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© Copyright, The Joint Commission Improving Emergency Management Standards Where to go from here? Robert A. Wise, M.D. VP –Division of Standards & Survey Methods The Joint Commission
© Copyright, The Joint Commission Overview New Standards for 2008 and 2009 Review of debriefing of recent disasters What are next challenges?
© Copyright, The Joint Commission A Brief History of Emergency Management Standards Pre-2001 Standards –Legacy Standards –Disaster Based (before all hazard) –Emphasis on response phase –Minimal community planning 2001 Standards –Heavily influenced by DoD and VA –Growing international/domestic threats HVA, All Hazards, 4 phases, Community coordination, hospital leadership
© Copyright, The Joint Commission 2008 Standards Developed after reviewing 5 years of disasters
© Copyright, The Joint Commission Debriefed Multiple Hospitals & Communities: Sample of Debriefings First - Tropical Storm Allison – June/2001 9/11 – September 2001 Power Outage – Summer 2003 San Diego Wild Fires – Summer 2003 Hurricane Isabel – Fall 2003 SARS (Asia/Toronto) - Spring 2003 Multiple hurricanes in Gulf and Florida Katrina/Rita
© Copyright, The Joint Commission Communications –With staff; suppliers; EOC Supplies –Unclear inventory, lack of reliable supplier Security –Protection of assets (drugs, fuel, vaccine); –Ability to maintain operations Staff –Housing; pay; family; mental health; safety; leadership Utilities –Fuel; electricity; water (potable and others); sewage - others (ventilation, medical gases) Clinical Activity –Vulnerable populations, changing patient needs; ongoing assessment; – (altered standards of care) 6 Critical Parameters Became structure of 2008 standards
© Copyright, The Joint Commission 2008 Standards Overview Planning to Manage Consequences (EC.4.11) Emergency Operation Plan (EC.4.12) Critical Parameters –Communications (EC.4.13) –Supplies (EC.4.14) –Security (EC.4.15) –Staff (EC.4.16) –Utilities (EC.EC.4.17) –Clinical Activity (EC.4.18) Exercises & CQI (EC.4.20)
© Copyright, The Joint Commission Expanded and New Requirements Highlight in RED postponed from 1/08 to 1/09 In that dialog with field, suggests the state of preparedness of the country
© Copyright, The Joint Commission EC.4.11 Managing Consequences of Emergencies Hazard Vulnerability Analysis (HVA) –Broad review of threats –In sync with community –Prioritize events Communicates to community, needs & vulnerabilities –Recognizes unresponsive communities remain For each event in HVA, define –Mitigation activities –Preparedness activities –Response strategies –Recovery strategies
© Copyright, The Joint Commission EC.4.11 Managing Consequences of Emergencies EP#9 - Document inventory of onsite assets & resources; to include –PPE –Staffing –Water, fuel –Medical, surgical, pharmaceuticals EP#10 -Methods for monitoring quantities of assets and resources during emergency Scope, objectives, performance of emergency management planning is annually evaluated
© Copyright, The Joint Commission EC.4.12 Develop Emergency Operations Plan (EOP) Develop & maintain Emergency Operations Plan Emergency Operations Plan (EOP) –Establishes ICS consistent with communitys –Identifies staff reporting relationships –EP#6 – The Plan identifies capacity and establishes response efforts in 6 critical areas when organization cannot be supported by community for at least 96 hours –Evacuation is an acceptable strategy but reallocation preferred –Identifies alternative sites for care
© Copyright, The Joint Commission Striving for more…. 24 hrs 48 hrs 96 hrs 0 hrs 72 hrs Normal - Generator Fuel Curtail services – curtail services, discharge patients Normal – Clinical Supplies Normal – Water (Sanitary) Conserve resources – save water (sponge baths, waste disposal). Conserve resources – shut down floors, cancel elective surgeries
© Copyright, The Joint Commission EC.4.13 – Emergency Communications Internal planning with staff, external authorities, patients and families Communicating with suppliers and services during emergency
© Copyright, The Joint Commission EC.4.14 – Managing resources and assets Potential sharing of resources and assets with HCOs outside of community Transporting patients with supplies and staff to alternative care site
© Copyright, The Joint Commission EC.4.15 Managing safety/security Identifies role of community security and coordination with agencies
© Copyright, The Joint Commission EC.4.16 – Defines & manages staff roles Roles and responsibilities are defined for all critical areas Training for roles Communication to physicians and other licensed independent physicians and to whom they report
© Copyright, The Joint Commission EC.4.17 Managing utilities Identifies alternative means of providing fuel for building operations or essential transport
