’tlack of inducements to write a plan train and exerciselicensing issues intra and interstatefundingStandards of care- whole different presentation

Hardware/software that talks to each other and people that can communicate with each other in the same language (no codes)Systems that need to work together include radios, phones, faxes, email, notification systems, IT systems, software, secure data systemsPeople that need to work together include Hospital, Health Department, EMS, Fire, Law Enforcement, Emergency Management, Social Services…Procedures and plans need to be written to specify how communication will work during COOP activationMaintain the capability to communicate with internal and external clients, critical customers and the public.

Interoperable Communications

Information Technology

Information Technology (IT) needs should be a component of each essential function

Consider during planning: The essential function’s dependence on IT

Managing the IT infrastructure during COOP activation

Help desk tasks to support IT needs for identified essential functions

Ability to provide remote access to programs

Information Systems Support

Each essential service area must define their unique or critical information system requirementsEach essential service area must define their equipment needs and availability of this equipment

Where is it storedHow do we move itWhere do we get it if we do not have itIT contingency plans

Designate responsible individuals/departments within the organization for moving and reestablishing IT If relocation to an alternate facility is necessary, these services could be allocated to support organizations

Vital Records Include:Emergency operating plans

Policy and Procedural records

Legal documents

Financial records

Personnel files

Patient records

Property management (inventory)

Vital Records

Vital Records

Provisions for classified or sensitive dataProcedures for data backup and restorationIdentify location and accessibility to vital recordsHow often are your vital records on computer backed-up? Do you have back-up records for all of the paper based records at your facility? Where are your back-up files kept? On site or off?


“With Planning and Preparation we ensure our safety today and preserve the future for younger generations”

Your most important tool will be Public Information!

Have trained back up PIO and spokes personsPlan for working out of a different location (i.e. JIC) Have a go-kitMaintain contact lists for mediaDevelop alternate methods of dissemination Develop templates during pre-planning to avoid creating during an emergency

Message mapsPress releasesInformation sheetsHow to find alternate sitesNavigation of alternate sites (Signs)

Public Information

Human Resources- HR Policies

Plan for a reduction in work forceIdentify emergency policies for:

OvertimeLeave with payLeave without payFlexible leave optionsVacation timeSick time

Identify plans for employees to work from homeTele-work

Potential health and safety issues Liability assessment by general counsel

Union issues (overtime issues,disaster support, etc)Training on contingency planning Employee Assistance Program (EAP) for mental health and health insurance provisions

Human Resources-Employee Support

Essential Staff functioning during a COOP activation may have different support needsPlans should include consideration for staff:

TransportationFood and LodgingChild careElder carePet care

Consider developing a Family Preparedness ProgramEncourage personal go-kits

Safety and Security Concerns

Emergency Planning Committee County Emergency Response Plan

(Emergency Support Function 8).Hospital EOPs

Ensure all necessary security and access controls are providedEnsure that local law enforcement authorities are notified concerning the status of the emergency.

Logistics

Food and water

Fuel

Billeting

Medical

Transportation

Health, Safety, Personal

Implementation Phases

Phase I- Activation and Relocation 0-12 Hours

Notify facilities, organizational elements and personnel of impending COOP activation

Activate plans to transfer to alternate facility, when necessary.

Instruct Ops team to ready facility/alternate facility. Assemble documents/equipment required for essential

functions at facility/alternate facility. Secure facilities. Continue essential functions at regular facility, if

available, until alternate facility is ready if needed

ImplementationPhase II- Alternate Facility/Work Site Operations 12 Hours to Termination of Emergency

Provide guidance to preparedness team personnel and information to the public.

Identify and brief replacements for missing or rotating personnel Commence full execution of operations supporting essential

functions.

Phase III- Reconstitution Termination of Emergency

Inform all personnel that the threat no longer exists. Supervise return to normal operating facility or normal business

practices at original facility. Conduct an after action review of COOP plan execution and

effectiveness. Develop a Corrective Action Plan

Plans include annual individual and team training of agency COOP/COG emergency personnel.

Plans include annual agency testing and exercising of COOP/COG plans and procedures.

Plans include quarterly testing of emergency alert and notification procedures.

Plans include refresher orientation for COOP/COG staff.

Plans include inter-agency exercising of COOP/COG plans where applicable and feasible.

Training and Exercising

References:

CIDRAP- 10-Point Framework for Pandemic Influenza Business Contingency PlanningMassachusetts Department of Public Health- COOP for Massachusetts Government AgenciesCommonwealth of Pennsylvania- COOP Template 2005Florida Department of Health/Okeechobee County Health Department- COOPRocky Mountain Regional Care Model for Bioterroist Events- Alternate Care Site Selection ToolKDHE- Alternate Care Site Selection ToolKDHE- HVA Tool and Gap AnalysisKDHE- Business Impact Analysis Template

Contact Information

Stacy Robarge-Silkiner

SNS Coordinator

Kansas Department of Health and Environment

[email protected]

Greg Morgan

Contingency Planner

Kansas Depatment of Health and Environment

[email protected]

Questions????

Continuity of Operations Planning for Public Health and Medical Services Greg Morgan Contingency...

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