SE Minnesta Disaster Health Calitin Enhancing Reginal Preparedness, Respnse and Recvery Healthcare Multi-Agency Crdinatin Center () September 2016
TABLE OF CONTENTS Intrductin... 3 Healthcare Overview... 4 Operating Levels... 6 Relatinships By EOC Activatin Type... 7 Functinal Respnsibilities... 9 Resurce Allcatin... 12 Data Use & Release... 13 Infrmatin Validatin... 13 Public Infrmatin Sharing... 14 Dembilizatin Cnsideratins... 14 Frms... 15 References... 16 Appendix A Cnference Call Infrmatin... 17 Appendix B Initial Actins... 18 Appendix C Essential Elements f Infrmatin... 20 Appendix D Frm 202 Type 1 Incident Objectives (MCI)... 25 Appendix E Frm 204 Organizatin Assignment List... 26 Appendix F Frm 205 Cmmunicatin Plan... 27 Appendix G Frm 214 Operatinal Lg... 29 Appendix H Resurce Request Prcess... 30 Appendix I [REGION NAME] Resurce Request frm... 31 Appendix J State Department f Health Medical Materiel Supply Requisitin Frm... 34 Appendix K H- Actin Items Lg... 35 2
INTRODUCTION The [REGION NAME] Disaster Health Calitin cnsists f rganizatins with respnsibilities t mitigate the likelihd f a hazard negatively impacting the ability f a healthcare system t prvide services and t prepare fr, respnd t, recver frm cnsequences f a disaster t the healthcare system, the purpse f the Calitin is t facilitate preparedness t assist cmmunities with building a Health and Medical Services (Emergency Supprt Functin 8/ESF8) Capability t respnd t and recver frm disasters. The fllwing grups are represented as part f the [REGION NAME] Disaster Health Calitin: Hspitals Lcal Public Health Emergency Management Emergency Medical Services Regulatry Bard (EMSRB) Reginal Emergency Medical Services (EMS) Lng Term Care Facilities Vlunteers Organizatins Active in Disasters (VOAD) Specialty Services (e.g., dialysis centers, hspice centers, American Red Crss) Calitin partners will carry ut health and medical respnse and recvery activities within the parameters f statutry authrity, jurisdictinal Emergency Operatins Plans and as defined in peratinal supprt cmpacts, mutual aid agreements, and memranda f understanding r ther peratinal agreements. This dcument utlines the functins f the [Regin Name] Healthcare Multi- Agency Crdinatin Center (H-). The scpe f this dcument is invlves H- activities; infrmatin shuld be integrated within rganizatinal and cmmunity peratinal dcuments as applicable.
What is a Healthcare-? HEALTHCARE OVERVIEW The [REGION NAME] Healthcare- is a multi-disciplinary rganizatinal mdel that allws healthcare entities a means t btain additinal supprt during disasters. The [REGION NAME] Healthcare- perfrms a clearing huse functin by cllecting, prcessing, and disseminating data and infrmatin t Calitin partners, as applicable, during a disaster. The Healthcare- des nt serve a cmmand and cntrl functin fr the regin; hwever, it can supprt functins t imprve a crdinated respnse, including: Facilitating infrmatin sharing and situatinal awareness amng Calitin partners, Facilitating resurce supprt and resurce sharing amng Calitin members, including supprting the request and receipt f assistance frm lcal, State, and Federal authrities, and Facilitating patient transfers during a disaster. Supprting incident management plicies and pririties. Wh Participates in the [REGION NAME] Healthcare-? Any Calitin member r partner r State Department f Health may request [REGION NAME] Healthcare- activatin by cntacting the [List Organizatin/Department]. Representatives frm hspitals and EMSRB generally staff the H- fr acute incidents (e.g., MCI, hspital business cntinuity incident). Fr hspital representatin, this wuld generally invlve representatives frm the Affected Hspital and the fllwing [List Organizatin/Department] entities: [24/7 cntact], Admissins Crdinatin Office, Administratin, and [List Organizatin/Department] HICS. Fr extended incidents with health and medical impact, ther disciplines may be invlved with Healthcare- activities, including, but nt limited t: Emergency Management Lng Term Care Public Health VOAD Varius Subject Matter Experts Why d we need a Healthcare-? The Healthcare- helps imprve disaster respnse crdinatin by ensuring Calitin partners have the infrmatin they need t adequately respnd t majr events. This infrmatin exchange builds cnsistency in respnse activities and in the public message. It als allws the healthcare partners frm acrss the regin t better interface with nn-medical respnders at the jurisdictin level by prviding timely and Page 4 f 35
