Hazard Planning for Hospitals Large and Small Darrell Ruby, CEM Region 9 Coordinator Today’s Discussion • Emergency Planning. • Hazard Vulnerability Analysis (HVA). What is it, who does it, why? • Why plan? • Planning references. – Federal, State, Local • Getting started. • HVA Tool. Emergency Planning for Hospitals • 5 W’s plus…. – Who should be involved? – What are the requirements? – When should you do it? – Where do you begin? – Why and How often? – What resources do you use? Whole Community – Unity of Effort • Preparedness is a shared responsibility. Everyone plays a role: Individuals and families, including those with disabilities or others with access and functional needs Businesses and nonprofits Faith-based and community organizations Schools and academia Media outlets All levels of government Risk-Driven, Capabilities-Based • Natural hazards • Pandemic influenza • Technological and accidental hazards • Terrorist attacks • Cyber attacks Hazard Vulnerability Analysis (HVA) Hospitals are required to conduct and annually review their Hazard Vulnerability Analysis (HVA). The HVA provides a systematic approach to recognizing hazards that may affect demand for the hospitals services or its ability to provide those services. The risks associated with each hazard are analyzed to prioritize planning, mitigation, response and recovery activities. The HVA serves as a needs assessment for the Emergency Management program. This process should involve community partners and be communicated to community emergency response agencies. It is important to note that cities and counties are also required to prepare HVAs; the hospital HVA should consider hazards identified in the community plans that may impact the hospital. In some communities the hospital and community HVAs are developed together. Also referred to as Hazard Identification and Vulnerability Analysis (HIVA) or Threat and Hazard Identification and Risk Analysis (THIRA) ~ New PPD - 8 Presidential Policy Directive (PPD) 8: National Preparedness was released in March 2011 with the goal of strengthening the security and resilience of the United States through systematic preparation for the threats that pose the greatest risk to the security of the Nation. PPD-8 defines five mission areas—Prevention, Protection, Mitigation, Response, and Recovery—and mandates the development of a series of policy and planning documents to explain and guide the Nation’s approach to ensuring and enhancing national preparedness. National Planning Frameworks http://www.fema.gov/medialibrary/mediarec ords/11954 National Preparedness Goal • Prevention. Prevent, avoid or stop an imminent, threatened or actual act of terrorism. • Protection. Protect our citizens, residents, visitors, and assets against the greatest threats and hazards in a manner that allows our interests, aspirations, and way of life to thrive. • Mitigation. Reduce the loss of life and property by lessening the impact of future disasters. • Response. Respond quickly to save lives, protect property and the environment, and meet basic human needs in the aftermath of a catastrophic incident. • Recovery. Recover through a focus on the timely restoration, strengthening and revitalization of infrastructure, housing and a sustainable economy, as well as the health, social, cultural, historic and environmental fabric of communities affected by a catastrophic incident. Mitigation Core Capabilities The National Preparedness Goal identified 31 core capabilities these are the distinct critical elements needed to achieve the goal. Mitigation ~ Sustained actions taken to reduce or eliminate long-term risk to life and property from hazards.