S:\Mutual Aid Agreements\Mutual Aid MOU final draft doc

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1 Hospital Mutual Aid Memorandum of Understanding This Hospital Mutual Aid Memorandum of Understanding is entered into as of, 2006, by, a Maine nonprofit corporation operating a licensed hospital in, Maine. I. Introduction and Background 1 DRAFT As in other parts of the nation Maine is susceptible to disasters, both natural and man-made, that could exceed the resources of any individual hospital. A disaster could result from incidents generating an overwhelming number of patients, a smaller number of patients whose specialized medical needs may exceed the resources of the affected facility (e.g., hazmat injuries, pulmonary, trauma surgery, etc.), or incidents such as building or plant problems that may result in the need for partial or complete hospital evacuation. II. Purpose of Mutual Aid Memorandum of Understanding The mutual aid support concept is well established and is considered "standard of practice" in most emergency response disciplines. The purpose of this mutual aid support agreement is to aid hospitals in their emergency management by authorizing a Hospital Mutual Aid System that addresses the loan of medical personnel, pharmaceuticals, supplies and equipment, or assistance with emergent hospital evacuation, including accepting transferred patients. This Mutual Aid Memorandum of Understanding (MOU) is a voluntary agreement among the hospital members within the State of Maine for the purpose of providing mutual aid (pooling resources) at the time of a medical or public health disaster. For purposes of this MOU, a disaster is defined as an overwhelming incident that exceeds the effective response capability of the affected health care facility or facilities. An incident of this magnitude will almost always involve the local and county emergency management agencies and possibly the Maine Centers for Disease Control. The disaster may be an external or internal event for hospitals and it is assumed that each affected hospital s emergency management plans have been fully implemented. This document addresses the relationships between and among hospitals and is intended to support and supplement, rather than replace each facility's disaster plan. Further, this document does not replace but rather supplements the rules and procedures governing interaction with other organizations during a disaster (e.g., emergency management, law enforcement, emergency medical services, local public health, fire departments, American Red Cross, volunteer agencies, etc.). By signing this Memorandum of Understanding each hospital is demonstrating its intent to abide by the terms of the MOU in the event of a medical disaster as described above. The terms of this MOU are to be incorporated into each hospital's emergency management plans. III. General Principles of Understanding A. Medical Disaster - An incident that exceeds a facility's effective response capability or cannot be appropriately resolved solely by a facilities own resources. Such disasters will likely involve local emergency management (EMA) and local Regional Resource Center (RRC), and may involve loan of medical and support personnel, pharmaceuticals, supplies and equipment from another facility, or the emergent evacuation of patients. B. Emergency Operations Center: The Emergency Operations Center (EOC) is a communication coordination and information center that is available to facilitate the transfer or support of hospital resources at the time of a disaster. The EOC will include the local municipal and county emergency management (EMA) officers and the Regional Resource Center (RRC) participant. The EOC does not have any decision-making or

