DC Emergency Healthcare Calitin Emergency Operatins Plan Emergency Operatin Plan (EOP) fr The DC Emergency Healthcare Calitin Versin 6-2014 DC EHC 1
DC Emergency Healthcare Calitin Emergency Operatins Plan Executive Summary The Emergency Operatins Plan (EOP) fr the DC Emergency Healthcare Calitin (DC EHC) prvides a management cnstruct fr healthcare rganizatins in the District f Clumbia t respnd in an integrated fashin t an emergency f any type, including thse that challenge the surge capacity and/r capability r the resiliency f ne r mre healthcare rganizatins in Washingtn DC. The cncepts used t cnstruct this EOP are based upn fundatinal Emergency Management (EM) principles and are cnsistent with the Incident Cmmand System r ICS cncepts. At its cre, this EOP describes hw vlunteers frm the healthcare rganizatins themselves staff a lean respnse team that facilitates infrmatin management using virtual methdlgies. These persnnel may be drawn frm healthcare rganizatins that have been impacted by the hazard, s great care has been taken t utline prcesses and prcedures that minimize the time and effrt f these individuals and t facilitate the wrk that they must accmplish. In many situatins, the actin guidance in this dcument incrprates activities that already ccur as healthcare rganizatins seek t interface with external respnse rganizatins. The intent here is t streamline thse effrts and t crdinate them with all ther respnse actins. The EOP is frmatted accrding t basic EM principles and cntains an all hazards Base Plan. Attachments t the Base Plan are referenced where apprpriate. These attachments are cnsidered tls that DC EHC persnnel and healthcare rganizatins can utilize during the actual respnse t an incident. The EOP als includes annexes that present actinable guidance fr respnse t specific incident types r t specific hazard situatins. The respnse bjectives f the Calitin can be summarized as fllws: 1. Facilitate incident-related infrmatin management: The DC Emergency Healthcare Calitin will ntify participating healthcare rganizatins f an actual r ptential emergency situatin, then serve t cllect, cllate, and apprpriately disseminate healthcare related infrmatin relevant t incident respnse. The surces and recipients f this infrmatin can ptentially be healthcare rganizatins themselves as well as public sectr entities. The fllwing are examples f infrmatin categries related t Calitin respnse peratins: Ntificatins: The Calitin has the capability t receive and send ntificatins during the initial stages and thrughut an incident. The ntificatins develped and cnveyed by the Calitin are categrized in rder t prvide an immediate understanding f the message imprtance. They are als designed t prvide actinable infrmatin t recipients. Situatin assessments: The Calitin prmpts healthcare rganizatins fr their situatin assessments pre and pst-hazard impact. The reprting frequency will vary accrding t the incident parameters. The Calitin may aggregate this infrmatin and facilitate the rapid disseminatin t Calitin healthcare rganizatins and relevant public agencies as nted abve. In additin, the Calitin may slicit nn-medical infrmatin frm the public sectr relevant t healthcare rganizatin respnse and cnvey it t them. Resurce assessments: The Calitin can facilitate the aggregate assessment f healthcare rganizatins resurce status during respnse. This includes the capability t cllect infrmatin beynd the usual bed cunts. 2. Prmte crdinatin f strategies and tactics amng respnding healthcare rganizatins: The Calitin emergency respnse prcesses prvide an pprtunity fr members t develp and apply cnsistent strategies and tactics during emergencies and disasters. Wrking with public health and ther 2
DC Emergency Healthcare Calitin Emergency Operatins Plan relevant public agencies, the Calitin can frm ad hc wrk grups (Task Frces) t rapidly develp cmmn appraches t issues, such as patient screening prtcls fr an unusual rganism r txin, treatment regimens fr unusual illness r injury, r a need-based distributin and administratin f scarce medical supplies. In additin, a cnsistent apprach t media messages can be facilitated. 3. Facilitate resurce supprt t individual healthcare rganizatins, t include mutual aid/cperative assistance, gvernmental assistance, and vlunteers/dnatins: The Calitin can facilitate resurce allcatin amngst healthcare rganizatins during emergency respnse, prmting mutual aid r cperative assistance between calitin rganizatins, requests fr assistance t DC r federal agencies, and distributin f resurce in respnse t the requests. 4. Prmte integratin f healthcare rganizatins with ther emergency respnse disciplines: Thrugh its actins during respnse, the Calitin will enhance integratin f healthcare rganizatins int the larger respnse cmmunity. 3
DC Emergency Healthcare Calitin Emergency Operatins Plan Table f Cntents EOP Overview: purpse and design 7 Acrnym list 8 DC EHC EOP Base plan Purpse and missin Scpe Assumptins Cncept f Operatins 9 9 9 11 System Descriptin 11 DC EHC Baseline Cnfiguratin 12 Calitin Ntificatin Center Calitin Duty Officer 12 13 DC EHC Emergency Respnse Cnfiguratin 14 Healthcare Calitin Respnse Team HCRT Leader HCRT Liaisn Officer DC EHC Public Infrmatin Officer HCRT Operatins Sectin Chief HCRT Planning Sectin Chief HCRT Lgistics Sectin Chief & 14 16 16 16 16 18 19 Cmmunicatins Unit DC EHC Senir Plicy Grup (SPG) 19 DC EHC Baseline Operatins 20 Calitin Duty Officer Scheduling Calitin Ntificatin Center Baseline Ops 20 20 DC EHC Stages f Incident Respnse 21 Incident Recgnitin Activatin/initial ntificatin Mbilizatin Incident Operatins 21 22 23 24 Initial Critical HCRT Actins 24 Onging Critical HCRT Actins 25 HCRT Incident Actin Planning HCRT Interactin with SPG Infrmatin Management Crdinating Strategies and Tactics Facilitating Resurce Sharing and Acquisitin Integratin with Jurisdictin 27 28 29 29 30 31 Dembilizatin 32 4