* 44 CFR §201.2 Mitigation Planning - Definitions CPG – 101: Developing and Maintaining Emergency Operations Plans (EOP’s) • This Guide provides information and instruction on the fundamentals of planning and their application CPG – Comprehensive Preparedness Guide CPG – 201: Developing and Maintaining Emergency Operations Plans (EOP’s) • Threat and Hazard Identification and Risk Assessment (THIRA) guide provides a comprehensive approach for identifying and assessing risks and associated impacts. It expands on existing local, tribal, territorial, and state Hazard Identification and Risk Assessments (HIRAs) and other risk methodologies by broadening the factors considered in the process, incorporating the whole community throughout the entire process, and by accounting for important community-specific factors CPG – Comprehensive Preparedness Guide CPG – 201: Threat and Hazard Identification and Risk Assessment (THIRA) Five Step Process 1. Identify the threats and hazards of concern - What could happen in my community? 2. Give the threats and hazards context - Describe how a threat or hazard could happen in my community, and when and where it could happen. 3. Examine the core capabilities using the threats and hazards - How would each threat or hazard affect the core capabilities identified in the National Preparedness Goal? 4. Set capability targets - Using the information above, set the level of capability a community needs to prevent, protect against, mitigate, respond to, and recover from its risks. 5. Apply the results - Use the capability targets to decide how to use resources from the Whole Community. CPG – Comprehensive Preparedness Guide Local Mitigation Planning Handbook • Handbook highlights case studies and tools for community officials providing practical guidance on how to incorporate risk reduction strategies into existing local plans, policies, codes, and programs that guide community development or redevelopment patterns. Task 5 – Conduct a Risk Assessment Defining Risk Assessment Illustrates the concept of risk as the relationship, or overlap, between hazards and community assets. The smaller the overlap, the lower the risk. Risk Assessment Terminology • Natural hazard – source of harm or difficulty created by a meteorological, environmental, or geological event. • Community assets – the people, structures, facilities, and systems that have value to the community. • Vulnerability – characteristics of community assets that make them susceptible to damage from a given hazard. • Impact – the consequences or effects of a hazard on the community and its assets Risk Assessment Terminology (Continued) • Risk – the potential for damage, loss, or other impacts created by the interaction of natural hazards with community assets. • Risk assessment – product or process that collects information and assigns values to risks for the purpose of informing priorities, developing or comparing courses of action, and informing decision making. • Threat or human-caused incident – intentional actions of an adversary, such as a threatened or actual chemical or biological attack or cyber event. References/Statutes ** • Revised Code of Washington, Chapters 38.10, 38.52, 43.21, 43.70 • Public Health Service Act • Public Law 93-288, as amended, "The Robert T. Stafford Disaster Relief and Emergency Assistance Act" • National Response Framework (NRF) • Public Law 107-188, Public Health Security Bioterrorism Preparedness and • Response Act 2002 • Public Law 107-296, Homeland Security Act 2002 • Federal Food, Drug and Cosmetic Act ** As identifed in the WA State CEMP, ESF 8 – Public Health and Medical Services Joint Commission (aka JCAHCO) • Mission: To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. So now that we are all on the same page…… Let’s look at a specific tool created for hospitals. Where do you start? Issues to consider for probability include, but are not limited to: 1 Known risk 2 Historical data 3 Manufacturer/vendor statistics Issues to consider for response include, but are not limited to: 1 Time to marshal an on-scene response 2 Scope of response capability 3 Historical evaluation of response success Issues to consider for human impact include, but are not limited to: 1 Potential for staff death or injury 2 Potential for patient death or injury Issues to consider for property