Advanced Health Care Emergency Management. Presented by Your Name

Transcription

1 Advanced Health Care Emergency Management Presented by Your Name

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3 Getting to know you Refer to Activity 1 in your information packet.

4 Disclaimer The development of this course was partially funded by the US Department of Health and Human Services (HHS), Office of the Assistant Secretary for Preparedness and Response (ASPR), Office of Preparedness and Emergency Operations (OPEO), Division of National Healthcare Preparedness Programs. Catalog of Federal Domestic Assistance (CFDA) No This course is not all inclusive. It is not intended to supersede or substitute for compliance with statute, regulation, or requirement of the State of Florida. The Florida Hospital Association thanks the Georgia Department of Public Health (GDPH), Division of Health Protection, Section of Emergency Preparedness and Response for sharing the content of this course.

5 Health Care Emergency Management Course The complete Health Care Emergency Management course is designed to be delivered in three, eight-hour segments for a total of twenty-four hours of educational content. The Health Care Emergency Management course offers three-days of discussion-based, interactive, scenario-driven didactic education culminating in a table-top exercise.

6 Basic Health Care Emergency Management Course Provides an introduction and overview of emergency management principles, key components, and regulations of health care emergency management as it pertains to hospitals, health systems, and other non-acute health care organizations. The basic course furthers the student s knowledge with an overview of the agencies, organizations, and systems in Florida that they will work with in the practice and profession of emergency management. A course completion examination will be administered at the end of this course. A course completion examination will be administered at the end of this course.

7 Advanced Health Care Emergency Management Course Focuses on the five mission areas of emergency management and integrates these principles with the practice of health care across the state of Florida. The advanced course ends with an interactive, scenario-based tabletop blending the course content with the learner s abilities. A course completion examination will be administered at the end of this course.

8 FEPA Certification Health Care This certification recognizes devoted individuals who have met all the necessary requirements for certification as a Florida Associate Emergency Manager (FAEM) and the Florida Professional Emergency Manager (FPEM). Additionally, the health care certification (FAEM-HC / FPEM-HC) recognizes those who possess advanced knowledge, skills, and abilities to perform effectively within a comprehensive realm of a health care emergency management program. The 24-hour Health Care Emergency Management course is a required component of the FAEM-HC/FPEM-HC certifications.

9 Advanced Health Care Emergency Management Unit One Basic Elements of Health Care Emergency Management

10 Objectives 1. Provide an overview of emergency management principles. 2. Discuss health care provider preparedness. 3. Understand the National Health Care Preparedness Program (NHPP).

11 2017 Domestic Security Strategy Goal 1: PREPARE for all hazards, natural, technological or manmade, to include terrorism. Objective 1.1 PLANNING Objective 1.2 PUBLIC INFORMATION AND WARNING Objective 1.3 OPERATIONAL COORDINATION

12 Disaster Implications Food, Water, Shelter Power Economic / Social Disruption Child Safety Domestic Animals Personal Property Damage Renal Dialysis

13 Vulnerable / At-Risk Populations Non-English speaking Homeless Children Foster Children Elderly People with Disabilities Migrant workers/illegal aliens

14 Challenges Buy-In and leadership engagement Integration Sustainability Staff Engagement Structure Population-based vs. Individual-based

15 Challenges Scarce Resources Standard of Care Evacuation / Patient Movement Fatality Management Globalization of Supply Chain Cyber-technology Adequate Security

16 A Way Forward Build a health care system emergency management program. Strengthen the health care system and fully integrate emergency management into the daily delivery of care. Strengthen links between community partners. Use evidence-based approach to improve health care emergency management.

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18 The Preparedness Cycle Plan Organize / Equip Train Exercise Evaluate

19 Preparedness Cycle = Quality/Performance Improvement

20 Incident Management Process by which an agency, institution, facility, or organization effectively and efficiently manages resources and personnel, through internal or cooperative networks, in an attempt to gain, obtain, or retain control over a situation or incident, whether routine, emergent, or disastrous.

21 Incident Management Priorities 1. Life safety. 2. Incident stabilization. 3. Property and infrastructure protection / preservation. 4. Mitigating harm, destruction and the long-term effects on the community and environment.

22 Incident Command Structure

23 Hospital Incident Command System (HICS) HICS is like the incident command system (ICS) with regard to purpose, application, components, principles, functions and structures.

24 Nursing Home Incident Command System (NHICS)

25 Emergency Management Mission Areas Protect: capabilities necessary to avoid, prevent or stop a threatened or actual act of terrorism. Prevent: capabilities necessary to secure the homeland against acts of terrorism and manmade or natural disasters. Respond: capabilities necessary to reduce the loss of life and property by lessening the impact of disasters. Recover: capabilities necessary to save lives, protect property and the environment, and meet basic human needs after an incident has occurred. Mitigate: capabilities necessary to assist communities affected by an incident to recover effectively.

26 Local, State and Federal Response Local - All disasters are local; assistance will be from local responders. State - Assists local agencies with response, communications, cross-border partners and with the federal government. Federal - The Governor is the only one who can request for the President to declare a locale a disaster area, freeing up money and resources from the federal government.

27 Whole Communities A Whole Community Approach to Emergency Management (December, 2011) /viewrecord.do?id=4941

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29 Health and Medical Response

30 Health Care Coalitions A group of individual health care organizations (e.g., hospitals, clinics, nursing homes, etc.) in a defined geographic location. Coalitions serve as a support group that may coordinate and integrate with emergency management and Emergency Support Function 8 - Health and Medical Services (ESF8) at the local level. They may: Support information sharing; Provide information for situational awareness; and, Facilitate resource support to their members in coordination with ESF8.

