Transcript Document

FQHCs and Emergency
Preparedness: a 2011 Accreditation
Odyssey
Amelia Muccio
Director of Emergency Mgt
NEW JERSEY PRIMARY CARE ASSOCIATION
Prologue
• Special thanks to Mollie Melbourne of
NACHC for her assistance & research on
the material in this PPT <*)))><
Objectives
• Review FQHC accreditation standards for
emergency preparedness:
– Bureau of Primary Health Care Policy
Information Notice 2007-15 (PIN)
– Joint Commission (JC)
– Accreditation Association for Ambulatory Care
(AAAHC)
– National Incident Management System (NIMS)
Emergency Management Plan (EMP)
• PIN: plans & procedures for EM must be
integrated…
• JC: EM.02.01.01-the organization has a
written EMP…
• AAAHC: 7.F-organization has
comprehensive written emergency plan…
• NIMS: 2008/2009 objective 3-revise and
update EOPs and SOPs…
What is in an EMP?
• EMP is comprehensive, self-contained document
that includes the components necessary to guide
all emergency activities
• Is essential to minimize the disruption of services
• Ensure predictable staff behavior during an
emergency
• All-Hazards approach
• Review ESF #8
• EMP should be aligned and integrated in local
and State EMPs “unified front”
FQHC’s EMP Elements
• Continuity of
Operations
• Command and
Control
• Staffing
• Surge Patients
• Medical and NonMedical Supplies
• Pharmaceuticals
• Security
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Evacuation
Decontamination
Isolation
Power Supply
Transportation
Water/Sanitation
Communications
Medical Records
Security and Access
Plan/Organization is NIMS compliant
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PIN: strongly encouraged…
JC: n/a
AAAHC: n/a
NIMS: 2008/2009 objective 1-adopt NIMS
and objective 2-fed preparedness awards
support NIMS implementation…
What is NIMS?
• A comprehensive, nationwide, systematic approach to
incident management, including the Incident Command
System, Multiagency Coordination Systems, and Public
Information
• National Incident Management System (NIMS) is a
comprehensive, national approach to incident management
that is applicable at all jurisdictional levels and across
functional disciplines (lowest jurisdictional level)
• Applicable across a full spectrum of potential incidents
and hazard scenarios, regardless of size or complexity
• Improves coordination and cooperation between public
and private entities in a variety of domestic incident
management activities
Hazard Vulnerability Analysis (HVA)
• PIN: should initiate emergency
management planning by conducting
HVA…
• JC: EM.01.01.01/EP2-HVA…
• AAAHC: 3.F-a program is maintained to
assess and where necessary reduce risks
(physical hazards, violence in workplace,
terrorism, etc)…
• NIMS: n/a
What is a HVA?
• Identifies potential emergencies and the direct/indirect effects these
emergencies may have on CHC’s operation and demand for services
• The risks identified should be prioritized based on likelihood of
occurrence and severity
Plan: Four Phases of Emergency Management
• PIN: EMP should address 4 phases of
EM…
• JC: EM.01.01.01/EP4/EP2/EP5/EP6-need
for planning, preparedness, response and
recovery activities….
• AAAHC: n/a
• NIMS: 2008/2009 objective 3- include
planning, training, response exercises,
corrective actions…
What are Four Phases of EM?
Mitigation (including
prevention): reduce or
eliminate impact of
hazards (generators)
Preparedness: build
capabilities to respond
and recover from the
impacts of those hazards
(this training)
Response: gain control over
on-going negative effects
of the hazards (staying
open)
Recovery: return to predisaster condition
(normal business
operations)
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Plan: Developed by Multi-Disciplinary Team
• PIN: Essential that EMP developed by
interdisciplinary approach…
• JC: EM.02.01.01/EP1-the organizations’s
leaders participate in development of
EMP…
• AAAHC: n/a
• NIMS: n/a
Possible Planners?
