Sshs lecture admin in disaster


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  • Explain that Executives/Senior Officials must ensure that incident responders are well trained and qualified. Tell them they must consider: If there are sufficient qualified personnel to assume ICS Command and General Staff positions. Explain that Executives/Senior Officials are responsible for ensuring that a qualified Incident Commander has been designated for the incident. Some agencies and jurisdictions maintain a roster of qualified Incident Commanders based on the complexity of the incident. Ask the participants to identify the qualities of an effective Incident Commander. If not mentioned by the participants, add any of the following qualities: skilled/experienced in directing tactical response operations; command presence; understanding of ICS; proven management record; strong decisionmaker; calm but quick-thinking; good communication skills; adaptability and flexibility; realistic about personal limitations; and political awareness. If they can verify that personnel meet established professional standards for: Training. Experience. Performance. When the last tabletop or functional exercise was conducted to practice command and coordination functions. Note that Executives/Senior Officials should participate in these exercises. February 2009 Page
  • Sshs lecture admin in disaster

    1. 1. Structuring the Administrative Side of a Hospital For Disaster Charles M. Little, DO FACEP Department of Emergency Medicine University of Colorado Denver
    2. 2. Today’s Objectives <ul><li>Outline the administrative needs in disaster response </li></ul><ul><li>Describe the US integrated disaster response system </li></ul><ul><ul><li>NIMS </li></ul></ul><ul><li>Delineate how hospitals fit into the structure </li></ul><ul><li>Describe typical hospital emergency preparedness activities </li></ul><ul><li>Discuss examples of typical responses </li></ul>
    3. 3. Federal Structure Bottom Up Approach <ul><li>Individuals, Households, </li></ul><ul><ul><li>Private Sector, NGOs </li></ul></ul><ul><ul><li>Emergency Preparedness </li></ul></ul><ul><ul><li>Starts Here! </li></ul></ul><ul><li>Local Officials </li></ul><ul><ul><li>Primary Responsibility for Preparedness & Response </li></ul></ul><ul><li>States </li></ul><ul><ul><li>Governor, Homeland Security Advisor, EMA, State Coordinating Officer (SCO) </li></ul></ul><ul><ul><li>Coordinates Resources & Support from other States & Federal Government </li></ul></ul>
    4. 4. Hospital Structure There are three groups of the administrative structure: Administration Nursing Ancillary Physicians and Licensed Independent Practitioners
    5. 5. Emergency Management Plan <ul><li>Mitigation/Preparedness & Program Support </li></ul><ul><ul><li>Hazard Vulnerability Analysis – Mitigation </li></ul></ul><ul><ul><li>MOUs & Other Agreements </li></ul></ul><ul><ul><li>Training Records </li></ul></ul><ul><ul><li>Exercise Plans & Records </li></ul></ul><ul><li>Response & Recovery </li></ul><ul><ul><li>Emergency Operations Plan </li></ul></ul>TJC 2009 EM Standards
    6. 6. Emergency Operations Plan Components <ul><li>6 Critical Function Areas </li></ul><ul><ul><li>Communication </li></ul></ul><ul><ul><li>Resources </li></ul></ul><ul><ul><li>Safety & Security </li></ul></ul><ul><ul><li>Staffing </li></ul></ul><ul><ul><li>Utilities </li></ul></ul><ul><ul><li>Clinical & Support Activities </li></ul></ul>
    7. 7. Major Points <ul><li>Emergency Operations Plan </li></ul><ul><ul><li>Annexes </li></ul></ul><ul><li>Need for ICS </li></ul><ul><ul><li>The UCH experience </li></ul></ul>
