Healthcare System Preparedness Capabilities

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HealtHcare PreParedness caPabilitiesnational GuidanceforHealtHcare system PreParednessJanuary 2012Office of the Assistant Secretary for Preparedness and ResponseHospital Preparedness Program

CONTENTSIntroductionviiBackground and HistoryviiNear-term Threats and Strengthening the Hospitals, Healthcare Coalitions and the Healthcare SystemviiStakeholder Vetting and EngagementviiiHealthcare Preparedness Capabilities Planning ModelviiiPlanning FundamentalsviiiThe Planning ProcessxiHealth Preparedness Capabilities/Public Health Preparedness Capabilities AlignmentxiiMoving ForwardxivThe Healthcare Preparedness Capabilitiesxv1CAPABILITY 1: Healthcare System Preparedness1Function 1: Develop, refine, or sustain Healthcare CoalitionsP1. Healthcare Coalition regional boundaries2P2. Healthcare Coalition primary members2P3. Healthcare Coalition essential partner memberships2P4. Additional Healthcare Coalition partnerships/memberships2P5. Healthcare Coalition organization and structure3P6. Multi-agency coordination during response3Function 2: Coordinate healthcare planning to prepare the healthcare system for a disaster4P1. Healthcare system situational assessments4P2. Healthcare System disaster planning5Function 3: Identify and prioritize essential healthcare assets and services5P1. Identify and prioritize critical healthcare assets and essential services6P2. Priority healthcare assets and essential services planning6E1. Equipment to assist healthcare organizations with the provision of critical services6Function 4: Determine gaps in the healthcare preparedness and identify resources for mitigation of these gaps7P1. Healthcare resource assessment7P2. Healthcare resource coordination8P3. Address healthcare information gaps8Function 5: Coordinate training to assist healthcare responders to develop the necessary skills in order to respond8P1. Healthcare organization — National Incident Management System (NIMS) training8S1. Training to address healthcare gaps and corrective actions9Function 6: Improve healthcare response capabilities through coordinated exercise and evaluation9P1. Exercise plans10P2. Exercise implementation and coordination10P3. Evaluation and improvement plans10P4. Best practice and lessons learned sharing10S1. Exercise and evaluation training10Function 7: Coordinate with planning for at-risk individuals and those with special medical needs11P1. Healthcare planning for at-risk individuals and functional needs11P2. Special medical needs planning11U.S. Department of Health and Human ServicesOffice of the Assistant Secretary for Preparedness and ResponseHealthcare Preparedness Capabilities:National Guidance for Healthcare System Preparednessiii

CONTENTS12CAPABILITY 2: Healthcare System RecoveryFunction 1: Develop recovery processes for the healthcare delivery system12P2. Assessment of healthcare delivery recovery needs post disaster13P3. Healthcare organization recovery assistance and participation13Function 2: Assist healthcare organizations to implement Continuity of Operations (COOP)13P1. COOP planning assistance for healthcare organizations14P2. Healthcare organization COOP implementation assistance14P3. Healthcare organization recovery assistance1516CAPABILITY 3: Emergency Operations CoordinationFunction 1: Healthcare organization multi-agency representation and coordination with emergency operations16P1. Healthcare organization multi-agency coordination during response16P2. Healthcare organization and emergency operations decision coordination1717Function 2: Assess and notify stakeholders of healthcare delivery statusP1. Healthcare organization resource needs assessment17P2. Incident information sharing17P3. Community notification of healthcare delivery status18Function 3: Support healthcare response efforts through coordination of resources18P1. Identify available healthcare resources18P2. Resource management implementation18P3. Public health resource support to healthcare organizations19P4. Managing and resupplying resource caches19E1. Inventory management system1919Function 4: Demobilize and evaluate healthcare operationsP1. Resource demobilization20P2. Evaluation and continuous program improvement20S1. Evaluation training2021CAPABILITY 5: Fatality ManagementFunction 1: Coordinate surges of deaths and human remains at healthcare organizations with community fatalitymanagement operations21P1. Anticipate storage needs for a surge of human remains21P2. Healthcare organization human remain surge plans22E1. Mortuary storage equipment and supplies22Function 2: Coordinate surges of concerned citizens with community agencies responsible for family assistance2222P1. Procedures for a surge of concerned citizensFunction 3: Mental/behavioral support at the healthcare organization level2323P1. Mental/behavioral health support24CAPABILITY 6: Information SharingFunction 1: Provide healthcare situational awareness that contributes to the incident common operating pictureiv12P1. Healthcare recovery planning24P1. Healthcare information sharing plans24P2. Healthcare essential elements of information25P3. Healthcare incident information validation25U.S. Department of Health and Human ServicesOffice of the Assistant Secretary for Preparedness and ResponseHealthcare Preparedness Capabilities:National Guidance for Healthcare System Preparedness