2 supervisory authority over the hospitals operational functions but merely collects and disseminates information, and makes arrangements for additional coordination and support as requested by each participating hospital. 1. During a disaster drill or actual emergency, upon the request by the Incident Commander or designee of the affected hospital, the Regional Resource Center (RRC) liaison to the EOC may contact the other participating hospitals within their region to determine the availability of additional personnel or material resources, including the availability of beds, as the situation warrants. 2. The recipient hospital will be informed by the RRC liason those hospitals that should be contacted directly for assistance that has been offered. 3. The RRC liason will communicate the information to the appropriate incident commander, local EMA or Unified Command EOC. 4. The Incident Commander (or designee) of the recipient hospital will coordinate directly with the Senior Administrator (or designee) of the donor hospital for this assistance. 5. The EOC may provide additional assistance in arranging transportation of equipment or other resources once the donor hospital has agreed they are able to provide that level of support. C. Participating Hospitals: Each hospital designates a representative to coordinate the mutual aid initiatives with the individual hospital s emergency management plans. Hospitals also commit to participate in pre-planned disaster drills and exercises that include communicating to the Regional Resource Center (RRC) liaison to the EOC a set of data elements or indicators describing the hospital's resource capacity (see appendices). The participating hospitals should develop, prior to any medical disaster, methods for coordinating communication between themselves and the Regional Resource Center (RRC) liaison to the EOC. 1. Donor Hospital - The hospital which provides personnel, pharmaceuticals, supplies, or equipment to a facility experiencing a medical disaster. 2. Recipient Hospital - The hospital where the disaster occurred or disaster victims are being treated. This hospital is referred to as the recipient hospital when personnel, pharmaceuticals, supplies, or equipment are requested and received from another hospital. D. Implementation of Mutual Aid Memorandum of Understanding: A health care facility becomes a participating hospital when an authorized administrator signs the MOU. During a medical emergency, the hospital incident commander (or designee), senior hospital administrator (or designee) at each hospital has the authority to request or offer assistance. Communications between hospitals for requesting and offering assistance should therefore occur through the hospital emergency operations centers (EOC). E. Hospital Emergency Operations Center (EOC) The affected facility's Emergency Operations Center is responsible for informing the Regional Resource Center (RRC) participant of the EOC of its situation and defining needs that cannot be accommodated by the hospital itself. The Incident Commander or designee is responsible for requesting personnel, pharmaceuticals, supplies, equipment, or authorizing the evacuation of patients. They will coordinate both internally, and with the donor hospital, all of the logistics involved in implementing assistance under this Mutual Aid MOU. Logistics include identifying the number and specific location where personnel, pharmaceuticals, supplies, equipment, or patients should be sent, how to enter the security perimeter, estimated time interval to arrival and estimated return date of borrowed supplies, etc. F. Requisition Documentation: During a disaster, the recipient hospital will accept and honor the donor hospital's standard requisition forms. Documentation should detail the items involved in the transaction, condition of the material prior to the loan (if applicable), and the party responsible for the materiel. G. Authorization to Use Equipment: The recipient facility will have supervisory direction over the donor facility's staff, borrowed equipment, etc., once they are received by the recipient hospital. 2

3 H. Independent Contractor: The parties shall at all times be acting and performing as independent contractors. Each party has the responsibility of paying its employees as required by law (including payment of social security taxes, workers compensation and unemployment compensation) and generally determining any and all appropriate forms of compensation and fringe benefits for them, and except as specified herein terms of employment, evaluation, discipline and qualifications. Hold Harmless: Each party (the Indemnitor ) shall indemnify and hold the other party, its employees, agents, and insurers (including the trustee of any self-insurance fund) harmless of and from any and all injury, loss, damage, claims and expenses whatsoever (including without limitation judgments, fines, and attorney fees and settlements reasonably incurred) arising out of or in connection with the Indemnitor s compensation of and legal duties to employees. I. Liability Insurance: Each party shall maintain general liability insurance in the minimum amount of $1/$3 million for itself and its employees. A current certificate of insurance shall be furnished to the other party upon request. Each party shall notify the other party of any and all incidents, untoward occurrences, or claims made arising out of its services hereunder. The parties shall cooperate in any investigation of claims or incidents to the extent that doing so does not jeopardize a party s own professional liability insurance coverage. Hold Harmless: Each party (the Indemnitor ) shall indemnify and hold the other party, its employees, agents, and insurers (including the trustee of any self-insurance fund) harmless from any and all injury, loss, damage, claims and expenses whatsoever (including without limitation judgments, fines, and attorney fees and settlements reasonably incurred) arising out of or in connection with anything done or omitted to be done negligently by the Indemnitor, or any employee or agent thereof. Staff member liability (other than physicians) for hospitals directly operated by the State of Maine is covered under the Maine Tort law. J. Communications: Hospitals will collaboratively develop a communication system between the county EOC, the RRC, and the other regional partnering hospitals to ensure a dedicated and reliable communication method is in place. K. Public Relations: Each hospital is responsible for developing and coordinating a disaster media response with other hospitals and responding organizations. Hospitals are encouraged to develop and coordinate the outline of their response prior to any disaster. The response should include reference to the fact that the situation is being addressed in a manner agreed upon by a previously established mutual aid protocol. L. Personnel Pool: Personnel offered by donor hospitals should be limited to staff that are privileged and fully credentialed in the donor institution. No resident physicians, medical/nursing students, or in-training persons should be volunteered. M. Evacuation of Patients: In the event of the evacuation of patients, the hospital incident commander (or designee), senior hospital administrator (or designee) of the transferring (evacuating) hospital will also notify the local fire department and/or emergency management agency of its situation and seek assistance. Assistance may also be requested from emergency medical services. During any evacuation the transferring (evacuating) hospital will notify the EOC. IV. Specific Principles of Understanding for Medical Operations/Loaning Personnel, Pharmaceuticals, Supplies, and/or Equipment. A. Communication of request: The request initially may be made verbally. The request then, must be followed up with written documentation. This should ideally occur prior to the arrival of personnel at the recipient hospital. The recipient hospital will identify to the donor hospital the following: 1. The type and number of requested personnel, pharmaceuticals, supplies and/or equipment. 2. An estimate of how quickly the request is needed. 3. The location where people are to report or supplies are to be delivered. 4. A time estimate of how long the personnel, pharmaceuticals, supplies and/or equipment will be needed. 3

