1. American College Health Association June 3, 2011 University Disaster Preparedness and Mission Continuity Plans Session FRO30 John Andrews, MD, MPH Assistant Senior VP Academic Health Center and Director, University Health Services University of Cincinnati

2. Disclosures I have nothing to disclose.

3. Sources  University Health Services Mission Continuity Plan, University of Cincinnati, Cincinnati, OH  ACHA Guidelines. Emergency Planning Guidelines for Campus Health Services: An All- Hazards Approach, February 2011.  http://www.fema.gov/ http://www.fema.gov/  http://www.bt.cdc.gov/cerc http://www.bt.cdc.gov/cerc  http://www.uc.edu/publicsafety/fire_emer gency/emergency_preparedness.html http://www.uc.edu/publicsafety/fire_emer gency/emergency_preparedness.html

4. Objectives  Explain why an effective Mission Continuity Plan embraces an All-Hazards Approach to Disaster Preparedness  Describe the importance of an Effective Mission Continuity Plan for University Disaster Preparedness  Identify the university operational areas that must be included in an effective university Mission Continuity Plan

5. Outline of Today’s Presentation I.Disaster Plans versus Mission Continuity Plans II.A few Definitions and Concepts III.Four Main Steps in Disaster Preparedness IV.Practical Ideas for Mission Continuity Plans (How we did them at the University of Cincinnati and How we Should Have Done them!) V.Communication in Disasters VI.Psychological Impacts of Disasters VII.Conclusion

6. Why Plan? The failure to plan is a plan to fail.

7. Disaster Plans Versus Mission Continuity Plans Disaster Plan: The plan that is used to respond to a disaster. Mission Continuity Plan: The plan that is used to get your organization back to normal functioning - or what do you do after the fire department has left and all of the injured people have been removed from the scene.

8. Outline of Today’s Presentation I.Disaster Plans versus Mission Continuity Plans II.A few Definitions and Concepts III.Four Main Steps in Disaster Preparedness IV.Practical Ideas for Mission Continuity Plans (How we did them at the University of Cincinnati and How we Should Have Done them!) V.Communication in Disasters VI.Psychological Impacts of Disasters VII.Conclusion

9. Purpose of the National Response Framework (NRF)  The National Response Framework is used by federal agencies including the U.S. Department of Homeland Security to respond to disasters  Respond effectively to any type of incident with Immediate actions to save lives, protect property and the environment, and meet basic human needs Implementing emergency plans and actions to support short-term recovery Reference: http://www.fema.gov/emergency/nrf

10. National Incident Management System (NIMS)  The National Incident Management System (NIMS) is a nationwide operations template that enables federal, state, tribal, and local governments, the private sector, and non- governmental organizations (NGOs) to work together regardless of cause, size, location, or complexity of a hazard in order to reduce the loss of life and property and harm to the environment. Reference: http://www.fema.gov/emergency/nims/

11. Governance, Command and Control During Disasters  Identify individuals who will be responsible for declaring an emergency, determining the hazard level, and activating the Disaster Plan.  Identify the location of the Emergency Operations Center (EOC)  Assign Incident Command System (ICS) roles for individuals reporting to the EOC. (University Management will assign the Incident Commander. The Incident Commander will assign Section Chiefs and Liaison Officers)

12. Incident Command System (ICS)  A proven mechanism for the effective management of emergencies that involve either a multiple agency response or a single unit with a Planned, Organized Structure Chain of Command Unity of Command Standardized terminology Facilities/Resources Management Communications and Information Management Source: http://www.fema.gov

13. Set Up and Use the Incident Command System Recommend that campuses and universities adopt the NIMS/ICS system on campuses for all emergencies  Incident Commander  Safety Officer, Liaison Officer, Public Affairs Officer, technical officers  Planning, Logistics, Operations, and Accounting/Finance Sections

14. Identify an Emergency Operations Center (EOC)  Identify personnel who will work in a Disaster.  Identify a location for working in a Disaster.  Identify equipment and information needed for working in a Disaster.  Identify a back-up location off-campus for working in a Disaster (consider a local hotel. They have large rooms, telephones, bathrooms, copiers, fax machines)

15. Evacuation Plans  Set up Evacuation Plans for the relevant parts of your university  Inform employees as to who can decide to evacuate a work area  Set up an area for employees to meet (recommend finding a convenient place that is inside, that is away from heat or cold, that has food and water, and that is near bathrooms.