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32 CMS Emergency Preparedness Rule New Requirements for Medicare and Medicaid participating Providers and Suppliers Published September 16, 2016 Applies to all 17 provider and supplier types Implementation date November 15, 2017 Compliance required for participation in Medicare

33 Goal Address systemic gaps Establish consistency Encourage coordination

34 Risk Assessment and Planning Policies and Procedures Emergency Preparedness Program Communication Plan Training and Testing 8

35 Who Must Comply? Inpatient Critical Access Hospitals (CAHs) Hospices Hospitals Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) Long Term Care (LTC) Psychiatric Residential Treatment Facilities (PRTFs) Religious Nonmedical Health Care Institutions (RNHCIs) Transplant Centers Outpatient Ambulatory Surgical Centers (ASCs) Clinics, Rehabilitation Agencies, and Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services Community Mental Health Centers (CMHCs) Comprehensive Outpatient Rehabilitation Facilities (CORFs) End-Stage Renal Disease (ESRD) Facilities Home Health Agencies (HHAs) Hospices Organ Procurement Organizations (OPOs) Programs of All Inclusive Care for the Elderly (PACE) Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)

36 Health Care Regulation and Accreditation Federal policy and state statutes License regulation and rules Accreditation Risk mitigation Local requirements Insurance requirements (CMS Rule) Grant requirements EMTALA HIPAA NIMS / HICS OSHA regulations ADA compliance Integrated health system partners

37 Health Care Regulation and Accreditation Organizations can be grouped into the following categories: Accrediting organizations; Regulatory organizations; Standard-setting bodies; Providers of guidance, grants, and training; and, Governmental agencies.

38 Health Care Regulation Regulation of healthcare facilities and systems is conducted by overlapping federal, state, and local. Most regulatory requirements for individual healthcare facilities are established and enforced at the state and local level.

39 Health Care Regulation State and local agencies have standards and regulations specific to every jurisdiction in the country. Some jurisdictions have specific emergency management provisions.

40 Health Care Accreditation Accreditation is a process of review that allows health care organizations to demonstrate their ability to meet regulatory requirements and standards established by a recognized accreditation organization. Accreditation is regarded as a key benchmark for measuring the quality of an organization.

41 Health Care Accreditation Accrediting bodies include: The Joint Commission (TJC); DNV Healthcare, Inc. (DNV); Accreditation Commission for Health Care (ACHC); Health Facilities Accreditation Program (HFAP); and, Community Health Accreditation Program (CHAP)

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43 Hospital and Health Care Preparedness Program Federal grant program administered by the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response (ASPR). ASPR provides leadership and funding to States, territories and eligible municipalities. Funding supports: Improving health and medical infrastructure. Capability-based planning. Development and sustainment of Health Care Coalitions.

44 2012 and Capabilities

45 Enhancing Medical Surge Capacity Critical Infrastructure Protection Regional Emergency Coordinators National Disaster Medical System Medical Reserve Corps Hospital Preparedness Program 45

46 Building Readiness for 21 st Century Threats Strong Leadership Public Health Security Capacity Regional Disaster Health Response System Medical Countermeasures Enterprise

47 Potential Regional Disaster Health Response System Aware Responsive Ready Regional Regional Disaster Health Response System Resourced 47

48 Enhance Health Care Coalitions Health Care Coalition Health Care Coalition EMS

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50 Advanced Health Care Emergency Management Unit Two Prevention

51 Objectives 1. Understand how prevention core capabilities support health care emergency management. 2. Discuss the role of law enforcement agencies as a prevention partner. 3. Understand the emergency operations plan and its use as a prevention tool.

52 2017 Domestic Security Strategy Goal 2: PREVENT, preempt and deter acts of terrorism. Objective 2.1 FORENSICS AND ATTRIBUTION Objective 2.2 INTELLIGENCE AND INFORMATION SHARING Objective 2.3 INTERDICTION AND DISRUPTION Objective 2.4 SCREENING, SEARCH AND DETECTION

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54 Prevention Core Capabilities Planning Public Information and Warning Operational Coordination Forensics and Attribution Intelligence and Information Sharing Interdiction and Disruption Screening, Search, and Detection

55 Core Capabilities and Health Care Emergency Management Health Care Organization(s) Planning Public Information Operational Coordination Forensics and Attribution Intelligence / Information Sharing Systematic process; whole community; operational planning Vetted and actionable info; clear and consistent; all hazards; actions and assets Unified, operational command across jurisdictions Analyze means and methods of terrorism; goal = prevent attack and/or develop counter options Vetted and actionable info; physical / cyber threats; terrorism and homeland security; fusion centers Systematic process; may involve community partners; Operational planning? Typically a receiver; PIO not a formal role; focus on the mission to the community HICS, NHICS, ALICS, etc.; do not typically operate outside of their affiliates Soft targets; unclear or limited role in authority / responsibility to prevent terrorism; warm, friendly environment problematic Increased involvement with fusion centers; health care coalitions provide environment for information sharing / situational awareness Interdiction / Disruption Delay, divert, intercept, halt, apprehend threats Limited role in authority / responsibility; variable levels of security Screening, Search, Detection Identify the threat; active / passive surveillance Suspicious activity reporting; law enforcement engagement; See something / Say Something

56 Intelligence Gathering Sources of information may include Florida Fusion Centers Homeland Security Information Network Health Alert Network FlaWARN Law Enforcement BOLOs (Be On The Lookout) Emergency notification platforms Suspicious Activity Reports Other sources.

57 Information Sharing Sharing information across traditional organizational boundaries Communication Who? What? How? When? Why? Communication Platforms - Telephone / Mobile phone Radio (800 MHz, HAM) Text message / Instant Messaging Social Media Other Interoperability

58 Federal Information Sharing Platforms National Network of Fusion Centers: Fusion centers serve as focal points within the state and local environment for the receipt, analysis, gathering, and sharing of threat-related information between the federal government and state, local, tribal, territorial (SLTT) and private sector partners. Nationwide Suspicious Activity Reporting Initiative: Our efforts, in coordination with the Department of Justice, to implement a unified process for reporting, tracking, and accessing [SARs] in a manner that rigorously protects the privacy and civil liberties of Americans, as called for in the National Strategy for Information Sharing.

59 Federal Information Sharing Platforms National Terrorism Advisory System (NTAS): The NTAS, replaces the colorcoded Homeland Security Advisory System (HSAS). This system will more effectively communicate information about terrorist threats by providing timely, detailed information to the public, government agencies, first responders, airports and other transportation hubs, and the private sector. If You See Something, Say Something : The Department s nation-wide public awareness campaign a simple and effective program to raise public awareness of indicators of terrorism and violent crime, and to emphasize the importance of reporting suspicious activity to the proper state and local law enforcement authorities.

