Is your center ready to manage a
disaster and its aftermath?
Practical tools to prepare you and
your staff to manage an emergency
event.
Amelia Muccio
Director of Disaster Planning
NEW JERSEY PRIMARY CARE ASSOCIATION
Learning Objectives
• Explain the “ings” of
disaster preparedness
• Review personal and
professional
preparedness
• Demystify “NIMS
Compliancy”
• Identify next steps for
CHC leadership
Top Answer on the Board
Most Frequent Thing Said About Disasters?
Survey Says
1.IT WILL
NOT
HAPPEN
TO ME!
In Review: Twenty Five Years
of Disasters
• A disaster is a natural
or man-made event
that negatively affects
life, property,
livelihood or industry,
often resulting in
permanent changes to
human societies,
ecosystems and
environment.
Beirut Barracks Suicide Bombing:
Lebanon (1983)
• American and
French troops sent
over to stabilize
Lebanese civil war
• 2 truck bombs
• 241 American
servicemen were
killed
Industrial Accident:
Bhopal, India (1984)
• Union Carbide plant
• 40 tons of toxic
methyl isocyanate
gas leaked out
• 20,000+ deaths
• World’s worst
industrial disaster
Extreme Famine:
Ethiopia (1985)
• Drought and
political instability
contributed to the
severity of the
famine
• one million
people died
between 1984-1985
Nuclear Accident:
Chernobyl, Ukraine (1986)
• Nuclear power plant
• Fourth reactor
exploded
• 200,000 additional
deaths in the period
between 1990 and
2004
• World’s worst
nuclear accident
Super Typhoon Nina:
Philippines (1987)
• Between 540-687
people were killed
and between 80,000
and 100,000 people
were left homeless.
• The damage in the
Philippines was at
$26 million (1987
USD).
Terrorist Air Disaster, Pan Am 103:
Lockerbie, Scotland (1988)
• Plastic explosive in
forward cargo hold
• The 270 fatalities
(259 on the plane,
11 in Lockerbie)
were citizens of 21
nations. Of them,
189 were
Americans.
Accidental Air Disaster, UA 232:
Sioux City, Iowa (1989)
• Uncontained failure
of the DC-10’s
number 2 engine
• All 3 of the aircraft's
hydraulic systems
were destroyed
• 111 killed
• 185 survived
Political Disaster, Land Mines:
Jammu-Kashmir Region (1990)
• 1990-2001 conflict
• Over 1,000 JammuKashmir civilians
were killed by land
mines over this
period along with
nearly 9,000
injuries.
Civil War:
Sierra Leone (1991)
• Revolutionary United
Front (RUF)
• 11 year civil war
• Tens of thousands
killed
• 2 million displaced
• Tactics of
decapitation,
mutilation, rape, and
murder
• Used child soldiers
Infrastructure Disaster:
Guadalajara, Mexico (1992)
• Numerous gasoline
explosions in the sewer
system under streets
• 206 killed
• 500 injured and 15,000
were left homeless
• Monetary damage $1
billion
• Mayor was informed of
gas smell but did not
order evacuation.
Severe Flooding:
Iowa (1993)
• Extensive flood damage
occurred in all 99 counties.
• 7/93, IDPH calls in CDC
• 5 of the 99 counties,
reported closures of primarycare physician offices.
• Persons hospitalized for
carbon monoxide poisoning,
hypothermia, electrocution,
wound infections, and
exacerbation of chronic
illnesses.
Northridge Earthquake:
California (1994)
• Damage was widespread, sections of
major freeways
collapsed, parking
structures and office
buildings collapsed,
and numerous
apartment buildings
suffered irreparable
damage.
Heat Wave:
Chicago (1995)
• 5 day period in July
• Temps reached 106
F degrees
• 600 heat related
deaths
• Deaths were mainly
poor, elderly
residents
North American Blizzard:
East Coast (1996)
• The Blizzard of 1996
was a nor'easter that
paralyzed the U.S. East
Coast with up to four
feet over a three-day
period.
• New Jersey: All roads
in the state were
closed, including the
entire length of the New
Jersey Turnpike for the
first time in that road's
history.
Soufriere Hills Volcanic Eruption:
Montserrat, West Indies (1997)
• 3 pyroclastic flows
• 23 deaths
• Exclusion zone still
in effect
• 14,000 permanently
displaced
Eschede Train Accident:
Germany (1998)
• 101 died
• 88 injured
• World's worst highspeed train disaster
• Surpassed the 1971
Dahlerau train
disaster as the
deadliest accident in
Germany’s history
The Erika Maritime Oil Spill:
Coast of France (1999)
• In heavy storm, the
tanker broke into two
pieces and sank.
• Thousands of tons of oil
were released into the
sea, killing marine life
and polluting shores.
