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Transcript of RESPONSE TO HURRICANE IRENE - IHI Home...
12/9/2012
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MARK SOLAZZO
Executive Vice President and COO
MARK JARRETT, MDChief Quality Officer
RESPONSE TO
HURRICANE IRENENORTH SHORE-LIJ HEALTH SYSTEM
Session C26: These presenters have nothing to disclose
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Objectives
� Describe the steps necessary to ensure the safety of patients,
employees and the community during multiple emergency
hospital evacuations
� Discuss the role of the Emergency Command Center and the
vital aspects of ongoing internal and external communication
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� System Administration is notified of an increasingly high probability of a
hurricane landfall on Long Island
� System Administration authorizes that an advisory notice be sent to all
employees
� Public Safety’s Emergency Management
Division establishes conference calls with all
critical infrastructure divisions
� Emergency Management briefs the following
entities:
� Executive Directors
� Department Heads of Materials
Management, IT & Telecommunications,
Facilities & Engineering, Risk Management
� All departments are to begin activating
emergency plans
Early Warning & PlanningTuesday, 8.23.11 – 0800 Hours
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96 Hours to Landfall: Actions BeginWednesday, 8.24.11 - 0800 Hours
� 24/7 surveillance of weather & hurricane
� 4-hour weather updates are issued
� Critical infrastructure departments are
briefed twice daily
� Hospital evacuations are under evaluation
� Emergency purchasing and leasing begins
� System Administration places the Health
System on a Level 1 HICS
� Health System EOC is opened
� Rapid discharge and surge plans are under
review
� Employees advisories are upgraded to alerts
� Employees are advised to begin personal
readiness actions
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72 Hours to LandfallThursday, 8.25.11 – 0800 Hours
� HICs Level 2 is ordered and all weather reports are confirming a L.I. - NYC
landfall
� Evacuations appear likely to occur at SIUH North and South sites
� All critical infrastructure needs and requests are being filled
� All municipal emergency management
agencies are consulted
� EOC initiates 24/7 staffing model
� Facilities leadership orders a stop work order
on all construction sites
� All sites are to be secured within 24 hrs
� Union labor issues are considered
� Vendors and contractors are asked to provide
their staffing models
� Employee alerts are increased to twiceper day
� Executive conference calls occur every 4 hrs4
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48 Hours to LandfallFriday, 8.26.11
� Decision has been made to evacuate SIUH North & South and begin
evacuating Southside Hospital, as well
� Emergency purchases begin to arrive at system hospitals and
Emergency Management Headquarters in Syosset
� Emergency generators are disbursed based
on assessments by facilities and
engineering leadership
� Hospitals are asked to prepare staffing
models and submit them to Emergency
Management
� Hospitals are instructed to begin rapid
discharges and surge plans are to be
activated
� Executive leadership have suspended all
elective surgeries through Tuesday6
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� Final checks are being made with all system partners at our sites
� All equipment requested by the sites have been delivered
� A decision has been made to evacuate
Southside Hospital
� Many nursing homes are seeking assistance
in evacuations as well as area hospitals
� NS-LIJ staff is sent to these facilities to
coordinate, evaluate and facilitate
evacuations and/or sheltering
24 - 36 Hours to Landfall
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� SIUH evacuations are completed
� Resources had been shifted east earlier as the need declined in Staten Island
� Southside evacuations completed
� NSHS begins to take additional evacuees from
nursing homes in Nassau and Queens
� NSHS coordinates additional evacuations in
Rockaway and to sites outside the Health
System
� NSHS begins to take patients who refuse
special needs sheltering
� Patient tracking and patient medical
evaluations are the primary operations sector
duties
12 Hours Out
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During the Storm
� All transportation services and deliveries are suspended
� Facility damage assessments are conducted regularly
� Monitoring of utilities is constant, many facilities go to generator
power
� Staff attendance shows no significant absentee rates
� No facilities are closed to emergencies, including the evacuated
facilities
� Patients continue to arrive in Emergency Departments
� All NSHS Hospitals are reporting “normal” operations
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Post Storm
� There are no patient deaths that are the result of the storm
� The NSLIJ health system:
– Evacuated 947 patients
– Accepted an additional 245 evacuated patients from non-health
system facilities
� Risk management and Finance have been dedicating time to
recovery efforts including FEMA reimbursements and insurance
claims
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Summary
� 947 patients were evacuated from Southside Hospital and Staten
Island University Hospital
� All evacuated inpatients were safely transported prior to the storm
� Southside Hospital and SIUH and both continued to keep their
Emergency Departments open throughout the storm
� Post storm, all of the evacuated patients were safely discharged or
transported back to their original facility depending on their medical
condition
� 70 nursing home patients from seven different facilities in the
Rockaways and Long Beach were accommodated at:
– North Shore University Hospital’s Stern Center for Extended Care and
Rehabilitation in Manhasset
– Long Island Jewish Medical Center
– Franklin Hospital
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Summary (cont’d.)
� Nassau University Medical Center also accepted many patients from
Long Beach Medical Center, which was also evacuated.
