Hospital Emergency Operations Plan
Workshop
Updating the Hospital and Rural Medical Center
EOP for the Use of Volunteers in Medical Surge
AGENCY LOGO
Acknowledgements:
• This workshop was developed by the Mesa County Health
Department as part of the National Association of City and
County Health Officials (NACCHO) Advanced Practice
Centers (APC) Program (Blueprint Project.)
• It takes into account new information in light of:
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–
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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 Clinic
Emergency Preparedness Project is acknowledged for
providing a framework from which a Hospital Emergency
Operations Plan template could be created.
• Contributions of Family Health West Hospital, Fruita, Colorado
in the review and revision of this information.
Objectives
• Participants will understand the importance and process
needed for All Hazard emergency operations planning in
Hospitals.
• Participants will understand the phases of Emergency
Management.
• Participants will understand how an incident command
leadership structure is an integrated component of the
Hospital emergency operations planning .
• Participants will understand the major components needed
to write an effective hospital emergency operations plan.
• Participants will understand why volunteer use in medical
surge is critical to writing an effective plan for rural
hospitals.
Why is this an issue today?
• Terrorism
• Disasters
• Other
I knew this
would
happen!
– What keeps you awake at
night?
– What often happens?
– What are you unprepared
for?
– What can be done to plan
for these situations?
FEMA News – Andrea Booher
How does terrorism/disasters
affect the healthcare system?
• Produces mass
casualties
– Murrah Building in
Oklahoma City
– Suicide bombers in
Middle East
– Olympic Park Bombing
in Atlanta
– Twin Towers in New
York
– Hurricane Katrina
– Virginia Tech School
Shooting
– Mexican Hat, Utah Bus
rollover
(AP-Associated Press)
How does terrorism/disasters
affect the healthcare system?
• Produces a redirection of
resources and change in
preparedness activities
– Smallpox planning for
hospitals and health
departments
– H1N1 Strategic National
Stockpile (SNS) – vaccines
and drug caches, mass
dispensing plans
– Surge capacity planning
– Agro-chemical/oil and gas
chemical regulatory
compliance issues
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 mean
a disaster plan, fire plan, utility failure plan.
• Current (post- 9-11) all-hazards expectations
(public/partners): community integration, address
all aspects of patient care issues, records and
data tracking/security, supply status tracking,
surge resource tracking.
• Result: more complex planning due to a more
complex response.
Hospital planning & preparedness
• County Mass Casualty Plan
• Surge capacity planning (H1N1)
• Aligns with EOP plans at
city/county level
• NIMS/ICS compliance
• Homeland Security compliance
funding
• HPP deliverables
• LPHA grants and deliverables
Hospital planning &
preparedness
• State Hospital Associations: Emergency planning,
HSEEP , state-level hospital coordination systems.
• “9-11” and heightened expectations for increased
integration in surge capacity and response.
• Tendency towards credentialing and accreditation:
– Credentialing for surge staff/volunteers
– National trends toward accreditation: schools and health
departments.
– What will be the future relationship between CMS-CoP’s and
Joint Commission Standards?
Chemical incidents –
planning considerations
• What measures must be planned in advance to safely
evacuate/ treat patients contaminated with toxic chemicals?
• Does your hospital have the capability to decontaminate?
• What antidote medications might be important if a chemical
terrorist attack occurred?
Definitions
• Capacity: amount or availability of resources and
ability of staff, training, and depth.
• Capability: type of services in terms of
emergencies, partnerships, and readiness.
• Vulnerability: susceptibility to failure due to
inadequate resources, training, equipment, or
planning. The goal is to decrease vulnerability.
• Readiness/Preparedness: a direct result of the
adequacy of planning and the potential of those
plans to create results in the area of training and
resources.
What is an incident?
• Any event that overwhelms
existing resources to deal with
that event.
– Weather – tornadoes,
flooding, severe storms
– Terrorism
– Infrastructure failures
affecting operations for a
prolonged period
– Hazardous materials
incident
– Large volume of patients
– Pandemic
Incident implications
•
•
•
•
•
•
•
Transportation
Electrical
Telephone
Water
Fuel
Structural
Communications
Incident implications
• Incidents restrict and overwhelm
resources, communications,
transportation and utilities.
• Individuals and communities are cut off
from the outside support.
What is your goal in an
incident?
• RESPONSE – manage victims (treat,
triage, transfer, disposition).
• RECOVERY – operational, financial, and
return to “normal” operations.
All Hazards approach to
planning
• A conceptual
framework for
organizing and
managing
emergency
protection efforts.
Who is involved in All Hazard
response efforts?
