Emergency Response Contingency Planning

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					Emergency Response
Contingency Planning


 Is your clinic prepared?
             Bureau of Primary Health Care
     Program Assistance Letter (PAL) 2002-02

The Bureau of Primary Health Care is asking health centers to
implement a two pronged approach to emergency response
planning which includes:
• planning and preparation steps which can be implemented in real time
  and with existing resources.
• identification of and planning for steps which would need to be taken
  to effectively manage emergency situations including natural and man-
  made disasters (i.e. bioterrorism)
    Four Phases of Emergency Management

• MITIGATION: this phase includes identifying risks and hazards
  likely to affect the clinic or its resources, and planning an effective
  strategy for lessening the impact and severity of the event on clinic
  operations.
• PREPAREDNESS: this phase involves capacity building and
  includes activities such as inventory of resources and supplies, staff
  training, and actual drills.
• RESPONSE: this phase is divided into two parts: staff actions, and
  management actions. Staff actions might include work schedules,
  meeting places, etc. Management actions would include liaison with
  external sources.
• RECOVERY: this phase might be concurrent with the response
  phase, and includes actions related to loss of revenues or capital
  equipment, support of staff, and community reactions.
    Risk Analysis – internal and external threats
        What disasters/hazards could your clinic expect to see?

• Security hazards:
     – Bomb threats, gang-related activities, terrorist attacks, workplace violence
•    Utility Failures:
     – Electrical failure, generator failure, fire alarm failure, information
       systems failure, sewage, telephone systems, water main breaks, heating /
       air conditioning systems
•    Weather related hazards:
     – Snowstorm, ice storm, severe cold, extreme heat/humidity, flood, tornado
•    Structural hazards:
     – Fire, smoke, chemical or hazardous materials spills, flooding, gas leaks
       Risk Analysis – internal and external threats
                      How likely is each to occur in your clinic?


  Hazard                            Factors                              Risk
Gang Violence Located in high crime area, no on-site security,     High
                 narcotics on premises on days of pain mgmt
                 clinic
Chemical Spill Chemical Mfr plant less than 1 mile upwind.         Moderate
                 History of spills. Per newspaper account, 3
                 chemical releases in 2001
Fire             Alarm system new in 2002, battery backup          Low
                 check q month, staff training in fire safely on
                 hire and q 6 mths, install of sprinkler to be
                 complete 4/02
Bioterrorism     Not in populous or political area, but level of   Low for actual
                 “worried well” accessing clinic services was      bioterrorism, but
                 high during Anthrax scare.                        high for related
                                                                   MH services
    Evaluation of Capacity in a Crisis
     Will you need to change your scope of services in response to the
                              emergency?
Whether the crisis is natural or man-made, health centers
should consider several factors in deciding whether to try
and maintain normal operations during the crisis. They
include:
•   Staffing Requirements
•   Hours / Locations of Operations
•   Scope of Services
•   Supplies on Hand
•   Equipment and Facilities
Evaluation of Capacity in a Crisis
• Staffing Requirements:
   –    Is the staff available and willing to work during the crisis? Are they able
       to get to work? Do you know which employees might use public
       transportation to get to work? Do employees have a plan for children if
       school /daycare is closed because of the crisis?

   – Is there a plan for securing additional staff if needed? Are these
     individuals trained in your clinic’s procedures? How will the clinic
     handle the fiscal impact of hiring additional staff?

   – Is there a plan for cross-training of staff so that if changes in scope of
     services were necessary to better respond to the crisis, the staff would be
     familiar with clinic procedures?

   – Does the staff know who to contact to find out if clinic services have been
     discontinued during the crisis? Who decides if disaster procedures are to
     be implemented?
Evaluation of Capacity in a Crisis
• Hours /Locations of Operations:
   –   Is there a plan for staff coverage for extended hours of operation?

   – Has the clinic assessed the impact of reducing its normal hours of
     operations so that clinic staff may assist in crisis efforts elsewhere if
     needed? What will you do if the local EMS officials ask to “borrow”
     your physician and mid-level providers to staff disaster relief stations
     elsewhere? Is there a plan in place for continued operations if your NHSC
     providers are suddenly re-deployed?

   – Does the clinic have alternate sites at which it could provide care if
     providing care at the current location is made impossible by the crisis?
     These sites may be non-traditional. How will supplies be obtained for
     these new “alternate” sites? How will staff be notified of their new
     worksite?
Evaluation of Capacity in a Crisis
• Scope of Services:
   –    If the emergency is not internal to the clinic, you should decide what
       services might be most appropriate for you to offer as an aid to the effort.
       For example, most clinics might not want to or be able to take trauma
       patients, but could provide supplies or personnel to other sites.

   – Clinics might be able to utilize appropriate staff to offer mental health
     support to health care workers and family members of those affected by
     the emergency for a specified period.