60 Health Care Security Hospitals May not be 24/7 Typically not armed Limited in authority May utilize local law enforcement or retired police Outsourced? Lack physical barriers Friendly environment Other Providers May not use security at all reliance on community law enforcement Unknown risks / hazards Lack physical barriers Friendly environment Other

61 Crime Prevention Crime Prevention Through Environmental Design Multi-disciplinary approach to deterring criminal behavior through environmental design. CPTED strategies rely upon the ability to influence offender decisions that precede criminal acts. Specifically altering the physical design of the communities in which humans reside and congregate in order to deter criminal activity is the main goal of CPTED.

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65 Domestic Security Strategic Plan Goals 1. PREPARE for all hazards, natural, technological or man-made, to include terrorism. 2. PREVENT, preempt and deter acts of terrorism. 3. PROTECT our citizens, residents, visitors and critical infrastructure against threats and hazards.

66 Domestic Security Strategic Plan Goals 4. MITIGATE the impact of incidents and events to reduce the loss of life and to property and the environment. 5. RESPOND in an immediate, efficient and coordinated manner, focused on the survivors and their needs. 6. RECOVER quickly and effectively to restore our way of life following an incident or event.

67 Law Enforcement Partners Federal Bureau of Investigation Florida Attorney General Florida Department of Law Enforcement Florida Highway Patrol County Sheriffs Municipal Police Departments Representative Organizations Florida Sheriffs Association Florida Police Chiefs Association

68 Local Law Enforcement Engagement Federal Bureau of Investigation Florida Attorney General Florida Department of Law Enforcement Florida Highway Patrol County Sheriffs Municipal Police Departments Representative Organizations Florida Sheriffs Association Florida Police Chiefs Association

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70 CMS Planning Develop an emergency plan based on a risk assessment. Perform risk assessment using an all-hazards approach, focusing on capacities and capabilities. Update emergency plan at least annually.

71 Prevention Begins with All-Hazards Planning An integrated approach to emergency preparedness planning that focuses on capacities and capabilities that are critical to preparedness for a full spectrum of emergencies or disasters, including internal emergencies and a man-made emergency (or both) or natural disaster. This approach is specific to the location of the provider or supplier and considers the particular type of hazards most likely to occur in their areas.

72 Prevention Begins with All-Hazards Planning An integrated approach to emergency preparedness planning that focuses on capacities and capabilities that are critical to preparedness for a full spectrum of emergencies or disasters, including internal emergencies and a man-made emergency (or both) or natural disaster. This approach is specific to the location of the provider or supplier and considers the particular type of hazards most likely to occur in their areas.

73 Prevention Begins with All-Hazards Planning These may include, but are not limited to, care-related emergencies, equipment and power failures, interruptions in communications, including cyber-attacks, loss of a portion or all of a facility, and interruptions in the normal supply of essentials such as water and food.

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75 Let s Play Refer to Activity 2 in your information packet.

76 Advanced Health Care Emergency Management Unit Three Protection

77 Objectives 1. Discuss how risks are assessed and how hazards are identified typically with health care providers; and, distinguish the differences and similarities of community risk assessments. 2. Understand physical protection and hardening measures health care providers may undertake. 3. Discuss common threats health care facilities face in a given community.

78 2017 Domestic Security Strategy Goal 3: PROTECT our citizens, residents, visitors and critical infrastructure against threats and hazards. Objective 3.1 ACCESS CONTROL AND IDENTITY VERIFICATION Objective 3.2 CYBERSECURITY Objective 3.3 PHYSICAL PROTECTIVE MEASURES Objective 3.4 RISK MANAGEMENT Objective 3.5 SUPPLY CHAIN INTEGRITY AND SECURITY

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80 Natural Disasters Tornadoes Forest Fires Floods Blizzards Cyclones/Typhoon Hurricanes Heat wave Tsunami Volcanic Eruption Earthquakes Mudslides Limnic Eruption Draught/Famine Hail

81 Unintentional / Accidental Engineering Failures Bridges, Buildings, Dams Utility interruption Transportation accidents Environmental Explosions Mine disasters Industrial accidents Fire

82 Terrorism Radical fundamentalist Sovereign citizens Domestic groups Political groups Paramilitary groups Cyber-terrorism Other The goals of terrorists are to: Create confusion, fear, chaos, and mistrust. Break down physical and political infrastructures. Intimidate, subjugate, and weaken authority.

83 Other Threats The physical location of a health care facility may be problematic Flood zones Proximity to hazardous materials Ingress / egress for transportation Older construction standards may increase risk Inadequate security

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85 Basic Element of Protection Emergency Operations Plan Based on the hazard vulnerability analysis (HVA) Risk analysis Facility-based (system) Community-based Statewide threats, risks and hazards

86 Hazard Vulnerability Analysis Organized and formal approach to evaluating the probabilities and consequences of all hazards that might affect a facility.

87 Hazard Vulnerability Analysis To create an HVA, these need to be assessed: Identifiable hazards Probability / risk of hazard Vulnerability to hazard Preparedness efforts

88 What are Hazards? Natural and/or man-made objects or events which provide for potential adverse effects on the health and safety of individuals, communities, and/or the environment, as well as the activity of business and other social, political, and economic considerations.

89 All-Hazards Approach to Planning Be sure to think outside the box. Include all types of hazards, man-made or natural. Consider hazards within the facility, as well as in the surrounding community and environment. Use historical data. Look at other healthcare EOPs and HVAs.

90 Consult a Variety of Resources Review your county EOP and HVA Visit various state and federal websites to view hazard maps Consult FEMA for flood maps View the National Weather Service s history of storms Other

91 Sample HVA Tool Available at:

92 Hazard Identification Aims to determine the qualitative nature of: The source of the hazard Potential adverse consequences The strength of the hazard Effects Once hazards are identified - prioritize risks

93 Probability vs. Risk Individual risk - the probability an incident or event will occur Overall risk considers: Probability of occurrence Vulnerability to the impact Preparedness efforts

94 Managing Risk Identify those risks that could cause an interruption or loss of a critical function or service. Use a scoring tool that can help prioritize the risks such as: Probability x Impact = Risk

95 Managing Risk Identify unacceptable concentrations of risk or critical, single points of failure. Develop a Risk Reduction Plan, which helps to ensure preparedness.

