Emergency Preparedness: Can You Manage An Emergency?
Emergency Preparedness: Can You Manage An Emergency?
9/25/2019 Can You Manage a Disaster? Emergency Preparedness Objectives Understand the federal regulations related to emergency preparedness State the four phases of emergency management Describe the components of an emergency management plan Complete a table top exercise 2 1
9/25/2019 Emergency Preparedness 3 4 Phases of Emergency Management Mitigation Recovery Preparedness Response ses%20of%20Emergency %20Management.pdf 4 2
9/25/2019 484.102 Emergency Preparedness Medicare Condition 484.102 E-001 Must comply with all federal, state and local emergency preparedness Must develop a comprehensive approach to meet health, safety, and security needs of staff and patients Must coordinate with other health care facilities and the community Must be reviewed annually 5 484.102 Emergency Preparedness: PLAN 484.102(a) Standard: The HHA must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. The plan must do all of the following: – (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an allhazards approach. – (2) Include strategies for addressing emergency events identified by the risk assessment. – (3) Address patient population, including, but not limited to, the type of services the HHA has the ability to provide in an emergency; and continuity of operations, including delegations of authority and succession plans. 6 3
9/25/2019 484.102 : PLAN Why Hazard Assessment ? Overview: A first step in effective emergency preparedness and management is defining and analyzing jurisdictional hazards. Although all hazards should be addressed, time and resource limitations usually do not allow this to happen in one single planning event. Hazard assessments are a key step to help establish priorities so that the hazards with the highest potential consequences are addressed first and those least likely to occur and/or least likely to cause major problems can be considered later. 7 Conduct a Hazard Assessment Hazards differ by probability of occurrence, resources available for response, and potential health impact-at both the individual (human) and system level. A thorough hazard assessment can establish planning priorities so that the most important hazards, including highly probable and/or major health care impacts, are planned for first, and those least likely to occur or have minor/moderate public health impact can be deferred until later. The outcome of the assessment can also be used to target mitigation resources, as well as serve as a basis for broader community engagement in response ment.htm d mitigation planning. 8 4
9/25/2019 Types of Hazards to Consider Natural Man Made Biological Technological Infrastructure Event Probability Vulnerability Preparedness Score 10 5
9/25/2019 484.102 Emergency Preparedness; COOPERATION 484.102(a) Standard: The HHA must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. The plan must do all of the following: (continued) – (4) 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, including documentation of the HHA’s efforts to contact such officials and, when applicable, of its participation in collaborative and cooperative planning efforts. 11 484.102 Emergency Preparedness: P&Ps Individual Patient Assessment 484.102(b) Standard: Policies and procedures. The HHA must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least annually. At a minimum, the policies and procedures must address the following: ( – (1) The plans for the HHA’s patients during a natural or manmade disaster. Individual plans for each patient must be included as part of the comprehensive patient assessment, which must be conducted according to the provisions at §484.55 Comprehensive Assessment of Patients 12 6
9/25/2019 484.102 Emergency Preparedness: Procedure to Evacuate 484.102(b) Standard: Policies and procedures. (continued) – (2) The procedures to inform State and local emergency preparedness officials about HHA patients in need of evacuation from their residences at any time due to an emergency situation based on the patient’s medical and psychiatric condition and home environment. – (3) The procedures to follow up with on-duty staff and patients to determine services that are needed, in the event that there is an interruption in services during or due to an emergency. The HHA must inform State and local officials of any on-duty staff or patients that they are unable to contact. 484.102 Emergency Preparedness: Availability of Records 484.102(b) Standard: Policies and procedures. (continued) – (4) A system of medical documentation that preserves patient information, protects confidentiality of patient information, and secures and maintains the availability of records. – (5) The use of volunteers in an emergency or other emergency staffing strategies, including the process and role for integration of State or Federally designated health care professionals to address surge needs during an emergency. 7