•
•
•
•
•
•
•
•
•
•
Federal
Tribal
State
Local
Emergency
Management
Public Works
Fire/Rescue
EMS
Hospitals
Public Health
All Hazard steps
•
•
•
•
Planning
Training
Exercising
Policies &
procedures
• Resource
requirements
• Resource upgrade
Major Incident Operations
• Disruption of normal
process of health
care delivery
• Displacement of dayto-day patient
management of
casualties
• Distraction of health
care providers from
usual workflow
• Addition of mental
health burden
• Disruption of supply
chain
• Disruption of
communication
systems
• Fiscal disruption
Emergency Operations Plan
• Introduction
• Procedures &
Operations
• HICS Job Action
Sheets
• Specific
Departmental
Tools
• Forms/Resources
Emergency Operations
Plan-Part 1
• Introduction
– General overview of <Hospital Name> and
facilities/support.
• Purpose/Policy
– Provide continuous quality improvement.
– Provide coordination and integration.
• Scope
– Addresses Joint Commission and CMS
Conditions of Participation (CoPs.)
All Hazards Emergency
Operations
• Mitigation:
– Removing/lessening the conditions that lead to
incidents.
• Preparedness
– Readiness for the unavoidable.
• Response
– Decreasing the severity/intensity of an incident.
• Recovery
– Getting back to normal.
Mitigation
• Hospital Hazard
Vulnerability
Analysis (HVA)
• Multiple Tools
Available
Mitigation
• Hazard
identification
• Hazard
Assessment
(HVA)
• Structural code
compliance
• Equipment and
maintenance
Preparedness
•
•
•
•
Plan development
Training courses
Exercises
Employee
education and
competencies
• Public education
Response
• Alerting
• Assessment
• Mobilizing- Healthcare
partners and ESF8
• Implementing plan
• Activate systems
(HICS, EOC)
• Control, Set prioritiesInfection etc.
• Communication and
situational awareness
Recovery
• Those activities undertaken by a
hospital after an emergency or
disaster occurs to restore minimum
services and move towards longterm restoration.
Recovery
• Return to
“normal”
• Detailed damage
assessment
• Care and shelter
continues
• Funding
assistance
• Remove debris
Part 2- Specific procedures
& operations
• Patient Flow
– Triage
– Treatment Areas
• Security Activities
– Entry & Egress
– Visitors Access
Procedures & operations
• Communications
– Telephone
– Back-up systems
– Radio (VHF/800)
– Satellite phone
– Walkie – Talkies
– HAM radio
– Fax
Procedures & operations
• Patient
admissions,
triage, disaster
tags, registration
process
– Elective
procedures
– Discharge of
patients
Procedures & operations
• News Media
– Public
Information
Officer (PIO)
– Strategic
location
– Joint
Information
Center (JIC)
Procedures & operations
• Hotline
• Family of victims,
visitors, outpatients
Procedures & operations
• Supplies &
equipment
–
–
–
–
–
–
–
–
Essential supplies
Pharmaceuticals
Medical supplies
Equipment
Food
Water
Linen
Utilities
Procedures & operations
• Morgue
– DOAs
– Others that
expire
Procedures & operations
• Evacuation
– Authority
– Transportation
– Location
– Evacuation
routes
– Practice/Test
Procedures & operations
• Continuing and/or
reestablishing
operations
• Off – site care
(Alternate Care
Sites, or ACS)
Procedures & operations
• Essential utility
alternatives
– Electrical
– Water
– Medical gas
– Waste
disposal
– Fuel
Procedures & operations
• Isolation &
decontamination
– Plan &
procedure
– Equipment
– Training
Procedures & operations
• Orientation &
education
• Annual plan
evaluation
Emergency Operations Plan
Part 3- HICS Job Action
Sheets
HICS Job Action sheets
• Incident
Command
• Operations
• Logistics
• Finance and
Administration
• Planning
• Others
HICS Job Action sheets
• One for each
position.
• Embodies title,
mission/function
and duties.
• Adjusted to meet
hospital needs.
Emergency Operations Plan
Part 4
Specific department tools
Specific departmental plans
• Emergency
Department
• Security
• Maintenance
• Nursing floors
• Admission policy
& registration
• Emergency
triage
• Evacuation
• Communications
• Emergency
Operations
Center
Emergency Operations Plan
Part 5-forms/resources
Forms/Resources
• Help drive
positions
• Documentation
aid
• Financial
recovery
• Decreases
liability
• Enhances &
tracks
communication
Emergency Management
A successful interface
needs:
• Planning
• Training
• Exercising
According to Joint
Commission1:
• Emergency Management is now its own
accreditation manual chapter.
• All Standards and Elements of Performance
from 2009 are incorporated into the 2010
Emergency Management chapter.