   – Does the clinic have services that could be suspended during the crisis to
     allow staff to perform more critical functions? Educational groups, etc
Evaluation of Capacity in a Crisis
• Supplies:
   – Are the supplies you have on hand appropriate for those events you
     decided were of highest likelihood of happening? If you decided that
     gang violence was likely, does your facility have appropriate/sufficient
     supplies to provide immediate care to trauma patients until help arrives?

   – Is there a plan for borrowing or otherwise accessing supplies and
     pharmaceuticals from others in your area?

   – Does the clinic know how to enlist local Emergency Management
     Officials assistance in obtaining supplies and pharmaceuticals?

   – Is there a procedure in place for checking the outdate of rarely used
     supplies? Is the code blue drug box checked periodically?
  Evaluation of Capacity in a Crisis
• Equipment and Facilities:
   –    Is there an established plan to “lock down” or otherwise control access
       and egress of the facility? Has this plan been tested? Does the clinic have
       plans for evacuation of the building in an emergency? Is the staff familiar
       with the plan? Are there quarantine plans in place in the event of
       bioterrorism?

   – Is there a plan to control vehicle and pedestrian traffic in the event that
     large numbers of persons are trying to access care at the same time?

   – Does the clinic administration have a plan for verifying the credentials of
     those health care workers who may arrive to assist your facility in the
     crisis? How will those workers be oriented to your facility?

   – What alternate means of communication has been provided for in the
     event that telephone communications are lost? Is local EMS familiar with
     your alternate communication means? How will they contact you? Do
     you know how to contact local EMS officials?
 Planning for Increased Capacity
  What to do if you had difficulty answering the previous questions.


• Collaboration with Local Emergency
  Management
• Clinical Preparedness and Training
• Communication Abilities
• Recordkeeping
 Planning for Increased Capacity
• Collaboration with Local Emergency Management:
   –    Begin by identifying the local emergency management agency and
       informing them of your identified capabilities in the event of a crisis.
       These officials might be your best resource for getting personnel and
       supplies moved into otherwise closed areas. The middle of the disaster is
       not the time to introduce your organization and defend its contribution to
       the effort.

   – Since local emergency management is sometimes the responsibility of
     public health organizations, the same sort of connection is necessary with
     the local public health department. It will be essential to partner with
     these organizations also. They will be your link to public health
     information.

   – You should consider becoming a part of the planning team for the
     emergency response in your community.
 Planning for Increased Capacity
• Clinical Preparedness and Training:
   –    Staff members should be educated in all aspects of working and
       protecting themselves in emergency situations.

   – At a minimum the topics for training should include:
      • Emergency Identification
      • Triage Procedures
      • Decontamination Procedures
      • Treatment for Illnesses and Injuries
      • Media and Crowd Control
      • Stress Management

   – Resources for training materials appear at the end of this presentation
 Planning for Increased Capacity
• Communication Abilities:
  – Don’t rely on just one form of communication in an emergency. Even if
    the phones work, the land and cellular systems could quickly become
    overloaded.

  – Find out what forms of communication local emergency management
    officials have chosen.

  – Remember, you’ll need to communicate with the staff, the staff may need
    to communicate with their family, EMS may need to communicate with
    you, and you with them.

  – Prepare a plan for communicating with the media.
 Planning for Increased Capacity
• Recordkeeping:
  –    If your patient records are electronic, and the information system is
      inoperable, you’ll need a back-up plan for recordkeeping.

  – Don’t forget to enlist the input of the business office in your plans for
    recordkeeping, especially if your plan calls for abbreviated recordkeeping
    during the crisis. The clinic will surely want to obtain payment for its
    services as appropriate. You’ll need documentation even if you’re trying
    to collect from FEMA directly.

  – Consider how records might move throughout the facility and from
    facility to facility if necessary. You’ll need plans for assuring
    confidentiality even during the crisis.

  – If the event is suspected bioterrorism, the clinic will need to assure that it
    has collected enough information to complete the necessary surveillence
    reports.
     Consequence Management
              What happens after the crunch is over?


• There may be widespread need for mental health
  services depending on the nature of the
  emergency.
• The clinic will need to assess the fiscal impact on
  its operations, and begin to make plans for
  recovery if needed.
• An assessment of the clinic’s ability to deal
  effectively with the event should be made, and
  contingency plans altered if necessary.
              Additional Resources
• CDC Public Health Emergency Preparedness http://www.bt.cdc.gov
• CDC Bioterrorism Readiness Plan:A Template for HealthCare Facilities
    http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4904a1.htm
•    CDC Protocols for Reporting Suspected Outbreaks
    http://www.phppo.cdc.gov/han/
•   Joint Commission on Accreditation of Health Care Organizations
    http://jcaho.org
•    National Domestic Preparedness Office http://ndpo.gov
•    United States Postal Service http://www.usps.gov
•    Federal Emergency Management Association http://www.fema.org
•    National Guideline Clearinghouse http://www.guideline.gov