accurate snapshts, r cmpsite updates f lcal healthcare facilities peratins and capabilities, including: Facility infrastructure status Bed availability Service availability Resurce availability Persnnel Supplies Equipment Pharmaceuticals Organizatinal and Reginal Where is the [REGION NAME] Health lcated? Often, is virtual; participants engage via phne, [Cmmunicatin tl], email, etc. If Healthcare- persnnel need t lcate gegraphically tgether, the primary Healthcare- lcatin is the [lcatin]. Alternatively, if a lcal Emergency Operatins Center is activated, culd be lcated there. When is the [REGION NAME] Health activated? Calitin members have a respnsibility t prepare fr situatins that culd negatively impact health and medical peratins. A minimum level f preparedness is expected frm participating rganizatins t minimize und pressure n Calitin members due t lack f preparedness and capability frm ther Calitin members. Calitin members are expected t maintain the capability t manage the cnsequences f emergencies, independent f supprt frm the Calitin (i.e., addressed at the rganizatinal r lcal jurisdictinal level). Given the results f cmmunity and reginal hazard assessments, this minimum level f preparedness will minimize the need fr Calitin supprt and thereby the need t activate. The Healthcare- shuld nly be activated when a disaster r an emergency has been declared by lcal r state authrities r when necessary t save lives r ensure critical patient care cntinuity in absence f a declared emergency r disaster. Any impacted healthcare entity may activate by cntacting [24/7 cntact infrmatin]. Ptential situatinal triggers fr [REGION NAME] Healthcare- activatin include, but are nt limited t: A request t pen by a Calitin member r partner (lcal Emergency Management, EMS, Lng Term Care, Hspital, Lcal Public Health) A request t pen by State Department f Health Multi-jurisdictinal incident r utbreak An incident in an area with few resurces, such as a lw ppulatin cunty r a cunty withut a hspital An incident large enugh t require resurce sharing including: Page 5 f 35
Any substantive Health Alert Netwrk message requiring actin frm public health and/r healthcare. Pssible examples - Strategic Natinal Stckpile deplyment Epidemilgic investigatin Facility Evacuatin A natural disaster (e.g. widespread trnad r flding) A bilgical attack (e.g. anthrax dispersin) A chemical attack r spill (e.g. train derailment that frces a cmmunity evacuatin) A bilgical disease utbreak (e.g. pandemic influenza) OPERATING LEVELS Operating Level Awareness / Alert Mnitring Threat Level Incident ptential exists (e.g., fld watch/warning, trnad watch/warning, increased incident f a disease, CDC/WHO Pandemic Status) An incident that can be managed at the rganizatinal level r lcal level ccurs; r, an incident that has the POTENTIAL fr needing Calitin supprt. Assciated Activities [REGION NAME] Healthcare- representatives are made aware f weather alerts thrugh existing cmmunicatin channels (e.g., TV, radi, NOAA radis, direct agency ntificatin, phne applicatins, Health Alert Netwrk ntificatins) N specific actin/activities are cnducted. Primary Healthcare- members shuld have a heightened awareness that Healthcare- activatin is a ptential. [REGION NAME] Healthcare- ntified by affected rganizatin via [methd]. [REGION NAME] Healthcare- representatives will cnference call with affected rganizatin t gain situatinal awareness. If n Calitin supprt is needed, a prcess fr situatinal mnitring will be established; [REGION NAME] Healthcare- representatives will be updated accrdingly. Determine if a [Cmmunicatin tl] Alert shuld be sent t Calitin members r if a [Cmmunicatin tl] Crdinatin Rm shuld be established. Determine if the Hspital Cmpact shuld be activated. Determine if Healthcare- Activatin needs t be implemented. Page 6 f 35
Operating Level Activatin Deactivatin Threat Level A request t activate the [REGION NAME] H- has been made fr an incident that impacts EMS, hspital r lng term care facility peratins. (e.g., MCI) Pst event; rganizatins/ cmmunities n lnger require [REGION NAME] Healthcare- assistance. Assciated Activities If the incident expands, increased mnitring may be required. A prcess t meet situatinal mnitring needs will be established. [REGION NAME] Healthcare- will ntify Calitin members, [State] State Duty Officer and State Department f Health OEP the Healthcare- has been activated. Send a [Cmmunicatin tl] Alert t Calitin members. Determine if a [Cmmunicatin tl] Crdinatin Rm shuld be established. Determine if the Hspital Cmpact shuld be activated. [REGION NAME] Healthcare- will supprt infrmatin management/situatinal awareness and resurce and patient transfer requests in accrdance with peratinal agreements and reginal guidelines. (Refer t References Sectin.) Ntify Calitin partners and State Department f Health f Healthcare- deactivatin. Finalize dcumentatin and initiate after actin review prcess. RELATIONSHIPS BY EOC ACTIVATION TYPE Activatin Withut Lcal EOC Activatin In this type f activatin, the incident is sufficient enugh t require additinal supprt frm ther healthcare rganizatins, but nt large enugh t require a jurisdictinal Emergency Operatins Center activatin. The Healthcare- will interface directly with rganizatins t btain Essential Elements f Infrmatin and facilitate infrmatin sharing t create situatinal awareness. Refer t Appendix B fr typical Essential Elements f Infrmatin assciated with healthcare emergency peratins crdinatin and Healthcare- representatives respnsible fr btaining the infrmatin fr Healthcare- peratins. Page 7 f 35
