Hospital Emergency Plan


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The Emergency Operations Plan (EOP) provides the structure and processes that the organization utilizes to respond to and initially recover from an event. The EOP is therefore the response and recovery component of the EMP.

The Joint Commission Emergency Management Standards are very specific to the requirements of the hospital EOP, however it should be noted that some of these requirements cross over to mitigation and preparedness activities. For a suggested outline of the Emergency Management Program and for further guidance, see the following

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  • Purpose of the Workshop is to begin the process of refining the Hospital EOP in light of: New building New organizational changes/responsibilities (basically MORE) New collaboration/coordination efforts
  • Blueprint project- focus is reaching standardized and easily implemented Volunteer management plan for rural hospitals Coordinated efforts with ESF8 have identified gaps in community planning and part of this project will help address those. Community Clinic and Health Center Emergency Operations Plan Template and tools were useful in addressing preparation and planning for similar “level of care” issues that CAH’s and rural hospitals would address. <Agency Name> for participation in this project which will benefit <Agency Name> operations, planning, and also MRC integration into healthcare response.
  • Application of regs should be straightforward for first receivers due to their increased risk…or is it? These ground zero firefighters are being exposed to a broad range of toxins even though they are in an open air environment, but the limitations of SCBA generally mean that outside a confined space, they are not used, despite continued smoke and particulate exposure. Few fire companies carry dust/mist masks or PAPRs which could be used for longer durations. Joint Commission, Centers for Medicare and Medicaid Services, (CMS), and Public Health Emergency Preparedness requirements are all similar in an effort to reduce redundancy, increase uniformity in compliance, and increase efficiency in management of resources and facilities. Public perceptions that healthcare organizations are “prepared” as a result of Homeland Security funding, multi-agency partnerships, and increased levels of expectations due to increased public awareness have resulted in a sense of “entitlement” on the part of the public. Individuals feel that they are entitled to an immediate response and a higher level of care in extreme situations simply because it is an emergency. One only has to look at the frustration with the timeliness of vaccine delivery during H1N1 to see this.
  • What factors seem to be affecting (dictating?) planning and preparedness activities? Mass Casualty Plan! Do the plans reflect the facilities and individuals in the community? Has a EMS transportation plan been exercised since a new facility was built. Have physicians been “scrambled” to figure out where they’d go in an emergency? And who would scramble Whom? Surge capacity during H1N1… staffing was already in short supply. How can we plan NOW for Volunteer deployment? Respiratory Therapists and those that were contracted were in great demand! ALL Plans are being structured at the city/county level to encourage ESF8 alignment and integration- Family Health West needs to integrate ESF8 Plan activation as well. NIMS/ICS incorporated planning and response has become a REQUIREMENT for all agencies receiving federal funding and reimbursement. Department of Homeland Security has required all grantees to comply with federal NRF guidelines and HSEEP guidance. The Federal HHS Assistant Secretary of Preparedness and Response (ASPR), Hospital Preparedness Program (HPP) requires NIMS/ICS, HSEEP, and EOP planning to incorporate recent changes and concepts. Local Public Health Agency (LPHA) deliverables and special grants (H1N1) require community benefit, integration, and partnerships.
  • State Hospital Associations have been leading (due to grant funding themselves) initiatives aimed at emergency preparedness. We’ve already talked about the “entitlement” that the public feels to have emergency services at their disposal. Increasing our capacity/capability is crucial to a facilities success. Medical Reserve Corps can augment and provide surge staffing, and operations support. Medical supply warehouses/caches are an extension of supply coordination- resource even though they don’t plan.
  • These types of “scenarios” point out a couple of key terms: Go to next slide!
  • While being cut off from outside support seems unlikey… scenarios do exist which will require a higher level of coordination (evacuation) or a higher level of support (water failure.) The likelihood of increased staff support is slim given rural hospitals relative lack of surge staff with necessary training.
  • Response and Recovery have their own categories of issues: Federal/state support FEMA support “ Disaster” funds Mutual Aid
  • The core idea here is that Hospitals are part of an integrated plan for response involving a variety of Public/private partnerships. The label of ESF8 adequately describes the functional elements but relies heavily on a deeper understanding of what ESF8 is and how it functions in partnership with the member organizations. (Medical Reserve Corps, Red Cross, Hospitals, Emergency Medical Systems, Dispatch, etc…)
  • During many incidents the “lead” for ESF8 is public health. The close partnership between the Local Public Health Agency and the hospitals in their county crucial factor in determining the effectiveness and efficiency of the response and the success of the recovery effort.
