Survival of the Fittest: Engage Effectively in Emergency Preparation

1. Survival of the Fittest: Engage Effectively in Emergency Preparation Carolyn Ross, RN, MSN, COHN-S Going for the Gold • APHCA 2012 Annual Conference and Trade Show September 25 - 27, 2012 • Perdido Beach Resort, Orange Beach

2. Emergency Management Program:Community Health Centers Going for the Gold • APHCA 2012 Annual Conference and Trade Show September 25 - 27, 2012 • Perdido Beach Resort, Orange Beach

3. Role of Community Health CentersNon-Disaster Times • Community Health Centers: • Provide access to medical care for: • Vulnerable population groups • Uninsured • Poor • Rural or remote locations • Future Role • Healthcare Reform – push to increase the number of CHCs? Going for the Gold • APHCA 2012 Annual Conference and Trade Show September 25 - 27, 2012 • Perdido Beach Resort, Orange Beach

4. Enhancing Community Disaster Preparedness and Response Building a Foundation of Capabilities: Tools, Templates, Plans, Supplies, Training Commitment & Leadership Risk Threats/ Lessons Learned Mandates/Legislation Meeting the Disaster Challenge: Collaboration, Partnerships HTVA HTVA Other Disasters Terrorism Earthquakes Hurricanes Tornadoes

5. Community Health Centers Role in Disasters Community Health Centers play a vital role in community disaster response by: • Managing Internal Emergencies • Mass Casualty Care • Reception and Triage • Reception of Hospital Overflow • Maintaining Ongoing Routine Patient Care • Mental Health Services • Bio-Agent Identification and Reporting • Staff Protection • Mass Prophylaxis • Hazardous Material Response • Risk Communication • Provide Volunteer Staff • Receive/Utilize Volunteers • Community/Clientele Preparedness • Sheltering

6. Types of Post-Disaster Response Facilities • Permanent • Hospitals • Acute Care Facilities • Primary Care Facilities • Community Health Centers • Public Health Centers • State Health Agencies • Physician Offices • Urgi- Care Centers • Temporary • Mass Shelters • Medical Needs Shelters • Comfort Care Centers • Alternative Care Sites

7. Underlying Theory of Emergency Response Most emergencies are limited in scope and range, and are managed at the local level In this context – CHCs are a vital part of effective emergency response in the communities they serve.

8. SECTION 2 NIMS/ICS/NRF

9. Emergency Response Related Federal Policies National Incident Management System (NIMS) Incident Command System (ICS) National Response Framework (NRF) DHHS requires that healthcare organizations implement NIMS in order to eligible for preparedness funding through ASPR/HPP program. (* Changes July 1, 2012)

10. NIMS National Incident Management System Established to create uniformity: • Organization Structure (ICS) • Plans • Training/Exercises Organization • Resources • Communications/Technology Organization

11. NIMS- Outline of the 11 Elements • Adoption of NIMS…throughout the healthcare organization including all appropriate departments and business units. • Federal Preparedness awards support NIMS Implementation…in accordance with the eligibility and allowable use of the awards. • Revise and Update EOPs, SOPs and SOGs to incorporate NIMS components. • Mutual-Aid and/or Assistant Agreements…to include public/private sector and non-governmental organizations. • Training and Exercises(IS 100,200, 700) 6.Training and Exercises (IS 800) 7. Apply NIMS and ICS to all training and exercises 8. Processes, equipment, communication and data interoperability • Common and Consistent Terminology • Manage events with ICS and NIMS 11. Adopt Public Information (PI) Principles by using both JIS and JIC During Events

12. ICS Incident Command System

13. September 2012 Incident Command CHC Incident Commander [Administrator] Liaison Officer (Facility Representative) [Nursing Director] Pubic Information (Media/Public Relations) [PIO/Administrator] Medical/Technical Specialists [Medical Director] Safety Officer (Facility Safety Prgm) [Maintenance] Planning Chief [Asst. Administrator] Logistics Chief [Asst Administrator] Finance Chief [Business Mgr.] Operations Chief [Medical Director] Situation Unit (Information Manager) [? Admin ?] Services (Essential Services) [? Director ?] Personnel Time (Employee/Volunteer Time Accounting) [Payroll Dept.] Medical Care (Healthcare Services) [Nursing Director] Documentation (Information Records) [Med. Records Dir.] Support (Essential Resources) [? Director ?] Infrastructure (Facility Management) [Maintenance] Procurement/ Claims/Costs (Obtaining Resources) [Risk/QM] Security (Campus Security) [Security/Maintenance] Staging (Resource Gathering) [? Director ?] * Suggested Positions – ICS vs. Daily Duties

14. To have an effective EMP each CHC should: • Build Healthcare Coalitions through existing relationships with natural partners at the local level: • Hospitals • County Health Departments (ESF-8) • Emergency Management Agencies • Build on existing relationships with natural partners at the state level: • State Hospital Associations • State Health Department • State Emergency Management

15. State Primary Care Associations CHCs are encouraged to work with their associated State Primary Care Association. The State Primary Care Association is expected to provide state leadership to the CHC through: • Integration of health centers into Statewide and community preparedness and response plans • Direct assistance in the area of Emergency Preparedness Planning to CHCs

16. National Response Framework Went into effect in March 2008. Updated and revised the National Response Plan. The NRF establishes . . . • Federal coordination structures/mechanisms • Direction for incorporation of existing plans • Consistent approach to managing incidents COORDINATION

