Legal Issues in Hospital Preparations for Disaster Response – “Operational Considerations”...
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Transcript of Legal Issues in Hospital Preparations for Disaster Response – “Operational Considerations”...
Legal Issues in Hospital Preparations for Disaster Response –“Operational Considerations”
Knox Andress, RN, FAENDesignated Regional CoordinatorLouisiana Region 7 HospitalsEmergency Preparedness CoordinatorCHRISTUS Schumpert Health SystemShreveport, Louisiana
3/6/2007National Emergency Management
Summit – New Orleans
Topics of Discussion Recognizing the potential issues Hospital standards origination The Emergency Management Plan
Command and management Emergency communications Credentialing
Surge capacity
3/6/2007National Emergency Management
Summit – New Orleans
Practical Hospital Applications
Operational goal – recognize and respond to the disaster or incident
Methods - Preparedness, Mitigation, Response and Recovery
3/6/2007National Emergency Management
Summit – New Orleans
Issues - Potential and Reality AHRQ project “Altered Standards of
Care” (August 2004) 40 experts/3 days 2 terrorism scenarios Medical and response resources
overwhelmed Resulted in – recognized extraordinary
measures for health care delivery and “altered” or degraded standards of care.
Hurricane Katrina and Rita (August – September 2005)
3/6/2007National Emergency Management
Summit – New Orleans
Louisiana Hospital Impact
Katrina – directly impacted 88 Critical and Non-Critical Care Facilities
Rita – directly impacted 53 Critical and Non-Critical Care Facilities
(includes Acute, Critical Access, Limited Services, and Specialty Hospitals)
3/6/2007National Emergency Management
Summit – New Orleans
Standards Origination
Standards – law and statues Federal – Health Insurance
Portability and Accountability Act (HIPAA)
Emergency Medical Treatment and Active Labor Act (EMTALA)
Regulatory standards – OSHA State licensing requirements
3/6/2007National Emergency Management
Summit – New Orleans
Standards origination (continued) Hospital industry standards –
The Joint Commissions for the Accreditation of Health Care Organizations (JCAHO)
Professional organization standards- National Fire Protection Association;
1600, Standard on Disaster/Emergency Management and Business Continuity Programs, 2004 ed.
National Incident Management System (NIMS) – Implementation for Hospitals and Health
Care Systems.
3/6/2007National Emergency Management
Summit – New Orleans
Issues may arise…..
During deviation from usual standards
When hospital operations are NOT “business as usual”
3/6/2007National Emergency Management
Summit – New Orleans
Meeting standards
Issues largely met by responsibly planning for and preparing for emergencies and disasters
Done by following and implementing appropriate guidance.
Consider JCAHO, NFPA and NIMS…
3/6/2007National Emergency Management
Summit – New Orleans
The Emergency Management Plan JCAHO E.C. 4.1 – The hospital
has an emergency management plan. Leadership including medical staff
participation Based on a Hazards Vulnerability
Analysis (HVA) Describes specific procedures for
preparedness, mitigation, response and recovery.
3/6/2007National Emergency Management
Summit – New Orleans
HVA exampleSEVERITY = (MAGNITUDE - MITIGATION)
EVENT
PROBABILITY HUMAN IMPACT
PROPERTY IMPACT
BUSINESS IMPACT
PREPARED-NESS
INTERNAL RESPONSE
EXTERNAL RESPONSE
RISK
Likelihood this will occur
Possibility of death or injury
Physical losses and damages
Interuption of services
PreplanningTime,
effectivness, resouces
Community/ Mutual Aid staff
and suppliesRelative threat*
SCORE
0 = N/A 1 = Low 2 = Moderate 3 = High
0 = N/A 1 = Low 2 = Moderate 3 = High
0 = N/A 1 = Low 2 = Moderate 3 = High
0 = N/A 1 = Low 2 = Moderate 3 = High
0 = N/A 1 = High
2 = Moderate 3 = Low or none
0 = N/A 1 = High
2 = Moderate 3 = Low or none
0 = N/A 1 = High
2 = Moderate 3 = Low or none
0 - 100%
Hurricane 0 2 3 2 1 2 1 0%
Tornado 2 2 3 2 2 2 2 48%
Severe Thunderstorm
3 2 3 2 1 2 1 61%
Snow Fall 1 2 2 1 3 3 3 26%
Blizzard 1 2 2 1 3 3 3 26%
Ice Storm 1 2 2 1 3 3 3 26%
Earthquake 2 3 3 3 2 2 2 56%
Tidal Wave 0 3 3 3 3 0 3 0%
Temperature Extremes
3 2 1 1 1 1 1 39%
Drought 2 1 1 1 1 1 1 22%
Flood, External 2 3 3 3 1 2 1 48%
Wild Fire 1 2 3 2 1 3 1 22%
Landslide 0 2 3 2 2 0 2 0%
Dam Inundation 1 3 3 3 2 3 2
Volcano 1 3 3 2 2 3 2 28%
Epidemic 2 3 1 3 2 1 2 44%
AVERAGE SCORE 1.38 2.31 2.44 2.00 1.88 1.94 1.88 32%
*Threat increases with percentage.
22 RISK = PROBABILITY * SEVERITY
199 0.32 0.46 0.69
3/6/2007National Emergency Management
Summit – New Orleans
The Hospital Emergency Management Plan (continued)
NFPA 1600, 4.1 – Establishes the need for a hospital
emergency management plan with goals, objectives, plans and procedures
NIMS, Implementation for Hospitals and Health Care Systems – requires NIMS be adopted into the
hospital emergency management plan
3/6/2007National Emergency Management
Summit – New Orleans
Command and Management - JCAHO, E.C. 4.10
Hospitals establish an “all hazards” command structure linking with the community’s (ICS via NIMS)
Provides for - Staff support, logistics, security, communication, staff family support, activities related to care
Planning with other hospitals in contiguous geographic areas including command structures and alternate roles and responsibilities.