  • Emergency Operations Plan development through each of these aspects, and the manner in which other response agencies and the level of preparation of the volunteers will affect the success of the implementation of the Plan.
  • Goal is to adequately plan, train, and prepare for a volunteer workforce to mitigate the effects of each of these. Pre-identify trained and credentialed volunteers. Identify areas of patient management/patient management support. Maintain workflow AND additional duties through Just-in-time training (JITT.) Decrease mental stress that comes with multi-tasking. Identify duties that can be delegated. Create a routine. Facilitate supply processes during surge and support those with volunteer support. Add volunteers to support communication between integrated response agencies. Minimize the fiscal effects of increase staff by utilizing volunteers.
  • General Discussion of past/previous plans and what led up to these revisions.
  • These are simply general information and declarative statements regarding the compliance aspects of the plan and the objectives regarding what the plan is meant to explain/do.
  • Hospital Vulnerability Analysis (HVA) – Appendix D.1 Risk Assessment – Appendix D.2 Hazard Mitigation- D.3 Roles/Responsibilities (Appendix E)
  • An EOP that “hits all the marks” Aligned with HICS/NIMS HSEEP documented ESF8 Plan Integrated with ESF8 and exercised with ESF8 organizations Joint Exercises/Training Based on Training and Exercise Plan Workshop (TEPW)- See HSEEP materials for more information. Based on HVA- annually updated Involves a higher level of awareness in community
  • Section 3- Response, H.1 Emergency Procedures ICS structure? Who/Where? EOC? Backup EOC? Medical Care/Medical Information Communication can mean MANY MANY things- public, media, patients, family, staff….. These sections really need their own training.
  • Work done during the response that HAS NOT been effectively structured or organized will be less likely to recover successfully and less likely to be able to be tracked for cost recovery and reimbursement.
  • What is needed? What are Critical Response Tools that ALREADY exsist but have not been incorporated? What is the review/revision schedule and who is involved?
  • Has the basic structure of most “planning” documents with a Basic Plan, Plan Appendices, Annexes, and Attachments.
  • Hospital Emergency Plan

    1. 1. Hospital Emergency Operations PlanWorkshopUpdating the Hospital and Rural Medical CenterEOP for the Use of Volunteers in Medical SurgeBy Mr.Mahboob alikhan MHA CPHQ USA
    2. 2. Acknowledgements:• This workshop was developed by the Mesa County HealthDepartment as part of the National Association of City andCounty Health Officials (NACCHO) Advanced PracticeCenters (APC) Program (Blueprint Project.)• It takes into account new information in light of:– Emergency Support Function 8 (ESF8) Planning;– Homeland Security Exercise and Evaluation Program (HSEEP);– Hospital Incident Command System (HICS); and– National Health Security Strategy (NHSS).• California Emergency Medical Services Authority’s ClinicEmergency Preparedness Project is acknowledged forproviding a framework from which a Hospital EmergencyOperations Plan template could be created.• Contributions of Family Health West Hospital, Fruita, Coloradoin the review and revision of this information.
    3. 3. Objectives• Participants will understand the importance and processneeded for All Hazard emergency operations planning inHospitals.• Participants will understand the phases of EmergencyManagement.• Participants will understand how an incident commandleadership structure is an integrated component of theHospital emergency operations planning .• Participants will understand the major components neededto write an effective hospital emergency operations plan.• Participants will understand why volunteer use in medicalsurge is critical to writing an effective plan for ruralhospitals.
    4. 4. Why is this an issue today?• Terrorism• Disasters• Other– What keeps you awake atnight?– What often happens?– What are you unpreparedfor?– What can be done to planfor these situations?FEMA News – Andrea BooherI knew thiswouldhappen!
