Health Centers: An Important Piece to the Preparedness Puzzle

Health Centers: An Important Piece to the Preparedness Puzzle

Agenda CMS Proposed Changes to COP- what s new for you? Emergency Operations Plans- what do you need? Coalitions- where do Health Centers fit in?

CMS Proposed Changes to Conditions of Participation

CMS concludes that the current set of federal, state and local laws and guidelines, combined with the various accrediting organizations emergency preparedness standards, fall short of what is needed to require that health care providers and suppliers be adequately prepared for a disaster.

Proposed COP Changes Risk assessment and planning based on an all hazards approach; Policies and procedures based on risk assessment and planning Communications plan Training and testing

CMS will use the proposed hospital requirements as a template for the proposed requirements for other providers and suppliers, but modifies specific requirements to tailor them to the unique needs of each provider/supplier.

Risk Assessment Must perform a risk assessment based on an all hazards approach prior to establishing an emergency preparedness plan. A facility based risk assessmentexamines only the risks to the facility and its patients A community based risk assessment is carried on outside the organization, within the defined community.

In order to meet this requirement- CMS expects hospitals to at least consider Identification of essential business functions that should be continued in an emergency Identification of all risks or emergencies that the hospital may reasonably expect to confront Identification of all contingencies for which the hospital should plan

In order to meet this requirement- CMS expects hospitals to at least consider Assessment of the extent to which emergencies may cause the hospital to cease or limit operations; and Determination of whether arrangements with other hospitals or entities might be needed to ensure the provision of essential services

Include a process for ensuring cooperation and collaboration with local, tribal, regional, State and federal emergency preparedness officials

Policies and Procedures

EOP Based on HVA EOP reviewed and updated annually Alternate sources of energy Temperatures to protect patient health and safety and for the safe and sanitary storage of provisions Emergency Lighting Fire detection, extinguishing and alarm systems Sewage and waste disposal

EOP A system to track the location of staff and patients in the hospital both during and after an emergency FQHCs have the flexibility to cancel appointments during an emergency so they will not need to assume responsibility for tracking patients.

EOP- Safe Evacuation Consideration of care and treatment needs of evacuees Staff Responsibilities Transportation Identification of evacuation locations Primary and alternative means of communication with external sources of assistance.

Shelter in Place A means to shelter in place for patients, staff and volunteers who remain in the facility

Must have a system of medical documentation that preserves patient information, protects confidentiality of patient information, and ensures records are secure and readily available.

Volunteers Include in the plan Use of volunteers in an emergency Other emergency staffing strategies

The role of the hospital under a waiver declared by the Secretary, in accordance with section 1135 of the Act, allows for provision of care and treatment at an alternate care site. CMS intends this to encourage providers to collaborate with emergency officials in proactive planning.

Communication Plan Must develop and maintain an emergency preparedness communication plan and it must be reviewed and updated annually.

Communication Plan- must include Names and contact information for the following: Staff Entities providing services under agreement Patients physicians Other hospitals/health centers volunteers

Com plan must include: Contact information for the following: Federal, State, tribal, regional, and local emergency preparedness staff Other sources of assistance Primary and alternate means for communicating with staff and emergency management agencies

Private-sector preparedness is not a luxury; it is a cost of doing business in the post-9/11 world. It is ignored at a tremendous potential cost in lives, money and national security. The 9 11 Commission Report

Training and Testing

Why provide training? To lead an untrained people to war is to throw them away. - Confucius

Must develop and maintain an emergency preparedness training and testing program that must be reviewed and updated at least annually.

Training Program- Must do all of the following: Initial training in emergency preparedness policies and procedures to: all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected role.

Training must include: Provide emergency preparedness training at least annually Maintain documentation of training Ensure that staff can demonstrate knowledge of emergency procedures

Testing- must conduct drills and exercises and: Participate in a community mock disaster drill at least annually If no community exercise is availableconduct a facility based mock disaster drill annually. If there is an actual (real world) event that causes the hospital to activate the EOP they are exempt from doing a drill for 1 year

Testing- must conduct drills and exercises and: Conduct a paper-based, tabletop exercise at least annually. Analyze the hospital s response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the hospital s emergency plan as needed. Exercises and drills should be conducted based on scenarios from HVA

Emergency and Standby Power Systems Generator location- the generator must be located in accordance with the requirements found in NFPA 99, NFPA 101 and NFPA 110.

Generator Inspection and Testing Must follow inspection and testing requirements found in NFPA 99 AND At least once every 12 months, test each generator for a minimum of 4 continuous hours. The test load must be 100% of the load the hospital anticipates it will require. Maintain a written record which is available upon request of all inspections, tests, operations and repairs.

Generator Fuel Hospitals that maintain an onsite fuel source to power emergency generators must maintain a quantity of fuel capable of sustaining emergency power for the duration of the emergency or until likely resupply.

Why Prepare? It wasn t raining when Noah built the ark. -- Howard Ruff

FQHC Requirements

FQHCs currently do not have specific requirements for emergency preparedness; however, they do have emergency procedures requirements. CMS proposed FQHCs meet the proposed hospital requirements with the following exceptions:

Policy and Procedures/FQHC No requirement to meet the need for subsistence needs of patients and staff. No need for tracking location of patients and staff. No need to have a plan for an alternate care site.