9/25/2019 484.102 Emergency Preparedness: Communication Plan 484.102(c) Standard: Communication Plan The HHA must develop and maintain an emergency preparedness communication plan that complies with Federal, State, and local laws and must be reviewed and updated at least annually. The communication plan must include all of the following: (1) Names and contact information for (2) the following: (i) Staff (ii) Entities providing services under arrangement. (iii) Patients’ physicians (iv) Volunteers. 15 484.102 Emergency Preparedness 484.102(c) Standard: Communication Plan (continued) – (2) Contact information for the following: (i)Federal, State, tribal, regional, or local emergency preparedness staff (ii) Other sources of assistance – (3) Primary and alternate means for communicating with the HHA’s staff, Federal, State, tribal, regional, and local emergency management agencies. – (4) A method for sharing information and medical documentation for patients under the HHA’s care, as necessary, with other health care providers to maintain the continuity of care. – (5) A means of providing information about the general condition and location of patients under the facility’s care as permitted under 45 CFR 164.510(b)(4) 8
9/25/2019 484.102 Emergency Preparedness 484.102(c) Standard: Communication Plan (continued) – (6) A means of providing information about the HHA’s needs, and its ability to provide assistance, to the authority having jurisdiction, the Incident Command Center, or designee, delegation of authority. 17 18 9
9/25/2019 Tribal Land Communication Tribal governments and their members are an essential part of our nation's emergency management team https://www.fema.gov/fema-tribal-affairs 19 Transfer and Health Information: 45 CFR 164.510(b)(4) – 45 CFR 164.510(b)(4) Uses and disclosures for disaster relief purposes. A covered entity may use or disclose protected health information to a public or private entity authorized by law or by its charter to assist in disaster relief efforts, for the purpose of coordinating with such entities the uses or disclosures permitted by paragraph (b)(1)(ii) of this section. The requirements in paragraphs (b)(2), (b)(3), or (b)(5) of this section apply to such uses and disclosures to the extent that the covered entity, in the exercise of professional judgment, determines that the requirements do not interfere with the ability to respond to the emergency circumstances. 20 10
9/25/2019 484.102 Emergency Preparedness 484.102(d) Training and testing. The HHA must develop and maintain an emergency preparedness training and testing program that is based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, policies and procedures at paragraph (b) of this section, and the communication plan at paragraph (c) of this section. The training and testing program must be reviewed and updated at least annually. 21 484.102 Emergency Preparedness 484.102(d) Training and testing. (continued) (1) Training program. The HHA must do all of the following: (i) 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 roles. (ii) Provide emergency preparedness training at least annually. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. 22 11
9/25/2019 484.102 Emergency Preparedness 484.102(d) (con’t) Community Training and Testing – (2) Testing. The HHA must conduct exercises to test the emergency plan at least annually. The HHA must do the following: (i) Participate in a full-scale exercise that is community-based or when a community-based exercise is not accessible, an individual, facilitybased. If the HHA experiences an actual natural or manmade emergency that requires activation of the emergency plan, the HHA is exempt from engaging in a community-based or individual, facility-based full-scale exercise for 1 year following the onset of the actual event. ii. Conduct an additional exercise that may include, but is not limited to the following 23 484.102 Emergency Preparedness 484.102(d) (con’t) Annual and Analysis Training and Testing – (2) Testing. The HHA must conduct exercises to test the emergency plan at least annually. The HHA must do the following: (ii)Conduct an additional exercise that may include, but is not limited to: – (A) A second full-scale exercise that is communitybased or individual, facility based. – (B) A tabletop exercise that includes a group discussion led by a facilitator, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. iii. Analyze the HHA’s response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the HHA’s emergency plan, as needed. 12
9/25/2019 484.102 Emergency Preparedness: 484.102(e) Integrated healthcare systems If a HHA is part of a healthcare system consisting of multiple separately certified healthcare facilities that elects to have a unified and integrated emergency preparedness program, the HHA may choose to participate in the healthcare system’s coordinated emergency preparedness program. If elected, the unified and integrated emergency preparedness program must do all of the following: – (1) Demonstrate that each separately certified facility within the system actively participated in the development of the unified and integrated emergency preparedness program. – (2) Be developed and maintained in a manner that takes into account each separately certified facility’s unique circumstances, patient populations, and services offered. 484.102 Emergency Preparedness 484.102(e) (con’t) Integrated healthcare systems – (3) Demonstrate that each separately certified facility is capable of actively using the unified and integrated emergency preparedness program and is in compliance with the program. – (4) Include a unified and integrated emergency plan that meets the requirements of paragraphs (a)(2), (3), and (4) of this section. The unified and integrated emergency plan must also be based on and include all of the following: (i) A documented community- based risk assessment, utilizing an all-hazards approach. (ii) A documented individual facility-based risk assessment for each separately certified facility within the health system, utilizing an all-hazards approach. 26 13
