Presentation on theme: "Continuity of Operations Planning for Public Health and Medical Services Greg Morgan Contingency Planner Stacy A. Robarge-Silkiner SNS Coordinator."— Presentation transcript:
1Continuity of Operations Planning for Public Health and Medical Services Greg Morgan Contingency Planner Stacy A. Robarge-Silkiner SNS Coordinator KDHE Center for Public Health Preparedness
2Purpose of COOPEnsure the continued operation of organizations through a disaster (manmade, natural, technological) or a biological event (pan flu, anthrax, etc)Facilitate the preparation of, site or activity specific plans and procedures that help ensure the safety of personnelAllow organizational elements to continue essential operations in the event of an emergency or threat emergency.Health System leadership will ensure that personnel are aware of their assigned COOP responsibilities via devolution of staffing concepts and just in time training.
9Assumptions and Considerations COOP doesn’t apply to temporary disruptions of serviceCOOP plans will be operational within 12 hoursMaintain essential operations up to and beyond 30 days
108 January President Bush declared a major disaster for Kansas covering 44 counties in the state recovering from winter storms.
11Key Elements of COOP Planning Essential Functions Delegation of AuthorityOrder of SuccessionAlternate FacilitiesInteroperable CommunicationsPublic InformationVital RecordsHuman CapitalSecurityLogisticsTraining and Exercising
12Planning Essential functions are listed and prioritized Staffing requirements for each essential function are identifiedResource requirements for each essential function are identifiedCritical data and data systems for each essential function are identified
13Planning cont.Support activities are addressed as part of essential functionsPlans exist for attaining operational capability within 12 hoursProcesses and procedures exist to acquire resources necessary to continue essential functions and sustain operations for up to 30 days
15ProceduresProcedures for employee advisories, alerts and COOP/COG plan activation.Provisions for personnel accountability.Procedures exist for an annual review and revision of the COOP plan
16Alert and Notification Procedures Alert ProceduresCOOP activation under any condition With Warning:few hours warningdeployment of key personnel to a pre-determined location.Notification methodsWithout Warning:Terrorist/bio-terror attackAct of warNatural disaster Notification Procedures Notify proper authorities of COOP activationNotify the PT members Cell phone, pagers, blackberry, land-line, radio, etc
17Essential FunctionsIdentification and prioritization of essential functions necessary for agency continuity of operations. Essential functions include services that are:Loss of lifePublic health and safetyFood and Shelter24/7 Direct Care and Critical Ancillary Providers Economic impactSymbolic value
18Essential Functions agency specific Define the agency mission and goalsIdentify the functions that are needed to accomplish the missionIdentify the tasks to accomplish those functionsIdentify the resources needed to support those tasks
19Essential Function Prioritization Essential Function Prioritization rankingCritical- function cannot be delayedImportant- function can be delayed but should be resumed as soon as possibleNon-essential- function can be delayed until normal business operations resume
20Public Health Essential Functions Communicable Disease ContainmentImmunizationWomen, Infants, and Children (WIC) and Commodity Supplemental Food Program (CSFP)Family PlanningMaternal and Child Health (MCH)Child Care Licensing and RegistrationVital StatisticsFood ProtectionBioterrorism and Public Health ResponseHuman ResourcesFiscal ManagementPublic Information Officer (PIO)Public EducationHome Health/Hospice/In-Home Care ProgramInformation System SupportEnvironmental Health
21Hospital Essential Functions Patient Care including triage and treatment for inpatient and outpatient recipientsPatient movement to care centers with appropriate levels of care for patientsPostmortem care and disposition with appropriate community partnersPatient tracking including medical screeningsLong term care of elderly and other fragile populationsLab capabilities consistent with facility needMedical billing for procedures performedPatient decontamination and stabilizationFacility and personnel security for patients and employeesMeeting standards of care as required by State regulation or accrediting organization
22Courtesy of Doug Williams, St. Catherine Hospital, Garden City, Ks
23Courtesy of Doug Williams, St. Catherine Hospital, Garden City, Ks
24ExecutionTrain successors and delegates identified for essential functionsUpdate contact information for all staff24/7 facilities must include a plan for:StaffingMedication and food supplyMedical assessmentInfection controlCommunications
25Execution Provide devolution of essential functions for operation Identify:Critical systemsCapabilities to perform essential functions due to staff depletion Logistical support Services and infrastructure alternatives Communications Related computer/software issues
26Order of Succession vs Delegation of Authority Order of Succession-list of individuals who would sequentially assume responsibility if the primary staff person is no longer able to carry out their functionsDelegation of Authority-positions in which the primary staff person has the authority to complete a particular taskExample: The Kansas Director of Health is a physician as well as the administrative head of the department of health. In our COOP plan several persons who are not physicians are listed in the order of succession for Director of Health but his tasks as State Health Officer will be delegated to another person in the agency that is a physician.