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CEO
COO
DON
CFO
Director of Security
Emergency
Preparedness Contact
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Billing Manager
Medical Director
Facility Manager
Administrative
Supervisor
• PCA
Plan: Patient Surge
• PIN: CHCs should describe approach to
responding to increased demand on
organizaitons’s services…
• JC: EM.02.02.11-as part of EMP, the
organization prepares for how it will
manage patients during emergencies…
• AAAHC: n/a
• NIMS: n/a
Plan: Resource Management
• PIN: EMP should address possible roles for CHCs
including medical and non-medical supplies…
• JC: EM.02.02.03/EP1/EP2/EP3/EP12-As part of EMP,
organization prepares for how it will manage resources
and assets during emergencies/obtain and replenish
supplies...
– EMP must address advance preparation to provide
resources and assets during an emergency…
• AAAHC: 8.C-The organization has the necessary
personnel, equipment and procedures to deliver safe care,
and to handle emergencies…
• NIMS: n/a
Resource Management
• Standardized seven-step cycle for
managing resources during an incident
• Step 1: Identify Requirements
• Step 2: Order & Acquire
• Step 3: Mobilize
• Step 4: Track & Report
• Step 5: Recover/Demobilize
• Step 6: Reimburse
• Step 7: Inventory
Plan: Method for Structuring Staff During
Emergency Response
• PIN: CHCs should have all-hazards command
structure within the organization such as ICS…
• JC: EM.02.02.07/EP1/EP2/EP3/EP4-manage staff
during emergencies; role and responsibilities of
staff; assigning staff; chain of command
(reporting structure)…
• AAAHC: the organization has the necessary
personnel, equipment and procedures to deliver
safe care and to handle medical and other
emergencies…
• NIMS: 2008/2009 objective 11/12-ICS/ICS with
IAP…
ICS 101
• Incident-Focused organizational structure that can be
implemented along side of day-to-day administrative
structure of an organization
• Allows its users to adopt an integrated organizational
structure to match the demands of the incident
• Based on best practices
• Promotes incident safety
• Achievement of tactical objectives
• Efficient use of resources
• 3 Priorities of ICS
– Life Saving
– Incident Stabilization
– Property Preservation
Key Features of ICS
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Common terminology
Modular organization
Management by
objectives
Reliance on IAP
Chain of
command/unity of
command
Unified command
Manageable span of
control
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Pre-designated incident
locations and facilities
Resource management
Information and
intelligence
management
Integrated
communications
Transfer of command
Accountability
Dispatch/Deployment
ICS Functions
Plan: Use of Volunteer Licensed Independent
Practitioners
• PIN: n/a
• JC: EM.02.02.13/15-during disasters, the
organization may grant disaster privileges to
volunteer licensed independent practitioners and
may assign responsibilities to volunteer
practitioners who are required by law to have a
license, certification or registration; refer to 2009
Standards for Ambulatory Care
• AAAHC: n/a
• NIMS: n/a
Federal Tort Claims Act (FTCA)
• FTCA coverage for eligible HRSA grantees was
initially legislated through FSHCAA of Public
Health Service Act
• In the event a medical malpractice lawsuit is filed
against a deemed entity or covered provider
acting within the scope of his/her employment in
grant related activities, the United States is
substituted for the deemed entity and the covered
employee
• The CHC and employee are dismissed from case
and the case continues against the United States
as the sole defendant
Plan: Detailed Communication Section
• PIN: EMP should identify policies and procedures
for communicating with internal staff and external
stakeholders…
• JC: EM.02.02.01/EP1/EP3-method for
communicating during emergencies and how
internal and external stakeholders are notified…
• AAAHC: n/a
• NIMS: 2008/2009 objective 9, 13, 14communication standards, public information,
PIO, JIC, JIS…
Public Information
• PIOJICJIS
• PIO provides accurate, coordinated, timely and
understandable information
• JIS provides an organized, integrated and coordinated
mechanism for providing info to the public during an
emergency (JIC is physical asset)
• Public information, education strategies, and
communications plans help ensure that numerous