96 Managing Risk

97 Risk Reduction Plan Accept the risk where the impact and probability are low. Transfer the risk through insurance when appropriate. Avoid the risk by removing the source of the threat (prevention). Manage the risk if it is frequent, but of low impact, by monitoring and finding a way to reduce it. Reduce the risk through mitigation activities or outsourcing.

98 Once the Analysis is Complete Use HVA results to: Determine areas that require the most attention and which are most important. Tailor sections of the EOP to address organizational and / or community-specific hazards. Classify from greatest risk down to low-level risk areas.

99 Business Continuity Key Method Key Parameters Type of Incident Risk Management Risk Analysis Impact and Probability All hazards, usually segmented Business Continuity Management Business Impact Analysis Impact and Time Events causing significant business interruption

100 More to do Refer to Activity 3 in your information packet.

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102 Vulnerability Hard Targets Military instillations Government buildings Secure Areas Soft Targets Hospitals and health care facilities Schools Churches

103 Hardening Examples Although it was anchored and not displaced by floodwaters, this generator was out of service after being submerged Elevated utility box

104 Hardening Examples Access Restriction

105 Hardening Examples Window Protection

106 Hardening Examples Window Protection

107 Hardening Examples Access Control

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109 Advanced Health Care Emergency Management Unit Four Mitigation Measures

110 Objectives 1. Understand how health care facility may reduce vulnerabilities once they are identified. 2. Understand the concept of whole community as it relates to community resilience. 3. Discuss how health care providers manage business continuity and the links to sustaining a community s continuity of operations activities.

111 2017 Domestic Security Strategy Goal 4: MITIGATE the impact of incidents and events to reduce the loss of life and to property and the environment. Objective 4.1 COMMUNITY RESILIENCE Objective 4.2 LONG-TERM VULNERABILITY REDUCTION Objective 4.3 RISK AND DIASTER RESILIENCE ASSESMENT Objective 4.4 THREATS AND HAZARD IDENTIFICATION

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114 Philosophical Approach Whole Community is a means by which residents, emergency management practitioners, organizational and community leaders, and government officials can collectively understand and assess the needs of their respective communities and determine the best ways to organize and strengthen their assets, capacities, and interests. Attempts to engage the full capacity of the private and nonprofit sectors, including businesses, faith-based and disability organizations, and the general public, in conjunction with the participation of local, tribal, state, territorial, and Federal governmental partners.

115 Benefits Shared understanding of community needs and capabilities. Greater empowerment and integration of resources from across the community. Stronger social infrastructure. Establishment of relationships that facilitate more effective prevention, protection, mitigation, response, and recovery activities. Increased individual and collective preparedness. Greater resiliency at both the community and national levels.

116 Strategic Themes Understand community complexity. Recognize community capabilities and needs. Foster relationships with community leaders. Build and maintain partnerships. Empower local action. Leverage and strengthen social infrastructure, networks, and assets.

117 Path to Action How can we better understand the actual needs of the communities we serve? What partnerships might we need in order to develop an understanding of the community s needs? How do we effectively engage the whole community in emergency management to include a wide breadth of community members? How do we generate public interest in disaster preparedness to get a seat at the table with community organizations?

118 Path to Action How can we tap into what communities are interested in to engage in discussions about increasing resilience? What activities can emergency managers change or create to help strengthen what already works well in communities? How can communities and emergency management support each other?

119 Mitigation Examples Submarine Doors and Gates

120 Mitigation Examples Floodwalls

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122 Advanced Health Care Emergency Management Unit Five Health and Medical Response

123 Objectives Discuss and understand the elements of health and medical disaster response to include: Transportation Environmental response Life Safety Security and access control Facility closure Infrastructure system support Fatality management Supply chain and logistics Mass care Operational communications First responders, first receivers

124 2017 Domestic Security Strategy Goal 5: RESPOND in an immediate, efficient, and coordinated manner, focused on the survivors and their needs. Objective 5.1 CRITICAL TRANSPORTATION Objective 5.2 ENVIRONMENTAL RESPONSE/ HEALTH SAFETY Objective 5.3 FATALITY MANAGEMENT SERVICES Objective 5.4 INFRASTRUCTURE SYSTEMS Objective 5.5 MASS CARE SERVICES Objective 5.6 MASS SEARCH AND RESCUE OPERATION

125 2017 Domestic Security Strategy Goal 5: RESPOND in an immediate, efficient, and coordinated manner, focused on the survivors and their needs. Objective 5.7 ON-SCENE SECURITY AND PROTECTION Objective 5.8 OPERATIONAL COMMUNICATIONS Objective 5.9 PUBLIC AND PRIVATE SERVICES AND RESOURCES Objective 5.10 PUBLIC HEALTH AND MEDICAL SERVICES Objective 5.11 SITUATIONAL ASSESMENT

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127 Governance Florida Statutes Chapter 401 Medical Telecommunications and Transportation Chapter 395 Hospital Licensing and Regulation Part II: Trauma Administrative Rules Chapter 64J-1: Emergency Medical Services Chapter 64J-2: Trauma Chapter 64J-3: 911 Public Safety Telecommunicator

128 Strategic Priorities 1. EMS Industry Health and Safety 2. Clinical and Operational Performance 3. EMS System Infrastructure and Finance 4. Readiness for Emerging Health Threats 5. Community Redevelopment and Partnerships 6. Regulatory Efficiency

129 Florida EMS Providers Florida Department of Health, Division of Emergency Preparedness and Community Support, Bureau of Emergency Medical Oversight. September Florida Emergency Medical Providers Licensure and Call Volume Report. Available at:

130 EMS Capacity Florida Department of Health, Division of Emergency Preparedness and Community Support, Bureau of Emergency Medical Oversight. September Florida Emergency Medical Providers Licensure and Call Volume Report. Available at:

131 EMS Capacity Florida Department of Health, Division of Emergency Preparedness and Community Support, Bureau of Emergency Medical Oversight. September Florida Emergency Medical Providers Licensure and Call Volume Report. Available at:

