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  • WORKING DRAFT 8/17/07

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    Louisiana Hospital Emergency Preparedness and Response

    August 2007

    Louisiana Hospital Emergency Preparedness and Response Plan Designated Regional Coordinators

    Emergency Operations Plan

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    Table Of Contents

    I. Introduction and Background

    II. Louisiana Hospital Emergency Preparedness and Response A. Infrastructure

    i. NIMS Compliance ii. Regional structures iii. State and federal Interface

    B. Critical Initiatives i. Communication ii. Patient Movement Process iii. Medical Queue for Mass Evacuation iv. Emergency Codes v. Special Needs Sheltering

    III. Individual Hospital Response

    Appendices Appendix A Map of Louisiana Planning Regions Appendix B Designated Regional Coordinators Appendix C Hospitals by Region and Type Appendix D Louisiana Emergency Support Function 8 Health

    and Medical Incident Command Structure Appendix E Emergency Patient Transfer Process Appendix F - NIMS Compliance (to be developed) Appendix G - Interim Patient Tracking System Appendix H- Emergency Support Function 8 Hospital Emergency

    Preparedness and Response for Hurricanes Appendix I Hospital CEO Checklist Appendix J - Medical Institutional Evacuation Plan

    Louisiana Hospital Emergency Preparedness and Response I. Introduction and Background As in other parts of the nation, Louisiana is susceptible to disasters, both natural and man-made, that could exceed the resources of any individual hospital. A disaster could result from incidents generating an overwhelming number of patients, from a smaller number of patients whose specialized medical requirements exceed the resources of the impacted facility (e.g., hazmat injuries, pulmonary, trauma surgery, etc.), or from incidents such as building or plant problems resulting in the need for partial or complete hospital evacuation.

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    Impact of 2005 Hurricane Season Hurricane Season 2005 was the most active and deadly in our nations history. Louisiana was hit by one tropical storm and four hurricanes: Cindy, Dennis, Katrina and Rita. All of Louisianas coastal areas were impacted. As the result of Hurricanes Katrina and Rita 58 hospitals were evacuated (19 remain closed to this date). That evacuation involved the transportation of more than 15,000 hospital patients, staff, and visitors. All state and local resources were impacted. Federal support via the National Disaster Medical System was required. More than 1200 individuals lost their lives as a result of the storms. With federal funding provided through the Health Resources Services Administration (HRSA) Hospital Bioterrorism Grant Program, Louisiana established an infrastructure to facilitate:

    o Development of a plan of action in response to the identified needs o Upgrade the ability of hospitals and other healthcare entities to respond to

    biological events, and o Development a multi-tiered systems in which local health care entities are

    prepared to triage, treat, stabilize and refer multiple casualties to identified centers for care.

    Individual hospitals developed inter-hospital plans to upgrade resources required to support an emergency response. II. Hospital Emergency Preparedness and Response A. Infrastructure

    i. Adoption of National Incident Management System (NIMS) NIMS was developed as a comprehensive national approach to incident management, applicable at all jurisdictional levels and across functional disciplines, to further improve the effectiveness of emergency response providers and incident management organizations across a full spectrum of potential incidents and hazard scenarios. Louisiana has adopted NIMS at all government departments and agencies as well as in the private public partnership of health care providers networked through the Louisiana Hospital Emergency Preparedness and Response (LHEPR). Further, LHERP encourages NIMS adoption by associations, partners, and suppliers.

    ii. Regional structures

    To facilitate the multi-layered response, nine (9) planning regions for private and public hospitals were identified. These regions correspond with those used by Louisiana Department of Health and Hospitals Office of Public Health.