    8. 8. EOP – Critical Function Areas <ul><li>Communication </li></ul><ul><ul><li>Systems & Strategies </li></ul></ul><ul><li>Resources </li></ul><ul><ul><li>Inventory, Acquisition, Monitoring, and Replenishment </li></ul></ul><ul><ul><li>Hospital Resource Directory </li></ul></ul><ul><ul><li>Staff Support </li></ul></ul><ul><ul><li>Shared Resources and Assets </li></ul></ul><ul><ul><li>Transportation </li></ul></ul><ul><li>Safety & Security </li></ul><ul><ul><li>Internal Safety & Security </li></ul></ul><ul><ul><li>Control Access & Movement </li></ul></ul><ul><ul><li>Coordination of Security with External Agencies </li></ul></ul><ul><ul><li>Management of Hazardous Materials & Waste </li></ul></ul><ul><ul><li>Radioactive/Biological/Chemical Isolation & Decontamination </li></ul></ul>
    9. 9. EOP – Critical Function Areas <ul><li>Utilities </li></ul><ul><ul><li>Electricity, Water, Fuel, Medical Gasses, etc. </li></ul></ul><ul><li>Clinical & Support Activities </li></ul><ul><ul><li>Management of Patient Clinical Activities </li></ul></ul><ul><ul><li>Evacuation </li></ul></ul><ul><ul><li>Surge Activities & Altered Standards of Care </li></ul></ul><ul><ul><li>Clinical Services for Vulnerable Populations </li></ul></ul><ul><ul><li>Patient Hygiene and Sanitation </li></ul></ul><ul><ul><li>Patient Mental Health Needs </li></ul></ul><ul><ul><li>Decedent Management </li></ul></ul><ul><ul><li>Clinical Documentation and Tracking </li></ul></ul>
    10. 10. Support Annexes Coordination of Common Functional & Admin Processes <ul><li>Critical Infrastructure and Key Resources </li></ul><ul><li>Financial Management </li></ul><ul><li>Private Sector Coordination </li></ul><ul><li>Public Affairs </li></ul><ul><li>Tribal Relations </li></ul><ul><li>Volunteer and Donations Management </li></ul><ul><li>Worker Safety and Health </li></ul>
    11. 11. Incident Annexes Describe CONOPS for Specific Contingencies & Hazards <ul><li>Biological Incident </li></ul><ul><li>Cyber Incident </li></ul><ul><li>Nuclear/Radiological/Chemical Incident </li></ul><ul><li>Mass Evacuation Incident </li></ul>
    12. 12. Incident Command System (ICS) <ul><li>Originated 1970s </li></ul><ul><ul><li>Fire service based </li></ul></ul><ul><li>Tested in multiple disasters </li></ul><ul><li>Similar organization across all responders </li></ul><ul><ul><li>NIMS: National Incident Management System </li></ul></ul><ul><ul><li>Joint Commission </li></ul></ul>
    13. 13. ICS Purposes <ul><li>Using management best practices, ICS helps to ensure: </li></ul><ul><ul><li>The safety of providers and others. </li></ul></ul><ul><ul><li>The achievement of tactical objectives. </li></ul></ul><ul><ul><li>The efficient use of resources. </li></ul></ul><ul><li>Flexible based on complexity of the incident </li></ul>
    14. 14. Incident Complexity and Resource Needs Incident Complexity Resource Needs ICS Structure Complexity 90% of Incidents only require a simple ICS structure!
    15. 17. ICS Structure
    16. 18. Who should be Incident Commander?
    17. 19. Training FEMA IS – 100, 200,700 IS- 800 Advanced IS – 300, 400
    18. 20. Training, Credentialing, and Exercising <ul><ul><li>Do you have sufficient qualified personnel to assume ICS Command and General Staff positions? </li></ul></ul><ul><ul><li>Can you verify that personnel meet established professional standards for: </li></ul></ul><ul><ul><ul><li>Training? </li></ul></ul></ul><ul><ul><ul><li>Experience? </li></ul></ul></ul><ul><ul><ul><li>Performance? </li></ul></ul></ul><ul><ul><li>When was the last tabletop or functional exercise that practiced command and coordination functions? Did you participate in that exercise? </li></ul></ul>
    19. 21. Chief Executive <ul><li>Delegate Command Authority to Incident Commander. </li></ul><ul><li>Provide Policy Guidance on Priorities and Strategic Direction based on situational needs. </li></ul><ul><li>Provide Financial Authority and Restrictions. </li></ul><ul><li>Provide Reporting Requirements </li></ul><ul><li>Provide Guidance on Demographic and Political Implications </li></ul>