• One of the greatest
environmental disasters
in the world.
Ebola Hemorrhagic Fever Outbreak:
Uganda (2000)
• Gulu, Masindi, and
Mbarara Districts
• Approx. 500
infected
• Highly lethal
hemorrhagic virus
(50-90%)
• No vaccine or
treatment
• Animal reservoir
unknown
9/11 Terrorist Attack:
USA (2001)
•
•
•
•
19 hijackers
4 airplanes
2,974 deaths
Victims were
civilians
• Rescue workers
falling ill from
contaminated air at
WTC site
MV Joola Ferry Disaster:
Senegal (2002)
• The disaster
resulted in the
deaths of at least
1,863 people,
making it the
deadliest maritime
disaster in African
history and one of
the deadliest of all
time.
Space Shuttle Columbia Disaster:
USA (2003)
• Disintegrated over
Texas during reentry into the
Earth's atmosphere.
• All seven crew lost,
shortly before
concluding its 28th
mission.
Indian Ocean Tsunami:
South East Asia (2004)
• 9.1 earthquake
triggered tsunami
• 230,000 killed
• Devastating toll on
Indonesia, Sri
Lanka, India, and
Thailand
• Second largest
earthquake ever
reported
Hurricane Katrina:
Gulf Coast (2005)
• 1,300+ killed (most
deadly U.S. storm
since 1928)
• Costliest natural
disaster in U.S.
history
• Criticism remains
over delayed
response efforts
and lack of recovery
plans
Sago Mine Disaster:
West Virginia (2006)
• Sago Mine disaster
in Tallmansville,
West Virginia, USA,
13 miners trapped
for nearly two days,
• Only one survivor
Randall McCloy
Kansas Tornado:
Greensburg (2007)
• All that remains of
Greensburg,
Kansas (right).
• Tornado destroyed
more than 90% of
the town, which
about 1400 people
called home.
Megatsunami:
East Coast, USA (Future?)
• Cumbre Vieja is a
volcanic ridge on the
island of La Palma in
Spain's Canary Islands.
• Landslide of CV during
volcanic eruption could
trigger Megatsunami.
• Megatsunami could
destroy NYC, Boston,
and Miami.
The “ings” of Disaster Preparedness
Leadership
• How do you
PREPARE?
1. Planning
2. Partnering
3. Training
4. Exercising
Disaster Planning—Where Do We Start?
• Overwhelming
• Impossible
• Lack of
communication
• Lack of clear
guidance
• Time consuming
• Resource constraint
• No EP on staff
Disaster Needs Mimic Everyday Needs
•
•
•
•
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•
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Organizational agility
Plans, drills, and evaluations
Training and education
Staff protection and support
Communications and reporting
Supplies and equipment
Security
• Joint Commission & HRSA PIN*
Four Phases of Disaster Planning
Expect the Unexpected:
Planning Activities
• Start with Needs Assessment/Gap Analysis
– Avoid wasting resources
– Clear picture of needs and expectations
– Jumping off point
• HVAs-What are our hazards?
– Risk assessment for potential
emergencies
– Prioritized by likelihood of occurrence and
severity
Example of HVA
Different Types of Disaster Plans
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•
•
•
•
•
•
HVA (Hazard Vulnerability Analysis)
EOP (Emergency Operating Plan)
EMP (Emergency Management Program)
CEM (Comprehensive Emergency Plan)
SOP (Standard Operating Procedure)
IAP (Incident Action Plan)
Business Continuity (Continuity of
Operations)
• Corrective Action (Lessons
Learned/Hindsight
EMP-HRSA PIN
– Continuity of
Operations
– Communication
– Staffing
– Surge Capacity
– Supplies
– Security
– Evacuation
– Decontamination
– Isolation
– Power Supply
– Transportation
– Water
– Sanitation
– Medical Records
Perpetual Preparedness Vs. “Times of
Crisis” Preparedness
If you jump out
the window at the
42nd floor and
you're still doing
fine as you pass
the 27th floor,
that does not
mean you don't
have a serious
problem. Charles Munger
M+P>R+R
Successful Disaster Planning Equation
• CHC’s are planning for events (pandemic,
hurricane, power outage, outbreak, terrorism)
that require high levels of pre-disaster
preparedness (prevention, and mitigation
activities).
• Disaster is reasonably expected and
preparedness initiatives have been
undertaken.
• Example of low level, economic depression,
long-term civil war
Basic Disaster Planning Curriculum for CHCs
(Personal)
PLANNING TOOLS
• Family
Preparedness Plan
–
–
–
–
Children
Elderly/Disabled
Pets
Emergency
Communication Plan
– Evacuation &
Sheltering
• How to Construct a
Go-Bag (supplies)
Resources are Available
•
•
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FEMA
American Red Cross
Ready.Gov
72hours.org
ASPCA
HSUS
AARP
Thanks for the Lovely Brochure—
Now What?