DC Emergency Healthcare Calitin Emergency Operatins Plan Recvery 33 DC EHC EOP Attachments Operatinal Checklist: DC EHC ( Calitin ) Duty Officer 35 Operatinal Checklist: DC EHC HCRT Leader 38 Operatinal Checklist: DC EHC Operatins Sectin Chief 39 Operatinal Checklist: DC EHC Planning Sectin Chief 42 Operatinal Checklist: DC EHC Lgistics Sectin Chief 44 201 Initial Event Lg 45 202 HCRT Incident Objectives 47 205 HCRT Incident Cmmunicatins Plan 49 207 Organizatinal Chart 52 209 Incident Status Summary 54 213 General Message 56 214(a) Operatinal Lg 58 Resurce Request Frm 60 Calitin Ntificatin Center Operatinal Checklist 62 Ntificatin Categrizatin Template 64 HIS Ntificatin Template 66 HMARS Ntificatin Template 67 Situatin and Resurce Status frm 69 General Meeting/Telecnference Template 72 Resurce Meeting/Telecnference Template 74 Situatin Update Meeting/Telecnference Template 76 Strategy Crdinatin Meeting/Telecnference Template 78 HCRT Dembilizatin checklist 80 Current Hazard Vulnerability Analysis (2-4) 2013 DC EHC Hazard Vulnerability Analysis DC EHC Functinal Annexes (Sectin 5) (5) Resurce Management Functinal Annex (6) Plicy fr Reginal Health Infrmatin Exchange DC EHC Supprt Annexes (Sectins 6, 7, & 8) (7-8) Cmmunicatins Annex (9) DC EHC Public Infrmatin Functinal Annex DC EHC Incident Specific Annexes (Sectins 9-33) (10) Evacuatin f a healthcare facility (11-13) Residential Healthcare Facility Mass Fatality Prcedures Template (14-16) DC EHC Burn Mass Casualty Incident Respnse Plan (17-24) Natinal Capitl Regin Burn Mass Casualty Incident Respnse Plan 5
DC Emergency Healthcare Calitin Emergency Operatins Plan (25) Active Shter Planning Template (26) Lckdwn Planning Template (27) DC EHC Acute Care Facilities Decntaminatin Planning Template (28) Vlunteer Management Planning Template (29) Intra-Hspital Bld Bank Needs Identificatin Tl (30) Business Cntinuity Planning Template (31) Mdified Delivery f Critical Care Services (32) Disaster Behaviral Health Planning Template (33) HCF Respnse t an IND Detnatin Planning Template (34) Cmprmised HCF Planning Template Appendices (35) Appendix A: DC EHC EM Regulatins and Standards (36) Appendix B; List f participating healthcare rganizatins (37) Appendix C: MOU fr hspitals in the District f Clumbia (38) Appendix D: DC EHC Capabilities Requirements 6
DC Emergency Healthcare Calitin Emergency Operatins Plan EOP Overview: purpse and design The District f Clumbia Emergency Healthcare Calitin (DC EHC) Emergency Operatins Plan (EOP) is a dcument that describes the rganizatinal structure and emergency respnse prcesses used by participating healthcare rganizatins in DC t cllectively respnd t and recver frm an incident that severely challenges r exceeds nrmal day-t-day healthcare system management and/r healthcare delivery peratins. The dcument is designed t be cnsistent with standard Emergency Management and Incident Cmmand System principles and practices. It is an all hazards plan, with annexes that prvide mre detailed guidance. The DC EHC (als referred t in this dcument as The Healthcare Calitin ) was initially established thrugh grant funding frm the US Department f Health and Human Services (HHS). It built upn existing relatinships and prcesses that were previusly established thrugh the District f Clumbia Hspital Assciatin, but prvides an expanded membership beynd hspitals and incrprates enhanced respnse methdlgy. Participatin in the Healthcare Calitin is nt limited t hspitals. See Appendix B fr currently participating healthcare rganizatins. The verall cnstruct f the DC EHC EOP is based upn State and lcal guidance prvided by the Federal Emergency Management Agency (FEMA). 1 The EOP Base Plan prvides an verall systems descriptin f hw DC EHC resurces are rganized during respnse, and a cncept f peratins then describes hw they interact during emergency respnse and initial recvery. Functinal annexes prvide detailed respnse guidance fr specific functins the Calitin culd perfrm. Supprt Annexes present guidance that is applicable t the Calitin respnse team AND individual healthcare rganizatins acrss all hazards. Fr example, a prminent Supprt Annex addresses cmmunicatins technlgies utilized by the Calitin. Incident Specific Annexes prvide guidance fr individual hazards beynd what the Base Plan and the Supprt Annexes describe. In sme areas, there are attachments t the Base Plan and the Annexes which serve as the respnse tls fr use during actual respnse. The DC EHC EOP is designed t supprt the wide range f activities in the DC EHC emergency management prgram. While primarily cnsidered a guide fr emergency respnse and initial recvery actins, the EOP cntains much infrmatin that is designed t be utilized during preparedness rather than during actual respnse. Fr example, the EOP shuld be useful fr develping and cnducting instructinal activities (educatin and training), fr develping exercises, and as the surce fr metrics in measuring Calitin perfrmance during exercises and actual incidents (e.g. when develping the after actin reprt). Only select sectins f the EOP are designed specifically fr regular use during emergency respnse. These include the abve-mentined specific tls such as peratinal check lists r cmmunicatins templates. The Calitin s EOP is ne prduct f the larger DC EHC Emergency Management Prgram (EMP). The established methd fr managing this prgram is the DC EHC Emergency Management Cmmittee (EMC). The EMC is a preparedness rganizatin as defined in NIMS and des nt perate during respnse. 2 Strategic directin fr the EMC during preparedness cmes frm the DC EHC Executive Cuncil. It is imprtant t recgnize that fr the EOP (and the Healthcare Calitin EMP) t be successful, a cmmitment t and supprt fr these effrts must exist at the executive level f the participating healthcare rganizatins. 1 FEMA. State and Lcal Guidance (SLG) 101: Guide fr All-Hazard Emergency Operatins Planning and it s successr Cmprehensive Preparedness Guide (CPG) 101. 2 Preparedness rganizatins prvide crdinatin fr emergency management and incident respnse activities befre an incident r scheduled event (NIMS December 2008). 7
DC Emergency Healthcare Calitin Emergency Operatins Plan Acrnym list CHC CNC DC EHC DCHA DOH EMP EMS EOC EOP ESF FEMS HCO HCRT HECC HIS HMARS HSEMA ICS MACS MPD NIMS OAP OCME PIO SNF SPG Cmmunity Health Center Calitin Ntificatin Center District f Clumbia Emergency Healthcare Calitin District f Clumbia Hspital Assciatin DC Department f Health Emergency Management Prgram Emergency Medical Services Emergency Operatins Center Emergency Operatins Plan Emergency Supprt Functin DC Fire and Emergency Medical Services Healthcare Calitin Organizatin Healthcare Calitin Respnse Team Health Emergency Crdinatin Center Hspital Infrmatin System Hspital Mutual Aid Radi System DC Hmeland Security and Emergency Management Agency Incident Cmmand System Multiagency Crdinatin System DC Metrplitan Plice Department Natinal Incident Management System Office f the Attending Physician, US Capitl DC Office f the Chief Medical Examiner Public Infrmatin Officer Skilled Nursing Facility Senir Plicy Grup 8