CONTENTSP4. Healthcare information sharing with the public26E1. Healthcare information systems26P5. Bed tracking26E2. Bed tracking system27S1. Bed tracking system training27P6. Patient tracking27E3. Patient tracking system27P7. Patient record tracking28Function 2: Develop, refine, and sustain redundant, interoperable communication systems28P1. Interoperable communications plans28E1. Interoperable communication system29S1. Communication training2930CAPABILITY 10: Medical SurgeFunction 1: The Healthcare Coalition assists with the coordination of the healthcare organization response duringincidents that require medical surge30P1. Healthcare Coalition preparedness activities31P2. Multi-agency coordination during response31Function 2: Coordinate integrated healthcare surge operations with pre-hospital Emergency Medical Services (EMS)operations31P1. Healthcare organization coordination with EMS during response32P2. Coordinated disaster protocols for triage, transport, documentation, CBRNE32S1. Training on local EMS disaster triage methodologies32S2. Coordinated CBRNE training33Function 3: Assist healthcare organizations with surge capacity and capability3333P1. Medical surge planningP2. Medical surge emergency operations coordination34P3. Assist healthcare organizations maximize surge capacity34P4. Assist healthcare organizations maximize surge capability36P5. Medical surge information sharing37P6. Healthcare organization patient transport assistance37P7. Medical surge considerations for at-risk individuals and those with special medical needs37E1. Specialty equipment to increase medical surge capacity and capability38S1. Special training to maximize medical surge competency38P8. Mobile medical assets for surge operations38E2. Mobile Medical Assets39P9. Decontamination assistance to healthcare organizations39E3. Decontamination assets40S2. Decontamination training40P10. Mental/Behavioral health support4041Function 4: Develop Crisis Standards of Care guidanceP1. State crisis standards of care guidance41P2. Indicators for crisis standards of care42P3. Legal protections for healthcare practitioners and institutions42U.S. Department of Health and Human ServicesOffice of the Assistant Secretary for Preparedness and ResponseHealthcare Preparedness Capabilities:National Guidance for Healthcare System Preparednessv

CONTENTSP4. Provide guidance for crisis standards of care implementation processes42P5. Provide guidance for the management of scarce resources43S1. Crisis standards of care training44Function 5: Provide assistance to healthcare organizations regarding evacuation and shelter in place operations44P1. Healthcare organization evacuation and shelter-in-place plans44P2. Healthcare organization preparedness to receive evacuation surge45P3. Transportation options for evacuation45E1. Specialized equipment needed to evacuate patients4546CAPABILITY 14: Responder Safety and HealthFunction 1: Assist healthcare organizations with additional pharmaceutical protection for healthcare workers46P1. Pharmaceutical needs assessment46P2. Pharmaceutical cache storage, rotation, replacement, and distribution47P3. Medical Countermeasure dispensing47E1. Pharmaceutical cache protection47S1. Pharmaceutical cache training48Function 2: Provide assistance to healthcare organizations with access to additional Personal Protective Equipment (PPE)for healthcare workers during response48P1. Personal protective equipment needs assessment48P2. Personal protective equipment caches48P3. Personal protective equipment supply and dispensing49E1. Personal Protective Equipment for healthcare workers49S1. Personal protective equipment training4950CAPABILITY 15: Volunteer ManagementFunction 1: Participate with volunteer planning processes to determine the need for volunteers in healthcareorganizationsP1. Volunteer needs assessment for healthcare organizations response50P2. Collect, assemble, maintain, and utilize volunteer information51E1. Electronic volunteer registration system51Function 2: Volunteer notification for healthcare response needs51P1. Process to contact registered volunteers51P2. Process to confirm credentials of responding volunteers51P3. Volunteer request process51Function 3: Organization and assignment of volunteers52P1. Volunteer deployment protocols52P2. Briefing template for healthcare volunteers52P3. Volunteer support services52Function 4: Coordinate the demobilization of volunteers53P1. Volunteer Release Processes53P2. Volunteer exit screening ntsvi50U.S. Department of Health and Human ServicesOffice of the Assistant Secretary for Preparedness and Response57Healthcare Preparedness Capabilities:National Guidance for Healthcare System Preparedness