132 EMS Capacity Florida Department of Health, Division of Emergency Preparedness and Community Support, Bureau of Emergency Medical Oversight. September Florida Emergency Medical Providers Licensure and Call Volume Report. Available at:

133 EMS Capacity Florida Department of Health, Division of Emergency Preparedness and Community Support, Bureau of Emergency Medical Oversight. September Florida Emergency Medical Providers Licensure and Call Volume Report. Available at:

134 EMS Data Florida Department of Health, Division of Emergency Preparedness and Community Support, Bureau of Emergency Medical Oversight. September Florida Emergency Medical Providers Licensure and Call Volume Report. Available at:

135 EMS Data Florida Department of Health, Division of Emergency Preparedness and Community Support, Bureau of Emergency Medical Oversight. September Florida Emergency Medical Providers Licensure and Call Volume Report. Available at:

136 Lessons Learned Hurricane Harvey Inappropriate Reliance on Hospitals as Shelters and Evacuation As the flood waters rose, and the National Guard, local fire departments and Good Samaritans alike rescued people from their cars and homes, hospitals were used as evacuation sites. Hospitals shared dramatic stories of people arriving in dump trucks in groups of 30 or more or being dropped off by Blackhawk helicopters.

137 Lessons Learned Hurricane Harvey Coordination of Transfers Vulnerable or medically fragile patients transfer to hospitals outside of the impacted areas. Coordinating these transfers was difficult.

138 Lessons Learned Hurricane Irma Successes Having the federal ambulance strike team coordination was very helpful 36 hospitals evacuated Areas for improvement Access to transportation Local push-back and resistance with mission requests for transportation assets

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140 Environmental Health Preparedness Protecting drinking water supplies Department of Health and Department of Environmental Protection Boil water notices Public drinking water inventory Controlling food and waterborne illness Illness outbreaks, intentional or otherwise, associated with food and water consumption and recreational water use Food product recalls

141 Environmental Health Preparedness Preventing arthropod-borne diseases and zoonoses Arbovirus and vector-borne illness (e.g., West Nile Virus, Equine Encephalitis, Zika, etc.) Controlling biomedical waste County Health Departments have primary authority and responsibility for facilities that generate, transport, store, or treat biomedical waste through processes other than incineration. These facilities include hospitals, clinics, nursing homes, laboratories, funeral homes, dentists, veterinarians and physicians.

142 Environmental Health Preparedness Protecting the public from radiation Bureau of Radiation Control Conduct population monitoring during a response involving radiation exposure. Preventing chemical exposure EH may provide technical assistance to partners as needed. Hazardous chemical release has the potential to harm peoples health. Chemical releases can be unintentional/accidental or intentional.

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144 Life Safety System Any interior building element designed to protect and evacuate the building population in emergencies. Includes: Fire / smoke detection, suppression, alarms, notification, containment Power failure Protected exits (corridors, stairways and exterior exits) Coordinated activities that seek either to minimize or to eliminate hazardous conditions that can cause bodily injury.

145 Life Safety Code A consensus standard widely adopted in the United States. It is administered, trademarked, copyrighted, and published by the National Fire Protection Association. The standard is not a legal code and has no statutory authority in its own right. However, it is deliberately crafted with language suitable for mandatory application to facilitate adoption into law by those empowered to do so.

146 Life Safety Code The bulk of the standard addresses "those construction, protection, and occupancy features necessary to minimize danger to life from the effects of fire, including smoke, heat, and toxic gases created during a fire." The standard does not address the "general fire prevention or building construction features that are normally a function of fire prevention codes and building codes."

147 LSC and CMS Subsistence needs for staff and patients Facilities must establish policies and procedures that determine how maintain temperatures, emergency lighting, fire detection and extinguishing systems and sewage and waste disposal during an emergency situation if there were a loss of the primary power source. Whatever alternate sources of energy a facility chooses to utilize must be in accordance with local and state laws as well as relevant LSC requirements. Portable generator - the Life Safety Code (LSC) provisions outlined under the NFPA guidelines would not be applicable. Permanent generator - LSC provisions will apply and the facility may be subject to LSC surveys to ensure compliance is met.

148 LSC and CMS Hospital CAH and LTC Emergency Power CMS requires Hospitals, CAHs and LTC facilities to comply with the 2012 edition of the National Fire Protection Association (NFPA) 101 Life Safety Code (LSC) and the 2012 edition of the NFPA 99 Health Care Facilities Code in accordance with the Final Rule (CMS 3277 F). NFPA 99 requires Hospitals, CAHs and certain LTC facilities to install, maintain, inspect and test an Essential Electric System (EES) in areas of a building where the failure of equipment or systems is likely to cause the injury or death of patients or caregivers.

149 LSC and CMS Hospital CAH and LTC Emergency Power NFPA 99 identifies the 2010 edition of NFPA 110 Standard for Emergency and Standby Power Systems as a mandatory reference, which addresses the performance requirements for emergency and standby power systems and includes installation, maintenance, operation, and testing requirements.

150 Interpretive Guidelines and Surveys CMS Survey & Certification Group (SCG) develops the Interpretive Guidelines (IGs) which assist in implementation the regulations. Facilities must be in compliance with the requirements by 11/15/2017. In the event facilities are non-compliant, the same general enforcement procedures will occur as is currently in place for any other conditions or requirements cited for non-compliance.

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152 Increased Security = Protection and Hardening Security augmentation Facility design / construction standards New construction location Community engagement Lockdown capabilities Mitigation projects

153 Enhancing Security Program Administration Security Department Operations Investigations Services-Patient Services Staff [All] Emergency Management

154 Enhancing Security Systems Physical Security Electronic Security Systems Access Control Identification System Key Control Facility Restricted Access (Emergency Lockdown) Visitor Control Video Surveillance Communication Systems and Equipment Testing of Physical and Electronic Security Systems Security Signage

155 Examples Video Surveillance

156 Examples Locking Mechanisms

157 Examples Visitor Management

158 Examples Visitor Screening

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160 Agency for Health Care Administration (AHCA) Develops and writes hurricane construction standards for new and existing health care facilities. Requires health facility reporting and status updates. Maintains emergency management planning criteria. Staffs ESF-8 the emergency operations centers (central and local). Conducts damage assessments of all health care facilities.