audiences receive timely, consistent messages about
• Lifesaving measures
• Evacuation routes
• Threat and alert system notices
• Other public safety information
Plan: Communication Systems
• PIN: EMP has redundant communication…
• JC: EM.02.02.01/EP14/EP17-backup
communications for internal/external, in
advance of emergency…
• AAAHC: n/a
• NIMS: 2008/2009 objective 8 & 10interoperability (equipment,
communications, data) and accurate
information during incident…
Communication Features
• Integrated communications:
– Common interoperable communication plan
(modes, planning and networks)
• Information and intelligence management:
– Critical info for response (gather, share and
manage info)
– Weather info, risk assessments, surveillance)
Plan: Activating and Deactivating Plan
• PIN: EMP should describe under what
circumstances and how, when and by whom the
EMP is activated…
• JC: EM.02.01.01/EP5/EP6-process of initiating
and terminating the organizations’s response and
recovery phases; EMP identifies individuals
responsible for activating the response and
recovery phase…
• AAAHC: n/a
• NIMS: n/a
Plan: Provisions for Staff Training
• PIN: CHCs should provide ongoing training on
emergency management and the implementation
of the EMP to employees…
• JC: n/a
• AAAHC: The organization provides documented
periodic instruction of all personnel in the proper
use of safety, emergency and fire extinguishing
equipment…
• NIMS: 2008/2009 objective 5/6/7-complete IS
100, 200, 700 and 800 courses, Promote NIMS
and ICS
Rationale for Staff Training
• We are only as prepared as the lowest common
denominator
• Disaster planning assists with:
– Ability to rotate staff
– Organizational agility
– Plans, drills, and evaluations
– Training and education
– Staff protection and support
– Communications and reporting
– Supplies and equipment
– Obligation to community
• Educating staff is an investment!
Plan: Conducting Drills and Exercises
• PIN: CHCs should continually test and
evaluate the effectiveness of their EMP and
make adjustments as necessary; the
frequency and methods of testing and
evaluation (tabletops, functional exercises,
etc) should be determined by org. but
should be at least on annual basis…
Plan: Conducting Drills and Exercises
• JC:EM.03.01.03/EP1/EP2/EP5/EP13/EP14/
EP16/EP17-the organization evaluates the
effectiveness of its EMP, as an emergency
response exercise; the organization
activates its EMP twice a year at each site
included in the Plan (tabletops not
acceptable)-each site of the organization
that offers emergency services or is a
community-designated disaster receiving
station…
Plan: Conducting Drills and Exercises (JC Con’t)
• at least one of the organization's two
emergency response exercises includes an
influx of simulated patients; exercises
incorporate likely disaster scenarios that
allow the organization to evaluate its
handling of communications, resources,
and assets, security, staff, utilities and
patients, representatives from
administration and clinical services should
participate in response exercise/actual
emergency…
Plan: Conducting Drills and Exercises (JC Con’t)
• evaluation of all exercises and actual
emergencies includes identification of
deficiencies and opportunities for
improvement (must be documented);
organization modifies its EMP based on
evaluations of emergency response
exercises and actual emergencies;
subsequent emergency response exercises
reflect modifications and interim measures
as described in modified EMP…
Plan: Conducting Drills and Exercises
• AAAHC: 8.E-the organization requires at least
one (1) drill each calendar quarter of the internal
emergency preparedness plan; one (1) of the
annual drills must be a documented
cardiopulmonary resuscitation (CPR) technique
drill; the organization must complete a written
evaluation of each drill and promptly implement
any corrections…
• NIMS: 2008/2009 objective 3/7-revise and update
EOPs/SOPs and promote NIMS/ICS in all
training and exercises…
Homeland Security Evaluation and Exercise
Program (HSEEP)
• The Homeland Security Exercise and Evaluation Program
(HSEEP) is a capabilities- and performance-based
exercise program that was developed to provide common
exercise policy and program guidance that constitutes a
national standard for exercises
• HSEEP is designed to be adaptable to any exercise
program, regardless of the nature and composition of its