DC Emergency Healthcare Calitin Emergency Operatins Plan DC EHC Base Plan Purpse and missin The gal f the DC Emergency Healthcare Calitin is t supprt healthcare system resiliency and the cllective medical surge capacity and capability fr the District f Clumbia in respnse t mass casualty 3 r mass effect 4 incidents. Healthcare Calitin respnse bjectives supprt this gal: Facilitate infrmatin sharing between the participating healthcare rganizatins and with relevant public agencies in a structured fashin. Prmte crdinated and cnsistent strategies and tactics acrss the respnding healthcare rganizatins. Facilitate resurce supprt t individual healthcare rganizatins, t include mutual aid/cperative assistance, gvernmental assistance, and vlunteers/dnatins. Facilitate the integratin f individual healthcare rganizatins respnse effrts with thse f apprpriate DC jurisdictinal agencies. Scpe The scpe f the authrity and the actins f the DC EHC is limited t supprting the participating healthcare rganizatins in their cntinuity f peratins and their ability t effectively respnd t emergencies and disasters. The DC EHC therefre supplements, but des nt supplant, effective emergency management prgrams (EMP) at each participating healthcare rganizatin that address mitigatin and emergency preparedness fr that rganizatin. During emergency respnse, the DC EHC Healthcare Calitin Respnse Team (HCRT) perates under the premise that partner rganizatins agree t participate in return fr benefits derived frm effective infrmatin sharing, resurce facilitatin, and strategic and tactical crdinatin. The HCRT manages crdinatin acrss the partner rganizatins; it des nt cmmand. Significant decisins are develped n a cnsensus basis and, while nt binding n the DC EHC members, are expected t achieve benefits acrss the emergency respnse. Significant issues where cnsensus cannt be reached may be elevated t cnsideratin by the DC EHC Senir Plicy Grup (SPG). The authrity fr the DC EHC is derived frm the dcument entitled DC Emergency Healthcare Calitin Strategic Guidance dated April 4 th, 2008. A supprting dcument is entitled DC Emergency Healthcare Calitin Executive Cuncil dated June 10, 2008. Planning Assumptins Prcesses and prcedures utlined in the EOP are designed t supplement and nt supplant individual healthcare rganizatin emergency respnse effrts. 3 Mass casualty incident: A casualty-creating hazard impact in which the available rganizatinal and medical resurces, r their management systems, are severely challenged r becme insufficient t meet the medical needs f the affected ppulatin. Insufficient management, respnse, r supprt capability and capacity can result in increased mrbidity and mrtality amng the impacted ppulatin. Mass casualty equates t a disaster, whereas multiple casualty incident equates t an emergency. Frm Medical Surge Capacity and Capability, HHS, Secnd ed, 9/07. 4 Mass effect incident: A hazard impact that primarily affects the ability f the rganizatin t cntinue its usual peratins (in cntrast t a mass casualty incident). Fr healthcare systems, the usual medical care capability and capacity can be cmprmised. Frm Medical Surge Capacity and Capability, HHS, Secnd ed, 9/07. 9
DC Emergency Healthcare Calitin Emergency Operatins Plan Except in unusual circumstances, individual private sectr healthcare rganizatins retain their respective decisin-making svereignty during emergencies. Exceptins might include rare public health actins such as quarantine. Recmmendatins made thrugh the DC Emergency Healthcare Calitin are nn-binding fr participating healthcare rganizatins. The use f NIMS cnsistent prcesses and prcedures by the Calitin will prmte integratin with public sectr respnse effrts. Persnnel staffing the Calitin respnse are primarily frm healthcare rganizatins. They are ften ccupied primarily with their respective rganizatinal respnse. Staffing f the Calitin respnse must therefre be lean as pssible. In mst situatins, it is expected the jurisdictinal agency that the Calitin primarily interfaces with during respnse will be either DC DOH r DC FEMS. In large scale incidents, the Calitin may have the primary interface with the ESF 8 Desk at the DC EOC. Hwever, activatin f the HCRT is nt cntingent upn emergency respnse by any f these entities. 10
DC Emergency Healthcare Calitin Emergency Operatins Plan Cncept f Operatins System descriptin T meet the respnse bjectives, the Calitin functins as a Multiagency Crdinatin System (MACS) as defined in NIMS (see textbx). In this manner, the healthcare calitin respnse rganizatin can be viewed as prviding supprt t the IMTs frm each participating healthcare rganizatin. Thugh the DC EHC Healthcare Calitin Respnse Team is a functinal EOC, it has imprtant variances frm a standard lcal gvernment r State EOC. Figure 1 delineates the similarities and differences. Figure 1: Similarities and differences f the HCRT t an EOC Similarities The HCRT des nt have direct authrity ver r cmmand participating rganizatins The HCRT facilitates infrmatin flw between participating rganizatins including situatin assessments and resurce requests The HCRT facilitates and enhances the individual effrts f the participating rganizatins. Differences The HCRT is staffed and perated by private sectr rganizatins (a private sectr EOC is cnsistent with NIMS principles) The HCRT, in mst instances, will nt require the physical assembly f its respnse persnnel in ne place (a designated facility). An EOC is cmmnly described as a physical lcatin rather than a functin. 11
