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Continuity of Operations Planning for Public Health and Medical Services Greg Morgan Contingency Planner Stacy A. Robarge-Silkiner SNS Coordinator.

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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:

1 Continuity 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

2 Purpose of COOP Ensure 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 personnel Allow 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.


4 Hazard Vulnerability Assessment
Probability of an event occurring and the impact the event would have on departmental and system wide operations Clara Barton Hospital Hoisington, Ks


6 Hazard Vulnerability Tool
Allows individual health agencies to identify and rank various risk and mitigating factors Coordinate with local law enforcement and emergency management HVA Tool

7 Hazard Vulnerability Gap Analysis
Priority projects related to health agency emergency preparedness. Interprets results of HVA into useable format HVA Gap Analysis


9 Assumptions and Considerations
COOP doesn’t apply to temporary disruptions of service COOP plans will be operational within 12 hours Maintain essential operations up to and beyond 30 days

10 8 January President Bush declared a major disaster for Kansas covering 44 counties in the state recovering from winter storms.

11 Key Elements of COOP Planning Essential Functions
Delegation of Authority Order of Succession Alternate Facilities Interoperable Communications Public Information Vital Records Human Capital Security Logistics Training and Exercising

12 Planning Essential functions are listed and prioritized
Staffing requirements for each essential function are identified Resource requirements for each essential function are identified Critical data and data systems for each essential function are identified

13 Planning cont. Support activities are addressed as part of essential functions Plans exist for attaining operational capability within 12 hours Processes and procedures exist to acquire resources necessary to continue essential functions and sustain operations for up to 30 days


15 Procedures Procedures 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

16 Alert and Notification Procedures
Alert Procedures COOP activation under any condition  With Warning: few hours warning deployment of key personnel to a pre-determined location. Notification methods Without Warning: Terrorist/bio-terror attack Act of war Natural disaster  Notification Procedures   Notify proper authorities of COOP activation Notify the PT members  Cell phone, pagers, blackberry, land-line, radio, etc

17 Essential Functions Identification and prioritization of essential functions necessary for agency continuity of operations. Essential functions include services that are: Loss of life Public health and safety Food and Shelter 24/7 Direct Care and Critical Ancillary Providers                                    Economic impact Symbolic value

18 Essential Functions agency specific
Define the agency mission and goals Identify the functions that are needed to accomplish the mission Identify the tasks to accomplish those functions Identify the resources needed to support those tasks

19 Essential Function Prioritization
Essential Function Prioritization ranking Critical- function cannot be delayed Important- function can be delayed but should be resumed as soon as possible Non-essential- function can be delayed until normal business operations resume

20 Public Health Essential Functions
Communicable Disease Containment Immunization Women, Infants, and Children (WIC) and Commodity Supplemental Food Program (CSFP) Family Planning Maternal and Child Health (MCH) Child Care Licensing and Registration Vital Statistics Food Protection Bioterrorism and Public Health Response Human Resources Fiscal Management Public Information Officer (PIO) Public Education Home Health/Hospice/In-Home Care Program Information System Support Environmental Health

21 Hospital Essential Functions
Patient Care including triage and treatment for inpatient and outpatient recipients Patient movement to care centers with appropriate levels of care for patients Postmortem care and disposition with appropriate community partners Patient tracking including medical screenings Long term care of elderly and other fragile populations Lab capabilities consistent with facility need Medical billing for procedures performed Patient decontamination and stabilization Facility and personnel security for patients and employees Meeting standards of care as required by State regulation or accrediting organization

22 Courtesy of Doug Williams, St. Catherine Hospital, Garden City, Ks

23 Courtesy of Doug Williams, St. Catherine Hospital, Garden City, Ks

24 Execution Train successors and delegates identified for essential functions Update contact information for all staff 24/7 facilities must include a plan for: Staffing Medication and food supply Medical assessment Infection control Communications

25 Execution Provide devolution of essential functions for operation
Identify: Critical systems Capabilities to perform essential functions due to staff depletion  Logistical support  Services and infrastructure alternatives  Communications  Related computer/software issues

26 Order 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 functions Delegation of Authority-positions in which the primary staff person has the authority to complete a particular task Example: 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.