27Order of SuccessionOrder of succession should be established for the highest positions of authority.i.e. Public Health Director, Hospital Administrator, Director of EMSLine of succession should be established for the other leadership positions.i.e. Infection Control Nurse, ER Head,Limitations on delegate authority should be listed
28Order of SuccessionRosters of trained/qualified personnel with the authority to perform essential functions and activities are maintainedRules and procedures for implementing order of succession should be establishedinitiating conditionsnotification methodsterminating conditions
29Order of succession for essential functions Three deepShould include Name and titlePoint of contact information for 24/7Same successor may be named for different positions but avoid listing the same person as the first successor to several key positions
30Courtesy of Doug Williams, St. Catherine Hospital, Garden City, Ks 1 January As of 1800 the following hospitals are still on generator power: Gove County Hospital, Santanta Distirct, Grisell Memorial, Ness County HospitalCourtesy of Doug Williams, St. Catherine Hospital, Garden City, Ks
31Delegation of Authority Delegation of Authority for each essential function should include: Name and title of delegatePosition title and/or source of authority being delegatedPoint of contact information (phone, cell, pager, …)Limitations (if any) or exceptions to the authority being delegatedDate or event that triggers delegation (Activation of COOP plan)Date of termination or revocation (i.e. 30 day)Name, title and signature of the official empowered to delegate the authority specified
32Delegation of Authority to sign for Schedule Drugs
33Command and ControlAll response agencies are required to use Incident Command System (ICS) and follow National Incident Management System (NIMS) requirements (Hospitals use HICS)Command staff provides overall coordination of the response and is the central communications pointOperations Section responsible for clinical duties including triage and treatment and directs all patient care resourcesLogistics Section responsible for providing facilities, services (food, billeting, communications) and materialsPlanning Section determines and provides for the achievement of each medical objective and manages human resourcesFinance/Administrative Section responsible for maintaining accounting records, issuing purchase orders, and stressing facility wide documentation
34Command and Control Form an Operations Team (OT) for your COOP Responsible for relocation activitiesEnsure all necessary and pre-planned communications systems are established and functioning properly Serve as the first shift operations at the alternate siteProvide cross training to personnel Utilize Job Action Sheets (JAS) and Just in Time (JIT) trainingEmploy call-down rosterAdvise staff where to reportWhat to bring
35Courtesy of Bob Hanzlick Lab Manager CMCI Colby Ks
36Alternate FacilitiesAlternate facilities may be needed in the event that the health care facility is damaged, destroyed or overwhelmedIn hospital terms: Alternate Care Site (ACS)Site for hospital administrationSite for hospital patient care functionsDefine ACSLocation for the delivery of medical care that occurs outside the acute hospital setting for patients who, under normal circumstances, would be treated as inpatients.Site may provide delivery of chronic care, the distribution of vaccines or medical countermeasures, or the quarantine, cohorting, or sequestration of potentially infected patients in the context of an easily transmissible infections diseaseIn Health Department terms this could be a PODMass Medical Care with Scarce Resources: A Community Planning Guide, Health Systems Research Inc.
37Alternate Facilities Consider: FMS, EMEDS, NDMS, Field Hospitals level and scope of care to be deliveredfoot print or size neededstaffing requirementsequipment and suppliesICS structure needed to integrate this facility with other health facilities in the eventSecurityStaffingCommunicationsEMS and other transportation issuesrules/policies for operationFMS, EMEDS, NDMS, Field Hospitals
38Alternate Facilities Plan should identify: Logistical considerations (utility services, food, water, etc.)Pre-positioning of resourcesHot site- pre-wiredCold site- needs installationProvisions for establishing interoperable communications with all identified essential internal and external organizations, critical customers and the publicProvisions to sustain operations for a period of up to 30 days24/7 OperationsConsiderations for the health and safety of relocated employeesPhysical security and access controlsCo-location and duel useFormal agreements (MOU, MOA)
39Alternate Facilities Lessons Learned from Katrina: Consider pre-planning and relationship building among agenciesUse of ICSPublic health (shower, toilets, amenities, hygiene)SecurityTransportation (EMS, self transported)Supplies (medical, pharmaceutical, food, water)CredentialingStaffingPatient tracking and documentationCommunicationPatient screeningPediatrics, geriatrics and psychiatric patientsAccessibility to the publicSpecial populations
40Alternate Facilities How to determine appropriate facilities Alternate Care Site Selection ToolBased on the Rocky Mountain Regional Care Model for BT EventsKansafiedDo a Hazard Vulnerability AnalysisDetermine population to be cared for at the designated siteTrain and Exercise
41Alternate Facilities Challenges: lack of regional/state planning with clear delineation of responsibility and authorityrequirement that multiple entities work together who normally don’tlack of inducements to write a plan train and exerciselicensing issues intra and interstatefundingStandards of care- whole different presentation
43Interoperable Communications Hardware/software that talks to each other and people that can communicate with each other in the same language (no codes)Systems that need to work together include radios, phones, faxes, , notification systems, IT systems, software, secure data systemsPeople that need to work together include Hospital, Health Department, EMS, Fire, Law Enforcement, Emergency Management, Social Services…Procedures and plans need to be written to specify how communication will work during COOP activationMaintain the capability to communicate with internal and external clients, critical customers and the public.
