DEVELOPING AN EFFECTIVE AND COMPLIANT EMERGENCY ...€¦ · (IC) position is the only position that...
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6/8/2017 1 DEVELOPING AN EFFECTIVE AND COMPLIANT EMERGENCY PREPAREDNESS PROGRAM FOR LONG TERM CARE SESSION #2 AGENDA: THE FOUNDATION Plan Activation & Incident Command Communications Plans Full Building Evacuation Plans Surge / Influx Plans “THIS IS WHY → THIS IS HOW”
Transcript of DEVELOPING AN EFFECTIVE AND COMPLIANT EMERGENCY ...€¦ · (IC) position is the only position that...
6/8/2017
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DEVELOPING AN EFFECTIVE AND COMPLIANT EMERGENCY PREPAREDNESS PROGRAM
FOR LONG TERM CARESESSION #2
AGENDA: THE FOUNDATION
Plan Activation & Incident Command
Communications Plans
Full Building Evacuation Plans
Surge / Influx Plans
“THIS IS WHY → THIS IS HOW”
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Emergency Operations Plan (EOP)
The LTC facility must develop and maintain an Emergency Preparedness Plan that must be reviewed and updated at least annually.
Based on your Risk Assessment (HVA)
Addresses resident population, services provided and continuity of operations
Collaboration with local, state, and federal partners
EMERGENCY OPERATIONS PLAN
Why an EOP
Required!
Documents and Guides Planning Efforts
Provides ACTION PLANS / GUIDES to use during a disaster
Provides a FOUNDATION for decision-making at the time of a disaster
Reference Manual
EMERGENCY OPERATIONS PLAN
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How to Document an EOP
LTC Facility Leaders, including the Medical Director, participate in planning activities to develop an EOP
Use the HVA and collaborate with community partners
Document “the LTC Facility’s efforts to contact such officials and, when applicable, its participation in collaborative and cooperative planning efforts”
Ensure the Incident Command System is integrated into and consistent with the community's
EMERGENCY OPERATIONS PLAN
READY TO WORK TOGETHER WITH
RESPONSE PARTNERS
EMERGENCY OPERATIONS PLAN
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BUT WE ARE…
THEIR FIRST RESPONDERS, TOO
EMERGENCY OPERATIONS PLAN
SAMPLE TABLE OF CONTENTS
EPP MANAGEMENT PLAN: Policies and Planning
PROCEDURES APPLICABLE TO ALL HAZARD
RESPONSES
EM
ER
GE
NC
Y O
PE
RA
TIO
NS
PL
AN
INCIDENT COMMAND SYSTEM
FULL BUILDING EVACUATION PLAN
EMERGENCY PROCEDURES FOR SPECIFIC EVENTS
EMERGENCY LISTS
C.O.O.P. & RECOVERY PLAN
APPENDICES
EMERGENCY OPERATIONS PLAN
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EMERGENCY OPERATIONS PLAN
Plan Activation
How is the Plan activated?
Who is authorized to “activate” the plan?
Who is to be notified (internal & external)?
Immediate Action Plans: Code Word vs. Plain Language Fire – “Code Red”
Missing Resident
Person with a Weapon / Active Shooter
How is staff on & off duty notified?Overhead page? Radios?
Mass notification systems?
Phone trees?
PLAN ACTIVATION
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One Facility’s “Hybrid Approach”
The following are emergency coded announcements:Emergency Operations Plan Activated: “Code D”
Bomb Threat: “Code Black”
Hostage: “Code Silver”
Missing Resident: “Code Green”
The following “plain language” announcements:Active Shooter / Person with Weapon: Announce “Active shooter or person with weapon” and the location
Building Lockdown: Announce the need to lockdown the building for an external threat
PLAN ACTIVATION
Survey Procedures Interview leadership and ask them to describe the following:
The facility’s patient populations that would be at risk during an emergency event.
Strategies the facility has put in place to address the needs of at-risk or vulnerable patient populations.
Services the facility would be able to provide during an emergency.
How the facility plans to continue operations during an emergency.
Delegations of authority and succession plans.
Verify that all of the above are included in the written
emergency plan.
EMERGENCY OPERATIONS PLANS
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Incident Command System
Organize the Chaos!!
All images © from their source
INCIDENT COMMAND
Incident Command System
INCIDENT COMMAND
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National Incident Management System (NIMS) and the Incident Command System (ICS)
One of the most important 'best practices' that has been incorporated into the NIMS
is the Incident Command System (ICS), a standardized, on-scene, all-hazards incident management system already in use by firefighters, hazardous materials
teams, rescuers and emergency medical teams.