16. Shelter-In-Place Plans  Set up Shelter-in-Place Plans for situations in which work areas do not need to be evacuated.  Inform employees as to who can decide they need to shelter-in-place.

17. Areas of Rescue Assistance  Identify and placard Areas of Rescue Assistance for employees who are not able to leave work areas.  Inform local emergency personnel of who may need to be rescued and where the areas of rescue assistance are located.  Identify employees who can assist employees with disabilities in leaving the area.

18. Outline of Today’s Presentation I.Disaster Plans versus Mission Continuity Plans II.A few Definitions and Concepts III.Four Main Steps in Disaster Preparedness IV.Practical Ideas for Mission Continuity Plans (How we did them at the University of Cincinnati and How we Should Have Done them!) V.Communication in Disasters VI.Psychological Impacts of Disasters VII.Conclusion

19. Four Main Parts of Disaster Preparedness  Mitigation/Prevention  Preparedness  Response  Recovery

20. Mitigation/Prevention  Campuses cannot prevent all disasters  Campuses can identify risk reduction strategies to prevent incidents and mitigate the impact of emergencies  The first strategy is to develop a preparedness plan  Create teams to decrease the risks due to acts of violence (Threat Assessment Team) and decrease exposure during public health outbreaks (School closure plan, immunization plan, etc.)

21. Preparedness  Interdepartmental project involving key individuals in various constituencies working on a plan with realistic deadlines.  Identify if the institution has policies, procedures, structures or templates to respond to an emergency  Determine if policies, procedures, structures or templates can be adapted to all hazards  Determine who is responsible for emergency preparedness on the campus.

22. Preparedness (cont)  If there is no plan, determine whom you need to engage in the conversation to get emergency planning on the agenda.  Determine if your school has participated in NIMS training/certification  Identify membership of the campus emergency management team. Include legal, risk management, human resources, and safety and security.  Identify the decision makers and a chain of command

23. Preparedness (cont)  Identify how essential groups will work together  Define and explain roles and responsibilities for the operational plans for each department.  Identify the role of the campus health service  Provide exercises and drills to rehearse the response to a disaster. Coordinate drills with multiple departments.  Keep staff informed. Encourage staff participation in webcasts, disaster response training seminars and continuing education programs

24. Preparedness (cont)  Monitor CDC, World Health Organization, ACHA, and state health department information  Encourage staff to make personal and family emergency preparedness plans so they are better able to be responders in the event of an emergency  Fit test staff with N95 respirator protection. Consider positive air purifying respirators (PAPRs)  Identify staff roles and responsibilities for all types of critical incidents.

25. Preparedness (cont)  Compile a list of supplies that are needed  Identify supply sources  Identify storage area for supplies  Maintain a stock supply of needed items  Establish a plan for continued cleaning and waste removal services  Investigate the feasibility of establishing negative pressure rooms in the campus health service  Coordinate with local hospitals

26. Preparedness (cont)  Consider cancelling classes and asking students to leave campus  Plan for a reduction in the campus health services workforce.  Consider volunteers to assist with answering phones, moving supplies, and providing bedside assistance to the ill.  Consider developed a clinic schedule based on 24/7 operation  Consider suspending nonemergency services.

27. Preparedness (cont)  Identify community resources that students could use.  Set up a system for reporting cases both on and off campus  Develop a plan for care of the deceased that considers storage until notification of the family and transfer  Develop plans for conducting mass immunization clinics.  Develop plans to provide food to students and staff

28. Preparedness (concl)  Plan for how to handle international students  Determine how research activities will be handled  Establish a plan for care of laboratory animals and cell cultures  Establish a plan for specimen storage  Set up an evaluation and continuous process improvement plan

29. Response  Once an incident occurs, priorities shift from planning to saving lives and protecting property  Four actions in the response phase Obtain situational awareness Activate and deploy resources Coordinate response actions Demobilization

30. Response - Situational Awareness  Continuous monitoring of information regarding actual and developing incidents  Type of monitoring depends on the event

31. Response – Activate and Deploy Resources  Assess the situation  Identify and prioritize requirements  Activate available resources  Develop an Incident Action Plan Set up an Incident Command System Activate an Incident Management Team Activate specialized teams as needed Position resources based on need Request additional resources from state or federal government.

