National PACE Association Emergency Preparedness (EP) Compliance Project EMERGENCY OPERATIONS PLAN HANDS ON TRAINING: HVA, EOP & ICS Connect Consulting Services, Inc.
Training Agenda 2 National PACE Association Emergency Preparedness (EP) Compliance Project Welcome Emergency Operations Plan & the CMS Final Rule Hands-On Risk Assessment with the KAISER HVA Tool External Collaboration & Community-Based Planning EOP & ICS Hands-On Exercise Debrief and Next Steps
Connect Consulting Services, Inc. Project Team Members 3 Nora O Brien, MPA, CEM, CEO: CPCA staffer from 2001-2009, launched CCS in 2009 to assist clients with developing emergency management plans, training and drills and exercises; Cathy Larsen, MA, Director of Planning and Development: Former Executive Director of Southern Trinity Health Center and years of healthcare emergency management planning; Norma Springsteen, BA, Director of Operations: Years of coordinating projects for the Yolo County Department of Public Health and the California Society of Health-System Pharmacists; Alisha King, CEM, MEPP: Director of Training and Exercises- she has worked in local Public Health, and is a Master Exercise Practitioner Karen Garrison, BA, Senior Services Lead: has worked in senior service program design and implementation for more than 25 years.
CMS Emergency Preparedness Requirements 4 In 2016, the Centers for Medicare and Medicaid issued final Conditions of Participation (CoP) for 17 types of Medicaid and Medicare providers, including PACE, by November 15, 2017. Requirements Include: 1. Conduct Risk Assessment and Planning 2. Develop Policies and Procedures 3. Create Communication Plans 4. Training and Plan Testing
Emergency Operations Plan 5
Emergency Management Program 6 1. Emergency Operations Plan: Hazard Vulnerability Assessment (HVA) Emergency Plan based on HVA Strategies for addressing emergency events (job action sheets) Business Continuity Plan 2. Policies and Procedures (Annexes, Quick Reaction Checklists); 3. Emergency Communications Plan (ECP); 4. Training and Plan Testing (Full-Scale Exercise-FSX; Tabletop Exercise-TTX).
Emergency Operations Plan: Basics
Emergency Operations Plan: Goals 8 1 2 3 Safeguarding Human Resources Protecting Physical Resources Ensuring Business Continuity
Emergency Operations Plan: Phases 1.Mitigation 2.Preparedness 3.Response 4.Recovery 9
Phase 1: Mitigation MITIGATION is preventing future emergencies or minimizing their effects; INCLUDE activities in your Plan that prevent an emergency, reduce the chance of an emergency happening, or reduce the damaging effects of unavoidable emergencies; EXAMPLE: Buying flood and fire insurance for your organization; or creating defensible space are mitigation activities. 10
Phase 2: Preparedness 11 PREPAREDNESS involves Plans or Preparation for an Emergency; INCLUDE Resources & Supplies; ASSIGN & Train Staff; EXAMPLES: Evacuation Plans and Storage of Food and Water. 11
Phase 3: Response RESPONSE begins when an emergency event is imminent or immediately after an event occurs; PUTTING Preparedness Plans into Action (Job Action Sheets); EXAMPLES: Restoring critical infrastructure (e.g., utilities); Providing emergency assistance to victims. 12
Phase 4: Recovery 13 GOAL is to return the PACE organization s systems and activities to normal; RECOVERY begins right after the emergency; SOME recovery activities may be concurrent with response efforts. 13
Emergency Operations Plan: Required Elements 1. Risk Assessment aka HVA; 2. Strategies for Tackling Emergency Events; 3. Business Continuity Plan; 4. Delegation of Authority & Succession Planning; 5. External Cooperation & Collaboration. 14
Questions? 15
Risk Assessment 16
Hazard Vulnerability Analysis (HVA) Natural Hazards 17 Wild Fire Earthquake (> 5.0) Landslide Severe Thunderstorm Tidal Wave Flood, External Drought Snow Fall Blizzard Ice Storm Temperature Extremes Dam Inundation
Hazard Vulnerability Analysis (HVA) Technological Hazards 18 Information Systems Failure (> 4 hrs.) Communications Failure (> 4 hrs.) Fire, Internal (major) Electrical Failure Generator Failure Total Elevator Failure Water Failure Flood, Internal Fuel Shortage Sewer Failure Natural Gas Failure Fire Alarm Failure HVAC Failure Data Compromise Denial of Services (computer/network/website)
Hazard Vulnerability Analysis (HVA) Human Hazards 19 Epidemic/Pandemic Mass Casualty Incident (trauma) Violent Person Train Crash (at facility) Terrorism (CBERN) Bomb Threat Civil Disturbance Hostage Situation Labor Action Active Shooter
Hazard Vulnerability Analysis (HVA) Risk Assessment Tool - Kaiser Permanente 20 Probability x Severity* = RISK * SEVERITY = Magnitude (Impact) Mitigation (Preparedness + Response)
Hazard Vulnerability Analysis (HVA) Planning Resource Tool - Kaiser Permanente 21
Hazard Vulnerability Analysis (HVA) Planning Resource Tool - Kaiser Permanente 22
Hazard Vulnerability Analysis (HVA) Summary 23 I have the HVA done, now what do I do with all this info?
