Organizing & Managing The Hospital Command Center In

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Organizing & Managing theHospital Command Center inNew York StateEmergency Operations SensitiveAdministration Schedule Breaks Restrooms CellPhones/Pagers Emergency ExitsIntroductions NameAgencyPositionICS & HCC ExperienceCourse ExpectationsHow does your departmentsupport the event/incident?1

Course GoalIncrease hospital resiliency andsustainability by enhancing theparticipants’ overall knowledge andawareness for the planning and operationof the Hospital Command CenterThis goal reflects the capability definition provided by theDHS Core CapabilitiesCourse Objectives Discuss incident management, activation and operation of theHospital Command Center (HCC) for a pre-planned or nonotice event Enhance the participants’ overall knowledge to provide multidepartment coordination Review the hospital’s role in the regional HealthcareEmergency Preparedness Coalition (HEPC) and/or a multiagency coordination (MAC) system Participate in a group activity to develop an activation and/orplanning job aid for the Hospital Command CenterCourse Topics HCC Basics HCC Staffing and Organization––––HCC ActivationCommand StructureInternal/External ParticipationFlow of Information HCC & Incident Management– Incident Action Planning– Meetings and Briefings– Emergency Declarations and Orders Coordination– Healthcare Emergency Preparedness Coalitions– Multi-Agency Coordination System Job Action Aids for the HCC2

Organizing & Managing the HospitalCommand Center in New York StateModule 1 – IntroductionHCC BasicsEmergency Operations SensitiveKnowledge CheckCan you answer the following questions: When is the last time you exercised or activated your HCC? Who are the key players in your organization and how can theybe contacted? How is coordination and information exchange accomplished?– Within your HCC, Health System?– Externally with the County EOC and other partners? Where is your alternate HCC located?What is aHospital Command Center?An HCC is a designated location to conveneand coordinate response activities, resourcesand information during a complex incident,emergency or disaster3

Command CenterversusCommand PostHospital Command Center Command Coordination/strategic SupportIncident Command Post Management Operations/tactics ResponseCountyEOCEDPatient CareUnitsOff SitesNon-ClinicalServicesMISSION of the HCCTo coordinate information and resourcesfor incident and event management The HCC must receive, analyze, display, anddisseminate information about the incident toenable executive decision-making The HCC must find, prioritize, deploy, and trackcritical resources The HCC must enhance decision making usingC4I (communication, cooperation, coordination,collaboration, and intelligence)4

Why an HCC? Increased demands on the organizationHigher volume of patientsResource prioritization and allocationLegal considerationsInteroperabilityProactive posture by hospitalFinancial elementsEstablishing HCC PrioritiesFundamental Priorities1.2.3.4.Life SafetyIncident StabilizationProperty ConservationBusiness Continuity (COOP)HCC manages by objectives: Critical when resources are limitedAccomplish the most good with availableresourcesResponsibilities of an HCCMonitors the management of: CommunicationsResources and AssetsSafety and SecurityStaff ResponsibilitiesUtilitiesClinical Support(The Joint Commission Critical Components)5

HCC Information Management Internal and External Situational Awareness Common Operating Picture Collect, evaluate, disseminate relevantinformation to all HCC staff, stakeholdersand partnersHCC Coordination A Multi-department verses a singledepartment approach can accomplish more Use of department resources beyondnormal scope of business Direction & Support– Strategic within the facility/system– Tactical within the facility/system– Fiscal awareness– Continuity of OperationsMUTUAL AID Agreements Developed:–– Ensures:–– Before an incident occursAmong all parties providing orrequesting resourcesStandardizationInteroperabilityNIMS resourcemanagement requirement6

SummaryCan you now .1. Describe the purpose and coreresponsibilities of an HCC?2. Identify value in activating an HCCfor a pre-planned or no notice events?Organizing and Managingthe Hospital Command Centerin New York StateModule 2 – HCC Staffing &OrganizationModule Objectives Identify and discuss key components of your HCCactivation plan Identify features of the Hospital Incident CommandSystem found in the management and organizationof your HCC Discuss what departments are or should beidentified in the HCC activation plan Discuss what management and support staff wouldbe needed in the HCC for a given scenario7

HCC Activation CriteriaThe activation of the HCC is determined by theemergency or event. Considerations include: Resources beyond capabilities are requiredNeed to coordinate activities of several departmentsThe emergency/event is of long duration/recoveryMajor policy decisions may be neededA local or state emergency is declaredHospital policy/thresholds are metAs specified in the EOPHCC Activation LevelsTriggered by incident complexity Normal OperationsMonitoringPartial ActivationFull ActivationNOTIFICATIONSWho should you notifywhen you activate?8