DC Emergency Healthcare Calitin Emergency Operatins Plan DC EHC baseline system descriptin (cnfiguratin during nn-respnse perids) Fr the Calitin t be immediately available fr incident peratins, tw functins are designated as always available: the Calitin Ntificatin Center and the Calitin Duty Officer. They are cntinuusly staffed 24/7 t prvide immediate Healthcare Calitin actins and then fld int the Healthcare Calitin respnse rganizatin as it is activated. The relatinship f these DC EHC entities with participating healthcare rganizatins and ther entities is depicts in Figure 2. Figure 2. Relatinship f the Calitin Ntificatin Center (CNC) and Calitin Duty Officer t member healthcare rganizatins and ther respnse rganizatins. Calitin Ntificatin Center & Duty Officer Relatinships: Baseline Operatins DC HSEMA DC DOH DC FIRE & EMS DC MPD & Others DC EHC Duty Officer Calitin Ntificatin Center (CNC) & CNC Technician OTHERS (Calitins, SMEs) HMARS - HIS - FAX - EMAIL- PHONE - HAN Healthcare Facility Healthcare Facility Healthcare Facility Healthcare Facility Healthcare Facility Healthcare Facility DC DOH Department f Health HAN Health Alert Netwrk DC EMS Emergency Medical Services HIS Healthcare Infrmatin System DC HSEMA Hmeland Security & Emergency Management Agency HMARS Hspital Mutual Aid Radi System DC MPD Metrplitan Plice Department SME Subject Matter Experts 1. Calitin Ntificatin Center (CNC) and CNC Technician Resurce Descriptin: The Calitin Ntificatin Center 5 prvides incident respnse ntificatins (bth initial and n-ging) thrugh HMARS t Calitin facilities with HMARS receivers. 6 The infrmatin that prmpts ntificatins may riginate within the healthcare rganizatin cmmunity itself, within the public sectr, ptentially frm the media as well as ther surces. In additin, the CNC is respnsible fr ntifying the Calitin Duty Officer f any ptential incident (wh then may send ut additinal ntificatins via HIS). The CNC is staffed by a CNC Technician, whse rles and respnsibilities are the fllwing: Receive messages frm DC EMS, DOH, HSEMA, MPD, r ther jurisdictinal agencies fr transmissin t Calitin healthcare rganizatins. Receive messages frm healthcare rganizatins themselves fr transmissin t Calitin healthcare rganizatins and/r t jurisdictinal agencies. Maintain cnnectivity with ther entities such as the US Capitl Office f the Attending Physician (OAP) r gegraphically prximate Calitins in ther jurisdictins. Cntact Healthcare Calitin Duty Officer, as apprpriate, t ntify them f incident parameters and as needed, t seek assistance in clarifying message cntent r determining the mst apprpriate delivery methd befre sending ntificatins. 5 See Appendix D fr the capabilities requirements fr the CNC. 6 Alternate ntificatin methds are in place fr nn HMARS facilities. 12
DC Emergency Healthcare Calitin Emergency Operatins Plan Cnstruct messages accrding t the ntificatin message template (see HMARS template). Assigns apprpriate urgency categry t message (see Categrizatin f ntificatins template). Send ntificatin thrugh HMARS with verbal request fr emergency department (ED) capacity r ther resurce status when indicated.. When sending messages via HMARS, cntact recipient healthcare rganizatins that d nt answer call dwn n radi (i.e., re-cntact thrugh radi r ther means t ensure receipt f message). Send HMARS Alerts independently when Trnad Warning is issued fr the District f Clumbia. Calitin Ntificatin Center (CNC) Technician Psitin Descriptin: 7 The CNC Technician is a staffed psitin 24/7 at the n-duty and back-up Calitin Ntificatin Centers. This psitin mnitrs baseline infrmatin fr any anmalies which might require issuance f an initial Ntificatin Message. This includes infrmatin frm jurisdictinal agencies, nn-jurisdictinal rganizatins (e.g. a healthcare system), meterlgical entities, and thers. Fllwing prtcls fr the CNC (see CNC OCL and Cmmunicatins Supprt Annex), the CNC Technician will issue an immediate HMARS Alert when indicated. When initial indicatins are less emergent, the CNC Technician ntifies the Calitin Duty Officer and briefs him/her n the situatin. A Calitin ntificatin may be the prduct f this interactin. These prcedures apply t any ther ntificatin sent ut during an incident. Alternate Ntificatin Center: An alternate Calitin Ntificatin Center pssesses the same capabilities and executes the same functins as the primary CNC. The Calitin Ntificatin Center functin is currently c-jintly prvided by the Children s Natinal Medical Center (CNMC) Emergency Cmmunicatin and Infrmatin Center (ECIC), Medstar Transprt at Washingtn Hspital Center, and Prvidence Hspital. 2. Calitin Duty Officer Psitin Descriptin: The Calitin Duty Officer 8 maintains cnstant availability fr initial cnsultatin t the Calitin Ntificatin Center (regarding imprtance f message, message cntent r ther) as well as t jurisdictinal authrities as the representative f the Healthcare Calitin (e.g. regarding ideal methds f sending ntificatins). In additin, the duty fficer is fficially recgnized as the cllective healthcare rganizatin liaisn during initial stages f an incident. The psitin may therefre cntact jurisdictinal authrities n behalf f the healthcare rganizatins fr infrmatin regarding a develping situatin (and in turn share this infrmatin with the Calitin s healthcare rganizatins). The psitin als: Serves as a cnsultant when a healthcare rganizatin r public sectr entity is unsure f what message shuld be disseminated r what it shuld state. Prvides cnsultatin t the Calitin Ntificatin Center (as indicated r requested) regarding cntent r categry f ntificatins t be disseminated. Sends r assigns respnsibility t send HIS ntificatins during early stages f an incident (i.e. nce ntified by CNC r ther entity f ptential incident) In anticipatin f activating the Healthcare Calitin Respnse Team (HCRT), determines the initial staffing plan fr the HCRT. Pre-HCRT activatin, btains initial incident infrmatin relevant t healthcare rganizatins and disseminates t Healthcare Calitin members using the mst apprpriate cmmunicatins methd. Assumes the HCRT Leader r ther team psitin and/r briefs HCRT persnnel as they are assigned. 7 See Appendix D fr the capabilities requirements fr the CNC Technician. 8 See Appendix D fr the capabilities requirements fr the Calitin Duty Officer. 13