    5. 5. How does terrorism/disastersaffect the healthcare system?• Produces masscasualties– Murrah Building inOklahoma City– Suicide bombers inMiddle East– Olympic Park Bombingin Atlanta– Twin Towers in NewYork– Hurricane Katrina– Virginia Tech SchoolShooting– Mexican Hat, Utah Busrollover(AP-Associated Press)
    6. 6. How does terrorism/disastersaffect the healthcare system?• Produces a redirection ofresources and change inpreparedness activities– Smallpox planning forhospitals and healthdepartments– H1N1 Strategic NationalStockpile (SNS) – vaccinesand drug caches, massdispensing plans– Surge capacity planning– Agro-chemical/oil and gaschemical regulatorycompliance issues
    7. 7. Haven’t we done this before?• Pre-1950’s “Civil Defense” Era.• “Fire Protection” Era (1960’s-1970’s)• “Disaster” Planning Era (1970’s)• Emergency response for hospitals used to meana disaster plan, fire plan, utility failure plan.• Current (post- 9-11) all-hazards expectations(public/partners): community integration, addressall aspects of patient care issues, records anddata tracking/security, supply status tracking,surge resource tracking.• Result: more complex planning due to a morecomplex response.
    8. 8. Hospital planning & preparedness• County Mass Casualty Plan• Surge capacity planning (H1N1)• Aligns with EOP plans atcity/county level• NIMS/ICS compliance• Homeland Security compliancefunding• HPP deliverables• LPHA grants and deliverables
    9. 9. Hospital planning &preparedness• State Hospital Associations: Emergency planning,HSEEP , state-level hospital coordination systems.• “9-11” and heightened expectations for increasedintegration in surge capacity and response.• Tendency towards credentialing and accreditation:– Credentialing for surge staff/volunteers– National trends toward accreditation: schools and healthdepartments.– What will be the future relationship between CMS-CoP’s andJoint Commission Standards?
    10. 10. Chemical incidents –planning considerations• What measures must be planned in advance to safelyevacuate/ treat patients contaminated with toxic chemicals?• Does your hospital have the capability to decontaminate?• What antidote medications might be important if a chemicalterrorist attack occurred?
    11. 11. Definitions• Capacity: amount or availability of resources andability of staff, training, and depth.• Capability: type of services in terms ofemergencies, partnerships, and readiness.• Vulnerability: susceptibility to failure due toinadequate resources, training, equipment, orplanning. The goal is to decrease vulnerability.• Readiness/Preparedness: a direct result of theadequacy of planning and the potential of thoseplans to create results in the area of training andresources.
    12. 12. What is an incident?• Any event that overwhelmsexisting resources to deal withthat event.– Weather – tornadoes,flooding, severe storms– Terrorism– Infrastructure failuresaffecting operations for aprolonged period– Hazardous materialsincident– Large volume of patients– Pandemic
    13. 13. Incident implications• Transportation• Electrical• Telephone• Water• Fuel• Structural• Communications
    14. 14. Incident implications• Incidents restrict and overwhelmresources, communications,transportation and utilities.• Individuals and communities are cut offfrom the outside support.
    15. 15. What is your goal in anincident?• RESPONSE – manage victims (treat,triage, transfer, disposition).• RECOVERY – operational, financial, andreturn to “normal” operations.
    16. 16. All Hazards approach toplanning• A conceptualframework fororganizing andmanagingemergencyprotection efforts.
    17. 17. Who is involved in All Hazardresponse efforts?• Federal• Tribal• State• Local• EmergencyManagement• Public Works• Fire/Rescue• EMS• Hospitals• Public Health
    18. 18. All Hazard steps• Planning• Training• Exercising• Policies &procedures• Resourcerequirements• Resource upgrade
    19. 19. Major Incident Operations• Disruption of normalprocess of healthcare delivery• Displacement of day-to-day patientmanagement ofcasualties• Distraction of healthcare providers fromusual workflow• Addition of mentalhealth burden• Disruption of supplychain• Disruption ofcommunicationsystems• Fiscal disruption
    20. 20. Emergency Operations Plan• Introduction• Procedures &Operations• HICS Job ActionSheets• SpecificDepartmentalTools• Forms/Resources
    21. 21. Emergency OperationsPlan-Part 1• Introduction– General overview of <Hospital Name> andfacilities/support.• Purpose/Policy– Provide continuous quality improvement.– Provide coordination and integration.• Scope– Addresses Joint Commission and CMSConditions of Participation (CoPs.)