161 AHCA Damage Assessments Provides information to the state and federal response teams. Helps AHCA monitor and support providers and provider associations in the management of evacuations. Determines short and long term impact on state wide health care delivery systems. Helps AHCA apply new knowledge to future hurricane mitigation projects.

162 Damage Assessment Categories Structural Failures Roofing Failures Roof Appendage and Site Failures Exterior Unit Failures Interior Facility Damage System Failures Surge Damage

163 Typical Survey Concerns Have Fire Safety Issues been addressed? Is the Environment of Care being maintained? Have utilities been restored to the building? Is there emergency electrical service for power to the residents for air conditioning, lighting, basic services? Are the residents under extreme stress? What alternative methods have been taken to off-set non compliance? When will facility be able to return to full service?

164 Reoccupation Notify AHCA before Re-occupancy Power must be restored Check all systems for proper operation Check all structural elements Check for water intrusion and mold growth. If there has been water intrusion follow AHCA protocol

165 AHCA Best Practices Hurricane Irma Hospitals, nursing homes and remote emergency departments that have closed or evacuated may proceed with reopening and reoccupancy if the facility is undamaged and all critical systems are functional and staffing is sufficient. Provide an update of evacuation status. If power is not fully restored, even if generators are operational, contact local emergency operation officials as necessary prior to reentry. If the hospital is damaged, contact the AHCA Office of Plans and Construction to discuss damage and impact prior to re-opening and reoccupancy.

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167 Critical Infrastructure Protecting Florida s health care and public health critical infrastructure is essential to Florida s security, economic vitality and way of life. Includes actions to shield health care and public health assets, systems, networks and their inter-connecting links from exposure, injury, destruction, incapacitation or exploitation.

168 Critical Infrastructure Involves actions to deter, mitigate or neutralize the threat, vulnerability or consequences associated with all hazards. Wide range of activities, including hardening facilities, building resilience and redundancy and implementing cyber security measures.

169 Health and Medical Infrastructure Direct Patient Health Care (hospitals, ambulatory health care facility, extended care facility, health practitioner office or clinic, home health care) Public Health Agency (clinical or non-clinical agency/department) Health Care Educational Facility (medical, dental, nursing, pharmacy or allied health school)

170 Health and Medical Infrastructure Health Supporting Facility (medical and diagnostic laboratory, blood, organ and tissue facility, pharmaceutical and biopharmaceutical production, medical supplies, devices or equipment manufacturing facility) Fatality/Mortuary facility (morgue, funeral home or crematorium) Regulatory, Oversight or Industry Organization (federal, state or local agency or department)

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172 FEMORS Mission Assist and support the local District Medical Examiners Office, Florida Department of Law Enforcement and other responding agencies, in the event of a mass fatality incident as directed by the Florida Department of Health. Created to serve the needs of Medical Examiners in their mission to bring dignity and professionalism to caring for the deceased.

173 FEMORS Develop and implement protocols to respond to a mass fatalities incident using trained personnel from multiple state, and local agencies, as well as other specialized resources in the event of a human-made or natural catastrophic incident.

174 FEMORS Duties Initial Scene Response and Evaluation Processing the Scene Temporary Morgue Operations and Administration The roles of various forensic units within the morgue (e.g., pathologist, anthropologist, odontologist, radiologist, fingerprint specialist, DNA analyst, funeral director, and others)

175 FEMORS Duties Victim Identification Disposition of Human Remains (Embalming/casketing) Personal Effects Evidence Collection

176 Medical Examiners The Medical Examiners Act, Chapter 406, Florida Statutes, was enacted to establish minimum and uniform standards of excellence in statewide medical examiner services. Governed by a nine member commission which has certain disciplinary oversight of medical examiner activities. The Commission interacts with local, state and federal agencies in an effort to enhance medical examiners role of assisting the citizens of Florida in the area of death investigations and reporting.

177 ME Districts

178 Mass Fatality Plan Focus: to identify methods through which medical examiners may obtain support assets to accomplish the goals of identifying the deceased and arranging proper final disposition. No attempt is made to create a onesize-fits-all operational set of procedures, as each district is unique.

179 Mass Fatality The plan presents major categories of service response that must be adapted to the nature of disasters ranging from naturally occurring events to manmade events including delivery of weapons of mass destruction.

180 Mass Fatality Natural disease outbreaks occurring under normal circumstances (e.g. not terrorist related) do not normally fall under the jurisdiction of the medical examiner. Planning for such outbreaks is covered in the Florida Natural Disease Outbreak and the Pandemic Influenza Fatality Management Response Plan (2008).

181 Hospital Morgues Space is limited! Positive temperature - 36 F and 39 F. Bodies are kept until mortuary service or coroner can accommodate pick-up and transfer.

182 Hospital Morgues Hospitals not equipped for mass fatality. What are the options? Need strong relationships with ME office and public health. Refrigerated trucks? It s not like TV!

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184 Surge Capacity The ability to evaluate and care for a markedly increased volume of patients one that challenges or exceeds normal operating capacity. The surge requirements may extend beyond direct patient care to include such tasks as extensive laboratory studies or epidemiological investigations. Assistant Secretary for Preparedness and Response. 2010a. Medical surge capacity handbook: What is medical surge? Washington, DC: HHS,

185 Surge Capability The ability to manage patients requiring unusual or highly specialized medical evaluation and care. Surge requirements span the range of specialized medical and health services (expertise, information, procedures, equipment, or personnel) that are not normally available at the location where they are needed (e.g., pediatric care provided at non-pediatric facilities or burn care services at a nonburn center). Assistant Secretary for Preparedness and Response. 2010b. Medical surge capacity handbook: Glossary. Washington, DC: HHS,

186 Surge Capability Surge capability also includes patient problems that require special intervention to protect medical providers, other patients, and the integrity of the medical care facility (example highly infectious disease). Assistant Secretary for Preparedness and Response. 2010b. Medical surge capacity handbook: Glossary. Washington, DC: HHS,

