Hospital Preparedness Program Update

1. Hospital Preparedness Program Update Barbara Taylor Deputy Director for Public Health Emergency Preparedness California Department of Public Health May 2018

2. FY 2019 HPP Funding FormulaSchematic* B aseAmount Population Risk THREATS/HAZARDS CONSEQUENCE • Humanimpact • Potentialevent intensity • Terrorism • Natural disasters • Naturally occurringevents • Accidents • Recipient’s Population Proportion • U.S. CensusData $500,000(states and cities)or $250,000(territories) VULNERABILITY MODIFIER • Capacity for providingcare • RecipientInfrastructure • Vulnerablepopulations • Access tocare • Specialty care • TerrorismModifier • DiscretionaryModifier Manual cap ensures no recipient had a loss in funding from FY 18 larger than5%

3. Funding Formula Risk Components Consequence Vulnerability Threat/Hazard • Terrorism • Influenza • Damaging winds • Flashfloods • Flood • Icestorm/ Blizzard • Stormsurge • Tornado • Wildfire • Hurricane • Earthquake • Tsunami • HAZMAT release • Volcano • Radiological exposure • Rail accidents • Pre-planned special events Humanimpact • Capacity forproviding care • Staffed hospital beds per capita • Recipient Infrastructure Access tocare • Percent population within 25 or 50 miles of a hospital inurban or rural areas, respectively • CDC Social VulnerabilityIndex • Historical human impact: The number of people affected by a threat/hazard event type in the U.S. • State population: U.S. Census Day/Night Population Estimates • CBPinternational travel • Stateinfrastructure score Access to specialty care • Vulnerablepopulations • Elderly (65+ years); Children (0-8years); Electrically Dependent; Medicaid; Major behavioral health diagnosis Potential eventintensity • ABA certifiedburn units perCapita • Trauma I and II centers percapita • Pediatric beds per capita • Long-term care beds per capita • Historical Incidence of billion- dollar events in the U.S. will be used as multiplier to modify the human impactconsequence

4. New HPP FOAStructure HPPREADINESSAND OPERATIONSCYCLE CAPABILTIY OBJECTIVES CAPABILITIES Capability 1: Foundationfor Health Care and Medical Readiness Capability2: Health Care and Medical Response Coordination Planand Prepare Trainand Equip Evaluate & Share Lessons Learned Exercise/ Respond Outline the objectives insideof eachcapability Capability 3: Continuity of Health Care ServiceDelivery Capability4: MedicalSurge

5. HPP and PHEPAlignment • ASPR’s Hospital Preparedness Program (HPP) and CDC’s Public Health Emergency Preparedness (PHEP) grantsremain programmaticallyaligned • Separate grants management: ASPR GrantsManagement • Continued coordination of private health care sector and state and local public healthsector • Continued joint HPP and PHEP activities

6. Joint HPP and PHEPActivities • Exercises and Response: • Joint statewide exercise including surge of patients into healthcaresystem • Federal health care situational awareness initiatives • Common operating picture, information sharing platforms • Management ofvolunteers • Ensure the ability to surge to meet the demands during a highly infectious diseaseresponse • Plan andPrepare: • Administrative preparedness activities andJurisdictional Risk Assessment (JRA) • Inclusive planning for whole community, including Health Care Coalitions (HCCs)and SME groups (formerly described as planning for at-risk and vulnerablepopulations) • All-hazards response planning, including MCM, infectious diseases, provision of medical care in shelters, and HCC coordination and communication • Evaluate and Share LessonsLearned • SubmitAAR/IPs • Train andEquip: • Provide PIO and PPE training andeducation Saving Lives. ProtectingAmericans.

7. HCC AnnualRequirements BENCHMARKS Subject towithholding SELECTADDITIONALREQUIREMENTS Verified with HCC Budget, Work Plan orResponse Plan UploadedinCAT Verified During Sitevisit Uploaded inCAT • Clinical Advisorengagement • Readiness & Response Coordinatorengagement • NIMS Implementation • HCC Information System Training • CommunicationCoordination • Staff / Volunteer Management • ResourceInventory Assessment • HCCGovernance • HCC HVA • HCCPreparedness Plan • HCC TrainingPlan • HCC ResponsePlan • Inventory ManagementProtocol (ifapplicable) • NDMS FCCExercise (if applicable) – AAR/IP • HCC ResponsePlan Annexes • HCC AnnualBudget • HCC Annual WorkPlan • Pre-EventEEIs • Coalition SurgeTest • Performance Measures (must also be submitted to recipient) • HCC Staffingx2 (1FTE) • Projects tiedto Hazards/Risks • HCC EEI Integration