Hospital Command Center StructureHCC OrganizationCommand Staff and General StaffCommand StaffIncident CommanderMedical/TechnicalSpecialistPublic InformationSafetyLiaisonOperations SectionPlanning SectionLogistics SectionFinance & AdminSectionGeneral StaffHCC OrganizationGeneral Staff - OperationsIncident CommanderOperations SectionChiefPlanning SectionStaging ManagerSecurity BranchDirectorMedical Care BranchDirectorHazmat BranchDirectorInfrastructure BranchDirectorBusiness ContinuityBranch DirectorLogistics SectionFinance & AdminSectionPatient FamilyAssistance BranchDirector9

HCC OrganizationGeneral Staff - PlanningIncident CommanderOperations SectionPlanning SectionChiefFinance & AdminSectionLogistics SectionResource Unit LeaderDemobilization UnitDocumentation UnitLeaderSituation Unit LeaderHCC OrganizationGeneral Staff - LogisticsIncident CommanderOperations SectionPlanning SectionFinance & AdminSectionLogistics SectionService BranchDirectorSupport BranchDirectorHCC OrganizationGeneral Staff- Finance/AdminIncident CommanderOperations SectionPlanning SectionLogistics SectionTime Unit LeaderProcurement UnitLeaderFinance & AdminSection ChiefCompensation &Claim Unit LeaderCost Unit Leader10

HCC OrganizationSystem ModelStaffing the HCC Internal Representative– Departmental External Representatives– Technical Specialist– LiaisonInternal (Departmental)Representative Staffing Hospital should be prepared to staff theHCC 24/7 during activations Consider overlapping for debriefingpersonnel Relief must be briefed in detail beforeyou leave11

Check In HCCCheck in provides for: Name Credentials Department/Agency Receive Assignment Receive Resources &EquipmentIncoming Personnel Briefing Incident Briefing Job responsibilities / Job Action Sheet Reporting Structure Location of work area Instructions on obtaining any/all support Operational period work shiftsManaging Communications Call Center/Message CenterSocial MediaWebsites (Internal/External)Public Information Officer (PIO)Joint Information CenterMessage Consistency12

HCC Demobilization Demobilize according to plan Complete all assignments Brief team members and direct reports Complete and file forms and reports Follow check-out procedures Provide follow-up contact information (individual and agency) Conduct Incident Hotwash/Debrief and AAR DevelopmentHICS-221SummaryCan you now 1. Identify and discuss key componentsof your HCC activation plan?2. Identify features of the HICS found inthe management and organization ofyour HCC?3. Identify the key roles that are part ofthe HCC activation plan?Organizing and Managingthe Hospital Command Centerin New York StateModule 3 – HCC & IncidentManagement13

Module Objectives Discuss the incident action planningprocess relative to an HCC Identify key meetings and briefings thatmay take place in the HCC Identify the types of emergency waiversthat could be requested in a localemergency declarationHCC Action Planning Process1. the situation (priorities)Determine objectives and strategiesDetermine tasks and assignmentsPrepare the planImplement the planEvaluate the planCriteria for DeterminingIncident Priorities General Community– Threat to life– Real propertythreatened– High damage potential– Incident complexity– Environmental impact– Politics Healthcare- Patient Safety- Staff Safety- Threat to facility- Supply/StaffResource Access- Disease Control- Reputation14

The Planning Process (The “P”)Source: FEMA, NIMSIncident Action Planning in the HCC Planned response more productive thanreactive response HCC Incident Action Plan providesguidance for all staff in the HCC Delineates priorities and plannedresponses of the organization for a definedoperational period Identifies needs, organizes resources, andassigns tasksHCC IAP Elements Objectives for the HCC based uponestablished priorities (201 handout) Objectives and strategies for departments Weather Forecast and other technical info Organization Assignments Communications/Directories Situation15

SMART ObjectivesDiscussion QuestionWhy do we conductmeetings and briefingsin the HCC?To maintain situational awareness and set policyEssential Meetings & Briefings Executive BriefingPlanning MeetingSection/Departmental BriefingsPolicy Group MeetingMedia Briefings16

Meetings and BriefingsKeys to success Have an agenda, start and end on timeDocument minutesOnly invited key personnel speakAllow preparation time (as possible)Communication devices turned offSituation Status Reports(Sit/Stat Reps)During an HCC activation, each department isresponsible for submitting a Status Report tothe Planning Section, at least once peroperational period. Status Reports are used by HCC Managementto gather:– current internal and external situation summaries– current mission and resource capabilities– future concerns or objectives that need to beaddressed17

Stat Reps – Critical Information Department NameYour NameDate & Time/Operational Period of ReportOngoing Actions and Results, Ongoing/PreviousActions Not Yet Reported New Actions Taken Since Last Report Summary of Resources Committed to Incident(give location and primary activities) Planned & Anticipated ActivitiesEmergency Waiver Request Process Identify barrier regulation or statute Request to county and state public healthwith justification Request is forwarded to DOHCommissioner or GovernorSummary1. Discuss the incident action planningprocess relative to an HCC2. Maintain situational awareness3. Identify key meetings and briefings thatmay take place in the HCC4. Process to request waivers18