187 Conventional, Contingency and Crisis Capacity Conventional Capacity: The spaces, staff, and supplies used are consistent with daily practices within the institution. These spaces and practices are used during a major mass casualty incident that triggers activation of the facility emergency operations plan. Hick, J. L., J. A. Barbera, and G. D. Kelen Refining surge capacity: Conventional, contingency, and crisis capacity. Disaster Medicine and Public Health Preparedness 3(Suppl. 2):S59-S67

188 Conventional, Contingency and Crisis Capacity Contingency Capacity: The spaces, staff, and supplies used are not consistent with daily practices but provide care that is functionally equivalent to usual patient care. These spaces or practices may be used temporarily during a major mass casualty incident or on a more sustained basis during a disaster (when the demands of the incident exceed community resources). Hick, J. L., J. A. Barbera, and G. D. Kelen Refining surge capacity: Conventional, contingency, and crisis capacity. Disaster Medicine and Public Health Preparedness 3(Suppl. 2):S59-S67

189 Conventional, Contingency and Crisis Capacity Crisis capacity: Adaptive spaces, staff, and supplies are not consistent with usual standards of care, but provide sufficiency of care in the context of a catastrophic disaster (i.e., provide the best possible care to patients given the circumstances and resources available). Crisis capacity activation constitutes a significant adjustment to standards of care. Hick, J. L., J. A. Barbera, and G. D. Kelen Refining surge capacity: Conventional, contingency, and crisis capacity. Disaster Medicine and Public Health Preparedness 3(Suppl. 2):S59-S67

190 Institute of Medicine Guidance for establishing crisis standards of care for use in disaster situations: A letter report. Washington, DC: The National Academies Press,

191 Mutual Aid Mutual aid is an agreement between two entities to lend assistance across jurisdictional boundaries. This may occur due to an emergency that exceeds local resources. It may be ad hoc, requested only when such an emergency occurs. It may also be a formal standing agreement for cooperative emergency management on a continuing basis.

192 Mutual Aid We re All In This Together! Two common types Memoranda of Understanding Memoranda of Agreement

193 Memoranda of Understanding (MOU) Document that expresses mutual accord on an issue between two or more parties, indicating an intended common line of action, rather than a legal commitment. MOUs are generally recognized as binding, even if no legal claim could be based on the rights and obligations laid down in them.

194 Memoranda of Understanding (MOU) To be legally operative, an MOU must: Identify the contracting parties. Spell out the subject matter of the agreement and its objectives. Summarize the essential terms of the agreement. Must be signed by the contracting parties.

195 Memoranda of Agreement (MOA) MOA is a document written between parties to cooperatively work together on an agreed upon project or an objective. Purpose is to have a written understanding of the agreement between parties. Can be a legal document that is binding and hold the parties responsible to their commitment or just a partnership agreement.

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197 Alerts and Notification Who needs to be notified? What technologies are used for notification? When should they be notified? Where are alert and notification procedures and equipment located? Why do they need to be notified? How are alert and notification procedures and equipment tested?

198 Who? Internal Incident Command Staff Leadership / Executives EM Committee Security Staff Switchboard / Dispatch Staff Patients visitors, and families Others? External Emergency Management Public Health Fire Service / EMS Utility providers AHCA Vendors Media

199 What? Situational information Incident action plan information Facility Status Information Facility response information Emergency operations plan information Job actions Flash reports and updates

200 When? Develop trigger points to include in Emergency Operations Plan. For example, If a tornado/severe weather warning is issued, incident command system will be activated. Talk to external partners (EM, Public Health, etc.) to find out when in an event they would need to be notified.

201 Where are Procedures and Equipment Located? Emergency Operations Plan Consider posting relevant contact information near alert and notification technologies. Many technologies are located in the Emergency Department, others are in the Command Center or other Administrative Areas dependent on your organization. Make Sure Your Staff Knows!

202 Why? Best Practices Communications are always problematic. Allows internal and external staff to support the response efforts.

203 How? Exercise! Exercise! Exercise! In every exercise and drill During evenings, weekends, and holidays Use exercises as opportunities to train staff on equipment, check accuracy of contact information, and time it takes to notify and alert external partners.

204 Notification Systems Switchboard Overhead page Alert Systems Pager Call Trees Electronic Bulletin Board Intranet Others?

205 Notification Systems HAM Radios 800 MHz radios Reverse Notification Systems Information Management System (WebEOC, E-Team) Others?

206 Media Relations Be responsive and helpful to the media. Control the information. Always tell the truth but resist giving every detail. Demonstrate confidence. Deliver a clear message. Redundant messaging and messengers. Identify a media staging area in your plan.

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208 First Responders U.S. Homeland Security Presidential Directive, HSPD-8: those individuals who in the early stages of an incident are responsible for the protection and preservation of life, property, evidence, and the environment, including emergency response providers as defined in section 2 of the Homeland Security Act of 2002 (6 U.S.C. 101), as well as emergency management, public health, clinical care, public works, and other skilled support personnel (such as equipment operators) that provide immediate support services during prevention, response, and recovery operations.

209 First Responders Defined by 6 U.S.C. 101: The term emergency response providers includes Federal, State, and local governmental and nongovernmental emergency public safety, fire, law enforcement, emergency response, emergency medical services providers (including hospital emergency facilities), and related personnel, agencies, and authorities.

210 First Receivers Healthcare workers at a hospital receiving contaminated victims for treatment may be termed first receivers (Koenig, 2003). Typically include personnel in the following roles: clinicians and other hospital staff who have a role in receiving and treating contaminated victims (e.g., triage, decontamination, medical treatment, and security) and those whose roles support these functions (e.g., set up and patient tracking).

211 First Receivers Frontline health care facilities Rapidly identify and triage Assessment hospitals receive and isolate Treatment centers - provide comprehensive care Disaster Health Response System

212 Mass Care National Mass Care Strategy Sheltering (including household pets) Feeding Distribution of emergency supplies Family reunification services Immediate health, emotional and spiritual health services Access to information

213 ESF-6 (Mass Care) Primary Functions Mass Care Emergency Assistance Housing Human Services

214 ESF-6 Providers Human services agencies and organizations at the local, state, tribal, territorial, insular area, and Federal levels work together to provide life-sustaining assistance to disaster survivors.