Lcal Public Health Hspital State Health Department Healthcare- EMS Agency Direct Reprt Relatinship Infrmatin/Resurce Crdinatin Relatinship Infrmatin Sharing Relatinship Lng Term Care Facility Activatin With Lcal EOC Activatin In this type f activatin, the incident is sufficient enugh t require additinal supprt frm ther healthcare rganizatins and activatin f ne r mre jurisdictinal Emergency Operatins Centers (EOC). In this situatin, supprts ne r mre lcal EOCs by supprting pre-hspital and hspital respnse peratins. While the jurisdictinal Emergency Operatins Center is respnsible fr crdinating the verall disaster respnse, can be used as a supprt functin f an EOC s Operatins sectin, r ESF#8, r a fully separate Medical Operatins sectin t help crdinate healthcare respnse and recvery activities. Thrugh this structure, has access t multiple agencies (e.g., public health, VOAD grups) t supprt respnse peratins if necessary. The lcal medical rganizatins may als be directly represented in jurisdictinal Emergency Operatins Centers. Depending upn hw is rganized t supprt a jurisdictinal Emergency Operatins Center, Essential Elements f Infrmatin and ther infrmatin management activities between the jurisdictinal Emergency Operatins Center and the Healthcare- can ccur thrugh the lcal medical rganizatins liaisn fficer activated as a rle within the jurisdictinal Emergency Operatins Center (preferred) r in absence f such a rle, directly with an apprpriate rle (e.g., Planning Chief, Operatins Chief, ESF8 Team Leader) within the jurisdictinal Emergency Operatins Center management structure. Additinally, is able t interface directly with healthcare rganizatins. (Refer t Appendix B fr typical Essential Elements f Infrmatin assciated with healthcare emergency peratins crdinatin and Healthcare- representatives respnsible fr btaining the infrmatin fr Healthcare- peratins.) Page 8 f 35
State Emergency Operatins Center Department f Health Department Operatins Center Healthcare- Lcal Emergency Operatins Center/ Emergency Management Agency Lcal Emergency Operatins Center/ Emergency Management Agency Hspital Hspital EMS Agency EMS Agency Lng Term Care Facility Lng Term Care Facility Lcal Public Health Lcal Public Health Direct Reprt Relatinship Infrmatin/Resurce Crdinatin Relatinship Infrmatin Sharing Relatinship FUNCTIONAL RESPONSIBILITIES General ptential tasks assciated with Healthcare- discipline representatives are described in this sectin. Affected Healthcare Facility (if applicable) Participate in activatin cnference call. Prvide the fllwing infrmatin t : Incident Lcatin Incident Type What supprt is needed: Patient Evacuatin/Transfer Supprt Page 9 f 35
Reference: Patient Intake Frm Supply/Equipment Supprt Reference: SE Regin Supply/Equipment Request Frm Persnnel/Staffing Supprt Type, Quantity Supprt situatinal awareness by updating as requested. Emergency Medical Services (Typically EMSRB Specialist) Lg activities n the Operatinal Lg. (Refer t Appendix G.) Ntify lcal EMS f Healthcare- activatin. Determine EMS asset needs. Assess available EMS assets/obtain EMS Essential Elements f Infrmatin. Crdinate emergency transprtatin asset supprt. Crdinate with Reginal EMS Prgram t activate Sutheast EMS Task Frce. Crdinate with Reginal EMS Prgram t deply EMS Disaster Respnse Trailers. Open EMS [Cmmunicatin tl] Crdinatin Rm. Ntify Statewide EMS if necessary and request cnference call thrugh MRCC. Reprt t [REGION NAME] Healthcare-, lcal EOC and/r State EOC. Participate in [Cmmunicatin tl] [REGION NAME] Healthcare- Crdinatin Rm, EMS Crdinatin Center Rm, and incident specific crdinatin rms. Prvide EMS staging and cmmunicatins infrmatin Wrk with lcal emergency management and EMS partners t prvide just in time training fr taking KI during a nuclear incident. Supprt patient tracking activities. Patient infrmatin sharing during tracking/transprt will ccur in accrdance with HIPAA infrmatin security/privacy requirements. (EMS uses a triage tagging system. EMS has a number and tag tied t the patient and run sheet, which is handed ff t the receiving facility.) Crdinate with public health, if applicable (e.g., Prairie Island radiatin incident). Healthcare (Primary: HICS Incident Cmmander; Secndary: Administratr/Administratr n Call) Lg activities n the Operatinal Lg. (Refer t Appendix G.) Ntify healthcare facilities f Healthcare- activatin. Request [Organizatin] t issue [Cmmunicatin tl] Alert and/r pen hspital cmpact cnference call. Determine healthcare facility needs. Assess available healthcare assets/obtain hspital Essential Elements f Infrmatin. Open healthcare [Cmmunicatin tl] Crdinatin Rm. (Request [Organizatin] representative t pen the rm.) Page 10 f 35