    22. 22. All Hazards EmergencyOperations• Mitigation:– Removing/lessening the conditions that lead toincidents.• Preparedness– Readiness for the unavoidable.• Response– Decreasing the severity/intensity of an incident.• Recovery– Getting back to normal.
    23. 23. Mitigation• Hospital HazardVulnerabilityAnalysis (HVA)• Multiple ToolsAvailable
    24. 24. Mitigation• Hazardidentification• HazardAssessment(HVA)• Structural codecompliance• Equipment andmaintenance
    25. 25. Preparedness• Plan development• Training courses• Exercises• Employeeeducation andcompetencies• Public education
    26. 26. Response• Alerting• Assessment• Mobilizing- Healthcarepartners and ESF8• Implementing plan• Activate systems(HICS, EOC)• Control, Set priorities-Infection etc.• Communication andsituational awareness
    27. 27. Recovery• Those activities undertaken by ahospital after an emergency ordisaster occurs to restore minimumservices and move towards long-term restoration.
    28. 28. Recovery• Return to“normal”• Detailed damageassessment• Care and sheltercontinues• Fundingassistance• Remove debris
    29. 29. Part 2- Specific procedures& operations• Patient Flow– Triage– Treatment Areas• Security Activities– Entry & Egress– Visitors Access
    30. 30. Procedures & operations• Communications– Telephone– Back-up systems– Radio (VHF/800)– Satellite phone– Walkie – Talkies– HAM radio– Fax
    31. 31. Procedures & operations• Patientadmissions,triage, disastertags, registrationprocess– Electiveprocedures– Discharge ofpatients
    32. 32. Procedures & operations• News Media– PublicInformationOfficer (PIO)– Strategiclocation– JointInformationCenter (JIC)
    33. 33. Procedures & operations• Hotline• Family of victims,visitors, outpatients
    34. 34. Procedures & operations• Supplies &equipment– Essential supplies– Pharmaceuticals– Medical supplies– Equipment– Food– Water– Linen– Utilities
    35. 35. Procedures & operations• Morgue–DOAs–Others thatexpire
    36. 36. Procedures & operations• Evacuation– Authority– Transportation– Location– Evacuationroutes– Practice/Test
    37. 37. Procedures & operations• Continuing and/orreestablishingoperations• Off – site care(Alternate CareSites, or ACS)
    38. 38. Procedures & operations• Essential utilityalternatives– Electrical– Water– Medical gas– Wastedisposal– Fuel
    39. 39. Procedures & operations• Isolation &decontamination– Plan &procedure– Equipment– Training
    40. 40. Procedures & operations• Orientation &education• Annual planevaluation
    41. 41. Emergency Operations PlanPart 3- HICS Job ActionSheets
    42. 42. HICS Job Action sheets• IncidentCommand• Operations• Logistics• Finance andAdministration• Planning• Others
    43. 43. HICS Job Action sheets• One for eachposition.• Embodies title,mission/functionand duties.• Adjusted tomeet hospitalneeds.
    44. 44. Emergency Operations PlanPart 4Specific department tools
    45. 45. Specific departmental plans• EmergencyDepartment• Security• Maintenance• Nursing floors• Admission policy& registration• Emergencytriage• Evacuation• Communications• EmergencyOperationsCenter
    46. 46. Emergency Operations PlanPart 5-forms/resources
    47. 47. Forms/Resources• Help drivepositions• Documentationaid• Financialrecovery• Decreasesliability• Enhances &trackscommunication
    48. 48. Emergency ManagementA successful interfaceneeds:•Planning•Training•Exercising
    49. 49. According to JointCommission1:• Emergency Management is now its ownaccreditation manual chapter.• All Standards and Elements of Performancefrom 2009 are incorporated into the 2010Emergency Management chapter.• This new chapter contains some standardsthat were in HR, EC and MS sections.• Critical Access Hospital requirements aresimilar to other types of hospitals in mostcounties.1
    50. 50. Emergency Operations PlanEmergency Operations Plan (EOP) describesresponse procedures:– Written plan– Capabilities to self-sustain for up to 96 hours[EM.02.01.01]– As well as• Recovery strategies and surge capabilities.• Initiation and termination of response and recoveryphases.• Defines authorities and community relationships• Alternative care sites, alternate EOC.• Actual implementation is documented.