17. Relationship: NIMS vs. NRF • NIMS • Aligns command, control, organization structure, terminology, communication protocols, & resources/resource-typing • Used for all events Resources Knowledge Federal Abilities • NRF • Integrates & applies Federal resources, knowledge, & abilities before, during, & after an incident • Implemented for incidents requiring Federal coordination Response or Support State Response or Support Local Response Incident

18. NRF Structure Base Framework Describes the domestic incident management structures and processes Include acronyms, definitions, authorities, and a compendium of national interagency plans Appendixes Describe the structures and responsibilities for coordinating incident resource support Emergency Support Function Annexes - 15 Support Annexes Provide guidance for the functional processes and administrative requirements Incident Annexes Address contingency or hazard situations requiring specialized application of the NRF

19. Scope of Emergency Support Functions ESF #5 – Emergency Management Homeland Security/FEMA • Coordination of incident management and response efforts • Issuance of mission assignments • Resource and human capital • Incident action planning • Financial management ESF #6 – Mass Care, Emergency Assistance, Housing, and Human Services Homeland Security/FEMA • Mass care • Emergency assistance • Disaster housing • Human services ESF #7 – Logistics Management and Resource Support Homeland Security/FEMA • Comprehensive, national incident logistics planning, management, and sustainment capability • Resource support (facility space, office equipment and supplies, contracting services, etc.) ESF #8 – Public Health and Medical Services Dept Health & Human Srvcs. • Public health • Medical • Mental health services • Mass fatality management

20. Tiered Response to Disaster Federal Response DHHS Tier 6 ----------- Inter-state Coordination Tier 5 ---------- Region 4 DHHS Tier 4 ---------- Intra-state Coordination ADPH/CEP Area Jurisdiction Response: Area Health Care Coalition Tier 3 --- Area PH County Jurisdiction Response: County Health Care Coalition Tier 2 --- County PH Health Care Facility Response HCF Tier 1 ---- Going for the Gold • APHCA 2012 Annual Conference and Trade Show September 25 - 27, 2012 • Perdido Beach Resort, Orange Beach

21. Alabama Department of Public Health Area Emergency Preparedness Teams Going for the Gold • APHCA 2012 Annual Conference and Trade Show September 25 - 27, 2012 • Perdido Beach Resort, Orange Beach

22. SECTION 3 EXAMPLES OF CHC ACTIVITIES DURING EMERGENCY RESPONSES

23. Common Post Disaster Healthcare Needs Post-Katrina 78%Primary care for acute & chronic conditions Recovery Period – First Month post Katrina: • Injuries – 22% • Major 8%, minor 92% • Illnesses – 28% • Skin / Wound infection • URI / LRI • Rashes and Stings • N & V, Diarrhea • Mental Health • Chronic Disease - 50% • Decrease in Medication Refills • Re-establishing Chronic Disease management

24. CHC Response to Hurricane Katrina in New Orleans In the aftermath of Hurricane Katrina, West Jefferson Hospital collaborated with a CHC to set up ‘shop’ across the street in an evacuated nursing home facility- to handle the ‘over flow’ primary care need patients out of the West Jefferson ER. West Jefferson Hospital Patient Flow: Pre-Katrina: 300-400 pat./day Post Katrina- 2-3000 pt./day Triage: Set up in West Jefferson Hospital Parking Lot- DMAT Nurses performed ‘drive through triage’ (Triaged over 200, 000 patients) Treatment: Emergent patients were routed to the ER for treatment Non emergent- Primary Care patients were sent to CHC established at Meadowcrest Hospital

25. CHC Response to Hurricane Katrina in New Orleans Collaboration • Results: • West Jefferson Hospital Emergency Room was “more free” to handle the true emergencies • Primary Care Patients care needs were taken care of in an efficient and effective manner • The community’s needs were met through creative and collaborative partnering between West Jefferson Hospital and the Community Health Center

26. SECTION 4 AIMS ALABAMA INCIDENT MANAGEMENT SYSTEM

27. Currently there are 12 unique modules: • EOC Modules • State & Area Operations views • Hospital Liaison Module • Medical Needs Shelter Module • Community Health Center Module • Nursing Home Module • Dialysis Center Module • Emergency Medical Services Module • Mass Care Shelter Module • Alternate Care Facility Module • Blood Center Module • Surveillance Module *(H1N1) • Patient Tracking Module

28. Community Health Center Module https://www.al.aimslive.org http://training.aimslive.org Contacts: Center for Strategic Health Innovation 251-461-1805 David Wallace DWallace@usouthal.edu James Muisyo jmuisyo@usouthal.edu Carolyn Ross carolynross@usouthal.edu

29. SECTION 5 COMPONENTS OF AN EMP PLAN

31. SECTION 6 National Center for Disaster Medical Response (NCDMR) University of South Alabama Mobile, AL dwallace@usouthal.edu carolynross@usouthal.edu 251-461-1805

33. 2012-2013 ARRTC Training Topics • Chemical Awareness • Radiological Awareness • Biological Awareness • NFR • Blast/Explosive Awareness • IS 100, 200, 700, 800 • Decontamination • PPE • Rapid Assessment and Disaster Triage • Altered Standards • PODS/SNS • Current Topics NIMS NIMS Requirements for Healthcare Facilities NFR ICS IS 100, 200, 700, 800 HTVA and Disaster Plans Surge Capacity COOP Altered Standards Fatality Management Emergency Operations Center/AIMS Evacuation Training: ARRTC Basic- 2 day in-house training at CSHI ARRTC Road Show- 1 day customized training at your site

34. QUESTIONS? Going for the Gold • APHCA 2012 Annual Conference and Trade Show September 25 - 27, 2012 • Perdido Beach Resort, Orange Beach