Participate in [REGION NAME] Healthcare- [Cmmunicatin tl] Crdinatin Rm. Cnnect with State Department f Health DOC r OEP 24/7. (Refer t Cmmunicatins Plan, Appendix D.) Maintain situatinal awareness f healthcare status. Assess and crdinate available supplies and resurces (Refer t [REGION NAME] HCC Resurces Guidelines.) Facilitate patient infrmatin flw between healthcare entities. Multiple systems in place supprt patient tracking frm entry t the healthcare system via EMS thrugh arrival t hspital (MTAT) and arrival at hspital thrugh discharge (patient admissins system). Patient infrmatin sharing during tracking/transprt will ccur in accrdance with HIPAA infrmatin security/privacy requirements. Supprt situatinal awareness/cmmn perating picture by prviding healthcare system situatin/status and patient tracking status t hspitals, jurisdictinal Emergency Operatins Center(s) and State Department f Health Department Operatins Center, if activated. Infrm Public Affairs [cntact number]. Facilitate deplyment f disaster stckpiles. Admissins Crdinatin Office Lg activities n the Operatinal Lg. (Refer t Appendix G.) Supprt situatinal awareness/cmmn perating picture by btaining bed and service availability at area hspitals. [Online tl name] is the primary electrnic tl t supprt bed availability situatinal awareness. Alternate methds include email, fax, phne, and facility status bards. As necessary t supprt situatin infrmatin needs r as defined in the Essential Elements f Infrmatin (Appendix C), request [Organizatin] t issue a [Cmmunicatin tl] Bed Availability Update Alert. (Refer t the Data Use & Release Sectin.) Alternatively, r in cnjunctin with the [Cmmunicatin tl] Alert, bed updates can be requested during Hspital Cmpact cnference calls. Prvide bed/services availability updates fcusing n challenges/barriers t success during peratins briefings, r as requested, t supprt situatinal awareness/cmmn perating picture. Supprt disaster respnse activities as defined in the Hspital Disaster Preparedness and Respnse Cmpact agreement. Supprt patient tracking activities. Supprt scene-t-hspital and hspital-t-hspital patient dispsitin activities. Primary 24/7 Call Center (takes initial call) Lg activities n the Operatinal Lg. (Refer t Appendix G.) Supprt infrmatin sharing by activating ntificatin prtcls as requested. [Cmmunicatin Tl] Page 11 f 35
[Cmmunicatin tl] Alert [Cmmunicatin tl] HAvBED [Cmmunicatin tl] Crdinatin Rm CISM Team EMS Disaster Trailer EMS Task Frce Supprt infrmatin sharing by pening cnference call lines. Healthcare- Reginal Hspital Cmpact Supprt disaster respnse activities as defined in the Hspital Disaster Preparedness and Respnse Cmpact agreement. Supprt incident situatinal awareness/cmmn perating picture by prviding patient tracking. Primary patient tracking system is the [name f Tl], which is readily available t Healthcare- persnnel althugh specific patient details are limited due t Patient Health Infrmatin security requirements (HIPAA). The Healthcare- [rganizatin name] representative has access t cmplete infrmatin. Infrmatin is updated by authrized [rganizatin name] persnnel as updates are received. Secndary patient crdinatin/tracking system during NDMS events is the [tl name]. Patient infrmatin sharing during tracking/transprt will ccur in accrdance with HIPAA infrmatin security/privacy requirements. Prvide bed/services availability updates fcusing n challenges/barriers t success during peratins briefings, r as requested, t supprt situatinal awareness/cmmn perating picture. RESOURCE ALLOCATION Appendix H prvides a resurce request prcess flw chart. Material Resurces Each hspital wns ne POD f centrally warehused supplies; the hspital may request the supplies based n its wn situatinal triggers and deplyment decisin making prcesses. The supplies can be deplyed withut additinal authrizatin. Release f a POD wned by anther hspital will be deplyed in accrdance with prcedures utlined in the Hspital Disaster Preparedness & Respnse Cmpact. Essentially, a hspital wuld need t authrize deplyment f its POD t anther requesting entity. Crdinate stckpile deplyment thrugh [list prcess]. Refer t the [REGION NAME] HCC Disaster Resurces Guidelines fr additinal resurce deplyment prcesses. Page 12 f 35
Hspital Resurces In accrdance with the Hspital Disaster Preparedness & Respnse Cmpact, [List Organizatin/Department] crdinates patient distributin and tracking acrss Participating Hspitals t ensure apprpriate patient care is made available t patients. Decisin making fr patient placement will be made in accrdance with current prcedures and will cnsider the current peratinal status (e.g., bed availability, facility status, service line availability) t determine the mst apprpriate allcatin f hspital resurces t ensure patients receive apprpriate care. [Discuss reginal availability] Transprtatin Resurces In accrdance with the Hspital Disaster Preparedness & Respnse Cmpact, [List Organizatin/Department] is the primary cntact t assist with rganizing transprtatin fr patient transfers/evacuatin frm an Affected Hspital t an Assisting Hspital. In cllabratin with EMS representative, the [List Organizatin/Department] will crdinate EMS transprtatin in accrdance with established prtcls. DATA USE & RELEASE Hspital data use will ccur as utlined in the Hspital Disaster Preparedness & Respnse Cmpact, State Department f Health [Infrmatin sharing tl] Agreement Reginal Hspitals, and [ther tls] User Agreement. Refer t the agreements fr further details. Sharing f nnpublic data btained by via [Cmmunicatin tl] is limited t [List Organizatin/Department] and the State Department f Health. Sharing f ther nnpublic data, including Essential Elements f Infrmatin, btained by is limited t Healthcare- representatives, the rganizatin wning the data, and [List Organizatin/Department] HICS as necessary t supprt disaster respnse peratins. Refer t the Public Infrmatin Sharing sectin fr additinal data use guidance. INFORMATION VALIDATION Infrmatin validatin actins will be taken when incnsistencies with established reprting mechanisms r incnsistent/missing data have been identified. Mechanisms t validate incnsistent r missing data are prvided in Appendix C. Page 13 f 35