3/6/2007National Emergency Management
Summit – New Orleans
Command and Management (continued) NFPA 1600, 5.8.2
Addresses the need for hospital emergency management plans with organizational roles, titles and responsibilities for those named in the plan
NIMS Implementation Activities for Hospitals and Health Care Systems, Element 2 Use of Incident Command System (ICS),
organizational structures, doctrine and procedures
3/6/2007National Emergency Management
Summit – New Orleans
Hospital Incident Command System (HICS)
3/6/2007National Emergency Management
Summit – New Orleans
HEICS – Katrina & Rita
3/6/2007National Emergency Management
Summit – New Orleans
Hospital Command Center – Katrina & Rita
3/6/2007National Emergency Management
Summit – New Orleans
Hospital Emergency Communications JCAHO, E.C. 4.1 –
The plan provides processes for communications.
Internally – patients, staff, family Externally – community authorities Backup internal and external systems in
event of failure NFPA 1600, 5.9 –
Regularly tested systems and procedures and protocols to notify officials and alert…interoperable.
3/6/2007National Emergency Management
Summit – New Orleans
Emergency Communications
3/6/2007National Emergency Management
Summit – New Orleans
Managing Emergency Communications – Equipment Primary –
Telephone Cell phone Email Fax
Secondary – 2 way pagers 800 MHz radio Blackberry Webpage Satellite Ham radio VOIN
Don’t forget extra batteries
3/6/2007National Emergency Management
Summit – New Orleans
Hospital Emergency Communications (continued) NIMS Implementation for
Hospitals and Health Care Systems, Elements 2 and 3 – Emergency operations plan
coordinates and supports response through multi agency systems (MACS)….
Establishes connectivity with local command posts, 911 centers, Emergency Operation Centers…
3/6/2007National Emergency Management
Summit – New Orleans
“Hospital Relationship to Community Response Partners”
3/6/2007National Emergency Management
Summit – New Orleans
Managing Emergency Communications Develop communications plan
Identify threats, processes and responses /
alternative to communication outage “Needs – Assessment”
To document & coordinate communication assets and location
Assistance from State and/or local Office of Emergency Management, and/or Hospital Association
3/6/2007National Emergency Management
Summit – New Orleans
Credentialing -
JCAHO, HR 1.25, MS 4.110 Organizations may grant disaster
privileges/responsibilities to volunteer practioners.
Mechanism to identify Valid government photo ID and
appropriate license Organization oversees
independent practioners
3/6/2007National Emergency Management
Summit – New Orleans
Credentialing (continued) NFPA 1600, 5.5.2; 4
Resource management shall consider personnel, equipment, training
Liability connected with using involved resources
Donations shall be managed
3/6/2007National Emergency Management
Summit – New Orleans
Credentialing (continued)
NIMS Implementation for Hospitals and Health Care Systems, Elements 15, 16 – Hospitals will maintain an inventory of
organizational response elements. Ensure relevant national standards and
guidance to achieve and incorporate equipment, communications and data interoperability.
3/6/2007National Emergency Management
Summit – New Orleans
Credentialing initiatives are found… Emergency System Advanced
Registration Volunteer Health Professionals (ESAR-VHP)
Federal Disaster Medical Assistance Teams (DMATs)
Individual state programs – Uniformed Badging System (UBS), Nevada.
3/6/2007National Emergency Management
Summit – New Orleans
Surge Capacity
Health care systems’ ability to rapidly expand beyond normal services…demand for personnel, medical and public health…in the event of public health or other emergencies.
Planning provided for by HRSA – NBHPP (500/1,000.000) MRC AHRQ MMRS CDC
3/6/2007National Emergency Management
Summit – New Orleans
Examples of Surge
3/6/2007National Emergency Management
Summit – New Orleans
Providing Adequate Surge Capacity
3/6/2007National Emergency Management
Summit – New Orleans
Flu Surge – Potential Louisiana Region 7 admissions
8 week outbreak – 25% attack rate
3/6/2007National Emergency Management
Summit – New Orleans
Altered or relaxed standards - Medical response for catastrophic
disasters has and will require relaxed or altered standards for health care facilities.
3/6/2007National Emergency Management
Summit – New Orleans
Resources -
Websites: http://www.ahrq.gov/browse/bioterbr.htm http://www.pandemicflu.gov http://www.emsa.ca.gov http://www.who.int/en/ http://www.osha.gov/dts/osta/bestpractice
s/firstreceivers_hospital.html http://www.jcaho.org/ http://www.nfpa.org/
3/6/2007National Emergency Management
Summit – New Orleans
Acronyms
AHRQ – Agency for Healthcare Research and Quality CDC – The Center for Disease Control ESAR-VHP – Emergency System for the Advance
Registration of Volunteer Health Professionals HRSA – Health Resources and Services
Administration JCAHO – Joint Commission on Accreditation of
Healthcare Organizations MMRS – Metropolitan Medical Response System MRC – Medical Reserve Corps NFPA – National Fire Protection Association NIMS – National Incident Management System VOIN – Voice Over InterNet
3/6/2007National Emergency Management
Summit – New Orleans
Thanks
Knox Andress, RN, FAENDesignated Regional CoordinatorLouisiana Region 7 Hospitals
Emergency Preparedness CoordinatorCHRISTUS Schumpert Health System#1 St Mary PlaceShreveport, Louisiana 71101Ph (318) 681-4255; Cell (318) [email protected] [email protected]