Transcript Sanford Health Incident Management Team Project

Creative NIMS Compliance
Building incident management teams to support
long term operations
Greg Santa Maria
Emergency Preparedness Manager
Sanford Health System
Sioux Falls, SD
The Sanford Health System
• 24 hospitals
– Mostly critical access
• 105 clinics
• 4 states
• RURAL SERVICE AREAS
How it all began
• Medical Center main campus update - 2004
– HEICS Updates
– Tabletops
– Decon Training
• Random network hospital requests
– Emerging patterns
What the heck is a Critical Access Hospital?
Starting out – the initial projects
• HEICS training
• Simple scenarios
• Realistic events
– Webster
• Elevated awareness of local hazards
– Large gatherings
– HAZMATS
The burning questions
How does a critical access hospital with a limited
number of employees and resources respond to a
large incident in their community?
How do they maintain operations over multiple
operational periods?
How does this also apply to rural fire and EMS?
First Things First
Effective ICS Training
• Internet vs classroom
– Who is monitoring comprehension?
• Advanced ICS
• What about practical applications?
– If you needed surgery and your doctor was
licensed through an online course, would you put
your life in his hands?
– Why Incident Command?
Walking the Talk
• ICS
• NIMS
– Five year NIMS training plan
• Exercises
• Planning
A team is born
• Wouldn’t it be cool if………
Just like wildland fire fighting , we could develop seasoned
and confident incident managers and use them to create
incident management teams for our Health System
and then beyond…….
Sanford Health
Incident Management Team Project
Nice Vest!!!
• Hospital use of ICS is limited
– ICS is still “new” to hospitals
– Still HCC Confusion on roles
– Standards are staggered
• Few have taken ICS 300 / 400
Job Description
Planning Section
Chief
Sanford Health
Incident Management Team Project
• Disasters cost money
– Why?
• Long term operations stress staff
– Lack of replacement staff
– Other issues
• What about incident commanders
– Who replaces them?
• Decon teams?
Disaster
Business
Now is the time
• Nationwide Emergency Management Expectations
• The Joint Commission EM Standards
• Hospital Ops may last longer than scene Ops
Sanford Health
Incident Management Team Project
• Scenario 1 – Pre - IMT
– Disaster in Winner, SD
• Isolated location
• Finite staff
• Multi period event will stress local resources
• System plan activation
– Takes IC focus from local to system communication
– May delay local decision making and IAP
Sanford Health
Incident Management Team Project
• Scenario 2 - HIMT
– Disaster in Winner
• Disaster response begins
• Multi period disaster identified
• Local SH facilities deploy HIMT support staff
• On Call Team leader notified
• Initial Situation Assessment completed
• If applicable, system plan activated
– Team members act as liaisons to local as well as
system resources
• Communications link with Local EM established
Activation
• Pulling the Trigger
• What barriers to activation exist?
– Personal
– Administrative
• Policy
– Other
– “The Orwell Syndrome”
Sanford Health
Emergency Preparedness
Hospital Situation Assessment Form
Yes
No
Does this incident have a direct impact on your facility?
-
Water loss
Power loss
Communications loss
Direct storm damage
Other incident inside or on facility campus
Will this incident last longer than 2 hours
-
any incident that will use your resources for more than two hours is reportable
Do you anticipate the need for additional staff?
-
Clinical Staff
Support Staff (environmental, maintenance, security)
Decon Personnel
Does this incident require other resources not on campus?
-
-
Pharmaceuticals
Decon suits and PAPRS or additional showers
Generators
Other equipment
Is this incident outside of a “normal” patient presentation?
-
Large fire or chemical spill in the community
Major vehicle accident reports 2 or more patients
Weather related impact (tornado touchdown with damage, etc)
Meth lab incident
Patient with unexplained rash or unusual symptoms
Flu like symptoms outside of flu season
Does this incident require patient decontamination?
-
Any incident that requires even ONE patient decontamination
includes walk ins to clinic
Includes reports of patient decontamination in the field
Has your facility been contaminated?
-
Walk in with contaminates on their person
Unusual chemical odors on a patient
Patient reports exposure to a substance
Does this incident require a facility lockdown?
