ARE YOU PREPARED? A Disaster-Preparedness Workshop for Food and Nutrition Professionals October 12, 2006 UMDNJ-Scotch Pl

1. ARE YOU PREPARED?A Disaster-Preparedness Workshop for Food and Nutrition ProfessionalsOctober 12, 2006UMDNJ-Scotch Plains, NJ ALL HAZARDS EMERGENCY/DISASTER PREPAREDNESS ACROSS NJ’S HEALTHCARE CONTINUUM Gary J. Schnerr Director, Emergency Preparedness Health Care Association of New Jersey Hamilton, NJ 08691 609.890.8700 www.hcanj.org

2. Emergency ManagementThe “new normal” • Pre 9/11/01 • Focus on naturally occurring and accidental events i.e. fire, flood, hurricane/tornado, hazardous material spill, etc. • Post 9/11/01 • Expanded to include human-caused deliberate events i.e. chemical dispersal, biological agent, nuclear/radiological release, bomb, etc. *integrated, all hazards*

3. Primer on Emergency Management* collaborative alliances * • Life Cycle of “all hazards” EM Process Preparedness Hazards Vulnerability Analysis Response Mitigation 4 Phases Of EM Recovery *Collaborative alliances strengthen and expand the resources available in an Emergency situation*

4. Not an Island………. • Organize/Leverage External Resources • “Collaborative alliances”- define responsibilities of participants • Municipal, county, state, private resources • DHSS/Health Infrastructure Preparedness & Response, Police, Fire, EMS, OEM, CERT, MRC • Suppliers (goods and services)

5. Healthcare Continuum……*Partners in Preparedness* • Preparedness For: • “all hazards” including natural and man-caused • fire, flood, food-borne pathogen, biological event, etc. • single facility, local, regional, state, multi-state • Acute Care Hospitals- 83 • Primary Care Centers (FQHC)- 19 • Long Term Care- 800+licensed facilities • SNF, ALF, CPCH, RHCF, ADS, Senior Housing • Home Care-600+ certified agencies Facilitated through Professional Trade Associations Partners:

6. Role of the Professional Trade Associations • Provide Advocacy & Representation of respective constituency members at state level • Provide active liaison for Disaster/Emergency Preparedness at local, municipal, regional, and state levels • Provide targeted training and education applicable to membership needs • Provide Disaster/Emergency planning guidance in form of tools, coaching, exercise review, etc. • Meet as a group, “Healthcare Associations Emergency Preparedness Alliance”, monthly to ensure that “healthcare continuum” Disaster/Emergency Preparedness is coordinated for maximum efficiency and effectiveness.

7. Preparedness Planning….. • Facilities required to have comprehensive Disaster/Emergency plans: • Acute Care Hospitals • Long Term Care Facilities • Federally Qualified Health Centers • Home Care Agencies

8. Sample TOC for Residential Health Care Facility Draft RHCF 1 • 8:43-12.2 Emergency Preparedness Plan • Scope of Plan/General Statement • Chain of command • Emergency phone list • Description of facility including: • Type of construction, number of floors, and number of beds • Fire/smoke detection systems • Fire suppression systems • List names, addresses, telephone numbers of companies • maintaining fire/smoke detection & fire suppression systems • 4. Facility floor plans including: 8:43-12.2(b) • Emergency exits • Fire pull alarms • Fire annunciator panels • Fire extinguishers • Fire sprinkler shut off • Fire department connection/standpipes • Utility identification (water, main electric, gas, etc) • Key lock box

9. Sample TOC for Residential Health Care Facility • NJDHSS Regulation for emergency preparedness • Potential hazards for an evacuation • Fire/smoke 8:43-12.3 • Explosion • Weather related emergency 8:43-15.5 • Cold 8:43-15.5(a) • Heat 8:43-15.5(b) • Snow 8:43-4.8(a)1 • Hurricane/severe storm 8:43-4.8(a)1 • Flood 8:43-4.8(a)1 • Tornado 8:43-4.8(a)1 • Earthquake 8:43-4.8(a)1 • Disruption of utilities 8:43-4.8(a)1 • Water 8:43-15.6(a) • Gas 8:43-4.8(a)1 • Electric 8:43-4.8(a)1 • Sewage 8:43-15.6(f) • Communication 8:43-4.8(a)1

10. Sample TOC for Residential Health Care Facility • Nuclear or radiological incident • Hazardous chemical incident • Biological incident • Terrorist incident • Bomb threat • Labor disputes/work stoppage • Civil disturbance • Structural damage • Evacuation and relocation 8:43-12.1(b) • Memorandum of understanding (MOU) with other facilities for relocation • Temporary holding facility for relocation (if necessary, i.e. school) • Partial evacuation to another area of facility • Transportation for relocation 8:43-12.1(b) • Agreement with transport provider • Agreement with local and surrounding rescue departments • Resident identification for relocation 8:43-12.1(b) • Medication, records, equipment, supplies for relocation 8:43-12.1(b) • Emergency staffing