Safe Evacuation Appropriate placement of exit signs Include staff responsibilities for evacuation Include the needs of patients in the plan.

Communications Plan No requirement to include methods for: Sharing information with other health care providers The release of patient information in the event of an evacuation The provision of information related to occupancy

Emergency Operations Plan Communications Resources and Assets Safety and Security Staff Responsibilities Utilities Management Client Care and Support Activities

EOP Healthcare Incident Command (HICS) Who is in charge of what Incident Commander Liaison Officer Operations Section Chief Logistics Section Chief Planning Section Chief Finance Section Chief

Communications Cell phones/texting Land Line phones Two-way radios HAM Radios Emergency Paging System Internet Media Weather radios

Communications Communication with staff (Internal and External) How are you going to do that? External Agency Communications With Clients and client families

Resources and Assets Disaster Equipment and Supplies Every day supplies

Healthcare Coalitions Within this management construct, Healthcare Coalition was defined as a group of individual healthcare organizations in a specified geographic area that agree to work together to maximize surge capacity and capability during medical and public health emergencies by facilitating information sharing, mutual aid, and response coordination.

Williams Fulton Lucas Henry Defiance Wood Sandusky Ottawa Erie Lorain Paulding Putnam Hancock Seneca Huron Wyandot Crawford Marion Allen Hardin Van Wert Mercer Auglaize ShelbY y Union Champaign Clark Montgomery Greene Clermont Warren Clinton Brown Adams Scioto Pike Highland Ross Fayette Madison Pickaway Franklin Licking Fairfield Delaware Hocking Vinton Jackson Lawrence Gallia Meigs Athens Washington Morgan Muskingum Noble Monroe Belmont Guernsey Coshocton Knox Harrison Jefferson Columbiana Stark Ashland Medina Cuyahoga Richland Summit Portage Mahoning Trumbull Geauga Lake Ashtabula Wayne Holmes Perry Tuscarawas Logan Preble Darke Hamilton Miami Butler Morrow Carroll NORTHEAST CENTRAL NORTHWEST CENTRAL SOUTHEAST REGION 2 SOUTHEAST REGION 1 WEST CENTRAL SOUTHWEST Ohio Hospital Preparedness Regional Map NORTHEAST 1 2 3 4 6 7

Healthcare Coalitions Responsibilities Expand the health systems emergency response capabilities through information and resource sharing Coordinate the health system s emergency response through effective communications Integrate the health system s response into the larger regional emergency response Advise public officials on health policy matters during a disaster

Healthcare Coalition Expectations Information sharing Coordination and sharing of resources during a disaster through the HIL Participation in coalition-sponsored activities Have current emergency preparedness

Coalition Structure CENTRAL OHIO TRAUMA SYSTEM Board of Trustees Central Ohio Healthcare Coalition (COHC) Community Healthcare Integrated Partners (CHIP) Subcommittee Coalition Steering Committee (CSC) Regional Healthcare Emergency Preparedness (RHEP) Subcommittee County Healthcare Coalition (CHC) Regional Healthcare Coalition Coordinator Safety and Security Subcommittee (SSS) OHIO CENTRAL REGION HEALTHCARE COALITION REPORTING STRUCTURE

Central Ohio Healthcare Coalition Basics Coalition Coalition Benefits Coalition Bylaws

Healthcare Incident Liaison On call 24/7 Coordinates Healthcare Response to Disasters: Clearinghouse for information Resource Allocation Role Inter-Facility Communication Liaison between the region and state agencies

Telephone Emergency Network NEWS/MEDIA EMS/FIRE/LE HOSPITAL PUBLIC HEALTH EMA COTS HIL OTHER

Central Ohio Healthcare Disaster Information Management System (COHDIMS) Incident Details Entry of Hospital Contact Information Situation Report Bed Capacity/Casualty Numbers to SurgeNet MARCS Radio to contact HIL

Central Ohio Healthcare Disaster Information Management System (COHDIMS) Continuing Incident Updates/Situation Reports Additional Instructions Incident Related Documents Hospital to Hospital Mutual Aid/Resource Requests

Resource Management NE NEC Public Health Central Region Caches HIL OHA Resource Managemen t System NW WC SE SW

Inter-Facility Communication During High Acuity Mass Care Needs SURGENET COHDIMS HIL TENS Alert

When to Call the HIL. The HIL should be notified as soon as possible during any event in which: A hospital may require disaster-related information or mutual aid resources from other hospitals Large numbers of ill and/or injured patients may overwhelm local healthcare resources A hospital goes on lockdown Large numbers of contaminated victims require care The event affects more than one central Ohio hospital Public health or public safety information needs to be quickly disseminated to Central Ohio hospitals

Regional Healthcare Coordinators NW- Kathy Silvestri ksilvestri@hcno.org NW Central- Pat Bernitt pbernitt@gdaha.org SW- Tonda Francis tfrancis@gchc.org NE- Beth Gatlin Beth.Gatlin@chanet. org NECO- Sara Metzger smetzger@arha.org SE- Penny Mills pennym@ohanet.org Central- Jodi Keller jkeller@goodhealthcol umbus.org

By failing to prepare you are preparing to fail. -- Ben Franklin

QUESTIONS Jodi Keller jkeller@goodhealthcolumbus.org 614-255-4407