8. HCC Fiscal YearRequirements • 2019 • SurgeEstimator • PediatricSurge Annex • PediatricAnnex TTX • 2021 • PIOTraining • HCC COOPPlan • Supply ChainAssessment • Infectious DiseaseAnnex • CSC Integration • Infectious DiseaseTTX • CSC Exercise(if applicable) • SurgeEstimator • 2022 • RadiationSurge Annex • RadiationAnnex TTX • 2023 • ChemicalSurge Annex • ChemicalAnnex TTX • SurgeEstimator • 2020 • BurnSurge Annex • Clinical Info SharingSOP • BurnAnnex TTX All Years • NDMS FCC Exercise (ifapplicable)

9. HPP – What’sNew? 4 5 6 1 2 3 Develop HCC specialty surgeannexes Encourageadditional HCCmembership Designate lead or co- lead hospital and 1FTE Complete HCC Surge Estimator Tool Flexibility for geographically isolated areas (FAR 4 + 60 miles between hospitals) Encourage hospital partnerships withNDMS

10. Encourage Additional HCCMembership The four core members of HCCs will remain the same. However, HPP encourages additional representation from these functional entities that are required to support acute health care service delivery. These are not limited to thefollowing: • Medical supply chainorganizations • Pharmacies • Bloodbanks • Long term careorganizations • Clinicallabs • Federal health careorganizations • Outpatient carecenters • In addition, all HCC inpatient facilities, must demonstrate existing transferagreements • specifically to the following specialty carecenters: • Pediatriccenters • Trauma and burncenters

11. Designate Lead or Co-Lead Hospital and 1FTE All HCCs should designate a lead or co-lead hospital or health careorganization. All HCCs mustfundat least 1.0 FTE (combined and may include in-kind support of dedicated time) to support the following role requirements. The breakdown is at the discretion of the HCC and recipient. HCC READINESSAND RESPONSECOORDINATOR CLINICALADVISOR Provide clinical guidance and coordination pertaining to acute medical surge readiness and response for CBRNE, trauma, burn, and pediatricemergencies. Individual must be clinically active – Oversee planning, training, exercising, operational readiness, financial sustainability, and evaluation of theHCC.

12. Encourage Hospital Partnerships withNDMS Hospitals should enter into formal agreements with the National Disaster Medical System (NDMS) to serve as receiving facilities ifthey: Meet the eligibility criteria for participation in theNDMS 1 2 Are members of HPP-fundedHCCs This is intended to improve the recipient and HCC's surge capacity and enhance hospital preparedness in response to a medical surgeevent.

13. National Disaster Medical Center(NDMS) At least once during the project period, HCCs with an FCC must participate in the NDMS patient movementexercise.

14. Develop HCC-Level Specialty SurgeAnnexes • HCCs will develop complementary coalition-level annexes to their base surge capacity/trauma mass casualty response plan to manage a large number of casualties with specific needs. • Five annexes will be developed and tested through tabletop exercises over the course of five years in thisorder: Pediatric Burn InfectiousDisease Radiation Chemical FY2019 FY2020 FY2021 FY2022 FY2023

15. Complete HCC Surge Estimator Tool HCCs must complete the HCC Surge Estimator Tool to support coalitions in determining surge capacity. Three distinct variables drive rapid development of surge capacity and vary significantly betweenhospitals: Use of all available “staffed” beds, including closed units that could be rapidly re- opened with appropriate staff but are otherwise equipped and appropriate for inpatientcare 1 Use of pre-induction, post-anesthesia, and procedural area beds that can be used for temporary inpatient care, usually at an intermediate care (telemetry) or higherlevel 2 Ability to generate space or reduce the numbers of patients requiring evacuation by early discharge of appropriate current inpatients to support surgedischarge 3

16. Flexibility for Geographically IsolatedAreas • ASPR is providing flexibility by adding additional locations to existing territory/FASguidance • Hospitals located in geographic regions that are classified by both criteria below are eligible for classification as an "isolated frontier hospital“ and will be offered modified objectives, activities, and funding requirements • Geographic US Region classified as Frontier and Remote (FAR)4 • Greater than 60 miles from nearest hospital / inpatient facility

17. Health Care Essential Elements of Information(EEI) • HCCrequirement: • Within the first 90 days of each budget period, all HCCs must provide ASPR anupdated pre-event specific EEI template. ASPR will provide recipients with a list of all required post-event and special-event EEIs for incorporation into state, local, and HCC reportingsystems. • HCC Requirement: • The HCC and its members must, at a minimum, define and integrate into their response plans procedures for sharing essential elements of information (EEIs). This includes but is not limitedto: • The current operational status offacilities • Elements of electronic systems (HCC-levelrequirement) • Resource needs andavailability. • Upload in to the CAT a list of all required post-event and special-event elements will be provided for incorporation into state, local, and HCC reportingtemplates. *Content of presentation provided by ASPR WebEx meetings - April 2019