    20. 22. Incident Command <ul><li>The activities at the Command Center (such as a Hospital Command Center-HCC) are directed by the Incident Commander (IC) </li></ul><ul><li>IC has overall responsibility for all activities within the HCC </li></ul><ul><li>The IC may appoint other Command Staff personnel to assist as the situation and resources warrant </li></ul>
    21. 23. Building Command & Staff Depth <ul><li>Three to five persons should be trained for each command position in case a prolonged response is required </li></ul><ul><li>Training and exercises should be used as a means of preparing personnel to competently and confidently assume one or more roles based on situational need and available resources. </li></ul><ul><li>Completion of the specified NIMS courses, either online or in the classroom, should help to prepare those persons likely to assume command roles. </li></ul>
    22. 24. Special ICS Issues <ul><li>Unified command </li></ul><ul><ul><li>Possible working with outside agencies </li></ul></ul>
    23. 25. Emergency Operations Plan Components <ul><li>Activation & Termination of EOP, HCC, ICS </li></ul><ul><li>Integration with Community ICS & Partners </li></ul><ul><ul><li>Status/Capacity, Resource Sharing, Patient Tracking/Management, Event Management </li></ul></ul><ul><li>HCC Specific ICS Job Action Sheets & Forms </li></ul><ul><ul><li>Only those that may be activated by your facility. </li></ul></ul><ul><li>Relevant Annexes, Policies & Procedures </li></ul><ul><ul><li>Based on HVA top priorities (3-5) </li></ul></ul><ul><ul><li>Surge Capacity, Pan Flu, Evacuation, Mass Fatality, Evacuation, etc. </li></ul></ul><ul><ul><li>Incident Response Guides (IRGs). </li></ul></ul><ul><ul><li>96 Hour Capability </li></ul></ul><ul><li>Recovery </li></ul><ul><ul><li>Return to Normal Operations </li></ul></ul><ul><ul><li>Event Evaluation </li></ul></ul>
    24. 26. EOP – Critical Function Areas <ul><li>Staffing </li></ul><ul><ul><li>Staff Roles & Responsibilities </li></ul></ul><ul><ul><li>Reporting Instructions </li></ul></ul><ul><ul><li>Training </li></ul></ul><ul><ul><li>Acceptance & Use of Staff from other Healthcare Organizations </li></ul></ul><ul><ul><li>Acceptance & Use of Volunteers </li></ul></ul><ul><ul><li>Workforce Identification </li></ul></ul>
    25. 27. Hazard Vulnerability Analysis <ul><li>Required Annually </li></ul><ul><li>Systematic Approach for Recognizing Hazards </li></ul><ul><li>The Risks of each Hazard are Analyzed </li></ul><ul><ul><li>Prioritizes Planning, Mitigation, Response, & Recovery Activities. </li></ul></ul><ul><li>Serves as the “Needs Assessment” for the Emergency Management Program. </li></ul><ul><li>Should Involve Community Partners. </li></ul>
    26. 28. HUMAN EVENTS - Anschutz Medical Campus EVENT PROBABILITY RISK PREPAREDNESS TOTAL           HUMAN (IN OUR BUILDING)   HOSPITAL DISRUPTION             HIGH MED LOW NONE DEATH HEALTH/SAFETY NONE HIGH MOD LOW POOR FAIR GOOD   SCORE 3 2 1 0 6 3 0 3 2 1 3 2 1   MASS CASUALTY INCIDENT (TRAUMA)   X         X X       X   7 MASS CASUALTY INCIDENT (MEDICAL)   X         X X       X   7 WMD (CHEMICAL)     X     X   X       X   9 WMD (BIOLOGICAL)     X     X   X       X   9 WMD (NUCLEAR)     X     X   X       X   9 INFANT ABDUCTION   X       X     X       X 8 CIVIL DISTURBANCE     X       X   X     X   5 HOSTAGE SITUATION     X     X   X     X     10 ACTIVE SHOOTER   X   X     X     X     14 BOMB THREAT     X     X     X       X 7 ILLEGAL CHEMICAL LAB     X     X       X   X   7 VIOLENCE IN THE EMERGENCY DEPT. X       X     X       X 9 WORK PLACE VIOLENCE   X       X       X     X 7 Action Point determined to be 9 or above
    27. 29. MCI Hospital Response <ul><li>ED empties of all noncritical patients </li></ul><ul><ul><li>Move into hospital all admission </li></ul></ul><ul><ul><li>D/C stable patients </li></ul></ul><ul><li>Critical patient flow should be unidirectional </li></ul><ul><ul><li>ED, critical studies, ICU or OR </li></ul></ul><ul><li>Operate in minimalist mode </li></ul><ul><ul><li>Defer tests not immediately mandatory </li></ul></ul>