The ICS has been established by the NIMS as the standardized incident organizational structure for the management of all incidents.
www.fema.gov/txt/nims/nims_ics_position_paper.txt
INCIDENT COMMAND
Incident Command System
National Incident Management System (NIMS) compatible
Customized to your facility (size, functions, and levels of care and staffing)
Activate positions that are needed to manage the incident
Ensure you assign, plan, and train for positions “3 Deep” to ensure continuity
INCIDENT COMMAND
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Incident Command System
Key Concept
The Incident Commander (IC) position is the only position that is ALWAYSactivated, and the authority and responsibility for the incident management belongs to them.
INCIDENT COMMAND
Incident Command System
Key Concept
When a function is needed and the position is not activated, the duties are fulfilled by the next highest activated position or as assigned by the IC.
INCIDENT COMMAND
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Incident Command System
Key Concept
UNIFIED COMMANDFire Service / Police statutorily are responsible, BUT the facility needs and objectives need to be represented by the Facility Incident Command System
INCIDENT COMMAND
Incident Command SystemKey Concepts
INCIDENT COMMAND
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Why a Nursing Home
Incident Command System?
Events can drag on!
Events can go sideways!
Provides continuity of care during an emergency
Provides for delegation of authority and succession plans
Provides a process for communication, cooperation, and collaboration of local, state, or federal emergency preparedness officials during an event –COMMUNICATIONS PLAN
INCIDENT COMMAND
INCIDENT COMMAND
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Incident Command SystemKey Concepts
The Leader
The Helpers
The Thinkers
The Getters
The Payers
The Doers
INCIDENT COMMAND
Incident Command SystemCustomize to your own Facility:
INCIDENT COMMAND
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Incident Command SystemOperationalize the Plan
Assign Positons 2-3 Deep (at least top tier)
Customize Job Descriptions (Job Action Sheets)
Provide Checklists for Positions
Develop Tool kits (Identification, Clip Boards, Signs, Forms, etc.)
INCIDENT COMMAND
Facility Command Center Operations
Location:Accessible, Emergency Power, Enough Room
Set-up ProceduresSetting it up for Operations
CommunicationsInternal and External
Redundant Communications
INCIDENT COMMAND
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Communication Plans
The LTC Facility must develop and maintain an emergency preparedness communications plan that must be reviewed and updated at least annually.
Names and contact info for:Staff, providers, residents physicians, hospitals, volunteers
Federal, state, tribal, regional, and local Emergency Management agencies, State Licensing Agency, Ombudsman
Primary and alternate means for communication internally and externally
Communicating with staff, residents, & families
COMMUNICATIONS PLANS
Communication PlansMethod for communication with the local Incident Command Center (AHJ) or designee – COMMAND CENTER PLAN
Method for sharing medical information in the event of an evacuation or special circumstances (1135b waivers, PHI, etc.) to maintain the continuity of care – FULL BUILDING EVACUATION PLAN
Method for sharing information from the emergency plan with residents and their families/representative that the facility has determined as appropriate.
Could include in family orientation and/or a newsletter
No frequency requirement by CMS – TRAINING PLAN
COMMUNICATIONS PLANS
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Communication Plans
Managing Resources & Assets During an Event:How do you get Status Report from all areas of your organization?
Who is responsible for ensuring critical supplies during an event (Hint: usually assigned as part of the Incident Command positions)?
Where are the strategies to remain operational (contingency plans)?
What is the status of consumable resources (48 hours of food supplies being used, what is left)?
MORE ON RESOURCE & ASSET PLANNING LATER!!!
COMMUNICATIONS PLANS
Status Reports
A process to collect information from all nursing units and support departments:
Census and resident status
Staffing and who is available
Operations and what is being impacted
Resources & Assets and what is available / what is needed
Process and method will be determined by the size and organization:
Verbally
Phone Calls
Forms
Technology
COMMUNICATIONS PLANS
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Status Reports
COMMUNICATIONS PLANS
Unit/Area Level
Other Corporate Facilities Other Corporate Facilities
Status Reports
COMMUNICATIONS PLANS
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Why a Full Building Evacuation Plan
Evacuation from a Healthcare Facility is the EXCEPTION, Not the Rule
FULL BUILDING EVACUATION PLAN
Full Building Evacuation Plan
Establish Incident Command System with roles and responsibilities to manage the event
Labor Pool & Evacuation Groups
Prepare residents on the Clinical Units
Move to an internal Holding/Staging Area
Transport from Holding/Staging Area to a Stop Over Point, receiving facilities, or discharge to home
Communication Plan: addresses communication with residents, families, providers, etc. and sharing medical information (electronic or paper-based)
FULL BUILDING EVACUATION PLAN
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FULL BUILDING EVACUATION PLAN
Conducting a systematic and organized approach to “safely” evacuate residents to other healthcare facilities during a non-urgent evacuation:
Will take hours to complete the evacuation
Challenge: Elevators are not functional or unable to be used
FULL BUILDING EVACUATION PLAN
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FULL BUILDING EVACUATION PLAN
Stretchers
Wheelchairs
Geri Chair
FULL BUILDING EVACUATION PLAN
Evacuation Chairs & Sleds
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Pre-Established Evacuation Sites
Primary sites should be pre-selected, written agreementsResident Categories of Care
Address highest acuity residents first
Address surge numbers next; assume they have no open beds
110% surge
Process to communicateWhere they are, point person, and contact information
Need to identify one facility at least fifty miles away as an evacuation site
FULL BUILDING EVACUATION PLAN
Stop-Over Points
Nearby facilities that can be converted to provide temporary resident care
Examples: School Gyms, Senior Centers, Churches, etc.
