David N. Gans, MSHA, FACMPE
Vice President, Practice Management Resources
Medical Group Management Association
July 22, 2008
Preparing Your Office Practice for Disaster and
Emergency Events
Idaho Bioterrorism Awareness and Preparedness Program (IBAPP)
Medical Group Management Association (MGMA)
Name, credentials
Organization
Copyright 2008. Medical Group Management Association. All rights reserved.
Date
About MGMA
Our mission…
To continually improve the performance of medical
group practice professionals and the organizations
they represent
MGMA has
• 22,000 members…
• Who manage and lead 12,500 organizations
• With 270,000 physicians
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Program Objectives
• Describe why a medical practice must be prepared for an
infectious disease epidemic or bioterrorism attack
• Describe how to protect your facility, physicians, staff,
and patients in the event of a natural disaster, contagious
disease outbreak, bioterrorist incident, or other
emergency
• Outline the key elements of a medical practice disaster
plan and the resources available to assist a medical
practice in the event of disaster or emergency
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Why Prepare for an Infectious Disease
Epidemic or Bioterrorism?
Name, credentials
Organization
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Date
Why Prepare for an Infectious Disease Epidemic or
Bio-Terrorism?
• Counter uncertainty by physicians and employees regarding
local, national, and international events
• Preparations for infectious disease epidemic and bioterrorism
are similar to preparations for many emergency situations
• Preparations for an epidemic bioterrorism will assist
physicians and employees deal with the emotional and
practical disruptions created by other emergencies and
disasters
• Future probability of an event is high
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The Bigger Picture: Disasters and Emergencies
• Practice Emergency: Any event that can disrupt practice
flow for more than 24 hours
• Types of Disasters and Emergencies
– Natural Events
– Acts of Violence
– Practice Emergencies
– Public Health Outbreaks
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Current Confirmed Human Cases of
Avian Flu
Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO
June 19, 2008
Country
Azerbaijan
Bangladesh
Cambodia
China
Djibouti
Egypt
Indonesia
Iraq
Lao PDR
Myanmar
Nigeria
Pakistan
Thailand
Turkey
Viet Nam
Total
2003
2004
2005
2006
2007
2008
Total
cases deaths cases deaths cases deaths cases deaths cases deaths cases deaths cases deaths
0
0
0
0
0
0
8
5
0
0
0
0
8
5
0
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
0
0
4
4
2
2
1
1
0
0
7
7
1
1
0
0
8
5
13
8
5
3
3
3
30
20
0
0
0
0
0
0
1
0
0
0
0
0
1
0
0
0
0
0
0
0
18
10
25
9
7
3
50
22
0
0
0
0
20
13
55
45
42
37
18
15
135
110
0
0
0
0
0
0
3
2
0
0
0
0
3
2
0
0
0
0
0
0
0
0
2
2
0
0
2
2
0
0
0
0
0
0
0
0
1
0
0
0
1
0
0
0
0
0
0
0
0
0
1
1
0
0
1
1
0
0
0
0
0
0
0
0
3
1
0
0
3
1
0
0
17
12
5
2
3
3
0
0
0
0
25
17
0
0
0
0
0
0
12
4
0
0
0
0
12
4
3
3
29
20
61
19
0
0
8
5
5
5
106
52
4
4
46
32
98
43
115
79
88
59
34
26
385
243
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Healthcare Workers Have Significant Risk from
Contagious Disease and Biological Agents
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Staff May Not Report to Work During a Pandemic
Reuters
Pandemic might keep some health staff
away
Updated: 4:38 p.m. MT May 22, 2007
NEW YORK - A survey of U.S. health care workers suggests that not all
are willing to staff the front lines if there should be an outbreak of bird
flu or other infectious disease. Some will opt to play it safe and stay
home, according to the survey.
About 50 percent of the hospital workers said “yes” they would report to
work, while 42 percent said “maybe” and 8 percent said “no, even if I
would lose my job.” Doctors (73 percent) were more likely than nurses
(44 percent) or other hospital personnel (33 percent) to indicate that
they would report to work in the event of bird flu pandemic.