11. Sample TOC for Residential Health Care Facility • Emergency responsibilities 8:43-12.2(c) • Administrator or designee • RN/EMS health maintenance and monitoring • Admission/office procedure • Housekeeping/laundry • Maintenance procedure • Dietary procedure 8:43-8.3(a)13. • Activities procedure • Support personnel • Incident Command System (ICS) • Resident Care during relocation 8:43-12.2(c) • Return of Resident 8:43-12.2(c) • Emergency facility food and water supply 8:43-8.3(a)13. • Memorandum of Understanding (MOU) for accepting residents from other facility (optional) • Memorandum of Understanding (MOU) with emergency management officials (local, county, state) • Disaster planner’s responsibilities • Staff training 8:43-12.2(b) • Evacuation drills 8:43-12.2(b) • Crisis Communications

12. Local Information Network & Communication System (LINCS) • Statewide emergency/routine information dissemination • Qualified agencies can “subscribe”, select type of info • http://www.state.nj.us/health/lh/lincs/index.htm • Internet-enabled • 21 county LINCS Agencies • Managed by DHSS Infrastructure Preparedness & Response • Directly connected to the Center for Disease Control (CDC) Health Alert Network (HAN) for national coverage • Example-Recent e-coli spinach contamination

13. NJ Office of Emergency Management (OEM)---Nucleus of Disaster/Emergency Response • A NJ State Police Agency • Network of OEM Coordinators (OEMC) • 21 County Coordinators-Full-time role • www.state.nj.us/njoem- list/contact info • 500 Regional/municipal/local Coordinators • Some full-time, many part-time role • List/contact info from County Coordinator • Local Emergency Planning Committee (LEPC) • 15 person; every municipality & county • OEMC serves as chairperson

14. NJ Office of Emergency Management (OEM) Regions

15. NJ Office of Emergency Management (OEM)---Nucleus of Disaster/Emergency Response • State Emergency Operations Center (EOC) • Staffed by key officials in disaster situations • NJ Dept of Health & Sr. Svcs. (DHSS) ; NJ Homeland Sec.; etc. • 800 MHZ radios maintain communications to all State Police locations independent of phones, Internet, etc. • Fully self-sufficient • Direct communications link to DHSS EOC • Direct communications link to other states and Federal officials • Full range of state-of-the-art situation status, asset tracking, other real-time software tools

16. DHSS Emergency Operations Center • “Command Central” for all public health and healthcare provider entities • Activated (stood up) in emergency situations • Inclusive of Emergency Medical Services, other first responders • Staffed by DHSS Commissioner, other senior-level staff from DHSS and other agencies • Real-time monitoring and decision making • Status and Information Dissemination out to appropriate public and private “partners” • Direct link to Health Auxiliary Command Ctr (HACC) • Staffed by Professional Trade Associations representing the Preparedness Partners

17. DHSS EOC-systems & capabilities • “HIPPOCRATES”—an evolving real-time software package developed by DHSS • Asset & Resource management • Epidemiological Surveillance • Geographic Information System (GIS) enabled to track mobile assets • Real-time hospital status, bed count, equipment, patient load, etc.

18. HIPPOCRATESKey Features Integrated Application Suite allowing for: • One-Stop-Shoppingfor information for Health Emergency Preparedness and Response • Mapping health locations from different sources • Tracking real time changes on maps • Performing analysis of critical health data on maps • Accessing theWeb based applicationanywhere, anytime • Grantingaccess based on user privileges so that users only see the information they need • FollowsFederal Geographic Data Committee (FGDC), Federal Emergency Management Agency (FEMA), and Homeland Security User Group (HSUG) guidelines • Incorporatingrequirementsbeyond health emergencies • Daily Monitoring • Training and Exercise

19. Collect Information in HOTS –Health Operations Tracking System • Means for collecting and disseminating health-related information • Incidents, and Events such as: • White powder • Chemical, biological, radiological, nuclear • Natural disasters • Immediate Email notification of incident status to concerned personnel within multiple agencies • Maintain logs by Command Center • Morbidity/Mortality statistics • Task Action Completion Sheet

20. Bio Survey Respondent Queries Summaries and Statistics Mortality Incident On Divert Morbidity News Ticker Medical Stockpile (RSS) Site Information on Medical Stockpile Thumbnails Map health locations and information