© Copyright, The Joint Commission EC.4.18 Managing services Clinical services of vulnerable population served by organization Mental health services of patients Mortuary services Documenting and tracking patient clinical information
© Copyright, The Joint Commission EC.4.20 EOP: Scope of Exercises EP#3 - One exercise is escalated to evaluate performance when community cannot support the organization
© Copyright, The Joint Commission EC.4.20 EOP: Scope of Exercises EP# critical functions monitored Exercises are critiqued Completed exercises are critiqued through multi-disciplinary process EOP modified in response to critiques Improvements to EOP are evaluated during next exercise Strengths/weaknesses are communicated to responsible multidisciplinary team
© Copyright, The Joint Commission And the disasters continue…
© Copyright, The Joint Commission Disasters Debriefed Since 2005 Southern California wild fires Hurricane Gustav 8/2008 Hurricane Ike – 9/2008
© Copyright, The Joint Commission What is Important? Preserving Communitys Medical Care Maintain medically frail in community Preserve hospital beds for seriously ill
© Copyright, The Joint Commission The Threat to Medical Care -Decrease supply of hospital alternatives -Increase demand for hospital beds Long Term Care (only segment with expected resiliency) Home Care closed Dialysis Center closed (no generators) Threat of loss of Ventilators/Oxygen Physician Offices closed Outpatient Pharmacy closed Discharged patients (wouldnt leave)
© Copyright, The Joint Commission Debriefing of 2 nd Assault San Diego –Wild fires – 2003 –Wild fires New Orleans –Hurricane Katrina & Rita – 2005 –Hurricane Gustav– 2008 Houston –Tropical Storm Allison – 2001 –Hurricane Rita – 2005 –Hurricane Ike
© Copyright, The Joint Commission Most important improvements Resilience of other healthcare providers Able to protect surge capacity Improve decision to evacuate or shelter in place Handling of 6 critical parameters Communication with: Staff Citizens HCO Community Focus of Second Debriefings
© Copyright, The Joint Commission Some Highlights from Debriefings San Diego – Hospital Association Houston - Hospital New Orleans – Charity/University reps
© Copyright, The Joint Commission Coordination of Emergency Planning San Diego – County level Texas – Regional level New Orleans- cooperation of public hospitals
© Copyright, The Joint Commission Communication Systems –Reverse 911 – landline –AlertSanDiego – registration of cell phones –211 – where to seek services; could register –Emergency Alert System (EAS) – ongoing communication to population – when to return home –RSAN Roam Secure Alert Network purchase –WebEOC – hospitals –Local media –New Orleans – minimal new city sponsored communication to citizens
© Copyright, The Joint Commission Staff, Families, and Pets San Diego & Houston –Able to handle pets off-site and even horses (San Diego) –Houston- needed food, water,leash, and crate –Set up help for children and elderly of staff but needed to bring own supplies New Orleans – Public hospital –No pets or support of family –Given time to make other arrangements
© Copyright, The Joint Commission Security Not an issue in any cities though New Orleans public hospital security now equipped & trained with assault-style rifles Houston – hired extra security – implemented armbands for family – dedicated security for childcare (since Allison)
© Copyright, The Joint Commission Evacuation Not needed in Houston –Increase expectation that LTC can shelter in place San Diego did successfully evacuate 3 hospitals and many LTC facilities New Orleans – no evacuation
© Copyright, The Joint Commission Special Needs Walgreens and CVS brought in pharmacy trucks and access to national network Community told to bring pill bottles Much more attention paid to oxygen – who needed it, where it was needed; rationing was required Dialysis remains a national problem – patients refused transporting to distant site
© Copyright, The Joint Commission What Determined Best Results? Second disaster similar to first (wild fire/hurricane) Systematic improvement driven by after-action Improvement with community-wide communication –Reverse 911, 211, WebEoc Improved coordination of multiple facilities –Government-based better than system inside of system Hospitals are integral part of community planning
© Copyright, The Joint Commission Conclusion Debriefings and Org discussions Significant improvement possible in 3 years (same disaster) Community-based communication better and important Need to harden multiple parts of delivery system –Long Term Care –Access to pharmacy –Increase use of shelter for special needs Community planning is preferred over aggregation of hospitals Inadequate experience: – With less warning of disaster e.g. terrorist attacks –When evacuation not possible (quadrant 4) – e.g.. Pandemic Unknown results of disasters with –No warning e.g. terrorist attacks –Evacuation not possible e.g.. pandemic
© Copyright, The Joint Commission Questions?