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Protecting your facility, physicians, staff, and
patients in the event of a natural disaster,
contagious disease outbreak, bioterrorist
incident, or other emergency
Name, credentials
Organization
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Date
How Can You Prepare?
• Learn how to diagnose and treat patients affected with
avian flue or who are exposed to biological agents and
toxins
• Train staff how to recognize potential cases
• Establish medical practice disaster plan
• Include pandemic and bioterrorism in the medical
practice disaster plan
• Develop a screening plan to identify and direct patients
with high risk for contagious disease or biological agent
exposure
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Ten Step Response to Pandemic or Bioterrorism
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Maintain an index of suspicion
Protect thyself
Assess the patient.
Decontaminate as appropriate
Establish a diagnosis
Render prompt treatment
Practice good infection control
Alert the proper authorities
Assist in the epidemiologic investigation
Maintain proficiency
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Screening Patients with a High Risk for
Contagious Disease or Biological Agent
• If there is a risk of pandemic or biological attack, train
receptionists to use a script that can identify patients at
risk
• Validate screening by triage nurse or physician
• Direct patient to the appropriate health care services
– Monitor symptoms for the scheduled appointment
– Come immediately to the doctor’s office
– Go directly to a designated health care facility
– Call 911 for the Emergency Medical Response
(EMR) system.
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Sample Script for Receptionists to Use in
Screening Patients
Key questions
– Symptoms
– Travel
– Military service
– Mass transit
– Public gatherings
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Sample Script for Receptionists to Use in
Screening Patients
What symptoms do you have? (Score 1 point for each
symptom)
• Fever?
• Fatigue?
• Sore throat?
• Difficulty swallowing?
• Nausea?
• Vomiting?
• Coughing?
• Headache?
• Back pain?
• Chest pain?
• Abdominal pain?
• Chills?
• Sweats?
How long have you had these symptoms? (Score: Less than week = 2
points, More than a week = 1 point)
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Sample Script for Receptionists to Use in
Screening Patients
Have you traveled outside the United States recently? If
yes,
• When did you leave the US?
• What countries were you in? (Score 1 point for each
country)
• When did you return? (Score: Less than a week=2
points, More than week=1 point)
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Sample Script for Receptionists to Use in
Screening Patients
Are you currently, or have you been in the military? If yes,
• Were you stationed outside the US? (Score 1)
• When were you discharged? (Score: Less than a
month=2 points, More than a month but less than year=1
points)
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Sample Script for Receptionists to Use in
Screening Patients
Have you recently utilized mass transportation? If yes,
(Score: If used all the time or within the past weeks = 2
points, otherwise 1 point)
• Subways?
• Buses?
• Trains?
• Airplanes?
Have you attended any large gatherings recently? If yes,
(Score 1 point for each positive answer)
• Where?
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Sample Script for Receptionists to Use
in Screening Patients
A score in the range of eight (8) or more might indicate that a patient
may be at risk of exposure to a contagious disease or biological agent
and should be referred to a physician or triage nurse who can better
assess the situation and direct the patient to come immediately to the
doctor’s office, to a designated health care facility, or to instruct the
patient to call 911 and notify the Emergency Medical Response (EMR)
system.
If the patient is asked to come to the physician’s office, upon arrival they
should be isolated immediately.
Walk-in patients also should be asked the appointment triage questions
at the front desk and isolated from public areas based on the scoring.
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Designing a disaster plan for your medical office
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Organization
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Sections of a Medical Practice Disaster Plan
• Preparation – What you do before disaster strikes
• Survival – Immediate actions
• Recovery – Coming back after the smoke clears
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Reverse Planning Helps Keep the Task in
Perspective
• Visualize what a successful recovery would look like
• Break a large problem into manageable tasks
• Evaluate each task in terms of how much closer it
brings you to the goal
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Recovery
•
•
•
•
•
•
•
•
•
•
•
What do you need to get back in business?
Who can help?
What resources are available?
Prepare for the worst - hope for the best
Patient care delivery – who, what, where
Communications - telephone, fax, e-mail, etc.