• A ton of information
on disaster
preparedness exists
already.
• What good is it to us
if we do not put it
into action?
First (Initial) Steps are the Hardest!
Family Disaster Plan (FDP)
1. Find out what disasters are mostly
likely to occur (local OEM, fire, police)
2. Call a family meeting (dinner)
3. Discuss why you (as a family) need to
prepare for a disaster
4. Plan for “vulnerable populations” first
Special Planning Considerations
Children
Elderly/Disabled/Pets
Child Disaster Psych Basics
• Disasters are extremely traumatic for
children
• We reduce this fear/anxiety by
providing children with information to
help them cope and understand
disasters (FEMA coloring books)
• We teach them to stay calm and listen
to the directions of adults
(teachers/parents)
Child Planning
Communication and School
• Make sure your child and child’s school
have all your updated contact info
• Know school disaster plan to avoid
confusion (dismiss or shelter)
• Find out if school requires authorization
to release child to designated alternate
if you cannot pick them up
Children Internet Planning
• Check out:
http://www.ready.go
v/kids/step3/index
.html
• Website is
interactive,
educational and
fun!
Disaster Stats:
The Elderly/Disabled
• Of the more than 1,300+ people who died
because of Hurricane Katrina, more than
70% were over age 60.
• New Orleans has one of the largest diabetic
populations in South
– People fled without shoes
– Medicare allows only one pair per year
– Many patients with diabetes developed
wounds (skin ulcers to limb amputations)
The Elderly/Disabled
• High risk of mortality/morbidity during
disaster due to mobility, transportation, social
network, and illness (O2 dependent) issues.
– Get input from family member first
– Reach out to police, fire, OEM
– Special needs registry
– Create a redundant plan (plan B)
– When in doubt, bring the kitchen sink
(medications)
“Won’t You Be My Neighbor”
• Check on your elderly/disabled neighbors
especially if they lack local family members
• Know their family contact info
• Keep in mind their limitations
• Power failures in high rises have killed many
elderly/disabled
• They die of dehydration in their own homes
b/c they could not walk down the stairs
(phones were out)
Saving Pets=Saving People
Ernie (Gulf Coast)
Swami (India)
Pet Stats:
Pet is Part of Family Dynamic
• 63% of American households have at
least one pet (2007)
• Many people chose not to evacuate b/c
of pet and lose their lives b/c of choice
• 600,000 animals died as a result of
Hurricanes Katrina and Rita
• Only 10% of owners reunited with their
pets post-Katrina
Pet Go Box
Free Box
$50.00 (All Animals)
The Makings of an “All-Pet” Go Box
Emergency Communication Plan
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•
•
•
Communication is Achilles heel
Select an out-of-town contact
Easier to make long distance calls
Contact should be far enough away in
hopes they will not be affected
• Make sure every family member has
contact person (Aunt Bunny’s) info
• Memorize or carry on you (wallet)
Meet “Aunt Bunny”
EMP Con’t
• All family members
should call “Aunt
Bunny” if disaster
strikes
• Get info to and from
her
• Family can
communicate
through her and
regroup
Emergency Supplies Kit or “Go Bag”
3 Day Supply for Evacuation or Sheltering
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Water
Non-Perishable food
Crank Radio/NOAA
Flashlight
Batteries
First Aid Kit
Whistle
Dust Mask
Cash
Matches
Bleach (16 drops)
•
•
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•
•
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•
•
Wrench/Pliers
Medication
Essential Documents
Can Opener
Maps
Clothes
Baby/Pet Food
Playing Cards
Sleeping Bag
Evacuation Planning
• Have a predetermined meeting place should
you be evacuated
• This avoids confusion
• 2 meeting places are ideal
• Local (house fire)
• Outside of neighborhood (evacuation)
• Includes pets in plan
• Check on your neighbor
• Evacuate early if possible
• Bring “Go Bag”
Shelter-In-Place 101
• SIP Ordered
• Have emergency
supplies to turn office
or home into safe
shelter.
• Immediate protection
for short time
1. Natural disasters
2. CBRNE events
• All Clear
• If in your car,
improvise!
Who Are You?