Organizing and Managingthe Hospital Command Centerin New York StateModule 4 – Multi-Agency CoordinationModule Objectives Discuss differences between commandand multiagency coordination Discuss the responsibilities ofmultiagency coordination groups Provide examples of the different levelsat which multiagency coordination iscommonly accomplishedDiscussion QuestionHow does incidentcommand differ fromcoordination?19

Command vs. CoordinationCommand Providing Direction Implementation TacticalCoordination Providing Support Decision Making StrategicMultiagency Coordination System (MACS)MAC (system) is . . . . . a combination of facilities, equipment,personnel, procedures, mutual aid plans,and communications integrated into acommon system with responsibility forcoordinating and supporting incidentmanagement activities.Multiagency Coordination:Simple to ComplexA coordination system:– May be as simple as ateleconference, or– May require an assembledgroup and associated supportsystems.20

Emergency Support FunctionsA mechanism that consolidates departmentswho have similar responsibilities, needs,functions, and/or resources to:1. Implement policy decisions with resource support2. Conduct strategic planning within the scope of thefunctional group3. Resolve conflicts and solve problems4. Coordinate and complete missionsEmergency Support Functions EXAMPLESLaw Enforcement and SecurityEmergency ServicesCritical Facilities and InfrastructureTransportation InfrastructurePublic Health and Medical ServicesHuman ServicesAnimal ProtectionESF-8: Hospital Representative Role(HCC Rep to County EOC/MACS) Represent hospital in local County EOCregarding– hospital issues, needs, resources– hospital policy in response to incident Serve as conduit of information to andfrom your hospital– Channel information to and from the hospitalexecutive staff21

Prior to reporting to the County EOC Have a clear understanding of yourdecision-making authority Verify what communications procedureswill be followed Ensure proper route to EOC Identification needed to enter EOCLocal State of Emergency Multi-agency coordination groups/EOCshould be advising chief executivesrelative to the need for emergencydeclarations and emergency orders. Authority for emergency declarations andemergency orders comes from NYSExecutive Law Article 2-b Section 24.Chief Executives in GovernmentWho isconsidereda chiefexecutive?Chief Executive means:County Executive or ManagerChairman of the County LegislatureMayor or Manager of a City or VillageTown Supervisor or Manager22

Discussion QuestionWhat types ofemergency orderscould be included inthe local emergencydeclaration?Discussion QuestionHow long areemergency ordersvalid for?What is the filingprocess?5 Days and should be filed in local newspaper, recordwithin 24 hours with county clerk, NYS DOS and SOEMSection 25 Use of Local GovernmentResources in a DisasterUpon threat or occurrence of a disaster theChief Executive is empowered to: Use all resources of the political subdivision to copewith the disaster. May request and accept assistance, coordinatedand directed by the County Chief Executive. May request and accept assistance from any otherpolitical subdivision on terms agreed to between thesubdivisions. The assistance may be used only toremediate the effects of the disaster23

Section 25 (cont.) A political subdivision shall not be liable forany claim based upon the exercise orperformance or failure to exercise orperform a discretionary duty or function onthe part of any officer or employee incarrying out the provisions of this section. The Chief Executive may request mutualaid only if his own forces have alreadybeen activated.Discussion QuestionWhat can the policymakers within a multiagency coordinationgroup do to facilitatetheir decision makingprocess?Establish Incident PrioritiesSummary1. Discuss differences between command andmultiagency coordination2. Discuss the responsibilities of multi-coordinationgroups3. Provide examples of the different levels at whichmultiagency coordination is commonlyaccomplished4. Discuss what is needed to send a hospital rep toEOC/MACS5. Basic understanding of Article 2b24

Organizing and Managingthe Hospital Command Centerin New York StateModule 5 – Job Aids for the HCCObjectives Identify Job Aids that may be used forvarious functions in the HCC Familiarize participants with the standardoperating procedures/guidelines typicallyused in an HCCDefine Job AidDevices or tools that allows an individual toquickly access the information he or sheneeds to perform a task.25

Job Aids Checklist – A position checklistProcedures list – An ordering procedureDecision guide – HCC activation algorithmForm or worksheet – Many HICS formsReference source – Telephone contact listSteps in Creating a Job Aid1. Analyze the task and associatedinformation2. Determine the kind of job aid to use3. Develop the job aid4. Test and revise if necessary5. Evaluate and exercise in intendedenvironment26

Common Job Aids used in HCC HCC Activation Algorithm Notification Algorithm Job Action Sheets for HCC Staff– Command, Support Incident SpecificSummary1. Identify job aids that may be used forvarious functions in the HCCThank you for yourparticipation .questions?27

agency coordination (MAC) system Participate in a group activity to develop an activation and/or planning job aid for the Hospital Command Center Course Topics HCC Basics HCC Staffing and Organization – HCC Activation – Command Structure – Internal/External Participation – Flow of Information HCC & Incident Management

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