• This new chapter contains some standards
that were in HR, EC and MS sections.
• Critical Access Hospital requirements are
similar to other types of hospitals in most
counties.
1 http://www.jointcommission.org/
Emergency Operations Plan
Emergency Operations Plan (EOP) describes
response 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 recovery
phases.
• Defines authorities and community relationships
• Alternative care sites, alternate EOC.
• Actual implementation is documented.
Emergency Operations Plan
• Plan Structure
Emergency Operations Plan
• Addresses Twelve Critical Access Hospital Joint
Commission Components:
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–
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Planning
The EOP
Communication
Resources & Assets
Safety & Security
Staff responsibilities
Utilities Management
Patient, clinical & support activities
Volunteer Management
Volunteer Credentialing
HVA and Evaluation
Plan Evaluation
[EM.01.01.01]
[EM.02.01.01]
[EM.02.02.01]
[EM.02.02.03]
[EM.02.02.05]
[EM.02.02.07]
[EM.02.02.09]
[EM.02.02.11]
[EM.02.02.13]
[EM.02.02.15]
[EM.03.01.01]
[EM.03.01.03]
Emergency Operations Plan
• EM.01.01.01 Planning (8 measures)
– The critical access hospital engages in planning activities prior
to developing its written Emergency Operations Plan.
• EM.02.01.01 The Plan (8 measures)
– The critical access hospital has an Emergency Operations
Plan.
• EM.02.02.01 Communication (15 measures)
– As part of its Emergency Operations Plan, the critical access
hospital prepares for how it will communicate during
emergencies.
• EM.02.02.03 Resources & Assets (9 measures)
– As part of its Emergency Operations Plan, the critical access
hospital prepares for how it will manage resources and assets
during emergencies.
Emergency Operations Plan
• EM.02.02.05 Safety and Security (9 measures)
– As part of its Emergency Operations Plan, the critical access
hospital prepares for how it will manage security and safety
during an emergency.
• EM.02.02.07 Staff Responsibilities (9 measures)
– As part of its Emergency Operations Plan, the critical access
hospital prepares for how it will manage staff during an
emergency.
• EM.02.02.09 Utilities Management (7 measures)
– As part of its Emergency Operations Plan, the critical access
hospital prepares for how it will manage utilities during an
emergency.
• EM.02.02.11 Patient, clinical & support activities (8
measures)
– As part of its Emergency Operations Plan, the critical access
hospital prepares for how it will manage patients during
emergencies.
Emergency Operations Plan
• EM.02.02.13 Volunteer Management (9 measures)
– During disasters, the critical access hospital may grant
disaster privileges to volunteer licensed independent
practitioners.
• EM.02.02.15 Volunteer Credentialing (9 measures)
– During disasters, the critical access hospital may assign
disaster responsibilities to volunteer practitioners who are not
licensed independent practitioners, but who are required by
law and regulation to have a license, certification, or
registration.
• EM.03.01.01 Vulnerability Assessment and Evaluation (3
measures)
– The critical access hospital evaluates the effectiveness of its
emergency management planning activities.
• EM.03.01.03 Evaluating the Plan (17 measures)
– The critical access hospital evaluates the effectiveness of its
Emergency Operations Plan.
Use of volunteers in
medical surge
• 18 Elements of Performance (EP’s) of Joint
Commission Standards address use of
volunteers.
• Medical Surge exercises that are HSEEPcompliant must address the use of
volunteers in surge activities.
• How deep is your hospital in each staff skill
area? By department? Supervisor? Facility?
Occupation? Specialty?
For Volunteer Licensed
Independent Practitioners and
Volunteer Practitioners
•
•
•
•
Section 1: Disaster Privileges
Section 2: Credentials Verification
Section 3: Volunteer Oversight
Section 4: Cessation of Volunteers
Use of volunteers
•
•
•
•
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What can they do?
What can’t they do, unless supervised?
What shouldn’t they do?
Who can they be?
Can spontaneous unassigned
volunteers (“SUVs”) be used?
• What are the most likely scenarios?
• Who can and cannot supervise
volunteers?
Review: The Emergency
Operations Plan
• Covers all of the All Hazards
phases of Emergency Management
– Mitigation
– Planning
– Response
– Recovery
• As well as communications with
ESF8 partners
Where do I start?
• <Hospital Name>
has:
– Emergency
Operations Plan
(a base plan to
start with).
– Departmental Plans (ED, Triage, Admissions,
Evacuation, Security.
– Email <hospital point of contact> to receive
the plans electronically.
Center for HICS Education &
Training- www.hicscenter.org
•
•
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•
Guidebook
Training Resources
Job Action Sheets
Forms
Internal (13) & External
(14) Scenarios
<Presenter POC information>