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Emergency Management : 

Emergency Management Preparing for Internal and External Emergencies and Disasters

Definition of an Emergency : 

Definition of an Emergency A sudden, unexpected event requiring immediate action due to a potential threat to health and safety. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defines an emergency as a natural or man-made event that suddenly or significantly: Disrupts the environment of care Disrupts care and treatment of patients Changes or increases the demand for services

Definition of a Disaster : 

Definition of a Disaster A sudden, unplanned event that makes it difficult, or impossible for a facility to carry out essential activities. During a disaster, the needed resources are greater than those available A facility disaster is an event in which the demand for health services from the event or existing patients, exceeds the ability of the to provide those services. A disaster can occur at any level – local, state, regional, country or multiple countries.

Classification of Facility Disasters : 

Classification of Facility Disasters Internal Disasters- events that result in loss of resources used for regular activities. Examples: fire, smoke, fumes, loss of utilities, worker strikes, release of chemicals or radiation, hostage situations, or bomb threats External Disasters – events that occur in the community outside the hospital that may effect the facility’s ability to carry out regular activities. Examples: hurricanes, tornados, floods, storms, earthquakes, train derailments, plane crashes, power outages, terrorist attacks, and riots.

Facility Emergency Preparedness : 

Facility Emergency Preparedness Facilities must be prepared to respond to a wide range of emergencies. These events may include natural disasters, terrorist attacks or any other situation that dramatically increases the number of patients who come to the facility needing treatment. Facility emergency preparedness helps to reduce the impact of emergencies and disasters while continuing to provide essential day-to-day services. Preparedness phases include: Prevention Response Recovery Mitigation

Emergency Management Activities : 

Emergency Management Activities Prevention – activities aimed at avoiding or intervening to stop an emergency from occurring ex. Examining the facility for potential dangers and correcting Mitigation – lesson or eliminate the impact ex. Back-up generator, Planning for likely events Response – address the immediate effects of the emergency ex. Transferring of Patients to Alternate Site Recovery – actions taken to restore normal operations ex. Clean-up operations

Goals and Objectives : 

Goals and Objectives Ensure safety of employees, staff, visitors Assure availability of dialysis care Protect PHI Mitigate Damage Planning, Sharing of Resources, Building/Equipment/System Changes Expedite return to normal operations Comply with laws and regulations

Emergency Management Plans : 

Emergency Management Plans Easy to understand Functional, flexible and adaptive Consider various views Written and updated annually Comprehensive, All-Hazard Education and Training Adhere to existing standards, requirements Include outside agencies

Slide 9: 

Creating a Plan Planning Administrative Communications Preparation Record Keeping Security Supplies Transportation Power Water Systems Waste Disposal Recovery

Assumptions when Creating a Plan : 

Assumptions when Creating a Plan Dialysis facilities are not usually included in state or local disaster plans Disasters burden outside resources Disasters may interrupt utilities services Communications may be impacted Staffing Shortages Impractical to plan for all emergency types and sizes Acute renal services may be in need

Risk Based Approach to Planning : 

Risk Based Approach to Planning Hazard Vulnerability Analysis 1) Identify Potential Risks/Hazards Internal/External 2) Identify Possible Causes 3) Assign Risk Level (Probability)

Hazard Vulnerability Analysis : 

Hazard Vulnerability Analysis

Slide 13: 

All Hazard Planning All-hazard planning, the foundation of preparedness, is a process that makes certain that each individual, each department and the entire facility is always ready for any type of emergency that might occur. Although each event has specific needs, many of the functions performed remain the same during any type of event.