� North Shore-LIJ ambulances assisted Saturday evening with the
transport of 125 patients from city nursing homes to Park Slope Armory
and New York Methodist Hospital in Brooklyn, and Metropolitan
Hospital Center in Manhattan. This was at the request of New York
State Health Commissioner Nirav Shah, MD, and the New York City
Office of Emergency Management
� In addition, numerous individuals who lost power in their homes
showed up during the storm at North Shore-LIJ hospitals seeking
shelter from Hurricane Irene.
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Summary (cont’d.)
Opportunities
� Train additional NS-LIJ staff as adjunct faculty to the Emergency
Operations Center
� NS-LIJ will continue to expand our “Ready -Set –Go” emergency
preparedness initiative
� Continue to enhance employee communications
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Planning and Preparation
Effective Strategies/Best Practices
� Early planning sessions and conference calls allowed time for
leadership to make critical decisions.
� Mandatory TQLT meeting on Thursday proved effective in getting
management focused on task at hand.
� Early assessment of facility vulnerabilities helped to visualize the
threat to the hospitals.
� Early assessment of resources allowed time to increase par levels
where indicated.
� Transfer of NICU patients immediately following evacuation order
allowed for their safe and orderly transfer with and to the
appropriate level of care.
� Implementation of HR Emergency Situation & Inclement Weather
Policy effectively ensured adequate staffing levels.
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Planning and Preparation (cont’d.)
Opportunities for Improvement
� Existing forms used to categorize patients’ transportation needs,
demographic information, and evacuation information proved
difficult to work with
– Patient Care Units Managers were provided the next day with a
more user-friendly form adapted from GNYHA
Recommendations
� Improve the status reporting form in the Evacuation Plan using the
adapted GNYHA format as a guide
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Stay Teams
� To address concerns that area residents may seek shelter and
medical care during the storm, Stay Teams were expanded to include
sufficient clinical staff to provide patient care, if needed
� Staffing plans were developed for
the following to cover through
Sunday night
� Dietary, sleeping, and parking
arrangements were made to
accommodate staff
Evacuation Processes
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Evacuation Processes (cont’d.)
Effective Strategies/Best Practices
� Coordinated effectively with the System to secure appropriate beds
and transportation for all patients
� Patient relations created an effective chain of communication
between hospital and patient family/friends
� Utilizing social networking, hospital website and HEICS hotline to
communicate scheduling decisions with staff
� Patient safety was maintained throughout the evacuation process
– No patient or staff injuries
� Efficiently distributed four day supply of medication to transferred
patients
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Evacuation Processes (cont’d.)
Effective Strategies/Best Practices
� Having a preexisting agreement (coalition) with other Staten Island
facilities for mutual support in a disaster
� Have expanded Stay Teams in place to provide emergency medical
care for surrounding community
� Provided printed information regarding nearest shelter location and
directions for both North and South sites
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Evacuation Processes (cont’d.)
Opportunities for Improvement
� Gaps in communication in patient transfer process
� Infrequent communication updates with on-duty staff
� No process in place to inform family members that were present
during evacuation
� Improved tracking process for equipment loaned to other facilities
� The Main Conference Room at North Site was not conducive to
implementation of Incident Command System
� Incident Command structure was not fully developed
� Key HEICS roles were not assigned
� No order of succession designated for relief of individuals in key roles
� Better communication with departments about labor pool
use/function
� Better utilize staff support function as described in HEICS structure
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Evacuation Processes (cont’d.)
Recommendations
� Make better use of radio and Spectralink phones to communicate
vertically among all levels of staff
� Better utilize technology to track patients and equipment
� Expedite relocation of Primary EOC to McGinn Education Center
� Incorporate a family reception/information area into the evacuation
plan
� Designate areas for HEICS Sections with communication capabilities
for each section
� Develop the role of EOC Manager to coach the Command staff during
plan activations
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Evacuation Processes (cont’d.)
Recommendations
� Resume ongoing education on the incident command structure for
hospital leadership
� Provide more frequent communication updates with on-duty staff
� Provide education to unit staff regarding evacuation triage and
transport needs
� Establish mechanism to assign physician and PCUM teams to
expedite evacuation process
� Train staff on new processes and evaluate effectiveness in an exercise
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Recovery
Effective Strategies/Best Practices
� Coordinated effectively with the System to quickly verify building
integrity and resume occupancy
� Department and unit management communicated needs to aid in
return to normal operations
� Patient repatriation process considered factors including patient
condition and family needs and availability of proper level of care
� Patient repatriation process took into account patient needs, family
requests, and availability of services at receiving facilities
� Setting priority order of re-opening departments and resuming
services
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Opportunities for Improvement
� Information regarding transferred patients was not easily accessible
� Equipment tracking and retrieval process could be better
coordinated
Recommendations
� Develop an evacuation database and improve Series application to
populate this data base as patients are transferred
� Create process for identifying and tracking equipment as it is loaned
to other facilities
Recovery (cont’d.)
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