Emergency Management In A Complex Environment

Transcription

1 Emergency Management In A Complex Environment Brandon Bond, MS, CBCP Administrative Director, Office of Emergency Management Stanford Health Care Stanford Children s Health

2 A little bit about us Stanford Hospital Level 1 Adult & Pediatric Trauma Center Life Flight 613 Licensed Beds 37 Operating Rooms Lucile Packard Children s Hospital Stanford 311 Licensed Beds 10 Operating Rooms Expanding Network of Specialty & Primary Care Clinics Office of Emergency Management 4 Full Time Staff, 2 Part Time 2 Part Time Medical Directors

3 First let me state why we believe health care is the most complex operating environment there is We are capital intensive with expensive buildings and expensive equipment. We are labor intensive. Unlike other industries that deploy a lot of capital, we don t use it to reduce down the size of our labor force, and in fact it often goes up with additional capital being deployed. We are in the service business, delivering our product with our customer being along side of us, and, if we are doing it right, they are highly involved in the process of care. We are in the knowledge management business, working in a network of information flow, with complex information development and communication as a key predictor of our ability to deliver high quality care. Related to that, unlike many industries, the people with the highest level of training and expertise are at the point of service, not in management. Ours is a highly regulated and litigious environment at the local, state and federal level. Our mistakes can have immediate life and death consequences. 3

4 Our Standard: Zero Downtime with a Recovery Time Objective of Zero minutes

5 Safety & Security Communications Staff Responsibilities Mitigation Utilities Management Recovery Planning Resources and Assets Emergency Management Patient Clinical & Support Activities Response Training

6 Emergency Management Governance Structure LPCH Hospital Board LPCH Medical Executive Committee SHC Hospital Board SHC Medical Executive Committee COMMUNITY INTERFACE LPCH Quality Improvement Committee SHC Quality Improvement Patient Safety Committee City of Palo Alto SCC Hospital Council SMC Hospital Council SU EM Committee SU IC Committee Unv, SoM, Hosp (USHER) SFO Emerg Mgt Group Operations Sub-Committees Finance Emergency Management Steering Committee Hospital Incident Management Team Planning Logistics PIO Senior Physicians Disaster Management Committee Emerging Infectious Diseases & Bioterrorism Sub- Committee Mitigation BCP Technology ERT Leads Contingency

7 Response to Asiana Flight 214, 6 July 2013

8 21 miles from SFO by ground 10 minute flight time

9 Response to Asiana 214 SHC received 55 patients transported patients 2 Immediate 11 Delayed 42 Minor 26% were pediatric 18 patients admitted to SHC 7 pediatric patients admitted to LPCH personnel responded to the incident ED remained open to both San Mateo and Santa Clara EMS

10 Initial Timeline of Events Asiana Flight 214 Boeing 777 crashes at SFO San Mateo County EMSystems ED MCI query ED RN In Lobby See s Breaking News Reports San Mateo County EMSystems ED MCI query Initial Code Triage Standby Page First two patients arrived by Coast Guard helicopter Code Triage Major Hospital Command Center Activated Last Patients Arrive by Bus ALL CLEAR ED Rapid Admission Plan Initiated Initial Staff Call Back Establish Direct Communications with EMS & PA OES San Mateo EMS reported 290 patients being triaged 1 st Ambulance with Four patients

11 1246 hrs. First Ambulance Arrive with Four Immediate Patients

12 1300 hrs. Mass Casualty Triage Established

13 Expanded Staging and Patient Waiting Areas

14 1315 hrs 6 Operating Rooms & Trauma Teams Mobilized

15 1315 hrs Hospital Command Center Fully Established

16 Waves of Ambulances Continued

17 1827 hrs. Last Patients Arrive by Bus

18 Many patients arrived with no documentation

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20 Unique aspects of the incident Mechanism of Injury International Diplomatic & Security Issues Patients without passports and who had not cleared customs Language barriers & confusion with names High number of Unaccompanied Minors San Francisco incident within San Mateo County transporting to outside county hospitals This was a worst best case scenario for and MCI

21 Patient Coordination Challenges Patient Tracking Manifest Reconciliation with DHS-HSI Family Re-Unification Unaccompanied Minors Discharge Planning Food & Comfort Counseling Transportation We did well, but we can do better!

22 Do nothing which is of no use Miyamoto Musashi

23 Systems Approach to C3: Technology People Infrastructure

24 Principles of the Stanford Operating System Continuous Improvement Challenge - We form a long-term vision, meeting challenges with courage and creativity to realize our dreams. Kaizen We improve our business operations continuously, always driving for innovation and evolution. Gemba We go to the source to find facts, understand how the work is done, and make correct decisions. Respect for People Respect - We respect others, making every effort to understand each other, and taking responsibility to do our best and to build mutual trust. Teamwork - We stimulate personal and professional growth, share the opportunities of development and maximize individual and team performance.