Plan Activation - Event Levels : 

Plan Activation - Event Levels

Problems in Disasters : 

Problems in Disasters During disasters, problems often occur because hospital and management systems that work well on a day-to-day basis cannot effectively meet the additional needs of the disaster. Lack of clearly defined leadership and chain of command Lack of accurate facts and information Lack of, miscommunication, right amount

Incident Command System : 

Incident Command System

Possible Emergencies and Associated Components : 

Possible Emergencies and Associated Components Contaminated Water Supply Loss of Utilities Fire/Water Damage Loss of Communications Supply Shortages Increase in Census/Surge Staffing Financial Concerns

Contaminated Water Supply : 

Contaminated Water Supply - May or May Not be Informed - Indicated by water system monitoring. Contact the municipal water supplier/County Health Department for present status of water supply Adjustments may have to be made to your water treatment system Contact water system vendor or manufacturer Water meets EPA requirements or pre-existing quality prior to use Increased Monitoring

Loss of Utilities : 

Loss of Utilities Generator Calculate Power Requirements Existing transfer switch Power Plan – full or partial load Fuel Plan Monitoring Test Emergency Power (Hospital Based) Bulk Water (could delay recovery phase) Calculate Consumption Connections Suspend Reuse Shorten Treatments Testing/Monitoring

Bulk/Tanker Water at the Facility : 

Bulk/Tanker Water at the Facility Typical Water Treatment Systems designs based on EPA MCL’s. NYSDOH Certification of Approval for Distribution of Bottle or Bulk Water Verification of compliance with EPA standards for drinking water Testing Records for MCL’s Disinfection Records Approved Transportation Container

Fire/Water Damage : 

Fire/Water Damage Damage Assessment Check List (Two Types) Survey Assessment – quick, brief What you Have What you Need What you Lost - Detailed Assessment Physical/Equipment/Supplies Current Condition and Safety Risk Certified for use or service

Communications : 

Communications Loss of Landline Cell Phones – Machine Interference Internet – HAN/HPN Two Way Radio Runners TV/Media Battery Powered Radio

Supply Shortages : 

Supply Shortages Days on Hand Dialysis Specific What is required Per/Treatment Emergency Purchase Orders/Cash on hand

Increase in Census/Surge : 

Increase in Census/Surge Limited to C of O Rationing of Treatments/Alternate Schedules Supplies, Utilities Consumption PHI Transportation Staffing NYS DOH Waivers?

Staffing : 

Staffing Availability Reserves and National Guard staff may be called Travel – Driving Bans Types Needed – Professional, Support Who can do what? Cross Credentialing Providing for staff in sustained operations Nutrition, Health, Rotation, Housekeeping, Family Issues, Incentives, Communication Educate Staff on Home Preparedness

Financial Concerns : 

Financial Concerns Obtaining Supplies Emergency Payroll Billing Personnel Policies Inventory Control Insurance Review Documentation

Summary : 

Summary Develop Emergency Management Plans Keep Plan readily available Train, Review, Update Plans to Changing Environment Be active with your local Emergency Management agency (EMO) Mutual Aid Agreements (MOU’s) List of local vendors/suppliers/labs for assistance Preventative Maintenance Establish a Decision Making Tree/Center (EOC) Incident Command System

Emergencies Stop Being One : 

Emergencies Stop Being One When You are Prepared for It

References : 

References http://www.cms.hhs.gov/ESRDNetworkOrganizations/Downloads/EmergencyPreparednessforFacilities2.pdf http://www.bt.cdc.gov/disasters/hurricanes/katrina/watersystems.asp http://www.bt.cdc.gov/disasters/hurricanes/katrina/reopen_healthfacilities.asp http://www.bt.cdc.gov/disasters/watersystemrepair.asp http://www.nyhealth.gov/nysdoh/water/main.htm http://www.fda.gov/cdrh/emergency/dialysis.html#1

References : 

References http://www.cdc.gov/ncidod/dhqp/dpac_dialysis_boilwater.html# http://www.aami.org/publications/HH/Katrina.pdf http://www.aami.org/publications/HH/Water.quality.Payne.pdf http://www.aami.org/publications/HH/Practical.Concepcion.pdf http://www.aami.org/publications/HH/Dialysate.Hoenich.pdf http://www.bt.cdc.gov/disasters/hurricanes/katrina/pdf/watersystems.pdf