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    Appendix A includes a map of the Louisiana Emergency Preparedness Response regions. All hospitals belong to a region and have participated in the development of regional plans. Hospitals have been asked to identify a point of contact, known as the Hospital Emergency Preparedness Coordinator. Leadership for Louisiana Hospital Emergency Preparedness and Response is provided thru hospital volunteers known as Designated Regional Coordinators (DRCs). The primary responsibilities for the DRCs are:

    o To serve as the liaison for hospitals with other health-related entities (i.e. Office of Pubic Health, Bureau of Emergency Medical Services) and on behalf of hospitals with non-health related entities (i.e) Office of Emergency Preparedness.

    o To support the patient transfer process during a declared state of emergency

    o To facilitate the identification of a medical evacuation queue during a declared state of emergency.

    o To facilitate the development and implementation of regional and Inter-hospital emergency preparedness plans for designated regions in the State of Louisiana.

    o To lead the regions process for development of, testing of, continuous improvement of and management of regional hospital response to emergency situation:

    o To be the leader for the region during a statewide emergency in which hospitals are tasked to respond.

    Appendix B provides a listing of FY 05-06 Designated Regional Coordinators. Louisianas hospitals provide various levels of care. A classification system of hospitals was identified based on capabilities was identified. Hospitals serve voluntarily as one of three levels: o Designated Regional Hospitals (DRH) hospitals are larger acute care facilities with

    emergency room capabilities and many subspecialty services. They serve voluntarily and have agreed to provide additional capacity and resources in the initial emergency response of a mass casualty or event.

    o Tier 1 Hospitals: Hospitals with emergency department capabilities 24/7. o Tier 2 Hospitals: Hospitals that do not provide emergency room capabilities and

    are more single service in nature such as psychiatric, rehabilitation, and/or long term acute service.

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    Appendix D provides a listing of Louisianas hospitals by region and level of service, and their Emergency Preparedness Coordinator. Most of Louisianas HRSA Hospital Bioterrorism Grant Program funds have been directed to hospitals. Louisiana has received HRSA grant funds to improve communications, surge capacity, isolation capabilities, coordination, planning, training, and purchase pharmaceuticals, personal protective equipment, decontamination equipment enhancing our emergency response capabilities.

    iii. State and Federal Interface The Louisiana Department of Health and Hospitals, Office of Emergency Preparedness provides coordination on behalf of the State of Louisiana and all other state agencies, to the federal government through Emergency Support Function (ESF) 8 - Health and Medical Services, and the Louisiana Hospital Emergency Preparedness and Response. An Incident Command Structure for Emergency Support Function 8 Health and Medical is included in Appendix E. NIMS Compliance will be addressed in Appendix F. B. Critical Initiatives Several critical initiatives have been developed by the Louisiana Hospital Emergency Preparedness and Response to support emergency preparedness: Initiatives include:

    o Enhancing communication capabilities and interoperability for all hospitals; and o The development of a patient movement process to facilitate movement of

    patients during a declared state of emergency. o Identification of a process to establish a medical queue during a mass

    evacuation.

    i. Communication EMSystem Louisiana hospitals implemented the emergency preparedness tool, EMSystem Resource Tracking. Hospitals participating in the EMSystem have been asked to report as needed: --- status of operations (open, limited, or closed) --- availability of beds by category (M/S, ICU, ped, psych, etc); and --- other resources that may be needed by hospitals in an emergency (blood products, fuel, pharmaceuticals, personnel, etc.)

    This data warehousing includes inventories of available resources against which incoming data can be continuously compared, and that resources can be quickly assessed and distributed.

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    Hospitals and other health care entities may receive an initial alert from the Governors Office of Homeland Security and Emergency Preparedness (GOHSEP) after identifying a potential threat through the use of blast fax and email. GOHSEP will coordinate the release of the alert with ESF 8 Incident Command. EMSystem also includes an alert and notification components allowing ESF 8 Incident Command structures to send request submission of specific information enabling coordination of activities during an event. EMSystem is compatible with Health and Human Services (HHS) Region VI enabling the federal government to oversee activities on the state level. Communication Systems The State identified communication systems for redundancy:

    o Primary system- Internet email o Secondary system Telephone and fax o Tertiary system Two-way radios

    All Tier 1 hospitals have at least