25 Disaster Planning by Following the Patient Value Stream Understand the Patient Value Stream. Identify key touch points of technology and infrastructure. Develop contingencies for the people around them. The technology enables interoperability and access. The facility and utility infrastructure is the foundation of the patient experience.

26 Kaizen We improve our business operations continuously, always driving for innovation and evolution. The Challenge: Improve the mass casualty patient registration process Role clarity Arrival process logistics Naming convention Access to equipment Patient identification and accountability Reporting on patients AND be ready to test the process in six weeks!

27 The Kaizen Process

28 The Kaizen Process

29 Current State

30 Future State

31 The Outcome Registration at triage Leveraging technology One touch registration Picture uploaded to record Tracking board in Command Center Daily standard work It was difficult for our team to keep track of all the patients who came in during the disaster, Now we will be able to put a patient s actual picture in the chart, how they look at that moment, so every doctor and nurse will be able to know who they are and make sure they are identified before being treated - Ian Brown, M.D. Medical Informatics

32 Planning for a long term deployment Mobilization Thoughts Family Considerations Household Considerations Personal Equipment In Theater Logistics

33 Top 10 Things an Emergency Manager Doesn t Want to Hear! 1. Is this real? 2. What s an HCC? (Hospital Command Center) 3. You mean you didn t just make up these HICS forms? 4. What am I supposed to wear to a disaster? 5. I just walked through the water! 6. I hope you re not planning an earthquake drill. 7. Seriously do I have to be here? 8. Sandwiches again? 9. Do I have to? I ve got blisters. 10. I ve got big problems, we have water up to our knees!

34 Mobilization thoughts You What is the mission? What should I bring? How should I prepare myself? Where are my boots? I m late; I better hurry Your family Is it safe? (Don t go!) Will we need anything from you while you re gone? How do we handle...? Slow down; spend some time with us; say goodbye

35 While you are away... Your paycheck arrives, and only you can cash it. How can your family buy groceries? Your partner needs to know if you paid the mortgage before you left. Did you? Your water heater breaks and floods the living room. Your spouse locks him/ herself out of the car.

36 Inaccurate information News flashes on TV: inaccurate, incomplete News media interviews your family: what can (should) they say about you? Inconsistent information from team members people react differently to stress

37 When you return, your family... Is stressed: they ve been worried about you; they dealt with problems you usually handle Is anxious: they prepared for your return Is excited: Tell us all about it Don t tell us all about it Want to tell you all about their experiences while you were away Is tired: from being stressed, anxious and excited

38 When you return, you are... Distressed/withdrawn: Don t want to talk about it Only want to talk with other team members Excited: You want to talk (will they listen)? They want to get back to normal Exhausted from the mission: let me sleep

39 Aftermath Unfinished business is still unfinished Problems don t seem as important (to you!) as before I ve had it worse You ve changed

40 Talk with your family Explain Your Role Emotional impact of disaster response Separation anxiety: Anticipation of loss Detachment (immediately before departure) Emotional disorganization Disinformation, conflicting information, lack of information, media impact

41 Talk with your family Handling stress while you re away Take care of yourself: eat, sleep Keep regular patterns Be unhappy or try to make the best of it! Homecoming Anticipation of return Emotions: exhaustion, excitement Give each other some space for a few days

42 Tips for you Your family may have changed, learned new skills, done different activities. Don t be threatened by independence. Ease back into your normal life. Don t try to resume your normal routine right away. Be positive about decisions your family made while you were gone, even if you would have done things differently.

43 Talk with your children Meet as a family, discuss possible problems Separation anxiety Lifestyle changes Re-divide chores Notify teachers, babysitter, day care They ll be more attuned to possible problems if they know what s happening at home

44 Plan ahead (financial) How to handle everyday issues (e.g. pay bills) List (name, address, phone): Job Landlord Insurance agents Plumber, electrician, heating/air conditioning, mechanic, etc. Pets: boarding, daycare, vet

45 Plan Ahead (checklist) Deployment Check List Tuesday Call Alyssa Call Mom Call Dad Cancel Karen Green CA CSS Cancel Lt. Christensen Cancel CTC Training Auto reply work Change work-personal voic

46 In Theater - Sleeping

47 In Theater - Sanitation

48 In Theater - Transportation

49 In Closing 1. The strength of our program starts in the C-Suite 2. Become a part of the corporate culture 3. Understand your value streams 4. Work to eliminate waste 5. Remember it is the constant pursuit of perfection

50 Thank You! Brandon Bond Administrative Director, OEM