INTRODUCTIONBackground and HistoryThe threat of Mass Casualty Incidents (MCIs) or Medical Surges to the Nation’s hospital and healthcare system has always beenpresent. For many trauma systems and emergency departments, it is simply part of normal day-to-day operations. Preparing hospitals,healthcare systems and their ESF #8 partners to prevent, respond to, and rapidly recover from these threats is critical for protecting andsecuring our Nation’s healthcare system and public health infrastructure.The 2009 H1N1 influenza pandemic and Hurricane Katrina highlighted the importance of hospitals and healthcare systems beingprepared for potential threats and the consequences that occur when a community is ill-prepared. The Office of the Assistant Secretaryfor Preparedness and Response (ASPR) plays a leading role in ensuring the healthcare systems in the Nation are prepared to respond tothese threats and other incidents. Through the Hospital Preparedness Program (HPP) Cooperative Agreement, ASPR provides fundingand technical assistance to state, local and territorial public health departments to prepare the healthcare systems for disasters. The HPPCooperative Agreement funding provides approximately 350 million annually to 50 states, four localities, and eight U.S. territories andfreely associated states for building and strengthening their abilities to respond to incidents.Near-term Threats and Strengthening the Hospitals, Healthcare Coalitions and the Healthcare SystemState, city, and territorial Departments of Public Health working in partnership with the hospitals and Healthcare Systems within theirjurisdictions have made progress since 2001, as demonstrated in ASPR report: From Hospitals to Healthcare Coalitions: Transforming HealthPreparedness and Response in Our Communities: ents/hpp-healthcare-coalitions.pdfTrauma Centers, Hospitals, and Healthcare Systems face multiple challenges daily in addition to the growing list of man-made and naturalthreats. Emergency department overcrowding, the rising uninsured, and an aging population all inhibit the healthcare system’s ability torespond effectively. Regardless of the threat, an effective medical surge response begins with robust hospital-based systems and effectiveHealthcare Coalitions to facilitate preparedness planning and response at the local level. Simply put, strong and resilient HealthcareCoalitions are the key to an effective state and local ESF #8 response to an event-driven medical surge.In response to these challenges and in preparation for a new Hospital Preparedness Program and Public Health Emergency Preparednessaligned Cooperative Agreement that takes effect in July 2012, ASPR has used an aligned process for defining a set of HealthcarePreparedness Capabilities, in conjunction with the 15 PHEP Capabilities previously released in March 2011, to assist healthcare systems,Healthcare Coalitions, and healthcare organizations with preparedness and response.The Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness will assist state, local, Healthcare Coalition,and ESF #8 planners identify gaps in preparedness, determine specific priorities, and develop plans for building and sustaining healthcarespecific capabilities. These capabilities are designed to facilitate and guide joint ESF #8 preparedness planning and ultimately assure safer,more resilient, and better-prepared communities. ASPR has identified the following eight capabilities (shown with their aligned HPP/PHEPCapability numeric designation) as the basis for healthcare system, Healthcare Coalition, and healthcare organization preparedness:1.Healthcare System Preparedness2.Healthcare System Recovery3.Emergency Operations Coordination5.Fatality Management6.Information Sharing10. Medical Surge14. Responder Safety and Health15. Volunteer ManagementU.S. Department of Health and Human ServicesOffice of the Assistant Secretary for Preparedness and ResponseHealthcare Preparedness Capabilities:National Guidance for Healthcare System Preparednessvii

