1. OSHA Training Institute 1 Regional Planning and Assistance OSHA Training Institute – Region IX University of California, San Diego (UCSD) - Extension

2. OSHA Training Institute2 Objectives To describe mutual aid compacts that enable disaster assistance between hospitals, and between states, and which could be accessed if local resources are overwhelmed To describe advantages of Regional Planning

3. OSHA Training Institute3 Federal Emergency Management Agency (FEMA), through the Robert T. Stafford Disaster Relief and Emergency Assistance Act Reimburses mutual aid agreement costs associated with emergency assistance provided all of the following conditions are met:  The assistance requested by the applicant is directly related to the disaster and is eligible for FEMA assistance  The mutual aid agreement is in written form and signed by authorized officials of the agreeing parties prior to the disaster

4. OSHA Training Institute4 Stafford Act (continued)  The mutual aid agreement applies uniformly in emergency situations. The agreement must not be contingent upon a declaration of a major disaster or emergency by the Federal government or on receiving Federal funds  The providing entity may not request or receive grant funds directly. Only the eligible applicant receiving the aid may request grant assistance  Upon request, the applicant must be able to provide FEMA with documentation that the services were requested

5. OSHA Training Institute5 Evacuation and Surge Capacity: The Link Evacuation of hospital patients is directly linked to surge capacity Surge capacity for an evacuation allows room for relocation of evacuated patients and staff Resources commonly referred to in surge planning are also potential resources as destinations for hospital evacuees Regional planning is one of the processes to achieve success when forced to evacuate hospitals

6. OSHA Training Institute6 Advantages of Regional Planning Training, purchasing, and planning should occur on regional basis, for hospital administrators, nurses and physicians Standardization of PPE, respiratory equipment, and surge supplies to maximize ability to use per diem and agency RNs and volunteers at multiple sites Group purchases lead to reduced costs per item. Contributions of expertise by each hospital in a region lead to stronger plans and better responses

7. OSHA Training Institute7 Example of Uses The “Metropolitan Area Hospital Compact” of the Twin Cities in Minnesota Off-Site Care Facility Operations Planning  The plan is regionally based, by hospitals Minnesota Dept of Health Website (http://www.health.state.mn.us/divs/idepc/diseases /flu/pandemic/plan/pccoscf.pdf.)http://www.health.state.mn.us/divs/idepc/diseases /flu/pandemic/plan/pccoscf.pdf

8. OSHA Training Institute8 Emergency Management Mutual Aid Compact 1996 - Ratified by Congress (P.L.104-321) as the first national disaster compact since 1950 (Civil Defense Compact) Allows quick response from state to state for disaster resources for mutual aid for a governor- declared disaster Once conditions of response have been set, there is a legal contract which makes affected state responsible for reimbursement

9. OSHA Training Institute9 EMAC: What it provides Responding state knows there will no financial burden incurred for assisting Personnel liability and Worker’s comp is assured Allows credential approval across state line Avoids bureaucratic wrangling Achieves rapid response for any type of assistance

10. OSHA Training Institute10 What do individual states do once they sign on to the compact…? Need to pass their own legislation to be consistent with the compact  Ex: professional licenses “Model Act,” for states to use to model their own state legislation on, to standardize state laws, can be seen and is available on the EMAC Web site at www.emacweb.org www.emacweb.org

11. OSHA Training Institute11 WHY is having state laws consistent with a compact important? Most states do not have legislation that allows medical professionals to practice with an out of state license, even when EMAC is utilized. “Some states do not have legislation facilitating out of state licensing during emergencies, and the issue of hospital privileging is still a challenge in most states. States should address those potential limitations now – at the state level.” http://www.astho.org/templates/display_pub.php?pu b_id=1595

12. OSHA Training Institute12 EMAC Responses - 2004 EMAC responses to Hurricanes Charley, Frances, Ivan & Jeanne  Deployed over 800 state and local personnel from 38 states (including one then non- member state, California)  Cost was $15 million in personnel, equipment, and National Guard expenditures

13. OSHA Training Institute13 EMAC Responses - 2005 EMAC scaled operations more than 20x as all member states combined deployed 65,929 personnel in response to Hurricanes Katrina and Rita to Louisiana, Mississippi, Texas, Alabama, and Florida. More than 1,300 search and rescue personnel from 16 states; searched more than 22,300 structures and rescued 6,582 people Nearly 3,000 Fire/Hazmat personnel from 28 states

14. OSHA Training Institute14 EMAC Responses - 2005 More than 6,880 sheriff's deputies and police officers from 35 states and countless local jurisdictions deployed across Louisiana and Mississippi - a total of 35% of all of the resources deployed More than 2,000 healthcare professionals from 28 states; treated more than 160,000 patients in the days and weeks after the storms

15. OSHA Training Institute15 Website: http://www.emacweb.org/

16. OSHA Training Institute16 Other Compacts EMAC-like agreement exists among northeast states and Canadian provinces from Quebec eastward International agreement, involving states in the northwest U.S. and neighboring Canadian provinces.

17. OSHA Training Institute17 Summary Regionalization of planning reduces costs, reduces amount of training required in a region Commonality of resources in a region is an advantage EMAC and other compacts were reviewed