PUBLIC INFORMATION SHARING Healthcare- members will nt directly release peratinal r patient infrmatin t the general public. [List Organizatin/Department] Public Affairs, r if activated [List Organizatin/Department] HICS Public Infrmatin Officer, will manage Healthcare- public infrmatin sharing activities in accrdance with existing plans (e.g., [List Organizatin/Department] Crisis Cmmunicatins Plan). The Plan describes hw t cmmunicate with the fllwing: patients and their families media infrmatin abut patients t third parties All requests fr infrmatin cncerning patients will be directed t the [List Organizatin/Department] Public Affairs Department [cntact number], r if activated [List Organizatin/Department] HICS Public Infrmatin Officer. Patient infrmatin release t the public will be shared in accrdance with [List Organizatin/Department] Plicy Patient Infrmatin: Release t Media. Additinal media relatins and release f infrmatin respnsibilities f hspitals are utlined in the Hspital Disaster Preparedness & Respnse Cmpact. DEMOBILIZATION CONSIDERATIONS As the emergency situatin subsides t nrmal activities, the [REGION NAME] Healthcare-, in cllabratin with supprted rganizatins, and if activated the State Department f Health Department Operatins Center, will determine the need t deactivate r dembilize. This may ccur in a tiered fashin as certain functins/rganizatins return t nrmal peratins r all at nce. Intentins t dembilize shuld be cmmunicated t all applicable stakehlders. The healthcare representative, in cllabratin with cmmunity respnse rganizatins, shuld cnsider the fllwing criteria when determining the need t dembilize the Healthcare-: Prjected end f an utbreak Ability t prvide inpatient care withut surge activities Ability t prvide emergency services withut surge activities Resumptin f nrmal peratins is imminent/cmpleted The EMS representative, in cllabratin with cmmunity respnse rganizatins, shuld cnsider the fllwing criteria when determining the need t dembilize the Healthcare-: Ability t prvide emergency services withut mutual aid Resumptin f nrmal peratins is imminent/cmpleted Page 14 f 35
An after actin review will be cnducted t identify what went well and pprtunities fr imprvement. FORMS The fllwing frms may be useful in supprting Healthcare- dcumentatin needs. Healthcare versins f the frms are readily available here http://www.emsa.ca.gv/hics/frms.asp ICS Frm Title Purpse Frm 202 Incident Objectives Prvides establishment f incident bjectives fr peratinal perid. Frm 203 Organizatin Assignment List Prvides establishment f staff assigned t varius psitins within the ICS fr the incident. Frm 205 Cmmunicatin Plan Prvides cmmunicatin infrmatin t supprt H- peratins. Frm 214 Operatinal Lg Prvides a recrd f persnnel rster and activities undertaken during the peratinal perid. NA NA [REGION NAME] Supply Request Frm State Department f Health Medical Materiel Supply Request Frm Prvides a recrd f medical supply requests by affected healthcare entities. Used by requesting rganizatins; submitted t H-. Prvides a recrd f medical supply request t State Department f Health. Used by requesting rganizatin r H-; submitted t State Department f Health. NA Actin Item Lg Prvides f recrd f pen actin items needing t be addressed, alng with status, wner, and date needed. NA Situatin Reprt Prvides a situatin update f the Health and Medical issues in the Regin. Page 15 f 35
REFERENCES Emergency Medical Treatment and Active Labr Act (EMTALA) Health Insurance Prtability and Accuntability Act (HIPAA) Hspital Disaster Preparedness & Respnse Cmpact [State] Statute Medical Reserve Crps [State] Statute Requests fr Health Vlunteers (by Lcal Public Health) [Cmmunicatin tl] Partner Channel Agreement [Name] User Agreement [REGION NAME] Disaster Health Calitin Vlunteer Management Guidelines [REGION NAME] Disaster Health Calitin Resurces Guidelines [REGION NAME] Disaster Health Calitin Cmmunicatins Guidelines Staffrd Act Page 16 f 35
APPENDIX A CONFERENCE CALL INFORMATION Cnference calls are activated by the [24/7 cntact]. Healthcare Multi-Agency Crdinatin Center (H-) Cnference Call Primary: Backup: Access Cde: Hspital Disaster Cmpact Cnference Call (at the request f a H- Healthcare Representative) Primary: Backup: Access Cde: Alternate Cnference Call (FreeCnferenceCall.cm) Number: 605.475.4000 Access Cde:
APPENDIX B INITIAL ACTIONS The [List Organizatin/Department] HICS Incident Cmmander (primary) r Administratr/ Administratr-On-Call (secndary) is respnsible fr facilitating Healthcare- initial actins. The fllwing identifies a generic prcess fr Healthcare- initial actins upn activatin: 1. Identify Healthcare- staffing gaps. i. Take actin t reslve staffing gaps (i.e., ntify State Duty Officer, 24/7 OEP, etc.) ii. Dcument H- staff n Frm 204 Organizatin Assignment List (Refer t Appendix E.) 2. Obtain incident brief frm affected rganizatin. i. What they currently knw/assume (Wh, Where, What, When, Why) ii. Specific needs (e.g., patient transfer, supplies, equipment, persnnel) iii. Lg H- activities n the Operatinal Lg. (Refer t Appendix G.) 3. Ntify Calitin Members and Partners f [REGION NAME] Healthcare- activatin. (Refer t Appendix F Cmmunicatins Plan.) i. Issue [Cmmunicatin tl] Alerts (including bed availability updates) as apprpriate. ([Organizatin] Representative) ii. Activate Hspital Cmpact cnference call, if apprpriate. ([Organizatin] Representative) iii. Establish [Cmmunicatin tl] Crdinatin Rms (EMS, Healthcare, Public Health) as apprpriate. ([Organizatin] Representative) 4. Ntify [List Organizatin/Department] Public Affairs (###-###-####) f [REGION NAME] Healthcare- activatin. ([List Organizatin/Department] HICS Incident Cmmander/Administratr On Call) 5. Ntify [State] State Duty Officer (###-###-####) and State Department f Health OEP (###-###-####) f [REGION NAME] Healthcare- activatin. ([List Organizatin/Department] HICS Incident Cmmander/Administratr On Call) (Nte: After hurs OEP uses a call service. Fr exercises, the call service shuld just nte the exercise and cnfirm they have the numbers fr the n call OEP staff (e.g., ask them t find the list and cnfirm the staff they wuld attempt t cntact.) 6. Identify Respnse Objectives. (Frm 202; Refer t Appendix D.) i. Implement actins t achieve respnse bjectives. (Dcument pen actin items n the Actin Items Lg, Appendix K.) ii. Identify barriers t achieving respnse bjectives. Page 18 f 35
7. Identify what Essential Elements f Infrmatin (EEI) are needed t supprt situatinal awareness/respnse. (Refer t Appendix C; check all that apply fr the current situatin.) 8. Take actin t btain EEI as apprpriate fr the incident. (Refer t Appendix C.) i. As assigned in Appendix C, Respnsible Data Cllectr ii. Activate Hspital Cmpact cnference call, if apprpriate t facilitate EEI gathering. ([Organizatin] Representative activates call) iii. Dcument pen actin items n the Actin Items Lg, Appendix K. 9. Facilitate activatin f disaster medical resurces. (Refer t Appendix H; and [REGION NAME] Disaster Health Calitin Guidelines.) i. Requesting rganizatins shuld submit resurce requests n the [REGION NAME] Resurce Request Frm, Appendix I. (If request is verbal, then btain infrmatin and dcument it n the frm; therwise, direct the requestr t cmplete and submit the frm t email@email.email) ii. Use the State Department f Health Medical Material Supply Frm, Appendix J t request supplies frm State Department f Health. iii. Track actin items related t activatin f medical resurces n the Actin Items Lg, Appendix K. 10. Fr nging events, establish a briefing schedule fr the [REGION NAME] H-. i. At designated time, cnduct Incident Brief. 1. Agenda a. External Situatin Status b. Health & Medical Discipline-Specific Status (fcus n current needs patient, staff, stuff -, barriers, and EEIs; shuld at least include affected rganizatin status) c. Other Calitin Member/Partner Status (as applicable t health and medical respnse) d. Public Infrmatin Status e. Safety & Security Status f. Lgistics Status g. Persnnel Status h. Identify Operatinal Cncerns i. Q&A j. Next Brief: Page 19 f 35
APPENDIX C ESSENTIAL ELEMENTS OF INFORMATION 1 Identify (check) the EEIs that shuld be cllected by fr the perating perid. 2 EEI Number - The reference number assigned t each EEI t be cllected. 3 Essential Element f Infrmatin - The categry/functinal element f data t be cllected. 4 Specific Infrmatin Required - The questin t be answered r data t be prvided by rganizatin identified in 6. 5 Data Cllectr (s) Grup/individual respnsible fr btaining the requested infrmatin frm the rganizatin in 6. 6 Data Surce(s) - The surce used by the data cllectr. Specify the name f reprt, prviding agency, etc. 7 Infrmatin Sharing Mechanism - T be cmpleted by Data Cllectr. Specify hw the requested infrmatin will be prvided t 8 Peridicity f prviding data t Healthcare-. 9 Validatin Mechanism if data nt received thrugh Infrmatin Sharing Mechanism. 1 Applicable EEI (Check) 2 EEI # 3 EEI Categry H.1 Bed Availability H.2 ED Availability 4 Specific Infrmatin Required Availability fr the fllwing: Operating Rms, Critical Care Rms, General Med/Surge Rms, Specialty Rms (e.g., Peds, Psych) Available fr the fllwing types f patients: Red/Pririty 1/Critical; 5 Respnsible Data Cllectr [Organizatin] [Organizatin] 6 Data Surce Cmpact Hspitals/MCHS Hspitals Cmpact Hspitals/MCHS Hspitals 7 Infrmatin Sharing Mechanism [Cmmunicatin tl] Phne 8 Infrmatin Sharing Peridicity As requested by Healthcare- As requested by Healthcare- 9 Infrmatin Validatin Mechanism Phne, Fax, ARMER Fax, ARMER