INTRODUCTIONStakeholder Vetting and EngagementA wide ranging and diverse group of stakeholders were engaged in developing, revising, and aligning the eight (8) Healthcare PreparednessCapabilities. This group included subject matter experts from within HHS as well as other national professional organizations within healthcareand public health. The Federal agencies actively involved in the alignment process included the HHS Office of the Assistant Secretary forPreparedness and Response, CDC’s Office of Public Health Preparedness and Response (OPHPR) and Division of State and Local Readiness(DSLR), DHS Federal Emergency Management Agency (FEMA) and Office of Health Affairs (OHA), and the U.S. Department of Transportation’sNational Highway Traffic Safety Administration (NHTSA). In addition, ASPR and DSLR collaborated with national partners such as theAmerican Hospital Association (AHA), Association of State and Territorial Healthcare Officials (ASTHO) and the National Association of Countyand City Health Officials (NACCHO) to engage the state and local healthcare and public health community. This dynamic and collaborativeprocess began in 2011 when ASPR and CDC representatives and other subject matter experts began working closely together to developaligned Healthcare Preparedness Capabilities, Functions, Tasks, and Resource Elements. ASPR and the CDC held weekly subject matter expertcapability working groups to develop recommendations for the scope of the selected capabilities, capability functions, and resource elementsfor each capability. Their work was extensively vetted with many key stakeholders throughout the process.Healthcare Preparedness Capabilities Planning ModelThe Healthcare Preparedness Capabilities were based on common preparedness methodologies from the Federal Emergency ManagementAgency (FEMA) regarding whole of community planning and in accordance with Presidential Policy Directive/PPD – 8: NationalPreparedness (March 30, 2011).1 This methodology is outlined in the FEMA document: Developing and Maintaining Emergency OperationsPlans, Comprehensive Preparedness Guide (CPG) 101, Version 2.0.2 To assist healthcare systems, healthcare coalitions and healthcareorganizations in using these new capabilities for planning, the Office of the Assistant Secretary for Preparedness and Response (ASPR)suggests using this document to assist them through the planning process. The integration with the Public Health Preparedness Capabilitiesand the Public Health Preparedness Capabilities Planning Model3 should occur during common steps of jurisdictional emergency operationsplanning noted in the FEMA guidance.Planning FundamentalsEmergency Management is the lead agency for planning in local and state jurisdictions. Healthcare systems, healthcare coalitions, andhealthcare organizations should follow Emergency Management’s lead in jurisdictional emergency operations planning and provide inputinto the public health and medical (ESF #8) considerations of the plans and annexes. Planning is collaborative. It is imperative that plansfor healthcare system emergency operations are not done in isolation from the community but are done in collaboration with the leadplanning agency in coordination with the ESF #8 lead agency of the jurisdiction.The following sections provide a summary of the fundamentals of planning as outlined by FEMA to assist healthcare disaster planners withan understanding of how to address the Healthcare Preparedness Capabilities. The complete text can be found in Chapter 1 of FEMA’sDeveloping and Maintaining Emergency Operations Plans, Comprehensive Preparedness Guide (CPG) 101, Version 2.0. This guidance provides thebasic understanding of planning processes that healthcare planners should integrate with to achieve successful planning. Planning Principles: Applying the following principles to the planning process is key to developing an all-hazards plan for protectinglives, property, and the environment:– Planning must be community-based, representing the whole population and its needs– Planning must include participation from all stakeholders in the community– Planning uses a logical and analytical problem-solving process to help address the complexity and uncertainty inherent in potentialhazards and threats– Planning considers all hazards and threats– Planning should be flexible enough to address both traditional and catastrophic incidents– Plans must clearly identify the mission and supporting goals (with desired results)– Planning depicts the anticipated environment for action1 Presidential Policy Directive (PPD)8: http://www.dhs.gov/xabout/laws/gc 1215444247124.shtm2 Developing and Maintaining Emergency Operations Plans, Comprehensive Preparedness Guide (CPG) 101, Version 2.0, November 2010 (CPG 101, V.2): http://www.fema.gov/pdf/about/divisions/npd/CPG 101 V2.pdf3 Public Health Preparedness Capabilities: National Standards for State and Local Planning; CDC, Division of State and Local Readiness, March, 2011, pages 6-9: http://www.cdc.gov/phpr/capabilities/viiiU.S. Department of Health and Human ServicesOffice of the Assistant Secretary for Preparedness and ResponseHealthcare Preparedness Capabilities:National Guidance for Healthcare System Preparedness

INTRODUCTION– Planning does not need to start from scratch– Planning identifies tasks, allocates resources to accomplish those tasks, and establishes accountability– Planning includes senior officials throughout the process to ensure both understanding and approval– Time, uncertainty, risk, and experience influence planning– Effective plans tell those with operational responsibilities what to do and why to do it, and they instruct those outside the jurisdictionin how to provide support and what to ex

Function 1: Develop recovery processes for the healthcare delivery system 12 P1. Healthcare recovery planning 12 P2. Assessment of healthcare delivery recovery needs post disaster 13 P3. Healthcare organization recovery assistance and participation 13 Function 2: Assist healthcare organizations to implement Continuity of Operations (COOP) 13 P1.

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