27 Order of Succession Order of succession should be established for the highest positions of authority. i.e. Public Health Director, Hospital Administrator, Director of EMS Line of succession should be established for the other leadership positions. i.e. Infection Control Nurse, ER Head, Limitations on delegate authority should be listed

28 Order of Succession Rosters of trained/qualified personnel with the authority to perform essential functions and activities are maintained Rules and procedures for implementing order of succession should be established initiating conditions notification methods terminating conditions

29 Order of succession for essential functions
Three deep Should include  Name and title Point of contact information for 24/7 Same successor may be named for different positions but avoid listing the same person as the first successor to several key positions

30 Courtesy 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 Hospital Courtesy of Doug Williams, St. Catherine Hospital, Garden City, Ks

31 Delegation of Authority
Delegation of Authority for each essential function should include:     Name and title of delegate Position title and/or source of authority being delegated Point of contact information (phone, cell, pager, …) Limitations (if any) or exceptions to the authority being delegated Date 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

32 Delegation of Authority to sign for Schedule Drugs

33 Command and Control All 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 point Operations Section responsible for clinical duties including triage and treatment and directs all patient care resources Logistics Section responsible for providing facilities, services (food, billeting, communications) and materials Planning Section determines and provides for the achievement of each medical objective and manages human resources Finance/Administrative Section responsible for maintaining accounting records, issuing purchase orders, and stressing facility wide documentation

34 Command and Control Form an Operations Team (OT) for your COOP
Responsible for relocation activities Ensure all necessary and pre-planned communications systems are established and functioning properly     Serve as the first shift operations at the alternate site Provide cross training to personnel  Utilize Job Action Sheets (JAS) and Just in Time (JIT) training Employ call-down roster Advise staff where to report What to bring

35 Courtesy of Bob Hanzlick Lab Manager CMCI Colby Ks

36 Alternate Facilities Alternate facilities may be needed in the event that the health care facility is damaged, destroyed or overwhelmed In hospital terms: Alternate Care Site (ACS) Site for hospital administration Site for hospital patient care functions Define ACS Location 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 disease In Health Department terms this could be a POD Mass Medical Care with Scarce Resources: A Community Planning Guide, Health Systems Research Inc.

37 Alternate Facilities Consider: FMS, EMEDS, NDMS, Field Hospitals
level and scope of care to be delivered foot print or size needed staffing requirements equipment and supplies ICS structure needed to integrate this facility with other health facilities in the event Security Staffing Communications EMS and other transportation issues rules/policies for operation FMS, EMEDS, NDMS, Field Hospitals

38 Alternate Facilities Plan should identify:
Logistical considerations (utility services, food, water, etc.) Pre-positioning of resources Hot site- pre-wired Cold site- needs installation Provisions for establishing interoperable communications with all identified essential internal and external organizations, critical customers and the public Provisions to sustain operations for a period of up to 30 days 24/7 Operations Considerations for the health and safety of relocated employees Physical security and access controls Co-location and duel use Formal agreements (MOU, MOA)

39 Alternate Facilities Lessons Learned from Katrina:
Consider pre-planning and relationship building among agencies Use of ICS Public health (shower, toilets, amenities, hygiene) Security Transportation (EMS, self transported) Supplies (medical, pharmaceutical, food, water) Credentialing Staffing Patient tracking and documentation Communication Patient screening Pediatrics, geriatrics and psychiatric patients Accessibility to the public Special populations

40 Alternate Facilities How to determine appropriate facilities
Alternate Care Site Selection Tool Based on the Rocky Mountain Regional Care Model for BT Events Kansafied Do a Hazard Vulnerability Analysis Determine population to be cared for at the designated site Train and Exercise

41 Alternate Facilities Challenges:
lack of regional/state planning with clear delineation of responsibility and authority requirement that multiple entities work together who normally don’t lack of inducements to write a plan train and exercise licensing issues intra and interstate funding Standards of care- whole different presentation


43 Interoperable 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 systems People 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 activation Maintain the capability to communicate with internal and external clients, critical customers and the public.

