Continuity of Operations Planning for Public Health and Medical Services Greg Morgan Contingency Planner Stacy A. Robarge-Silkiner SNS Coordinator KDHE Center for Public Health Preparedness

Purpose of COOP

Ensure the continued operation of organizations through a disaster (manmade, natural, technological) or a biological event (pan flu, anthrax, etc) Facilitate the preparation of, site or activity specific plans and procedures that help ensure the safety of personnel Allow organizational elements to continue essential operations in the event of an emergency or threat emergency. Health System leadership will ensure that personnel are aware of their assigned COOP responsibilities via devolution of staffing concepts and just in time training.

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Hazard Vulnerability Assessment

Probability of an event occurring and the impact the event would have on departmental and system wide operations Clara Barton Hospital Hoisington, Ks www.redcross.org

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Hazard Vulnerability Tool

Allows individual health agencies to identify and rank various risk and mitigating factors Coordinate with local law enforcement and emergency management HVA Tool

Hazard Vulnerability Gap Analysis

Priority projects related to health agency emergency preparedness . Interprets results of HVA into useable format

HVA Gap Analysis

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Assumptions and Considerations

COOP doesn’t apply to temporary disruptions of service COOP plans will be operational within 12 hours Maintain essential operations up to and beyond 30 days

Key Elements of COOP

Planning Essential Functions Delegation of Authority Order of Succession Alternate Facilities Interoperable Communications Public Information Vital Records Human Capital Security Logistics Training and Exercising

Planning

Essential functions are listed and prioritized Staffing requirements for each essential function are identified Resource requirements for each essential function are identified Critical data and data systems for each essential function are identified

Planning cont.

Support activities are addressed as part of essential functions Plans exist for attaining operational capability within 12 hours Processes and procedures exist to acquire resources necessary to continue essential functions and sustain operations for up to 30 days

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Procedures

Procedures for employee advisories, alerts and COOP/COG plan activation.

Provisions for personnel accountability.

Procedures exist for an annual review and revision of the COOP plan

Alert and Notification Procedures

Alert Procedures

COOP activation under any condition

With Warning:

 few hours warning  deployment of key personnel to a pre-determined location.

 Notification methods

Without Warning:

 Terrorist/bio-terror attack   Act of war Natural disaster

Notification Procedures

 Notify proper authorities of COOP activation  Notify the PT members  Cell phone, pagers, blackberry, land-line, radio, etc

Essential Functions

Identification and prioritization of essential functions

necessary for agency continuity of operations. Essential functions include services that are: Loss of life Public health and safety Food and Shelter 24/7 Direct Care and Critical Ancillary Providers Economic impact Symbolic value

Essential Functions agency specific

Define the agency mission and goals Identify the functions that are needed to accomplish the mission Identify the tasks to accomplish those functions Identify the resources needed to support those tasks

Essential Function Prioritization

Essential Function Prioritization ranking Critical- function cannot be delayed Important- function can be delayed but should be resumed as soon as possible Non-essential- function can be delayed until normal business operations resume

Public Health Essential Functions

Communicable Disease Containment Immunization Women, Infants, and Children (WIC) and Commodity Supplemental Food Program (CSFP) Family Planning Maternal and Child Health (MCH) Child Care Licensing and Registration Vital Statistics Food Protection Bioterrorism and Public Health Response Human Resources Fiscal Management Public Information Officer (PIO) Public Education Home Health/Hospice/In-Home Care Program Information System Support Environmental Health

Hospital Essential Functions

Patient Care including triage and treatment for inpatient and outpatient recipients Patient movement to care centers with appropriate levels of care for patients Postmortem care and disposition with appropriate community partners Patient tracking including medical screenings Long term care of elderly and other fragile populations Lab capabilities consistent with facility need Medical billing for procedures performed Patient decontamination and stabilization Facility and personnel security for patients and employees Meeting standards of care as required by State regulation or accrediting organization

Courtesy of Doug Williams, St. Catherine Hospital, Garden City, Ks

Courtesy of Doug Williams, St. Catherine Hospital, Garden City, Ks

Execution

Train successors and delegates identified for essential functions Update contact information for all staff

24/7 facilities

must include a plan for:  Staffing  Medication and food supply  Medical assessment  Infection control  Communications

Execution

Provide devolution of essential functions for operation Identify:  Critical systems  Capabilities to perform essential functions due to staff depletion  Logistical support    Services and infrastructure alternatives Communications Related computer/software issues

Order of Succession vs Delegation of Authority

Order of Succession-list of individuals who would sequentially assume responsibility if the primary staff person is no longer able to carry out their functions Delegation of Authority-positions in which the primary staff person has the authority to complete a particular task

Order of Succession

Order of succession should be established for the highest positions of authority.

i.e. Public Health Director, Hospital Administrator, Director of EMS Line of succession should be established for the other leadership positions.

i.e. Infection Control Nurse, ER Head, Limitations on delegate authority should be listed

Order of Succession

Rosters of trained/qualified personnel with the authority to perform essential functions and activities are maintained Rules and procedures for implementing order of succession should be established initiating conditions notification methods terminating conditions