impact include, but are not limited to: 1 Cost to replace 2 Cost to set up temporary replacement 3 Cost to repair Issues to consider for business impact include, but are not limited to: 1 Business interruption 2 Employees unable to report to work 3 Customers unable to reach facility 4 Company in violation of contractual agreements 5 Imposition of fines and penalties or legal costs 6 Interruption of critical supplies 7 Interruption of product distribution Issues to consider for preparedness include, but are not limited to: 1 Status of current plans 2 Training status 3 Insurance 4 Availability of back-up systems 5 Community resources Issues to consider for internal resources include, but are not limited to: 1 Types of supplies on hand 2 Volume of supplies on hand 3 Staff availability 4 Coordination with MOB's Issues to consider for external resources include, but are not limited to: 1 Types of agreements with community agencies 2 Coordination with local and state agencies 3 Coordination with proximal health care facilities 4 Coordination with treatment specific facilities Threats/Hazards by Category Natural Hazards HAZARD AND VULNERABILITY ASSESSMENT TOOL NATURALLY OCCURRING EVENTS SEVERITY = (MAGNITUDE - MITIGATION) PROBABILITY HUMAN IMPACT PROPERTY IMPACT BUSINESS IMPACT PREPAREDNESS INTERNAL RESPONSE EXTERNAL RESPONSE Likelihood this will occur Possibility of death or injury Physical losses and damages Interuption of services Preplanning Time, effectivness, resouces Community/ Mutual Aid staff and supplies Relative threat* SCORE 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 - 100% Hurricane 0 0 0 0 0 0 0 0% Tornado 1 1 1 1 2 3 3 20% Severe Thunderstorm 1 1 1 1 1 2 2 15% Snow Fall 3 2 1 2 1 2 2 56% Blizzard 3 2 1 2 1 2 2 56% EVENT RISK Ice Storm 2 2 1 2 2 2 2 41% Earthquake 1 1 1 1 3 3 3 22% Tidal Wave 0 0 0 0 0 0 0 0% Temperature Extremes 1 1 0 1 2 2 2 15% Drought 1 1 0 0 3 3 3 19% Flood, External 1 1 1 1 3 3 3 22% Wild Fire 1 1 1 1 2 2 1 15% Landslide 1 1 1 1 3 3 3 22% Dam Inundation 0 0 0 0 0 0 0 0% Volcano 1 1 1 1 3 3 3 22% Epidemic 1 1 1 1 1 1 1 11% AVERAGE SCORE 1.13 1.00 0.69 0.94 1.69 1.94 1.88 17% *Threat increases with percentage. RISK = PROBABILITY * SEVERITY 18 0.17 0.38 0.45 130 Technology Hazards HAZARD AND VULNERABILITY ASSESSMENT TOOL TECHNOLOGIC EVENTS SEVERITY = (MAGNITUDE - MITIGATION) PROBABILITY EVENT HUMAN IMPACT Likelihood this Possibility of will occur death or injury SCORE 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= Lo w 2 = M o derate 3 = High PROPERTY IMPACT BUSINESS IMPACT PREPAREDNESS INTERNAL RESPONSE EXTERNAL RESPONSE RISK Physical losses and damages Interuption of services Preplanning Time, effectivness, resouces Community/ Mutual Aid staff and supplies Relative threat* 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 - 100% Electrical Failure Generator Failure Transportation Failure Fuel Shortage Natural Gas Failure 1 1 1 1 1 1 2 3 2 2 2 2 2 2 19% 20% 1 1 1 2 2 2 2 19% 1 1 1 1 1 1 3 3 2 2 2 2 2 2 20% 20% Water Failure Sewer Failure 1 1 1 1 1 1 3 2 2 2 2 2 2 2 20% 19% Steam Failure 1 1 1 2 2 2 2 19% Fire Alarm Failure Communications Failure 1 1 1 2 2 2 2 19% 2 1 1 2 2 2 2 37% Medical Gas Failure 1 1 1 2 2 2 2 19% 1 1 1 2 2 2 2 19% 1 1 1 2 2 2 2 19% 1 1 1 3 2 2 2 20% Medical Vacuum Failure HVAC Failure Information Systems Failure Fire, Internal 1 1 1 3 2 2 2 20% Flood, Internal 1 1 1 3 3 2 2 22% Hazmat Exposure, Internal 1 1 1 3 2 2 2 20% Supply Shortage 1 1 1 2 1 2 2 17% Structural Damage 1 1 2 2 3 2 2 22% AVERAGE SCORE 1.05 1.00 1.05 2.42 2.05 2.00 2.00 21% *Threat increases with percentage. 