215 More to do Refer to Activity 4 in your information packet.

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217 Advanced Health Care Emergency Management Unit Six Recovery

218 Objectives 1. Understand the framework of Continuity of Operations planning (COOP). 2. Determine how COOP and Business Continuity Planning (BCP) are related to economic recovery for health care providers. 3. Discuss the importance of providing short and long-term recovery solutions to local communities.

219 2017 Domestic Security Strategy Goal 6: RECOVER quickly and effectively to restore our way of life following an incident or event. Objective 6.1 ECONOMIC RECOVERY Objective 6.2 HEALTH AND SOCIAL SERVICES Objective 6.3 HOUSING Objective 6.4 NATURAL AND CULTURAL RESOURCES

220 Size and Scope of Recovery Efforts

221 Recovery Following a disaster, communities and their local governments are often forced to make complex recovery decisions. These decisions range widely and can include important topics such as business reinvestment, affordable housing, and building long-term resilience.

222 Recovery In addition, many of these communities may lack the capability to address the planning and decision-making processes needed to start their recovery. The consequences of these decisions may impact community prosperity, safety, and identity for years to come.

223 National Disaster Recovery Framework Establishes a common platform and forum for how the whole community builds, sustains, and coordinates delivery of recovery capabilities. Resilient and sustainable recovery encompasses more than the restoration of a community s physical structures to pre-disaster conditions. Through effective coordination of partners and resources, we can ensure the continuity of services and support to meet the needs of affected community members who have experienced the hardships of financial, emotional, and/or physical impacts of devastating disasters.

224 National Disaster Recovery Framework Establishes a common platform and forum for how the whole community builds, sustains, and coordinates delivery of recovery capabilities. Resilient and sustainable recovery encompasses more than the restoration of a community s physical structures to pre-disaster conditions. Through effective coordination of partners and resources, we can ensure the continuity of services and support to meet the needs of affected community members who have experienced the hardships of financial, emotional, and/or physical impacts of devastating disasters.

225 Key Elements of Recovery Individual and Family Empowerment Leadership and Local Primacy Pre-Disaster Recovery Planning Engaged Partnerships and Inclusiveness Unity of Effort Timeliness and Flexibility Resilience and Sustainability

226 Key Elements of Recovery Psychological and Emotional Recovery Economic Recovery Health and Social Services Housing Infrastructure Systems Natural and Cultural Resources

227 Non-Government Organization Partners Voluntary organizations, 501(c)(3), with disaster response/recovery missions Faith-based organizations and ministerial alliances Community-based organizations Intertribal organizations Animal control, welfare, and/or rescue organizations Housing nonprofits Chambers of commerce and business organizations Environmental organizations Cultural organizations Professional organizations Academia Independent national, regional, and local advocacy, health, and social services agencies Fraternal organizations Regional planning commissions Planning and development districts National planning organizations Independent charities National and community-based foundations Volunteer recruitment groups Civic groups Veterans organizations Aging organizations

228 Continuity of Operations Planning (COOP) Effort within individual departments and agencies to ensure that Primary Mission Essential Functions (PMEFs) continue to be performed during a wide range of emergencies, including localized acts of nature, accidents and technological or attackrelated emergencies. Goal - identify their Essential Functions (EFs) and ensure that those functions can be continued throughout, or resumed rapidly after, a disruption of normal activities.

229 Continuity Capability Essential Functions Orders of Succession Delegations of Continuity Facilities Continuity Communications Vital Records Management Human Capital Tests, Training, and Exercises (TT&E) Devolution of Control and Direction Reconstitution

230 Four Phases of Continuity Activation Phase I - Readiness and Preparedness Phase II - Activation and Relocation: plans, procedures, and schedules to transfer activities, personnel, records, and equipment to alternate facilities are activated Phase III - Continuity Operations: full execution of essential operations at alternate operating facilities is commenced Phase IV Reconstitution: operation is at alternate facility are terminated and normal operations resume

231 Business Continuity Planning

232 Impact Analysis Lost income Delayed income Increased expenses (e.g., overtime labor, outsourcing, expediting costs, etc.) Regulatory fines Customer dissatisfaction or defection Delay of new business plans

233 Resources Supporting Recovery Employees Office space, furniture and equipment Technology (computers, peripherals, communication equipment, software and data) Vital records (electronic and hard copy) Facilities, machinery and equipment Inventory Utilities (power, natural gas, water, sewer, telephone, internet, wireless) Third party services

234 Strategic BCP Create internal awareness from the bottom up and from the top down. Drive awareness into the supply base through the supplier selection and supplier management processes. Prioritize suppliers and commodities to focus attention. Consider the full spectrum of resources and flows managed within the supply chain. Understand both probability and impact of supply-chain disruptions. Eliminate/reduce exposure where feasible; buffer or mitigate where elimination is not feasible. Develop and monitor predictive BCP specific indicators.

235 Strategic BCP Use multiple information sources to monitor risk. Revisit these issues on a regular basis. Plan for disruptions. Manage the impact of disruptions. Take a continuous improvement view of supply chain continuity planning. Conduct a post-event audit of supply chain disruptions as standard operating procedure. Share knowledge of supply-chain continuity planning throughout the organization

236 Health Care System Recovery Involves the collaboration community partners to develop efficient processes and advocate for the rebuilding of public health, medical, and mental / behavioral health systems to at least a level of functioning comparable to preincident levels and improved levels where possible. The focus is an effective and efficient return to normalcy or a new standard of normalcy for the provision of health care delivery to the community.

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238 Lessons Learned Harvey and Irma Power requirements Managing vendor networks Preparing employees Communicating successfully Having proper insurance coverage Having access to cash Planning for loss of your facility Working with government authorities Maintaining situational awareness Testing the strategy

239 Value of Recovery Planning The ability of a community to accelerate the recovery process begins with its efforts in pre-disaster preparedness, including coordinating with whole community partners, mitigating risks, incorporating continuity planning, identifying resources, and developing capacity to effectively manage the recovery process, and through collaborative and inclusive planning processes. Collaboration across the whole community provides an opportunity to integrate mitigation, resilience, and sustainability into the community s short- and long-term recovery goals.

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241 Advanced Health Care Emergency Management Table Top Exercise

242 EXERCISE EXERCISE - EXERCISE