4 B. Documentation: The arriving donated personnel will be required to present their donor hospital identification badge at the site designated by the recipient hospital's command center. The recipient hospital will be responsible for the following: 1. Meeting the arriving donated personnel (usually by the recipient hospital's security personnel or designated employee). 2. Confirming the donated personnel's ID badge with the list of personnel provided by the donor hospital. 3. Providing additional identification, e.g., "visiting personnel" badge, to the arriving donated personnel, as appropriate. C. Credentialing: The recipient hospital will accept the professional credentialing determination of the donor hospital but only for those services for which the personnel are credentialed at the donor hospital. The Chief Medical Officer (or designee) of the recipient hospital will be responsible for providing a mechanism for granting emergency privileges for physician, nurses and other licensed health care providers to provide services at the recipient hospital. D. Transporting of pharmaceuticals, supplies, or equipment: The recipient hospital is responsible for coordinating the transportation of materials to the donor hospital, and for the return of all materials not consumed by the event. This coordination may involve government and/or private organizations, or the donor hospital may also offer transport. Upon request, the receiving hospital must reimburse the donor hospital for all used equipment and supplies, including transportation costs. 1. The donor hospital is responsible for tracking the borrowed inventory through their standard requisition forms. Upon the return of the equipment, etc, the original invoice will be co-signed by the senior administrator or designee of the recipient hospital recording the condition of the borrowed equipment. E. Supervision: 1. The recipient hospital's senior administrator (or designee),identifies where and to whom the donated personnel are to report, and those professional staff of the recipient hospital should supervise the donated personnel. The supervising personnel (or designee) will meet the donated personnel at the point of entry of the facility and brief the donated personnel of the situation and their assignments. As appropriate, the "emergency staffing" rules of the recipient hospital will govern assigned shifts. The donated personnel's shift, however, should not be longer than the customary length practiced at the donor hospital. F. Demobilization procedures: 1. The recipient hospital will provide and coordinate, as appropriate, any necessary demobilization procedures and post-event stress debriefing. 2. The recipient hospital is responsible for coordinating return transport of donated personnel to the donor hospital. 3. The recipient hospital is responsible for the rehabilitation and prompt return of the borrowed equipment to the donor hospital. V. Emergency Operations Center Function A. The Emergency Operations Center (EOC) provides a means for the hospitals to coordinate internally among themselves, and externally with local, county, regional and state response partners (e.g., emergency management, law enforcement, emergency medical services, Regional Resource Centers, public health, fire 4