44Information Technology Information Technology (IT) needs should be a component of each essential functionConsider during planning:The essential function’s dependence on ITManaging the IT infrastructure during COOP activationHelp desk tasks to support IT needs for identified essential functionsAbility to provide remote access to programs
45Information Systems Support Each essential service area must define their unique or critical information system requirementsEach essential service area must define their equipment needs and availability of this equipmentWhere is it storedHow do we move itWhere do we get it if we do not have itIT contingency plansDesignate responsible individuals/departments within the organization for moving and reestablishing ITIf relocation to an alternate facility is necessary, these services could be allocated to support organizations
46Vital Records Vital Records Include: Emergency operating plans Policy and Procedural recordsLegal documentsFinancial recordsPersonnel filesPatient recordsProperty management (inventory)
47Vital Records Provisions for classified or sensitive data Procedures for data backup and restorationIdentify location and accessibility to vital recordsHow often are your vital records on computer backed-up?Do you have back-up records for all of the paper based records at your facility?Where are your back-up files kept? On site or off?
48“With Planning and Preparation we ensure our safety today and preserve the future for younger generations”
49Public InformationYour most important tool will be Public Information!Have trained back up PIO and spokes personsPlan for working out of a different location (i.e. JIC) Have a go-kitMaintain contact lists for mediaDevelop alternate methods of disseminationDevelop templates during pre-planning to avoid creating during an emergencyMessage mapsPress releasesInformation sheetsHow to find alternate sitesNavigation of alternate sites (Signs)
50Human Resources- HR Policies Plan for a reduction in work forceIdentify emergency policies for:OvertimeLeave with payLeave without payFlexible leave optionsVacation timeSick timeIdentify plans for employees to work from homeTele-workPotential health and safety issues Liability assessment by general counselUnion issues (overtime issues,disaster support, etc)Training on contingency planningEmployee Assistance Program (EAP) for mental health and health insurance provisions
51Human Resources-Employee Support Essential Staff functioning during a COOP activation may have different support needsPlans should include consideration for staff:TransportationFood and LodgingChild careElder carePet careConsider developing a Family Preparedness ProgramEncourage personal go-kits
52Safety and Security Concerns Emergency Planning CommitteeCounty Emergency Response Plan (Emergency Support Function 8).Hospital EOPs Ensure all necessary security and access controls are providedEnsure that local law enforcement authorities are notified concerning the status of the emergency.
53Logistics Food and water Fuel Billeting Medical Transportation Health, Safety, Personal
54Implementation Phases Phase I- Activation and Relocation0-12 HoursNotify facilities, organizational elements and personnel of impending COOP activationActivate plans to transfer to alternate facility, when necessary.Instruct Ops team to ready facility/alternate facility.Assemble documents/equipment required for essential functions at facility/alternate facility.Secure facilities.Continue essential functions at regular facility, if available, until alternate facility is ready if needed
55Implementation Phase II- Alternate Facility/Work Site Operations 12 Hours to Termination of EmergencyProvide guidance to preparedness team personnel and information to the public.Identify and brief replacements for missing or rotating personnelCommence full execution of operations supporting essential functions.Phase III- ReconstitutionTermination of EmergencyInform all personnel that the threat no longer exists.Supervise return to normal operating facility or normal business practices at original facility.Conduct an after action review of COOP plan execution and effectiveness.Develop a Corrective Action Plan
56Training and Exercising Plans include annual individual and team training of agency COOP/COG emergency personnel.Plans include annual agency testing and exercising of COOP/COG plans and procedures.Plans include quarterly testing of emergency alert and notification procedures.Plans include refresher orientation for COOP/COG staff.Plans include inter-agency exercising of COOP/COG plans where applicable and feasible.
571 January Santanta District Hospitals update: Gas tanker has hooked up the long term care center associated with the hospital and the heat/power are both back on-line. Hospital advises that if this continues to be effective another truck will be hooked up the power the emergency department so that patients may be stabilized.
58References:CIDRAP- 10-Point Framework for Pandemic Influenza Business Contingency PlanningMassachusetts Department of Public Health- COOP for Massachusetts Government AgenciesCommonwealth of Pennsylvania- COOP Template 2005Florida Department of Health/Okeechobee County Health Department- COOPRocky Mountain Regional Care Model for Bioterroist Events- Alternate Care Site Selection ToolKDHE- Alternate Care Site Selection ToolKDHE- HVA Tool and Gap AnalysisKDHE- Business Impact Analysis Template
59Contact InformationStacy Robarge-SilkinerSNS CoordinatorKansas Department of Health and EnvironmentGreg MorganContingency PlannerKansas Depatment of Health and Environment