32. Response – Coordinate Response Actions  Response operations are enhanced by full application of NIMS with its common principles, structures, and coordinating processes Coordinate actions with local authorities, including law enforcement, firefighting, and emergency medical services Continually assess operations and adapt existing plans to meet evolving circumstances Coordinate public information strategies

33. Response – Specific Response Actions  Ensure responder safety and health  Warning the public and providing information to the public  Implementing evacuation and sheltering plans that includes provisions for special needs populations and household pets  Perform search and rescue  Treat the injured  Assist law enforcement and investigation  Control hazards – extinguish fires, contain hazardous spills

34. Response – Demobilization  Decide when to call an end to the crisis  Set up a timeline for restoring normal operations  Communicate with employees, students, and others on the resumption of services  Provide post-event resources for assisting those who need psychological, financial, and social support  Evaluate the effectiveness of the emergency response including feedback from participants

35. Recovery  Actions to facilitate recovery (Mission Continuity) start almost as soon as the disaster occurs.  Recovery is getting the operation back to normal  Recommend not trying to “improve” the normal operation at this time. “Improvement” to the normal operation can occur after operations are back to normal

36. Outline of Today’s Presentation I.Disaster Plans versus Mission Continuity Plans II.A few Definitions and Concepts III.Four Main Steps in Disaster Preparedness IV.Practical Ideas for Mission Continuity Plans (How we did them at the University of Cincinnati and How we Should Have Done them!) V.Communication in Disasters VI.Psychological Impacts of Disasters VII.Conclusion

37. University Mission Continuity Plan University of Cincinnati A detailed plan of procedures for getting operations back to normal Our experience at the University of Cincinnati How we did it and how we should have done it!

38. Who needs to be involved?  All constituencies that will be involved in mitigation/prevention, preparedness, response, and recovery  Regularly scheduled meetings, written collaborative agreements, mutual aid planning, and/or memoranda of understanding  Frequent NIMS/ICS training, tabletop exercises, active drills, and specialized education for responders.

39. Mission Continuity Plans  Identify persons who will be in charge when a disaster occurs. Identify two back-up persons for each task (due to vacations, personnel being out- of-town or ill). Obtain addresses for these individuals  Identify persons who will be in charge when an emergency occurs. Indentify two back-up persons for each task  Identify who will document all activities during the emergency for legal, risk assessment, financial, and administrative purposes.

40. Mission Continuity Plans (contd.)  Identify who has access to any keys or equipment/forms/software/or data needed  Obtain contact information for other university personnel including the Biological Safety Office, Facilities Management, Construction Management, Risk Management, Public Safety, IT, Locksmith, Laboratory animals, Legal, Radiation, Supplies and Services, Work Control

41. Mission Continuity Plan Activities  List all activities in your areas as Critical (essential) or Non-Critical (non-essential).  It may be helpful to group activities into such categories as Education, Research, Patient Care, Business Support.  For both Critical and Non-Critical Functions, describe the processes/procedures/tasks that are required to carry out the function, the Recovery Time to have the activity operational, and the personnel (title/position) who will be needed to carry out the function.

42. Mission Continuity Plan Activities (contd.)  Identify the location of all equipment/forms that will be needed to carry about the function.  Indicate the space, software, connectivity, databases needed for the activity.  Set up teams for various areas of your university that will need to be operational in a disaster (Health Care, Environmental Health, Personnel, Legal, Public Relations, Finance, Administration, Executive, Liaison). Consider any technical experts that may be needed. Obtain contact information for these people.

43. Mission Continuity Plan Activities (contd.)  Inventory university equipment in enough detail that an underwriter will reimburse the university if the equipment is lost or damaged. Include band name, vendor, serial number, and purpose of the equipment, names of the equipment, and building and room number where equipment is kept.

