1. Biggest Pitfalls and Best Practices in Emergency Management Healthcare Engineering Consultants Strategies for the 2011 Emergency Management Standards

2. Emergency Management Healthcare Engineering Consultants The organization of the standards : EM.01.01.01: Plans for managing emergencies, including HVA EM.02.01.01: Emergency operations plan (EOP) developed – Direct Impact! EM.02.02.01: Establishes emergency communication strategies EM.02.02.03: Establishes strategies for managing resources EM.02.02.05: Establishes strategies for managing safety and security EM.02.02.07: Defines and manages staff roles and responsibilities EM.02.02.09: Identifies an alternative means for providing utilities EM.02.02.11: Identifies strategies for patient management EM.02.02.13: Privileges to LIP’s – Direct Impact! EM.02.02.15: Privileges to volunteer staff – Direct Impact! EM.03.01.01: Annual effectiveness review EM.03.01.03: Regularly tests the emergency operations plan

3. Emergency Management Healthcare Engineering Consultants Issue: Emergency Management Committee Best Practice: Dedicated EM committee not required, but suggested Leadership and physicians should be committee members and participate in planning The committee should perform the following functions: - Review the HVA annually - Plan for emergency drills - Evaluate actual emergencies and drills Plan for other emergency activities

4. Emergency Management Healthcare Engineering Consultants Issue: Hazard Vulnerability Analysis (HVA) Best Practice: A Hazard Vulnerability Analysis (HVA) is performed and documented, for each geographically separate location The HVA includes a numerical score The hazards are prioritized The HVA is used to define Mitigation and Preparedness The HVA includes the “disaster level” to determine how long the resource timeline charts must be for specific emergencies The HVA is reviewed and revised, as necessary, annually

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6. Emergency Management Healthcare Engineering Consultants Issue: Create an Emergency Operations Plan (EOP) Best Practice: Written EOP developed with participation by leadership and physicians EOP describes response procedures for HVA determined events EOP describes procedures for 96-hour community non-support EOP describes the recovery phase of disasters based on HVA EOP identifies the individual(s) who have the authority to activate the incident command function and phases EOP includes descriptions of the six critical core areas: 1) communications; 2) resources and assets; 3) safety and security; 4) staff roles; 5) utility management, and; 6) patient management EOP “crosswalk” is completed to locate required elements EOP is reviewed and revised, as necessary, annually

7. Emergency Management Healthcare Engineering Consultants Incident Commander Public Info Officer Liaison Officer Safety Officer Med/ Tech Specialist(s) Operations Section Chief Planning Section Chief Logistics Section Chief Finance/ Admin Section Chief HICS Organizational Chart

8. Emergency Management Healthcare Engineering Consultants Issue: 96-hour Timeline Charts Biggest Pitfall: Stocking supplies for 96-hours Best Practice:  Create color-coded timeline charts that indicate how long utilities will be operational and how long consumable supplies will be available in the event of an emergency in which no re-supply is possible  Ensure that decisions are made to determine whether any utility or supply changes will be implemented to extend “green” or “yellow” zones  Create timeline charts for all of the Level 3 scenarios from the HVA; the timeline is dependent upon the Level 3 duration (how many hours?) Level 1: Supplies are available and are ordered and received Level 2: Internal supply shortages or utility failures require partial or total patient evacuation from the facility Level 3: Shortages and/ or utilities are not sufficient to continue normal patient care, although evacuation is not possible and outside assistance is not available

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11. Emergency Management Healthcare Engineering Consultants Based on the duration of the Level 3 scenario, the timeline may only extend to 24 or 48 hours, rather than 96 24 hours48 hours

12. Emergency Management Healthcare Engineering Consultants Issue: Emergency Communication Strategies Best Practices:  Create notification charts with phone numbers, email addresses, etc.  Include for staff, external authorities, community, media, vendors  Determine what information will be shared with other health care providers in the area  Ensure that liaisons are established with government agencies  Verify that MOU’s for alternative care sites are updated  Establish and check operation of back-up communication systems, such as the internet, cell phones, two-way radios, emergency land lines, and amateur radio operators

