1. Presented By: Emergency Management Professionals Dee Grimm RN, JD MUTAL AID AGREEEMENTS FOR HOSPITAL EVACUATION

2. Presentation Objectives Presentation Objectives Examine the need for mutual cooperative efforts between healthcare agencies Review different approaches to developing mutual aid agreements Examine components of a mutual aid agreements between facilities Discuss potential issues that can arise during hospital to hospital evacuations

3. Need For Cooperative Efforts We can no longer operate in a silo Best care for patients Federal trend for grant funding NIMS/NRF Streamlines evacuation process

4. Mutual Aid Evacuation Agreement Purpose “To coordinate transportation and care of patients who have been evacuated from a member hospital in a qualified disaster, with minimal disruption to the provision of acute emergency care to the community” “To coordinate transportation and care of patients who have been evacuated from a member hospital in a qualified disaster, with minimal disruption to the provision of acute emergency care to the community”

5. Elements of the Plan Assumptions and definitions Evacuation criteria/Disaster declaration process Patients distribution/transportation Pre determined distribution charts Hospital responsibilities Cross Privileges Supplies, personnel, equipment, records

6. Basic Assumptions Only one hospital evacuating at a time No other emergency occurring in community Emergency Departments will not be receiving sites Evacuating hospital is at high average census minus a 10% reduction by discharge Emergency Manager of the jurisdiction will seek an emergency declaration Transfer will be to a facility with “similar services” Non-ambulance transport may need to be used Special care patients will be sent directly to receiving hospitals, not to external holding areas (may be the last patients sent)

7. Definitions Immediate evacuation – requires immediate, prompt departure due to life threatening conditions. Rapid movement of patients to external holding areas Urgent evacuation – quick, but orderly hospital departure. May allow for period of internal holding

8. Notification and Transfer Decisions Accepting numbers have been pre-determined Decision about where patients go made by EMS authority Disbursement based on type of patients – not red, yellow, green

9. Types – Not Color Codes Disbursement of patients based on “types”, not standard MCI color codes Why won’t red/yellow/green categories work? Based on transportation needs and special needs

12. ROLE OF MEDICAL DISPATCH and TRANSPORTING AGENCY Make notifications to hospitals and others Notify receiving facilities of patient information and ETA Receive updated acceptance information from receiving facilities Provide updated acceptance information to field personnel Final record to go to evacuating facility for patient tracking

15. Evacuating Facility Responsibilities Evacuating Facility will : –Reduce patient census –Track patients and document –Send records with patient –Send equipment, medications and staff –Maintain list of supplies, equipment transferred –Maintain SNF transfer agreement if applicable –Notify family, doctors of patient transfers

16. Receiving Facility Responsibilities Receiving Facility will : –Reduce patient census –Obtain additional equipment and staff –Update Medical Dispatch of acceptance numbers if needed –Set up non-ER reception sites to receive patients –Maintain patient tracking –Notify family, doctors of patients received –Be responsible for safety of staff received and maintenance of equipment –Return patients, equipment, and staff when appropriate

18. Hospital Agency Representative Assigned by evacuating hospital Reports to field IC or Liaison Officer and requests to participate in Unified Command Speaks for hospital with full authority Makes decisions in all matters affecting hospital Provides information for media release Participates in development of Incident Action Plan Shares incident management information with Hospital Incident Commander

19. Hospital Planning Technical Specialist Assigned by evacuating hospital Reports to IC or Liaison to participate in Medical Branch Operations as technical specialist to Patient Transportation Group Supervisor Obtains information from hospital on patients’ medical acuity, transportation requirements, equipment, and staffing needs Acts as liaison with evacuating hospital to share patient tracking information from the field and to obtain updated hospital information for the medical branch

20. Special Issues Liability (declared emergency to initiate limited liability) Confidentiality/HIPAA Cross privileges of staff/credentialing Worker Compensation and staff payment Notification to Bureau of Health Facilities, Licensure, and Certification Transfer of medications (scheduled drugs)

21. Guidelines for Hospital Participants Become familiar with your hospital’s own plan Become familiar with the evacuation annex and your field ICS roles/responsibilities Review the pre-planned patient distribution scheme your agency agreed to Your hospital agreed to make “best efforts” to accommodate evacuated patients

22. Overall Responsibilities Develop facility’s own internal plan Use same Patient Evacuation Tracking Sheets Inform Health Department of changes of hospital’s information in the annex Maintain adequate business interruption insurance Attend training, drills and participate in debriefing processes