DC Emergency Healthcare Calitin Emergency Operatins Plan 3. Calitin Healthcare Organizatin Duty Officer Psitins Psitin descriptin: Participating healthcare rganizatins are encuraged t establish a 24/7 psitin that is in their facility (ideally present n premises) that can serve as an initial pint f cntact fr that rganizatin. Examples include (within baseline peratin) administratrs n duty, administratrs n call, r Huse Operatins Supervisrs. If a specific questin arises fr that rganizatin r the rganizatin des nt respnd t a baseline request fr infrmatin, the Duty Officer therefre has a psitin he r she may cntact. DC EHC emergency respnse system descriptin (cnfiguratin fr emergency actins) Upn activatin f the DC EHC emergency respnse, a temprary ICS-based team will frm, with respnse psitins staffed by available and trained persnnel. NOTE: nt all psitins are needed fr every respnse and sme psitins may nly be temprarily needed during any individual incident. Experience has demnstrated that in many incidents, nly the HCRT Leader psitin will be required. Upn activatin f this Calitin respnse capability, the Duty Officer and CNC are subsumed int the respnse functin. 1. Healthcare Calitin Respnse Team (HCRT) system descriptin Resurce Descriptin The Healthcare Calitin Respnse Team (HCRT) prvides the Emergency Operatins Center functin fr the DC EHC during emergency respnse. The staffing f the HCRT is determined by the needs f the individual incident (initial decisins abut the HCRT are made by the Duty Officer, subsequent decisins are made by the HCRT Leader). The HCRT psitins are described and cnfigured using the traditinal ICS rganizatinal structure (see Figure 3). Given the bjectives develped fr the HCRT and the predicted respnsegenerated needs f prjected incidents, nly the HCRT psitins expected t be staffed are described. Functins that are nt specifically described becme the respnsibility f the supervisry psitin (e.g. Finance/Administratin rle becmes the respnsibility f the HCRT Leader unless specifically assigned t anther psitin). The HCRT is staffed frm a pl f persnnel wh als serve as Duty Officers fr the Calitin. In mst situatins, the wrk f the HCRT des nt require extensive r cntinuus peratins thrughut an incident. In mst situatins, the wrk f the HCRT can be cnducted virtually rather than requiring persnnel t physically cngregate in ne lcatin. The CNC cntinues t perfrm the functins it prvides during baseline peratins, but is subsumed int the HCRT Operatins Sectin and reprts t the Operatins Sectin Chief psitin. 14
DC Emergency Healthcare Calitin Emergency Operatins Plan Figure 3. The DC EHC Healthcare Calitin Respnse Team DC EHC Senir Plicy Grup HCRT Leader HCRT PIO HCRT Liaisn HCRT Operatins Sectin Chief HCRT Lgistics Sectin Chief HCRT Planning Sectin Chief Calitin Ntificatin Center Healthcare Organizatins Cmmunicatin Unit DC EHC Emergency Healthcare Calitin HCRT Healthcare Calitin Respnse Team PIO Public Infrmatin Officer The relatinship f the HCRT t member rganizatins and ther relevant respnse rganizatins is depicted in Figure 4. Figure 4. The Healthcare Calitin Respnse Team (HCRT) and its functinal relatinships during emergency respnse HCRT Cnceptual Relatinships Respnse Operatins DC HSEMA DC DOH DC FIRE & EMS DC MPD & Others DC EHC Senir Plicy Grup HCRT PIO HCRT Leader HCRT Liaisn OTHERS (NRCs, Calitins) HMARS - HIS - FAX - EMAIL PHONE - HAN HCRT Operatins Sectin Chief Calitin Ntificatin Center HCRT Lgistics Sectin Chief Cmmunicatin Unit HCRT Planning Sectin Chief Healthcare Facility Healthcare Facility Healthcare Facility Healthcare Facility Healthcare Facility Healthcare Facility DC DOH Department f Health HAN Health Alert Netwrk DC EMS Emergency Medical Services HIS Healthcare Infrmatin System DC HSEMA Hmeland Security & Emergency Management Agency HMARS Hspital Mutual Aid Radi System DC MPD Metrplitan Plice Department SME Subject Matter Experts 15
DC Emergency Healthcare Calitin Emergency Operatins Plan A. HCRT Leader Psitin Descriptin: The HCRT Leader 9 is respnsible fr setting the incident specific and peratinal perid bjectives fr the HCRT and assuring that the HCRT is functining as designed and accmplishing its bjectives. Rles and respnsibilities include: Respnsible fr the functins f all HCRT psitins unless the ther psitins are staffed. Reviews and adjusts assignments t HCRT psitins t maintain apprpriate staffing fr the incident needs. Prvides the supprt services f the finance/administratin sectin as indicated Keeps the SPG infrmed and determines when SPG shuld be cnvened (r respnds t request frm the jurisdictin r an SPG member t cnvene the SPG). Acts as meeting facilitatr fr any physical r virtual meetings f the SPG Establishes the Healthcare Calitin incident bjectives and bjectives fr the next peratinal perid (adapting generic bjectives frm this Base Plan and/r thse frm an Incident Specific Annex). B. HCRT Liaisn Officer Psitin Descriptin: The HCRT Liaisn Officer 10 cnducts r facilitates the infrmatin exchange between the HCRT and utside rganizatins, including District f Clumbia jurisdictinal authrities. Rles and respnsibilities include: Prvides incident infrmatin t jurisdictinal agencies regarding healthcare rganizatins (that is nt already made available thrugh the HIS website) Prvides infrmatin t jurisdictinal agencies regarding activities f the HCRT Cllects infrmatin frm jurisdictinal agencies fr transmissin t Calitin healthcare rganizatins Maintains infrmatin channels with ther healthcare calitins in the regin (as apprpriate) fr exchange f relevant infrmatin In sme situatins, the HCRT Liaisn may physically lcate at a public sectr agency t attend meetings r fr a lnger duratin (e.g. pre-planned events, impending hazard impacts such as hurricanes). These lcatins can include the HSEMA EOC (ESF 8 desk) r DOH Health Emergency Crdinatin Center (HECC). Infrmatin captured frm these activities is reprted back t the brader Calitin thrugh the HCRT. C. HCRT Public Infrmatin Officer (PIO) Psitin Descriptin: The Public Infrmatin Officer (PIO) 11 rles and respnsibilities include: Manages media message that deals directly with HCRT peratins Mnitrs the media fr media descriptins f the respnse perfrmance f the DC EHC r its member rganizatins, nting rumrs, misinfrmatin, and reprting errrs that shuld be addressed thrugh HCRT actin r referred t member rganizatins Ensures that the HCRT Operatins Sectin cnvenes healthcare rganizatin PIOs as a Jint Infrmatin System r JIS (usually virtually and as required) t prmte cnsistency f message amngst healthcare rganizatins It is prjected that the wrklad f the HCRT PIO will seldm be a full time requirement and that the HCRT PIO may be able t serve cllaterally, while fulfilling mst f their nrmal respnse duties fr their hme rganizatin. D. HCRT Operatins Sectin Chief 9 See Appendix D fr the capabilities requirements fr the HCRT Leader. 10 See Appendix D fr the capabilities requirements fr the HCRT Liaisn Officer. 11 See Appendix D fr the capabilities requirements fr the HCRT PIO. 16