13. Emergency Management Healthcare Engineering Consultants Issue: Resource and Asset Strategies Best Practice:  Plans should be in place to stockpile and reorder critical clinical and non-clinical supplies (supply inventory should be checked routinely)  Written procedures should describe how the needs of staff and families of staff will be met during an emergency  A plan to share community resources and assets should be in place  A practical patient evacuation plan that includes partial or total evacuation outside of the facility is required  Logistics for evacuation must include: 1) transportation; 2) staffing; 3) medications; 4) equipment, and; 5) the medical record

14. Emergency Management Healthcare Engineering Consultants Issue: Safety and Security Best Practices:  Security staffing plans during emergencies must be established  Expectations with outside police agencies should be identified  Plans to dispose of infectious and hazardous waste must be created  Procedures to treat contaminated patients must be written (radioactive, biological and chemical)  Methods to lock down the facility to prevent entry must be provided  Methods to minimize staff and patients from leaving the facility must be planned  Plans must be in place to control traffic accessing the facility

15. Emergency Management Healthcare Engineering Consultants Issue: Staff Roles and Responsibilities Best Practices:  Review and update as necessary, the ICS organizational chart and job action sheets (check after each drill)  Ensure that hospital staff have participated in NIMS training  Discuss emergency expectations with the independent physicians who have privileges at the hospital  Select the primary and back-up command center locations  Have a method to identify incident command staff (ID badges, vests, caps, etc.)  Make sure that decisions regarding staff and family support needs (house and feed family and pets?) have been determined and are in writing

16. Emergency Management Healthcare Engineering Consultants Issue: Utility Back-up Strategies Best Practices:  Complete the utility timeline chart for the Level 3’s on the HVA  Determine which utilities require additional supplies, especially water and fuel  Determine the feasibility of redundant systems or supplies Examples: Water – on-site well, water tower or nearby lake Electricity – additional generators installed Boilers – portable boiler “on a truck” Medical gas – low pressure external connection, manifold Fuel – additional on-site storage

17. Emergency Management Healthcare Engineering Consultants Issue: Patient Management Best Practices:  Identify which patients in the hospital are considered “vulnerable” (neonatal intensive, pediatric, geriatric, dementia, behavioral health, bariatric)  Consider plans to move vulnerable patients vertically without elevators  Plan for patient and staff hygiene and sanitation without water or sewer  Determine mortuary needs in the event of a pandemic  Evaluate back-up methods to track patient information in the event that the electronic information system fails

18. Emergency Management Healthcare Engineering Consultants Issue: Privileges to LIP’s During Disasters Best Practices: Privileges granted only when EOP has been activated Medical staff bylaws indicate to who and how to grant privileges, and policies will indicate how performance will be evaluated Minimum privileging requirements include: 1. Current picture ID and license to practice 2. Must be a member of a recognized disaster response group 3. Proof of government authority to provide services during a disaster Mentor must be provided to oversee LIP Hospital determines within 72 hours if privileges should continue

19. Emergency Management Healthcare Engineering Consultants Issue: Privileges to Volunteer Practitioners During Disasters Best practices: Hospital assigns responsibilities only when EOP has been activated Hospital identifies in writing who is eligible and how to assign disaster responsibilities to non-LIP’s Minimum requirements to assist during disasters include: 1. Current picture ID and license to practice professional specialty 2. Must be a member of a recognized disaster response group 3. Confirmation by hospital staff the individual is qualified Mentor must be provided to oversee volunteer Hospital determines a method to evaluate performance and decide within 72 hours if responsibilities should continue

20. Emergency Management Healthcare Engineering Consultants Issue: Emergency Drills Best Practices:  Two drills per rolling 12-month period should be performed, based on the HVA  At least one drill per 12 months for each business occupancy  At least one “influx” drill for a disaster receiving station  Community-wide and influx drills can be performed concurrently  Don’t forget about patient “surge” drills (IC.01.06.01) and infant/ pediatric abduction drills (EC.02.01.01)  The community “non-support” drill can be a tabletop  Trained staff, including a physician and leadership, must evaluate the drill and must document the six core areas in the evaluation

21. Emergency Management Healthcare Engineering Consultants Issue: Emergency Drills (continued) Best Practices:  To count, drills and actual disasters must: 1) initiate the incident command system (ICS) 2) require additional internal or external resources, beyond what is normally available 3) the drill or actual disaster must be documented and include an evaluation of the six critical core areas  Tabletop simulations are permitted for the community and community non- support drills only

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