21. Advanced Analysis • Analysis: • Attribute Queries:“Locate all hospitals with surge capacity greater than 80%” • Spatial Queries:“Locate the closest Point of Dispensing for each Biological/Outbreak incident” • Service Areas (Buffers): “Find areas around incidents that are affected and access demographic statistics for the affected area” • Best route: “Find the shortest or fastest route from one point to another on the map”

22. Advanced Analysis • Reports: • Thematic maps • distribution of dynamic data, such as bed capacity, morbidity, mortality, and stockpile inventory. • Summary Statistics • Display summary statistics which can be used during emergencies to report on the state of affairs, such as total morbidity or total surge capacity across the state. TOPOFF3 Exercise Data

23. Medical Coordination Centers (MCCs)-the regionalization strategy • Five regions across state using county boundaries • Standard Operating Procedures (SOPs) defines basic rules and guidelines- top-level standardization • Allows a degree of “customization” based on geography, other uniqueness • All-inclusive council made up of “locals” who can objectively represent regional needs and challenges

24. Medical Coordination Center Regions • Northeast -Bergen, Hudson, Essex • Northwest -Sussex, Warren, Morris, Passaic • Central East -Union, Middlesex, Monmouth, Ocean • Central West -Hunterdon, Somerset, Mercer • South -Burlington, Camden, Gloucester, Salem, Cumberland, Atlantic, Cape May

25. Medical Coordination Centers (MCCs)-the regionalization strategy • There are Five (5) Medical Coordination Centers (MCCs) programs that are housed in host hospitals. • There are regions with more than one (1) Medical Coordination Center. In these regions, the designated host hospital will serve as the core for the MCC Program in the respective region. • The MCCs are responsible for the development of regional planning, training, exercises and operations within the municipal, county and state Public Health, Healthcare and Emergency Management Systems. • The MCC Program will provide statewide standardization as well as specialization. • In addition, the MCCs will integrate/coordinate public health and healthcare systems both inter-intra state, based on the eight (8) national priorities. • The MCC will/should have information on hospital diversion status, healthcare facility bed status, pharmaceutical availability, medical information, as well as, EMS system(s) status.

26. MCC Regional Plans, Policy and OperationsThe Regional MCC Advisory Council Responsible for development and administration of regional plans, policies and operations • 5 MCC Regional Advisory Councils, (one council per region regardless of the number of MCCs per region) • Similar to Health Emergency Preparedness Advisory Council (HEPAC) • There will be a rotating Membership on each council • Membership will represent cross-section of MCC participants • Supervised by the DHSS • Standardized MCC operational concepts (SOPs) tailored to specifics of the regional area

27. DHSS* EMS* Hospitals* Long Term Care* Home Care* OEM* County/Region FQHCs* Ambulatory Care* Public Health/LINCSs* Law Enforcement Fire Service Medical Reserve Corps Epidemiology Office of Domestic Preparedness (ODP) Urban Area Security Initiative (UASI) Subject matter experts MCC State Advisory Council Design

28. Healthcare Auxiliary Command Center (HACC)*the “6th MCC” • At NJ Hospital Association facility • “Associations” emergency operations center • Full power back-up via generator • “activated” as required • Direct communications with DHSS EOC • Large screen video to present public and secured audio/video communications • Healthcare Continuum partners have “seat” • Phone, fax, computer, Internet • Expandable as necessary • Could be used as DHSS EOC if primary EOC is rendered inoperable or inaccessible

29. MCC MCC MCC MCC MCC HACC HCC

30. Some “Preparedness Best Practice” observations…. • All disasters are “local” but may have widespread impact • Get involved and be informed whether as an individual, public sector employee, or private sector employee • Consider Community Emergency Response Team (CERT) involvement • www.citizencorps.gov • Consider Medical Reserve Corps (MRC) involvement • www.njmrc.nj.gov • Relationship development with all stakeholders “before the crisis” is key to maximizing plan effectiveness and minimizing negative impact • Public and private sectors as necessary and appropriate • Take Personal Responsibility, be aware, plan • Exercise your plan, analyze, use Continuous Improvement Quality management principles to minimize shortcomings

31. Disaster Preparedness-the process continues…… • Emergency/Disaster Planning that maximizes Preparedness does not just “happen”. It involves a well-understood and exercised plan and a “partnership” with all internal and external stakeholders coupled with “walk the talk” management support of a culture that promotes Preparedness. • The following ageless cliché is appropriate: “An Ounce of Prevention is Worth a Pound of Cure”

32. Let’s Discuss Further….. • Health Care Association of New Jersey • 4 AAA Drive, Suite 203 • Hamilton, New Jersey 08691 • Gary J. Schnerr • gary@hcanj.org • www.hcanj.org Thank You!