    51. 51. Emergency Operations Plan• Plan Structure
    52. 52. Emergency Operations Plan• Addresses Twelve Critical Access Hospital JointCommission Components:– Planning [EM.01.01.01]– The EOP [EM.02.01.01]– Communication [EM.02.02.01]– Resources & Assets [EM.02.02.03]– Safety & Security [EM.02.02.05]– Staff responsibilities [EM.02.02.07]– Utilities Management [EM.02.02.09]– Patient, clinical & support activities [EM.02.02.11]– Volunteer Management [EM.02.02.13]– Volunteer Credentialing [EM.02.02.15]– HVA and Evaluation [EM.03.01.01]– Plan Evaluation [EM.03.01.03]
    53. 53. Emergency Operations Plan• EM.01.01.01 Planning (8 measures)– The critical access hospital engages in planning activities priorto developing its written Emergency Operations Plan.• EM.02.01.01 The Plan (8 measures)– The critical access hospital has an Emergency OperationsPlan.• EM.02.02.01 Communication (15 measures)– As part of its Emergency Operations Plan, the critical accesshospital prepares for how it will communicate duringemergencies.• EM.02.02.03 Resources & Assets (9 measures)– As part of its Emergency Operations Plan, the critical accesshospital prepares for how it will manage resources and assetsduring emergencies.
    54. 54. Emergency Operations Plan• EM.02.02.05 Safety and Security (9 measures)– As part of its Emergency Operations Plan, the critical accesshospital prepares for how it will manage security and safetyduring an emergency.• EM.02.02.07 Staff Responsibilities (9 measures)– As part of its Emergency Operations Plan, the critical accesshospital prepares for how it will manage staff during anemergency.• EM.02.02.09 Utilities Management (7 measures)– As part of its Emergency Operations Plan, the critical accesshospital prepares for how it will manage utilities during anemergency.• EM.02.02.11 Patient, clinical & support activities (8measures)– As part of its Emergency Operations Plan, the critical accesshospital prepares for how it will manage patients duringemergencies.
    55. 55. Emergency Operations Plan• EM.02.02.13 Volunteer Management (9 measures)– During disasters, the critical access hospital may grantdisaster privileges to volunteer licensed independentpractitioners.• EM.02.02.15 Volunteer Credentialing (9 measures)– During disasters, the critical access hospital may assigndisaster responsibilities to volunteer practitioners who are notlicensed independent practitioners, but who are required bylaw and regulation to have a license, certification, orregistration.• EM.03.01.01 Vulnerability Assessment and Evaluation (3measures)– The critical access hospital evaluates the effectiveness of itsemergency management planning activities.• EM.03.01.03 Evaluating the Plan (17 measures)– The critical access hospital evaluates the effectiveness of itsEmergency Operations Plan.
    56. 56. Use of volunteers inmedical surge• 18 Elements of Performance (EP’s) of JointCommission Standards address use ofvolunteers.• Medical Surge exercises that are HSEEP-compliant must address the use ofvolunteers in surge activities.• How deep is your hospital in each staff skillarea? By department? Supervisor? Facility?Occupation? Specialty?
    57. 57. For Volunteer LicensedIndependent Practitioners andVolunteer Practitioners• Section 1: Disaster Privileges• Section 2: Credentials Verification• Section 3: Volunteer Oversight• Section 4: Cessation of Volunteers
    58. 58. Use of volunteers• What can they do?• What can’t they do, unless supervised?• What shouldn’t they do?• Who can they be?• Can spontaneous unassignedvolunteers (“SUVs”) be used?• What are the most likely scenarios?• Who can and cannot supervisevolunteers?
    59. 59. Review: The EmergencyOperations Plan• Covers all of the All Hazardsphases of Emergency Management– Mitigation– Planning– Response– Recovery• As well as communications withESF8 partners
    60. 60. Where do I start?• <Hospital Name>has:– EmergencyOperations Plan(a base plan tostart with).– Departmental Plans (ED, Triage, Admissions,Evacuation, Security.– Email <hospital point of contact> to receivethe plans electronically.
    61. 61. Center for HICS Education &Training-• Guidebook• Training Resources• Job Action Sheets• Forms• Internal (13) & External(14) Scenarios
    62. 62. <Presenter POC information>