20 RISK = PROBABILITY * SEVERITY 200 0.21 0.35 0.58 Human Hazards HAZARD AND VULNERABILITY ASSESSMENT TOOL HUMAN RELATED EVENTS SEVERITY = (MAGNITUDE - MITIGATION) PROBABILITY EVENT HUMAN IMPACT Likelihood this Possibility of will occur death or injury SCORE Mass Casualty Incident (trauma) Mass Casualty Incident (medical/infectious) 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= Lo w 2 = M o derate 3 = High RISK PROPERTY IMPACT BUSINESS IMPACT PREPAREDNESS INTERNAL RESPONSE EXTERNAL RESPONSE Physical losses and damages Interuption of services Preplanning Time, effectivness, resouces Community/ Mutual Aid staff and supplies Relative threat* 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 - 100% 0 = N/A 1= Lo w 2 = M o derate 3 = High 2 3 2 2 2 2 2 48% 1 3 2 2 1 2 2 22% Terrorism, Biological 1 2 2 2 3 2 2 24% VIP Situation 1 2 2 2 3 2 2 24% Infant Abduction 1 3 1 2 1 2 1 19% Hostage Situation 1 3 2 2 2 2 1 22% Civil Disturbance 1 2 2 3 2 2 2 24% Labor Action 1 3 1 3 2 2 2 24% Forensic Admission 1 1 1 2 2 2 2 19% Bomb Threat 1 2 2 2 3 2 2 24% 1.10 2.40 1.70 2.20 2.10 2.00 1.80 28% AVERAGE *Threat increases with percentage. 11 RISK = PROBABILITY * SEVERITY 122 0.28 0.37 0.75 Hazardous Materials HAZARD AND VULNERABILITY ASSESSMENT TOOL EVENTS INVOLVING HAZARDOUS MATERIALS SEVERITY = (MAGNITUDE - MITIGATION) PROBABILITY EVENT HUMAN IMPACT PROPERTY IMPACT BUSINESS IMPACT PREPAREDNESS INTERNAL RESPONSE EXTERNAL RESPONSE Interuption of services Preplanning Time, effectivness, resouces Community/ Mutual Aid staff and supplies Relative threat* 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 - 100% Likelihood this Possibility of Physical losses will occur death or injury and damages SCORE 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= Lo w 2 = M o derate 3 = High RISK Mass Casualty Hazmat Incident (From historic events at your MC with >= 5 victims) 1 2 3 3 2 2 2 26% 2 2 3 3 2 2 2 52% 1 3 2 2 3 2 2 26% 1 2 2 2 2 2 2 22% 1 3 2 2 2 2 2 24% 1 3 3 3 2 2 2 28% 1 3 3 3 2 2 2 28% 1 3 3 3 2 2 2 28% 1 3 3 3 2 2 2 28% 1.11 2.67 2.67 2.67 2.11 2.00 2.00 29% Small Casualty Hazmat Incident (From historic events at your MC with < 5 victims) Chemical Exposure, External Small-Medium Sized Internal Spill Large Internal Spill Terrorism, Chemical Radiologic Exposure, Internal Radiologic Exposure, External Terrorism, Radiologic AVERAGE *Threat increases with percentage. 10 127 RISK = PROBABILITY * SEVERITY 0.29 0.37 0.78 Summary of Hazards Natural Technological Human Hazmat Total for Facility SUMMARY OF MEDICAL CENTER HAZARDS ANALYSIS Probability 0.38 0.35 0.37 0.37 0.36 Severity 0.45 0.58 0.75 0.78 0.60 Hazard Specific Relative Risk: 0.17 0.21 0.28 0.29 0.22 Hazard Specific Relative Risk to Medical Center Relative Threat to Facility 1.00 0.90 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00 Natural Technological Human Hazmat Probability and Severity of Hazards to Medical Center 1.00 Relative Im pact on Facility 0.90 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00 Probability Severity Best practices Open Discussion Lesson’s Learned Links and Articles • • • California Hospital Association Website http://www.calhospitalprepare.org/hazardvulnerability-analysis Planning Resources for Hospitals - CDC http://www.cdc.gov/phpr/healthcare/hospitals.htm Strengthening HVA: Results of Research in Maine http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056047/ • Cyber hazards and health care organizations, http://www.hitrustalliance.net/news/index.php?a=128 Thanks, for your time and participation. Contact info: Darrell Ruby druby@spokanecounty.org 509-477-3006 Back-ups Natural Hazards HAZARD AND VULNERABILITY ASSESSMENT TOOL NATURALLY OCCURRING EVENTS SEVERITY = (MAGNITUDE - MITIGATION) PROBABILITY HUMAN IMPACT PROPERTY IMPACT BUSINESS IMPACT PREPAREDNESS INTERNAL RESPONSE EXTERNAL RESPONSE Likelihood this will occur Possibility of death or injury Physical losses and damages Interuption of services Preplanning Time, effectivness, resouces Community/ Mutual Aid staff and supplies Relative threat* 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 - 100% EVENT SCORE RISK Hurricane 0% Tornado 0% Severe Thunderstorm 0% Snow Fall 0% Blizzard 0% Ice Storm 0% Earthquake 0% Tidal Wave 0% Temperature Extremes 0% Drought 0% Flood, External 0% Wild Fire 0% Landslide 0% Dam Inundation Volcano 0% Epidemic 0% AVERAGE SCORE 0.00 0.00 0.00 0.00 *Threat