1. Legal Issues in Hospital Preparations for Disaster Response – “Operational Considerations” Knox Andress, RN, FAEN Designated Regional Coordinator Louisiana Region 7 Hospitals Emergency Preparedness Coordinator CHRISTUS Schumpert Health System Shreveport, Louisiana

2. 3/6/2007 National Emergency Management Summit – New Orleans Topics of Discussion Recognizing the potential issues Hospital standards origination The Emergency Management Plan  Command and management  Emergency communications  Credentialing Surge capacity

3. 3/6/2007 National Emergency Management Summit – New Orleans Practical Hospital Applications Operational goal – recognize and respond to the disaster or incident Methods - Preparedness, Mitigation, Response and Recovery

4. 3/6/2007 National Emergency Management Summit – New Orleans Issues - Potential and Reality AHRQ project “Altered Standards of Care” (August 2004)  40 experts/3 days  2 terrorism scenarios  Medical and response resources overwhelmed  Resulted in – recognized extraordinary measures for health care delivery and “altered” or degraded standards of care. Hurricane Katrina and Rita (August – September 2005)

5. 3/6/2007 National Emergency Management Summit – New Orleans Louisiana Hospital Impact Katrina – directly impacted 88 Critical and Non- Critical Care Facilities Rita – directly impacted 53 Critical and Non- Critical Care Facilities (includes Acute, Critical Access, Limited Services, and Specialty Hospitals)

6. 3/6/2007 National Emergency Management Summit – New Orleans Standards Origination Standards – law and statues  Federal – Health Insurance Portability and Accountability Act (HIPAA)  Emergency Medical Treatment and Active Labor Act (EMTALA)  Regulatory standards – OSHA  State licensing requirements

7. 3/6/2007 National Emergency Management Summit – New Orleans Standards origination (continued) Hospital industry standards –  The Joint Commissions for the Accreditation of Health Care Organizations (JCAHO) Professional organization standards-  National Fire Protection Association; 1600, Standard on Disaster/Emergency Management and Business Continuity Programs, 2004 ed. National Incident Management System (NIMS) –  Implementation for Hospitals and Health Care Systems.

8. 3/6/2007 National Emergency Management Summit – New Orleans Issues may arise….. During deviation from usual standards When hospital operations are NOT “business as usual”

9. 3/6/2007 National Emergency Management Summit – New Orleans Meeting standards Issues largely met by responsibly planning for and preparing for emergencies and disasters Done by following and implementing appropriate guidance. Consider JCAHO, NFPA and NIMS…

10. 3/6/2007 National Emergency Management Summit – New Orleans The Emergency Management Plan JCAHO E.C. 4.1 – The hospital has an emergency management plan.  Leadership including medical staff participation  Based on a Hazards Vulnerability Analysis (HVA)  Describes specific procedures for preparedness, mitigation, response and recovery.

11. 3/6/2007 National Emergency Management Summit – New Orleans HVA example

12. 3/6/2007 National Emergency Management Summit – New Orleans The Hospital Emergency Management Plan (continued) NFPA 1600, 4.1 –  Establishes the need for a hospital emergency management plan with goals, objectives, plans and procedures NIMS, Implementation for Hospitals and Health Care Systems –  requires NIMS be adopted into the hospital emergency management plan

13. 3/6/2007 National Emergency Management Summit – New Orleans Command and Management - JCAHO, E.C. 4.10  Hospitals establish an “all hazards” command structure linking with the community’s (ICS via NIMS)  Provides for - Staff support, logistics, security, communication, staff family support, activities related to care  Planning with other hospitals in contiguous geographic areas including command structures and alternate roles and responsibilities.

14. 3/6/2007 National Emergency Management Summit – New Orleans Command and Management (continued) NFPA 1600, 5.8.2  Addresses the need for hospital emergency management plans with organizational roles, titles and responsibilities for those named in the plan NIMS Implementation Activities for Hospitals and Health Care Systems, Element 2  Use of Incident Command System (ICS), organizational structures, doctrine and procedures

15. 3/6/2007 National Emergency Management Summit – New Orleans Hospital Incident Command System (HICS)

16. 3/6/2007 National Emergency Management Summit – New Orleans HEICS – Katrina & Rita

17. 3/6/2007 National Emergency Management Summit – New Orleans Hospital Command Center – Katrina & Rita

18. 3/6/2007 National Emergency Management Summit – New Orleans Hospital Emergency Communications JCAHO, E.C. 4.1 –  The plan provides processes for communications.  Internally – patients, staff, family  Externally – community authorities  Backup internal and external systems in event of failure NFPA 1600, 5.9 –  Regularly tested systems and procedures and protocols to notify officials and alert…interoperable.