HVA Q&A 24
External Cooperation & Collaboration Jason Chenault, PhD, CEM, CHEP, OHCC, FACEM Senior Director of Emergency, Hospitalist & Critical Care Services Regional Health Services / UPMC Hamot University of Pittsburgh Medical Center 25
CMS Rule: Cooperation & Collaboration 26 # 1 The EOP include a process for cooperation and collaboration with local, tribal, regional, State, and Federal emergency preparedness officials' efforts to maintain an integrated response during a disaster or emergency situation.
CMS Rule: Cooperation & Collaboration 27 # 2 Include documentation of the PACE's efforts to contact such officials and, when applicable, of its participation in organization's collaborative and cooperative planning efforts.
External Cooperation & Collaboration 28 Increasing evidence indicates that collaboration between the private and public sectors could improve the ability of a community to prepare for, respond to, and recover from disasters. National Research Council
External Cooperation & Collaboration 29 Successful disaster preparedness occurs through: Strong collaboration; Detailed and well-understood plans of action; Written agreements in place Before a disaster occurs.
External Cooperation & Collaboration 30 Through public-private partnerships both government and the private sector can: Enhance situational awareness Improve decision making Access more resources Expand reach and access for communication efforts Improve coordination with other efforts by segments of the private sector Increase the effectiveness of emergency management efforts Maintain strong relationships, built on mutual understanding Create more resilient communities
External Cooperation & Collaboration 31 What Does a Community-Based Public-Private Partnership Look Like? Discussion
EOP Compliance Tool Industry Best Practices Review Annually Based on CMS EP Rule CMS Guidance To Date 32
Delegations of Authority & Succession Plans 33
Delegations of Authority & Succession Plans Accomplished Through: Incident Command System 34
ICS Structure 35 Top-down structure; Five Management Functions: 1. Incident Command 2. Logistics 3. Operations 4. Planning 5. Finance and Administration Operations Section Safety Officer Public Information Officer Planning Section Incident Commander Liaison Officer Logistics Section Finance/Admin Section
Incident Commander Incident Commander: Overall responsibility for incident: Sets incident objectives Determines strategies Establishes priorities Only position that is always staffed: Responsible until delegation Command Staff General Staff 36
Command Staff 37 Safety Officer: Monitors safety conditions, practices and procedures Liaison Officer: Primary contact for supporting agencies Public Information Officer Provides information to stakeholders Safety Officer Public Information Officer Incident Commander Liaison Officer 37
Command Staff 38 As Safety Officer, I ensure the safety of staff, participants, volunteers, and visitors impacted by and responding to the incident. Safety Officer Incident Commander Liaison Officer Public Information Officer 38
Command Staff 39 Safety Officer Public Information Officer Incident Commander Liaison Officer As Liaison Officer, I serve as the primary contact person with outside agencies also responding to the incident such as the local health department, other PACE, hospitals, fire and EMS providers, law enforcement, and others. 39
Command Staff 40 As Public Information Officer, or PIO, I serve as the conduit of information for internal and external stakeholders, including staff, participants, families, and the news media. Safety Officer Public Information Officer Incident Commander Liaison Officer 40
General Staff 41 The General Staff are divided into the following Sections: Operations Planning Logistics Finance and Administration Safety Officer Public Information Officer Incident Commander Liaison Officer Operations Section Planning Section Logistics Section Finance/Admin Section 41
Operations Section 42 The Operations Section are the DOERS! Operations Section Mission: Conducts tactical operations; Develops the tactical objectives and organization; Directs all tactical resources; Carry out the mission and Incident Action Plan. Lead by a Section Chief.
Planning Section 43 The Planning Section are the Planners! Collect, evaluate, and disseminate incident action information and intelligence to Incident Commander; Maintain resources status; Develop and document the Incident Action Plan (IAP); Maintain documentation for incident records; Plan for demobilization. Lead by a Section Chief.