Hospital Emergency Operations Plan Workshop Updating the Hospital and Rural Medical Center EOP for the Use of Volunteers in Medical Surge AGENCY LOGO.
Continuity of Operations Planning for Public Health and Medical Services Greg Morgan Contingency Planner Stacy A. Robarge-Silkiner SNS Coordinator KDHE.
National Incident Management System (NIMS) National Response Framework (NRF) Hospital Incident Command System (HICS) IS 100.HC, 200.a, 700.a, 800.b The.
Campus Emergency Preparedness: Planning in the Post 9/11 World Larry Gibbs Associate Vice Provost Stanford University Stanford SOC Workshop April 17, 2003.
SSEP PROGRAM DEVELOPMENT [NAME OF TRANSIT AGENCY] will implement the following process to develop and monitor the SSEP Program: STEP 1: Participate in.
Local Emergency Management, Public Health Preparedness, & Hospital Emergency Management “A recipe for success.”
National Incident Management System (NIMS) National Response Framework (NRF) Incident Command System (ICS) Independent Study – FEMA Courses The University.
Nancy Claflin RN PhD CCRN NEA-BC CPHQ FNAHQ VHA-CM.
AIRS/UWW Disaster Response Team September 14, 2010.
1 Continuity of Operations (COOP) Awareness Training NOAA Homeland Security Program Office.
Introduction to: Incident Command System (ICS) Hospital Emergency Incident Command System (HEICS) National Incident Management System (NIMS) (IS 100, 200,
EMERGENCY PREPAREDNESS AND SAFETY Jim Roberts Vice President for Business Campbell University.
Building the Resilient Community Roles and Responsibilities in Rural America 30 April 2014.
Managing Spontaneous Volunteers in Times of Disaster.
HSEEP Exercise Evaluation and Improvement. ODPs Mission q Primary responsibility within the executive branch to build and sustain the preparedness of.
[INSERT AGENCY NAME] 2010 Tabletop Exercise Volunteers in Surge Funded through a grant from NACCHO for Public Health Advanced Practice Centers.
CPAS Workshop / Chapel Hill, North Carolina March 4, 2008 Mike Brewer 1, Tim Owen 2, Roger Pulwarty 3, and Mark Svoboda 4 1. NOAAs National Weather Service,
Visual 1.1 Course Overview: Introduction to ICS Version 2.0 Unit 1: Course Overview Introduction to ICS.
The Basics of Disaster Response Thomas D. Kirsch, MD, MPH, FACEP Center for Refugee and Disaster Response Johns Hopkins Bloomberg School of Public Health.
Digital Technology and Disaster Response - EHRs, Satellites, and RHIOs: Lessons from Tulane University Hospital During Katrina Jeffrey P. Harrison, Ph.D.,
Arnold School of Public Health Office for the Study of Aging Ready or Not? Perceptions about Preparedness in Nursing Homes Before and After Hurricane Katrina.
IAEMs CEM 101 Basic Training Daryl Lee Spiewak, CEM, TEM, TCFM International Association of Emergency Managers CEM Commissioner March.
Final Report Briefing Working Group 1A Public Safety Consolidation Effective Practices and Recommendations October 7, 2010.
COGNITION, LLC and URBAN PREPAREDNESS, Inc. No Cost and Low Cost Resilience Strategies for Institutions of Higher Education for Institutions of Higher.
Louisiana Department of Health & Hospitals RELIEF WORKERS (WAEs) ROLES & RESPONSIBILITES.
JCAHO A Constant State of Readiness How to Encourage Staff to Become Engaged and Involved While Focusing on Patient Safety How to Encourage Staff to Become.
+ Healthcare Facility Sheltering, Relocation, and Evacuation December 8, 2010 Should I stay or should I go now?
1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 4 The Leadership Role of the Licensed Practical Nurse.
Patient Centered Medical Home Data and Recognition Review for Saint Lukes Medical Group by Jennifer Woods, RN, BSN Director of Physician Practice Management.
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