Supplies
Information processing and medical records recovery
Staff availability
Financial resources
Stress management
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Survival
• Rapid actions – prioritize
because there is never
enough time to get it all
done
• Patient and staff
protection is first priority
• Practice makes perfect have a “fire” drill
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• Communication must be
concise and clear
• Activity is reassuring in
fearful situations
• Account for everyone
• Rely on checklists instead of
memory
• Train and drill yearly
Preparation
• Assess vulnerability
• Develop a emergency plan
that fits each scenario –
one size does not fit all
• Consider both isolated and
community wide events
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• What systems are needed for
ongoing operations?
– Information Technology
– Financial
– Human resources
• Who do you need to
coordinate with?
– Hospital
– Other physicians
– Suppliers, etc.
Assessing the Potential Impact of an Event
• Will it result in:
o Injury or loss of life
o Business interruption
o Reduce staffing or
patients
o Impact financial
process
o Are there fines or
penalties?
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• Work the most serious and
probable problems first
• What can you cover with
insurance?
• What are your existing
resources?
• Develop a plan to fill the
gaps
Steps for Developing a Disaster Plan
• Keep the plan simple
• Obtain copies of disaster plans from hospital(s) and other
physicians
• Obtain copies of community disaster plans
• Model the practice’s plan on hospital and community plans
• Let the plan reflect uniqueness of practice staff and
resources available
• Distribute draft to physicians, nurses, and key staff member
for input
• Review plan with appropriate hospital/community entities,
defining role of the practice within framework of community
disaster plans
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Steps for Developing a Disaster Plan (continued)
•
•
•
•
Finalize plan, including group governance approval
Implement emergency response plan
Develop training modules
Conduct initial and on-going physician/staff training
program, including testing and simulation
• Re-evaluate and update emergency response plan
annually
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If an Emergency or Disaster Happens, Learn
from It
• Debrief all involved parties and look how to improve the
plan
• Recognize the circumstances are never exactly the
same
• Stay vigilant for symptoms of stress in the staff,
physicians, and you
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Federal and Community Agencies Providing
Emergency Assistance
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Organization
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Federal and Community Agencies Providing
Emergency Assistance
• The emergency preparedness system is
fragmented with overlapping responsibilities at
federal, state, and local government level as
well as multiple private organizations having
stakeholder interests
• Tip O’Neal described, “All politics are local.”
The same is true for emergency assistance
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FEDERAL GUIDANCE TO IMPROVE STATE-LEVEL
PANDEMIC INFLUENZA OPERATING PLANS
Presented to the American States, Territories
and District of Columbia
By
U. S. GOVERNMENT
March 11, 2008
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State Guidance
States should plan and develop pandemic influenza plans
with local, regional, State, and federal partners. Planning
should include, but is not limited to the following:
Form community-wide coalitions to include hospitals, urgent
care facilities, other ambulatory care facilities, public
health, long term care facilities, nursing homes, home
health care agencies, community health centers, primary
care offices, mental health and substance abuse treatment
facilities, EMS, and other first responders to accommodate
surge in patients expected from pandemic influenza.
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Idaho Bureau of Homeland Secruity
http://www.bhs.idaho.gov/index.htm
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Federal Emergency Management Agency
(FEMA)
(http://www.fema.gov/)
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Centers for Disease Control and Prevention
(CDC)
(http://emergency.cdc.gov/)
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American Red Cross Disaster Services
(http://www.redcross.org/services/disaster/)
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Small Business Administration
Disaster Assistance
(http://www.sba.gov/services/disasterassistance/
index.html)
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IBHS Information for Business
(http://www.ibhs.org/ibhs2)
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Employer Support of the Guard and Reserve
(ESGR)
(http://www.esgr.org)
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Questions?
David N. Gans, FACMPE
Vice President, Practice Management Resources
Medical Group Management Association
104 Inverness Terrace East, Englewood, CO 80112
877.275.6462 ext. 1270
dng@mgma.com
Copyright 2008. Medical Group Management Association. All rights reserved.