Logistics Section 44 The Logistics Section are the Getters! Oversee the acquisition of resources to support incident operations; Oversee the provision of physical support, services, communications, and Information Technology to the PACE staff and facility; Oversee and coordinate donations management; Led by a Section Chief.
Finance/Administration Section 45 The Finance/Administration Section are the Moneybags! Oversee the acquisition of supplies and services; Prepare cost reports of incident expenditures, and financial reports/ics forms for reimbursement; Supervise the documentation of expenditures relevant to the emergency incident; Direct financial recovery: Recovery activities start during response!
Incident Command System Practice Tabletop Exercise 46
Tabletop Exercise Ground Rules 47 Informal Discussion of Simulated Emergency Time Relaxed Low Stress Participate and offer suggestions Focus on Evaluating Plans and Procedures Allows for resolution of questions of concern, and coordination Accept the artificialities of the exercise There are no wrong answers
Exercise Objectives 48 1. Orient PACE Organizations to the concept of a tabletop exercise; 2. Problem solving techniques around the issues related the exercise; 3. Learn how you can conduct a tabletop discussion-based exercise at your PACE Organizations.
Scenario Background In October 2016, Hurricane Matthew, a powerful and devastating tropical cyclone which became the first Category 5 Atlantic hurricane since Hurricane Felix in 2007. Matthew already wrought widespread destruction and catastrophic loss of life during its journey across the Western Atlantic, including parts of Haiti, Cuba, and the Dominican Republic. It is expected to hit landfall in the southeastern United States within 24 hours but it is not clear exactly which states it will hit and when. 49
Hurricane Matthew Exercise Scenario 50 It is Friday, October 7 th Naples, Florida It is 1:00pm and the temperature is 54 degrees It has been raining heavily since Wednesday, October 5 th bringing 8-10+ inches of rain and gale force winds Due to the water logged ground, severe flooding of key streets throughout Naples, Florida is happening Hurricane Matthew hits landfall in Naples, FL
Impact of Hurricane Matthew on Hope PACE 51 Anticipating that Hurricane Matthew might impact Hope PACE in Naples, Florida, there are only a few of PACE participants at the Center Staff have been working to identify the location of the PACE participants some of whom have been evacuated in advance of Hurricane Matthew Hope PACE in Naples loses power within 45 minutes of Hurricane Matthew hitting landfall and the building does not have a generator Landline and cell towers go down within 2 hours HOPE PACE has 5 PACE Centers in Florida There are most of the staff on hand assessing impact to the participants and any damage to the PACE Center
Tabletop Exercise Module One 52 Time until restoration of main power, water, phone, Internet: Unknown What are the first steps? Who is the Incident Commander? Which Incident Management Team positions should be activated? What actions will you take? Staffing Hope PACE sites PACE Participant outreach Medical supplies Communications
Discuss and Report Out 53
Scenario Evolves 54 It has been 5 days since Hurricane Matthew hit and flooding is widespread; Power and Internet are sporadic nearly one million in Florida have lost power; Supply chains break-down, especially for food and water; Long lines at gas pumps; Staff have been evacuated from their homes into evacuation shelters- many participants are still evacuating; The Naples PACE Program building has some damage and must be closed until repaired; Staff having difficulties reaching participants due to evacuations and downed communications.
Exercise Module Two 55 What actions will you now take? Staffing Hope PACE sites Medical supplies Communications Participant Coordination
Discuss and Report Out 56
Training Debrief and Next Steps 57 Tell us what you liked about the training? Suggestions for improvement Project Next Steps Monthly CMS EP requirement conference calls
Offers of Support 58 As a member of NPA, Connect Consulting Services will offer a FREE 30 minute phone consultation regarding your CMS compliance needs. In addition, Connect Consulting Services will offer a 15% discount on our planning, training, and exercise services. Please contact Norma Springsteen at Norma@ConnectConsulting.biz to schedule a call with us to see how we can help your PACE organization!
Contact Us! 59 Chris van Reenen, PhD Vice President, Regulatory Affairs chrisvr@npaonline.org Office: (703) 535-1568 National PACE Association 675 N. Washington St., Suite 300 Alexandria, VA 22314 www.npaonline.org Nora O Brien, MPA, CEM, Chief Executive Officer Nora@ConnectConsulting.biz Mobile: (916) 806-7361 Twitter: @NoraConnect Cathy Larsen, MA, Director of Planning & Development Cathy@ConnectConsulting.biz Mobile: (916) 281-4595 Connect Consulting Services 701 12 th Street, Suite 202, Sacramento, CA 95814 Office: (916) 758-3220 www.connectconsulting.biz