1 Applicable EEI (Check) 2 EEI # 3 EEI Categry H.3 Facility Status H.4 Facility Status H.5 Resurce Status H.5.A Resurce Status H.6 Resurce Status 4 Specific Infrmatin Required Yellw/Pririty 2/Delayed; Green/Pririty 3/ Minimal Availability f ffered services Status f infrastructure/facility systems. Clinical/nn-clinical staffing needs. Clinical/nn-clinical staffing availability. Patient care/general supply and equipment needs. 5 Respnsible Data Cllectr ACO H- Healthcare Representative H- Healthcare Representative H- Healthcare Representative H- Healthcare Representative 6 Data Surce Cmpact Hspitals/MCHS Hspitals Affected Hspital Affected Hspital Cmpact Hspitals/MCHS Hspitals Affected Hspital 7 Infrmatin Sharing Mechanism Phne Phne Email Email Email 8 Infrmatin Sharing Peridicity Daily r as established by Daily r as established by Daily r as established by As requested by Daily r as established by 9 Infrmatin Validatin Mechanism Fax, ARMER Fax, Email, ARMER Phne, Fax, ARMER, [Cmmunicatin tl] Crdinatin Rm Phne, Fax, ARMER, [Cmmunicatin tl] Crdinatin Rm Phne, Fax, ARMER, [Cmmunicatin tl] Crdinatin Rm Page 21 f 35
1 Applicable EEI (Check) 2 EEI # H.6.A 3 EEI Categry Resurce Status H.7 Resurce Status H.7.A Resurce Status H.8 Patient Mvement H.9 Family Care 4 Specific Infrmatin Required Patient care/general supply and equipment availability. Pharmaceutical supply needs. Pharmaceutical supply availability. Patient health status, lcatin, dispsitin, transfer and transprtatin status. Where is the lcatin f the Family Assistance Center/Family Reunificatin Center? 5 Respnsible Data Cllectr H- Healthcare Representative H- Healthcare Representative H- Healthcare Representative H- Healthcare Representative H- Healthcare Representative 6 Data Surce Cmpact Hspitals/MCHS Hspitals Cmpact Hspitals/MCHS Hspitals Cmpact Hspitals/MCHS Hspitals Cmpact Hspitals/MCHS Hspitals Lcal EOC/EMA r American Red Crss 7 Infrmatin Sharing Mechanism Email Email Email Email 8 Infrmatin Sharing Peridicity As requested by Daily r as established by As requested by Daily r as established by 9 Infrmatin Validatin Mechanism Phne, Fax, ARMER, [Cmmunicatin tl] Crdinatin Rm Phne, Fax, ARMER, [Cmmunicatin tl] Crdinatin Rm Phne, Fax, ARMER, [Cmmunicatin tl] Crdinatin Rm Phne, Fax, ARMER, [Cmmunicatin tl] Crdinatin Rm Email Once Phne, Fax, ARMER Page 22 f 35
1 Applicable EEI (Check) 2 EEI # 3 EEI Categry H.10 Family Care LTC.1 LTC.2 LTC.3 LTC.4 LTC.4.A LTC.5 LTC.5.A Bed Availability Facility Status Facility Status Resurce Status Resurce Status Resurce Status Resurce Status 4 Specific Infrmatin Required What prvisins shuld be made t accmmdate care fr victims families? Bed availability fr the fllwing types: Female Unsecure; Male Unsecure; Female Secure; Male Secure Status f infrastructure/facility systems. Availability f ffered services. Clinical/nn-clinical staffing needs. Clinical/nn-clinical staffing availability. Supply and equipment needs. Supply and equipment availability. 5 Respnsible Data Cllectr H- Healthcare Representative [Organizatin] TBD TBD TBD TBD TBD TBD 6 Data Surce Lcal EOC/EMA r American Red Crss [REGION NAME] Skilled Nursing Facilities Affected LTC Facility [REGION NAME] LTCs Affected LTC Facility [REGION NAME] LTCs Affected LTC Facility [REGION NAME] LTCs 7 Infrmatin Sharing Mechanism Email [Cmmunicatin tl] Email Email Email Email Email Email 8 Infrmatin Sharing Peridicity Daily r as established by Daily r as established by Daily r as established by As requested by As requested by Daily r as established by As requested by 9 Infrmatin Validatin Mechanism Phne, Fax, ARMER Phne, Fax, Email Phne, Fax Phne, Fax Phne, Fax Phne, Fax Phne, Fax Phne, Fax Page 23 f 35
1 Applicable EEI (Check) 2 EEI # LTC.6 EMS.1 EMS.2 EMS.3 EMS.4 3 EEI Categry Resident Mvement Resurce Status Resurce Status Patient Mvement Patient Mvement 4 Specific Infrmatin Required Resident/client health status, lcatin, dispsitin, transfer and transprtatin status. Number f EMS units with persnnel nt dedicated t the EMS Task Frce available by the fllwing types: Basic Life Supprt; Advanced Life Supprt Number and lcatin f available Task Frces r Strike Teams Patient lcatin, health status, transfer and transprtatin status. Patient Identifiers (e.g., patient name, age) fr critical patients. 5 Respnsible Data Cllectr TBD H- EMS Representative H- EMS Representative H- EMS Representative 6 Data Surce [REGION NAME] LTCs/Transprt Agencies/Lcal EOC/EMA EMS Agencies EMS Agencies/SEOC EMS Agencies 7 Infrmatin Sharing Mechanism Email [Cmmunicatin tl] Crdinatin Rm [Cmmunicatin tl] Crdinatin Rm [Cmmunicatin tl] Crdinatin 8 Infrmatin Sharing Peridicity Daily r as established by As requested by As requested by As requested by Rm [Organizatin] EMS Agencies Phne All critical patient transfers 9 Infrmatin Validatin Mechanism Phne, Fax Phne, Fax, ARMER Phne, Fax, ARMER Phne, Fax, ARMER ARMER Page 24 f 35