Develop a MOU to ensure availability
FULL BUILDING EVACUATION PLAN
Pre-plan: supplies & equipment needs, vehicles to move equipment, etc.
Used for temporary relocation or “quick out” scenarios
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Transportation Needs for Evacuation
Pre-Planning: The “Transportation Survey”
Communicate resource needs to Public Health, Fire, EMS, & Emergency Management
Identifies ambulances, wheelchair vehicles, shuttle vans, and buses
Consider completing with monthly fire drills
Saves you $$$…
FULL BUILDING EVACUATION PLAN
FULL BUILDING EVACUATION PLAN
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Sharing Medical Records
FULL BUILDING EVACUATION PLAN
(4) A method for sharing information and
medical documentation for residents under the
LTC facility’s care, as necessary, with other
health care providers to maintain the continuity
of care.
(5) A means, in the event of an evacuation, to
release resident information as permitted
under 45 CFR 164.510(b)(1)(ii).
(6) A means of providing information about the
general condition and location of residents
under the facility’s care as permitted under 45
CFR 164.510(b)(4).
Also Consider…
Tracking of residents and on-duty staff, and document receiving facility or other location
Include considerations if some residents or staff stay behind to “shelter-in-place”
Sharing medical records and releasing resident information in the event of evacuation to receiving facilities or to family members
Method for sharing medical information in the event of an evacuation or special circumstances (1135b waivers, PHI, etc.) to maintain the continuity of care –COMMUNICATIONS PLAN
FULL BUILDING EVACUATION PLAN
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SURGE / INFLUX PLAN
Internal Surge
Horizontal – Fire, Infrastructure Damage Secondary Purpose: Staff Sleeping
External Surge
Long Term Care Evacuations Secondary Purpose: Community Events (e.g.,
sheltering request – not applicable in many areas)
SURGE / INFLUX PLAN
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SURGE / INFLUX PLAN
Vacant licensed beds
Transform non-sleeping areas into temporary shelter areas
Areas served with emergency power for residents with critical electric medical equipment
Expand resident room capacity
OPTIONS FOR INCREASING CAPACITY
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Surge Areas: Pre-set areas to surge above licensed beds or “shelter” residents
Activity Rooms
Lounges
Auditoriums
Meeting Rooms
Resident Rooms (ability to expand)
Dining Rooms (outside of main dining area)
Rehab / Therapy Rooms (lower on list!!!)
Pre-set area layout
See floor plan (next page)
SURGE / INFLUX PLAN
Rule of thumb:13’ room depth – expand to 2nd bed• Factor: Bathroom door and how it affects the room
19’ room depth – expand to 3rd bed
SURGE / INFLUX PLAN
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SURGE / INFLUX PLAN: SAMPLE PLANNING TOOLS
SURGE / INFLUX PLAN: SAMPLE PLANNING TOOLS
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SURGE / INFLUX PLAN: SAMPLE PLANNING TOOLS
SURGE / INFLUX PLAN: SAMPLE PLANNING TOOLS
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SURGE / INFLUX PLAN: SAMPLE PLANNING TOOLS
SURGE / INFLUX PLAN: SAMPLE PLANNING TOOLS
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CMS FINAL RULE ASSESSMENT
HELPING YOU: CONDUCT ASSESSMENT OF YOUR CURRENT PROGRAM
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HELPING YOU: CONDUCT ASSESSMENT OF YOUR CURRENT PROGRAM
QUESTIONS
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AGENDA: EMERGENCY OPERATIONS PLANS
Procedures Applicable to All Hazard Responses
Emergency Procedures for Specific Events
Continuity Of Operations And Recovery Plan
NEXT SESSION
THANK YOU
Andy McGuireFire & Emergency
Management Consultant
Nick GabrieleVice President