9/25/2019 484.102 Emergency Preparedness 484.102(e) (con’t)Integrated healthcare systems – (5) Include integrated policies and procedures that meet the requirements set forth in paragraph (b) of this section, a coordinated communication plan and training and testing programs that meet the requirements of paragraphs (c) and (d) of this section, respectively. Incident Commander Tasks Ensure welfare and safety of incident personal Supervise command and general staff Obtain initial briefing – Grab: P&P manuals, flashlight, phone charger, shoes, water Assess situation-ensure all local state and Federal agencies impacted by the incident have been notified Determine 1) needs 2) establish )3 participate in the unified command center Authorize protective measures/equipment/education necessary for patients, employees – Confirm work assignments – Brief IC team ( or IC staff as FEMA refers to your team ) https://training.fema.gov 28 14
9/25/2019 Briefing Incident Command Staff ID incident, access policy for management of incident Have patient priority list present Determine and assign who is taking notes of meeting Summary of current status of organization – Distinguish titles and who can perform in absence of incident staff – Where are field staff located in vicinity of incident – Are admissions in the area of incident – Are all new admissions on the priority listing Determine parameters and review availability of resources – Such as PPE, supply delivery, transport vehicles, water building structure – On –duty staff availability; off-duty staff availability – When to evacuate building and confirm alternate site Determine status of disaster declaration and delegation of authority – ID who will continue to monitor/receive communication and updates – Determine if incident commander cannot respond, who is delegation of authority 29 Briefing Incident Command Staff Review of any activities already occurring Written Incident Action Plan (IAP) Notification to CEOs, officials, hospitals, etc. Determine/propose next meeting time(s) – Approve necessary changes to the IAP – Keep CEO informed of incident related problems and progress Determine debriefing soon after incident 30 15
9/25/2019 Meeting Agenda with Incident Staff Home Health 1. Planning/Operations Section Chiefs (CL. Mgr) 2. Safety Officer 3. Incident Commander 4. Operations Section Chief (Cl, Mgr & Scheduler) 5. Operations Section Chief (Cl, Mgr & Scheduler) 6. Operations/Planning Section Chief (Cl, Mgr & Scheduler, IT, Supplies, HR) 7. Operations/Planning/Logistics Section Chief or Incident Commander 8. Logistics Section Chief 9. Logistics/Planning Section Chief , Liaison, IT property accountability, resources between sites 10. Finance/Administration Chief 11. Liaison Officer 12. Public Information Officer 13. Incident Command Officer/All Community Facilitator 1. Briefing on situation/resource status. 2. Discuss safety issues. 3. Set/confirm incident objectives 4. Plot control lines & Division boundaries. 5. Specify tactics for each Division/Group. 6. Specify resources needed for each division/group 7. Specify facilities and reporting locations. 8. Develop resource order. 9. Consider communications/medical/ transportation plans. 10. Provide financial update. 11. Discuss interagency liaison issues. 12. Discuss information issues. 13. Finalize/approve/implement plan. 31 After-Action Debriefing with Officials FEMA Incident Report will have words such as management coordination. Translate these to the medical home health terms you have in your debriefing report. Management Coordination Communications Planning/Briefing Activities Base of Operations/Layout/Setup Medical Issues Supply/Logistics Issues Personal Safety Issues Interpersonal Skills/Personal Performance 32 16
9/25/2019 Breakdown of FEMA Debriefing Management Coordination Intra-task force operations Integration of local jurisdictions; system 33 Communications How did we do? Emergency (Inter-task) team Inter-task briefings Shift scheduling/rotation Resource utilization 34 17
9/25/2019 Base of Operations/Layout/Set Up Need Improvement? Physical layout/site safety Structure remained safe Cache set up /organization Adequacy of sleeping/feeding/ sanitation, etc. Canine/vermin issues 35 Medical Issues: Patients Patient Care Outcome Yes No Improve Intake processes timely Care/treatment of patients Victim treatment/handoff Mgmt of controlled drugs/meds /supplies Canine/vermin issues Debrief referrals Classifications accurate Transfers effective Available Personnel aware of dangers 36 18
9/25/2019 Medical Issues: Staff Evaluate Care/treatment of personnel/volunteers Care/treatment of families Victim treatment/handoff Adequate surge operations Outcome Safety and welfare Did anyone come to your agency for help? Timely evacuation Did we offload referrals and request assistance timely? 37 Supplies/Logistics Issues OK or improve? PPE adequate Scheduling for patient visits Rest/feeding/rehab of personnel Mgmt of controlled drugs/meds /supplies Adequacy of cache Emergency signaling & charging procedures Available to all Off duty staff available? In-office Patient access/transport Adequate supplies Communication –did it work 38 19
9/25/2019 Interpersonal Skills/Personal Performance Task force mgmt personnel Task force personnel THANK YOU notes to all Debrief all Staff frequently Debrief Govern. Body Acknowledge families 39 Emergency Preparedness Tips and Tools An emergency plan is a framework for the emergency preparedness program Must conduct a facility and community based risk assessment using and “all-hazards” approach Consider man-made, natural, biological, facility, geographic hazards and head-line news If a community-based risk assessment is used, it is expected you have a copy of the assessment and you will work with the entity to ensure your emergency plan is in alignment. Consider all business functions in plan Document annual review and updates clearly 40 20