44 Information Technology
Information Technology (IT) needs should be a component of each essential function Consider during planning: The essential function’s dependence on IT Managing the IT infrastructure during COOP activation Help desk tasks to support IT needs for identified essential functions Ability to provide remote access to programs

45 Information Systems Support
Each essential service area must define their unique or critical information system requirements Each essential service area must define their equipment needs and availability of this equipment Where is it stored How do we move it Where do we get it if we do not have it IT contingency plans Designate responsible individuals/departments within the organization for moving and reestablishing IT If relocation to an alternate facility is necessary, these services could be allocated to support organizations

46 Vital Records Vital Records Include: Emergency operating plans
Policy and Procedural records Legal documents Financial records Personnel files Patient records Property management (inventory)

47 Vital Records Provisions for classified or sensitive data
Procedures for data backup and restoration Identify location and accessibility to vital records How 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”

49 Public Information Your most important tool will be Public Information! Have trained back up PIO and spokes persons Plan for working out of a different location (i.e. JIC) Have a go-kit Maintain contact lists for media Develop alternate methods of dissemination Develop templates during pre-planning to avoid creating during an emergency Message maps Press releases Information sheets How to find alternate sites Navigation of alternate sites (Signs)

50 Human Resources- HR Policies
Plan for a reduction in work force Identify emergency policies for: Overtime Leave with pay Leave without pay Flexible leave options Vacation time Sick time Identify plans for employees to work from home Tele-work Potential health and safety issues   Liability assessment by general counsel Union issues (overtime issues,disaster support, etc) Training on contingency planning Employee Assistance Program (EAP) for mental health and health insurance provisions

51 Human Resources-Employee Support
Essential Staff functioning during a COOP activation may have different support needs Plans should include consideration for staff: Transportation Food and Lodging Child care Elder care Pet care Consider developing a Family Preparedness Program Encourage personal go-kits

52 Safety and Security Concerns
Emergency Planning Committee County Emergency Response Plan (Emergency Support Function 8). Hospital EOPs  Ensure all necessary security and access controls are provided Ensure that local law enforcement authorities are notified concerning the status of the emergency.

53 Logistics Food and water Fuel Billeting Medical Transportation
Health, Safety, Personal

54 Implementation Phases
Phase I- Activation and Relocation 0-12 Hours Notify facilities, organizational elements and personnel of impending COOP activation Activate 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

55 Implementation Phase II- Alternate Facility/Work Site Operations
12 Hours to Termination of Emergency Provide guidance to preparedness team personnel and information to the public. Identify and brief replacements for missing or rotating personnel Commence full execution of operations supporting essential functions. Phase III- Reconstitution Termination of Emergency Inform 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

56 Training 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.

57 1 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.

58 References: CIDRAP- 10-Point Framework for Pandemic Influenza Business Contingency Planning Massachusetts Department of Public Health- COOP for Massachusetts Government Agencies Commonwealth of Pennsylvania- COOP Template 2005 Florida Department of Health/Okeechobee County Health Department- COOP Rocky Mountain Regional Care Model for Bioterroist Events- Alternate Care Site Selection Tool KDHE- Alternate Care Site Selection Tool KDHE- HVA Tool and Gap Analysis KDHE- Business Impact Analysis Template

59 Contact Information Stacy Robarge-Silkiner SNS Coordinator Kansas Department of Health and Environment Greg Morgan Contingency Planner Kansas Depatment of Health and Environment

60 Questions????

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