DC Emergency Healthcare Calitin Emergency Operatins Plan Psitin Descriptin: The HCRT Operatins Sectin Chief 12 directly manages the primary actins f the HCRT (i.e., the actins that directly address the HCRT bjectives). Rles and respnsibilities include: Facilitate situatinal awareness Facilitates r versees the cllectin f infrmatin frm healthcare rganizatins (establishes reprting frmat, timing, methdlgy, etc.). 13 This may include requesting healthcare rganizatins t fill ut templates n HIS fr cllectin f infrmatin. Templates culd include the bed capacity data fr hspitals and SNFs r Situatin and Resurce Status frms (see frm in attachment sectin t EOP). Cnvenes regular Situatin Update Meetings/Telecnferences fr Calitin members (see Situatin Update Telecnference template) These can be annunced via page grups, including HAN and/r HMARS depending upn the audience needed n the call The HCRT Operatins Sectin Chief facilitates the call r assigns the task t anther HCRT psitin Ensures that all infrmatin cllected frm healthcare rganizatins is made available t the cllective grup thrugh psting n HIS r ther means. Facilitates r versees the disseminatin f infrmatin t Calitin rganizatins t maintain cllective situatinal awareness acrss healthcare rganizatins 14 Ensures infrmatin frm DOH, EMS, Federal sites, scene Incident Management Team, utside experts, etc. is cnveyed back t healthcare rganizatins. Cnveyed thrugh HMARS Cnveyed thrugh HIS Cnveyed thrugh telecnference Mnitrs infrmatin psted n HIS by healthcare rganizatins fr a) inclusin in Incident Status Summaries (DC EHC frm 209), b) indicatin fr need fr resurce facilitatin, c) indicatin fr need t prmte/facilitate respnse strategy and tactics Prvide resurce facilitatin Facilitates infrmatin t and frm healthcare rganizatins regarding sharing f resurces Accepts and apprpriately disseminates resurce requests by Calitin members, using the DC EHC Mutual Aid Frm 1 t frmat and cnvey the resurce request (as apprpriate) Fr mutual aid, the request fr mutual aid message is cnveyed as an ALERT r ADVISORY thrugh HMARS/HIS, depending upn the nature f the request. Fr utside assistance, requests are aggregated and cnveyed t DC DOH r ESF #8 (thrugh the Calitin Liaisn). Mnitrs/tracks respnses t mutual aid requests psted n HIS and dcuments mutual aid actins as they evlve. Reprts infrmatin back t Calitin rganizatins regarding requests t the jurisdictinal authrities (such as availability f resurces, expected arrival time and rute) Cnvenes Resurce Meetings (see Resurce Meeting Template), r appints a Resurce Facilitatin Task Frce Leader, as indicated t address resurce assistance issues nt effectively managed thrugh the abve methds Recmmends t the HCRT Leader cnvening the Calitin SPG t address distributin f scarce utside resurces that must be distributed amngst the healthcare rganizatins, r t reslve difficult resurce assistance issues. 12 See Appendix D fr the capabilities requirements fr the HCRT Operatins Sectin Chief. 13 In sme cases, this may cme at the directin f a jurisdictinal agency. 14 It is recgnized that jurisdictinal agencies may cnvey infrmatin directly t the apprpriate healthcare rganizatins; this will als be captured by the HCRT (as apprpriate) and archived within situatin reprts. 17
DC Emergency Healthcare Calitin Emergency Operatins Plan Prmte respnse strategy crdinatin Facilitates sharing f infrmatin between Calitin rganizatins t prmte cnsistency f strategy and tactics applied at individual healthcare rganizatins Ensures disseminatin f expert infrmatin btained frm utside the system Requests, receives, prcesses, and disseminates apprpriate infrmatin frm respnding healthcare rganizatins, describing strategy and tactics used (e.g. triage algrithm fr unusual injuries, patient evaluatin prtcl fr a nvel disease, treatment regimen fr unusual txin, patient screening, etc.); This may be repeated and disseminated with Incident Status Summaries Requests incident actin plans (IAPs) 15, r relevant sectins f IAPs, frm healthcare rganizatins be psted t the HIS website, allwing respnding Calitin rganizatins and jurisdictin t nte cnsistency/cnflict f strategy and/r tactics between them (as agreed upn) Cnvenes a Strategy Crdinatin Meeting/telecnference (see Strategy Crdinatin Telecnference template) with representative Calitin rganizatins when n prtcls are available fr the specific situatin, r when greater cnsistency in respnse strategy and tactics is indicated. 16 As examples, this can be clinical persnnel, public infrmatin fficers, security prfessinals r ther disciplines that cnvene t share infrmatin and develp cmmn strategies. Prmte integratin int the cmmunity emergency respnse When indicated, assures transmissin f Incident Status Summaries t HCRT Liaisn (r Leader if Liaisn isn t staffed) fr frwarding t relevant DC authrities Assures apprpriate infrmatin is passed t HCRT Liaisn Officer fr exchange with relevant DC authrities. Invites apprpriate DC authrities t participate in r bserve HCRT meetings/telecnferences as indicated. Arranges (thrugh the HCRT Liaisn psitin) situatinal briefings and ther virtual meetings with apprpriate DC authrities as indicated t maintain situatin awareness, t discuss cmplex issues cmmn t healthcare rganizatins and respnse authrities (resurces, respnse strategy, etc.), and t prvide critical feedback. E. HCRT Planning Sectin Chief Psitin Descriptin: The HCRT Planning Sectin Chief 17 versees r cnducts all incident-related data cmpilatin and analysis regarding HCRT incident peratins and assigned resurces (frm ther HCRT psitins), cnducts HCRT planning meetings, prepares the HCRT incident actin plan (IAP) fr each peratinal perid and cnducts the HCRT peratins briefing. Rles and respnsibilities include: Dcuments/archives HCRT activities during incident peratins, including meeting prceedings, Incident Status Summaries, and written incident actin plans Facilitates internal HCRT meetings/telecnferences (planning meetings internal t the HCRT and the HCRT Operatins Briefing t HCRT psitins and participating healthcare rganizatins) When directed by the HCRT Leader, develps an HCRT incident actin plan (infrmal r written) fr each peratinal perid 15 Nte: As there is technically nly ne IAP fr a jurisdictin, these plans may be mre apprpriately referred t as Operatins Actin Plans fr the individual healthcare facilities. 16 As with any Calitin telecnference meeting, DC DOH and ther relevant jurisdictinal agencies are invited t participate in the telecnference. 17 See Appendix D fr the capabilities requirements fr the HCRT Planning Sectin Chief. 18