increases with percentage. RISK = PROBABILITY * SEVERITY 0 0.00 0.00 0.00 0 0.00 0.00 0.00 0% Technology Hazards HAZARD AND VULNERABILITY ASSESSMENT TOOL TECHNOLOGIC EVENTS SEVERITY = (MAGNITUDE - MITIGATION) PROBABILITY EVENT HUMAN IMPACT Likelihood this Possibility of will occur death or injury SCORE 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= Lo w 2 = M o derate 3 = High PROPERTY IMPACT BUSINESS IMPACT PREPAREDNESS INTERNAL RESPONSE EXTERNAL RESPONSE RISK Physical losses and damages Interuption of services Preplanning Time, effectivness, resouces Community/ Mutual Aid staff and supplies Relative threat* 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 - 100% Electrical Failure Generator Failure Transportation Failure Fuel Shortage Natural Gas Failure 0% 0% Water Failure Sewer Failure 0% 0% Steam Failure 0% Fire Alarm Failure Communications Failure 0% Medical Gas Failure 0% 0% 0% 0% 0% Medical Vacuum Failure HVAC Failure Information Systems Failure Fire, Internal 0% 0% 0% 0% Flood, Internal 0% Hazmat Exposure, Internal 0% Supply Shortage 0% Structural Damage 0% AVERAGE SCORE 0.00 0.00 0.00 0.00 *Threat increases with percentage. 0 RISK = PROBABILITY * SEVERITY 0 0.00 0.00 0.00 0.00 0.00 0.00 0% Human Hazards HAZARD AND VULNERABILITY ASSESSMENT TOOL HUMAN RELATED EVENTS SEVERITY = (MAGNITUDE - MITIGATION) PROBABILITY EVENT HUMAN IMPACT Likelihood this Possibility of will occur death or injury SCORE 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= Lo w 2 = M o derate 3 = High RISK PROPERTY IMPACT BUSINESS IMPACT PREPAREDNESS INTERNAL RESPONSE EXTERNAL RESPONSE Physical losses and damages Interuption of services Preplanning Time, effectivness, resouces Community/ Mutual Aid staff and supplies Relative threat* 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 - 100% 0 = N/A 1= Lo w 2 = M o derate 3 = High Mass Casualty Incident (trauma) Mass Casualty Incident (medical/infectious) 0% 0% Terrorism, Biological 0% VIP Situation 0% Infant Abduction 0% Hostage Situation 0% Civil Disturbance 0% Labor Action 0% Forensic Admission 0% Bomb Threat 0% AVERAGE 0.00 0.00 0.00 0.00 *Threat increases with percentage. 0 RISK = PROBABILITY * SEVERITY 0 0.00 0.00 0.00 0.00 0.00 0.00 0% Hazardous Materials HAZARD AND VULNERABILITY ASSESSMENT TOOL EVENTS INVOLVING HAZARDOUS MATERIALS SEVERITY = (MAGNITUDE - MITIGATION) PROBABILITY EVENT HUMAN IMPACT PROPERTY IMPACT Likelihood this Possibility of Physical losses will occur death or injury and damages SCORE 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= Lo w 2 = M o derate 3 = High BUSINESS IMPACT PREPAREDNESS INTERNAL RESPONSE EXTERNAL RESPONSE RISK Interuption of services Preplanning Time, effectivness, resouces Community/ Mutual Aid staff and supplies Relative threat* 0 = N/A 1= Lo w 2 = M o derate 3 = High 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 = N/A 1= High 2 = M o derate 3 = Lo w o r no ne 0 - 100% Mass Casualty Hazmat Incident 0% (From historic events at your MC with >= 5 victims) Small Casualty Hazmat Incident 0% (From historic events at your MC with < 5 victims) Chemical Exposure, External Small-Medium Sized Internal Spill Large Internal Spill 0% 0% 0% 0% Terrorism, Chemical Radiologic Exposure, Internal Radiologic Exposure, External Terrorism, Radiologic AVERAGE 0% 0% 0% 0.00 0.00 0.00 0.00 *Threat increases with percentage. 0 0 RISK = PROBABILITY * SEVERITY 0.00 0.00 0.00 0.00 0.00 0.00 0% Summary of Hazards Natural Technological Human Hazmat Total for Facility SUMMARY OF MEDICAL CENTER HAZARDS ANALYSIS Probability 0.00 0.00 0.00 0.00 0.00 Severity 0.00 0.00 0.00 0.00 0.00 Hazard Specific Relative Risk: 0.00 0.00 0.00 0.00 0.00 Hazard Specific Relative Risk to Medical Center Relative Threat to Facility 1.00 0.90 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00 Natural Technological Human Hazmat Probability and Severity of Hazards to Medical Center 1.00 Relative Im pact on Facility 0.90 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00 Probability Severity