5 departments, American Red Cross, volunteer agencies, etc.) during a disaster event. B. The EOC serves as the data center for collecting and disseminating timely information about equipment, bed capacity, and other hospital resources during a disaster (see appendices). C. In the event of a disaster or during a disaster drill, hospitals will be prepared to provide the EOC, through the RRC liaison, the following information: 1. Total number of injury victims your emergency department can accept, and if possible, the number of victims with minor and major injuries. 2. Total number of operating beds current available to accept patients in each hospital unit. 3. Total capacity to treat adult and pediatric trauma and burn victims. 4. Number of items currently available for loan or donation to another hospital to possibly include the following items: PAPR respirators for isolation, IV infusion pumps, dialysis machines, hazmat decontamination equipment, ventilators, external pacemakers, pharmaceutical caches. 5. Number of personnel currently available for loan to another hospital: physicians, anesthesiologists, emergency medicine providers, general surgeons, OB-GYN physicians, pediatricians, trauma surgeons, and registered nurses with emergency, critical care, operating, pediatric, and neonatal experience. Other Personnel to include maintenance staff, mental health staff, respiratory therapists, plant engineers, security workers, social workers, and others as indicated. VI. TERM The term of agreement shall be for a period of one (1) year beginning (MM, DD, YYYY) and ending (MM, DD, YYYY). This agreement shall be automatically renewed for successive periods of one year unless either party gives written notice of non-renewal to the other party at least 90 days in advance of the then current term. VII. MHA A copy of this signed agreement is to be forwarded to the Maine Hospital Association. All hospitals will be provided with a list of participating Maine hospitals that have sent signed agreements to the Maine Hospital Association. In the event of termination, the Maine Hospital Association will immediately notify all other signatory hospitals by sending notification to the hospital President/CEO by . Hospital Name: By: Signature of President/CEO 5

6 Appendix 1: PRIMARY DATA COLLECTION FORM In the event of an emergency, record the time of communication, the total number of injury victims the receiving hospital can accept, and, if possible, the number of major* and minor** injury victims the hospital can accept. Date: Page #: Hospitals (list abbreviated name of each member hospital) Time Total Number of Patients Minor Injuries Major Injuries Comments * Major injury victims: Those expected to require admission and/or significant medical/ hospital resources (operating room, critical care, extensive orthopedics intervention, etc.) ** Minor injury victims: Those expected to be treated and released or require very little medical/ hospital resources. 6

7 Appendix 2a: SECONDARY DATA COLLECTION FORM* If time or need permits, request the following information from the donating hospital. Hospital Name: Person completing form: Date: Time: Number of Open/Available Beds General medical (adult) General surgical (adult) General medical (pediatric) General surgical (pediatric) Obstetrics Cardiac ICU NICU PICU Burn Psychiatric Trauma OR Suites Total Available to Donate Respirators IV Infusion Pumps Dialysis Machines Hazmat Decontamination Equipment MRIs CT Scanners Hyperbaric Chamber Ventilators external pacemakers atropine ciprofloxin Pharmaceutical caches Other: Skilled Nursing & Subacute Care * During an actual disaster or disaster drill, hospitals should complete the above form with the most current information available and have this information ready for dissemination to (name of local) emergency management agency, fire department, requesting hospitals, and the EOC. 7

8 Appendix 2b: SECONDARY DATA COLLECTION FORM* Hospital Name: Person completing form: Date: Time: Physician Anesthesiology Emergency Medicine General Surgeon General Medicine OB-GYN Pediatrician Trauma Surgeon Other as indicated Registered Nurses Emergency Critical Care Operating Room Pediatrics Other as indicated Other Personnel Maintenance Workers Mental Health Workers Respiratory Therapists Plant Engineers Security Personnel Social Workers Other as indicated Number of Personnel Currently Available to Loan/Donate to Partner Hospital* * During an actual disaster or disaster drill, hospitals should complete the above form with the most current information available and have this information ready. 8