1. Hurricane Rita & Katrina Lessons Learned Renee Clack Unit Manager Regulatory Licensing Unit Texas Department of State Health Services (DSHS) 2006 Annual ConferenceAlexandria, Virginia Council on Licensure, Enforcement and Regulation Expect the Unexpected: Are We Clearly Prepared?

2. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia REGULATORY LICENSING UNIT FACILITY LICENSING GROUP ARCHITECTURAL REVIEW GROUP EMS CERTIFICATION & LICENSING GROUP CHEMICAL & PRODUCT SAFETY LICENSING GROUP FOOD & DRUG LICENSING GROUP RADIATION SAFETY & LICENSING BRANCH ENVIRONMENTAL & SANITATION LICENSING

3. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Licensing Boards/Agencies DEVELOP VIABLE BUSINESS CONTINUITY PLANS IMPORTANT TO HAVE BACKUP LICENSEE DATA AT ALTERNATIVE LOCATION IN THE EVENT OF POWER OUTAGES OR PRIMARY SITE INACCESSIBILITY BY STAFF

4. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia EMS/EMTs PARMEDICS LICENSED LARGE VOLUME OF PARAMEDICS & EMTs FROM OTHER STATES DEVELOPED AN EXPEDITED LICENSING PROCESS SHORT & CONDENSED TEMPORARY APPLICATION FORM 1 PAGE & AVAILABLE ON WEBSITE APPLICATION AVAILABLE AT TEMPORARY SHELTERS ACROSS STATE WAIVED LICENSING FEES

5. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia EMTs/PARAMEDICS LICENSE RENEWAL TEMPORARY LICENSE VALID FOR ONE YEAR OUT OF STATE LICENSEES MUST THEN COMPLY WITH NORMAL RENEWAL REQUIREMENTS, INCLUDING CEUs & PAYING RENEWAL FEES

6. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia NEW DISASTER PLANS FOR EMS DEVELOP MOAs WITH LICENSED EMS PROVIDERS FOR MUTUAL AID OF EMERGENCY MEDICAL SERVICES FOR PUBLIC ASSISTANCE IN A PENDING OR ACTUAL DISASTER STAFFED AMBULANCES WILL BE PLACED ON A LIST OF AMBULANCE RESOURCES & WILL BE REQUIRED TO RESPOND TO STATE FACILITIES FOR THE MISSION OF EVACUATING STATE SCHOOLS OR HOSPITALS AMBULANCE FIRMS ONLY COMMIT IF LOCAL SERVICE AREA WILL NOT EXPERIENCE DEGRADATIONOF SERVICE OR EXCEED OTHER CONTRACTUAL OBLIGATIONS DURING A DISASTER

7. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia NEW DISATER PLANS FOR EMS ONCE DSHS SENDS DEPLOYMENT LETTER TO EMS PROVIDER, MUST HAVE STAFFED AMBULANCES AT DESIGNATED MISSION WITHIN 3 HOURS EMS PROVIDER REQUIRED TO KEEP ∙PATIENT CARE RECORDS ∙PATIENT DEMOGRAPHICS, INCLUDING INSURANCE ∙A TIME LOG RECORD FROM ACTIVITIES AFTER BILLING MEDICARE, MEDICAID, PRIVATE INSURANCE/3rd PARTY PROVIDERS, WILL ACTUALLY BE ABLE TO BILL DSHS HOURLY FROM $47.92 (BASIC LIFE SUPPORT) - $57.92 (MOBILE INTENSIVE CARE UNIT)

8. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia END STAGE RENAL DISEASE FACILITIES (ESRDs) EXPEDITED TEMPORARY REQUESTS FOR ESTABLISHMENT OF ADDITIONAL STATIONS THAT HAD NECESSARY EQUIPMENT & STAFF AVAILABLE TO FUNCTION (30 – 90 DAY PERIOD) WAIVED FEES ALLOWED ESRDs TO RELOCATE TO ALTERNATE SITES IF A FACILITY WAS LOCATED IN AN AFFECTED AREA AND PROVIDER WAS ABLE TO STAFF/PROVIDE SERVICES ELSEWHERE

9. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia NEW DISASTER PLANS FOR ESRDS DESIGNATING SHELTERS ACROSS THE STATE SPECIFICALLY FOR DIALYSIS PATIENTS DSHS ENTERED A MOA WITH THE ESRD NETWORK FOR THE ESTABLISHMENT OF A STATEWIDE COMMAND CENTER TO BE OPERATED 24/7 IN THE EVENT OF A DISASTER TOLL FREE NUMBER WILL BE POSTED THROUGHOUT THE STATE VIA MEDIA SOURCES FOR DIALYLSIS PATIENTS TO CALL AND BE PROVIDED IMMEDIATE ACCESS TO SERVICE IN THE AREA

10. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia HOSPITALS EXPEDITED REQUESTS FOR ADDING ADDITIONAL BEDS TO HOSPITAL LICENSE WAVIED FEES FOR ADDITIONAL BEDS UP TO 6 MONTHS AFTER 6 MONTH PERIOD, HOSPITAL HAD TO PAY FOR ADDITIONAL BEDS

11. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia NEW DISASTER PLANS FOR HOSPITALS DEVELOPING LICENSING RULES TO ADDRESS DISASTER PREPARDNESS OF HOSPITALS

12. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia NEW DISASTER PLANS FOR HOSPITALS DISASTER PLANS SHALL INCLUDE: ∙NAMES & CONTACT NUMBERS OF CITY & COUNTY EMERGENCY MANAGEMENT OFFICERS ∙SCHEDULE FOR EXERCISING DISASTER PREPAREDNESS ANNUALLY & IN CONJUNCTION WITH STATE & LOCAL EXERCISES ∙METHODOLOGY FOR NOTIFYING THE HOSPITAL PERSONNEL & THE LOCAL DISASTER MANAGEMENT AUTHORITY OF AN EVENT THAT WILL SIGNIFICANTLY IMPACT HOSPITAL OPERATIONS

13. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia NEW DISASTER PLANS FOR HOSPITALS ∙EVIDENCE THAT THE HOSPITAL HAS COMMUNICATED PROSPECTIVELY WITH THE LOCAL UTILITY & PHONE COMPANIES re: NEED FOR THE HOSPITAL TO BE GIVEN PRIORITY FOR THE RESTORATION OF SERVICE ∙PROCESS FOR UPDATING DSHS OF BED AVALABILITY; EMERGENCY, BURN, ADULT ICU, MEDICAL/SURGICAL, NEGATIVE PRESSURE/ ISOLATION, ETC

14. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia NEW DISASTER PLANS FOR HOSPITALS ∙A COMPONENT FOR THE RECEPTION, TREATMENT & DISPOSITION OF CASUALTIES ∙A PROCESS TO ALLOW ESSENTIAL HEALTHCARE WORKERS & PERSONNEL TO SAFELY ACCESS THEIR DELIVERY CARE SITES ∙ PROVISION FOR USE OF PERSONAL PROTECTION EQUIPMENT FOR STAFF IN ADDITION TO IMMUNIZATION OF STAFF, VOLUNTEERS, STAFF FAMILIES, ETC. ∙PLAN TO PROVIDE FOOD & SHELTER FOR STAFF & VOLUNTEERS

15. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia NEW DIASTER PLANS FOR HOSPITALS ∙EVACUATION COMPONENT – INCLUDING WHEN WITHIN THE CONTROL OF THE HOSPITAL, PATIENT EVACUATION DESTINATION, INCLUDING PROTOCOL TO ENSURE THAT THE PATIENT DESTINATION IS COMPATIBLE TO PATIENT ACUITY & HEALTH CARE NEEDS, PLAN FOR THE ORDER OF REMOVAL OF PATIENTS & PLANNED ROUTE OF MOVEMENT, TRAIN & DRILL STAFF ON THE TRAFFIC FLOW & MOVEMENT OF PATIENTS TO A STAGING AREA, & ROOM EVACUATION PROTOCOL

16. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia NEW DIASTER PLANS FOR HOSPITALS ∙FAMILY/RESPONSIBLE PARTY NOTIFICATION ∙TRANSPORT OF RECORDS & SUPPLIES – INCLUDING PATIENT’S MOST RECENT PHYSICAL ASSESSMENT, MAR, ORDER SHEET, ETC. ∙ ALL PATIENTS SHOULD HAVE A WEATHER-PROOF PATIENT I.D. WRIST BAND

17. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Hospitals, Nursing Homes Other Facilities HOSPITALS, NURSING HOMES & OTHER FACILITIES SHOULD ALL HAVE REALISTIC EVACUATION PLANS THAT INCLUDE PRE- ESTABLISHED CONTRACTS FOR TRANSPORTATION SERVICES TO RELOCATE PATIENT/RESIDENTS. IMPORTANT TO ENSURE THAT ALL FACILITIES AREN’T PLANNING/CONTRACTING WITH THE SAME TRANSPORTATION COMPANY BECAUSE IN THE EVENT OF A REAL EMERGENCY, TIMELY ASSISTANCE CANNOT BE PROVIDED TO MULTIPLE FACILITIES AT THE SAME TIME.

18. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Hospitals, Nursing Homes Other Facilities AT LEAST ONE HOSPITAL, NURSING HOME, OR FACILITY EMPLOYEE SHOULD ACCOMPANY RESIDENTS/PATIENTS DURING TRANSPORTATION FOR RELOCATION PURPOSES TO ENSURE SAFETY AND ALSO ENSURE THAT PERTINENT MEDICAL RECORDS & MEDICATIONS ACCOMPANY RESIDENTS/PATIENTS TO THEIR NEW LOCATION.

19. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Hospitals, Nursing Homes Other Facilities RESIDENTS/PATIENTS SHOULD HAVE IDENTIFICATION BRACELETS THAT INCLUDE THEIR NAME, MEDICAL DIAGNOSIS, & OTHER IMPORTANT INFORMATION THAT CAN IDEALLY BE SCANNED DURING EVACUATION PURPOSES FOR EASY TRACKING.

20. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia MANY PROMISES ARE MADE DURING EMERGENCY SITUATIONS THAT ARE NOT LATER FULFILLED. FOR EXAMPLE, MANY INDIVIDUALS WHO LACK THE PROPER AUTHORITY SUCH AS DPS OFFICERS DEPLOYED EMS PROVIDERS WHO ARRIVED AT A DISASTER SITE TO GO TO OTHER CITIES/LOCATIONS TO ASSIST IN TRANSPORTING PATIENTS/RESIDENTS. LESSONS LEARNED… BROKEN PROMISES

21. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia LESSONS LEARNED…. UNIDENTIFIED POPULATION THERE IS A HUGE UNIDENTIFIED POPULATION THAT IS NOT INSTITUTIONALIZED THAT RECEIVE ASSISTANCE SUCH AS HOME HEALTH SERVICES IN THE COMMUNITY, THAT MAY NEED ASSISTANCE WITH EVACUATION. EFFORTS SHOULD BE UNDERTAKEN TO HELP IDENTIFY THESE INDIVIDUALS PRIOR TO AN EMERGENCY SITUATION SO THAT THEY CAN GET THE ASSISTANCE THEY NEED IN EVACUATING.

22. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia LESSONS LEARNED… IDENTIFICATION BADGES STATE GOVERNMENT & CITY OFFICIALS SHOULD HAVE I.D. BADGES THAT INCLUDE A STATE SEAL SUCH AS THE BADGES DPS OR OTHER LAW ENFORCEMENT OFFICERS CARRY IN ORDER TO ENSURE THEY CAN GET PAST BARRICADES TO PROVIDE ASSISTANCE AT DISASTER SITE.

23. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia LESSONS LEARNED… ACCOMMODATING EVACUEES TEXAS IS NOW WORKING OUT A PLAN WITH ALL THE HEALTH SCIENCE CENTERS AT STATE SUPPORTED UNIVERSITIES SO NURSING & MEDICAL STUDENTS CAN STAFF LOCAL SHELTERS THAT ARE TEMPORARILY SET UP TO ACCOMMODATE EVACUEES. EACH OF THE HEALTH SCIENCE CENTERS WILL ALSO BE SENT PRE-PACKAGED EMERGENCY KITS IN BULK THAT INCLUDE BASIC MEDICAL SUPPLIES LIKE STERILE BANDAGES, BOTTLED WATER, ETC..

24. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia LESSONS LEARNED… EVACUATION ROUTES TEXAS HAS DEVELOPED AN ORGANIZED PLAN FOR EVACUATION OF CITIES ALONG ITS COASTLINE. FOR EXAMPLE, PEOPLE IN BEAUMONT/PORT ARTHUR AREA WILL GO TO TYLER; CORPUS CHRISTI WILL GO TO SAN ANTONIO, HARLINGEN/BROWNSVILLE WILL GO TO TEMPLE, WACO & EL PASO, ETC… COMFORT STATIONS WILL BE DEVELOPED ALONG EVACUATION ROUTES TO PROVIDE MEDICAL ASSISTANCE TO EVACUEES

25. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia LESSONS LEANED… SPECIAL NEEDS POPULATION DURING SPRING OF THIS YEAR, PEOPLE ALONG COASTLINE WERE ENCOURAGED TO CALL “211” TO REGISTER & ALSO IDENTIFY IF NEED ASSISTANCE WITH TRANSPORTATION. BASED ON EVACUATION NEEDS – PEOPLE ASSIGNED LEVEL ONE (SELF – ECACUATE) TO LEVEL 5 (LEVEL 4/5 – NEED ASSISTANCE & WILL EITHER BE TRANSPORTED FROM HOSPITAL OR NURSING HOME TO ANOTHER HOSPITAL OR NUSRING HOME). FACILITIES ARE RESPONSIBLE FOR ENTERING AGREEMENT WITH DESTINATION FACILITIES & SECURING TRANSPORTATION MODALITIES.

26. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia FINAL POINTS EVERY STATE SHOULD HAVE A PRE- ESTABLISHED & STRUCTURED EMERGENCY MANAGEMENT PLAN THAT INCLUDES HOW INFORMATION/REQUESTS FOR ASSISTANCE, RESOURCES & SUPPLIES WILL BE DIRECTED & CLEARLY ESTABLISHES THE SINGLE AUTHORITY EMPOWERED TO MAKE DECISIONS/ISSUE DIRECTIONS/APPROVE REQUESTS FOR ASSISTANCE, RESOURCES, ETC. EFFECTIVE COMMUNICATION OF PREPARATION IS THE KEY TO SAVING LIVES

27. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Speaker Contact Information Speaker Name: Renee Clack, Unit Manager Organization: Regulatory Licensing Unit Texas DSHS Address:8407 Wall Street Austin, Texas Phone: (512) 834-6744 E-mail: renee.clack@dshs.state.tx.us