DC Emergency Healthcare Calitin Emergency Operatins Plan Cllects and frmats infrmatin generated by the HCRT Operatins Sectin: Recrds infrmatin frm HCRT meetings/telecnferences and prcesses infrmatin reprted thrugh HIS and ther methds Develps reprting dcuments, including Incident Status Summaries, Patient Tracking Reprts, and cllated Resurce Requests as directed by HCRT Leader Supprts the HCRT Leader in keeping the DC EHC SPG infrmed during the incident, including situatin updates, develping agendas fr SPG meetings and develping supprting infrmatin. F. HCRT Lgistics Sectin Chief and Cmmunicatins Unit Psitin Descriptin: The HCRT Lgistics Sectin Chief 18 is respnsible fr supprt t the HCRT itself. This can entail facilities, persnnel, and supplies. The HCRT typically requires little lgistical supprt except technical supprt fr cmmunicatins and infrmatin technlgy. Hence a cmmunicatins unit is described. If this sectin is staffed, it will mst likely be staffed by ne individual at the Lgistics Sectin Chief psitin whse primary fcus is supprting the cmmunicatins and infrmatin technlgy capabilities f the Calitin. Rles and respnsibilities include: Prvides technical supprt t the HCRT Leader and Operatins fr the HIS website. Prvides assistance, upn requests, fr lgging n and/r ther user activities within the HIS website When requested by HCRT Leader r Operatins Sectin Chief, uplads r therwise changes HIS web pages t present new r revised data reprting tls, peratinal templates, r ther adaptatins Assists with technical issues related t HMARS (i.e., can serve as interface with Teltrnix, the radi cmmunicatins cntractr with respnsibility fr the set-up and maintenance f HMARS). Prvides technical and lgistical supprt fr telecnference systems. G. HCRT Additinal Psitins: If an incident is f enugh size and/r cmplexity t require additinal staffed psitins n the HCRT, these psitins wuld be established accrding t standard NIM/ICS guidance. 2. DC EHC Senir Plicy Grup (Calitin SPG) system descriptin Resurce Descriptin: The Calitin SPG is cmpsed f the Chief Executive Officer, senir administratr, r their designee frm each DC EHC participating healthcare rganizatin, wh has authrity t make decisins, cmmit resurces, and accept high-level risk fr their rganizatin. Typically, the SPG membership fr a specific incident respnse is determined by the nature f the incident (e.g. all healthcare rganizatins may be invited t have a representative participate but many may decline if the incident des nt primarily impact them). The SPG is cnvened nly intermittently as needed, usually thrugh a virtual telecnference frmat, t address plicy level and majr funding decisins fr the Healthcare Calitin during emergency respnse. The meetings are intended t be brief and are facilitated by the HCRT Leader (unless delegated t the HCRT Planning Sectin Chief). Decisins are established thrugh a cnsensus prcess. While cmmn grup actin and cnsistency acrss healthcare rganizatins is sught, disagreeing healthcare rganizatins are nt bund by any Calitin decisin. Rles and respnsibilities fr the SPG include: Develps plicy level cnsensus decisins affecting all healthcare rganizatins and their respnse actins as indicated by the incident r requested by the HCRT Leader Makes decisins regarding the cmmitment f majr resurces affecting healthcare rganizatins Maintains situatin awareness fr healthcare executives regarding sensitive infrmatin that may nt be available t the larger healthcare cmmunity 18 See Appendix D fr the capabilities requirements fr the HCRT Lgistics Sectin Chief. 19
DC Emergency Healthcare Calitin Emergency Operatins Plan Mnitrs HCRT fr strategic effectiveness during incident peratins and prvide strategic feedback t the HCRT. Cncept f Operatins: DC EHC baseline peratins The DC EHC baseline peratins (during perids f nn-respnse) are cnducted by the Calitin Duty Officer Calitin Duty Officer scheduling All individuals apprved t serve as duty fficers fr the Calitin will have their cntact infrmatin available n the HIS website. A list f times fr the individuals respnsible t take call is maintained n the HIS website (call schedule). One individual is n call, with a back up, at all times. Call is perfrmed fr 24 hur intervals. Typically, call is scheduled fr ne week perids frm 0700 Mnday t 0700 the fllwing Mnday. N individual is scheduled fr mre than 7 cnsecutive days. Swaps in the schedule can be made; it is the respnsibility f the individual swapping ut f a shift t amend the schedule n the HIS website. In additin, a call shuld be made t the Calitin Ntificatin Center (CNC) and alternate CNC t infrm them f the schedule change. Between 0700 and 0900 n the first day f call, the n-cming Duty Officer will call the n-duty CNC t ntify them that they are the individual n call fr the week. In additin, they will send a HIS Advisry stating their name and that they are Duty Officer fr the week. On cming Duty Officers are als expected t test their hand-held radis with a test message t the CNC. Each individual accepting call fr the duty fficer psitin shuld indicate preferred methd f cntact (e.g. pager, cell) n the HIS website. Calitin Ntificatin Center baseline peratins The respnsible ntificatin center cnducts a weekly call dwn f the Calitin radi system, HMARS, at randmly selected times. Except under special circumstances, call dwns are limited t acute care facilities Once a mnth, call dwns include all HMARS participants Organizatins that d nt respnd are lgged and mnthly results are presented t the DC EHC EMC. If an individual healthcare rganizatin misses ntificatins, the ntificatin center infrms DCHA staff wh cntact the rganizatin fr clarificatin f status. Once a mnth, the call dwn is accmpanied by a request fr infrmatin n majr and minr bed cunts. During inclement weather (i.e. specifically when trnad activity is pssible), the ntificatin center mnitrs fr ptential trnad watches and warnings. If a trnad warning is issued fr the DC Metrplitan Area, the CNC will issue an Alert with relevant infrmatin ver HMARS. 20