9/25/2019 Emergency Preparedness Tips and Tools Leadership must be able to: – describe the emergency preparedness plan, delegation of authority and succession plan – describe your at risk populations and strategies put in place to address these needs – the communication process for notifying State and local officials of patient’s in need of evacuation – describe the process for ensuring cooperation and collaboration with local, tribal, regional, State, and Federal emergency preparedness officials 41 Emergency Preparedness Tips and Tools Practice, drill, have fun, and analyze. Have policies and procedures in place that meet the regulations. Review and update annually! Each patient must have an individualized emergency plan documented as part of the comprehensive assessment. Have a written communication plan including primary and secondary means for communication. What will you do if your EMR is down? Consider a contingency plan 42 21
9/25/2019 Emergency Preparedness Tips and Tools Have documented records of initial and annual emergency preparedness training. Document your analysis and any changes made to your emergency plan as a result of a community-based drill or a table top drill. If facility-based, know your role! 43 National Response Framework 22
9/25/2019 Educational Resources Work within your community Take classes: FEMA: https://training.fema.gov/EMICourses/ ISO: o-14001-emergencypreparedness-and-response/ 45 Multiple Resources Ready.gov Local emergency preparedness organizations NAHC Accreditation Organizations Talk with other agencies 46 23
9/25/2019 ASPR TRACIE The U.S. Department of Health and Human Services (HHS) Office ASPR: Assistant Secretary for Preparedness and Response sponsors TRACIE: Technical Resources, Assistance Center, and Information Exchange Three Domains TR AC IE Collaboration involving multiple HHS Operating Divisions and other federal government departments/agencies; local, state, and regional government agencies; national associations; academia, nonprofit organizations; and private sector partners. ASPR TRACIE WHO? 47 WHAT ASPRtracie.hhs.gov A healthcare emergency preparedness information gateway that ensures that all stakeholders—at the federal, state, local, tribal, and territorial government levels; in nongovernmental organizations; and in the private sector—have access to information and resources to improve preparedness, response, recovery, and mitigation efforts. “The Exchange” publishes stories of emergencies and lessons learned. 48 24
9/25/2019 ASPR TRACIE WHY ASPR TRACIE fills gaps in healthcare system preparedness capabilities Providing timely, innovative ways to share information and promising practices during planning efforts. In the dynamic environment of a disaster, ASPR TRACIE will leverage resources to better integrate support. Serves as a force multiplier by improving information sharing and minimizing duplication of effort. 844-5-TRACIE (844-587-2243) 49 Emergency Preparedness Resources Table Top Drills https://www.fema.gov/emergency-planning-exercises Live Shooter: Options for Consideration Preparedness Video 8 minutes ive-shooter-preparedness-video http://hhs.gov http://cdc.gov http://defense.gov http://justice.gov 50 25
9/25/2019 Emergency Preparedness Resources California Office of Emergency Services http://caloes.ca.gov/ – Information is in Spanish Disabled staff and evacuation for active shooter uments/CalOES-active-shooterawareness-Feb-2018.pdf Telecommunication Service Priority e-priority-tsp Wireless Priority Service -wps TABLE TOP EXERCISE 26
9/25/2019 Speaker Information Stephanie Phillips, RN, BSN, MBA Sharon Fredrichs, RN, BSN, PHN, CPHQ S&S Home Care Consulting, LLC P. O. Box 502222 San Diego, CA 92150-2222 (858) 442-9903 sshcconsult@gmail.com May 22‐24, 2018 CAHSAH CHAPCA Annual Conference 53 27
484.102 Emergency Preparedness 484.102(d) Training and testing. (continued) (1) Training program. The HHA must do all of the following: (i) 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 roles.
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emergency plan for your program, center, or home. As you go through the manual, consider the points below as a way to guide you through the process of creating your emergency preparedness plan. b. Complete the . Emergency Preparedness Self-Assessment. questionnaire (p. 6) to determine the st
program must include initial training for new and existing staff in emergency preparedness policies and procedures as well as annual refresher trainings. (2) The provider/supplier must offer annual emergency preparedness training so that staff can demonstrate knowledge of emergency procedures. The provide r/supplier
The program addresses means to coordinate with other healthcare facilities, and the community The program is reviewed and updated annually (e.g. date of reviews and updates) E-0004: Emergency Preparedness Plan The emergency preparedness program includes an emergency preparedness plan tha
412 Emergency Preparedness Patient Training 6 413 Emergency equipment 6 414 Emergency plans 6 415 Evaluation of the Facility Plan 7 416 Local Emergency Management Agency 7 Part II: Preparedness versus Readiness 8 Preparedness vs. Readiness 8 "R-E-A-D-Y" 9 PART III: Putting It All Together 10
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