APPENDIX D FORM 202 TYPE 1 INCIDENT OBJECTIVES (MCI) FORM 202 INCIDENT OBJECTIVES 1. INCIDENT NAME 2. DATE PREPARED 3. TIME PREPARED 4. OPERATIONAL PERIOD DATE/TIME 5. INCIDENT OBJECTIVES 1. Within 30 minutes f receiving ntificatin will be staffed with apprpriate discipline representatives. 2. Within 30 minutes f becming peratinal (i.e., after initial cnference call), the [REGION NAME] Healthcare- will gain and maintain situatinal awareness thrughut the regin. a. Incident Status (Wh, What, Why, Where, When) i. Needs f Impacted/Respnding Organizatins b. Hspital Status (as applicable) i. Current ED Situatin ii. Current OR, ICU, Med/Surg Capacity iii. Current Specialty Bed (e.g., Pediatrics, Psych) Capacity iv. Services Capabilities/Limitatins v. Facility Infrastructure Capabilities & Limitatins c. EMS Asset Availability i. Basic/Advanced Life Supprt Units ii. Task Frces/Strike Teams 3. Within 30 minutes f becming peratinal, the [REGION NAME] Healthcare- will ntify applicable Calitin partners is activated. i. Facilitate patient flw and tracking t ensure timely adequate care fr all patients, including cntinuity f care fr current nn-incident patients, thrughut the entire respnse. 4. Prvide crdinatin supprt t ensure the right supplies, are at the right place at the right time t meet peratinal needs. 5. Prvide crdinatin supprt t ensure the right persnnel resurces, are at the right place at the right time t meet peratinal needs. 6. Other: 6. FACTORS TO CONSIDER (cnsideratins fr the peratinal perid, which may include pririties r general situatinal awareness. It may be a sequence f events r rder f events t address.) 7. SAFETY / STAFF MESSAGES TO BE GIVEN Examples: Persnal Prtective Equipment (PPE), Precautins, Case Definitins 9. PREPARED BY: 10. APPROVED BY:
APPENDIX E FORM 204 ORGANIZATION ASSIGNMENT LIST FORM 203 ORGANIZATION ASSIGNMENT LIST 1. INCIDENT NAME 2. DATE PREPARED 3. TIME PREPARED 4. OPERATIONAL PERIOD DATE/TIME Represented Functin Representative Name Affected Hspital Affected Lng Term Care Facility Emergency Management EMS EMSRB Lab Respnse Netwrk (Hspital) [List Organizatin/Department] Administratin [List Organizatin/Department] Admissins Crdinatin Office [List Organizatin/Department] [Organizatin] [List Organizatin/Department] HICS Public Health Subject Matter Expert VOAD 12. PREPARED BY: Page 26 f 35
APPENDIX F FORM 205 COMMUNICATION PLAN FORM 205 COMMUNICATIONS PLAN 1. INCIDENT NAME 2. DATE/TIME PREPARED 3. OPERATIONAL PERIOD DATE/TIME Functin [Organizati n] H-/ EMSRB H-/ Hspital H-/ LTC State Departmen t f Health OEP State Duty Officer Radi Talkgrup [Name] [Name] [Name] [Name] [Name] [Name] Cnference Call: Primary: Backup: Access Cde: Direct: 24/7: Healthcare LNO: Primary: Backup: SatPhne: PHONE FAX EMAIL [Cmmunica tin tl] Crdinatin Rm X X X COMMENTS If unable t reach, cntact [State] Duty Officer fr EMSRB n-call t call in fr mre infrmatin. [Name] Hspital [Name] 24/7: EM-1: EM-2: X
PIO-1: PIO-2: Patient Transfer-1: Patient Transfer-2: Refer t the [REGION NAME] Healthcare Calitin Cmmunicatins Guidelines fr additinal cmmunicatin details. 5. PREPARED BY: Page 28 f 35
APPENDIX G FORM 214 OPERATIONAL LOG HICS 214 OPERATIONAL LOG 1. INCIDENT NAME 2. DATE/TIME PREPARED 4. FUNCTION 5. OPERATIONAL PERIOD DATE/TIME 6. ACTIVITY LOG Time Majr Events, Decisins Made, and Ntificatins Given 7. PREPARED BY (sign and print) 8. FACILITY NAME Page f
APPENDIX H RESOURCE REQUEST PROCESS Event Occurs Have rutinely available supplies/pharm been exhausted/prjected t be exhausted by requesting facility? Yes Healthcare Calitin Medical Resurce Request Prcess Have lcal/vendr cntingency supplies/pharm been exhausted/prjected t be exhausted? Yes Request supply/pharm resurces thrugh Healthcare-.1,2 1 Requesting facility shuld cmplete and submit a HCC Request Frm r prvide sufficient infrmatin fr H- staff t fill ut the frm. 2 Requesting facility shuld cntact{name] t activate the SEMN Healthcare-. /H- crdinate deplyment stckpiled hspital-wned/reginal supplies/pharm.3 If inadequate... 3 Crdinate stckpile deplyment thrugh Supply Chain Management r, if activated, [Name]. Have hspital-wned/reginal supplies/pharm met needs? Yes Establish Dembilizatin Plan, if applicable. N H- request/crdinate deplyment f state/federal supplies/pharm. If inadequate... H- cmplete state supply requisitin frm. Submit t state DOC. State DOC determines allcatin and fulfillment prcess. Has state/federal supplies/ pharm met needs? N H- request/crdinate supply/pharm supprt frm Hspital Disaster Preparedness & Respnse Cmpact Participating Hspitals.4 Establish Dembilizatin Plan, if applicable. Yes Establish Dembilizatin Plan, if applicable. 4 Refer t the Hspital Disaster Preparedness & Respnse Cmpact dcument fr specific details abut resurce sharing in the cntext f the Cmpact agreement. Page 30 f 35
APPENDIX I [REGION NAME] RESOURCE REQUEST FORM Requesting Facility Name: Request Date: Requesting Facility Pint f Cntact Lcal Emergency Manager/ EOC Cntact Name: EM Name: Address: EM Phne: City: EM Email: [Stat Cunty: State: e] Zip: EOC Phne: Phne: Fax: Other Infrmatin: Cell: Email: Name and/r Descriptin f Supply Being Requested QUANTITY REQUESTED Cmments Fr SE Regin Use QUANTITY APPROVED Submit This Request Frm t ALL LISTED BELOW: [REGION NAME] Health- [email address] r via [Cmmunicatin tl] Crdinatin Rm (if pen) Lcal Emergency Manager/EOC
Signature: Date: Time: Have yu exhausted lcal supplies? Yes N Please Explain: Delivery and Lgistical Ntes: Other ntes: Page 32 f 35
APPENDIX J STATE DEPARTMENT OF HEALTH MEDICAL MATERIEL SUPPLY REQUISITION FORM
APPENDIX K H- ACTION ITEMS LOG Actin Item Accuntable Persn Status/ Cmments Due Date Due Time