44. Put a Mission Continuity Plan into Writing  Distribute Plans to key personnel  Update Plans at least annually

45. Outline of Today’s Presentation I.Disaster Plans versus Mission Continuity Plans II.A few Definitions and Concepts III.Four Main Steps in Disaster Preparedness IV.Practical Ideas for Mission Continuity Plans (How we did them at the University of Cincinnati and How we Should Have Done them!) V.Communication in Disasters VI.Psychological Impacts of Disasters VII.Conclusion

46. Communication  Goal of Communication: Be first, Be right, Be credible.  Set up a Communication Plan for employees and students (beepers, cell phones, paging, enunciators, posters, bulletin boards, radio, television, Twitter, Facebook, Nixle)  Publicize the Communication Plan  Update personnel on the plan  Get staff cell phone and home phone numbers. Get phone numbers of relatives and for places the staff member is likely to stay if they aren’t at home http://www.bt.cdc.gov/cerchttp://www.bt.cdc.gov/cerc (CERC = Crisis and Emergency Risk Communication)

47. Communication (cont)  Discuss communication plan with communication and IT departments to be sure it is doable.  Identify who will be responsible for communications as well as at least two backups (Public Relations Officer)  Set up a central reporting plan for daily monitoring of illness or disease, employee and student absences, students in isolation, location and number of students transported to a hospital  Establish a plan for notifying essential personnel (calling tree ?)

48. Communication (cont)  Get appropriate approvals in advance so that messages can be disseminated quickly  On a regular schedule and as needed, provide information to the campus community on such topics as the disaster status on campus, travel advice, shelter-in-place, personal care, hand washing, cough etiquette, how/where/when to access healthcare services.  Consider crafting messages in advance  Ensure that messages are easy to understand and culturally appropriate.

49. Communication (concl)  Consider identifying translators and translating materials into different languages as appropriate.  Maintain communications with the local public health authorities, emergency preparedness groups, hospital systems regarding surveillance, case identification and reporting, control measures, and health care provisions. (Liaison Officer)  Maintain contact with other universities as appropriate (Liaison Officer)  Maintain up-to-date lists of key contacts (Liaison Officer)

50. Outline of Today’s Presentation I.Disaster Plans versus Mission Continuity Plans II.A few Definitions and Concepts III.Four Main Steps in Disaster Preparedness IV.Practical Ideas for Mission Continuity Plans (How we did them at the University of Cincinnati and How we Should Have Done them!) V.Communication in Disasters VI.Psychological Impacts of Disasters VII.Conclusion

51. Psychological Impact of Disasters  Most people (including disaster responders) will experience psychological distress in disasters (strong feelings of grief, sadness, fear, or anger)  Some individuals will need professional assistance to achieve the two primary goals of mental health crisis response Normalizing feelings Finding effective ways of coping with ongoing stress

52. Psychological Impact of Disasters (cont)  There is not a single “normal” pattern of reaction to a disaster.  If symptoms of distress do not dissipate in a period of weeks if they become worse, affected individuals should seek professional help.  Strategies they may help individuals include identifying safe areas and behaviors, maximizing the individual’s ability to care for self and their family, teaching calming skills, encourage connectedness to family and other social supports.

53. Psychological Impact of Disasters (cont)  Important for primary health care clinicians to screen patients for stress related symptoms and emotional distress.  Identify positive methods of coping (social supports, self-care, structure to daily routine, continue “normal” rituals, continue exercise and recreational activities, gently facing feared situations.  Professional assistance if severe fatigue, easily startled or hyper-vigilant, headaches, gastrointestinal symptoms, problems with concentration, social isolation, blaming, unable to experience pleasure, outbursts of anger.

54. Psychological Impact of Disasters (concl)  Care-givers and emergency response personnel require Stress debriefing meetings Counseling and support options Educational in-services or workshops regarding self-care Work rotation schedules and respite  Strategies most helpful focus on helping individuals to establish a feeling of being safe

55. Outline of Today’s Presentation I.Disaster Plans versus Mission Continuity Plans II.A few Definitions and Concepts III.Four Main Steps in Disaster Preparedness IV.Practical Ideas for Mission Continuity Plans (How we did them at the University of Cincinnati and How we Should Have Done them!) V.Communication in Disasters VI.Psychological Impacts of Disasters VII.Conclusion

56. Conclusion Go Forth and Plan Well