19. 3/6/2007 National Emergency Management Summit – New Orleans Emergency Communications

20. 3/6/2007 National Emergency Management Summit – New Orleans Managing Emergency Communications – Equipment Primary –  Telephone  Cell phone  Email  Fax Secondary –  2 way pagers  800 MHz radio  Blackberry  Webpage  Satellite  Ham radio  VOIN  Don’t forget extra batteries

21. 3/6/2007 National Emergency Management Summit – New Orleans Hospital Emergency Communications (continued) NIMS Implementation for Hospitals and Health Care Systems, Elements 2 and 3 –  Emergency operations plan coordinates and supports response through multi agency systems (MACS)….  Establishes connectivity with local command posts, 911 centers, Emergency Operation Centers…

22. 3/6/2007 National Emergency Management Summit – New Orleans “Hospital Relationship to Community Response Partners”

23. 3/6/2007 National Emergency Management Summit – New Orleans Managing Emergency Communications Develop communications plan  Identify  threats, processes and responses / alternative to communication outage  “Needs – Assessment”  To document & coordinate communication assets and location Assistance from State and/or local Office of Emergency Management, and/or Hospital Association

24. 3/6/2007 National Emergency Management Summit – New Orleans Credentialing - JCAHO, HR 1.25, MS 4.110  Organizations may grant disaster privileges/responsibilities to volunteer practioners.  Mechanism to identify  Valid government photo ID and appropriate license  Organization oversees independent practioners

25. 3/6/2007 National Emergency Management Summit – New Orleans Credentialing (continued) NFPA 1600, 5.5.2; 4  Resource management shall consider personnel, equipment, training  Liability connected with using involved resources  Donations shall be managed

26. 3/6/2007 National Emergency Management Summit – New Orleans Credentialing (continued) NIMS Implementation for Hospitals and Health Care Systems, Elements 15, 16 –  Hospitals will maintain an inventory of organizational response elements.  Ensure relevant national standards and guidance to achieve and incorporate equipment, communications and data interoperability.

27. 3/6/2007 National Emergency Management Summit – New Orleans Credentialing initiatives are found… Emergency System Advanced Registration Volunteer Health Professionals (ESAR-VHP) Federal Disaster Medical Assistance Teams (DMATs) Individual state programs – Uniformed Badging System (UBS), Nevada.

28. 3/6/2007 National Emergency Management Summit – New Orleans Surge Capacity Health care systems’ ability to rapidly expand beyond normal services…demand for personnel, medical and public health…in the event of public health or other emergencies. Planning provided for by  HRSA – NBHPP (500/1,000.000)  MRC  AHRQ  MMRS  CDC

29. 3/6/2007 National Emergency Management Summit – New Orleans Examples of Surge

30. 3/6/2007 National Emergency Management Summit – New Orleans Providing Adequate Surge Capacity

31. 3/6/2007 National Emergency Management Summit – New Orleans Flu Surge – Potential Louisiana Region 7 admissions 8 week outbreak – 25% attack rate

32. 3/6/2007 National Emergency Management Summit – New Orleans Altered or relaxed standards - Medical response for catastrophic disasters has and will require relaxed or altered standards for health care facilities.

33. 3/6/2007 National Emergency Management Summit – New Orleans Resources - Websites:  http://www.ahrq.gov/browse/bioterbr.htm http://www.ahrq.gov/browse/bioterbr.htm  http://www.pandemicflu.gov http://www.pandemicflu.gov  http://www.emsa.ca.gov http://www.emsa.ca.gov  http://www.who.int/en/ http://www.who.int/en/  http://www.osha.gov/dts/osta/bestpractice s/firstreceivers_hospital.html http://www.osha.gov/dts/osta/bestpractice s/firstreceivers_hospital.html  http://www.jcaho.org/ http://www.jcaho.org/  http://www.nfpa.org/ http://www.nfpa.org/

34. 3/6/2007 National Emergency Management Summit – New Orleans Acronyms AHRQ – Agency for Healthcare Research and Quality CDC – The Center for Disease Control ESAR-VHP – Emergency System for the Advance Registration of Volunteer Health Professionals HRSA – Health Resources and Services Administration JCAHO – Joint Commission on Accreditation of Healthcare Organizations MMRS – Metropolitan Medical Response System MRC – Medical Reserve Corps NFPA – National Fire Protection Association NIMS – National Incident Management System VOIN – Voice Over InterNet

35. 3/6/2007 National Emergency Management Summit – New Orleans Thanks Knox Andress, RN, FAEN Designated Regional Coordinator Louisiana Region 7 Hospitals Emergency Preparedness Coordinator CHRISTUS Schumpert Health System #1 St Mary Place Shreveport, Louisiana 71101 Ph (318) 681-4255; Cell (318) 465-9500 Knox.andress@christushealth.org knoxandress@yahoo.com