-
Decontamination occurring in the field
Violent incident in the community (school shooting, hostage situation, etc)
Threat to staff or patient
Heightened local or national security notification
Is there a major utility failure in the community?
-
Power outage
Water loss
Communications failure
Have you activated a code situation?
-
Code man
Code exit
Code red
Code search and report (bomb threat)
Does this incident involve the media?
-
Any incident that will require a press release
Any incident that involves the media response to the facility
IF YOU ANSWERED YES TO ANY OF THE QUESTIONS ABOVE, ACTIVATE YOUR
ADMINISTRATIVE CALL TREE AND A SYSTEM INCIDENT MANAGEMENT TEAM
LEADER (SEE PHONE LIST ON BACK), THEN BEGIN IMPLEMENTATION OF THE
INCIDENT COMMAND SYSTEM.
Activation
Category 1
Levels of Activation
System Wide Emergency
National Incident
Any Incident that could potentially tax the resources of the entire
health system. A National Disaster or National Security Activation
is in effect.
Example (Pandemic, power grid disruption, major catastrophe)
Category 2
Medical Center Campus Activation
Any Incident that will generate the arrival of fifteen (15) or more
patients to the Hospital campus
Example (Mass Casualty incident)
Category 3
Medical Center Campus Activation
Any Incident, regardless of patient count, that will generate patient
arrivals requiring decontamination at the Hospital campus
Example (HAZMAT Incident)
Category 4
Medical Center Campus SILENT Activation
Any incident or impending incident with a high impact potential
that could directly affect operations at the Hospital Campus. This
silent activation would bring executive leadership and directors to
the command center for incident action planning, but would not
interrupt business continuity
Example (recent Gas Leak, airport incidents, other potential or
unconfirmed citywide events)
Category 5
Area Command Activation
Any Incident or series of incidents that would require the system
command center to provide resource and administrative support to
affected facilities within the health system
Example (tornados, local outbreaks, ice storms)
Sanford Health
Incident Management Team Project
Project Description
• Develop a system wide team of responders
– Deployable to any system location
– Trained to assess a disaster situation and coach a
• Command center – EOC manager
• Decon team
– On call and on site team leaders that initiate the
system response
– Trained to coordinate efforts with local emergency
managers
Sanford Health
Incident Management Team Project
• The concept
– On location support
• Increases morale
• Reduces business losses
• Increases response effectiveness over multiple
operational periods
• Does NOT relieve local commander of
responsibility
– Manager role (not commander)
Sanford Health
Incident Management Team Project
• The concept
– Liaison between system and affected facility
• Enhances communication
• Creates ease of resource management
• Removes the “distant” responsibilities so IC can
focus on local event
• Allows local staff to maintain continuity of
operations
Sanford Health
Incident Management Team Project
• The concept
– Liaison between affected facility and local EM
• Establishes “trained” liaison
• Ensures appropriate use of local resource
• Reduces potential for duplication of services
• Knows who to call and when / where to call
them
Sanford Health
Incident Management Team Project
• The concept
– Bring needed support staff to affected facility
• Decon
• EOC “coach”
• Incident managers
Sanford Health
Incident Management Team Project
• Incidents start locally
– This is not only about “the big one”
– Webster SD – Lake Area Hospital – HAZMAT
– Can be used for
• Ice Storms
• Blizzards
• Tornado
• Any incident that will result in multiple
operational periods (8+ hours)
Sanford Health Incident Management
Team Project
• Current outreach programs
–
–
–
–
–
Preparedness evaluation
ICS / NIMS classroom training
Tabletops and functional exercises
Decon training (OSHA 1910.120)
Advanced ICS offerings
Sanford Health Incident Management
Team Project
• Coordination of multi agency exercises
• Winner
• Chamberlain
Basic Steps
•
•
•
•
•
•
•
ICS Training
Simple tabletop
Decon training
Multi agency training
Multi agency exercise
Multi facility exercises
Increasing complexities
Sanford Health
Incident Management Team Project
• Sanford HIMT Training