Order of succession for essential functions

Three deep

Should include  Name and title  Point of contact information for 24/7 Same successor may be named for different positions but avoid listing the same person as the first successor to several key positions

Courtesy of Doug Williams, St. Catherine Hospital, Garden City, Ks

Delegation of Authority

D

elegation of Authority

for each essential function should include: Name and title of delegate Position title and/or source of authority being delegated Point of contact information (phone, cell, pager, email…) Limitations (if any) or exceptions to the authority being delegated Date or event that triggers delegation (Activation of COOP plan) Date of termination or revocation (i.e. 30 day) Name, title and signature of the official empowered to delegate the authority specified

Delegation of Authority to sign for Schedule Drugs

POWER OF ATTORNEY FOR DEA ORDER FORMS

I, Howard Rodenberg, being authorized to sign the current application for registration under the Controlled Substances Act or the Controlled Substances Import and Export Act, by these presents, do make, constitute, and appoint Michael McNulty and/or Barry Autrey, acting jointly or severally, as my true and lawful attorney in fact to act for and in my name only in such manner as I could act as a registrant under the Controlled Substances Act or the Controlled Substances Import and Export Act, with respect to receiving and transferring the Strategic National Stockpile. In this connection, my attorney in fact is specifically authorized to execute applications for books of official order forms and to sign such order forms in requisition for Scheduled II and IV controlled substances, in accordance with Section 308 of the Controlled Substances Act (21 U.S.C. 828) and part 1305 of Title 21 of the Code of Federal Regulations. I hereby ratify and confirm all that said attorney shall lawfully do or cause to be done by virtue hereof until notice of revocation in writing. Dated this _____ day of _______________, 2006. ________________________________________ Howard Rodenberg, M.D. Director of Health and Registrant pursuant to the Controlled Substances Act or the Controlled Substances Import and Export Act State of Kansas ) County of Shawnee )ss ) This instrument was acknowledged before me on the ______ day of _____________, 2006 by Howard Rodenberg, M.D., of the Kansas Department of Health and Environment, in his capacity as Director of Health and Registrant pursuant to the Controlled Substances Act or the Controlled Substances Import and Export Act. My appointment expires: ____________________________ Notary Public ____________________________

Command and Control

All response agencies are required to use Incident Command System (ICS) and follow National Incident Management System (NIMS) requirements (Hospitals use HICS)

Command staff

provides overall coordination of the response and is the central communications point

Operations Section

including triage and treatment and directs all patient care resources responsible for clinical duties

Logistics Section

responsible for providing facilities, services (food, billeting, communications) and materials

Planning Section

human resources determines and provides for the achievement of each medical objective and manages

Finance/Administrative Section

responsible for maintaining accounting records, issuing purchase orders, and stressing facility wide documentation

Command and Control

Form an Operations Team (OT) for your COOP Responsible for relocation activities Ensure all necessary and pre-planned communications systems are established and functioning properly Serve as the first shift operations at the alternate site Provide cross training to personnel Utilize Job Action Sheets (JAS) and Just in Time (JIT) training Employ call-down roster Advise staff where to report What to bring

Alternate Facilities

Alternate facilities may be needed in the event that the health care facility is damaged, destroyed or overwhelmed In hospital terms: Alternate Care Site (ACS) Site for hospital administration Site for hospital patient care functions Define ACS Location for the delivery of medical care that occurs outside the acute hospital setting for patients who, under normal circumstances, would be treated as inpatients. Site may provide delivery of chronic care, the distribution of vaccines or medical countermeasures, or the quarantine, cohorting, or sequestration of potentially infected patients in the context of an easily transmissible infections disease In Health Department terms this could be a POD Mass Medical Care with Scarce Resources: A Community Planning Guide, Health Systems Research Inc.

Alternate Facilities

Consider: level and scope of care to be delivered foot print or size needed staffing requirements equipment and supplies ICS structure needed to integrate this facility with other health facilities in the event Security Staffing Communications EMS and other transportation issues rules/policies for operation FMS, EMEDS, NDMS, Field Hospitals

Alternate Facilities

Plan should identify: Logistical considerations (utility services, food, water, etc.) Pre-positioning of resources Hot site- pre-wired Cold site- needs installation Provisions for establishing interoperable communications with all identified essential internal and external organizations, critical customers and the public Provisions to sustain operations for a period of up to 30 days 24/7 Operations Considerations for the health and safety of relocated employees Physical security and access controls Co-location and duel use Formal agreements (MOU, MOA)

Alternate Facilities

Lessons Learned from Katrina: Consider pre-planning and relationship building among agencies Use of ICS Public health (shower, toilets, amenities, hygiene) Security Transportation (EMS, self transported) Supplies (medical, pharmaceutical, food, water) Credentialing Staffing Patient tracking and documentation Communication Patient screening Pediatrics, geriatrics and psychiatric patients Accessibility to the public Special populations

Alternate Facilities

How to determine appropriate facilities Alternate Care Site Selection Tool Based on the Rocky Mountain Regional Care Model for BT Events Kansafied Do a Hazard Vulnerability Analysis Determine population to be cared for at the designated site Train and Exercise