sponsoring agency or organization, and to the full
spectrum of exercise scopes and scenarios
• This includes consistent terminology, design process,
evaluation tools, and documentation standards
Types of Exercises—Building Block Approach
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Seminar (Discussion)
Workshop (Discussion)
Tabletop Exercise (TTX) (Discussion)
Games (Discussion)
Drills (Operations)
Functional Exercises (FXE) (Operations)
Full Scale Exercises (FSE) (Operations)
Plan: Integrating CHC Plan and Response with
Community
• PIN: CHC’s EMP should be integrated into State
and local EMPs already in place to maximize
alignment and integration…
• JC: EM.01.01.01/EP4-organization determines
what its role will be, if any, in the community
response plan…
• AAAHC: n/a
• NIMS: 2008/2009 objective 4-participate in
interagency mutual aid agreements (public and
private sector)…
External Partners (Integration)
– Feds
– State/Regional
– Local/Tribal
– Non-Profit
(voluntary)
– Social Services
– Healthcare and
Public Health
– Police/Fire/EMS
– Private Sector
– Industry
– Schools and
Academia
– Churches and
FBOs
– Animal Welfare
Orgs
Plan: Access for Special Populations
• PIN: CHCs should plan for assuring access
to special populations such as migrants and
seasonal farm workers, homeless, residents
of public housing, non-English speaking,
disabled, elderly and those living with
HIV…
• JC: n/a
• AAAHC: n/a
• NIMS: n/a
At Risk: CMIST-Functional Needs
• At-risk individuals are those who have, in
addition to their medical needs, other needs that
may interfere with their ability to access or
receive medical care. They may have additional
needs before, during, and after an incident in one
or more of the following functional areas (CMIST):
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Communication
Medical Care
Independence
Supervision
Transportation
Plan: Continuity of Operations
• PIN: EMP should describe how CHCs will continue to
provide primary care health services to current and surge
patients to the extent possible during an emergency; the
EMP should evaluate the CHC’s ability to maintain
normal operations and describe the circumstances that
must be met for CHC to discontinue non-emergency
primary care services or cease operations for a period of
time…
• JC: EM.02.02.11/EP1-EMP describes how organization
will manage activities related to patient care, treatment
and services and disruption of services…
• AAAHC: n/a
• NIMS: n/a
COOP
• Normal lines of direction and control may be disrupted
• Normal operations will be disrupted for a brief time or
until reconstitution is completed after the emergency ends
• Normal security arrangements will be disrupted and the
organization could be vulnerable to additional disruptions
until the COOP site is activated and all employees get
home or to a safe location
• Normal communication links and methods will be
disrupted until the COOP site is up and running and
reconstitution is complete
• A comprehensive COOP capability will minimize those
impacts
Continuity of Operations Plan (COOP)
• There are 9 elements of a viable COOP:
1.Essential functions
2.Delegations of authority
3.Alternate facilities
4.Interoperable communications
5.Vital records and databases
6.Human capital management
7.Tests, training, and exercises
8.Devolution
9.Reconstitution
Plan: Safety and Security Measures
• PIN: CHC’s EMP should address the following
components: security, decontamination and
isolation…
• JC: EM.02.02.05/EP1/EP5/EP10-EMP will
address internal security and safety during
emergency; EMP describes radioactive,
biological, chemical and decontamination,
organization implements EMP, in advance of
incident…
• AAAHC: n/a
• NIMS: n/a
Plan: Staff Preparedness
• PIN: the plan should also help staff prepare
their families for emergencies-if staff are
prepared at home, they are more likely to
carry out vital responsibilities and duties at
work in the health center…
• JC: n/a
• AAAHC: n/a
• NIMS: n/a
Personal Preparedness
Personal Preparedness
• Do you have a family
communications plan?
• Do you have a go bag?
• Do you have a pet go
bag?
• Have you made
arrangements for
childcare if you are
needed at work?
• What about your other
family members including
elderly and pets?
Wrap-Up
• Thanks for your time
• Please feel free to contact me with questions
• Amelia Muccio, [email protected]