“A Partner in Preparedness”
1. Get a seat at the
proverbial table
2. Inclusion in plans
3. Say in planning
process
4. Exercise/Drill with
local, regional,
State partners
We Are Assets
(Know What Your CHC Can Offer)
• Assist hospitals with patient surge
• Dispatch mobile vans into community
• Function as Alternate Care Site for treatment of
non-acute patients (walking wounded)
• Serve as POD (Point of Dispensing) for
prophylaxis
• Function as screening Center and provide
disease surveillance
• Serve existing patient population (vulnerable
population) during event (stay open later)
Partners in Preparedness: No Man is an
Island…
• NJHAEPA (NJ Healthcare
Associations Emergency
Preparedness Alliance)
– NJ Hospital
Association
– Health Care
Association of NJ
– Home Care
Association of NJ
– NJ Association of NonProfit Homes for the
Aging
– New Jersey Primary
Care Association
Partnerships:
Build Relationships and Inclusion
•
•
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•
•
Dept. of Health and Local Health Depts.
Local OEMs
Police/Fire
Feds
State/Regional Planners
Epidemiologists
Hospitals
Long Term Care/Home Health
Other FQHCs
FBOs and CBOs
Rationale for Disaster Training: Health
Center Investment
• We are only as prepared as the lowest
common denominator
• Ability to rotate staff
• Understaffing is a constraint and fuels burnout
• Staff hinder effective response
• We have unrealistic ideas of what we can do
in a disaster
• Educating staff is an investment
Rationale for Disaster Training: The Community
Example: Langa Settlement, South Africa
• Similar populations
• Patient demographic:
(Vulnerable)
• Underinsured &
Uninsured
• Stigmatized Poor
• Socially Stressed
• Migrant
• High Disease
Prevalence
Rebuilding Part of Langa Settlement after
Massive Fire (1000+)
Langa Rebuilt in 1 Day But
Our Communities Need Much Longer
• Lack of fiscal
resources
(savings)
• Lack of safety nets
(Renter’s
Insurance)
• Voiceless
• The population
FQHC’s serve will
have difficulties
recovering from a
disaster
Barriers and Obstacles to Training
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•
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•
•
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Uneven knowledge
Uninterested in subject
Lacked buy-in
Disproportionate vulnerability and needs
High turnover rate in Centers
Time of staff
Lost revenue (not seeing patients)
Overcoming Obstacles/Barriers
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Needs Assessment/Gap Analysis Data
Flexibility
Catered to specific needs
On-Site training
Buy-In (Lunch & Learn)
Understand Target Audiences' Needs and
Constraints
Overcoming Obstacles/Barriers
• Tailor-Fit programs
• Reinforce compliance
• Provide certificates and continuing
education credits
• Ownership of program (train the trainer)
Incorporate Reality
Basic Disaster Training Curriculum for CHCs
(Professional)
• IS 100 (Incident
Command Systems)
• IS 700 (National
Incident
Management
System)
• PPE lecture
• Fit-Testing
• Crisis
communication
Incident Command System (IS 100)
• ICS is a proven management system used for
decades by law enforcement and first
responders to manage crises.
• ICS is flexible and can be adapted to any
organization and used in any crisis, no matter
the size or type of incident.
• ICS has been used to successfully manage
response to fires, floods, hurricanes, tornados,
earthquakes, disease outbreaks, hazardous
material spills, and terrorist attacks.
National Incident Management System (IS 700)
• NIMS is mandated by Homeland Security
Presidential Directive 5 and 8.
• NIMS is applied to all jurisdictional levels
and across functional disciplines.
• NIMS improves coordination and
cooperation between public and private
organizations and ensures that efforts are
not duplicated.
What is NIMS Compliancy?
• There are 17
elements (in
NIMS) that need
to be adopted by
facilities to be
deemed NIMS
compliant.
17 Elements of NIMS
1.
2.
3.
4.
5.
6.
7.
8.
Full Adoption/Implementation of NIMS
Use Incident Command System
Use Multi-Agency Coordination
Public Information System
NIMS in Emergency Mgt Program
Coordinate Preparedness Funding
Revise Plans and Incorporate NIMS
Develop Mutual Aid Agreements
17 Elements of NIMS Con’t
9. Take IS 700 (NIMS training)
10. Take IS 800 (NRP training)
11. Take IS 100 & 200 (ICS training)
12. Use NIMS in Training/Exercises
13. All Hazards Exercises with Mult. Orgs
14. Corrective Action Plans
15. Inventory of Response Assets
16. Interoperable Resources
17. Standard and Common Terminology
Back to Herding Cats??
Exercising (3 Useful Exercises)
1. Tabletop Exercise
2. Functional Exercise
3. Live Drill
• EZ Recommendation:
– No Knock Communication Calldown
– How accurate is your info?
Create Disaster Scenarios
• Roads are closed
• Gas lines are 8+ hours
• Gas siphoning is taking
place
• Healthcare workers
lack credentials
• How will you report to
work?
• How will the home
health aide reach your
family member?
Use of Patient Simulators
Patient Simulator Exercise
When In Doubt…Use Common Sense!
Emergency Preparedness Builds Community
Resiliency
THANK YOU
Amelia Muccio
amuccio@njpca.org