Alternate Facilities

Challenges: lack of regional/state planning with clear delineation of responsibility and authority requirement that multiple entities work together who normally don’t lack of inducements to write a plan train and exercise licensing issues intra and interstate funding Standards of care- whole different presentation

Interoperable Communications

Hardware/software that talks to each other and people that can communicate with each other in the same language (no codes) Systems that need to work together include radios, phones, faxes, email, notification systems, IT systems, software, secure data systems People that need to work together include Hospital, Health Department, EMS, Fire, Law Enforcement, Emergency Management, Social Services… Procedures and plans need to be written to specify how communication will work during COOP activation Maintain the capability to communicate with internal and external clients, critical customers and the public.

Information Technology

Information Technology (IT) needs should be

a component of each essential function Consider during planning: The essential function’s dependence on IT Managing the IT infrastructure during COOP activation Help desk tasks to support IT needs for identified essential functions Ability to provide remote access to programs

Information Systems Support

Each essential service area must define their unique or critical information system requirements Each essential service area must define their equipment needs and availability of this equipment Where is it stored How do we move it Where do we get it if we do not have it IT contingency plans Designate responsible individuals/departments within the organization for moving and reestablishing IT If relocation to an alternate facility is necessary, these services could be allocated to support organizations

Vital Records

Vital Records Include: Emergency operating plans Policy and Procedural records Legal documents Financial records Personnel files Patient records Property management (inventory)

Vital Records

Provisions for classified or sensitive data Procedures for data backup and restoration Identify location and accessibility to vital records How often are your vital records on computer backed-up? Do you have back-up records for all of the paper based records at your facility? Where are your back-up files kept? On site or off?

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Public Information

Your most important tool will be Public Information! Have trained back up PIO and spokes persons Plan for working out of a different location (i.e. JIC) Have a go-kit Maintain contact lists for media Develop alternate methods of dissemination Develop templates during pre-planning to avoid creating during an emergency Message maps Press releases Information sheets How to find alternate sites Navigation of alternate sites (Signs)

Human Resources- HR Policies

Plan for a reduction in work force Identify emergency policies for: Overtime Leave with pay Leave without pay Flexible leave options Vacation time Sick time Identify plans for employees to work from home Tele-work Potential health and safety issues Liability assessment by general counsel Union issues (overtime issues,disaster support, etc) Training on contingency planning Employee Assistance Program (EAP) for mental health and health insurance provisions

Human Resources Employee Support

Essential Staff functioning during a COOP activation may have different support needs Plans should include consideration for staff: Transportation Food and Lodging Child care Elder care Pet care Consider developing a Family Preparedness Program Encourage personal go-kits

Safety and Security Concerns

Emergency Planning Committee  County Emergency Response Plan (Emergency Support Function 8).

 Hospital EOPs Ensure all necessary security and access controls are provided Ensure that local law enforcement authorities are notified concerning the status of the emergency.

Logistics

Food and water Fuel Billeting Medical Transportation Health, Safety, Personal

Implementation Phases

Phase I- Activation and Relocation  0-12 Hours  Notify facilities, organizational elements and personnel of impending COOP activation  Activate plans to transfer to alternate facility, when necessary.

 Instruct Ops team to ready facility/alternate facility.

 Assemble documents/equipment required for essential functions at facility/alternate facility.

  Secure facilities.

Continue essential functions at regular facility, if available, until alternate facility is ready if needed

Implementation

Phase II- Alternate Facility/Work Site Operations

 12 Hours to Termination of Emergency  Provide guidance to preparedness team personnel and information to the public.

 Identify and brief replacements for missing or rotating personnel  Commence full execution of operations supporting essential functions.

Phase III- Reconstitution

 Termination of Emergency  Inform all personnel that the threat no longer exists.

 Supervise return to normal operating facility or normal business practices at original facility.

 Conduct an after action review of COOP plan execution and effectiveness.

 Develop a Corrective Action Plan

Training and Exercising

Plans include annual individual and team training of agency COOP/COG emergency personnel.

Plans include annual agency testing and exercising of COOP/COG plans and procedures.

Plans include quarterly testing of emergency alert and notification procedures.

Plans include refresher orientation for COOP/COG staff. Plans include inter-agency exercising of COOP/COG plans where applicable and feasible.

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References:

CIDRAP- 10-Point Framework for Pandemic Influenza Business Contingency Planning Massachusetts Department of Public Health- COOP for Massachusetts Government Agencies Commonwealth of Pennsylvania- COOP Template 2005 Florida Department of Health/Okeechobee County Health Department- COOP Rocky Mountain Regional Care Model for Bioterroist Events Alternate Care Site Selection Tool KDHE- Alternate Care Site Selection Tool KDHE- HVA Tool and Gap Analysis KDHE- Business Impact Analysis Template

Contact Information

Stacy Robarge-Silkiner SNS Coordinator Kansas Department of Health and Environment [email protected]

Greg Morgan Contingency Planner Kansas Depatment of Health and Environment [email protected]

Questions????