    28. 30. Individual Responsibilities
    29. 31. Response <ul><li>Have a pre-existing plan for family emergencies, medicines, child and pet care </li></ul><ul><li>Respond When Requested or spontaneous? </li></ul><ul><li>Establish a Location & Point of Contact </li></ul><ul><ul><li>Hospitals need to pre-designate </li></ul></ul>
    30. 32. ED Initial Response <ul><li>ED Organizes </li></ul><ul><ul><li>Security!! </li></ul></ul><ul><ul><li>Red (Immediate, Critical) </li></ul></ul><ul><ul><li>Yellow (Intermediate, Delayed) </li></ul></ul><ul><ul><li>Green (Minor, Ambulatory) </li></ul></ul><ul><ul><li>Triage area set up </li></ul></ul><ul><ul><li>Disaster Registration commences </li></ul></ul><ul><ul><li>Form treatment teams for Red </li></ul></ul><ul><ul><ul><li>Physician, nurse, ancillary </li></ul></ul></ul>
    31. 33. Hospital Admin Response <ul><li>Hospital Command Center Opens </li></ul><ul><ul><li>Coordinate Response </li></ul></ul><ul><ul><li>Push out resources </li></ul></ul><ul><ul><ul><li>Labor Pool </li></ul></ul></ul><ul><ul><ul><li>Supplies </li></ul></ul></ul><ul><ul><li>Family Center </li></ul></ul><ul><ul><li>Behavioral Health Area </li></ul></ul><ul><ul><li>Morgue </li></ul></ul>
    32. 34. HCC Response <ul><li>Send staff and beds to ED </li></ul><ul><li>Set up labor pool </li></ul><ul><ul><li>ICU and PACU personnel ideal </li></ul></ul><ul><ul><li>Cross train </li></ul></ul><ul><li>Floor teams discharge all appropriate patients </li></ul><ul><ul><li>Use discharge holding area </li></ul></ul>
    33. 35. MCI Hospital Phases: Chaos <ul><li>Duration: minutes to hours </li></ul><ul><li>Poor communications </li></ul><ul><li>Minimal and unreliable information </li></ul><ul><li>Implement disaster plan, reorganize resources </li></ul><ul><li>Staff checks on family well being </li></ul>
    34. 36. Casualty Receiving <ul><li>Duration: few hours </li></ul><ul><li>Hospital resources limited to on hand only </li></ul><ul><li>Operate in damage control mode, limited treatment of life and limb threatening injuries to maximize surge </li></ul>
    35. 37. Consolidation <ul><li>Duration: about 24 hours </li></ul><ul><li>All casualties received </li></ul><ul><li>Restock supplies </li></ul><ul><li>Tally patients and prioritize surgeries </li></ul><ul><li>Rotate staff </li></ul>
    36. 38. Phases continued <ul><li>Definitive Care: weeks </li></ul><ul><ul><li>Further surgeries as needed </li></ul></ul><ul><li>Rehabilitation: months </li></ul>
    37. 39. IEDs <ul><li>Highest FBI ranked terrorist threat in USA </li></ul><ul><li>Easily made devices (recipes on the web) </li></ul><ul><li>Primary bombing </li></ul><ul><ul><li>Maximize casualties and PR impact </li></ul></ul><ul><ul><li>Closed spaces </li></ul></ul><ul><li>Secondary devices common </li></ul><ul><ul><li>Aimed at first responders </li></ul></ul><ul><li>Hospitals targeted overseas </li></ul>
    38. 41. Hospital Trauma Capacity <ul><li>1 critical patient/100 beds – normal operations </li></ul><ul><li>2-3 critical patients/100 beds – maximal response </li></ul><ul><li>A hospital ramp up requires 30-60 minutes </li></ul>How does casualty load affect trauma care in urban bombing incidents? A quantitative analysis. Hirshberg A, Scott BG, Granchi T, Wall MJ Jr, Mattox KL, Stein M .J Trauma. 2005 Apr;58(4):686-93
    39. 42. How does casualty load affect trauma care in urban bombing incidents? A quantitative analysis. Hirshberg A, Scott BG, Granchi T, Wall MJ Jr, Mattox KL, Stein M .J Trauma. 2005 Apr;58(4):686-93
    40. 43. Conclusions It is important to have a well developed EOP Exercises are key! Continued staff education and training is hard but necessary