• Four levels
–
–
–
–
HAZMAT operations technician
HAZMAT group supervisor
Hospital incident manager
Hospital incident management specialist
Level 1
Level
Level 1
Hazmat Operations Technician
Courses
Hours
OSHA 1910.120 Decon Class
ICS-100
ICS-200
IS-700
16
4 – Online option
4 – Online Option
2 – Online Option
Total Level Hours
26
Total Team Hours
26
Level 2
Level
Level 2
Decon Group Supervisor
Courses
Hours
All Level one courses
26
Decon Group Supervisor Course
DOJ –ERT-BC
CBRNE Awareness
6
16
4
Total Level Hours
26
Total Team Hours
52
Level 3
Level
Level 3
Incident Management Technician
Courses
Hours
All Level one and two courses
FEMA PDS
Emergency Management Program
Strategic Application of ICS Principles
ICS-300
52
Online - Approximately 24 hours
8
8
16
Total Level Hours
56
Total Team Hours
108
Level 4
Level
Courses
Level 4
Incident Management Specialist*
Requires Internship
Hours
All level one, two and three courses
Health system emergency response and
recovery
EM instruction, system evaluation and
organizational learning
ICS-400
108
8
8
16
Internship
32
Total Level Hours
64
Total Team Hours
172
http://www1.va.gov/emshg/page.cfm?pg=122
Training
• Can be modular
• Can be an immersion program
• Requires an internship at the highest level
• Is in development stages and requirements may
increase or content may change
Sanford Health
Incident Management Team Project
• Team Leaders
–
–
–
–
–
Become trainers
Train their facility and other “local” regional facilities
Develop HVA and preparedness assessments
Initiate, script and facilitate local and multi-agency drills
Are our disaster planning liaisons to
• Responder agencies
• Health systems
• Emergency management resources
Sanford Health
Incident Management Team Project
• Levels of Activation (not defined)
– Level 1
• 2 Managers and 1 Specialist
– Level 2
• 2 Managers and 1 Specialist with system EP
plan activation and main campus liaison
– Level 3
• Management team with decon support
– Level 4
• Management team with area command
activation
What will we accomplish
• System wide consistent response
– Incident command
– Decontamination
– HVA – Drill development
• NIMS Compliance
• The Joint Commission emergency management focus
• Enhanced Business Continuity
Reduction of operational losses due to large events
The good news…..a “value added” service
• Team members exist in most locations
– Safety officers
– BT coordinators
– Volunteer Fire Chiefs and Officers
– Emergency Managers
– EMS Supervisors
Identifying Team Members
• At least one from each facility required
– This is stated as “expected participation”
– At least one level 3 at each location
– Up to four active participants per facility
• This will be an active participation project
– Nobody just “says” they are participating
Utilization in Exercises
• Area command concept
• Encourages communication between
– Affected facilities
– System command center
– Local emergency management
Area Command Concept
Area Command
Planning
Logistics
Finance
Webster
Clear Lake
Planning
Luverne
Sioux Falls
PIO
Liaison
Safety
Expert
Operations
Logistics
Canton
Finance
Command Center Tool
• eSponder
– ICS
– Resource Tool
– Communication Tool
Preparedness is not just meeting a
“standard”
• Its IS
–
–
–
–
Achieving comfort levels
Gaining knowledge and experience
Denying complacency a place to grow
Motivating the not so interested
– IT WILL NEVER HAPPEN HERE
What's Next?
• Expansion outside of health system
–
–
–
–
Stand alone facilities
Other health systems
Region
State
– WHO ELSE?
The future
• Assists implementation of Regional Plans
• Cross border / Jurisdictional response
• The “next” big exercises
– Worthington, MN
– Rock Rapids, IA
Who else can benefit?
•
•
•
•
Volunteer FD
Large Municipal FD - FDNY is doing it as well
EMS
Emergency Management
– SD doing it!!!
The Incident Management Team
•
•
•
•
Achieves numerous elements
Supports long term operations
Provides EOC Support
Provides TRAINED support personnel
Thanks to the team
Training Resources
Department of Veterans Affairs
Emergency Management (EM) Principles and Practices for Healthcare Systems
http://www1.va.gov/emshg/page.cfm?pg=122
FEMA EMI
ICS 100
ICS 200
IS 700
Professional Development Series
http://training.fema.gov/IS/crslist.asp
California Hospital Association
http://www.calhealth.org/public/edu/nims.html
AHRQ – EPRI
http://www.ahrq.gov/research/epri/
Questions???