DC Emergency Healthcare Calitin Emergency Operatins Plan Cncept f Operatins: DC EHC emergency respnse T assure guidance is well rganized and addresses all aspects f the DC EHC emergency respnse, the Cncept f Operatins is presented accrding t stages f incident respnse (Figure 5) Figure 5. Stages f Incident Respnse Incident recgnitin Activatin/initial ntificatin Mbilizatin Incident Operatins Dembilizatin Incident 1. Incident recgnitin Incident recgnitin is the prcess that identifies an anmaly (independently r thrugh cmmunicatin frm thers), develps a rapid situatinal assessment f the anmaly and related details, and determines whether an incident respnse r EOP activatin is indicated. 19 Optimal recgnitin f the need t activate the DC EHC EOP and determine the earliest pssible but apprpriate respnse actins may be the mst critical factr in a successful incident utcme. Initial incident infrmatin fr the Calitin may be generated by a wide range f surces. Examples are prvided belw: Media reprts Individual healthcare rganizatins (e.g. pwer utage at ne facility) 20 Jurisdictinal agencies (e.g. DCDOH, DCFEMS, DCHSEMA, MPD, etc) Other gegraphically prximate healthcare rganizatins r calitins Nn-jurisdictinal agencies r rganizatins (e.g. OAP) Federal agencies (e.g. CDC Alert) Meterlgical mnitring rganizatins Others Given the diverse nature f surces fr initial infrmatin, it is imprtant that the Calitin maintains ne primary pint f initial cntact fr the Calitin the Calitin Ntificatin Center. 21 All initial cntact fr the Calitin during baseline peratins shuld be thrugh the CNC at 877-323-4262. DC FEMS als has the ability t cntact the CNC thrugh channel H-03. 19 Emergency Management Principles and Practices fr Healthcare Systems. The Institute fr Crisis, Disaster, and Risk Management (ICDRM) at the Gerge Washingtn University (GWU); fr the Veterans Health Administratin (VHA)/US Department f Veterans Affairs (VA). Washingtn, D.C., June 2006. 20 This can include individual healthcare rganizatins that have nticed a media reprt that they think might be f significance. 21 Anther methd fr initial Calitin ntificatin is fr the Duty Officer t receive a direct call frm a surce such as a jurisdictinal agency r a Calitin member rganizatin. 21
DC Emergency Healthcare Calitin Emergency Operatins Plan Once cntacted, the Calitin Ntificatin Center then has tw actin ptins: 1. If the initial message is frm a jurisdictinal agency requesting a message g ut, the CNC shuld cnsider the infrmatin t indicate a real incident fr the Calitin and cnduct necessary fllw n steps (see belw). 2. Fr initial infrmatin f unclear significance, the CNC shuld cntact the Duty Officer fr clarificatin and the need fr a ntificatin t be sent. Thugh the CNC is the primary pint f cntact fr the Calitin during baseline peratins, sme jurisdictinal agencies r ther entities (e.g. DC DOH) may elect t cntact the Duty Officer primarily wh then becmes respnsible fr fllw n actins (see belw). If there are persistent questins as t whether a ntificatin r activatin is necessary, the Duty Officer can cnvene a telecnference with Emergency Managers frm affected healthcare rganizatins t cllectively determine an actin decisin (see Cmmunicatins Annex fr page grups). In this situatin, the Duty Officer wuld serve as the facilitatr fr this brief telecnference using standard Calitin practices (see General Telecnference template). Initial activatin f the Calitin HCRT is usually in its lwest designated cnfiguratin (a single staffed psitin see belw), designed t minimize impact n individual healthcare rganizatin peratins; judgment criteria utilized t determine whether a DC EHC EOP activatin is necessary shuld be liberal. 2. HCRT Activatin/initial ntificatin Once the CNC Technician and/r Calitin Duty Officer has received initial incident infrmatin and determined an initial curse f actin (i.e. activate HCRT r nt), an initial imprtant activity is the distributin f ntificatins t Calitin members and relevant authrities. The fllwing categries are utilized fr all ntificatins sent ut thrugh HMARS r placed n the HIS website (see HMARS and/r HIS Ntificatin Template and Ntificatin Categrizatin Template fr mre details): ADVISORY: placed n HIS nly ALERT: sent ver HMARS with accmpanying HIS psting ACTIVATION: relates t activatin f HCRT nly (typically ges ut thrugh page grup via HAN and HIS t HCRT brader annuncement may be annunced ver HMARS r HIS as well). UPDATE: typically sent via email r psted n HIS. If the CNC is the initial pint f cntact, ne f the tw ntificatin actins shuld ccur based upn the incident recgnitin steps abve: 1. Send ut an immediate ALERT ntificatin message based upn urgent initial infrmatin via HMARS t Calitin facilities (see HMARS and/r HIS Ntificatin Template and Ntificatin Categrizatin Template). 22 In additin, the Duty Officer shuld be ntified directly and this individual will send a HIS message as apprpriate. 23 2. Cntact the Duty Officer fr clarificatin as t the need fr a ntificatin and/r the level f urgency and message infrmatin t be sent. This discussin can result in: i. An HMARS ALERT message being cnveyed and at least minimal activatin and staffing f the HCRT. The Duty Officer is then respnsible fr rapidly prviding HIS ntificatins. ii. An ADVISORY ntificatin is psted n HIS by the Calitin Duty Officer briefly describing the situatin; they then mnitr the evlving situatin. 22 Alternate ntificatin will then be cnveyed via HIS t Calitin rganizatins withut HMARS receivers. 23 If a message is sent, by default, the HCRT has been activated, even if minimally (see belw fr further discussin), unless it is an ADVISORY message that states n further actin is indicated. 22